Effectiveness of physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: protocol of a randomised controlled trial

INTRODUCTION

Temporomandibular disorders (TMDs) are considered a collection of musculoskeletal conditions involving the masticatory muscles, the temporomandibular joint and associated structures. The myogenous group appears to represent the most frequently diagnosed category. In the context of a multimodal approach, splint therapy and musculoskeletal physiotherapy are often considered as a preferred therapy. The purpose of this study will be to investigate the effects of musculoskeletal physiotherapy combined with occlusal splint and education versus occlusal splint and education alone in the treatment of chronic myogenous TMD on pain and mandibular range of motion.

METHODS AND ANALYSIS

All consecutive adults complaining of TMDs presented to the Department of Biomedical and Neuromotor Sciences of the University of Bologna will be considered eligible. Inclusion criteria shall be based on the presence of myogenous TMDs, as diagnosed through clinical examination in reference to the international diagnostic criteria of TMDs. Randomisation, concealed allocation, blinded assessment and intention-to-treat analysis will be employed. The splint therapy will consist of the use of the splint every night and concurrent delivery of an educational programme; the protocol shall have a duration of three consecutive months. The combined musculoskeletal physiotherapy, splint therapy and education will additionally consist of manual therapy techniques and exercise; such protocol shall consist of a duration of three consecutive months, inclusive of 10 sessions for the enhanced elements. All outcome measures will be collected at baseline, after treatment and at a 6 months follow-up.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Independent Ethic Committee in Clinical Research of AUSL Bologna-Italy (47/2018/SPER/AUSLBO). Pursuant to applicable rules,we will obtain informed consent from each participant and collect data anonymously to maintain privacy. Results will be disseminated to clinicians and researchers through peer-reviewed publications and conferences.

TRIAL REGISTRATION NUMBER

NCT03726060.

Application of patient-specific simulation workflow for obstructive sleep apnea diagnosis and treatment with a mandibular advancement device

A computational fluid dynamics simulation workflow was developed to analyze the upper airway of patients with obstructive sleep apnea, which is a potentially serious sleep-related breathing disorder. A single characteristic parameter was introduced to assess the severity of sleep apnea on the basis of the numerical results. Additionally, a fluid-structure interaction simulation was applied to study in detail the behavior of compliant pharyngeal walls. An experimental setup was designed to validate the patient-specific upper airway modeling. The suitability of the characteristic parameter was demonstrated in a retrospective analysis of radiological and clinical data of 58 patients as well as a prospective analysis of 22 patients. The simulation workflow was successfully used as part of an ongoing clinical investigation to predict the outcome of the obstructive sleep apnea treatment with a mandibular advancement device. The simulation results provided essential information about the critical region in the pharynx for the selection of an appropriate treatment and readily demonstrated the effect of mandibular protrusion on the air flow in the upper airway.

Improvement in accuracy of maxillary repositioning of Le Fort I osteotomy with Orthopilot™ Navigation System: evaluation of 30 patients

Traditional model surgery with facebow transfer is not very accurate. We aimed to demonstrate that the Orthopilot™ Navigation System improves the accuracy of maxillary repositioning during Le Fort I osteotomy. Thirty patients underwent Le Fort I osteotomy alone or associated to sagittal split osteotomy. The maxilla positioning was done in two phases. First, the maxilla was positioned with the traditional occlusal splint, the position ("without Orthopilot™") was recorded by the Orthopilot™. In the second phase, the Orthopilot™ was used to improve positioning; and the final position ("with Orthopilot™") was recorded, after osteosynthesis. Positioning data were compared with planned data. Positioning data with and without the Orthopilot™ were also compared. Accuracy was classified in distinct classes with three major criteria (conformity, non-conformity, failure) according to the discrepancies. Conformity rate was significantly greater with the Orthopilot™ (2 without the Orthopilot™ compared with 8 with the Orthopilot™; p=0.01). The failure rate was significantly lower with the Orthopilot™ (18 without Orthopilot™ compared with 7 with the Orthopilot™; p=0.002). Dispersions of discrepancies were usually lower in all directions with the Orthopilot™. Navigation reduced the risk of discrepancy without cancelling it, especially when large movements are planned. The Orthopilot™ therefore improved the accuracy of traditional occlusal splint during Le Fort I osteotomy.

