Search Results (15)

Introduction. Occlusal splints are oral appliances that have been designed to relieve the temporomandibular symptoms. However, the thickness of occlusal splints in order to have optimal efficacy is still controversial. Methods. An electronic search in Medline, Scopus, and Web of Science databases was conducted, using the following keywords up to 2025: (“occlusal splint” OR “stabilization splint” OR “bite splint”) AND (“vertical dimension” OR “thickness” OR “occlusal height”) AND (“temporomandibular disorder” OR “TMD” OR “disc displacement” OR “myofascial pain”). All titles and abstracts were screened. Studies comparing different thicknesses of occlusal splints were included. Results. Eight studies met the inclusion criteria, of which five were randomized controlled trials, one a retrospective study, and two finite element analyses. Mixed quality of the studies was found. Based on current evidence, although limited, the following results could be deduced: Occlusal splints with moderate thickness, 3 mm, are recommended for cases that involve both muscular and joint components, particularly when masticatory muscle pain is the primary complaint. Occlusal splints with minimal thickness, 2 mm, may be appropriate in internal derangements in the early stage, though evidence is low. Thicker splints, ≥4 mm, are for DDwoR and cases with crepitus. Occlusal splints of ≤2 mm and >6 mm were associated with symptoms such as reduced functional outcomes or comfort. Conclusion. In most cases, occlusal splints with thicknesses of 3–5 mm seem to be optimal for most TMD cases; however, personalized treatment based on the respective diagnosis is recommended. The decision on splint thickness should be based on evidence according to the severity of the diagnosis, but also patient-centered, to achieve comfort, compliance of the patient, and oral structure preservation. Further high-quality RCTs are needed to gain evidence-based guidelines and to achieve consistent results. Full article

Age-related differences in temporomandibular joint osteoarthritis (TMJ OA) have been suggested; however, age-specific patterns of functional recovery following occlusal splint therapy remain insufficiently characterized. This retrospective observational study evaluated longitudinal changes in bite force across different age groups in patients with unilateral TMJ OA undergoing stabilization splint therapy. Thirty-two patients diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were categorized into three age groups (20–39, 40–59, and ≥60 years). Maximum bite force was measured repeatedly from baseline to 2 weeks and up to 6 months during the observation period following splint application. Patients aged 60 years and older exhibited significantly lower baseline maximum bite force compared with younger groups (p = 0.011), but demonstrated a gradual and statistically significant increase over the observation period (p = 0.011). In contrast, patients aged 20–39 years showed a significant improvement in bite force asymmetry after 2 weeks of treatment (p = 0.047), which was maintained throughout follow-up. These findings suggest that functional recovery patterns in unilateral TMJ OA may vary according to age, with younger patients showing earlier improvement and older patients demonstrating slower but progressive functional gains. Bite force assessment may serve as a complementary functional parameter for characterizing age-related differences in functional change in patients with unilateral TMJ OA. Full article

Background/Objectives: When solving the problems of installing zygomatic implants after partial or full maxillectomy with subsequent attachment of a removable overdenture (ROD), computer simulation based on the finite element method (FEM) is an effective tool for treatment planning. In this study, stress-strain states of the ‘zygomatic bones–implants–splinting bar–ROD’ dental structure were evaluated under various loading conditions. Methods: A 3D FEM computer simulation was carried out to estimate stress-strain states of the elements of the dental structure and to study the effect of redistribution of the loads transferred from the ROD to the zygomatic bones through four implants. Results: That successive insertion and removal of the ROD caused identical stresses in the elements of the dental structure. Given the accepted level of critical stress of about 13 MPa, their values may be exceeded in the zygomatic bones during both processes. In the ROD, the equivalent stresses did not exceed the critical levels upon alternate loading of 50 N on the posterior teeth (both molars and premolars) under all biting and mastication. Taking into account the linear dependence of the applied load and the stresses in the ROD, it can be stated that its integrity is maintained until 118 N (or the generally accepted typical value of 100 N). Under the 90° biting angle, the equivalent stresses are below the critical level in all the studied cases; thus, the acceptable value increases to 213 N, but it is only 63 N at a biting angle of 45°. Conclusions: It has been established that the equivalent stresses in the zygomatic bones can exceed the critical stress level of 13 MPa. In addition, some practical recommendations and prospects of the study have been formulated. Full article

