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Klepzig K, Wendt J, Teusch L, Rickert C, Kordaß B, Lotze M. Pain and salivary biomarkers of stress in temperomandibular disorders were affected by maxillary splints. J Oral Rehabil 2024; 51:1025-1033. [PMID: 38475974 DOI: 10.1111/joor.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Longitudinal intervention studies on treatment options in temporomandibular dysfunction (TMD) including self reports and salivary biomarkers of stress are rare and the exact therapeutic function of occlusal splints widely unknown. METHODS We examined the therapeutic effects of a Michigan splint with occlusal relevance in patients with TMD using a placebo-controlled, delayed-start design. Two intervention groups received a Michigan splint, while one of them had a placebo palatine splint for the first 3 weeks. We collected pain intensities (at rest and after five occlusal movements), salivary measures associated with stress (cortisol and alpha-amylase) and self-reported psychological distress (stress, anxiety, catastrophizing) at baseline and 3 and 7 weeks after onset of intervention. RESULTS At baseline, we observed increased pain intensity and psychological distress in TMD patients compared to 11 matched healthy controls. Baseline anxiety was linked to movement pain intensity through stress. Over therapy reductions in pain intensity and morning cortisol were more pronounced in those patients starting immediately with the Michigan splint, while psychological distress decreased similarly in both groups. CONCLUSION Our results suggest that perceived stress plays a role for the association between anxiety and TMD pain and underlines the need for an interdisciplinary perspective on the pathogenesis and therapy of TMD in a setting where psychotherapeutic knowledge is still scarce or rarely applied.
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Affiliation(s)
- K Klepzig
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - J Wendt
- Psychology, Potsdam, Germany
| | - L Teusch
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - C Rickert
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - B Kordaß
- Department of Dental Radiology, Centre of Dentistry and Oral Health, University Medicine Greifswald, Greifswald, Germany
- Department of Clinical Dental CAD/CAM and CMD-Treatment, Centre of Dentistry and Oral Health, University Medicine Greifswald, Greifswald, Germany
| | - M Lotze
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
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Spille J, Conrad J, Sengebusch A, Wiltfang J, Dörfer C, Naujokat H. Preferences and experiences regarding the treatment of obstructive sleep apnea with mandibular advancement splints - a cross-sectional pilot survey. Cranio 2024; 42:298-304. [PMID: 34338613 DOI: 10.1080/08869634.2021.1962148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To obtain a current overview of the use of mandibular advancement splints (MAS) as a therapeutic option for obstructive sleep apnea (OSA) in the dental profession in Northern Germany. METHODS A questionnaire was mailed to 2431 dental professionals, and 8.3% responded. Descriptive data analysis was performed on each question separately. RESULTS Most of the surveyed dentists (51.7%) estimated the success rate of MAS therapy to be higher than 75%. Analysis of the relationship between the number of splints prescribed annually and the dental specialization (p = 0.22), work experience (p = 0.14), estimated success rate of MAS therapy (p = 0.96), and discontinuation of MAS therapy (p = 0.57) revealed no significant correlations. CONCLUSION Mandibular advancement splints seem to be a safe and successful therapy for OSA. There seems to be a lack of information on the patient side and a lack of education on the dentist side.
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Affiliation(s)
- Johannes Spille
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jonas Conrad
- Department of Conservative Dentistry and Periodontology, School of Dental Medicine, Kiel University, Kiel, Germany
| | - André Sengebusch
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christof Dörfer
- Department of Conservative Dentistry and Periodontology, School of Dental Medicine, Kiel University, Kiel, Germany
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Vanderveken OM, Van Daele M, Verbraecken J, Braem MJ, Dieltjens M. Comparative analysis of two custom-made mandibular advancement devices with varied designs for treating moderate to severe obstructive sleep apnea. Sleep Med 2024; 117:95-98. [PMID: 38518588 DOI: 10.1016/j.sleep.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Custom-made titratable mandibular advancement device (MAD) treatment can nowadays be considered a promising first-line treatment in patients with mild to severe obstructive sleep apnea (OSA). Specific manufacturing designs and titration mechanisms of MAD are on the market, characterized by their titration approach, vertical opening, and materials selection. The wing-designed MAD (SomnoDent® Flex™, SomnoMed Ltd, Sydney, Australia) has a lateral screw mechanism to advance the lower jaw in incremental steps of 0.1 up to 6.0 mm. The newer uniquely designed custom-made MAD with passive mouth closing (SomnoDent® Avant™ SomnoMed Ltd, Sydney, Australia) has a frontal exchangeable advancement strap of fixed lengths as a specific titration mechanism, all supporting freedom of lateral movement. We aimed to assess the associations between the type of MAD prescribed and OSA treatment outcome. METHODS Data from 209 patients (165 male, mean age 53.9 (±10.9) years, median baseline BMI and AHI 27.02 [24.8; 29.7] kg/m2 and 22.8 [17.7; 31.6]/hour sleep, respectively) were collected. Of this cohort, 91 patients with the traditional, wing-based SomnoDent® Flex™ and 118 patients with SomnoDent® Avant™. All patients were diagnosed with a type 1 polysomnography demonstrating moderate to severe OSA (15 ≤ AHI ≤65 per hour sleep). The selected MAD was fitted in the so-called maximal comfortable protrusion. After 3 months of subjective titration until resolution of subjective symptoms and/or achieving physical limits, a checkup with validated home sleep monitoring was conducted. Treatment success was defined as "AHI reduction ≥50% with MAD compared to baseline AHI and AHI with MAD <10 events per hour". RESULTS These real-world data set showed that 67% of patients achieved treatment success, with a statistically significant reduction in AHI from 22.8 [17.7; 31.6] to 7.45 [3.4; 15.0]/h sleep. The SomnoDent® Avant™ achieved 75% treatment success versus 56% for the traditional, wing-based SomnoDent® Flex™ (P < 0.05). Overall, AHI reduction was 70% for SomnoDent® Avant™ (P < 0.05) vs. 63% for SomnoDent® Flex™ (P < 0.05). CONCLUSIONS This study shows that choice of MAD design can impact the treatment outcome and could become an important consideration in selecting the type of MAD for personalized treatment for OSA patients. While the results of the traditional wing-based MAD design were comparable to the therapeutic outcome with other titratable, custom-made MADs, the MAD with the passive mouth closing feature showed significantly greater reduction in total AHI potentially due to encouraged nasal breathing, reduced mouth breathing and lesser vertical opening thereby decreasing the probability of tongue base collapse.
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Affiliation(s)
- Olivier M Vanderveken
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium.
| | - Margot Van Daele
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium; LEMP, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marc J Braem
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marijke Dieltjens
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
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Olcay V, Atria P, Hirata R, Sampaio C. A fully digital low-cost workflow of a multidisciplinary minimally invasive treatment: step-by-step from function to esthetics. Quintessence Int 2024; 55:286-294. [PMID: 38374723 DOI: 10.3290/j.qi.b4994315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
This clinical case outlines a comprehensive digital workflow for a minimally invasive multidisciplinary treatment. The process utilizes one open-source software for digital wax-up and one low-cost software to address esthetic concerns related to teeth misalignment. The patient's function was stabilized with a digitally made occlusal splint. The application of the described digital workflow technique, incorporating open-source, low-cost, and closed software, played a pivotal role in attaining a straightforward and predictable outcome with minimally invasive treatment. Furthermore, the continual evolution of technology contributes to the growing precision of dental procedures. The presented digital workflow helped formulate a predictable treatment plan, replicate a diagnostic digital wax-up, and achieve precise teeth alignment. This approach satisfactorily addressed the patient's esthetic concerns, providing an outstanding approximation of the definitive result.
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Nemani SM, Chidambaranathan AS, Muthukumar B, Srinivasan S. Evaluation of the effect of different kinds of treatment modalities for temporomandibular joint pain and its relevance to chronic cervical pain: A randomized controlled trial. J Indian Prosthodont Soc 2024; 24:128-135. [PMID: 38650337 DOI: 10.4103/jips.jips_468_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/10/2024] [Indexed: 04/25/2024] Open
Abstract
AIM The aim of this study was to evaluate the effect of different treatment modalities for temporomandibular joint (TMJ) pain and their relevance to chronic cervical pain after 12 months. SETTINGS AND DESIGN This was a randomized controlled trial. MATERIALS AND METHODS Forty-eight participants with chronic cervical and TMJ pain were selected using research diagnostic criteria and randomized into four groups (n = 12), which included control, soft splints, transcutaneous electrical nerve stimulation (TENS), and low-level laser (LLL). The cervical and TMJ pain was recorded using visual analog scale (VAS) scores at baseline, 3 months, 6 months, and 12 months. Occlusal equilibration was done for all groups except for the control. STATISTICAL ANALYSIS USED The mean pain scores were statistically analyzed using one-way analysis of variance and posthoc test. RESULTS The mean VAS scores in TMJ pain patients between the four groups at baseline and at final follow-up were 7.27 ± 1.29 in Group 1, 7.53 ± 0.70 in Group 2, 7.76 ± 0.80 in Group 3, and 7.61 ± 0.61 in Group 4. The mean difference between Groups 1 and 3, Groups 1 and 4, and Groups 2 and 3 was statistically significant (P < 0.00). Pearson correlation test yielded a mild and negative correlation between TMJ and cervical pain. CONCLUSION TENS and LLL were found to be equally effective in reducing pain in the jaw joint region, followed by soft splints, and there was no correlation between TMJ and cervical pain.
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Affiliation(s)
- Sai Madhuri Nemani
- Department of Prosthodontics, SRM Dental College, Ramapuram, Tamil Nadu, India
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Kato T, Lobbezoo F, Lavigne G. The efficacy of occlusal "dental" equilibration in the management of sleep bruxism: Still an unsolved mystery. J Sleep Res 2024; 33:e13937. [PMID: 37183168 DOI: 10.1111/jsr.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, and Sleep Medicine Center, Osaka University Hospital, Suita, Japan
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gilles Lavigne
- Faculty of Dental Medicine, Universite de Montreal, Stomatology-CHUM and Center for Advanced Research in Sleep Medicine, CEAMS-CIUSSS NIM, Montreal, Canada
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Sangalli L, Yanez-Regonesi F, Moreno-Hay I. Evolution of adherence and self-reported symptoms over 36 months with mandibular advancement device therapy for obstructive sleep apnea: a retrospective study. J Clin Sleep Med 2024; 20:487-496. [PMID: 37909061 PMCID: PMC10985294 DOI: 10.5664/jcsm.10900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/02/2023]
Abstract
STUDY OBJECTIVES Mandibular advancement devices (MAD) constitute a feasible option for management of mild-to-moderate obstructive sleep apnea (OSA) and in severe cases, when indicated. As a chronic condition, the management of OSA with MAD requires long-term patient adherence to treatment. The aim of the study was to investigate adherence to MAD therapy during a 36-month observation period in relation to changes in self-reported symptoms and objective response to therapy. METHODS Retrospective chart review of patients referred to the Orofacial Pain Clinic (University of Kentucky) between 2016 and 2021 for management of OSA with MAD was performed. Based on a posttreatment sleep study with MAD in situ, participants were subdivided into optimal response (> 50% reduction of baseline apnea-hypopnea index) and suboptimal response (< 50% reduction of baseline apnea-hypopnea index) groups. Outcomes included self-reported adherence to MAD use, self-reported OSA symptoms including snoring, apneic episodes, tiredness upon awakening, fatigue, and sleep quality (on a 100-mm numerical rating scale), and daytime sleepiness (0-24 on the Epworth Sleepiness Scale). Intragroup and intergroup differences at different time points over a 36-month observation period were assessed with one-way and repeated-measures analysis of variance. RESULTS Of 54 participants included (46.3% female, age 64.4 ± 10.71 years), 30 (55.6%) achieved optimal response and 24 (44.4%) achieved suboptimal response. At baseline, participants with optimal response differed from those with suboptimal response in apnea-hypopnea index (P = .007), snoring (P = .026), and sleep quality (P = .042). Although fluctuating in both groups, no difference was found over time in adherence (7 nights/wk, 7 h/night) and in OSA symptoms (all P > .05). CONCLUSIONS Adherence to MAD was maintained over 36 months regardless of fluctuation in self-reported OSA symptoms and effectiveness of MAD therapy. CITATION Sangalli L, Yanez-Regonesi F, Moreno-Hay I. Evolution of adherence and self-reported symptoms over 36 months with mandibular advancement device therapy for obstructive sleep apnea: a retrospective study. J Clin Sleep Med. 2024;20(4):487-496.