An 8-year prospective clinical investigation on the survival rate of feldspathic veneers: Influence of occlusal splint in patients with bruxism

OBJECTIVES

The aim of this study was to perform a 8-year prospective clinical investigation on the survival rate of feldspathic ceramic veneers, as well as analyse the influence of the occlusal splint in patients with parafunctional bruxism.

METHODS

Three hundred and sixty-four veneers fabricated using conventional feldspathic ceramic were provided in 64 patients. The patient sample included 40 individuals with bruxism. During the follow-up period, the effect of wearing the occlusal splint on the incidence of failure (fracture and/or debonding) in patients with bruxism was also assessed. The survival rate of veneers was determined using the Kaplan-Meier estimator. Statistical significance was set at p < 0.05 with a confidence interval of 95%.

RESULTS

The occurrence of fracture for the feldspathic veneers tested in this study was 7.7%, while only 1.9% of the total number of veneers debonded. The overall survival rate was 93.7% after 3 years, 91% after 5 years, and 87.1% after 8 years. Patients with bruxism using an occlusal splint showed a survival rate of 89.1% after 7 years, while the survival rate in patients with bruxism using no occlusal splint was 63.9% (p < 0.05).

CONCLUSION

This study confirmed that feldspathic veneers may represent a suitable clinical solution for indirect aesthetic restorations. Such a treatment may be an option also for those patients affected by bruxism, as long as they regularly wear an occlusal splint. However, patients with bruxism using no occlusal splint may still present a potential high-risk of failure and/or debonding.

The effectiveness of stabilization appliance therapy among patients with myalgia

BACKGROUND

The efficacy of stabilization appliance therapy for masticatory muscle pain is debated. Therefore, there are currently no clear usage standards. We analyzed patient factors influencing its efficacy and characterized masticatory muscle pain subtypes to determine appropriate therapy candidates.

METHODS

This case series study recruited patients diagnosed with local myalgia or myofascial pain and used variables related to temporomandibular disorders in the analysis. We used temporary appliance to screen patients for sleep bruxism for 2 weeks. Afterwards, we initiated therapy with stabilization appliances. Efficacy was evaluated via tenderness intensity during muscle palpation and the treatment satisfaction score after 2 months of treatment.

RESULTS

We analyzed 62 (91%) patients. Tenderness upon muscle palpation was mitigated in 27 patients. Mitigated tenderness odds ratios were 0.035 for myofascial pain, 0.804 for 15-item Patient Health Questionnaire scores, and 1.915 for facet length. Thirty-nine patients expressed satisfaction; satisfaction odds ratios were 0.855 for 9-item Patient Health Questionnaire scores, 1.606 for facet length, and 4.023 for awake bruxism awareness.

CONCLUSIONS

Stabilization appliance therapy is most effective for patients with awake bruxism awareness, local myalgia, long facets, and no psychosocial risk factors.

Different Treatments in Patients with Temporomandibular Joint Disorders: A Comparative Randomized Study

BACKGROUND AND OBJECTIVES

Temporomandibular joint disorders (TMJDs) are associated with pain and reduced jaw mobility. The aim of this study was to compare the outcome of patients with TMJ arthralgia when submitted to four different treatment modalities, in some cases using intra-articular injections of substances with anti-inflammatory properties and in others, a more conservative approach consisting only of a bite splint. Materials and Methods: The sample was made up of 80 patients, randomly distributed into 4 groups of 20 patients each. Each patient was given a nocturnal bite splint. One of the groups was treated with the bite splint only, while each patient in the other 3 was injected with betamethasone, sodium hyaluronate, or platelet-rich plasma in addition to using the bite splint. Two variables were assessed, namely pain intensity between 0 to 10 according to the visual analogue scale and maximum pain-free mouth opening in mm. The patients were evaluated at four different points: at the beginning of the treatment, as well as one week, one month and six months after initiation.

