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Objective: To evaluate the effect of individually manufactured earplug therapy on pain intensity (PI), symptom severity (SS), and maximum mouth opening (MMO), in patients with myogenous temporomandibular disorders (TMD). Methods: One-hundred-twenty patients were randomly allocated to six groups: Groups EP (earplug), OS (occlusal splint), EX (exercise), EPO (earplug with occlusal splint), EPE (earplug with exercise), and C (control). Outcomes were PI (assessed with a visual analog scale (VAS)), SS (assessed with the modified Symptom Severity Index Questionnaire (mSSI)), and MMO (evaluated with a digital caliper). Measurements were performed at T0 (before the therapy), T1 (1-month follow-up), and T2 (3-month follow-up). Data were analyzed using one-way analysis of variance (ANOVA), Tukey’s HSD, and chi-square tests (alpha = 0.05). Results: At T1 and T2, the greatest VAS and mSSI reduction was detected for the groups EPE (VAS = 5.3 ± 1.05, 3.3 ± 0.7; mSSI = 38.2 ± 2.27, 43.6 ± 3.94) and EPO (VAS = 5.2 ± 0.91, 3.2 ± 0.78; mSSI = 36.3 ± 3.97, 42.2 ± 3.19), respectively (p < 0.05). At T1, occlusal splint groups (groups OS (34.8 ± 2.97 mm) and EPO (33.8 ± 3.49 mm)) gave the highest MMO values, while T2 values did not constitute a significant difference with T1 (p > 0.05). Conclusions: The short-term use of combined earplug therapy resulted in a decrease in both PI and SS. Improvement in MMO in participants using occlusal splints was observed in the 1st month and was maintained through the 3rd month. Clinical Relevance: Earplug therapy can be applied as a complementary therapy to occlusal splint and exercise treatments to decrease PI and SS in patients with myogenous TMD. To achieve functional recovery such as MMO, its combined use with splints should be taken into consideration by clinicians. [ABSTRACT FROM AUTHOR]

Additive manufacturing resins used in dental prosthetics may retain uncured monomers post-polymerization, posing potential long-term patient exposure risks. Understanding the biological safety of these materials is crucial, particularly for 3D-printed acrylic-based prosthodontic devices such as occlusal nightguards, complete and partial dentures, and temporary fixed prostheses. This paper reviews the literature evaluating the cytotoxicity of such materials. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a scoping review using the MESH keywords related to population (P), intervention (I), comparison (C), and outcome (O) across databases, including OVID Medline, EMBASE, and SCOPUS. Our search, limited to peer-reviewed English language articles from 2015 to 2023, resulted in 22 papers. These studies, utilizing digital light processing (DLP) or stereolithography (SLA) printing methods, varied in examining different 3D-printed materials, as well as washing and post-curing protocols. The primary experimental cells used were human gingival fibroblasts (HGF) and mouse fibroblasts (L929). There are no statistical differences in biocompatibility regarding different commercially available resins, washing solutions, or methods. Improvements in cell viability were related to an increase in washing time, as well as post-curing time. After the polishing procedure, 3D resin-based printed occlusal devices perform similarly to milled and conventionally processed ones. Our findings underline the importance of appropriate washing and post-curing protocols in minimizing the cytotoxic risks associated with these 3D-printed resin-based devices. [ABSTRACT FROM AUTHOR]

Background: Single nucleotide polymorphisms (SNPs) may influence pain susceptibility and impact treatment response in pain‐related temporomandibular disorders (TMDp). Objective: Explore the role of COMT (rs4646310, rs6269, rs4818, rs4680) and OPRM1 (rs1799971) genotypes in regulating treatment response. Methods: Sixty TMDp patients (55 females and 5 males), diagnosed with the Diagnostic Criteria for TMD (DC/TMD), underwent standardised treatment (information and education, home physical therapy, occlusal splint) for 6 months. Treatment outcomes included: pain intensity, pain‐free mouth opening, jaw functional limitation, depression, and anxiety. Genotyping for COMT and OPRM1 SNPs was performed using DNA from buccal mucosa swabs and TaqMan assays. Statistical analysis was carried out to compare the changes in treatment outcomes and the influence of genotypes on treatment response. Results: Significantly less pain reduction was observed in minor allele carriers of rs4646310, and rs4680 compared to dominant homozygous (p <.025). Minor allele carriers of rs1799971 and rs4646310 demonstrated worsening in pain‐free mouth opening while dominant homozygous exhibited improvement (p <.025). Significantly less anxiety reduction was observed in minor allele carriers of rs4646310 compared to dominant homozygous (p =.003). Of the all variables assessed in the regression model, carrying a minor allele of rs1799971 predicted a poorer treatment response considering pain‐free mouth opening while carrying a minor allele of rs4646310 predicted less pain and less anxiety reduction. Conclusion: Our findings indicate that certain SNP variants of the COMT and OPRM1 genes were associated with poorer treatment response and may therefore play a significant role in the classification of TMDp patients. Also, assessment of patient genotype could potentially aid in predicting treatment response. [ABSTRACT FROM AUTHOR]

Background: Myogenic temporomandibular disorders (M‐TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT). Objectives: To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M‐TMD patients. Methods: In this double‐blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post‐treatment (T1) and 3 months post‐treatment (T2). Results: Intention‐to‐treat analysis revealed significant improvements favouring EG (VAS rest = −1.50 cm [CI95%: −2.67, −0.32], p =.04; VAS open = −2.00 cm [CI95%: −3.23, −0.75], p <.01; VAS chew = −1.71 cm [CI95%: −2.90, −0.52], p =.01; ROM = 4.61 [CI95%: 0.93, 8.30], p =.04). Additionally, VAS measures were influenced by follow‐up times (VAS rest = −0.73 cm [CI95%: −1.30, −0.17], p = 0.03; VAS open = −0.97 cm [CI95%: −1.57, −0.37], p <.01; VAS chew = −1.15 cm [CI95%: −1.73, −0.58], p <.01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ2(1) = 4.39, p =.04) and VAS chew (χ2(1) = 11.58, p <.01). Conclusion: Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M‐TMD. Trial Registration Number: NCT03726060. [ABSTRACT FROM AUTHOR]

Background: The term temporomandibular disorder (TMD) indicates a set of musculoskeletal conditions involving temporomandibular joint (TMJ), masticatory musculature, and related anatomical structures. Pain is the most common clinical manifestation of TMD, and the auditory system might be involved and affected, through tinnitus, dizziness, otalgia and ear fullness sensation. Objectives: The aim of this systematic review of randomised controlled trails (RCTs) was to evaluate the efficacy of rehabilitative approaches on otologic symptoms in patients with TMD. Methods: PubMed, Scopus and Web of Science were systematically searched from the inception until 8th October 2023 to identify RCTs presenting participants with a diagnosis of TMD associated with otologic signs and symptoms, rehabilitative approaches as interventions, and modification of the otological symptoms as outcome. Results: Out of 931 papers suitable for title/abstract screening, 627 articles were assessed for eligibility. Five studies were included reporting the efficacy of occlusal splint therapy, low‐level laser therapies, and physical therapy in patients diagnosed whit secondary otalgia or tinnitus associated with TMD. No RCTs evaluating other otologic symptoms, ear fullness, dizziness or vertigo were found. Conclusions: Results of this systematic review suggested that rehabilitative approaches might be effective in improving secondary otalgia and tinnitus in TMD patients. Thus, further RCTs with a higher level of evidence and more representative samples should be conducted to better understand the effects of TMD therapy on otologic complains. [ABSTRACT FROM AUTHOR]