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Affiliation(s)
- Linda Sangalli
- Orofacial Pain Clinic, College of Dentistry, University of Kentucky, Lexington, Kentucky
- College of Dental Medicine – Illinois, Midwestern University, Downers Grove, Illinois
| | | | - Isabel Moreno-Hay
- Orofacial Pain Clinic, College of Dentistry, University of Kentucky, Lexington, Kentucky
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Ferreira GF, Carletti TM, Gama LT, Magno MB, Maia LC, Rodrigues Garcia RCM. Influence of occlusal appliances on the masticatory muscle function in individuals with sleep bruxism: A systematic review and meta-analysis. Eur J Oral Sci 2024; 132:e12979. [PMID: 38421263 DOI: 10.1111/eos.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/20/2024] [Indexed: 03/02/2024]
Abstract
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.
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Affiliation(s)
- Guilherme Fantini Ferreira
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Talita Malini Carletti
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Lorena Tavares Gama
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Lei Q, Lin D, Lin K, Huang W, Wu D, Liu Y. Clinical and electromyographic signals analysis about the effect of space-adjustment splint on overerupted maxillary molars. BMC Oral Health 2024; 24:296. [PMID: 38431564 PMCID: PMC10909290 DOI: 10.1186/s12903-024-04039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/17/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Overerupted maxillary molars is common in adults, which can lead to insufficient intermaxillary vertical space ,great difficulty in prosthetic reconstruction ,and cause occlusal interference in movements.To reconstruct occlusal function, it is necessary to prepare enough space for prostheses. The aim of the present study was to evaluate the effect of space-adjustment occlusal splint on overerupted maxillary molars by clinical and electromyographic signals analysis. METHODS Eighteen patients with overerupted maxillary molars were selected to wear space-adjustment occlusal splint suppressing overerupted maxillary molars for three months. Satisfaction was assessed by 5-point Likert; intermaxillary vertical space and the teeth transportation distance were measured in models; clinical periodontal status were evaluated by periodontal probing depth (PPT) and bleeding index (BI); electromyographic recordings of the masseter and anterior temporal muscles were monitored by Cranio-Mandibular K7 Evaluation System. RESULTS All the patients were satisfied with the treatment effect (Likert scale ≧ 4). The intermaxillary space in edentulous areas after treatment showed statistically significant increasing when compared with those before treatment. PPT and BI showed no significant difference. No statistically significant differences were found in electromyographic activity of anterior temporal muscles, while a reduction of muscle activity in masseter in the contralateral side were detected in post-treatment evaluations compared with pre-treatment at mandibular rest position. CONCLUSIONS Space-adjustment occlusal splint is an efficient treatment option on overerupted maxillary molars by intruding the maxillary molar to obtain adequate intermaxillary space for prostheses.
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Affiliation(s)
- Qun Lei
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China.
| | - Dong Lin
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Kaijin Lin
- Fujian Medical University, Fuzhou, China
| | - Wenxiu Huang
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Dong Wu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Yuyu Liu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
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Ucak S, Dissanayake HU, Sutherland K, Bin YS, de Chazal P, Cistulli PA. Effect of mandibular advancement splint therapy on cardiac autonomic function in obstructive sleep apnoea. Sleep Breath 2024; 28:349-357. [PMID: 37770793 PMCID: PMC10955011 DOI: 10.1007/s11325-023-02924-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/11/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of mandibular advancement splint (MAS) therapy on cardiac autonomic function in patients with obstructive sleep apnoea (OSA) using heart rate variability (HRV) analysis. METHODS Electrocardiograms (ECG) derived from polysomnograms (PSG) of three prospective studies were used to study HRV of patients with OSA before and after MAS treatment. HRV parameters were averaged across the entire ECG signal during N2 sleep using 2-min epochs shifted by 30 s. Paired t-tests were used to compare PSG and HRV measures before and after treatment, and the percent change in HRV measures was regressed on the percent change in apnoea-hypopnea index (AHI). RESULTS In 101 patients with OSA, 72% were Caucasian, 54% men, the mean age was 56 ± 11 years, BMI 29.8 ± 5.3 kg/m2, and treatment duration was 4.0 ± 3.2 months. After MAS therapy, there was a significant reduction in OSA severity (AHI, - 18 ± 16 events per hour, p < 0.001) and trends towards increased low-frequency to high-frequency ratio, low-frequency power, and reduced high-frequency power (LF:HF, - 0.4 ± 1.5, p = 0.01; LF, - 3 ± 16 nu, p = 0.02, HF, 3.5 ± 13.7 nu, p = 0.01). Change in NN intervals correlated with the change in AHI (β(SE) = - 2.21 (0.01), t = - 2.85, p = 0.005). No significant changes were observed in the time-domain HRV markers with MAS treatment. CONCLUSION The study findings suggest that successful MAS treatment correlates with changes in HRV, specifically the lengthening of NN intervals, a marker for improved cardiac autonomic adaptability.
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Affiliation(s)
- Seren Ucak
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Hasthi U Dissanayake
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Kate Sutherland
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Yu Sun Bin
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Philip de Chazal
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- School of Biomedical Engineering, Faculty of Engineering, University of Sydney, Sydney, Australia
| | - Peter A Cistulli
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
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Palotie T, Peltomaa A, Bachour A, Bachour P, Mäkitie A, Peltomaa M, Vallittu P. Reasons for failure of mandibular advancement splint therapy in the treatment of obstructive sleep apnea. Cranio 2024; 42:185-189. [PMID: 33956581 DOI: 10.1080/08869634.2021.1922810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To investigate the reasons for poor adaptation to mandibular advancement splint (MAS) treatment.Methods: The study consisted of 44 patients with obstructive sleep apnea who had unsuccessful MAS treatment. Data were collected on age, body mass index, gender, general and mental diseases, continuous positive airway pressure (CPAP) tryout, usage of occlusal splint, dental overjet, temporomandibular disorders, shortened dental arch, sleep apnea severity, and Apnea-Hypopnea Index. Sixty patients who underwent successful MAS treatment were controls.Results: Patients with missing molars failed significantly more often in MAS therapy than the controls (p = 0.020). Patients with CPAP tryout prior to MAS treatment had a tendency to fail MAS treatment. MAS treatment was more likely to be successful in patients with prior occlusal splint experience (p = 0.050).Conclusion: The study could not identify a single reason for MAS failure.
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Affiliation(s)
- Tuula Palotie
- Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Anni Peltomaa
- Sleep Unit, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Adel Bachour
- Institute of Dentistry, University of Turku, Turku, Finland
| | - Patrick Bachour
- Department of Biomaterials Science, University of Turku and City of Turku Welfare Division, Turku, Finland
| | - Antti Mäkitie
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Miikka Peltomaa
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
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Potewiratnanond P, Vanichanon P, Limpuangthip N. Occlusal splint and combined multiwave locked system laser therapy demonstrated differential patient-reported outcomes and clinical parameters: A randomized controlled trial in patients with temporomandibular disorder. J Oral Rehabil 2024; 51:247-254. [PMID: 37727026 DOI: 10.1111/joor.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/18/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
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.
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Affiliation(s)
| | - Phanomporn Vanichanon
- Department of Occlusion, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nareudee Limpuangthip
- Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Sun X, Feng Y, Jiao Y, Liu W. Fully digital workflow for the fabrication of occlusal stabilization splints based on individual mandibular movement. J Dent 2024; 141:104826. [PMID: 38157975 DOI: 10.1016/j.jdent.2023.104826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE This study was conducted to present a completely digital workflow for the fabrication of occlusal stabilization splints using CAD/CAM systems and a digital face bow based on optical sensor technology. METHODS Digital scans of the maxillary and mandibular arches of 20 volunteers were obtained using an intraoral scanner. Jaw relation and mandibular movements were recorded with a digital face bow via optical sensors. The virtual increase of the vertical dimension of occlusion (VDO) was then performed, after which computer-aided design (CAD) of the occlusal stabilization splints was carried out. The corresponding splints were then manufactured using digitally controlled technology. RESULTS A completely digital workflow for the manufacturing of occlusal stabilization splints was found to be clinically feasible. The corresponding data analysis revealed high congruence between virtual and physical occlusal contacts on the occlusal splint. Moreover, the appropriate guidance of the anterior teeth area was easily obtainable, and the time for adjusting the occlusion was less. CONCLUSIONS This study demonstrated that the fabrication of occlusal stabilization splints using a fully digital workflow is feasible. Compared to traditional impression-based manufacturing, several advantages of digital manufacturing include easy accessibility, time-efficient manufacturing, high-level accuracy in splint quality, and potential to manufacture duplicate splints. CLINICAL SIGNIFICANCE The proposed fully digital approach may help young dentists fabricating stable occlusal splints with beneficial curative effects. Meanwhile, it could also improve the production efficiency of stable occlusal splints, saving time for both doctors and patients while reducing labor costs.
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Affiliation(s)
- Xinrong Sun
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Prosthodontics, Stomatological Hospital and Dental School of Tongji University, 399, Yanchang Middle Rd, Jing'an District, Shanghai 200072, China
| | - Yue Feng
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Prosthodontics, Stomatological Hospital and Dental School of Tongji University, 399, Yanchang Middle Rd, Jing'an District, Shanghai 200072, China
| | - Yi Jiao
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Prosthodontics, Stomatological Hospital and Dental School of Tongji University, 399, Yanchang Middle Rd, Jing'an District, Shanghai 200072, China
| | - Weicai Liu
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Prosthodontics, Stomatological Hospital and Dental School of Tongji University, 399, Yanchang Middle Rd, Jing'an District, Shanghai 200072, China.
