Case Report: Digital analysis of occlusion with T-Scan Novus in occlusal splint treatment for a patient with bruxism

Bruxism is a disease with a multifactorial etiology. Its clinical manifestations are most often an unaesthetic smile with abraded tooth surfaces, temporomandibular disorders and muscle hyperactivity. Here we present a case of bruxism where proper articulation of the occlusal splint was performed using the T-scan Novus system. A patient with bruxism underwent treatment with stabilization splint made by 3D printer technology. Intraoral scanning was performed using Trios Color (3Shape, 2014), and the digital design was achieved using the 3Shape Dental system design - splint studio. Formlabs Form 2 printer with biocompatible resin Dental LT Clear Resin was used for printing. The T-Scan Novus system with software attached to it, version 9.1, was used for digital examination of the occlusion. A 2.7 mm thick occlusal splint was developed, and the software adapted the occlusion with antagonists. After adjustment with T-Scan Novus, a reduction in disocclusion time of the patient was achieved, which is a desired result in the treatment of bruxism. The position of the joint components was proven radiologically. The treatment of bruxism with splint therapy continues to be the main method of treatment. Using digital technology allows for more accurate constructions and precise balancing of occlusal relationships.

T-Scan Novus System in the Management of Splints—Pilot Study

The purpose of this pilot study was to demonstrate the capabilities of the T-Scan Novus system in bruxism treatment by splints. Bruxism patients underwent treatment with a splint made by additive manufacturing. Intraoral scanning was performed using Trios Color (3Shape), and digital design was performed using 3Shape Dental system design - splint studio. The biocompatible material Dental LT Clear Resin was printed using a Formlabs Form 2 printer. The T-Scan Novus system with a software attached to it, version 9.1, was used for digital examination of the occlusion. A splint with an occlusal thickness of 2.5 mm was developed and software adapted with relief to antagonists. The digitally set occlusion with even contacts turned out to be clinically unbalanced. After adjusting with T-Scan Novus, a balanced occlusion was achieved in the right and left halves. The treatment of bruxism with splint therapy continues to be the main method. Its combination with digital technologies allows more precise constructions and more accurate balancing of occlusal relationships.

P013 A pilot study for ultrasound examination of the pterygomandibular raphe to predict efficacy of mandibular advancement splint therapy in obstructive sleep apnoea

Background A lack of predictive indicators for mandibular advancement splint (MAS) efficacy limits their use in the treatment of obstructive sleep apnoea (OSA). The absence of a tendinous pterygomandibular raphe (PMR) in the lateral nasopharynx on MRI may predict MAS efficacy, however MRI is time and resource intensive. We aimed to assess the feasibility of ultrasound in determining PMR absence compared to MRI. Methods 10 healthy participants were recruited to undergo both MRI and ultrasound of the lateral airway. Surrounding anatomical landmarks were examined to establish the presence or absence of the PMR. These results will be compared to MRI to determine parameters on ultrasound which correlate to an absent PMR. Progress to date 8 of the 10 participants have undergone both MRI and ultrasound, of which half were women, mean age 53 years, mean BMI 28 and mean AHI 3. In all 8 participants so far parameters for assessment of the PMR were identified and described, including presence of anatomical landmarks, localisation and width of the PMR space, and presence of a hyperechoic structure within the space. Comparison of these parameters with MRI to determine predictors of PMR presence or absence is currently underway. Intended outcome and impact Validation of ultrasound in the assessment for presence or absence of a tendinous PMR will enable further study of this structure as a predictive marker for MAS efficacy in OSA. This could assist clinicians in identifying suitable patients for MAS therapy.

Effects of low-level laser therapy versus soft occlusive splints on mouth opening and surface electromyography in females with temporomandibular dysfunction: A randomized-controlled study

Background Low level lasers have been used as an alternative pain relief therapy for muscle and joint pain, since it induces analgesic, anti-inflammatory, and biomodulation effects of the physiological cell functions. The effectiveness of low-level laser therapy in temporomandibular joint dysfunction (TMD) treatment, however, is not well established. Although Surface electromyography (sEMG) has been suggested as a complementary means in TMD diagnosis, the effect of conservative treatments on muscle activity has not yet been thoroughly correlated with (sEMG) findings. Purpose To assess the efficacy of low-level laser therapy (LLLT) as compared to occlusive splint therapy (OST) on the TMJ opening index (TOI) and sEMG of masticatory muscles. Materials and methods 112 female subjects suffering from unilateral myogenous TMD, aged 21–30 years-old, were recruited and divided into three groups: LLLT; soft occlusive splint therapy OST and a waitlist group as controls. Outcome measures TMJ opening index (TOI), Visual analogue scale (VAS), surface electromyography (sEMG). Results A significant reduction was reported in TOI, VAS and the sEMG within the LLLT and OST groups as well as significant decrease in all outcomes between groups in favor of the LLLT group (P< 0.0001). Meanwhile, there was a weak significant difference within the control group probably attributed to the analgesic. Post-hoc pairwise comparisons between groups [control vs occlusive splints, control vs low-level laser and low-level laser vs occlusive splints] revealed significant differences in the VAS and TOI [P = 0.0001; 95% CI: 0.9–2.2, 1.61–4.01, 0.65–1.96]. Conclusions Findings support an evident short term therapeutic effect of the LLLT on improving VAS, TOI and sEMG in females suffering from myogenous TMD.