We carried out a comparison of the neuromuscular and clinical effects produced by electrostimulation therapies, as an adjuvant to the use of occlusal splints (removable muscle relaxation apparatus) in patients with temporomandibular disorders In this simple randomized clinical trial, 91 patients were randomly divided into three groups. Group A (GA) received transcutaneous electrostimulation therapy and an occlusal splint, Group B (GB) received percutaneous electrostimulation therapy and an occlusal splint, and Group C (GC) received an occlusal splint. The neuromuscular activity, as well as the signs and symptoms of each patient, were evaluated every week throughout the treatment (T0 = baseline; T1 = 7 days; T2 = 14 days; T3 = 21 days; T4 = 28 days; and T5 = 35 days). Pain was measured with a visual analog scale, and neuromuscular electrical activity was determined by the root mean square of the masseter muscles through the use of a UNAM-CINVESTAV 1.2 electromyograph. Comparisons were made using ANOVA for repeated measures (p-value = 0.05). The comparison between the groups determined that muscle fatigue (p-value = 0.001), joint pain (p-value = 0.009), and muscle pain (p-value = 0.003) decreased to a greater extent, and in the short term for the group treated with transcutaneous electrostimulation therapy as an adjuvant to the use of the occlusal splint. The comparison between the groups determined that muscle fatigue (p-value = 0.001), joint pain (p-value = 0.009), and muscle pain (p-value = 0.003) decreased to a greater extent and in a shorter term in the GA (calculation therapy, transcutaneous electrostimulation) and GB (occlusal splint). Transcutaneous electrostimulation is a feasible and faster alternative that was accepted by most of the patients for treating temporomandibular disorders. [ABSTRACT FROM AUTHOR]

Abstract Background Few studies have been conducted on treating temporomandibular disorders (TMDs) with new digital occlusal splints, which has increasingly attracted wide attention. Methods To evaluate the clinical efficacy and quality of life (QoL) of Kovacs digital occlusal splint (KDOS) treatment in patients with TMD. Materials and methods Eighty-nine patients with TMD who were treated using KDOS were analyzed. The patients were divided into three groups according to the Wilkes stage. The clinical symptoms and QoL scores of the patients in each group were recorded before and at least three months after treatment, and the data were statistically analyzed and compared. The relationships between the disease severity, sex, age, and level of QoL before treatment and improvement in the clinical symptoms were analyzed using binary logistic regression. Results The mean age and follow-up period of the patients were 28.0 ± 10.4 years and 4.9 ± 2.1 months, respectively. After KDOS treatment, the improvement rates of joint noise and pain were 80.4% and 69.8%, respectively. Additionally, the patients’ maximum mouth opening and global QoL mean scores significantly improved compared to those before treatment (p

Background: Few studies have been conducted on treating temporomandibular disorders (TMDs) with new digital occlusal splints, which has increasingly attracted wide attention. Methods: To evaluate the clinical efficacy and quality of life (QoL) of Kovacs digital occlusal splint (KDOS) treatment in patients with TMD. Materials and methods: Eighty-nine patients with TMD who were treated using KDOS were analyzed. The patients were divided into three groups according to the Wilkes stage. The clinical symptoms and QoL scores of the patients in each group were recorded before and at least three months after treatment, and the data were statistically analyzed and compared. The relationships between the disease severity, sex, age, and level of QoL before treatment and improvement in the clinical symptoms were analyzed using binary logistic regression. Results: The mean age and follow-up period of the patients were 28.0 ± 10.4 years and 4.9 ± 2.1 months, respectively. After KDOS treatment, the improvement rates of joint noise and pain were 80.4% and 69.8%, respectively. Additionally, the patients' maximum mouth opening and global QoL mean scores significantly improved compared to those before treatment (p < 0.001). Binary logistic regression analysis revealed that the factors affecting the improvement in the clinical symptoms were disease severity and level of QoL before treatment. Conclusions: KDOS can improve the clinical symptoms and QoL of patients with TMD. Moreover, patients without osteoarthritis and with low pretreatment QoL levels are more likely to demonstrate clinical improvement. Trial registration: The trial was registered with Chinese Clinical Trial Registry (ChiCTR) (ID: ChiCTR2300076518) on 11/10/2023. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this review was to analyze mechanical and biological properties of resin materials used with subtractive or additive techniques for oral appliances fabrication and compare them to those conventionally manufactured. Materials and methods: The protocol was registered online at Open Science Framework (OSF) registries () and the study was based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). An electronic search was conducted on MEDLINE (via PubMed), Scopus, and Web of Science from 1 February 2022 to 1 May 2022. Inclusion criteria: in vitro and in vivo studies published in the last 10 years, with CAD-CAM or 3D printed resins for occlusal splints. Data considered homogenous were subjected to meta-analysis (95% confidence interval [CI]; α = 0.05) with Stata17 statistical software. Since all variables were continuous, the Hedge g measure was calculated. A fixed-effects model was used for I2 = 0%, while statistical analysis was conducted using a random-effects model with I2 > 0%. Results: 13 studies were included after full-text reading. The mechanical properties most studied were wear, flexural strength, surface hardness and surface roughness, while only 1 study investigated biological properties, performing the XTT viability assay. For the meta-analysis, only surface roughness, volume loss, and flexural strength were selected. Considering surface roughness, the subtractive specimen had a lower average value compared to traditional ones (Hedge’s g with 95% CI = -1.25[ -1.84, − 0.66]). No significant difference was detected in terms of volume loss (P > 0.05) between the groups (Hedge’s g with 95% CI = -0.01 [-2.71, − 2.68]). While flexural strength was higher in the control group (Hedge’s g with 95% CI = 2.32 [0.10–4.53]). Conclusion: 3D printed materials showed properties comparable to conventional resins, while milled splint materials have not shown better mechanical performance compared with conventional heat-cured acrylic resin. Polyetheretherketone (PEEK) have great potential and needs to be further investigated. Biological tests on oral cell populations are needed to confirm the long-term biocompatibility of these materials. Clinical relevance: The use of “mixed splints” combining different materials needs to be improved and evaluated in future research to take full advantage of different characteristics and properties. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the influence of printing material, build angle, and artificial aging on the accuracy of SLA- and DLP-printed occlusal devices in comparison to each other and to subtractively manufactured devices. A total of 192 occlusal devices were manufactured by one SLA-printing and two DLP-printing methods in 5 different build angles as well as milling. The specimens were scanned and superimposed to their initial CAD data and each other to obtain trueness and precision data values. A second series of scans were performed after the specimens underwent an artificial aging simulation by thermocycling. Again, trueness and precision were investigated, and pre- and post-aging values were compared. A statistically significant influence was found for all main effects: manufacturing method, build angle, and thermocycling, confirmed by two-way ANOVA. Regarding trueness, overall tendency indicated that subtractively manufactured splints were more accurate than the 3D-printed, with mean deviation values around ±0.15 mm, followed by the DLP1 group, with ±0.25 mm at 0 degree build angle. Within the additive manufacturing methods, DLP splints had significantly higher trueness for all build angles compared to SLA, which had the highest mean deviation values, with ±0.32 mm being the truest to the original CAD file. Regarding precision, subtractive manufacturing showed better accuracy than additive manufacturing. The artificial aging demonstrated a significant influence on the dimensional accuracy of only SLA-printed splints. [ABSTRACT FROM AUTHOR]

Background and Aims: Temporomandibular disorders refer to a set of musculoskeletal problems that affect the temporomandibular joint, masticatory muscles, and surrounding anatomical structures. These disorders are associated with symptoms such as pain, click, asymmetry, or reduced maximum opening. The etiology of many temporomandibular disorders is complex, for this reason the initial treatments must be reversible and non-invasive. The use of occlusal splints is effective in reducing symptoms, and therefore, it is recommended in early and even long-term treatment of these disorders. These appliances play major role in developing conditions such as stabilizing joint position, creating favorable occlusal conditions that lead to normal muscle function, and protecting teeth and supporting structures against dental wear. The purpose of this article was to present a comprehensive review of occlusal splints in Persian language. Materials and Methods: A search on Pubmed and Google scholar databases was done and the keywords "occlusal splints" and "temporomandibular disorders" were used. The inclusion criterion was articles published in English in the field of the types of occlusal splint between 1980 and 2020. Conclusion: In this review, the occlusal splints and their applications have been introduced. The success or failure of treatment with occlusal splints depends on various factors such as the correct selection of patients, the process of manufacturing, occlusal adjustment of splints, and the patients’ cooperation. [ABSTRACT FROM AUTHOR]