Background and objectives: This study analyzed and compared the distribution patterns of occlusal forces using T-Scan III before and after the hydrostatic temporary oral splint (Aqualizer Ultra) therapy in healthy subjects and subjects with temporomandibular disorders (TMDs). Materials and Methods: Fifty-one subjects were divided into groups based on anamnesis and responses to the Fonseca questionnaire. The first group, non-TMDs group (n = 19), and the second group, TMDs group (n = 32), had mild-to-severe TMDs, as identified by the Fonseca questionnaire. The non-TMDs group had an average age of 25.4 years (SD = 4.8, range 20–38) with 15 females (78.95%) and 4 males (21.05%). The TMDs group had an average age of 27.4 years (SD = 7.0, range 22–53) with 25 females (78.125%) and 7 males (21.875%). T-Scan III device was used for occlusal analysis before and after hydrostatic splint usage. Results: Significant differences were observed in the TMDs group for anterior and posterior right percentages of forces before and after hydrostatic splint usage. The analysis of force distribution per sector before and after hydrostatic splint therapy showed no significant differences in the non-TMDs group. Analysis of force distributions in the entire study population before and after hydrostatic splint therapy showed significant differences in the anterior and posterior right regions. Occlusal force increased by 32–56% in the front region and decreased in the posterior area after hydrostatic splint usage. Conclusions: Hydrostatic splint therapy is recommended as a part of full-mouth rehabilitation treatment for all patients regardless of the severity of TMDs. Full article

Background: The main objective of this study was to compare the clinical efficacy of two different devices, the Eptamed elastodontic device and a common bite sold in pharmacies, by assessing a computer aid evaluation of patients’ surface electromyography (sEMG) and kinesiography activity of four pairs of masticatory and postural muscles (anterior temporalis, digastricus, masseters and sternocleidomastoids muscles) before and after 6 months of treatment. Materials and Methods: Twelve adult patients with temporomandibular disorders and in need of orthodontic treatment were enrolled in the study and divided into cases and controls. Cases underwent orthodontic treatment with the Eptamed elastodontic device, while controls were treated with a bite sold in pharmacies. Both groups underwent electromyographic and kinesiographic examinations before and after 6 months from the start of treatment. Results: The Eptamed device was found to guarantee an improvement in the electrical activity of the muscles examined. The subjects in the control group, on the other hand, had a general worsening of electrical activity after wearing a splint purchased in a pharmacy. As for the kinesiographic examination, there was no significant improvement in both groups. Conclusions: the use of the Eptamed device in subjects with TMD ensured a greater relaxation of the chewing muscles than a standard bite, effectively reducing the risk of worsening the symptomatology of temporomandibular disorders. Full article

Three-dimensional (3D)-printed occlusal splints are becoming more prevalent in the treatment of tooth substance loss due to their fast and cost-effective production. The purpose of this in vitro study was to investigate whether the mechanical properties (tensile strength—TS, modulus of elasticity in tension—ME, and Vickers hardness—HV) vary between the materials (printed dimethacrylate-based resins: Keyprint KeySplint soft—KEY, Luxaprint Ortho Plus—LUX, V-Print splint—VPR, printed methacrylate-based resins Freeprint splint 2.0—FRE, and milled methacrylate-based material, CLEAR splint—CLE), and the influence of aging processes (extraoral storage conditions and nightly or daily use) was examined. The printed methacrylate-based resins (FRE, LUX, and VPR) had much higher TS (43.7–48.5 MPa compared to 12.3–13.3 MPa), higher ME (2.01–2.37 GPa compared to 0.43–0.72 GPa), and higher HV (11.8–15.0 HV compared to 3.3–3.5 HV) than both of the methacrylate-based resins (KEY and CLE) after the production process. Although the TS, ME, and HV of the printed dimethacrylate resins (FRE, LUX, and VPR) decreased significantly under humid conditions with possibly elevated temperatures (thermocycling as well as 37 °C), these mechanical properties were significantly higher than both methacrylate-based resins (KEY and CLE). Therefore, printed dimethacrylate resins should be used rather than methacrylate-based resins for high expected masticatory forces, low wall thicknesses, or very long wearing times (≥6 months). Full article