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14
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Piskin B, Yılmaz Savaş T, Topal SC, Akbulut K, Ezmek B, Uyar A, Sahin N, Karakoc O. Comparison of efficacy and usability of custom mandibular advancement devices fabricated with the conventional method and digital workflow: A pilot clinical study. J Prosthodont 2024; 33:123-131. [PMID: 37272723 DOI: 10.1111/jopr.13720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/20/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE To compare the effects of fabricating methods of custom monoblock mandibular advancement devices (MADs) on usability and efficacy in patients with mild and moderate obstructive sleep apnea (OSA). MATERIALS AND METHODS Digitally fabricated custom MADs (dMADs) were produced for 11 OSA participants who had previously used conventionally fabricated custom MADs (cMADs). The participants answered a modified usability questionnaire for both MADs, and the average scores that were given to the questionnaire were evaluated by age, sex, and body mass index (BMI), and the scores of cMADs and dMADs were compared. After 6 months of usage of each MAD, the apnea-hypopnea index (AHI), mean and lowest oxygen saturations, and total sleep time were measured for efficacy assessment. Data were analyzed with Cronbach's alpha, Mann-Whitney U, Kruskal-Wallis, Wilcoxon signed-rank, one-way repeated measures analyses of variance, and Bonferroni tests (α = 0.05). RESULTS Cronbach's alpha was found at 0.834 and 0.722 for the conventional and digital questionnaires, respectively. The usability scores of the dMADs were significantly higher than those of cMADs (p = 0.013). There was no difference in usability scores in terms of sex or BMI (p > 0.05). No statistically significant difference was found for cMAD (p = 0.113) among age groups; however, there was a significant difference for dMAD (p = 0.046). The AHI, mean, and lowest oxygen saturation values were significantly affected by MAD usage (p < 0.001). However, total sleep time values did not differ after the MAD treatments (p > 0.05). Significantly lower AHI and significantly higher lowest oxygen saturation values were observed with dMAD, while both appliances led to similar results for mean oxygen saturation and total sleep time values (p > 0.05). CONCLUSIONS Participant usability scores were higher for digitally manufactured MADs than conventionally manufactured MADs. However, both conventional and digital MADs were found effective in decreasing the AHI levels and increasing the mean and lowest oxygen saturation values of the participants.
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Affiliation(s)
- Bulent Piskin
- Department of Prosthodontics, Faculty of Dentistry, Cappadocia University, Nevşehir, Turkey
| | - Tuba Yılmaz Savaş
- Department of Prosthodontics, Faculty of Dentistry, Selçuk University, Konya, Turkey
| | | | - Kuddusi Akbulut
- Department of Prosthodontics, Faculty of Dentistry, Cappadocia University, Nevşehir, Turkey
| | - Bahadir Ezmek
- Department of Prosthodontics, Gülhane Faculty of Dentistry, Health Sciences University, Ankara, Turkey
| | - Alper Uyar
- Department of Prosthodontics, Gülhane Faculty of Dentistry, Health Sciences University, Ankara, Turkey
| | - Nesrin Sahin
- Center of Dental Technologies, Cappadocia Vocational College, Cappadocia University, Nevşehir, Turkey
| | - Omer Karakoc
- Department of Otolaryngology, Head and Neck Surgery, Gülhane Faculty of Medicine, Health Sciences University, Ankara, Turkey
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Ding WH, Li YF, Liu W, Li W, Wu N, Hu SY, Shi JJ. Effect of occlusal stabilisation splint with or without arthroscopic disc repositioning on condylar bone remodelling in adolescent patients. Int J Oral Maxillofac Surg 2024; 53:156-164. [PMID: 37357072 DOI: 10.1016/j.ijom.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
The aim of this study was to investigate the treatment effects of a stabilisation splint (SS) with and without arthroscopic disc repositioning (ADR) on condylar bone remodelling in adolescent patients with anterior disc displacement without reduction (ADDwoR). Cone beam computed tomography and magnetic resonance imaging were used to analyse condylar bone remodelling, condyle position, and disc position. Twenty-two temporomandibular joints of 14 patients who underwent ADR (age range 12-20 years; mean follow-up 12.5 ± 7.8 months) and 21 temporomandibular joints of 14 patients who did not undergo ADR (age range 13-20 years; mean follow-up 11.1 ± 5.1 months) were included. The change in bone volume (P < 0.001), rate of bone volume change (P < 0.001), and change in condyle height (P = 0.031) were significantly greater in patients with ADR than in those without ADR. The changes in posterior joint space (P = 0.013), superior joint space (P = 0.020), and ratio of condyle sagittal position (P = 0.013) were significantly greater in patients with ADR than in those without ADR. All discs in patients who underwent ADR and one disc in those who did not undergo ADR were backward repositioned. In conclusion, in adolescent patients with ADDwoR, ADR with SS therapy achieved better condyle and disc position than SS therapy alone, and also induced bone generation.
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Affiliation(s)
- W H Ding
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Y F Li
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - W Liu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - W Li
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - N Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - S Y Hu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - J J Shi
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China.
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Pereira A, Gurgel M, Pereira R, Fabbro CD, de Barros Silva P, Costa F, Leite L, Moro A, Cevidanes L, Junior CM. Evaluation of condylar and mandibular movements on the upper airway during the use of mandibular advancement device for obstructive sleep apnea treatment. Clin Oral Investig 2024; 28:122. [PMID: 38286954 DOI: 10.1007/s00784-024-05513-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device (MAD) and to identify the influence of these anatomic factors on upper airway (UA) volume and polysomnographic outcomes after treatment. MATERIALS AND METHODS Twenty OSA patients were prospectively treated with MAD. Clinical examinations, cone-beam computed tomography, and polysomnography were performed before MAD treatment and after achieving therapeutic protrusion. Polysomnographic variables and three-dimensional measurements of the TMJ, mandible, and upper airway were statistically analyzed. RESULTS Condylar rotation, anterior translation, and anterior mandibular displacement were directly correlated with total UA volume, while vertical mandibular translation was inversely correlated with the volume of the inferior oropharynx. MAD treatment resulted in an increase in the volume and area of the superior oropharynx. There was no statistically significant correlation between condylar rotation and translation and polysomnographic variables. With MAD, there was a significant increase in vertical dimension, changes in condylar position (rotation and translation), and mandibular displacement. The central and medial lengths of the articular eminence were inversely correlated with condylar rotation and translation, respectively. The lateral length of the eminence was directly correlated with condylar translation, and the lateral height was directly correlated with condylar rotation and translation. CONCLUSION Condylar and mandibular movements influenced UA volume. The articular eminence played a role in the amount of condylar rotation and translation. CLINICAL RELEVANCE Individualized anatomical evaluation of the TMJ proves to be important in the therapy of OSA with MAD.
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Affiliation(s)
| | | | | | | | | | - Fabio Costa
- Federal University of Ceará, Fortaleza, Brazil
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17
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Ainoosah S, Farghal AE, Alzemei MS, Saini RS, Gurumurthy V, Quadri SA, Okshah A, Mosaddad SA, Heboyan A. Comparative analysis of different types of occlusal splints for the management of sleep bruxism: a systematic review. BMC Oral Health 2024; 24:29. [PMID: 38182999 PMCID: PMC10770907 DOI: 10.1186/s12903-023-03782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024] Open
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.
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Affiliation(s)
- Sultan Ainoosah
- Department of Substitute Dental Science, College of Dentistry, Taibah University, Madinah, Saudi Arabia
| | - Ahmed E Farghal
- Department of Substitute Dental Science, College of Dentistry, Taibah University, Madinah, Saudi Arabia
| | - Marwa Saad Alzemei
- Department of Restorative Dental Sciences, College of Dentistry, Taibah University, Madinah, Saudi Arabia
| | - Ravinder S Saini
- Department of Dental Technology, COAMS, King Khalid University, Abha, Saudi Arabia
| | | | | | - Abdulmajeed Okshah
- Department of Dental Technology, COAMS, King Khalid University, Abha, Saudi Arabia
| | - Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Qasr-E-Dasht Street, Shiraz, Iran.
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia.
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18
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Maheshwari K, Srinivasan R, Singh BP, Tiwari B, Kirubakaran R. Effectiveness of anterior repositioning splint versus other occlusal splints in the management of temporomandibular joint disc displacement with reduction: A meta-analysis. J Indian Prosthodont Soc 2024; 24:15-24. [PMID: 38263554 PMCID: PMC10896308 DOI: 10.4103/jips.jips_355_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024] Open
Abstract
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.
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Affiliation(s)
- Komal Maheshwari
- Department of Prosthodontics and Crown and Bridge, ESIC Dental College and Hospital, Delhi, India
| | - Ramya Srinivasan
- Department of Prosthodontics and Crown and Bridge, King George's Medical University, India
| | - Balendra Pratap Singh
- Department of Prosthodontics and Crown and Bridge, King George's Medical University, India
- Cochrane Affiliate Center, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bhawana Tiwari
- Department of Prosthodontics and Crown and Bridge, ESIC Dental College and Hospital, Delhi, India
| | - Richard Kirubakaran
- Centre for Biostatistics and Evidence-Based Medicine, Vellore, Tamil Nadu, India
- Department of Research, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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Guo MY, Li PJ, Xiao Y, Cao Y, Liang ZA. Effectiveness of mandibular advancement devices in the treatment of obstructive sleep apnea and the impact of different body positions on treatment: A systematic review and meta-analysis. Sleep Med 2024; 113:275-283. [PMID: 38071926 DOI: 10.1016/j.sleep.2023.11.1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE The meta-analysis aimed to evaluate the efficacy of mandibular advancement device (MAD) for the treatment of obstructive sleep apnea (OSA) and explore the effect of different positions on MAD for OSA. METHODS The Embase, PubMed, Medline, and Cochrane Library databases were searched for relevant studies evaluating the effect of MAD on the treatment of OSA from database inception to November 2022. The Bayesian random-effects mode was used to calculate the pooled outcome. Subgroup analysis and sensitivity analysis were applied to investigate the heterogeneity. RESULTS A total of 6 studies enrolling 643 patients were eligible for further analysis. MAD treatment led to improvements in total apnea-hypopnea index (AHI) for both positional OSA(POSA) and Non-POSA groups, but there was no significant difference in the effect of MAD on Non-POSA and POSA (MD = -1.46,95%CI [-4.89,1.97], P = 0.40). In the supine position, AHI improvement after MAD treatment in POSA group was more than that in Non-POSA group by 15 events/hour in average (MD = 14.82, 95%CI [11.43,18.22], P<0.00001), while in the non-supine position, the change of AHI in Non-POSA group was significantly better than that in POSA group by approximately 8 events/hour (MD = -7.55,95%CI[-10.73,-4.38],p < 0.00001). CONCLUSION MAD is more suitable for POSA compared to Non-POSA in patients with habitual sleep in the supine or supine predominant position. While for patients with habitual sleep in the non-supine position, MAD is an effective treatment option for Non-POSA.
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Affiliation(s)
- Meng-Yao Guo
- West China School of Medicine/West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, PR China
| | - Pei-Jun Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, PR China.
| | - Yao Xiao
- West China School of Medicine/West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, PR China
| | - Yuan Cao
- West China School of Medicine/West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, PR China
| | - Zong-An Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, PR China
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Huth KC, Bex A, Kollmuss M, Wuersching SN. Recording the maxillomandibular relationship with the Aqualizer system prior to occlusal splint therapy for treating temporomandibular disorders: a randomized controlled trial. Sci Rep 2023; 13:22535. [PMID: 38110552 PMCID: PMC10728157 DOI: 10.1038/s41598-023-49911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023] Open
Abstract
Temporomandibular disorders (TMD) present a public health issue and are one of the most common musculoskeletal conditions causing chronic pain. This study compares the outcomes of occlusal splint therapy in patients with TMD following two different maxillomandibular relationship (MMR) registration techniques. 40 TMD patients were randomly allocated to MMR registration with the Aqualizer system (AQU) or with chin point guidance (CPG) prior to fabricating occlusal splints. TMD symptoms, subjective pain intensity, and quality of life (QoL) were recorded at baseline and after 3 and 6 months. The treatment led to an overall reduction of TMD symptoms in both groups (Conover test, p < 0.00001). TMJ sounds, TMJ pain with palpation and muscle pain with palpation subsided regardless of the type of MMR registration method used (Cohen's d > 0.8). AQU-based occlusal splints led to a better improvement of TMJ pain with maximum opening compared to CPG-based occlusal splints (Cohen's d = 0.9; CPG d = 0.13). In both groups, occlusal splint treatment had little to no effect on correcting lateral mandible deviation or improving restricted jaw opening. After 6 months occlusal splints in both groups had a large effect on improving subjective pain intensity (Cohen's d > 0.8), however, patients reported a higher QoL in the AQU group compared to the CPG group (Mann-Whitney-U-test, p < 0.05). The results of this study support the premise that occlusal splints are effective in relieving pain-related TMD symptoms. The Aqualizer can be considered for determining MMR in cases, where guided registration techniques are not possible.Trial registration: DRKS00031998.