It is a well-known fact that white teeth, harmonically located in the dental rows, with no defects, wear signs and pathology in the periodontium, are a sign of youthfulness and some kind of a mirror of overall body health. Actually, the dentist can be the first one to detect the first manifestations of any somatic diseases or deficiencies during examination of the patient. Modern digital technologies can offer high quality and aesthetics of the dental procedures, that also benefits in the time of dental sessions, which is less stressful for the patient, the dentist and the laboratory. This study presents a clinical case of complex functional and aesthetical dental rehabilitation of a 34-year-old patient. The main complaint of the patient was a change of the face image, tooth wear and unsatisfactory appearance of the teeth, as well as discomfort during the jaw movements and occlusion. Since the patient had clear time limits, namely 3 months, rehabilitation, was carried out according to a fast protocol. It included increase of the vertical dimension, using botulinum therapy of the masticatory muscles, temporary prosthetic crowns and final full zirconia crowns. Also, splint therapy for the treatment of temporomandibular disorder was included to the protocol, as this problem hasn`t been treated in time. During the rehabilitation process, cone-beam computed tomography of the jaws and joints, an intraoral scanner, and the most modern digital workflow for prosthetics were performed. As a result of the rehabilitation, the lost chewing function and aesthetics of the teeth were restored. The tone of the masticatory muscles and the range of the jaw movements were harmoniously corrected, the cheek pits, the upper and lower lips increased in volume, therefore the shape and size of the lower part of the face increased and the patient’s smile became snow-white. The patient’s general condition and mood improved, he gained a new younger look.

Currently, there are several digital technologies for the manufacture of occlusal appliances used in bruxism, which may involve subtractive technologies or additive technologies. The purpose of the study is the presentation of a digital workflow for occlusal splint through CAD-CAM with 3D printing. Material and method: The technology used for the manufacture of the occlusal splint included as stages: obtaining digital models, creating the digital design of the splint, 3D printing of the splint from a rigid PMMA material, adapting the splint on dental arch and in occlusion. Results: The digital technology for the occlusal appliance was used for a patient with sleep bruxism. The patient wore the occlusal splint for 9 weeks, with positive feedback. Conclusions: The digital technology proposed for occlusal splints in bruxism is reliable, and the rigid PMMA occlusal splints 3D printed are a viable alternative to conventional occlusal appliances in bruxism.

This systematic review answers the question: "Does occlusal appliance use influence masticatory muscle function of dentate individuals with sleep bruxism?". The literature search included six databases, grey literature, and manual search for articles. Randomized and non‐randomized clinical trials were included comparing muscle function of sleep bruxers before and after receiving occlusal appliances. Risk of bias was assessed with risk of bias assessment for randomized and non‐randomized clinical trials tool. Twelve studies, three represent randomized clinical trials, were included. Risk of bias was considered low, moderate, or serious. Meta‐analyses indicated that soft and hard appliances did not influence muscle activity and bite force of bruxers. Qualitative analysis showed that occlusal appliance use did not influence masticatory performance and muscle volume. However, it was effective in reducing tongue force. Certainty of evidence was considered very low for muscle activity when evaluated with hard appliances, and for bite force evaluated with both appliance materials. Low certainty of evidence was observed for muscle activity with soft appliances. Based on the findings of this meta‐analysis, occlusal appliances do not affect masticatory muscle function of sleep bruxers. Regardless of appliance material, the activity of masseter and temporal, and bite force of sleep bruxers was not influenced. [ABSTRACT FROM AUTHOR]

Occlusal splint is a treatment alternative that gives positive results in reducing the symptoms of temporomandibular diseases. This treatment involves placing an appliance made of various materials specifically for the cutting and chewing surfaces of the teeth. The most popular materials used in the construction of occlusal splints are soft and hard acrylic-based materials such as polymethylmethacrylate, ethylene vinyl acetate, polycarbonate, polyethylene terephthalate and polyetheretherketone. PEEK is a high performance, semi-crystalline, thermoplastic and thermally stable polymer belonging to the polyaryletherketone family. PEEK, which has very good dimensional stability against intraoral temperature changes, is not affected by the intraoral chemical environment. Since PEEK material is chemically stable, has high biocompatibility and abrasion resistance, its use as an occlusal splint material has become widespread today. The aim of this review is to provide information about occlusal splints produced using PEEK material and digital procedures, which are becoming increasingly popular in dentistry, and to contribute to the literature. [ABSTRACT FROM AUTHOR]

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Introduction: Bruxism is a spectrum of masticatory muscles activities. According to the recent evidence and international consensus, there is no indication to treat bruxism unless clinical consequences are present. The aim of the present study was to investigate the approach of Italian dentists to bruxism in their clinical practice. Methods: An anonymous online survey was developed, composed by 26 items grouped into five sections: (1) Characteristics of the respondent (Q1–Q6); (2) Bruxism frequencies (Q7–Q11); (3) Bruxism assessment (Q12–Q15); (4) Bruxism management (Q16–Q20); (5) Occlusal splints therapy (Q21–Q26). Results: A total of 384 practitioners, including specialists and non‐specialists, participated in this survey. The majority of the respondents reported that 1–3 out of ten patients presented with bruxism. The diagnosis is mainly performed with non‐instrumental methods, and facial pain and dental wear are the major clinical consequence associated with bruxism. Almost the entire sample of respondents report to offer occlusal splints to bruxism patients, and 41% refer to perform occlusal adjustments. Almost half of the respondents have never proposed any form of cognitive‐behavioural therapy. Conclusion: The results of the current survey highlighted several inconsistencies in Italian dentists' approaches to bruxism, suggesting the need for better education of practitioners and for the development of a standardized protocol to assess and manage bruxism in dental practices. [ABSTRACT FROM AUTHOR]

(1) Background: This study aims to compare the effects of 3D-printed splints and conventional manufactured splints on sleep bruxism (SB) EMG activity. (2) Methods: Twenty-six patients (19 M, 7 F, 25.8 ± 2.6 years) were randomly allocated to a study group (3D splints) and a control group (conventional manufactured splints) and followed for a period of three months with night EMG–ECG recordings. Samples of the involved materials were analyzed for nanoindentation. The outcomes of interest considered were the overall SB index, the total amount of surface masseter muscle activity (sMMA), and general and SB-related phasic and tonic contractions. A statistical evaluation was performed with a confidence interval (CI) between 2.5% and 97.5%. (3) Results: Differences between groups with OAs were observed for general tonic contraction (p = 0.0009), while differences between recording times were observed for general phasic contractions (p = 0.002) and general tonic contractions (p = 0.00001). Differences between recording times were observed for the total amount of sMMA (p = 0.01), for general phasic contractions (p = 0.0001), and for general tonic contractions (p = 0.000009) during night recordings without OAs. (4) Conclusions: Three-dimensional splints seem to have a higher impact on SB-related electromyographic activity but not on the overall sleep bruxism index. The more regular surfaces offered by 3D splints could be related to phasic contraction stabilization. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of occlusal splint plus laser therapy (OS + LT) compared with OS alone on the patient‐reported outcomes and clinical parameters of patients with temporomandibular disorders (TMDs). Methods: Twenty‐three patients with TMDs were randomly assigned to two treatment approaches: OS and OS + LT (multiwave locked system). The two outcomes were clinical parameters (mouth‐opening distances, number of muscles and TMJs with pain) and patient‐reported outcomes (pain score and oral health‐related quality of life [OHRQoL] determined using the 14‐item oral health impact profile [OHIP‐14]). The outcomes were measured at four time points: baseline, 2 weeks, 1 and 3 months after treatment. According to DC/TMD Axis I classification, the participants were diagnosed as having pain only and pain with intraarticular joint disorder. Adjusting for age and sex, the outcome changes were analysed using generalized estimating models at a 5% significance level. Results: The pain‐free mouth‐opening distance of the patients who received OS + LT continuously increased from 2 weeks to 3 months. However, the value was significantly increased at 3 months in patients who received OS alone. The unassisted mouth‐opening distance significantly increased after 3 months in both groups. In both treatment approaches, the number of muscles and TMJs with pain, as well as the pain and OHIP‐14 scores gradually decreased from baseline to 3 months. Conclusions: The patients who received OS and OS + LT demonstrated better OHRQoL and clinical parameters during 3 months after treatment. An improvement in the pain‐free mouth‐opening distance at 2 weeks was found only in OS plus LT group; however, this difference may not be clinically significant. [ABSTRACT FROM AUTHOR]