RESULTS

The results showed that maximum pain-free mouth opening improved in all the groups that made up the sample, with either a reduction in pain severity or with no pain. However, the group injected with platelet-rich plasma yielded the best results after six months, while patients treated with sodium hyaluronate or betamethasone obtained the best results at the end of the first week.

CONCLUSIONS

We concluded that all the treatments used caused a reduction in pain and increased pain-free mouth opening. The splint combined with the platelet-rich plasma injection achieved long-term success.

Temporomandibular disc displacement with reduction treated with anterior repositioning splint: a 2-year clinical and magnetic resonance imaging (MRI) follow-up

Clicking may appear in the initial, middle, or final phase of mandibular opening. Magnetic Resonance Imaging (MRI) is the most appropriate diagnostic imaging for diagnosing disc position. With anterior repositioning splint (ARS), disc recapture is achieved through a change in the position of the condyle to encourage adaptation of the retrodiscal tissues. Three patients reported pain and sounds during movement and clicking in the final phases; also, the MRI confirmed anteriorized disc position and the treatments consisted of an ARS. The post-treatment examination confirmed a normal opening without deviations and deflections. After 2 years, the conditions were stable, and the MRI showed thickening of the retrodiscal tissues, including extra fibrous tissue, resulting in a pseudodisc. Treatment using ARS can stimulate tissue fibrosis and the formation of a pseudodisc. MRI is the gold standard for diagnosis and treatment planning of disc displacement cases.

Intraoral sensor-based monitoring of stabilization splint therapy in patients with myofascial pain

AIM

The present study aimed to evaluate intraoral microsensors for the objective measurement of patient compliance during splint therapy and to comparatively analyze the duration of mandibular and maxillary splint application in patients with myofascial pain.

MATERIALS AND METHODS

Thirty-two patients with sole myofascial pain without limited opening (Research Diagnostic Criteria for Temporomandibular Disorders [RDC/TMD] Ia) were divided into two groups. To ensure patient comparability, all pressure-sensitive sites from the initial palpation were summarized as pain scores. The subjects in group 1 were treated with maxillary stabilization splints, and those in group 2 with mandibular stabilization splints. All splints were equipped with a microsensor without interfering static or dynamic occlusion. Wear pattern was recorded at three intervals of 30 days each. Following the observation period, the data were retrieved and statistically evaluated using multi-factor analysis of variance (ANOVA) and the Bland-Altman analysis.

RESULTS

During the observation period, maxillary splints were applied in 44.4% and mandibular splints in 44.2% of the days. Regarding patient compliance, there was no significant difference between the maxillary and mandibular splints (P = 0.359). Patients with an increased pain score (P < 0.0001) and female patients (P = 0.013) wore their splints significantly more often. The wear time decreased over the observation period, whereas only the initial and terminal interval differed significantly across both the mandibular and maxillary splint groups (P < 0.0001).

CONCLUSION

The microsensor used in the present study was an effective and reliable tool for monitoring patient compliance in patients with temporomandibular disorders (TMD). This method also allows for the reliable recording of intraoral splint application prior to the required bite elevations. The two types of splints analyzed in the present study had no significant influence on compliance.

Computerized occlusal analysis - innovative approaches for a practice-oriented procedure

A hands-on method for instrument-based occlusal analysis with digital technology is presented using a patient case example. The method is based on new software for digital occlusal analysis that includes a new measuring system for recording mandibular function (Jaw Motion Analyser Optic System/oJMA). With the new system, occlusal contact patterns in the real movement function of the mandible are captured and analyzed digitally with regard to occlusal interferences or a suitable therapeutic position of the mandible. For this purpose, scans of both jaws are brought together with the movement recordings by means of a special coupling tray and then visualized together as one complete image. Since the movement paths of the temporomandibular joints (TMJs) are also captured, the new system makes it possible to define a suitable therapeutic position specifically aimed at relieving the TMJs, and a therapeutic change in the jaw relation can be adjusted, for instance, by using an occlusal splint. Dedicated software modules provide a layer-by-layer analysis of the intercuspation relationship and the generation of 'envelopes' for occlusal gliding movements. This system is used to gain a deeper and more comprehensive understanding of the relationship between the structure and function of the occlusion. Interfaces to CAD software have also been established.