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Affiliation(s)
- Karin Christine Huth
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany
| | - Alexandra Bex
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany
| | - Maximilian Kollmuss
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany.
| | - Sabina Noreen Wuersching
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany
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Hellemans S, Van de Perck E, Braem MJ, Verbraecken J, Dieltjens M, Vanderveken OM. The prevalence of treatment-emergent central sleep apnea with mandibular advancement device therapy. J Clin Sleep Med 2023; 19:2035-2041. [PMID: 37539639 PMCID: PMC10692941 DOI: 10.5664/jcsm.10742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
STUDY OBJECTIVES Treatment-emergent central sleep apnea (TECSA) describes the appearance or persistence of central sleep apnea while undergoing treatment for obstructive sleep apnea. TECSA is well studied in continuous positive airway pressure therapy with an estimated prevalence of 8%. Based on a few case reports, mandibular advancement devices (MAD) may also provoke TECSA. This study aims to gain insight into the prevalence of TECSA with MAD therapy. METHODS This retrospective study includes a total of 129 patients with moderate to severe obstructive sleep apnea who were treated with a custom-made titratable MAD. Baseline and follow-up sleep studies were compared to identify patients with TECSA. Since different diagnostic criteria to define TECSA are used in literature, prevalence was calculated according to three definitions (TECSA-1, -2, and -3). Demographics, MAD treatment variables, and findings of the diagnostic polysomnography were compared between TECSA and non-TECSA patients to identify possible predictors. RESULTS Depending on the definition used, TECSA was found in 3.1%-7.8% of patients undergoing MAD therapy. TECSA patients had a higher apnea index (9.2 vs 2.0 events/h, P = .042), central apnea-hypopnea index (4.1 vs 0.2 events/h, P = .045) and oxygen desaturation index (23.9 vs 16.3 events/h, P = .018) at baseline compared to non-TECSA patients. No differences were found in demographics and treatment variables. CONCLUSIONS These findings demonstrate that TECSA also occurs in patients starting MAD treatment. Patients with TECSA had a higher apnea index, central apnea-hypopnea index, and oxygen desaturation index at baseline compared to non-TECSA patients. CITATION Hellemans S, Van de Perck E, Braem MJ, Verbraecken J, Dieltjens M, Vanderveken OM. The prevalence of treatment-emergent central sleep apnea with mandibular advancement device therapy. J Clin Sleep Med. 2023;19(12):2035-2041.
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Affiliation(s)
- Simon Hellemans
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Eli Van de Perck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J. Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
- Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M. Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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22
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van der Hoek LH, Rosenmöller BRAM, van de Rijt LJM, de Vries R, Aarab G, Lobbezoo F. Factors associated with treatment adherence to mandibular advancement devices: a scoping review. Sleep Breath 2023; 27:2527-2544. [PMID: 37386300 PMCID: PMC10656313 DOI: 10.1007/s11325-023-02862-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is frequently treated with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs). For various reasons, both treatment options are often affected by low adherence. While factors associated with low CPAP adherence are described in the literature extensively, less is known about adherence to MAD therapy. This scoping review aimed to synthesize the body of literature on the factors associated with adherence to MAD treatment. METHODS A systematic literature search was conducted using bibliographic databases PubMed, Embase.com , Web of Science, and the Cochrane Library (Wiley) to identify relevant studies that described factors associated with adherence to MAD in the treatment of OSA or snoring combined with OSA in adults. RESULTS The literature search yielded a total of 694 references. Forty studies were found eligible for inclusion. The literature showed that factors with a possible negative influence on the adherence to MAD treatment are personality aspects; failing effectiveness of MAD; side effects during MAD therapy; using a thermoplastic MAD; dental treatments during MAD therapy; and a poor first experience with the MAD with inadequate guidance by professionals. Factors that may have a positive effect on MAD adherence include effectiveness of therapy, custom-made MAD, good communication skills of the practitioner, early recognition of side effects, stepwise titration of the MAD, and positive first experience with MAD. CONCLUSIONS The knowledge of factors associated with MAD adherence can be used to provide further insight into individual adherence to OSA treatments.
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Affiliation(s)
- Liselotte H van der Hoek
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Boudewijn R A M Rosenmöller
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, location Academic Medical Center (AMC), and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Liza J M van de Rijt
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Langaliya A, Alam MK, Hegde U, Panakaje MS, Cervino G, Minervini G. Occurrence of Temporomandibular Disorders among patients undergoing treatment for Obstructive Sleep Apnoea Syndrome (OSAS) using Mandibular Advancement Device (MAD): A Systematic Review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions. J Oral Rehabil 2023; 50:1554-1563. [PMID: 37644889 DOI: 10.1111/joor.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long-term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users. METHODS A comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB-2 was used to evaluate the methodological quality of the included studies. RESULTS A total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ-related parameters from baseline to follow-up intervals. Temporary increases in TMJ-related pain or symptoms at the beginning of the follow-up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs. CONCLUSION The findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ-related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches.
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Affiliation(s)
- Akshayraj Langaliya
- Department of Conservative Dentistry and Endodontics AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Mohammad Khursheed Alam
- Orthodontic Division, Preventive Dentistry Department, Orthodontic Division, College of Dentistry, Jouf University, Sakakah, Saudi Arabia
| | - Usha Hegde
- Department of Oral Pathology and Microbiology JSS Dental College & Hospital Mysore JSS Academy of Higher Education & Research, Mysore, India
| | - Mangesh Shenoy Panakaje
- Department of Oral & Maxillofacial Pathology and Oral Microbiology, Affiliated College, A B Shetty Memorial Institute of Dental Sciences (A Constituent College of Nitte Deemed to be University) Karnataka, Mangalore, India
| | - Gabriele Cervino
- School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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24
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Benli M, Al-Haj Husain N, Ozcan M. Mechanical and chemical characterization of contemporary occlusal splint materials fabricated with different methods: a systematic review. Clin Oral Investig 2023; 27:7115-7141. [PMID: 37910242 DOI: 10.1007/s00784-023-05360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To systematically review studies on various occlusal splint materials and describe their mechanical and chemical properties. METHODS MEDLINE (PubMed), Scopus, and Web of Science searches were conducted for in vitro studies focusing on occlusal splint materials. Two reviewers performed an assessment of the identified studies and data abstraction independently, and this was complimented by an additional hand search. The articles were limited to those in the English language that were published between January 1st, 2012, and December 1st, 2022. RESULTS The initial search yielded 405 search results of which 274 were selected for full-text review following abstract evaluation. 250 articles that did not meet the inclusion criteria were excluded, and the remaining 25 articles (with 1 article identified from the reference lists of included articles) providing mechanical and chemical values were used in this review. Poly methyl methacrylate (PMMA) -based occlusal splint materials showed the highest values in terms of hardness, wear resistance, flexural strength, flexural modulus, e-modulus, and fracture toughness. The material group with the highest water sorption and water solubility was 3D printed (PR) splint materials. In addition, the lowest degree of double bond conversion was also observed in this group of materials. CONCLUSIONS The outcome of this review suggests that mechanically and chemically acceptable properties can be attained with PMMA-based occlusal splint materials using both conventional and digital production methods. PR splint materials should not be considered as the primary choice for long-term treatments due to their low mechanical and chemical properties. CLINICAL RELEVANCE This review provides clinical recommendations for selecting the appropriate material and fabrication method for occlusal splints while taking the patients' needs and the materials´ mechanical and chemical properties into account.
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Affiliation(s)
- Merve Benli
- James B. Edwards College of Dental Medicine, Department of Oral Rehabilitation, Division of Removable Prosthodontics, MUSC, Charleston, USA.
- Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
| | - Nadin Al-Haj Husain
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010, Bern, Switzerland
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - Mutlu Ozcan
- Division of Dental Biomaterials, Center for Dental Medicine, Clinic for Reconstructive Dentistry, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
- Clinic for Chewing Function Disturbances, Center for Dental Medicine, Clinic for Reconstructive Dentistry, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
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25
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Blasi A, Henarejos-Domingo V, Palacios-Bañuelos R, Vidal-Ponsoda C, Aparicio C, Roig M. CAD-CAM and analog occlusal splints comparison based on the amount of occlusal adjustments. 3D analysis of the volumetric changes: A pilot study. J ESTHET RESTOR DENT 2023; 35:1271-1278. [PMID: 37395327 DOI: 10.1111/jerd.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To evaluate the volumetric changes on occlusal surface of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal devices fabricated following a fully digital workflow after occlusal adjustment, compared to those fabricated with an analog workflow. MATERIALS AND METHODS Eight participants were included in this clinical pilot study, receiving two different occlusal devices fabricated with two different workflows, fully analog and fully digital. Every occlusal device was scanned before and after the occlusal adjustments to compare the volumetric changes using a reverse engineering software program. Moreover, three independent evaluators assessed a semi-quantitative and qualitative comparison using visual analog scale and dichotomous evaluation. The Shapiro-Wilk test was performed to validate normal distribution assumption, and a dependent t-Student test for paired variables was used to determine statistically significant differences (p-value < 0.05). RESULTS The root mean square value was extracted from the 3-Dimensional (3D) analysis of the occlusal devices. The average values of the root mean square were higher for the analogic technique (0.23 ± 0.10 mm) than the digital technique (0.14 ± 0.07 mm) but the differences were not statistically significant (paired t-Student test; p = 0.106) between the two fabrication techniques. The semiquantitative visual analog scale values between the impression for the digital (5.08 ± 2.4 cm) and analog (3.80 ± 3.3 cm) technique were significant (p < 0.001), and statistically significant differences values were assessed for evaluator 3 compared to the other evaluators (p < 0.05). However, the three evaluators agreed on the qualitative dichotomous evaluation in 62% of the cases, and at least two evaluators agreed in 100% of the evaluations. CONCLUSIONS Occlusal devices fabricated following a fully digital workflow resulted in fewer occlusal adjustments, as they could be a valid alternative to those fabricated following an analog workflow. CLINICAL SIGNIFICANCE Fabricated occlusal devices following a fully digital workflow could have some advantages over analog workflow such reduce occlusal adjustments at delivery appointment, which can result in reduced chair time and therefore increased comfort for the patient and clinician.