To compare the short-term clinical results between disc repositioning by open surgery (DROS) and stabilization splint (SS) for the treatment of temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDwoR). Patients diagnosed with ADDwoR by magnetic resonance imaging (MRI) and treated by either DROS or SS from June 2020 to January 2022 were reviewed. They were selected to match the baseline data before each treatment and then to compare the clinical results including maximum interincisal opening (MIO), protrusion and lateral excursion distances, visual analogue scale (VAS) scores of pain, diet, and quality of life (QoL) and their effective rates, total satisfaction rate after 3 and 6 months of the treatment, and between the 2 treatment methods. SPSS software was used to analyze the statistical differences. A total of 175 patients were included in the study. There were 95 patients in the DROS group and 80 patients in the SS group. MIO and VAS scores were significantly improved after each treatment at 3 and 6 months (p < 0.05). DROS improved more at 6 months than 3 months (p < 0.001), whereas SS had no significant changes (p > 0.05). DROS had significantly better MIO, VAS score and effect rates than SS (p < 0.001). The total satisfaction rate was 94.73% in DROS and 86.25% in SS. The protrusion and lateral excursions decreased after DROS at 3 months (p < 0.001) but improved at 6 months to better than before the surgery (p = 0.03, p = 0.10). There were no significant changes in protrusion and lateral excursions after SS (p > 0.05, p > 0.05). DROS had better short-term clinical results than SS in the treatment of ADDwoR. • Through VAS evaluation and mouth opening measurement, DROS obtained better results than OS for the treatment of ADDwoR. [ABSTRACT FROM AUTHOR]

Abstract Background Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including occlusal splints, have been used to manage sleep bruxism and temporomandibular disorders, including occlusal splints. This study aimed to compare the effectiveness of different occlusal splints in managing sleep bruxism. Methods The PICO framework encompasses the characterization of the population, intervention, comparison, and pertinent outcomes. A comprehensive and systematic literature review was conducted on PubMed, Scopus, and Google Scholar to identify grey literature. The search specifically targeted scientific studies published before September 20, 2023. The Cochrane Collaboration Risk of Bias Tool assessed the accuracy of the included Randomized Control Trials (RCTs). The modified Newcastle–Ottawa Scale assessed non-randomized studies. Data were systematically extracted, synthesized, and reported thematically. Results Out of the total of 808 articles that were evaluated, only 15 articles were found to meet the specified inclusion criteria. Adjustable splints, such as full-occlusion biofeedback splints, were more effective in reducing sleep bruxism episodes, improving patient-reported symptoms, and enhancing overall well-being. The impact of different occlusal sprints on electromyographic activity varies, and potential adverse effects should be considered individually. Conclusions This review provides valuable insights into the effectiveness of occlusal splints in managing sleep bruxism. The results of this study indicate that occlusal splint therapy is a viable treatment approach for sleep bruxism.

Aim of the study The aim of this literature review was to assess the difference in muscle activity recorded on electromyography in patients with TMDs before and after receiving different types of treatments. Materials and method. The study is the literature review, an electronic search was initiated using PubMed, to identify the relevant literature. The search string comprised a combination of keywords (Medical Subject Headings [MeSH]) and free-text terms. The inclusion criteria were represented by clinical trial and randomized controlled trial, publications available in English and full text publications. Results. The final electronic search provided 23 articles. After removing the duplicates, 20 articles were selected for eligibility. According to the inclusion criteria, 16 articles were selected for this review. Conclusions. Short term therapeutic effect of the low-level laser therapy improves the pain and sEMG findings in TMD patients, better than soft occlusive splints. Sensorimotor training has a positive effect on pain for patients with myofascial TMD pain and a reduction in muscular activity on sEMG. Splint assisted by transcutaneous electrical nerve stimulation, TENS, had better results than splint alone in EMG recordings.

Additive manufacturing resins used in dental prosthetics may retain uncured monomers post-polymerization, posing potential long-term patient exposure risks. Understanding the biological safety of these materials is crucial, particularly for 3D-printed acrylic-based prosthodontic devices such as occlusal nightguards, complete and partial dentures, and temporary fixed prostheses. This paper reviews the literature evaluating the cytotoxicity of such materials. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a scoping review using the MESH keywords related to population (P), intervention (I), comparison (C), and outcome (O) across databases, including OVID Medline, EMBASE, and SCOPUS. Our search, limited to peer-reviewed English language articles from 2015 to 2023, resulted in 22 papers. These studies, utilizing digital light processing (DLP) or stereolithography (SLA) printing methods, varied in examining different 3D-printed materials, as well as washing and post-curing protocols. The primary experimental cells used were human gingival fibroblasts (HGF) and mouse fibroblasts (L929). There are no statistical differences in biocompatibility regarding different commercially available resins, washing solutions, or methods. Improvements in cell viability were related to an increase in washing time, as well as post-curing time. After the polishing procedure, 3D resin-based printed occlusal devices perform similarly to milled and conventionally processed ones. Our findings underline the importance of appropriate washing and post-curing protocols in minimizing the cytotoxic risks associated with these 3D-printed resin-based devices.

We carried out a comparison of the neuromuscular and clinical effects produced by electrostimulation therapies, as an adjuvant to the use of occlusal splints (removable muscle relaxation apparatus) in patients with temporomandibular disorders In this simple randomized clinical trial, 91 patients were randomly divided into three groups. Group A (GA) received transcutaneous electrostimulation therapy and an occlusal splint, Group B (GB) received percutaneous electrostimulation therapy and an occlusal splint, and Group C (GC) received an occlusal splint. The neuromuscular activity, as well as the signs and symptoms of each patient, were evaluated every week throughout the treatment (T0 = baseline; T1 = 7 days; T2 = 14 days; T3 = 21 days; T4 = 28 days; and T5 = 35 days). Pain was measured with a visual analog scale, and neuromuscular electrical activity was determined by the root mean square of the masseter muscles through the use of a UNAM-CINVESTAV 1.2 electromyograph. Comparisons were made using ANOVA for repeated measures (p-value = 0.05). The comparison between the groups determined that muscle fatigue (p-value = 0.001), joint pain (p-value = 0.009), and muscle pain (p-value = 0.003) decreased to a greater extent, and in the short term for the group treated with transcutaneous electrostimulation therapy as an adjuvant to the use of the occlusal splint. The comparison between the groups determined that muscle fatigue (p-value = 0.001), joint pain (p-value = 0.009), and muscle pain (p-value = 0.003) decreased to a greater extent and in a shorter term in the GA (calculation therapy, transcutaneous electrostimulation) and GB (occlusal splint). Transcutaneous electrostimulation is a feasible and faster alternative that was accepted by most of the patients for treating temporomandibular disorders.