Rehabilitation of Severely Attrited Teeth with Hobo Twin Stage Technique: A Case Report

Restoration of excessively worn dentition is a challenging treatment procedures. It requires efficient diagnosis and treatment plan. Hobo's techniques and Pankey Mann Schuyler's philosophy are widely used and documented for full mouth rehabilitation. We have reported the case of a 56-year-old male patient who presented with the severely worn dentition and had difficulty in chewing. To rehabilitate this case Hobo's twin stage technique had been adopted as it is based on scientific data and mathematical analysis for both disocclusion and anterior guidance thus reducing chair side time.

Intelligent Occlusion Stabilization Splint with Stress-Sensor System for Bruxism Diagnosis and Treatment

Bruxism is a masticatory muscle activity characterized by high prevalence, widespread complications, and serious consequences but without specific guidelines for its diagnosis and treatment. Although occlusal force-based biofeedback therapy is proven to be safe, effective, and with few side effects in improving bruxism, its mechanism and key technologies remain unclear. The purpose of this study was to research a real-time, quantitative, intelligent, and precise force-based biofeedback detection device based on artificial intelligence (AI) algorithms for the diagnosis and treatment of bruxism. Stress sensors were integrated and embedded into a resin-based occlusion stabilization splint by using a layering technique (sandwich method). The sensor system mainly consisted of a pressure signal acquisition module, a main control module, and a server terminal. A machine learning algorithm was leveraged for occlusal force data processing and parameter configuration. This study implemented a sensor prototype system from scratch to fully evaluate each component of the intelligent splint. Experiment results showed reasonable parameter metrics for the sensors system and demonstrated the feasibility of the proposed scheme for bruxism treatment. The intelligent occlusion stabilization splint with a stress sensor system is a promising approach to bruxism diagnosis and treatment.

Dental side effects of long-term obstructive sleep apnea therapy: a 10-year follow-up study

OBJECTIVES

Patients with obstructive sleep apnea (OSA) are usually treated with either mandibular advancement device (MAD) or continuous positive airway pressure (CPAP) therapy. The objective of this study is to evaluate changes in dental occlusion associated with long-term MAD and CPAP therapy.

MATERIALS AND METHODS

Data from 14 OSA patients using MAD and 17 OSA patients using CPAP therapy were evaluated at baseline, 2-year and 10-year follow-up. Changes in dental occlusion were analyzed from dental plaster casts with a digital sliding caliper.

RESULTS

At 2-year follow-up, MAD therapy resulted in significant dental changes when compared with baseline values. In MAD therapy, overjet and overbite decreased with 1.1 ± 1.8 mm and 1.1 ± 1.2 mm respectively. With CPAP therapy overjet and overbite decreased significantly with 0.2 ± 0.5 mm and 0.3 ± 0.5 mm, respectively. Both groups also showed significant changes in molar occlusion. After a 10-year follow-up, significant and more pronounced changes were seen in overjet and overbite. In MAD therapy, overjet and overbite decreased with 3.5 ± 1.5 mm and 2.9 ± 1.5 mm respectively when compared with baseline values. In CPAP therapy, overjet and overbite decreased with 0.7 ± 1.5 mm and 0.8 ± 1.4 mm respectively when compared with baseline values.

CONCLUSIONS

This study demonstrates that MAD and CPAP therapy result in significant changes in dental occlusion. These changes appear progressive and more pronounced with MAD compared to CPAP therapy.

CLINICAL RELEVANCE

Long-term OSA treatment results in significant dental side effects that may progress over time. Informed consent is fundamental before starting MAD treatment and individualized long-term follow-up is of eminent importance.

[Mechanical properties and cytotoxicity of three-dimensional printing polycarbonate for occlusal splints]

PURPOSE

To evaluate the mechanical properties and cytotoxicity of a 3D printing polycarbonate material used in digital occlusal splints, and to use this material to manufacture a splint with CAD/CAM technology.