Splint therapy as a separate approach in the complex treatment of tem-poromandibular joint dysfunction from the point of view of physiological concepts

BACKGROUND: Among the adult socially active population, one of the most common pathologies of the maxillary system is musculoskeletal dysfunction of the temporomandibular joint (TMJ). One of the modern methods of correction and treatment of TMJ dysfunction is splint therapy, which involves the use of splints and permits to consistently and selectively act on a particular level of disorders: occlusive, muscular, articular. This ultimately forms a new myostatic reflex of holding the jaw, builds physiological biomechanics and neuromuscular activity of the speech apparatus and the stomatognathic system as a whole. AIM: To prove the positive effectiveness of the use of splint therapy from the point of view of physiological concepts in optimizing the neuro- and myofunctional state of the stomatognathic system with an analysis of the effectiveness of the mode of using occlusal splints in patients with TMJ dysfunction. MATERIALS AND METHODS: The treatment was carried out in 34 patients with diagnosed TMJ dysfunction at the age from 17 to 40 years. For the treatment of patients, a relaxing therapeutic and diagnostic articular splint was used. The patients were divided into 2 groups of 17 people each: for the first group of patients, a round-the-clock mode of wearing a splint was set, for the second group, a 16-hour mode was set. The total observation period was 6 months. The criteria for achieving therapeutic goals were considered: absence/reduction of pain in the TMJ and orofacial pain, absence of pain on palpation of the masticatory muscles and in the TMJ, stable position of the lower jaw in the central occlusion, stability and uniformity of movements of the lower jaw at various functional positions, comfort when chewing and at rest, absence/reduction of hypertonicity of the masticatory muscles. RESULTS: The treatment results were evaluated 3 and 6 months after the primary stabilization of the mandible position. At the same time, among the patients of the first group, primary stabilization was achieved on average at the third visit (after 1.5 months from the start of splint therapy), in the second group of patients only at the fourth or fifth visit (after 2–2.5 months). Three months later, all patients of the first group and 8 patients from the second group noted a decrease in pain and orofacial pain, as well as the absence of pain on palpation of muscles and TMJ. Chewing discomfort was observed in 4 patients from the first group and 7 from the second. According to the results after 6 months, all patients were satisfied according to all criteria, all established objective criteria for treatment goals were achieved. CONCLUSIONS: With the correct selection of patients with symptoms indicative of muscle or occlusive dysfunction, splint therapy shows itself as an effective method that allows, with a full understanding of the biomechanics and functional physiology of the occlusal-muscular-articular complex, to effectively correct the neuromuscular state of the stomatognathic system towards it full balance.

Case Report: Digital analysis of occlusion with T-Scan Novus in occlusal splint treatment for a patient with bruxism

Bruxism is a disease with a multifactorial etiology. Its clinical manifestations are most often an unaesthetic smile with abraded tooth surfaces, temporomandibular disorders and muscle hyperactivity. Here we present a case of bruxism where proper articulation of the occlusal splint was performed using the T-scan Novus system. A patient with bruxism underwent treatment with stabilization splint made by 3D printer technology. Intraoral scanning was performed using Trios Color (3Shape), and the digital design was achieved using the 3Shape Dental system design - splint studio. Formlabs Form 2 printer with biocompatible resin Dental LT Clear Resin was used for printing. The T-Scan Novus system with software attached to it, version 9.1, was used for digital examination of the occlusion. A 2.7 mm thick occlusal splint was developed, and the software adapted the occlusion with antagonists. After adjustment with T-Scan Novus, a reduction in disocclusion time of the patient was achieved, which is a desired result in the treatment of bruxism. The position of the joint components was proven radiologically. The treatment of bruxism with splint therapy continues to be the main method of treatment. Using digital technology allows for more accurate constructions and precise balancing of occlusal relationships.

Pain Assessment during Gnathological Treatment of Temporomandibular Myofascial Pain through Mandibular Repositioning Splints Designed after a Posture-Stabilometric Evaluation

The aim of the study is to evaluate the effectiveness of two complementary mandibular repositioning splints (SVED and MORA) designed after a preliminary patients’ posture-stabilometric evaluation in treatment for temporomandibular myofascial pain (TMP) using the Pain-Intensity Numeric Rating Scale (PI-NRS) assessment. Eighty-six consecutive sportive non-agonistic subjects with TMP were randomly divided in two groups. Forty-two wear mandibular repositioning splints designed by a posture-stabilometric evaluation, thus constituting the test group. The other 44 subjects were not subjected to any treatment, thus represented the control group. To record pain intensity, subjects in both groups were asked to fill in a PI-NRS which ranged from 0 (no pain) to 10 (worst imaginable pain). In the test group, PI-NRS was assessed three times: before starting therapy (t0), after 4 months (t1) and after 8 months (t2) of treatment. Instead, in the control group PI-NRS was recorded during the first visit (t0) and after 8 months (t2). The Friedman test showed a statistically significant decrease in PI-NRS mean scores after 4 (t1) and 8 (t2) months from the start of the gnathological therapy with mandibular repositioning splints, (p < 0.001) in test group. There is enough evidence to assess that occlusal splint therapy for mandibular repositioning (MORA and SVED) designed through a posture-stabilometric evaluation could be considered in the treatment of temporomandibular myofascial pain.

Occlusal Splint Therapy Followed by Orthodontic Molar Intrusion as an Effective Treatment Method to Treat Patients with Temporomandibular Disorder: A Retrospective Study

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.