Stabilization Splint (Night Guard, Mouth Guard) Comparative Research MDJ

MDJ Stabilization Splint (Night Guard, Mouth Guard) … Vol.:6 No.
:2 2009
MDJ
Stabilization Splint (Night Guard, Mouth Guard)
Comparative Research
Dr. Kais George Zia B.D.S, M.Sc, Ph.D.
Abstract
This research compares between the effect of flexible and hard stabilization splint
(night guard, mouth guard) in the treatment of patients with tempro-mandibular joint
problems.
Four different categories of patients are used for comparison, each composed of
ten patients. Category number one and two are treated with flexible mouth guard,
while category three and four are treated with hard type of mouth guard for the same
periods of time, one month and three months respectively. Analysis of the results
indicate that patient category treated with soft stabilization splints for longer period of
time show improved treatment and the patients are more relived and willing to
continue the treatment than those treated with hard splints.
Keywords: Stabilization Splint, acrylic resin (hot cure type).
Introduction
Tempromandibular disorder (TMD) etiologic treatment by avoiding
is a common; patients experience undesirable occlusal contacts and
either pain or complain from propping, interferences6.
clicking, and other noises that emanate The aim of this study is to compare
while the tempromandibular joint between the stabilization splints that
(TMJ) is in motion1. are made from hard acrylic with those
Numerous factors may cause pain made from flexible one (custom made),
associated with TMD. A history of for the treatment of TMD.
bruxism, (involuntary clenching and
grinding of teeth usually occurring at Materials and Methods
night), poorly aligned teeth, ill fitting
dentures, trauma and physical and Forty patients (30 female, 10 male),
emotional stresses. It is characterized with age group (20-60 years old) were
by a dull, aching, radiating pain that randomly selected and taken in this
becomes aggravated with jaw research. They were suffering from
movement and function, and may symptoms in the TMJ and who had
involve limited mouth opening 1, 2,3,4,5. visited private clinic in Al Solaimanya
The most widely and common for this reason.
treatment employed for TMD is the All patients suffer from clicking
stabilization splint, which protects the and limited mouth opening and pain,
teeth in patients with bruxism and the clinical examination was dependent
improve jaw muscle and TMJ function on case history and palpitation of TMJ
and relive related pain. It acts as done by one operator to decrease
159
MDJ Stabilization Splint (Night Guard, Mouth Guard) … Vol.:6 No.:2 2009
variables. Two types of mouth (night) flasking in a manner that simulate the
guard were made for 40 patients thicknesses of prefabricated cakes of
divided into four categories, ten the flexible mouth guard.
patients each, category numbers one All patients were advised to apply
and two were made from flexible the splint during night, in each follow
materials by the use of Biostar device up the occlusal contacts were checked
as shown in Figure (1). and adjusted. In all follow up visits
And category numbers three and clinical examination was performed in
four were made from hard acrylic, for order to evaluate effect of guard
the same periods of time, one month therapy as tooth loosening, tooth
and three months respectively. Both intrusion and sensitivity on biting all
types were custom made, in four stages were checked as if present they were
as shown in Figure (2). considered as side effect. All
1. Impression and model. examinations were done by one
2. Fabrication. investigator.
3. Trimming.
4. Delivery. Results
The categories were divided as All the selected groups were
follows: suffering from limited mouth opening
1. Category No.1 consisted from 8 at the first clinical examination and
female and 2 male age range (25- were randomly selected.
55). Measurements were taken by the
2. Category No.2 consisted from 6 use of digital vernier as shown in
female and 4 male age range (30- Figure (4), for all categories with and
60). without stabilization splint. For
3. Category No.3 consisted from 6 categories one and three measurements
female and 4 male age range (20- were taken for every week until the
50). end of month, while for categories two
4. Category No.3 consisted from 8 and four measurements were taken
female and 2 male age range (20- after first week and then every month
60). until the end of the forth visit. The
mean difference and standard deviation
All patients showed history of of all categories are shown in Table
psychological diagnosis like low (1).
perceived life control. The After application of t-test,
night guards that all patients received significant differences appeared
cover the whole upper dental arch to between all categories especially
the level of the cervical gingiva as between category one and three and
shown in Figure (3), care was taken between two and four as shown in
that all mouth guards were properly Table (2). All categories did not show
fitted and the occlusal contact during teeth mobility after the end of study.
static occlusion was checked For Analysis of Variance
intraorally for balance. (ANOVA) Table (3), the results show
For the flexible mouth guard two significant difference for categories
thickness cakes were used 2mm, for (1,3), (3,4), and (2,4) except for
one month and 4mm for three month categories (1,2) which shows non
period time, while for the hard acrylic significant difference.
the occluding thickness was
determined during packing and
160
Discussion reversible therapy for TMD patients