METHODS

Specimen of two different materials, 3D printing polycarbonate(PC-plus) and transparent base resin (PMMA) were processed. The flexural strength, elastic modulus, microhardness, hygroscopicity and water-solubility of these materials then were evaluated. According to the standard of GBT16886.5-2003, cell culture and cytotoxicity test in vitro were conducted to evaluate the target materials on the morphology, growth and proliferation of cultured cells (L929). By using 3D printing technology, a splint was made of this 3D printing polycarbonate material. Statistical analysis was performed using SPSS 24.0 software package.

RESULTS

For the group of PC-plus, the flexural strength ranged from 89.4 to 109.8 MPa, the elastic modulus from 1939.4 to 2470.9 GPa, the microhardness from 15.6 to 24.7 MPa, hygroscopicity from 2.43 to 11.42 μg/mm³ and water-solubility from 0.11 to 0.30 μg/mm³. For PMMA group, the flexural strength ranged from 75.2 to 88.4 MPa, the elastic modulus from 1349.2 to 2470.2 GPa, the microhardness from 17.5 to 35.3 MPa, hygroscopicity from 12.80 to 16.16 μg/mm³ and water-solubility from 4.74 to 7.44 μg/mm³. The difference between 3D printing PC-plus group and PMMA base resin group was statistically significant (P<0.05). L929 cells showed normal morphology and proliferation increased with culture time. The toxicity grade of all groups was 0-1, and the 3D printing splint was made successfully.

CONCLUSIONS

The polycarbonate material for 3D printing has adequate mechanical properties and biocompatibility to meet the requiement of clinical application.

Evaluation of the effectiveness of infrared light-emitting diode photobiomodulation in children with sleep bruxism: Study protocol for randomized clinical trial

BACKGROUND

Sleep bruxism is a masticatory muscle activity characterized as rhythmic (phasic) or nonrhythmic (tonic). In children and adolescents, etiological factors, such as breathing pattern and sleep quality, have recently been addressed in studies investigating sleep bruxism. New therapies for adults, such as botulinum toxin, have been investigated, but such techniques are not applicable for individuals in the growth and development phase.

METHODS

The participants will be 76 children, which will be randomly allocated to a control group, that is group 1, absence of bruxism; group 2, children with bruxism treated with infrared light-emitting diode (LED); and group 3, bruxism treated with occlusal splint. All participants will be submitted to a clinical evaluation to evaluate muscle activity and salivary biomarkers, before and after treatments. Muscle activity will be verified by electromyography of muscles mastication, masseter and temporal, and salivary biomarkers observed will be cortisol and dopamine levels.

DISCUSSION

Photobiomodulation therapy has piqued the interest of researchers, as this noninvasive method has demonstrated positive results in problems related to muscle tissues. This document describes the protocol for a proposed study to evaluate morphological and psychosocial aspects in children and adolescents with awake bruxism and their responses to photobiomodulation therapy with infrared LED. CLINICAL TRIALS:.

Phenotypes to Predict Response to Mandibular Advancement Device Therapy

CITATION

Heiser C. Phenotypes to predict response to mandibular advancement device therapy. JClin SleepMed. 2019;15(8):1073-1074.

Effects of occlusal splint therapy in patients with migraine or tension-type headache and comorbid temporomandibular disorder: A randomized controlled trial

BACKGROUND

Migraine and tension-type headache often occur comorbid with temporomandibular disorder; occlusal splint therapy is the most common treatment for temporomandibular disorder. The aim of this study was to assess the effects of occlusal splint therapy on headache symptoms in patients with migraine and/or tension-type headache comorbid with temporomandibular disorder.

METHODS

Sixty adult patients with migraine and/or tension-type headache and comorbid temporomandibular disorder were randomly assigned to individualized occlusal splint therapy applied during day- and nighttime plus usual care (n = 30) or usual care alone (n = 30). Primary outcome was the change in current pain intensity on a 100 mm visual analogue scale from week 1 to week 12. Secondary outcomes included changes in headache days and headache hours assessed by headache diaries over a 2-week period, health-related quality of life (SF-36), and adverse events from week 1 to week 12 and (in the occlusal splint plus usual care group only) to week 24.