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

Temporomandibular joint disorders (TMDs) have always been the subject of studies due to the difficult management of symptoms and the complex stabilization of the so-called therapeutic position. In this effort, digital technologies open new opportunities for such planning, allowing the clinician to digitally assess the situation and verify the stability of the new position from a functional point of view. The present case series shows examples of preliminary full-digital planning of treatment in TMDs patients made with the preliminary evaluation of the kinematic activity of the mandible through a digital device (Tech in motion™, ModJaw, Villeurbanne, France). Three TMD clinical cases are analyzed with full-digital techniques and workflow. A personalized treatment for each case was digitally planned on the base of proper kinematic tracings recorded for each patient, and intraoral appliances were digitally customized through a full-digital or semi-digital workflow. The digitalization of mandibular kinematic gave us the possibility of making a more “aware” diagnosis, especially in a dynamic key, and then it allowed a faster realization and execution of the intraoral appliance through a digital workflow, memorizing the therapeutic position and early checking the device, before its realization, on the real kinematics of the patient. Full article

Fully digital workflows gained acceptance in dental practice and thereby are of interest for undergraduate education. An exploratory clinical observation was designed to track the implementation of such a workflow with novice digital users in order to describe its feasibility, time investment, and pitfalls. Methods: Students were invited to provide feedback for their experiences with a training module that consisted of the following: intraoral scanning, computer-aided design (CAD), manual finishing, and insertion of a 3D-printed bite splint for the lower jaw. Results: A total of 82 fourth-year students participated in the module. The average time required to perform an intraoral scan was 17 m 5 s, and all students were able to design a splint with an average time of 2 h 38 m. Students who indicated prior experience with CAD seem to outperform inexperienced students in both CAD task completion and intraoral scanning. The initial fit was reported as clinically acceptable by 68.5% of the participants, while 79% rated the workflow as very good to satisfactory and indicated that the training was helpful for dental practice. Conclusions: The implementation of a digital workflow in undergraduate dental education is feasible and has acceptable clinical results. However, CAD is time-intensive, and the experience can be challenging. Full article

The orthodontic treatment of patients having temporomandibular disorders are some of the most complicated cases to treat. The positions of the mandibular condyles are often unstable, which means clinicians find it difficult to have definite criteria for making an accurate and reliable orthodontic diagnosis. This article reports the orthodontic treatment of a patient showing skeletal Class II and temporomandibular disorders with condylar resorption. To stabilize her condylar position and to relieve her symptoms in the temporomandibular joint, a stabilization splint was used before orthodontic tooth movement. After the splint therapy, the patient exhibited significantly increased open bite and a more severe Class II occlusal relationship as her mandibular condyles were seated anteriorly and superiorly in the articular fossae. The occlusion and facial esthetics of the patient were improved by orthodontic camouflage treatment with the proper use of temporary skeletal anchorage devices and treatment mechanics. Full article

Background and Objectives: The long face type is associated with excessive vertical facial growth and most often with anterior open bite. In many cases of anterior open bite of high severity associated with bimaxillary dento-alveolar protrusion, lips are unable to form an adequate seal at rest. This leads to many issues, including facial dysmorphism. The aim of this study was to describe the case of a 15 year old girl who addressed the orthodontist in November 2015, having complaints related to the skeletal and dental open bite. Case Description: A 15.7 year old patient required a consultation with the orthodontic service for impaired dento-facial aesthetics at rest, smile and speech due to an exaggerated superior protrusion of the upper frontal teeth, labial incompetence with excessive gingival exposure at rest and smile associated with upper and lower anterior teeth crowding. The orthodontic diagnostic consisted of skeletal open bite with a hyperleptoprosop morphological facial type, high degree of hyperdivergence, bimaxillary dento-alveolar protrusion, 7 mm skeletal open-bite, 3 mm vertical inocclusion of the anterior teeth, skeletal class II relationships, bilateral half cusp class II molar and canine relationships, labial incompetence, highly increased interlabial gap, facial asymmetry, excessive gingival exposure of 7 mm at smiling and bimaxillary anterior crowding. Because the patient initially refused orthognathic surgery, prior to starting the orthodontic treatment, the patient was recommended to receive a bilateral extraction of the first upper premolars. Key objectives of pre-surgical orthodontic treatment were to achieve a retroclined position of the upper incisors under their normal inclination for the planned upward maxillary rotation, to maintain slightly lower incisor proclination. The orthognathic surgery consisted of Le Fort I impaction osteotomy with 8 mm anterior impactation, bilateral sagittal split osteotomy, and mandibular repositioning using occlusal splint. Conclusions: At the end of the orthodontic-surgical treatment, the patient presented significant improvement in dento-facial aesthetics, and optimal skeletal, muscular and dental balance. Full article