Background: Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including occlusal splints, have been used to manage sleep bruxism and temporomandibular disorders, including occlusal splints. This study aimed to compare the effectiveness of different occlusal splints in managing sleep bruxism. Methods: The PICO framework encompasses the characterization of the population, intervention, comparison, and pertinent outcomes. A comprehensive and systematic literature review was conducted on PubMed, Scopus, and Google Scholar to identify grey literature. The search specifically targeted scientific studies published before September 20, 2023. The Cochrane Collaboration Risk of Bias Tool assessed the accuracy of the included Randomized Control Trials (RCTs). The modified Newcastle–Ottawa Scale assessed non-randomized studies. Data were systematically extracted, synthesized, and reported thematically. Results: Out of the total of 808 articles that were evaluated, only 15 articles were found to meet the specified inclusion criteria. Adjustable splints, such as full-occlusion biofeedback splints, were more effective in reducing sleep bruxism episodes, improving patient-reported symptoms, and enhancing overall well-being. The impact of different occlusal sprints on electromyographic activity varies, and potential adverse effects should be considered individually. Conclusions: This review provides valuable insights into the effectiveness of occlusal splints in managing sleep bruxism. The results of this study indicate that occlusal splint therapy is a viable treatment approach for sleep bruxism. [ABSTRACT FROM AUTHOR]

Objectives: This study is to evaluate the color stability, surface roughness, and hardness of additively manufactured and hand-cast splint materials after a 6-month commercially available denture cleaning tablet immersion simulation. Materials and methods: Disc-shaped additively manufactured and hand-cast auto polymerizing acrylic resin specimens were prepared (N = 40 each). All specimens were exposed to coffee solution totally 2 days. Thereafter, all specimens were immersed into three different effervescent solutions that simulated 6 months of clinical use. The total color change (ΔE*ab), surface roughness (Ra), and Vickers hardness (Vh) were measured at baseline and after immersion protocols. A two-way ANOVA and Bonferroni’s post hoc test were used for color change. The dependent t-test and ANOVA were used for roughness and hardness evaluation. Results: Additively manufactured splint materials were more affected by coffee immersion. It was observed that all denture cleaning tablets induced a noticeable alteration in color of the specimens (p < 0.05). Roughness and hardness measurement changes after solution immersions were statistically significant for both splint groups (p < 0.05). On the other hand, distilled water and denture cleaning tablets created similar roughness and hardness measurements at baseline and after immersion. Conclusions: After 6 months use of tested cleaning tables, the color stability, surface roughness, and hardness of both groups were affected. The evaluation of the surface properties of splint materials could be recommended to the dentists in periodic controls during splint treatments. Clinical relevance: The use effervescent denture cleaning tablets altered the surface characteristics of tested splint materials over time with nonsignificant difference between each other. After 6 months, awareness should be raised about surface characteristics of splint materials. [ABSTRACT FROM AUTHOR]

Objectives: This clinical study aims to analyze the levels of cortisol, dehydroepiandrosterone (DHEA), and tumor necrosis factor alpha (TNF-α) in the gingival crevicular fluid (GCF) of persons with bruxism and to compare the efficacy of botulinum toxin (botox) and occlusal splint treatments through biomarkers. Materials and methods: A total of 40 patients with bruxism were selected according to the clinical examination and anamnesis of which 20 received occlusal splint treatment and 20 botox treatment. GCF samples were taken from the patients before and after treatment. Cortisol, DHEA, and TNF-α levels were measured by enzyme-linked immunosorbent assay test. The change in measurements between time and groups and the time-group interaction were tested by repeated measures ANOVA. Results: There was a statistically significant difference between the cortisol levels before and after treatment in both groups (p = 0.001). In individuals with bruxism, a statistically significant decrease in cortisol levels was observed after both treatments (p < 0.05), while DHEA levels increased after treatment but were not statistically significant (p > 0.05). There was no statistically significant difference between TNF-α intra-group measurements (p > 0.05). Conclusions: Stress and inflammatory biomarkers were found to be associated with bruxism. Cortisol levels decreased in people with bruxism after treatment with both occlusal splint and botox. Clinical relevance: Both splint and botox treatments were effective for bruxism by reducing the stress levels. [ABSTRACT FROM AUTHOR]

This article explores the use of 3D printing technology in the creation of occlusal splints for the treatment of bruxism. The study demonstrates that digital technology and 3D printing can be reliable and effective in producing occlusal splints. The article discusses the advantages and disadvantages of different manufacturing techniques and materials used in the process. Overall, the use of 3D printing for occlusal splints shows promise, but further research is needed to assess long-term use. Additionally, a list of references is provided for further exploration of the topic, covering various aspects of occlusal splints and their fabrication. [Extracted from the article]

Background: Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc– condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients. Aim: The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc–condyle relationship. Materials and Methods: We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software. Results: A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04–5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31–5.95) and long term (MD 0.00, 95% CI-2.86–2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level. Conclusion: Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor. [ABSTRACT FROM AUTHOR]

Background: The term "temporomandibular disorders" (TMDs) refers to a group of painful conditions that affect both the hard and soft orofacial anatomical structures. The primary objectives of TMD treatment are to lessen pain and enhance mandibular movements, re-establishing proper functioning. One of the widely used treatment options for TMDs pathology is the occlusal splint. This non-invasive intraoral device, determines both the muscle relaxation and reversibly repositions the temporomandibular joint structures. The study aimed to compare the efficacy of different occlusal splint designs or materials in managing TMD symptoms. Methods: Twenty-six patients, nineteen of whom were female and seven of whom were male, ranging in age from twenty to seventy, met the criteria needed participate in this study. Two different questionnaires were formulated: a patient-focused and a clinician-focused questionnaire. The patient's data encompassed general health status and TMD signs and symptoms, whereas the clinician's questions addressed assessment and treatment alternatives, including the particularities of occlusal splint therapy. Results: The majority of the patients were diagnosed with disc displacement with reduction (61.5%), followed by myalgia (26.9%). The only form of treatment preferred by physicians was the Michigan occlusal splint, which was mainly used on the maxillary dental arch (84,6%). After the splint therapy was completed and the intended results were obtained, the treatment plan was finished using selective grinding, prosthetic dental restorations, orthodontic therapy, or a combination of these procedures. The patient was required to continue physical therapy (7,7%), wear a full-arch night guard (42.3%), and undergo rigorous periodic control sessions (34.6%) to maintain the final aesthetic and functional results. Conclusions: Occlusal splints are an efficient and reliable initial therapy preference for patients with temporomandibular disorders. In addition to improving symptoms in the temporomandibular joint, occlusal splints may determine mandibular repositioning, which also implies a variety of treatment approaches, ranging from the minimally invasive to the most complex, to achieve a functional occlusal status. [ABSTRACT FROM AUTHOR]

The increasing demand for dental aesthetics, articulation corrections, and solutions for pain and frequent bruxism demands quick and effective restorative dental management. The biomedical research aimed to create a beneficial, ecological, and readily available anterior deprogrammer to determine the centric relation (CR) of cases. This medical device is additively manufactured from a biocompatible material. Size is customizable based on the width of the patient's anterior central incisors. This is a pilot study with two subjects. The task was to develop a complete data protocol for the production process, computer-aided design (CAD), and three-dimensional (3D) printing of the anterior deprogrammers. The research focused on creating simple and practically applicable tools for the dentist's prescription (anterior deprogrammer in three sizes), and secondly for the communication between the dentist and the patient (computer application). The tested hypothesis was whether, according to these novel tools, it is possible to produce functional occlusal splints, which could be manufactured using current technologies. This study compared a traditional splint with a digitally designed and 3D-printed one. The tested hypothesis was whether manufactured occlusal splints differ in patients' subjective perception of comfort. Each conservative treatment was monitored for ten weeks. Initial results are promising; no statistically significant difference was found between the productive technologies. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the influence of printing material, build angle, and artificial aging on the accuracy of SLA- and DLP-printed occlusal devices in comparison to each other and to subtractively manufactured devices. A total of 192 occlusal devices were manufactured by one SLA-printing and two DLP-printing methods in 5 different build angles as well as milling. The specimens were scanned and superimposed to their initial CAD data and each other to obtain trueness and precision data values. A second series of scans were performed after the specimens underwent an artificial aging simulation by thermocycling. Again, trueness and precision were investigated, and pre- and post-aging values were compared. A statistically significant influence was found for all main effects: manufacturing method, build angle, and thermocycling, confirmed by two-way ANOVA. Regarding trueness, overall tendency indicated that subtractively manufactured splints were more accurate than the 3D-printed, with mean deviation values around ±0.15 mm, followed by the DLP1 group, with ±0.25 mm at 0 degree build angle. Within the additive manufacturing methods, DLP splints had significantly higher trueness for all build angles compared to SLA, which had the highest mean deviation values, with ±0.32 mm being the truest to the original CAD file. Regarding precision, subtractive manufacturing showed better accuracy than additive manufacturing. The artificial aging demonstrated a significant influence on the dimensional accuracy of only SLA-printed splints.