and can reduce pain in most cases.
The present study compare two
types of stabilization splints, one made
Conclusion
from hard acrylic and one made from
soft material in treatment of patients The present study allowed the
with TMD. This study came in conclusion that soft stabilization splints
agreement with nearly all previous are better than hard acrylic splints in
ones, as the application of stabilization reducing sign and symptoms of
splint will reduce the symptoms of etiologic factors of the TMD,
TMD and helps in improving the especially in prolonged treatment time
opening and closing of the oral cavity, than short treatment time.
because of its tried protective
properties5. Stabilization splints are References
employed to provide a balanced
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redistribute the forces applied to the Temporomandibular Disorders in Primary
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and decrease the bruxism6. Nelson D, Sauer J. and Stefonek T. Mouth
Considering the results in Table (2) Guard for Treating Bruxism with
and Table (3), it can be stated that Electrostimulation. Biomedical
there was significant difference Engineering. 2001; 3-27.
3- Gavish A, Winocur E, Ventura Y,
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as the prolonged treatment gives better stabilization Splint Therapy on Pain
out coming results than short ones and during Chewing in Patients Suffering from
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better than the hard acrylic. This study 1181-1186.
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agreed with7, in that a hard acrylic Naeije M. Dental Implants in Patients with
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clinical results than soft splints. 152–159.
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showed a positive outcome in TMD Avoort P, Wicks D, Hamburger H. and
Naeije M. Effects of Pergolide on Severe
treatment need which agrees with this Sleep Bruxism in a Patient Experiencing
study and also showed disagreement Oral Implant Failure. J. Oral. Rehab,
with Ekberg et al as revealed in8. 2007; 34: 317–322.
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that the use of stabilization splint has Stabilization Appliance. Evaluation of its
Efficacy in the Treatment of
the effect of reducing the hyperactivity Temporomandibular Disorder. J. Appl.
and the asymmetry in the activity of Oral. Sci 2004;12 (3): 238-243.
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al, Lobbezoo et al, and Visser et al, all Management of Patients with Masticatory
Muscle Pain: A Qualitative Systematic
showed a decrease in nocturnal muscle Review. Clin Oral Invest. 2004; 8: 179–
activity after insertion of stabilization 195.
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This study also came in agreement Occlusal Appliance Therapy in Secondary
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with12, and13, as the stabilization splint Disorders. Acta Odontol Scand. 2002; 60:
are considered conservative and 248-254.
161
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Oral. Rehab. 2005; 32: 474-479. Stabilization Splint on Masticatory Muscle
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Table (1): shows the mean and standard deviation of all categories.
Categories Mean Standard deviation
Category 1 33.0525 1.6954
Category 3 30.6075 0.9846
Category 2 33.375 1.5017
Category 4 31.1825 1.4073
Table (2): shows the significance of differences between all categories.

Categories *P-value Confidence Interval Significance level
1,3 0.0112 1.0586 3.8314 S
1,2 0.0298 -1.4302 -0.1398 S
3,4 0.1011 -0.2065 -1.3565 NS
2,4 0.0194 0.8136 4.4964 S
*P-value according to Student’s t-test.
(P > 0.05) significant difference (S).
(P < 0.05) not significant differences (NS).
Table (3): shows the significance of differences between all categories.

Categories ss Df Ms F P
11.9561 1 11.9561 6.22 0.0469 S
1,3 11.5314 6 1.9219
23.4874 7
1.2325 1 1.23245 0.48 0.5141 NS
1,2 15.3882 6 2.56469
16.6206 7
14.0891 1 14.0891 6.66 0.0114 S
2,4 12.707 6 2.1178
26.805 7
0.66125 1 0.66125 0.45 0.5281 S
3,4 8.85015 6 1.47502
9.5114 7
ss= sum of squares.
df= degree of freedom.
Ms= mean square.
F= ratio.
P= probability.
162
Figure (1): Biostar device used for

fabrication of flexible mouth guard.
Figure (2): Flexible and hard mouth guards respectively.
Hard
Soft
Figure (3): Some random selection of patients with hard and soft stabilization splint.
Figure (4): Digital vernier caliper
163

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MDJ Stabilization Splint (Night Guard, Mouth Guard) … Vol.:6 No.

Dr. Kais George Zia B.D.S, M.Sc, Ph.D.

Keywords: Stabilization Splint, acrylic resin (hot cure type).

Discussion reversible therapy for TMD patients

9- Steisch-Scholz M, kempert J, Wolter S, Masticatory Muscle Disorders. Journal of

Table (2): shows the significance of differences between all categories.

Table (3): shows the significance of differences between all categories.

Figure (1): Biostar device used for

Figure (2): Flexible and hard mouth guards respectively.

Figure (4): Digital vernier caliper

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