Effectiveness of anterior repositioning splint versus other occlusal splints in the management of temporomandibular joint disc displacement with reduction: A meta-analysis.

BACKGROUND: Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc-condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients. AIM: The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc-condyle relationship. MATERIALS AND METHODS: We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software. RESULTS: A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04-5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31-5.95) and long term (MD 0.00, 95% CI-2.86-2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level. CONCLUSION: Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor.

Effect of a centric stabilization splint on masticatory muscles in patients with temporomandibular disorders: An electromyographic study.

AIM: Occlusal splint treatment is commonly used to treat a variety of temporomandibular disorders (TMDs), with efficacy ranging between 70% and 90%. Centric splints are effective in relieving muscular soreness in individuals with TMD. Electromyography (EMG) quantifies muscle activity and can be used as an accessory diagnostic tool to evaluate the efficiency of the splint on the masticatory complex. Electromyography is used for assessing patients with TMD and observing muscle electromyography. TMD patients have altered electromyographic (EMG) masticatory muscle activity because of its change in electrical activity index or because of the compensatory mechanism for the disorder. Therefore, this study serves to evaluate the efficacy of the centric stabilization splint on TMD using EMG. SETTINGS AND DESIGN: This cross-sectional study enrolled Ten TMD Patients with TMD, who underwent treatment with centric stabilization splint. MATERIALS AND METHODS: The study involved ten young adults with TMD aged 18-45 years who were recruited without regard to sex, religion, caste, or socioeconomic background. The participants were randomized to receive a flat-contact upper stabilization splint and pregelled EMG electrodes to assess the immediate impact of centric splints on TMDs. After 3 months of follow-up, muscle activity and muscle symmetrical activity were measured to assess improvement in the symptoms of TMD. STATISTICAL ANALYSIS USED: The Shapiro-Wilk test was used to assess the normality of the variables' distribution using SPSS 26.0. Symmetrical activity and treatment response were investigated using the Wilcoxon signed-rank test. RESULTS: It showed an improvement in the temporalis, masseter, and sternocleidomastoid muscles' resting EMG activity. A statistically significant improvement was seen in the EMG activity of the bilateral temporalis, right masseter, right sternocleidomastoid, and left digastric muscles while clenching. The masseter, sternocleidomastoid, and digastric muscles all displayed significantly enhanced symmetrical activity (P < 0.05). CONCLUSIONS: This research concludes that a centric stabilizing splint assists in relieving TMD symptoms. There was enhanced masticatory muscle activity both at rest and during function. Furthermore, there was an improvement in symmetrical activity of the masticatory muscles, which improved balance and enhanced the effective functioning of the masticatory complex.

Sepsis among Patients Admitted to the Intensive Care Unit of a Tertiary Care Centre.

Introduction: Sepsis is a life-threatening dysfunction and is one of the common causes of admission in intensive care units. Early diagnosis and management improves the outcome of patients. The aim of this study was to find out the prevalence of sepsis among patients admitted to the intensive care unit of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the intensive care unit of a tertiary care centre after obtaining ethical approval from the Institutional Review Committee. Data of patients admitted from 1 February 2022 to 31 January 2023 was collected between 6 April 2023 to 27 April 2023. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 1001 patients, the prevalence of sepsis was 278 (27.77%) (25-30.54, 95% Confidence Interval). Among them, 209 (75.17%) developed septic shock. The mean age was 56.6±19.34 years. Pneumonia 43 (15.46%) and genitourinary infection 43 (15.46%) were the most common sources of infection and the source was unknown in 124 (44.60%) of patients. Hypertension 75 (26.97%) was the most common comorbidity. Acute kidney injury 166 (59.71%) was the most common complication followed by thrombocytopenia 165 (59.35%) and transaminitis 79 (28.41%). Conclusions: The prevalence of sepsis among patients admitted to the intensive care unit was higher than other studies done in similar settings. Keywords: infection; intensive care unit; sepsis; tertiary care centre.