We aimed to investigate whether the collaboration of shear wave elastosonography (SWE) and B-mode ultrasonography (US) could be offered as diagnostic tools to assess the presence, severity, and progress of bruxism, as well as a biomarker for the effectiveness of treatment in daily clinical practice. The study was designed as a quantitative evaluation of the masseter muscles (MMs) of the clinically diagnosed bruxism patients suffering from myofascial pain and MMs of the healthy individuals. Clinical examinations were made according to the diagnostic criteria for temporomandibular disorders (DC/TMD), and pain was assessed using a visual analog scale (VAS). Painful MMs with VAS scores ≥ 4 were assigned to Group A, and healthy MMs were assigned to Group B. Also, the MMs of the painful bruxers were analyzed based on wearing occlusal splints. Group A was divided into two subgroups as splint users (Group AI) and non-users (Group AII). All the participants were scanned with dynamic US and SWE to quantify the size and stiffness of the MMs. Measurements of each muscle pair while the jaw is in a resting position (relaxation) and clenching position (contraction) were recorded. The significant differences in stiffness and thickness became visible in the relaxation state. Bruxism patients with myofascial pain had significantly harder and thinner MMs than healthy individuals. During the relaxation, the mean thickness and elasticity values were 9.17 ± 0.40 mm and 39.13 ± 4.52 kPa for Group A and 10.38 ± 0.27 and 27.73 ± 1.92 for Group B, respectively. Also, stiffer MMs were measured in Group AII (38.16 ± 3.61 kPa) than in Group AI (26.91 ± 2.13 kPa). In conclusion, the combination of SWE and US using a dynamic examination technique has the potential to be a valuable tool for the management of bruxism patients suffering from myofascial pain. [ABSTRACT FROM AUTHOR]

Background: Anterior repositioning splint (ARS) is used to treat temporomandibular joint (TMJ) disc displacement with reduction (DDwR). However, high recurrence rate remains a problem especially in patients with unstable occlusions. Objective: This study optimised standard ARS therapy and proposed a step‐back ARS retraction (SAR) method in adult patients with DDwR. Methods: Dental examinations and magnetic resonance imaging of TMJ were obtained before treatment (T0), 1 to 3 months (T1), 3 to 6 months (T2) and 6 to 12 months (T3) during treatment in 48 adults (average age 27.1 ± 5.7 years). After 3 months of basic ARS wearing, personalised treatment for patients with normal disc–condyle relationship was prescribed depending on bilaminar zone adaptations and severity of molar openbite. SAR which required sequential ARS wearing was designed for patients with deep overbite/overjet until retrodiscal tissue adaptations and stable occlusions were achieved. Results: The maximum interincisal opening was increased from 44.3 ± 6.9 to 45.3 ± 6.3 mm (p <.01), and joint pain was alleviated after ARS treatment. The overall success rate of ARS wearing was 92.1% (58/63) featured by a recaptured disc. Fifteen patients who underwent SAR therapy all showed bilaminar zone adaptations in the end, and one patient had positive condylar bone remodelling. Conclusions: ARS treatment could improve mouth opening and joint symptoms in adult DDwR patients. SAR method was suitable for treating DDwR patients with deep overbite and overjet and improved retrodiscal tissue adaptations and condylar bone remodelling. [ABSTRACT FROM AUTHOR]

This literature review explores different treatment options for temporomandibular disorders (TMDs) and their effects on electromyographic (EMG) activity in the jaw muscles. The review found that low-level laser therapy, sensorimotor training, and splint assisted by transcutaneous electrical nerve stimulation (TENS) had positive effects on pain reduction and muscle activity. Occlusal splints are considered the standard procedure for managing TMDs, but other therapies such as acupuncture, biofeedback, and low-level laser therapy have also shown promise. The choice of treatment can be difficult due to varying results, and a combination of therapies may be the most effective approach. [Extracted from the article]

The development of digital technologies has allowed for the fabrication of new materials; however, it makes it difficult to choose the best methods to obtain occlusal splints with optimal properties, so it is essential to evaluate the effectiveness of these materials. The aim of the study is to compare the fracture resistance of occlusal splints made of different materials after thermo-mechanical aging. Methods: A total of 32 samples were made from 4 materials (two 3D printed polymeric materials, a PMMA disc for CAD/CAM, and a conventional heat-cured acrylic resin); subsequently, the fracture test was performed using the load compression mode applied occlusally on the splint surface. Statistical analysis: Four statistical tests were used (Shapiro-Wilk, Levene's test, ANOVA, and Tukey's HSD test). Results: The following study showed that there are differences in fracture strength among the four materials investigated, where the highest strength was observed in the milled splint, with a mean of 3051.2 N (newton) compared to the strength of the flexible splint with 1943.4 N, the printed splint with 1489.9 N, and the conventional acrylic splint with 1303.9 N. Conclusions: The milled splints were the most resistant to fracture. Of the printed splints, the splint made with flexural rigid resin withstood the applied forces in acceptable ranges, so its clinical indication may be viable. Although the results of this research indicated differences in the mechanical properties between the CAD/CAM and conventional fabrication methods, the selection may also be influenced by processing time and cost, since with a CAD/CAM system there is a significant reduction in the production time of the splint material. [ABSTRACT FROM AUTHOR]

Objective: To determine the accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. Material and Methods: A retrospective analysis of 28 patients that underwent virtually planned orthognathic surgery with maxillary Le Fort I osteotomy either using VSP-generated splints (n = 13) or patient-specific implants (PSI) (n = 15) was conducted. The accuracy and surgical outcome of both techniques were compared by superimposing preoperative surgical planning with postoperative CT scans and measurement of translational and rotational deviation for each patient. Results: The 3D global geometric deviation between the planned position and the postoperative outcome was 0.60 mm (95%-CI 0.46–0.74, range 0.32–1.11 mm) for patients with PSI and 0.86 mm (95%-CI 0.44–1.28, range 0.09–2.60 mm) for patients with surgical splints. Postoperative differences for absolute and signed single linear deviations between planned and postoperative position were a little higher regarding the x-axis and pitch but lower regarding the y- and z-axis as well as yaw and roll for PSI compared to surgical splints. There were no significant differences regarding global geometric deviation, absolute and signed linear deviations in the x-, y-, and z-axis, and rotations (yaw, pitch, and roll) between both groups. Conclusions: Regarding accuracy for positioning of maxillary segments after Le Fort I osteotomy in orthognathic surgery patient-specific implants and surgical splints provide equivalent high accuracy. Clinical relevance: Patient-specific implants for maxillary positioning and fixation facilitate the concept of splintless orthognathic surgery and can be reliably used in clinical routines. [ABSTRACT FROM AUTHOR]