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Affiliation(s)
- Alvaro Blasi
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
- Department of Restorative Sciences, Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Víctor Henarejos-Domingo
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
| | - Ricardo Palacios-Bañuelos
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
| | - Carla Vidal-Ponsoda
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
| | - Conrado Aparicio
- Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
| | - Miguel Roig
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
- Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
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26
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Fu W, Li L, Zhang S, Liu S, Liu W. Effects of CPAP and Mandibular Advancement Devices on depressive symptoms in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath 2023; 27:2123-2137. [PMID: 37119355 DOI: 10.1007/s11325-023-02829-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/25/2023] [Accepted: 04/07/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE Studies show that patients with obstructive sleep apnea (OSA) are more likely than the general population to have psychological disorders such as depression. However, it is less clear how OSA treatment affects this association. This meta-analysis aimed to assess whether or not continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) reduce depression symptoms in patients with OSA. METHODS We searched Pubmed, Embase, Web of Science, and Cochrane Library from creating the databases until November 2022. Our analysis included RCTs that examined CPAP and MAD treatment effectiveness for depression in patients with OSA. RESULTS We identified 17 CPAP studies comprising 1,931 patients for inclusion in the meta-analysis. The results of the meta-analysis using a fixed effects model found that CPAP improved depressed mood in patients with OSA relative to controls (SMD = 0.27;95% CI:0.18,0.36), with small heterogeneity among trials (I2 = 8.1% < 50%, P = 0.359). We performed subgroup analyses on three factors: the length of trial follow-up, patient adherence data, and depression assessment scales. The meta-analysis also identified six MAD studies involving 315 patients. According to this analysis, there was no heterogeneity between studies (I2 = 0%, P = 0.748). MADs did not significantly improve depression symptoms compared to controls, indicating a combined effect of SMD = 0.07 (95% CI: - 0.15,0.29), P > 0.05. CONCLUSION The present findings confirm that CPAP may improve depressive symptoms in patients with OSA. However, the review results suggest that MADs have no significant effect on depressive symptoms in patients with OSA, a finding that is different from the results of previous meta-analyses.
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Affiliation(s)
- Wenli Fu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Leping Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Sha Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Shengfei Liu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Weiying Liu
- Department of Respiratory and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
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27
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3D printing resins for flexible splints. Br Dent J 2023; 235:988. [PMID: 38102280 DOI: 10.1038/s41415-023-6685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
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Yu M, Ma Y, Han F, Gao X. Long-term efficacy of mandibular advancement devices in the treatment of adult obstructive sleep apnea: A systematic review and meta-analysis. PLoS One 2023; 18:e0292832. [PMID: 38015938 PMCID: PMC10684110 DOI: 10.1371/journal.pone.0292832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/28/2023] [Indexed: 11/30/2023] Open
Abstract
This study aims to review the long-term subjective and objective efficacy of mandibular advancement devices (MAD) in the treatment of adult obstructive sleep apnea (OSA). Electronic databases such as PubMed, Embase, and Cochrane Library were searched. Randomized controlled trials (RCTs) and non-randomized self-controlled trials with a treatment duration of at least 1 year with MAD were included. The quality assessment and data extraction of the included studies were conducted in the meta-analysis. A total of 22 studies were included in this study, of which 20 (546 patients) were included in the meta-analysis. All the studies had some shortcomings, such as small sample sizes, unbalanced sex, and high dropout rates. The results suggested that long-term treatment of MAD can significantly reduce the Epworth sleepiness scale (ESS) by -3.99 (95%CI -5.93 to -2.04, p<0.0001, I2 = 84%), and the apnea-hypopnea index (AHI) -16.77 (95%CI -20.80 to -12.74) events/h (p<0.00001, I2 = 97%). The efficacy remained statistically different in the severity (AHI<30 or >30 events/h) and treatment duration (duration <5y or >5y) subgroups. Long-term use of MAD could also significantly decrease blood pressure and improve the score of functional outcomes of sleep questionnaire (FOSQ). Moderate evidence suggested that the subjective and objective effect of MAD on adult OSA has long-term stability. Limited evidence suggests long-term use of MAD might improve comorbidities and healthcare. In clinical practice, regular follow-up is recommended.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, P.R. China
- Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, Haidian District, P.R. China
- National Center for Stomatology, Beijing, Haidian District, P.R. China
| | - Yanyan Ma
- Department of Stomatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, Chaoyang District, P.R. China
| | - Fang Han
- Sleep Division, Peking University People’s Hospital, Beijing, Xicheng District, P.R. China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, P.R. China
- Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, Haidian District, P.R. China
- National Center for Stomatology, Beijing, Haidian District, P.R. China
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29
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Peixoto KO, Abrantes PS, De Carvalho IHG, De Almeida EO, Barbosa GAS. Temporomandibular disorders and the use of traditional and laser acupuncture: a systematic review. Cranio 2023; 41:501-507. [PMID: 33433268 DOI: 10.1080/08869634.2021.1873605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate current studies to establish and compare the efficacy of traditional and laser acupuncture in reducing the signs and symptoms of temporomandibular disorders (TMD). METHODS PubMed, Cochrane, Scopus, and Web of Science databases were searched. Clinical, controlled, and randomized trials written in English and having used traditional or laser acupuncture as therapy for TMD and RDC/TMD or DC/TMD as a diagnostic criterion for TMD were included. RESULTS Six studies that evaluated the intensity of pain and the level of mouth opening of the patients submitted to acupuncture were selected, and all showed improvement. However, similar results were also observed in the groups treated with occlusal splint and placebo acupuncture. Only one study evaluated laser acupuncture and showed a higher proportion of patients with remission of symptoms in the experimental group. CONCLUSION The traditional acupuncture seems to relieve the signs and symptoms of TMD, as well as laser acupuncture when associated with occlusal splint. However, more rigorous and high-quality clinical trials are needed.
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Borg H, Azer SS, El Hadary A, Helaly O, Shoeib A, Hassan M. Evaluation of enamel wear by 3 occlusal splint materials: An in vitro study. J Prosthet Dent 2023; 130:743.e1-743.e6. [PMID: 37743141 DOI: 10.1016/j.prosdent.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023]
Abstract
STATEMENT OF PROBLEM Occlusal devices used to manage bruxism have been commonly fabricated from polymethyl methacrylate with the powder-liquid technique. More recently, Vertex ThermoSens (VTS) and the biocompatible high-performance polymer (BioHPP), an optimized material having polyetheretherketone (PEEK) as its basis, have been used, but little is known about the wear of these materials on human enamel. PURPOSE The purpose of this in vitro study was to assess via a mastication simulation test how 3 occlusal device materials affected the wear and roughness of enamel antagonists. MATERIAL AND METHODS A noncontact 3D optical profilometer was used to measure the enamel surface roughness (Ra) against 3 occlusal device materials: vertex regular, VTS, and PEEK high-performance polymer (BioHPP). A dual-axis mastication simulator was used to perform a 2-body wear test on specimens from each group. The test consisted of 10 000 cycles with a 70-N force and 5 to 55 °C thermocycling. Following simulated mastication, the weight of each specimen and the Ra change were compared with the Kolmogorov-Smirnov test, paired specimens t test, Wilcoxon signed-rank test, and 1-way analysis of variance (α=.05). RESULTS The polyamide group caused the lowest amount of enamel wear (P<.05), while the heat-polymerized acrylic resin group induced the largest amount of enamel wear (P<.05). For polyamide and PEEK, the change in enamel surface roughness exhibited a smooth texture, whereas it found a rougher surface for the heat-polymerized acrylic resin. CONCLUSIONS According to this study, surface roughness and wear on human enamel were not correlated. PEEK is a promising material for the fabrication of occlusal devices.
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Affiliation(s)
- Hisham Borg
- Assistant Professor of Removable Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Oral and Dental Medicine, Alsalam University, Tanta, Egypt
| | - Shereen S Azer
- Associate Professor and Chair, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio.
| | - Amany El Hadary
- Professor, Removable Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt; Adjunct Professor of Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Osama Helaly
- Lecturer of Removable Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
| | - Ahmad Shoeib
- Lecturer of Removable Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
| | - Mohammed Hassan
- Lecturer of Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Dental Medicine, King Salman International University, South Sinai, Egypt
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D'Attilio M, Bondi D, Castellani M, Verratti V, Pietrangelo T. Sports performance adaptations through occlusal splint: Case reports of triathlon athletes. Cranio 2023; 41:556-564. [PMID: 33554766 DOI: 10.1080/08869634.2021.1883386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Occlusal disturbances affect human posture and sports performance. This study aimed to monitor biomechanical adaptations to personalized occlusal splints. METHODS Splints were customized based on stabilometry, thermography, sEMG, and kinesiography, and administered to three triathlon athletes. They were evaluated during a 4-month period, using isokinetic indexes, running kinematics and anaerobic outputs. RESULTS Individuality emerged as a key factor driving type, quantity, quality, and time trajectories of adaptations. The use of instrumental and clinical tests allowed the detection of static balance and biting function improvements, but not necessarily parallel to sports performance improvements. CONCLUSION The authors argue that strength and kinematic imbalances are joint and task-specific and support the use of multi-stage monitoring of the biomechanical effect of mouthpieces. Kinematics of cycling and running may be widely assessed with ecological and inexpensive methods. Strength imbalances need to be continuously monitored due to the high informative value to injury prevention.
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Affiliation(s)
- Michele D'Attilio
- Department of Medical and Oral Sciences and Biotechnologies, University "G. d'Annunzio" of Chieti - Pescara, Chieti, Italy
| | - Danilo Bondi
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti - Pescara, Chieti, Italy
| | - Marco Castellani
- Department of Medical and Oral Sciences and Biotechnologies, University "G. d'Annunzio" of Chieti - Pescara, Chieti, Italy
| | - Vittore Verratti
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti - Pescara, Chieti, Italy
| | - Tiziana Pietrangelo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti - Pescara, Chieti, Italy
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Groth C, Kravitz ND. Direct 3D-printed occlusal splints. J Clin Orthod 2023; 57:640-643. [PMID: 38346214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
| | - Neal D Kravitz
- Editor-in-Chief, Journal of Clinical Orthodontics, Greenwood Village, CO; Private Practice of Orthodontics in South Riding, VA.
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Buchbender M, Keplinger L, Kesting MR, Adler W, Schmitt CM. A clinical trial: Aqualizer ™ therapy and its effects on myopathies or temporomandibular dysfunctions. Part II: Subjective parameters. Cranio 2023; 41:479-485. [PMID: 33586626 DOI: 10.1080/08869634.2021.1885887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Temporomandibular dysfunction (TMD) reduces patients' quality of life (QoL). The aim was to assess the effects of initial Aqualizer™ therapy. METHODS Group 1 (initial Aqualizer™ therapy) before definitive splint therapy or Group 2 (no initial therapy). Patients with arthrosis, partial/total prosthesis, or were undergoing splint therapy were excluded. Subjective parameters were evaluated: duration and intensity of pain, influence on wellbeing, changes in the head/neck area, handling and improvement of the Aqualizer™, improvement in QoL. The statistical significance level was 5% (p < 0.05). RESULTS In 53 patients (Group 1 n = 25; Group 2 n = 28), the improvement in patients' well-being and intensity of pain in both groups was significant (p < 0.001). An improvement in QoL was found in 84% of patients in Group 1 and 75% in Group 2. CONCLUSION Initial Aqualizer™ therapy can decrease the intensity of pain and increase patients'.
