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Occlusal splints: A critical assessment of their use in prosthodontics
cases. Long-term assessment through the entire growth period is being done to determine the ultimate success of the method employed. T. M. Graher
Effect of Experimental Tooth Movement on the Mechanical Strength of the Periodontium in the Rat Mandibular First Molar M. Tsuruta, S. Ohkawa, Y. Nakatani, Y. Kuwahara, and M. Chiba Arch.
Oral Biol.
27:875-879.
1982
A total of ninety-four rats made up the experimental sample used for testing the mechanical strength of the periodontal ligament. Latex rubber bands (Unitek 404-156) were inserted between the mandibular first and second molars to produce tooth movement. The mechanical strength of the periodontium was assessed by extracting the first molar 0, 1, 2, and 4 days later from the socket in the dissected jaw. The fifth group served as a control. From the first to the fourth day, the extraction loads decreased markedly, while the interdental space remained about the same. About 5 minutes after elastic insertion, the ultimate load was not significantly changed and the interdental space was greatly reduced. Restoration of the mechanical strength of the periodontium occurred gradually after removal of the elastic. Recovery was complete on the fourth day. Restoration of the original interdental space was most marked in the first 24 hours. The forces exerted on the teeth were of the order of several tens of newtons initially and were reduced to a few newtons after tooth movement. It is suggested that the decrease in the ultimate extraction loads was caused by changes in the constitution of the periodontal collagen, by the disorganization of the periodontal structures, and by the loosening of the attachment of the periodontal fibers to the bone. T. M. Graber
Oraie Physiotherapie-Eine Zusatzliche hilfe fur Myoarthopathie-patienten (Oral Physiotherapy-A Supplementary Help Program for TMJ Myoarthropathy patients) P. Wiehl Schweiz.
Monatsschr.
Zahnheilkd.
93:235-247,
1983
Myofascial pain dysfunction syndrome has many obscure aspects, and the etiology is not always apparent. Pain elimination may rely on more than one form of therapy. Splints, occlusal equilibration, and medication all have their place in the total therapeutic correc-
tion. However, one useful adjunct is oral physiotherapy. A comprehensive exercise regimen has been developed and is used at the University of Base1 Dental School. As the author notes, he has reason to believe that such exercises can and do influence the neurovegetative systern favorably. This is in spite of the fact that emotional and psychic factors may be significantly involved. The effective myogymnastic program (oral gymnastics) is used to relieve pain, muscle spasm, and restriction of jaw movement. Excellent patient photographs illustrate the supra-eyebrow massage and the manipulation of the masseter. temporalis, digastric. medial, and lateral pterygoid muscles. Mouth-opening procedures with tongue exercises are also illustrated. as are protractive and excursive mandibular movements to relax the two heads of the lateral pterygoid muscle. The routine is compared with that prescribed by other authors in the field (Schulte, Graber, Harrer, Doms, Kott, Steiger, Ramfjord and Ash, Motsch, etc.). T. M. Grabcr
Occlusal Splints: A Critical Assessment of Their Use in Prosthodontics I. Klineberg Aust. Dent. .I. 28:1-X,
19X3
Splints are an essential aid in diagnosis and treatment planning for occlusal dysfunctions. The prime purpose is to disclude selected teeth so as to provide bilaterally balanced jaw support in the retruded position (RP) and bilateral simultaneous contacts on anterior and posterior teeth in the median occlusal position (MOP), according to the author. He prefers heat-cured acrylic and recommends coverage of the lingual and occlusal surfaces as well as 2 to 3 mm. of the labial and buccal surfaces of the teeth involved. The splint should have sufficient bulk to permit appropriate adjustment on the occlusal aspects. The physiologic and psychological effects in relation to jaw function must be recognized, and their influence on general muscle performance should be interpreted with care. Specifically, the splint should (1) provide for the possibility of change in jaw position to a more harmonious relationship of the temporomandibular joint and muscles; (2) allow jaw muscles to re-establish a coordinated pattern of activity in the absence of the influence of tooth guidance; (3) allow jaw manipulation to be carried out more easily and thus provide the opportunity for jaw registration to be made correctly; (4) allow resolution of muscle hyperactivity and spasm and thus promote the re-establishment of adequate blood flow and a return to normal muscle metabolism. The author recognizes the occasional need for long-term wear in chronic cases of parafunction.
Volume Number
84 2
Reviews und abstracts
Short-term splint wear should cause no irreversible effects. In general, the full-arch, flat-plane splint is preferred, and it shouldbe designedto cover all maxillary or m a n d ibularteeth, providing a flat-planecontact for opposingcuspsat retrudedposition, with simultaneous bilateral contactson posterior teeth. G u idancemay be built in for anterior teeth on lateral and protrusive movements,and simultaneousbilateral contactsaround the arch on the anterior and posterior teeth should be presentin m e d ianocclusal position.
AA0
MEETING
179
The techniqueof making splints is illustrated and carefully described,as well as the fitting and management of splint therapy. The physiologic effects of splints are discussed.Where there are intra-articular derangements,such as an anterior disk displacement, an anterior repositioningsplint is recommendedand a different constructionis required. In such cases, the hinge axis registrationwould not be appropriate.
CALENDAR
1984-Kansas City, Missouri, May 13 to 16, Kansas City Convention Center 1985-Las Vegas, Nevada, May 5 to 9, Las Vegas Convention Center 1986-Chicago, Illinois, May 10 to 14, Hyatt Regency Hotel 1987-Montreal, Canada, May 10 to 13, Le Palais des Congress’de Montreal 1988-New Orleans, Louisiana, April 29 to May 4, New Orleans Convention Center
T. M. Graber
Effect of Experimental Tooth Movement on the Mechanical Strength of the Periodontium in the Rat Mandibular First Molar M. Tsuruta, S. Ohkawa, Y. Nakatani, Y. Kuwahara, and M. Chiba Arch.