RESULTS

No group differences in changes in pain intensity from week 1 to week 12 were found. The number needed to treat was 3.8. Physical quality of life reduced stronger in the usual care group than in the occlusal splint plus usual care group. In the occlusal splint plus usual care group, headache intensity significantly decreased and physical quality of life significantly increased from week 1 to week 12 and to week 24 (all P < .001). No adverse events were reported.

CONCLUSIONS

A day- and night-time occlusal splint therapy in addition to usual care was not superior to usual care alone in patients with chronic headache and comorbid TMD. Four patients need to be treated to induce a minimal clinically relevant improvement in one patient. The small sample size and lack of power limit these findings.

Evaluation of the Use of a Force Diagram in the Management of Temporomandibular Joint Sounds: A Prospective Cross-sectional Study

Context

Occlusal splints are widely used in clinical practice as a noninvasive treatment for patients with temporomandibular disorders (TMDs) and for reduction of TMD-related symptoms. A force diagram allows a health care professional to evaluate the interactions of loads caused by muscular effort, which are sensed by the teeth and the temporomandibular joint during the protrusive movement of the mandible.

Objective

To evaluate the efficacy of occlusal splints combined with occlusal adjustment (OA) based on a force diagram in the management of joint sounds (clicking and crepitation).

Methods

Patients were examined clinically and administered a questionnaire for the diagnosis of TMD and orofacial pain. Patients were then assigned to 1 of 2 splint therapies: (1) an anterior bite plane of the front-plateau type (FP) or (2) a maxillary muscle relaxation appliance (MRA), both combined with OA based on a force diagram performed at 6 visits, with an interval of 24 to 48 hours between each visit. To measure the effects of treatment, at each of the 6 visits, patients also rated the severity of their TMD-related symptoms on a visual analog scale. Data were dichotomized into presence and absence of symptoms and compared using the McNemar test.

Results

A total of 199 patients were included in the study. At baseline, 38 patients (19.1%) had crepitation and 161 (80.9%) had clicking. A total of 150 patients were treated with FP+OA, with a statistically significant reduction in the number of patients reporting clicking (42.6%, P<.001) and crepitation (42.9%, P<.001). Among patients treated with MRA+OA (n=49), there was a statistically significant reduction in the number of patients reporting clicking (50%, P<.001). All 3 patients with crepitation in the MRA+OA group reported total remission (P>.05).

Conclusion

The 2 treatment strategies, FP+OA and MRA+OA, improved both clicking and crepitation. Both strategies prioritize the concept of mutually protected occlusion, in which all jaw and temporomandibular joint movements must synchronize, which may be conveniently done using the force diagram.

Evaluation of changes in the upper airway after Twin Block treatment in patients with Class II malocclusion

The purpose of this prospective case control study is to describe in growing patients with mandibular hypoplasia, treatment outcomes following functional therapy in terms of volumetric changes in nasopharynx and oropharynx, that is, upper and lower pharynx. We recruited 60 study participants aged between 8 and 12 years having mandibular Class II malocclusion and a reduced upper airway (UA) size, as determined by McNamara cephalometric analyses. Forty patients received Twin Block treatment, whereas the remaining 20 patients did not receive treatment, thus constituting the control group. The control group included patients who did not start treatment after their first visit but returned for a consultation one or 2 years later. All patients underwent an initial teleradiography examination of the skull and a final teleradiography examination to measure changes using McNamara cephalometric analysis of the UA. Pretreatment and posttreatment changes were assessed using Student's t test for independent samples with a significance level of 0.05. Both anatomical structures analyzed-the upper pharynx (nasopharynx) and lower pharynx (oropharynx)-showed significant increases after treatment regardless of whether the patients were boys or girls. The controls showed a decrease in UA size on average after approximately 2 years of growth. A clear relationship exists between the mandibular advancement achieved with TB treatment and an increased UA size. Therefore, the appliance is considered suitable for improving the respiratory quality of growing patients with a decreased UA size.

Effects of Treatment with Nociceptive Trigeminal Inhibition Splints on Electromyography in Temporomandibular Joint Disorder Patients

AIM

This research aimed at evaluating the effects of the nociceptive trigeminal inhibition splint (NTIS) on electromyography (EMG) for masseter and temporalis muscles in patients with temporomandibular joint disorders (TMDs), and at detecting the discomfort degree originating from this splint.