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Affiliation(s)
- Mayte Buchbender
- Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany
| | - Lukas Keplinger
- Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany
| | - Marco R Kesting
- Head of the Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen Nuremberg, Erlangen, Germany
| | - Christian M Schmitt
- Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany
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Blasi Á, Henarejos-Domingo V, Palacios-Bañuelos R, Aparicio C, Roig M. Comparison accuracy of digital and analog method using milled occlusal splints. J ESTHET RESTOR DENT 2023; 35:1103-1112. [PMID: 36942721 DOI: 10.1111/jerd.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This clinical trial aims to compare the accuracy of interocclusal registration in centric relation taken with polyvinyl siloxane and intraoral scanner (IOS) with the fabrication of occlusal devices. METHODS Thirty-one participants were included in the trial registered at ClinicalTrials.gov (NCT05317182) receiving two different occlusal devices from two different workflows. One workflow was performed using polyvinyl siloxane impression material and the other with IOS. Every splint was scanned before and after the occlusal adjustments to compare the volumetric changes using the Root Mean Square deviation (RMS). Furthermore, three evaluators assessed the 3D comparison using color maps in a Visual Analog Scale (VAS). RESULTS The average values of RMS were higher for the analog approach (0.01 ± 0.067) than the digital approach (0.065 ± 0.035). However, the differences were not statistically significant (p < 0.063) between the two impression techniques. For the semiquantitative analysis performed by blinded evaluators, differences in VAS values between the impression for the digital (2.08 ± 2.4) and analog (3.80 ± 3.3) technique were statistically significant. The three evaluators agreed in more than 90% of the qualitative dichotomous evaluation. CONCLUSION Digital impressions did not show inferior accuracy compared to conventional impressions when assessed using quantitative measurements. CLINICAL SIGNIFICANCE This clinical trial provided evidence on registering interocclusal relationship at increased vertical dimension with fully digital workflow for complete arch prosthesis.
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Affiliation(s)
- Álvaro Blasi
- Department of Restorative Sciences, Dental College of Georgia at Augusta University, Augusta, Georgia, USA
- Department of Restorative Dentistry, Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
| | - Víctor Henarejos-Domingo
- Department of Restorative Dentistry, Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
| | - Ricardo Palacios-Bañuelos
- Department of Restorative Dentistry, Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
| | - Conrado Aparicio
- Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
| | - Miguel Roig
- Department of Restorative Dentistry, Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
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Cameron AB, Tong K, Tadakamadla S, Evans JL, Abuzar M. Effect of build orientation on the trueness of occlusal splints fabricated by three-dimensional printing. J Oral Sci 2023; 65:261-264. [PMID: 37690838 DOI: 10.2334/josnusd.23-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
PURPOSE Scientific evidence pertaining to the evaluation of trueness of occlusal splints fabricated using different three-dimensional (3D) printers and build orientations compared to subtractive technologies is lacking. METHODS Overall, one hundred and ten occlusal splints were manufactured using two different 3D printers and a dental mill. Five groups of ten were fabricated using the 3D printers at different build orientations (0, 30, 45, 60, and 90 degrees). In addition, a comparison group of ten occlusal splints was subtractively manufactured using a five-axis dental mill. All occlusal splints were scanned and exported as a standard tessellation language file. Analysis was conducted with metrology software with root mean square estimate average positive deviation and average negative deviation used as the measured outcome. RESULTS The 0 degree printing orientation was the most accurate for printer one with the root mean square value of 0.05 ± 0.01 mm, and 60 degree printing orientation was most accurate for printer two with the RMS value of 0.11 ± 0.01 mm. Subtractively manufactured occlusal splint had significantly higher trueness with the lowest RMS value of 0.03 ± 0.05 mm. CONCLUSION Build orientations influence the trueness of additively manufactured occlusal splints while occlusal splints produced by subtractive manufacturing were statistically significantly more accurate.
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Affiliation(s)
| | - Keith Tong
- School of Medicine and Dentistry, Griffith University
| | - Santosh Tadakamadla
- Dentistry and Oral Health, Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University
| | - Jane L Evans
- School of Medicine and Dentistry, Griffith University
| | - Menaka Abuzar
- School of Medicine and Dentistry, Griffith University
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Solanki N, Jurel SK, Singh BP, Chand P, Kant S, Nigam N. Evaluation of mandibular advancement device placement based on levels of TNF-alpha in participants with obstructive sleep apnea: A clinical study. J Prosthet Dent 2023; 130:581-585. [PMID: 34973834 DOI: 10.1016/j.prosdent.2021.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM Objective assessments of the effect of mandibular advancement device on patients with obstructive sleep apnea are lacking. PURPOSE The purpose of this clinical study was to compare levels of serum tumor necrosis factor alpha (TNF-alpha), Epworth Sleepiness Scale score, and Berlin Questionnaire score in patients with mild to moderate obstructive sleep apnea before and after treatment with a mandibular advancement device. MATERIAL AND METHODS Twenty participants diagnosed with mild to moderate obstructive sleep apnea based on polysomnography testing were enrolled. A custom nonadjustable mandibular advancement device with 70% mandibular protrusion was provided for each participant for management of the obstructive sleep apnea. Evaluation of TNF-alpha levels was performed before treatment (baseline) and 3 and 6 months after starting mandibular advancement device therapy by using a Human TNF-alpha enzyme-linked immunoassay (ELISA) sandwich kit. The Epworth Sleepiness Scale and Berlin Questionnaire were also filled out by the participants at the same time intervals (α=.05). RESULTS A statistically significant decline in the levels of TNF-alpha was observed at 3 and 6 months compared with baseline (P<.001). The Epworth Sleepiness Scale scores showed a statistically significant reduction at 3 and 6 months compared with baseline (P<.001). The risk of obstructive sleep apnea assessed by using the Berlin Questionnaire was found to be significantly reduced at 6 months compared with baseline (P=.001). CONCLUSIONS Patients with mild to moderate obstructive sleep apnea showed reduced levels of TNF-alpha and Epworth Sleepiness Scale and Berlin Questionnaire scores when treated with a mandibular advancement device.
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Affiliation(s)
- Neeti Solanki
- Senior Resident, Department of Prosthodontics, Crown and Bridge, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sunit Kumar Jurel
- Professor Jr Grade, Department of Prosthodontics, Crown and Bridge, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Balendra Pratap Singh
- Professor, Department of Prosthodontics, Crown and Bridge, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pooran Chand
- Professor, Department of Prosthodontics, Crown and Bridge, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Surya Kant
- Professor, Department of Pulmonary and Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nitu Nigam
- Associate Professor, Center for Advance Research, King George's Medical University, Lucknow, Uttar Pradesh, India
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Zheng P, Chalidapongse P, Changsiripun C. Mandibular advancement devices used with morning occlusal guides for treating obstructive sleep apnea-changed incisor inclination and its associated factors. Sleep Breath 2023; 27:2059-2067. [PMID: 36862328 DOI: 10.1007/s11325-023-02796-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Mandibular advancement devices (MADs) effectively treat patients with obstructive sleep apnea (OSA). Although the use of morning occlusal guides (MOGs) along with MADs is recommended to prevent dental side effects, there is no evidence to support this. The aim of this study was to evaluate the change in incisor inclination in patients with OSA treated with MADs and MOGs, and to identify its predictive factors. METHODS Patients with OSA who received MAD and MOG therapy and had a reduction in their apnea-hypopnea index greater than 50% were analyzed. Cephalometric measurements were performed at baseline and at a 1-year follow-up or longer to assess the dentoskeletal side effects of MAD/MOG treatment. Multivariable linear regression analysis was used to assess the association between the change in incisor inclination and the independent variables that may cause the observed side effects. RESULTS Among 23 patients enrolled in the study, there was significant upper incisor retroclination (U1-SN: 2.83° ± 2.68°, U1-PP: 2.86° ± 2.46°; P < 0.05) and significant lower incisor proclination (L1-SN: 3.04° ± 3.29°, L1-MP: 1.74° ± 3.13°; P < 0.05). However, no significant skeletal changes were observed. Multivariable linear regression revealed that advancement ≥ 95% of the patients' maximal mandibular protrusion was associated with greater upper incisor retroclination. Increased treatment duration was also associated with increased upper incisor retroclination. No \measured variables were associated with the change in lower incisor inclination. CONCLUSIONS Dental side effects occurred in patients who used MADs with MOGs. The amount of mandibular protrusion by MADs and treatment duration were predictive factors associated with upper incisor retroclination.
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Affiliation(s)
- Prapaporn Zheng
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Premthip Chalidapongse
- Department of Oral Diagnostic Science, Faculty of Dentistry, Prince of Songkla University, Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
- Dental Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand
| | - Chidsanu Changsiripun
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand.
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Orgev A, Levon JA, Chu TMG, Morton D, Lin WS. The effects of manufacturing technologies on the surface accuracy of CAD-CAM occlusal splints. J Prosthodont 2023; 32:697-705. [PMID: 36227731 DOI: 10.1111/jopr.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/01/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the effects of the manufacturing technologies on the surface (cameo and intaglio) accuracy (trueness and precision) of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal splints. MATERIALS AND METHODS The digital design of the master occlusal splint was designed in a CAD software program. Six groups (n = 10) were tested in this study, including Group 1 - Milling (Wax), Group 2 - Heat-polymerizing, Group 3 - Milling (M series), Group 4 - Milling (DWX-51/52D), Group 5 - 3D-printing (Cares P30), and Group 6 - 3D-printing (M2). The study samples were placed in a scanning jig fabricated from putty silicone and Type III dental stone. The study samples were then scanned with a laboratory scanner at the intaglio and cameo surfaces, and the scanned files were exported in standard tessellation language (STL) file format. The master occlusal splint STL file, was used as a reference to compare with all scanned samples at the intaglio and cameo surfaces in a surface matching software program. Root mean square (RMS, measured in mm, absolute value) values were calculated by the software for accuracy comparisons. Group means were used as the representation of trueness, and the standard deviation for each group was calculated as a measure of precision. Color maps were recorded to visualize the areas of deviation between study samples and the master occlusal splint file. The data were normalized and transformed to rank scores, and one-way ANOVA was used to test for the differences between the groups. Pairwise comparisons were made between different groups. Fishers least square differences were used to account for the family-wise error rate. A 5% significance level was used for all the tests. RESULTS The null hypotheses were rejected. The manufacturing technologies significantly affected the trueness of occlusal splints at both intaglio and cameo surfaces (p < 0.001). At the cameo surfaces, Group 1 - Milling (Wax) (0.03 ± 0.02 mm), Group 3 - Milling (M series) (0.04 ± 0.01 mm), and Group 4 - Milling (DWX-51/52D) (0.04 ± 0.01 mm) had the smallest mean RMS values and highest trueness. Group 3 had the smallest standard deviation and highest precision among all groups (p < 0.001, except p = 0.005 when compared with Group 2). Group 5 had the largest standard deviation and lowest precision among all groups (p < 0.001). At the intaglio surfaces, Group 1 - Milling (Wax) (0.06 ± 0.01 mm) had the smallest RMS values and highest trueness among all groups (p < 0.001), and Group 2 - Heat-polymerizing (0.20 ± 0.03 mm) and Group 5 - 3D-printing (Cares P30) (0.15 ± 0.05 mm) had significantly larger mean RMS and standard deviation values than all other groups (p < 0.001), with lowest trueness and precision. In the color maps, Group 2 - Heat-polymerizing and Group 5 - 3D-printing (Cares P30) showed the most discrepancies with yellow and red (positive discrepancies) in most areas, and Group 1 - Milling (Wax) showed the best and most uniform surface matching with the most area in green. CONCLUSION The manufacturing technologies significantly affected the trueness and precision of occlusal splints at both intaglio and cameo surfaces. The 5-axis milling units and industrial-level CLIP 3D-printer could be considered to achieve surface accuracy of occlusal splints.