Socket shield technique: An unconventional method for immediate implant placement - A review.

The aim of this review is to present the currently available studies on the treatment outcome of socket shield technique (SST) with an attempt to compare it with the conventional technique for immediate implant placement. An electronic search was performed using PubMed, Google Scholar, and Cochrane databases. All relevant human studies reporting the treatment outcome of SST in conjunct with immediate implant placement were included. In vitro studies, case reports, reviews, systematic reviews and articles not related to SST were excluded. The initial electronic database search identified 606 articles. After removing the duplicates, reading the titles and abstracts, 19 articles were eligible for full-text reading. Two case series were excluded as the specific treatment outcomes of the clinical cases were not mentioned. Further, one article was included after hand searching of the reference lists. Eighteen articles were included for the final review. These 18 articles consisted of 15 full texts and 3 abstracts. Out of them, 3 were randomized controlled trials, 7 were retrospective studies, 4 were prospective studies, 1 was a prospective case series, 1 was a prospective nonrandomized controlled study and 2 were comparative studies. This review concludes that though the implant survival rate may be comparable in SST and the conventional technique, the SST seems to perform better in terms of bone preservation, esthetic outcome, and patient satisfaction. Furthermore, further randomized clinical trials are required to generate strong evidence for recommending SST over the conventional technique for long-lasting successful treatment outcomes with immediate implants.

History of Pivot Teeth - Artificial Crowns upon Natural Roots.

Dentistry in the 18th and 19th century witnessed the development of a variety methods for attaching artificial crowns to natural roots (many known as pivots), the purpose being to provide a dental restoration that created the most natural appearance, in a simple and economical manner. The present article discusses and summarizes the historical 18th and 19th century pivot teeth.

Bone augmentation as an adjunct to dental implant rehabilitation in patients with diabetes mellitus: A review of literature.

The aim of the present article is to review the success of bone augmentation performed as an adjunct to dental implant rehabilitation in patients with diabetes mellitus. A literature review was conducted in PubMed on this topic, which yielded a total of 102 publications. For inclusion, publications had to be human studies, written in English language and should report on the success of bone augmentation as an adjunct to dental implant rehabilitation in diabetic patients. After screening the titles and abstracts, 11 full texts publications were obtained, of which seven were included in the review. These studies provided data on various bone augmentation techniques such as sinus floor elevation (SFE), guided bone regeneration (GBR), and onlay bone grafting. Even though the current review revealed that there are not many studies reporting data relevant to the analyzed topic, the data obtained suggests that; (1) staged GBR technique should be considered more feasible and predictable for bone augmentation, (2) clinicians must take meticulous care when planning and conducting SFE, and (3) block bone augmentation technique should be avoided.

Occlusal concepts in full mouth rehabilitation: an overview.

Restoration of occlusion in patients with severely worn dentition is a challenging situation as every case is unique in itself. There is great apprehension involved in reconstructing debilitated dentition due to widely divergent views concerning the choice of an appropriate occlusal scheme for successful full mouth rehabilitation. This article is an overview of the various occlusal concepts/philosophies in full mouth rehabilitation which will help the clinician select an appropriate occlusal scheme for an individual case.

Type 2 diabetes and edentulism as chronic co-morbid factors affecting Indian elderly: an overview.

In past 50 years, type 2 diabetes has emerged as one of the major public health problem. India leads the world with the largest number of diabetic patients and has a huge elderly population. The present article discusses the effect of diabetes and edentulism on the overall general health of elderly. The prevalence of type 2 diabetes and edentulism in Indian elderly and their inter-relationship has been discussed. Dentists must provide optimum oral care with special attention towards comprehensive periodontal management and oral hygiene awareness among diabetics to prevent tooth loss. Dental and medical professionals can improve patient management of the oral and overall effects of diabetes by implementing various awareness programs; organizing camps; distributing informative pamphlets and dietary counseling. Dentists can detect undiagnosed cases of diabetes and refer patients to physicians for further evaluation and management.