Does the facebow affect the outcome of CAD/CAM occlusal splint. Randomized clinical trial

Sagittal condylar guidance angle measurement methods: A systematic review

STATEMENT OF PROBLEM

Precise assessment of the condylar guidance angle can aid successful prosthodontic treatment. However, the reliability and accuracy of current methods remain unclear.

PURPOSE

The purpose of this systematic review was to evaluate the reliability and accuracy of current methods of determining the sagittal condylar guidance angle, including protrusive interocclusal records, axiography, cone beam computed tomography (CBCT), and panoramic and cephalometric radiographs.

MATERIAL AND METHODS

A literature search was conducted using BASE, Embase, PubMed, and Web of Science databases up to June 2022. Inclusion criteria involved studies that compared protrusive interocclusal records against other methods of sagittal condylar guidance angle assessment in adult dentate and edentulous patients. Studies that did not provide the values for the right and left joint separately were excluded. The methodological quality of the included studies was assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data were tabulated and analyzed for correlations and their significance.

RESULTS

A total of 24 articles qualified for the analysis. The differences between protrusive interocclusal records and panoramic radiograph sagittal condylar guidance angle values were up to 9 degrees. Lateral cephalometric radiographs revealed greater condylar guidance values than facebow transfers or the Bonwill methods. Correlations between average sagittal condylar guidance angle values obtained from CBCT and protrusive interocclusal records differed depending on the method of registration. For protrusive interocclusal records, axiographic or pantographic measurement variance analysis showed that the condylar inclination values recorded with wax were statistically lower than those recorded with a pantograph (P<.05).

CONCLUSIONS

Although CBCT appears to be the most suitable method of evaluating the sagittal condylar guidance angle, the limitations and discrepancies among methods, including protrusive interocclusal records and panoramic and cephalometric radiographs, should be acknowledged. Digital axiography, with its potential to capture comprehensive functional data, may surpass other techniques. The use of mean values for articulators may be a practical solution for some patients. Further research is needed to refine sagittal condylar guidance angle assessment methods and to develop more reproducible and reliable approaches for the future.

Botulinum toxin and occlusal splints for the management of sleep bruxism in individuals with implant overdentures: A randomized controlled trial

BACKGROUND

The available treatment options fail to provide definitive or curative management for bruxer patients rehabilitated with implant overdentures (OD). The data regarding Botulinum toxin (BTX) injection as a management strategy for bruxism remains unclear. This randomized, single-blinded, control-group, pretest-posttest prospective trial evaluated the occlusal guard and Botox injections (BTX) effectiveness in managing sleep bruxism (SB) in subjects whose one of the edentulous arches had been restored with the implant-supported OD.

METHODS

Forty-two patients diagnosed with definite bruxism were selected, all of which had implant-retained ODs opposing natural dentition. The participants were allocated randomly to three equal groups. Participants in group I (control group) were instructed to remove the OD at night; group II was managed with conventional occlusal stents. Those in group III were given BTX injections. New ODs were constructed for all groups, and all ball attachments were replaced with a new nylon cap. A baseline assessment (one month of OD insertion) of patient satisfaction and sleep quality was conducted, and then again at 3, 6, 9, and 12 months of treatment. Subjective sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI). Patients' satisfaction was evaluated using Temporomandibular disorders/numeric scales (TMD/NS). Prosthodontic (mechanical) complications were recorded during the follow-up period.

RESULTS

Group III showed a statistically significant improvement in patient satisfaction and sleep quality compared to the other two groups at 3, 6, 9, and 12 months follow-up period ( P  = 0 0.001, 0.0001, 0.0013, and 0.0001 respectively). Regarding prosthodontic (mechanical) complications, the highest number of events was revealed in the control group.

CONCLUSIONS

BTX and occlusal appliances effectively improve patient satisfaction and sleep quality of Bruxer patients rehabilitated with single arch implant overdentures.