Our goal is to show that temporomandibular disorder (TMD) patients with orthopaedic instability can be effectively treated by the combination of occlusal splint therapy and molar intrusion. Diagnostic records of 18 patients reporting previous TMD and treated with splint therapy were evaluated. Postsplint anterior open bite was treated by skeletally anchored molar intrusion. Changes in overjet (OJ), overbite (OB) were measured on articulator mounted models: initially in maximal intercuspidation (MI), centric “de jour”, postsplint centric relation (CR) and postintrusion CR. Changes in ANB (A point-Nasion-B point) angle, mandibular plane–palatal plane angle and facial axis angle were assessed on lateral cephalograms. Morphological changes of the condyle were detected on pre-and posttreatment CBCT images. When compared screening mountings to MI models, significant differences were found in OJ and OB. Following splint wear, there was a significant increase in lower facial height and significant decrease in facial axis angle, which in turn increased ANB angle. OB and OJ showed a significant change on the postsplint mountings when compared to MI. After intrusion, mandible exhibited counterclockwise rotation, which decreased lower facial height, increased OB and facial axis angle and decreased ANB and OJ. Posttreatment CBCTs confirmed improved condylar morphology.Occlusal splint therapy followed by orthodontic molar intrusion provides MI-CR harmony, therefore, it seems to be an effective method for treating TMD patients. Full article

The nonsuppurative osteomyelitis of the mandible is a rare condition that can occur in children due to low-grade inflammatory processes, dental cavities, periodontal lesions as well as the eruption process of the teeth. We submit a case report involving the orthodontic management of a 9-year-old female patient who presented in our service in the mixed dentition period with diagnosed Garre’s sclerosing osteomyelitis of the entire mandibular body. After a full work-up, the following symptoms and signs were noted: bilateral temporomandibular joint (TMJ) pain, loss of the leeway space, anterior open bite, distalization of the secondary maxillary right canine, nail biting and tongue thrust. Our orthodontic objectives were to relieve the TMJ pain, limit the eruption process of the teeth and to diminish the evolution of the osteomyelitis, reduce the growth of the inferior lower third of the face and to prevent further invasive treatment of the patient. In the first phase of treatment, we established a centric relationship using an orthopedic appliance (occlusal splint) and physiotherapy to deprogram the muscles and the TMJ. Throughout the second phase of treatment, we used orthopedic appliances to inhibit the overeruption of the secondary molars. After another year of treatment, the osteomyelitis lesions were under control with the permanent teeth in final position, good facial esthetic and as a functional result, no root resorption. We can conclude that by using low physiological forces to direct and control the growth pattern, good results could be obtained in stabilizing and controlling the sclerosing osteomyelitis of the mandible. Full article

Background and Objectives: Temporomandibular joint disorders (TMJDs) are associated with pain and reduced jaw mobility. The aim of this study was to compare the outcome of patients with TMJ arthralgia when submitted to four different treatment modalities, in some cases using intra-articular injections of substances with anti-inflammatory properties and in others, a more conservative approach consisting only of a bite splint. Materials and Methods: The sample was made up of 80 patients, randomly distributed into 4 groups of 20 patients each. Each patient was given a nocturnal bite splint. One of the groups was treated with the bite splint only, while each patient in the other 3 was injected with betamethasone, sodium hyaluronate, or platelet-rich plasma in addition to using the bite splint. Two variables were assessed, namely pain intensity between 0 to 10 according to the visual analogue scale and maximum pain-free mouth opening in mm. The patients were evaluated at four different points: at the beginning of the treatment, as well as one week, one month and six months after initiation. Results: The results showed that maximum pain-free mouth opening improved in all the groups that made up the sample, with either a reduction in pain severity or with no pain. However, the group injected with platelet-rich plasma yielded the best results after six months, while patients treated with sodium hyaluronate or betamethasone obtained the best results at the end of the first week. Conclusions: We concluded that all the treatments used caused a reduction in pain and increased pain-free mouth opening. The splint combined with the platelet-rich plasma injection achieved long-term success. Full article

Introduction: In the past, most efforts aimed at treating internal derangement of the temporomandibular joint (TMJ) have involved nonsurgical modalities and/or conventional open surgical procedures (i.e. arthrotomy). Common nonsurgical methods include physical therapy, bite splint appliances, anti-inflammatory medications and patient education regarding potentially destructive habits such as clenching and bruxing. If these methods failed to yield symptomatic and functional improvement, open arthrotomy of the joint was often proposed. These procedures consist of disk repositioning, arthroplasty, meniscectomy with and without implants and other treatments (AAOMS, 1984). The purpose of this article is to describe TMJ arthroscopy: a useful alternative to open surgery for the diagnosis and treatment of intracapsular TMJ pathology. Full article