A Pragmatic Approach to the Management of Severe Awake Bruxism in an Adolescent with Cerebral Palsy and Global Developmental Delay

Cerebral palsy is a neurological and motor condition characterised by muscle balance and posture impairments. Bruxism and malocclusion were frequently observed in patients with cerebral palsy, in contrast to other oral anomalies. The report outlines how severe awake bruxism is managed in a 16-year-old Korean boy who has nonverbal spastic cerebral palsy and global developmental delay. The treatment protocol involved the fabrication of soft occlusal splints of three and four millimetres in thickness, followed by the placement of stainless-steel crowns on all first permanent molars whilst video recording and a bruxism diary was kept. Fixed restorations demonstrate increased endurance in withstanding bruxism force in persons who are dependent on their caretaker.

3Shape Digital Design Software in Splints Creation—A Pilot Study

Objectives Digital technologies have widened their horizons into the world of dental medicine and now further expanding to cover all branches. This new modern technology replaces traditional laboratory techniques allowing effective patient care. Patients who suffer from bruxism—the act of involuntary habitual grinding of teeth—have widely been benefited by splint treatments. The aim of this article is to display the variety of occlusal splints that can be created by the 3Shape Digital Design Software and their application in specific clinical situations. Materials and Methods Six variations in the splints were created digitally—three with uncombined designs and the remaining three with a combination of two of the main options available. During this study, 36 splints were made for patients aged 24 to 55 inclusively. Results The largest number of splints according to the clinical picture were made of “raise to antagonist cusp tips” (14 pieces) and the remaining were of combined type “raise to antagonist cusp tips + raise to antagonist plane” (12 pieces). There thickness was within the range of 1.5 and 5 mm. Conclusion 3Shape Digital Design Software—Splint Studio is a suitable system for designing and creating occlusal splints with respect to certain clinical situations. It is possible to combine the three main types in a separate section of the dental arch according to the case.

Software Details in Occlusal Splint Creation through 3Shape Design Studio

Introduction: Occlusal splints are usually the first choice in the treatment of bruxism. Splints can also be the only treatment or can be ended with adhesive restoration, orthodontic or prosthetic treatment. Methods: This article demonstrates the steps of a digital workflow through the 3Shape Design system - splint studio. The initial units are virtual models, scanned by Trios Color Scanner (3Shape). Results: The digital protocol includes eight steps that allow precise and detailed creation of the searched object. Each step is described from the perspective of a clinician, prosthetist and orthodontist, not a dental technician. Possible complications and ways to management with them are described. Conclusion: Digital protocol of occlusal splint creation gives many opportunities according to design, thickness and occlusion.

Surgical treatm ent of dento maxillary anomalies class III angle. Clinical case

Dento-maxillary anomalies are relatively widespread among the population, eventually leading to serious psychological and lifestyle deterioration. The purpose of this paper is to evaluate the complex orthodontic-surgical treatment in the dento-maxillary anomaly class III Angle. We aim to present the clinical case of a female patient suffering from skeletal third-class, gnathic form, who came to „Omni Dent” clinic in order to complete the second stage of associate orthodontic and surgical treatment. Medical investigations: OPG, CBCT, TRG, digital scanning, dental photography, digital programs, used at collecting data for virtual planning, establishing a complex diagnosis and choosing the best surgical technique for this case, subsequently, with the transfer of the virtual plan in the operating room through surgical guides and occlusal splints. Postoperatively, there was an obvious improvement of the facial appearance, supported by the comparison of pre- and postoperative cephalometric indices: SNA (from 76,6° to 84°), SNB (from 80,6° to 78,8°), ANB (from -4° to 5,2°), Wits (from -9,6° to 0°). Early diagnosis and detailed planning by using modern methods of examination may ensure an efficient rehabilitation of patients suffering from dento-maxillary anomalies.

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.

Occlusal Splints and Exercise Performance: A Systematic Review of Current Evidence

The role of the dento-mandibular apparatus and, in particular, occlusion and jaw position, received increased attention during last years. In the present study, we aimed to systematically review, on the light of the new potential insights, the published literature covering the occlusal splint (OS) applications, and its impact on exercise performance. A structured search was carried out including MEDLINE®/PubMed and Scopus databases with additional integration from external sources, between March and June 2021. To meet the inclusion criteria, studies published in the English language, involving humans in vivo, published from 2000 to 2021 and that investigated the role of occlusal splints on athletes’ performance were selected. Starting from the 587 identified records, 17 items were finally included for the review. Four main aspects were considered and analyzed: (1) occlusal splint characteristics and occlusion experimental conditions, (2) jump performance, (3) maximal and explosive strength, and (4) exercise technique and biomechanics. The results of the systematic literature analysis depicted a wide heterogenicity in the experimental conditions and suggested the application of the OS as a way to improve athletes’ or individuals’ oral health, and as a potential tool to optimize marginal aspects of exercise performance.