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Affiliation(s)
- Ahmet Orgev
- Department of Restorative Dentistry, University at Buffalo School of Dental Medicine, Buffalo, New York
| | - John A Levon
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana
| | - Tien-Min G Chu
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, Indiana
| | - Dean Morton
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana
| | - Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana
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Verma A, Jain S. Efficacy of Mandibular Advancement Device in the Treatment of Obstructive Sleep Apnoea by Evaluating Upper Airway Space Volume Using CBCT. J Coll Physicians Surg Pak 2023; 33:1194-1197. [PMID: 37804029 DOI: 10.29271/jcpsp.2023.10.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/31/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To evaluate the efficacy of mandibular advancement device as a treatment of mild to moderate obstructive sleep apnoea and to evaluate the change in upper airway space volume by using cone beam CT (CBCT). STUDY DESIGN In vivo observational study. Place and Duration of the Study: Department of Prosthodontics, Crown and Bridge, Sri Aurobindo College of Dentistry, Indore (M.P), India, from March 2017 to January 2021. METHODOLOGY Patients with mild to moderate obstructive sleep apnoea patients using Berlin questionnaire were selected. Pre- and posttreatment-CBCT analysis was done to compare the changes in superior and inferior upper airway space before and after using mandibular advancement device. The pre and postoperative CBCT were also compared using a paired t-test for the quantitative variables. After two months, the patients were asked to complete a self-administered questionnaire to assess their sleep improvement, initial symptoms regression, and effectiveness of the mandibular advancement device. RESULTS On comparative evaluation of the pre- and post-CBCT, the mean score before the mandibular advancement device placement was found to be 7.77+2.79 cc, whereas the mean score after the mandibular advancement device placement was found to be 9.75+3.34 cc (p<0.001). Significant volumetric change was seen in upper airway space after receiving treatment for the two months. The patient noticed a substantial improvement in their sleep as well as a reduction in the original symptoms. CONCLUSION This study showed statistically significant volumetric change in the upper airway space and reduction in their symptoms after treatment with the mandibular advancement device (MAD). KEY WORDS Obstructive sleep apnoea syndrome (OSA), Continuous positive airway pressure (CPAP), Cone beam computed tomography, Mandibular advancement device (MAD), Upper airway volume.
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Affiliation(s)
- Aanchal Verma
- Department of Prosthodontics, Crown and Bridge, Sri Aurobindo College of Dentistry, Indore (M.P), India
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Perea-Lowery L, Gibreel M, Garoushi S, Vallittu P, Lassila L. Evaluation of flexible three-dimensionally printed occlusal splint materials: An in vitro study. Dent Mater 2023; 39:957-963. [PMID: 37666693 DOI: 10.1016/j.dental.2023.08.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To evaluate and compare the mechanical properties, water sorption, water solubility, and degree of double bond conversion of three different commercially available three-dimensional (3D) printing resins used for the fabrication of flexible occlusal splints. METHODS A digital printer was used to generate specimens from the evaluated splint materials (KeySplint Soft, IMPRIMO LC Splint flex, and V-Print splint comfort). The specimens were equally divided and tested either dry or after water storage at 37 °C for 30 days. A three-point bending test was used to assess flexural strength, elastic modulus, and fracture toughness. A two-body wear test was performed using a dual-axis chewing simulator. Water sorption and water solubility were measured after 30 days. The degree of double bond conversion was determined by FTIR-spectrometry. All data for the evaluated properties were collected and statistically analyzed. RESULTS Both material and storage conditions had a significant effect on the flexural strength (P < 0.001), elastic modulus (P < 0.001), fracture toughness (P < 0.001), and wear (P < 0.001). The highest water sorption was noticed with IMPRIMO LC Splint flex (1.9 ± 0.0 %), while V-Print splint comfort displayed the lowest water solubility (0.2 ± 0.0 %). For the degree of conversion, it was statistically non-significant among the different materials (P = 0.087). SIGNIFICANCE Different flexible 3D-printed splints available in the market displayed variations in the evaluated properties and clinicians should consider these differences when choosing occlusal device materials. Among the tested flexible splint materials, KeySplint Soft had the greatest flexural strength, elastic modulus, fracture toughness, wear resistance, and degree of conversion. It also showed the lowest water sorption.
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Affiliation(s)
- Leila Perea-Lowery
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku 20520, Finland.
| | - Mona Gibreel
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku 20520, Finland
| | - Sufyan Garoushi
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku 20520, Finland
| | - Pekka Vallittu
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku 20520, Finland; City of Turku Welfare Division, Oral Health Care, Puolalankatu 5, 20101 Welfare Division, Turku FI-20101, Finland
| | - Lippo Lassila
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku 20520, Finland
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Harichane Y. 3D Printing of Thermoflexible Therapeutic Splints: Treating Bruxism More Comfortably. Compend Contin Educ Dent 2023; 44:518-521. [PMID: 37850956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Three-dimensional (3D) printing has helped drive rapid and abundant growth in the field of digital dentistry and has been largely spurred on by the development of material innovation. Thermoflexible occlusal splints represent a recent innovation in this area, as they feature a remarkably elastic behavior. Now, practitioners can provide patients with a comfortable, soft, class II medical device generated through a simple digital workflow. This article presents a case report that demonstrates the management of temporomandibular joint disorders by means of a flexible 3D-printed splint. Providing the patient relative comfort while wearing the splint to prevent the negative effects of bruxism helped enhance patient acceptance and compliance. The simple, non-invasive splint fabrication described in this report can be performed by any clinicians willing to incorporate occlusal devices into their digital workflow.
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Sun J, Zhu H, Lu C, Zhao J, Nie X, Yang Z, He D. Temporomandibular joint disc repositioning and occlusal splint for adolescents with skeletal class II malocclusion: a single-center, randomized, open-label trial. BMC Oral Health 2023; 23:694. [PMID: 37759222 PMCID: PMC10537145 DOI: 10.1186/s12903-023-03402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) disc repositioning through open suturing (OSu) is a new disc repositioning method. Its result for adolescents with condylar resorption and dentofacial deformities combined with and without postoperative occlusal splints (POS) has not been well studied. OBJECTIVE This study was to evaluate and compare the effects of OSu with and without POS in the treatment of TMJ anterior disc displacement without reduction (ADDwoR) in adolescent skeletal Class II malocclusion. METHODS A total of 60 adolescents with bilateral ADDwoR were enrolled in this study. They were randomly allocated into two groups: OSu with and without POS. Magnetic resonance imaging (MRI) and lateral cephalometric radiographs were used to measure changes in condylar height and the degree of skeletal Class II malocclusion from before operation and at 12 months postoperatively. Changes in these indicators were compared within and between the two groups. RESULTS After OSu, both groups exhibited significant improvements in condylar height and occlusion at the end of 12 months follow-up (P < 0.05). The group of OSu with POS had significantly more new bone formation (2.83 ± 0.75 mm vs. 1.42 ± 0.81 mm, P < 0.001) and improvement in dentofacial deformity than the group of OSu only (P < 0.05). The new bone height was significantly correlated with POS (P < 0.001), the changes of SNB (P = 0.018), overjet (P = 0.012), and Wits appraisal (P < 0.001). CONCLUSION These findings indicated that OSu can effectively stimulate condylar regeneration and improve skeletal Class II malocclusion in adolescents with bilateral ADDwoR. The results are better when combined with POS. TRIAL REGISTRATION This trial was prospectively registered on the chictr.org.cn registry with ID: ChiCTR1900021821 on 11/03/2019.
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Affiliation(s)
- Jiali Sun
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Huimin Zhu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chuan Lu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Jieyun Zhao
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Xin Nie
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Zhi Yang
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China.
| | - Dongmei He
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Shi X, Lobbezoo F, Chen H, Rosenmöller BRAM, Berkhout E, de Lange J, Aarab G. Effects of mandibular advancement devices on upper airway dimensions in obstructive sleep apnea: responders versus non-responders. Clin Oral Investig 2023; 27:5649-5660. [PMID: 37589748 PMCID: PMC10492877 DOI: 10.1007/s00784-023-05186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023]
Abstract
STUDY OBJECTIVES To compare the effects of mandibular advancement device (MAD) therapy on upper airway dimensions between responders and non-responders with mild to moderate obstructive sleep apnea (OSA). METHODS Thirty-one participants (21 men and 10 women) with a mean ± SD apnea-hypopnea index (AHI) of 16.6 ± 6.7 events/h, and aged 48.5 ± 13.9 years, were included in this study. Polysomnographic recordings and cone beam computed tomography (CBCT) scans in supine position were performed for every participant at baseline and at 3-month follow-up with their MAD in situ. Responders were defined as having ≥ 50% reduction in baseline AHI with a residual AHI < 10 events/h. The primary outcome variable was the minimal cross-sectional area of the upper airway (CSAmin). RESULTS No significant differences were found between responders (n = 15) and non-responders (n = 16) in age, gender distribution, body mass index, and neck circumference (P = 0.06-0.93), nor in AHI and CSAmin (P = 0.40 and 0.65, respectively) at baseline. The changes of the CSAmin with MAD in situ in the responder group were not significantly different compared to those in the non-responder group (P = 0.06). CONCLUSION Within the limitations of this study, we conclude that the changes of the upper airway dimensions induced by MADs are not significantly different between responders and non-responders with mild to moderate OSA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02724865. https://clinicaltrials.gov/ct2/show/NCT02724865.
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Affiliation(s)
- Xiaoxin Shi
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral Radiology & Digital Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hui Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road West, Jinan, 250012, Shandong, China.
| | - Boudewijn R A M Rosenmöller
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Erwin Berkhout
- Department of Oral Radiology & Digital Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Wang P, Wang Y, Xu H, Huang Y, Shi Y, Chen S, Bai D, Xue C. Effect of offset on the precision of 3D-printed orthognathic surgical splints. Clin Oral Investig 2023; 27:5141-5151. [PMID: 37415046 DOI: 10.1007/s00784-023-05134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE This study evaluated the effect of offset on the precision of three-dimensional (3D)-printed splints, proposing to optimize the splint design to compensate for systematic errors. MATERIALS AND METHODS 14 resin model sets were scanned and offset as a whole by given distances (0.05, 0.10, 0.15, 0.20, 0.25, 0.30, 0.35, and 0.40 mm). Intermediate splints (ISs) and final splints (FSs) were generated from the non-offset and offset models and grouped correspondingly, named as splint type-offset value, IS-0.05, for instance. Dentitions occluded with the splint were scanned. Translational and rotational deviations of the lower dentition relative to the upper dentition were 3D measured. RESULTS Deviations of ISs and FSs were more evident in the vertical and pitch dimensions, and were mostly acceptable in other dimensions. ISs with offset ≥ 0.05 mm showed vertical deviations significantly below 1 mm (P < 0.05) while ISs with 0.10- to 0.30-mm offsets had pitch rotations significantly lower than 1° (P < 0.05). The Pitch of IS-0.35 was significantly larger than ISs with 0.15- to 0.30-mm offsets (P < 0.05). Meanwhile, FSs fit better as the offset increased and FSs with offsets ≥ 0.15 mm all had deviations significantly lower than 1 mm (for translation) or 1° (for rotation) (P < 0.05). CONCLUSIONS Offset affects the precision of 3D-printed splints. Moderate offset values of 0.10 to 0.30 mm are recommendable for ISs. Offset values ≥ 0.15 mm are recommended for FSs in cases with stable final occlusion. CLINICAL RELEVANCE This study found the optimal offset ranges for 3D-printed ISs and FSs via a standardized protocol.