Oral Biol.
27:875-879.
1982
A total of ninety-four rats made up the experimental sample used for testing the mechanical strength of the periodontal ligament. Latex rubber bands (Unitek 404-156) were inserted between the mandibular first and second molars to produce tooth movement. The mechanical strength of the periodontium was assessed by extracting the first molar 0, 1, 2, and 4 days later from the socket in the dissected jaw. The fifth group served as a control. From the first to the fourth day, the extraction loads decreased markedly, while the interdental space remained about the same. About 5 minutes after elastic insertion, the ultimate load was not significantly changed and the interdental space was greatly reduced. Restoration of the mechanical strength of the periodontium occurred gradually after removal of the elastic. Recovery was complete on the fourth day. Restoration of the original interdental space was most marked in the first 24 hours. The forces exerted on the teeth were of the order of several tens of newtons initially and were reduced to a few newtons after tooth movement. It is suggested that the decrease in the ultimate extraction loads was caused by changes in the constitution of the periodontal collagen, by the disorganization of the periodontal structures, and by the loosening of the attachment of the periodontal fibers to the bone. T. M. Graber
Oraie Physiotherapie-Eine Zusatzliche hilfe fur Myoarthopathie-patienten (Oral Physiotherapy-A Supplementary Help Program for TMJ Myoarthropathy patients) P. Wiehl Schweiz.
Monatsschr.
Zahnheilkd.
93:235-247,
1983
Myofascial pain dysfunction syndrome has many obscure aspects, and the etiology is not always apparent. Pain elimination may rely on more than one form of therapy. Splints, occlusal equilibration, and medication all have their place in the total therapeutic correc-
tion. However, one useful adjunct is oral physiotherapy. A comprehensive exercise regimen has been developed and is used at the University of Base1 Dental School. As the author notes, he has reason to believe that such exercises can and do influence the neurovegetative systern favorably. This is in spite of the fact that emotional and psychic factors may be significantly involved. The effective myogymnastic program (oral gymnastics) is used to relieve pain, muscle spasm, and restriction of jaw movement. Excellent patient photographs illustrate the supra-eyebrow massage and the manipulation of the masseter. temporalis, digastric. medial, and lateral pterygoid muscles. Mouth-opening procedures with tongue exercises are also illustrated. as are protractive and excursive mandibular movements to relax the two heads of the lateral pterygoid muscle. The routine is compared with that prescribed by other authors in the field (Schulte, Graber, Harrer, Doms, Kott, Steiger, Ramfjord and Ash, Motsch, etc.). T. M. Grabcr
Occlusal Splints: A Critical Assessment of Their Use in Prosthodontics I. Klineberg Aust. Dent. .I. 28:1-X,
19X3
Splints are an essential aid in diagnosis and treatment planning for occlusal dysfunctions. The prime purpose is to disclude selected teeth so as to provide bilaterally balanced jaw support in the retruded position (RP) and bilateral simultaneous contacts on anterior and posterior teeth in the median occlusal position (MOP), according to the author. He prefers heat-cured acrylic and recommends coverage of the lingual and occlusal surfaces as well as 2 to 3 mm. of the labial and buccal surfaces of the teeth involved. The splint should have sufficient bulk to permit appropriate adjustment on the occlusal aspects. The physiologic and psychological effects in relation to jaw function must be recognized, and their influence on general muscle performance should be interpreted with care. Specifically, the splint should (1) provide for the possibility of change in jaw position to a more harmonious relationship of the temporomandibular joint and muscles; (2) allow jaw muscles to re-establish a coordinated pattern of activity in the absence of the influence of tooth guidance; (3) allow jaw manipulation to be carried out more easily and thus provide the opportunity for jaw registration to be made correctly; (4) allow resolution of muscle hyperactivity and spasm and thus promote the re-establishment of adequate blood flow and a return to normal muscle metabolism. The author recognizes the occasional need for long-term wear in chronic cases of parafunction.
Volume Number
84 2
Reviews und abstracts
Short-term splint wear should cause no irreversible effects. In general, the full-arch, flat-plane splint is preferred, and it shouldbe designedto cover all maxillary or m a n d ibularteeth, providing a flat-planecontact for opposingcuspsat retrudedposition, with simultaneous bilateral contactson posterior teeth. G u idancemay be built in for anterior teeth on lateral and protrusive movements,and simultaneousbilateral contactsaround the arch on the anterior and posterior teeth should be presentin m e d ianocclusal position.
AA0
MEETING
179
The techniqueof making splints is illustrated and carefully described,as well as the fitting and management of splint therapy. The physiologic effects of splints are discussed.Where there are intra-articular derangements,such as an anterior disk displacement, an anterior repositioningsplint is recommendedand a different constructionis required. In such cases, the hinge axis registrationwould not be appropriate.
CALENDAR
1984-Kansas City, Missouri, May 13 to 16, Kansas City Convention Center 1985-Las Vegas, Nevada, May 5 to 9, Las Vegas Convention Center 1986-Chicago, Illinois, May 10 to 14, Hyatt Regency Hotel 1987-Montreal, Canada, May 10 to 13, Le Palais des Congress’de Montreal 1988-New Orleans, Louisiana, April 29 to May 4, New Orleans Convention Center
T. M. Graber