MATERIALS AND METHODS

The sample consisted of 15 patients having TMDs of muscular origin to be treated by NTIS. The activity degree of masseter and temporalis muscles was measured using the EMG two times: before the treatment and after 6 months. Besides, patients' discomfort was assessed after the start of treatment four times: 1 day, 2 weeks, 1 month, and 6 months.

RESULTS

After the treatment, there was a significant decrease in masseter and temporalis muscles' activity in both right and left sides (p < 0.001). No significant differences were observed in the electrical muscular activity mean change between the masseter muscles (-43.87 ± 26.82) and the temporalis muscles (-54.91 ± 21.16) (p = 0.082), or between the right muscles (-51.97 ± 26.30) and the left muscles (-46.81 ± 22.90) (p = 0.422). In addition, the discomfort degree gradually decreased after 2 weeks (p < 0.01).

CONCLUSION

The use of NTIS is associated with reduction in the masseter and temporalis muscles' activity. Also, the patients' discomfort degree from NTIS progressively decreases after 2 weeks of treatment.

CLINICAL SIGNIFICANCE

The NTIS is an effective therapeutic approach for patients having TMDs of muscular origin.

Effect of occlusal splint and therapeutic exercises on postural balance of patients with signs and symptoms of temporomandibular disorder

The aim of this study was to investigate the effects of the use of an occlusal splint on postural balance considering the occlusal splint as a device for treating temporomandibular joint disorder. A randomized, controlled, prospective clinical trial was conducted. The research group consisted of 49 patients (36 as test group and 13 as control group) between 18 and 75 years old, both genders, diagnosed as temporomandibular disorder by Research Diagnostic Criteria/Temporomandibular Disorders questionnaire and magnetic resonance imaging of the temporomandibular joints. Test group was treated with orientations for physiotherapeutic exercises and occlusal splint, whereas control group received orientation for physiotherapeutic exercises only. Postural equilibrium was evaluated by means of a force plate. After 12 weeks, the groups were re-evaluated. Patients from both groups presented a significant increase in antero-posterior speed with eyes closed, test group (P < 0.001) and control group (P = 0.046). Only patients of the test group presented a significant increase in antero-posterior speed with eyes opened (P = 0.023). We concluded that the use of occlusal splint affected the postural balance.

Crossover comparison between CPAP and mandibular advancement device with adherence monitor about the effects on endothelial function, blood pressure and symptoms in patients with obstructive sleep apnea

Mandibular advancement device (MAD) is an alternative therapeutic option for CPAP to treat obstructive sleep apnea (OSA). While MAD showed the better adherence, patients with over moderate OSA have been treated more frequently with CPAP despite increasing positive evidence on the cardiovascular outcome with MAD, even in severe patients. Thus, more information is needed regarding the cardiovascular and symptomatic outcome of MAD treatment objectively compared to CPAP. Forty-five supine-dependent OSA patients (apnea-hypopnea index 20-40/h) were randomized to either CPAP or MAD and treated for 8 weeks and switched to another for 8 weeks. The primary endpoint was improvement in the endothelial function, indexed by the flow-mediated dilatation (FMD), and the secondary endpoint was the sleep-time blood pressure (BP). The duration of MAD use was evaluated objectively by an implanted adherence monitor. Treatment efficacy was also evaluated by home sleep monitor and a questionnaire about the symptoms. The adherence was not significantly different (CPAP vs. MAD: 274.5 ± 108.9 min/night vs. 314.8 ± 127.0 min/night, p = 0.095). FMD and sleep-time mean BP were not markedly changed from the baseline with either approach (CPAP vs. MAD: FMD, + 0.47% ± 3.1% vs. + 0.85% ± 2.6%, p = 0.64; BP, - 1.5 ± 5.7 mmHg vs. - 1.2 ± 7.5 mmHg, p = 0.48), although sleepiness, nocturia, and sleep-related parameters were similarly improved and more patients preferred MAD. As MAD and CPAP showed similar effects on cardiovascular outcome and symptomatic relief even with a comparable length of usage, we might expect MAD as an alternative treatment option for CPAP in this range of OSA group.