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Affiliation(s)
- Peiqi Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Yipeng Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Hui Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Yixi Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Yu Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Siqi Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Ding Bai
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China
| | - Chaoran Xue
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section of Renmin Nan Road, Chengdu, 610041, China.
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Radi IA. OCCLUSAL APPLIANCES MIGHT BE CLINICALLY EFFICIENT IN TREATING SLEEP BRUXISM. J Evid Based Dent Pract 2023; 23:101890. [PMID: 37689458 DOI: 10.1016/j.jebdp.2023.101890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Minakuchi H, Fujisawa M, Abe Y, Iida T, Oki K, Okura K, Tanabe N, Nishiyama A. Managements of sleep bruxism in adult: A systematic review. Jpn Dent Sci Rev. 2022; 58:124-36. SOURCE OF FUNDING None was reported. TYPE OF STUDY/DESIGN Systematic review.
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Malenova Y, Ortner F, Liokatis P, Haidari S, Tröltzsch M, Fegg F, Obermeier KT, Hartung JT, Kakoschke TK, Burian E, Otto S, Sabbagh H, Probst FA. Accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery. Clin Oral Investig 2023; 27:5063-5072. [PMID: 37382718 PMCID: PMC10492762 DOI: 10.1007/s00784-023-05125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
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.
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Affiliation(s)
- Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany.
| | - Florian Ortner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Matthias Tröltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
- Center for Oral, Maxillofacial, and Facial Reconstructive Surgery, Ansbach, Germany
| | - Florian Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Katharina T Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Jens T Hartung
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Tamara K Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Egon Burian
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
| | - Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital LMU Munich, Munich, Germany
| | - Florian A Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital LMU Munich, Munich, Germany
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Wu B, Lv K. Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures. J Craniofac Surg 2023; 34:e582-e584. [PMID: 37236625 DOI: 10.1097/scs.0000000000009418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. METHODS To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. RESULTS AND DISCUSSION Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.
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Affiliation(s)
- Benxing Wu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, People's Republic of China
| | - Kun Lv
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, People's Republic of China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
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O'Toole S, Moazzez R, Wojewodka G, Zeki S, Jafari J, Hope K, Brand A, Hoare Z, Scott S, Doungsong K, Ezeofor V, Edwards RT, Drakatos P, Steier J. Single-centre, single-blinded, randomised, parallel group, feasibility study protocol investigating if mandibular advancement device treatment for obstructive sleep apnoea can reduce nocturnal gastro-oesophageal reflux (MAD-Reflux trial). BMJ Open 2023; 13:e076661. [PMID: 37620257 PMCID: PMC10450077 DOI: 10.1136/bmjopen-2023-076661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Just under half of patients with obstructive sleep apnoea (OSA) also have gastro-oesophageal reflux disease (GORD). These conditions appear to be inter-related and continual positive airway pressure (CPAP) therapy, the gold standard treatment for OSA to prevent airway collapse, has been shown to reduce GORD. As the impact of mandibular advancement devices, a second-line therapy for OSA, on GORD has yet to be investigated, a feasibility study is needed prior to a definitive trial. METHODS This will be a single-centre, single-blinded, tertiary-care based, interdisciplinary, parallel randomised controlled study. Potential OSA participants presenting to the sleep department will be pre-screened for GORD using validated questionnaires, consented and invited to receive simultaneous home sleep and oesophageal pH monitoring. Those with confirmed OSA and GORD (n=44) will be randomly allocated to receive either CPAP (n=22) or MAD therapy (n=22). Following successful titration and 3 weeks customisation period, participants will repeat the simultaneous sleep and oesophageal pH monitoring while wearing the device. The number of patients screened for recruitment, drop-out rates, patient feedback of the study protocol, costs of interventions and clinical information to inform a definitive study design will be investigated. ETHICS AND DISSEMINATION Health Research Authority approval has been obtained from the Nottingham 2 Research Ethics Committee, ref:22/EM/0157 and the trial has been registered on ISRCTN (https://doi.org/10.1186/ISRCTN16013232). Definitive findings about the feasibility of doing 24 hour pH oesophageal monitoring while doing a home sleep study will be disseminated via clinical and research networks facilitating valuable insights into the simultaneous management of both conditions. TRIAL REGISTRATION NUMBER ISRCTN Reg No: 16013232.
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Affiliation(s)
- Saoirse O'Toole
- Centre for Clinical, Oral and Translational Sciences, King's College London, London, UK
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Rebecca Moazzez
- Restorative Dentistry, University of the Pacific Arthur A Dugoni School of Dentistry, San Francisco, California, USA
| | | | - Sebastian Zeki
- Oesophageal Physiology Laboratory, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Jafar Jafari
- Oesophageal Physiology Laboratory, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | - Andrew Brand
- NWORTH (North Wales Organisation for Randomised Trials in Health), School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Zoe Hoare
- NWORTH (North Wales Organisation for Randomised Trials in Health), School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Suzanne Scott
- Queen Mary University of London Wolfson Institute of Population Health, London, UK
| | - Kodchawan Doungsong
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Victory Ezeofor
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Panagis Drakatos
- Oesophageal Physiology Laboratory, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Joerg Steier
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Medicine, King's College London, London, UK
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Iftikhar IH, Cistulli PA, Jahrami H, Alamoud KA, Saeed M, Soulimiotis AP, BaHammam AS. Comparative efficacy of mandibular advancement devices in obstructive sleep apnea: a network meta-analysis. Sleep Breath 2023; 27:1365-1381. [PMID: 36374442 DOI: 10.1007/s11325-022-02744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/25/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To analyze relative efficacies of mandibular advancement devices (MAD) in sleep apnea treatment. METHODS From eligible randomized controlled trials (RCT), MADs were classified based on their mechanistic designs. Data on apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), nadir oxygen saturation (minSaO2), and sleep efficiency (SE%) from RCTs were then analyzed in network meta-analyses, and relative ranking of different MADs was computed based on P scores (a method of ranking similar to SUCRA). Similar analyses were conducted based on the different brands of MADs. RESULTS There were no statistically significant differences between MADs in any of the outcomes analyzed. However, the P-scores, based on the point estimates and standard errors of the network estimates, ranked some MADs higher than others in some of the outcomes. Of the different mechanistic designs, the highest P scores were achieved for attached midline traction (P score = 0.84) and unattached bilateral interlocking (P score = 0.78) devices for AHI reduction, attached bilateral traction (P score = 0.78) and unattached bilateral interlocking (P score = 0.76) for ESS, monobloc (P score = 0.91) and unattached bilateral interlocking (P score = 0.64) for minSaO2, and unattached bilateral interlocking (P score = 0.82) and attached bilateral traction (P score = 0.77) for SE%. Notable findings in the network meta-analyses based on MAD brands, of the limited number of studies that specified them were the effects of SomnoDent Flex™, TAP™, and IST® in their effects on AHI reduction, with P scores of 0.94, 0.83, and 0.82, respectively. Monobloc decreased supine-AHI the most (- 44.46 [- 62.55; - 26.36], P score = 0.99), and unattached bilateral interlocking had the greatest effect on REM-AHI (- 11.10 [- 17.10; - 5.10], P score = 0.87). CONCLUSIONS Findings from this study show clinically (but not statistically) significant differences between MADs in terms of their relative efficacy when analyzed for different sleep apnea treatment outcomes and sleep apnea phenotypes.
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Affiliation(s)
- Imran H Iftikhar
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, Atlanta, USA.
- Atlanta Veterans Affairs Medical Center, Atlanta, USA.
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Haitham Jahrami
- Ministry of Health, Manama, Bahrain
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Khalid A Alamoud
- Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maarij Saeed
- Dental College, HITEC Institute of Medical Sciences, Rawalpindi, Pakistan
| | - Andrew P Soulimiotis
- Sleep Apnea & Snoring Solutions (Private Practice), North Druid Hills Georgia, Atlanta, USA
| | - Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia (08-MED511-02), Riyadh, Saudi Arabia
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Sangalli L, Yanez-Regonesi F, Fernandez-Vial D, Moreno-Hay I. Self-reported improvement in obstructive sleep apnea symptoms compared to treatment response with mandibular advancement device therapy: a retrospective study. Sleep Breath 2023; 27:1577-1588. [PMID: 36449217 DOI: 10.1007/s11325-022-02754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Mandibular advancement device (MAD) is recognized as the treatment option for management of obstructive sleep apnea (OSA) in mild-moderate cases or those unable to tolerate positive airway pressure therapy. Post-treatment sleep study is recommended to establish MAD efficacy when maximal therapeutic benefit is achieved based on OSA symptom improvement or maximum anatomical protrusion. The aim of this study was to investigate the difference between responders and non-responders in OSA symptom improvement and predictors of treatment success. METHODS Medical charts of patients referred to the Orofacial Pain Clinic between 2016 and 2021 for management of OSA with MAD were retrospectively evaluated. Participants with post-treatment sleep study with MAD in situ were included. Participants were categorized as responders according to different criteria: 50% reduction in apnea-hypopnea index (AHI) compared to baseline; post-treatment AHI ≤ 10 with ≥ 50% reduction from baseline; AHI ≤ 5 with ≥ 50% reduction. OSA symptoms included snoring, apneas, sleep quality, tiredness upon awakening, daytime sleepiness, and subjective improvement. Differences in pre- and post-treatment variables within/between groups and predictors were analyzed with t test and logistic regression. RESULTS Among 53 participants (30 females), mean age was 64.2 ± 10.7 and pre-treatment was AHI 23.3 ± 17.2. Depending upon the criteria, responders ranged between 26 and 57%. At first follow-up after MAD delivery, non-responders reported less tiredness upon awakening (p = 0.003), better sleep quality (p = 0.005), and greater subjective improvement (p = 0.012) than responders. Among significant OSA symptoms, tiredness upon awakening, poorer sleep quality, and less subjective improvement were consistently found as predictors of treatment response. CONCLUSION Subjective improvement, sleep quality, and tiredness upon awakening significantly improved in non-responders at first follow-up compared to responders, according to the strictest definition of treatment response. Therefore, a post-treatment sleep study is crucial to confirm proper management of OSA with MAD.
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Affiliation(s)
- Linda Sangalli
- Department of Oral Health Science, College of Dentistry, Orofacial Pain Clinic, University of Kentucky, Lexington, KY, USA.
- College of Dental Medicine-Illinois (CDMI), Midwestern University, Downers Grove, IL, USA.
| | - Fernanda Yanez-Regonesi
- Department of Oral Health Science, College of Dentistry, Orofacial Pain Clinic, University of Kentucky, Lexington, KY, USA
| | - Diego Fernandez-Vial
- Department of Oral Health Science, College of Dentistry, Orofacial Pain Clinic, University of Kentucky, Lexington, KY, USA
| | - Isabel Moreno-Hay
- Department of Oral Health Science, College of Dentistry, Orofacial Pain Clinic, University of Kentucky, Lexington, KY, USA
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