Background: Digital occlusal splint is a novel approach in the treatment of temporomandibular disorders (TMD) and there is a lack of evaluation. Objective: To introduce Kovacs digital occlusal splint (KDOS) and evaluate its clinical and magnetic resonance imaging (MRI) outcomes and influencing factors in the treatment of TMD. Patients and Methods: Patients diagnosed of TMD by MRI and treated with KDOS from June 2020 to December 2021 were retrospectively reviewed. They were divided into three groups: anterior disc displacement with reduction (ADDwR), anterior disc displacement without reduction (ADDwoR) and ADDwoR + osteoarthritis (ADDwoR + OA). Visual analogue scales (VAS) scores of pain, diet, mandibular function, quality of life (Qol) and maximum interincisal opening were compared before and at least 8 weeks after treatment. Binary logistic regression was used to analyse the influence of four factors including age, gender, Wilkes stage and the severity of symptoms on treatment. MRI was used to evaluate the condylar bone status and disc length after at least 3 months treatment. Results: One hundred and eighty‐four patients were included in the study. The average age was 30.9 ± 14.2 years and the average follow‐up was 19.8 ± 10.0 weeks. Pain, diet, mandibular function and Qol were all significantly improved after KDOS treatment (p <.05), with the effective rates of 71.6%, 56.4%, 55.3% and 54.1%. Binary logistic regression showed that higher probabilities of improvement were related to the patients with older age, ADD without OA and higher VAS scores before treatment. MRI showed that 94.1% of the condylar bone status remained stable or improved and the disc length was unchanged after treatment. Conclusion: KDOS is effective for the treatment of TMD. Older age, ADD without OA and higher VAS scores before treatment had better results. [ABSTRACT FROM AUTHOR]

Dental 3D-printing technologies, including stereolithography (SLA), polyjet (triple-jetting technology), and fusion deposition modeling, have revolutionized the field of orthodontic occlusal splint manufacturing. Three-dimensional printing is now currently used in many dental fields, such as restorative dentistry, prosthodontics, implantology, and orthodontics. This study aimed to assess the mechanical properties of 3D-printed materials and compare them with the conventional polymethylmethacrylate (PMMA). Compression, flexural, and tensile properties were evaluated and compared between PMMA samples (n = 20) created using the "salt and pepper" technique and digitally designed 3D-printed samples (n = 20). The samples were subjected to scanning electron microscope analysis. Statistical analysis revealed that the control material (PMMA) exhibited a significantly higher Young's modulus of compression and tensile strength (p < 0.05). In the flexural tests, the control samples demonstrated superior load at break results (p < 0.05). However, the 3D-printed samples exhibited significantly higher maximum bending stress at maximum load (MPa) (p < 0.05). Young's modulus of tensile testing (MPa) was statistically significant higher for the control samples, while the 3D-printed samples demonstrated significantly higher values for elongation at break (p < 0.05). These findings indicate that 3D-printed materials are a promising alternative that can be effectively utilized in clinical practice, potentially replacing traditional heat-cured resin in various applications. [ABSTRACT FROM AUTHOR]

Data regarding the mechanical properties of three-dimensionally (3D) printed materials for occlusal splint manufacturing are scarce. The aim of the present study was to evaluate the flexural strength and surface hardness of modern 3D-printed occlusal splint materials and compare them with two control groups, namely, milled and conventional cold-polymerized occlusal splint materials. A total of 140 rectangular specimens were manufactured for the present study. The specimens were prepared in accordance with the International Organization for Standardization standards (ISO 20795-1:2013). Five 3D-printed (NextDent Ortho Rigid, Dental LT Clear, Dentona Flexisplint, Cosmos Bite Splint, and ProArt Print Splint), one milled (ProArt CAD Splint), and one cold-polymerized (ProBase Cold) occlusal splint materials were used to determine flexural strength and surface hardness values. The three-point flexure test was used for the determination of flexural strength values, while Vickers hardness was measured to determine surface hardness. Ten specimens (n = 10) of each material were tested using these procedures. One-way ANOVA and Tukey's post-hoc test were used to analyze the obtained results (α = 0.05). The values of flexural strength ranged from 46.1 ± 8.2 MPa to 106 ± 8.3 MPa. The Vickers hardness values ranged from 4.9 ± 0.5 VHN to 20.6 ± 1.3 VHN. Significant differences were found among the tested materials (p < 0.0001). The milled and cold-polymerized materials yielded higher values for both flexural strength (only one 3D-printed resin had comparable results to cold-polymerized acrylics) and surface hardness. There are differences in the mechanical properties of the various tested occlusal splint materials. The flexural strength of most of the 3D-printed materials and their surface hardness values are still inferior when compared to the milled or cold-polymerized materials. [ABSTRACT FROM AUTHOR]

Abstract Background This systematic review aims to examine the existing original studies to determine the effectiveness of occlusal splints (OSs) in the management of orofacial myalgia and myofascial pain (MP) in comparison with no treatment or other interventions. Materials and methods Based on the inclusion and exclusion criteria of this systematic review, randomized controlled trials were qualified, in which the effectiveness of occlusal splint therapy in the management of muscle pain was examined in comparison with no treatment or other interventions. This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The authors searched three databases (PubMed, CINAHL (The Cumulative Index to Nursing and Allied Health Literature) and Scopus) for English publications published between January 1, 2010, and June 1, 2022. The last database search was carried out on June 4, 2022. Data were extracted from the included studies and assessed for risk of bias using the revised Cochrane risk-of-bias tool for randomized trials. Results Thirteen studies were identified for inclusion in this review. In total, 589 patients were diagnosed with orofacial muscle pain who underwent education and various forms of therapy including different types of OSs, light emitting diode therapy, acupuncture, low-level laser therapy, device-supported sensorimotor training, Kinesio Taping, myofunctional therapy, and physical therapy. All studies included demonstrated a high risk of bias. Conclusions There is insufficient evidence regarding whether OS therapy in the treatment of orofacial myalgia and MP offers an advantage over other forms of interventions or no treatment. Further reliable clinical studies in this area are needed to improve the quality of research, which should be performed with larger groups of blinded respondents and controls. Clinical relevance Due to the large-scale nature of orofacial muscle pain, it is assumed that each dental clinician will meet patients with orofacial muscle pain repeatedly in daily practice; hence, the review of the effectiveness of OSs in the management of orofacial myalgia and MP is necessary.

The objective was to compare different dental splint models and materials for inducing abnormal loading on the gross morphology and histological appearance of the mandibular condylar processes of Sprague Dawley rats. Three different types of dental splints (resin molar, aluminum incisor, stainless-steel incisor) were placed unilaterally to induce occlusal perturbation for 4 weeks. At that time, mandibular condylar processes were assessed by gross appearance and histology. Quantitative measurements were also conducted on the hematoxylin & eosin images for condyle shape. The results showed that although the condylar cartilage was affected by all splint types, the resin molar splint was associated with the most extensive mandibular condylar process remodeling, which was primarily a slant (skewness) of the lateral aspect of the condylar process. Additionally, quantitative measurements on the histological specimens demonstrated that the split and tilt angle of the left (ipsilateral) condylar processes in the resin molar group (124.8 ± 12.7° and 104.1 ± 12.7°, respectively) increased significantly (p < 0.05) when compared to right (contralateral) condylar processes (104.7 ± 5.8°and 91.6 ± 4.4°, respectively). However, no changes were noted on the thickness of the fibrocartilage layer at medial, central, and lateral regions of the condylar process. Another major finding is the high variability of morphology of the naïve animals. Future studies will assess the impact of longer durations of splinting, age, and sex on the remodeling of the mandibular condylar process, allowing for the development of diagnostics and therapies.

Background. Occlusal splints with sensors help in the bruxism diagnosis and monitoring, by recording the patient’s bite force. The aim of this study was to evaluate the accuracy of a pressure sensor when it is covered with different thicknesses of a 3D printing resin (Anycubic 405nm Translucent Green UV Resin, Anycubic, UK). Methods. In this preliminary study, the evaluated sensor (FlexiForce A201 Sensor, Tekscan) was firstly calibrated without any type of cover material, and later tested with 3D printing resin with different thicknesses (1 mm, 1.15 mm, 1.4 mm and 1.6 mm). The load tests were performed by a force tester (MultiTest 2.5 dV, Mecmesin). Results. When the pressure sensor was covered with resin of 1mm and 1.6 mm thick specimens, a higher difference was found between the applied load and the corresponding sensor reading. Conclusion. It was concluded that it is possible to use this type of pressure sensor and that it showed better accuracy with the 1.15 mm and 1.4 mm 3D printing resin covering.