Occlusal Splints and Periodontal/Implant Therapy

BACKGROUND

Occlusal trauma, defined as an injury to the tooth or implant supporting tissues, is a resultant of parafunctional habits such as bruxism. It has been shown to accelerate periodontal breakdown and also contribute to implant complications, thereby adversely affecting the long-term success of periodontal and implant therapy. This review aims to discuss the effects of bruxism on periodontal and implant treatment. In addition, the effectiveness of occlusal splints to manage bruxism will be examined.

METHODS

An electronic literature search using PubMed and Scopus databases and a manual search for relevant papers published in English from January 1965 up to August 2017 was performed..

RESULTS

An occlusal splint appears to be effective in reducing symptoms related to temporomandibular disorder and bruxism. However, high quality evidence is severely lacking to support its use. Therefore, as it is a non-invasive and reversible therapy, its use in patients with bruxism is proposed.

CONCLUSIONS

Therefore, as it is a non-invasive and reversible therapy, occlusal splint use in patients with bruxism is proposed.

[The need for specific toothpaste in patients receiving occlusal splint therapy]

The aim of the study is to determine the optimal properties of toothpaste for patients receiving occlusal splint therapy. The study comprised 50 people with full dentition (21 male and 29 female) divided into two groups. The main group included 25 individuals receiving occlusal splint therapy while 25 people who did not use splints were recruited as controls. Each group was further divided into two subgroups according to toothpaste used for regular oral hygiene. Examinations were performed after 14, 30 and 90 days using hygienic indices of NCI-C and Turesky and PMA gingival index. The combined effect of toothpaste was estimated by the change in the volume and acidity of saliva. The results suggest a better level of hygiene in the group I, which used toothpaste with sodium bicarbonate and silica.

[Diagnostic criteria for the transition from occlusal splints to non-removable orthopedic appliances in patients with TMJ dysfunction with disc disorders]

The aim of the study was to elaborate Diagnostic criteria for the transition from occlusal splints to non-removable orthopedic appliances in patients with TMJ dysfunction with disc disorders. The study involved 95 patients with the clinics of TMJ dysfunction. An examination included electrovibrography and computerized electromyography in order to assess diagnostic value of the methods. Electrovibrography is a method based on arthrophonography, which makes it possible to obtain data on intraarticular noise in the TMJ. Computerized electromyography provides an objective assessment of the bioelectrical activity of the masticatory muscles in occlusive disorders, changes in the height of the lower facial area, and their relationship with the development of musculo-articular dysfunction of the TMJ and allows monitoring the effectiveness of orthopedic treatment. Within the normal function of the jaws the graphic trajectories of mandibular movements are within the limits of norm, and in the case of a violation of the TMP function, the graphic and linear indices are significantly different from the normal values.

Influence of dental occlusion on the athletic performance of young elite rowers: a pilot study

OBJECTIVES

The present study aimed to assess the influence of dental occlusion on body posture and the competitive performance of young elite rowers.

METHOD

Dental occlusion disturbance devices were used to simulate dental malocclusions. We assessed the influence of malocclusion on the body balance, paravertebral muscle contraction symmetry, and muscular power of young elite rowers. A nonparametric permutation test for repeated measures ANOVA, a Cochran's Q test for paired data and a paired Student's t-test were used in order to statistically evaluate the influence of artificial occlusal disturbance on each factor. A force platform and a Dyno Concept 2 machine were used as measuring instruments.

RESULTS

A total of 7 members of the "Pôle France Aviron" (age range of 15-17 years) were enrolled in the study. None of the body balance parameters was significantly influenced by the artificial occlusal disturbance. The interposition of an occlusal silicone splint significantly increased the proportion of athletes presenting asymmetric muscular contractions from 14.3% to 85.7% (p=0.025) and induced a significant 17.7% decrease in the athletes' muscular power (p=0.030).

CONCLUSIONS

This study shows the negative impacts of an occlusal disturbance on the athletic performance of young elite rowers. The detection of malocclusion traits by regular occlusal monitoring would be of great interest in this population.