Objective: Conservative treatment modalities are recommended for managing masticatory myalgia in individuals with temporomandibular disorders. The aim of this study was to retrospectively review and compare the effectiveness of four conservative treatments: counseling and occlusal splint therapy, counseling and manipulation integrated with electrophysiotherapy, the combination of the two treatments, and counseling only. Method and materials: One hundred and sixty-eight patients who had myalgia with limited jaw movement were retrospectively observed in this study. Between January 2015 and December 2017, 63 patients received counseling and stabilization occlusal splint therapy (Group 1), 35 patients received counseling and manipulation integrated with electrophysiotherapy (Group 2), 33 patients received the combination of counseling, splint therapy, and manipulation integrated with electrophysiotherapy (Group 3), and 37 patients received counseling only (Group 4). All subjects were followed up for 12 weeks. The intensity of spontaneous pain, palpation pain, chewing pain in the masticatory muscles, and range of pain-free maximal mouth opening were recorded in the clinical assessments. Intragroup and intergroup differences were examined by using analysis of variance (ANOVA) and the Kruskal-Wallis test. Results: Spontaneous pain in the masticatory muscles was relieved significantly in all groups at the 6-week visit (P < .05), and no significant difference was found among the groups (P > .05). Palpation pain was relieved significantly at the 9-week visit in the counseling + occlusal splint therapy group, counseling + manipulation + electrophysiotherapy group, and counseling + occlusal splint + manipulation + electrophysiotherapy group (P < .05). In the treatment group with counseling alone, significant palpation pain relief occurred at 12 weeks. Chewing pain was relieved significantly at the 6-week visit in the counseling + occlusal splint therapy group, counseling + manipulation + electrophysiotherapy group, and counseling + occlusal splint + manipulation + electrophysiotherapy group (P < .05), yet no significant difference compared to the baseline was observed in the counseling-only group (P > .05). A significant increase in the maximal range of pain-free mouth opening was observed at the 9-week visit in the counseling + occlusal splint therapy group, and at the 3-week visit in the counseling + manipulation + electrophysiotherapy group and counseling + occlusal splint + manipulation + electrophysiotherapy group (P < .05). Nevertheless, no significant change in the range of mouth opening was found throughout the follow-up period in the counseling-only group (P > .05). Conclusion: Each of the included treatment modalities relieved spontaneous pain and tenderness to palpation of the masticatory muscles during the follow-up intervals. Counseling alone did not help patients with chewing pain and limited mouth opening in the short term. Treatment protocols including counseling, occlusal splint therapy, and manipulation, integrated with electrophysiotherapy showed the best shortterm outcomes for symptomatic improvement.( [ABSTRACT FROM AUTHOR]

The goal of the current study was to determine the mechanical proprieties of polymethylmethacrylate (PMMA) and the improved compound, the graphene-based PMMA, with Zn and Ag and to compare the results. Scanning electron microscopy analysis of the samples before and after the mechanical test was conducted. The compression behavior, flexural properties, tensile strength, and shape of the samples were all investigated and compared between the variants of PMMA. Commercially available polymethylmethacrylate was used (Orthocryl®—Dentaurum, Ispringen, Germany) with the salt and pepper technique according to the manufacturer's instructions to produce 20 samples for each mechanical trial with standard cylinders (4 mm diameter × 8 mm length) for compression, parallelepipedal prisms for flexing (2 mm × 2 mm × 25 mm) and flat samples for traction. There was no statistical difference in the mechanical proprieties of the samples evaluated, although there were values that could suggest significance. The graphene-based PMMA demonstrated good mechanical proprieties, like the commercially available PMMA, and appears promising for future clinical use based on its multiple advantages. [ABSTRACT FROM AUTHOR]

Severe wear of the anterior teeth facilitates the loss of anterior guidance, which protects the posterior teeth from wear during excursive movement. Additionally, when treating patients with collapsed occlusion due to multiple tooth loss and tooth wear, it is important to determine the presence of vertical dimension loss through accurate clinical and radiographic examinations and diagnostic wax-up. The patient of this case is a 44-year-old female patient who complained of overall tooth wear and loss of posterior teeth due to bruxism and clenching habits, visited the hospital with the address of restoring masticatory function and improving aesthetic appearance through prosthetic treatment. Through model analysis and diagnostic wax-up, an increase in vertical dimension was determined, and full mouth restoration with fixed prostheses was planned. The degree of adaptation to the vertical dimension was confirmed step by step using an occlusal splint designed with CAD (Computer aided design) software and 3-D (3-Dimensional) printed, and then restored with provisional restoration and after a 4-month adaptation period, the entire dentition was restored with metal ceramic crowns and implants. Through this procedure, satisfactory treatment results were obtained in terms of function and aesthetics. [ABSTRACT FROM AUTHOR]

The aim of this systematic review was to evaluate the effectiveness of conservative different therapeutic modalities for temporomandibular disorders (TMD) pain. An electronic systematic search was conducted in the MEDLINE (PubMed) database to identify the randomized clinical trials (RCTs) published between 2001 and 2021. The following, simple or multiple conjunctions, search keywords were selected: TMD pain, TMD management or conservative treatment or treatment strategies and TMD pain, therapeutic modalities or interventions and TMD. Studies included must have patients older than 18 years, with painful TMD, which diagnosis was performed by Research Diagnostic Criteria for TMD or Diagnostic Criteria for TMD. Outcome variables were pain relief and post treatment pain intensity reduction. Data were analysed with non-parametric tests and the level of significance was set at p<.05. Out of 1599 articles obtained, 28 RCTs fulfilled all selection criteria and were included. The results of this study show that there was a significant decrease in short-term post-treatment TMD pain with the use of occlusal splint alone or in combination with other therapeutic modalities when compared with the control group. Statistically significant differences were also detected between laser and photobiomodulation group and the control, in short-term treatment TMD-related pain. The primary findings of the present systematic review showed that the occlusal splint alone or combined with other therapeutic intervention presented positive effect on short-term TMD pain reduction. Secondary outcome suggests that laser and photobiomodulation therapy had, also, a significant role in short term pain relief. [ABSTRACT FROM AUTHOR]

Arthrocentesis for arthralgia of the temporomandibular joint (TMJ) is often only indicated when conservative, non-surgical interventions have failed. However, performing arthrocentesis as initial therapy may facilitate earlier and better recuperation of the joint. The aim of this study was to assess the efficacy of this therapy with a long-term follow-up. Eighty-four patients were randomly allocated to receive either arthrocentesis as initial treatment (n = 41) or non-surgical intervention (n = 43). Pain (100-mm visual analogue scale, VAS) and mandibular function impairment questionnaire scores (MFIQ, 0–100) were recorded at 3, 12, and 26 weeks, and ≥ 5 years (median 6.2, interquartile range 5.6–7.4 years). Univariable analyses were performed and linear mixed-effect models were constructed. Patients in the arthrocentesis group experienced significantly lower TMJ arthralgia compared to those treated non-surgically (pain during movement: −10.23 mm (95% confidence interval −17.86; −2.60); pain at rest: − 8.39 mm (95% confidence interval −13.70; −3.08)), while mandibular function remained similar in the two groups (MFIQ −2.41 (95% confidence interval −8.61; 3.78)). Of the final sample, 10 patients (10/39, 26%) in the non-surgical intervention group and two patients (2/34, 6%) in the arthrocentesis group received additional treatment during follow-up. Thus, initial treatment with arthrocentesis reduced TMJ arthralgia more efficaciously than non-surgical intervention in the long term, while maintaining similar mandibular function. [ABSTRACT FROM AUTHOR]