Effects of respiratory exercises in sleep bruxism and associated obstructive sleep apnea: a double-blind, placebo-controlled randomized clinical trial.

PURPOSE: The aim of this study is to assess the effects of respiratory exercises (inspiratory and expiratory) in individuals with sleep bruxism (SB) and associated obstructive sleep apnea (OSA). METHODS: This is a double-blind, placebo-controlled randomized clinical trial including individuals with SB and associated respiratory events in OSA. Respiratory physical therapy was performed using inspiratory (Threshold® IMT), expiratory (Threshold® PEP) muscle training, and compared with a placebo group. A total of 30 daily respiratory cycles (inspiration and expiration) were performed five times a week for 12 weeks. Individuals were reassessed at two times, at baseline (T1) and after 12 weeks of training (T2) by means of the Pittsburgh Sleep Quality Index and Polysomnography. RESULTS: Awakening was significantly different (p ≤ 0.05) between the inspiratory group and placebo 12 weeks after respiratory physical therapy. The number of contractions of the masseter muscle differed between the inspiratory, expiratory, and placebo groups (p ≤ 0.05). CONCLUSION: Respiratory physical therapy for OSA improved awaking levels in 80 and 67% of the number of masseter muscle contractions, when compared to placebo. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (No. RBR-9F6JKM).

Sleep bruxism: The past, the present, and the future-evolution of a concept.

BACKGROUND: The concept of sleep bruxism (SB) has evolved exponentially over the past several decades. Many theories and hypotheses have been proposed as to the definition, pathophysiology, and management of SB, from the early 1960s through the present. The role of peripheral factors, such as dental occlusion, in the pathogenesis of SB has been discarded. TYPES OF STUDIES REVIEWED: The authors searched several electronic databases (ie, PubMed, Google Scholar, Web of Science, Embase, and Ovid MEDLINE) for studies on bruxism. The search was conducted from January 1961 through May 2023 and yielded 4,612 articles, of which 312 were selected for comprehensive review after eliminating duplicates and nonfocused articles. RESULTS: There has been an evident progressive shift from the role of peripheral factors, such as dental occlusion, to more central factors, such as the involvement of a central pattern generator as well as the autonomic nervous system, in the genesis of bruxing movements. There is continued robust interest in the dental community to elucidate the contributing factors involved in SB. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The neurophysiology of SB appears to be leaning more toward central rather than peripheral factors. There is increasing evidence of the role of the autonomic nervous system, genetics, and comorbidities in the genesis of SB. The scientific literature seems to refute the role of dental occlusion in the causation of bruxing movements. As per the literature, there has been a paradigm shift in the definition and genesis of SB and its possible dental implications and management, which also highlights the need for succinct scientific studies in this regard.

Comparative analysis of different types of occlusal splints for the management of sleep bruxism: a systematic review.

BACKGROUND: Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including occlusal splints, have been used to manage sleep bruxism and temporomandibular disorders, including occlusal splints. This study aimed to compare the effectiveness of different occlusal splints in managing sleep bruxism. METHODS: The PICO framework encompasses the characterization of the population, intervention, comparison, and pertinent outcomes. A comprehensive and systematic literature review was conducted on PubMed, Scopus, and Google Scholar to identify grey literature. The search specifically targeted scientific studies published before September 20, 2023. The Cochrane Collaboration Risk of Bias Tool assessed the accuracy of the included Randomized Control Trials (RCTs). The modified Newcastle-Ottawa Scale assessed non-randomized studies. Data were systematically extracted, synthesized, and reported thematically. RESULTS: Out of the total of 808 articles that were evaluated, only 15 articles were found to meet the specified inclusion criteria. Adjustable splints, such as full-occlusion biofeedback splints, were more effective in reducing sleep bruxism episodes, improving patient-reported symptoms, and enhancing overall well-being. The impact of different occlusal sprints on electromyographic activity varies, and potential adverse effects should be considered individually. CONCLUSIONS: This review provides valuable insights into the effectiveness of occlusal splints in managing sleep bruxism. The results of this study indicate that occlusal splint therapy is a viable treatment approach for sleep bruxism.

Research routes on awake bruxism metrics: Implications of the updated bruxism definition and evaluation strategies.

BACKGROUND: With time, due to the poor knowledge on it epidemiology, the need to focus on awake bruxism as a complement of sleep studies emerged. OBJECTIVE: In line with a similar recent proposal for sleep bruxism (SB), defining clinically oriented research routes to implement knowledge on awake bruxism (AB) metrics is important for an enhanced comprehension of the full bruxism spectrum, that is better assessment and more efficient management. METHODS: We summarised current strategies for AB assessment and proposed a research route for improving its metrics. RESULTS: Most of the literature focuses on bruxism in general or SB in particular, whilst knowledge on AB is generally fragmental. Assessment can be based on non-instrumental or instrumental approaches. The former include self-report (questionnaires, oral history) and clinical examination, whilst the latter include electromyography (EMG) of jaw muscles during wakefulness as well as the technology-enhanced ecological momentary assesment (EMA). Phenotyping of different AB activities should be the target of a research task force. In the absence of available data on the frequency and intensity of wake-time bruxism-type masticatory muscle activity, any speculation about the identification of thresholds and criteria to identify bruxers is premature. Research routes in the field must focus on the improvement of data reliability and validity. CONCLUSIONS: Probing deeper into the study of AB metrics is a fundamental step to assist clinicians in preventing and managing the putative consequences at the individual level. The present manuscript proposes some possible research routes to advance current knowledge. At different levels, instrumentally based and subject-based information must be gathered in a universally accepted standardised approach.

Awake bruxism in temporomandibular disorders patients referred to tertiary care: A retrospective study on its assessment and TMD management.

BACKGROUND: Bruxism is defined as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can occur during sleep (sleep bruxism, SB) or during wakefulness (awake bruxism, AB). To date, the effect of AB on the purported negative consequences of bruxism has remained unclear. OBJECTIVES: The assessment of AB, its relation to temporomandibular disorders (TMD) treatment modalities, and their possible outcomes were investigated among TMD patients resistant to treatment in primary care and referred to a tertiary care clinic. METHODS: The records of 115 patients were studied. Patients were referred to the Head and Neck Centre, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, for TMD treatment between 2017 and 2020. The data derived from the eligible patients' records included the following: background data (age and sex), referral data (reason and previous treatment), medical background (somatic and psychiatric), clinical and possible radiological diagnoses at a tertiary care clinic, treatment modalities for masticatory muscle myalgia, bruxism assessment, its possible treatment modalities and their outcomes, and overall management outcome. We analysed the outcomes of single treatment modalities and combined groups of modalities. For the demographic data, the Chi-squared test and Fischer's Exact test were used to determine the associations between the categorical variables. A Sankey-diagram was used to describe the flow of treatment. RESULTS: Temporomandibular joint-pain-dysfunction syndrome (K07.60) was the most frequent single reason to refer a patient to tertiary care (17.4%). At referral, men had myalgia (M79.1) significantly more often (p = .034) than women. Similarly, men had depression (p = .002) more often and other psychiatric diagnoses (p = .034). At tertiary care, the presence of AB was assessed in 53.9%, and self-reported AB was recorded in 48.7%. In patients with possible AB, those who were prescribed neuropathic pain medication showed significantly less improvement in symptoms (p = .021) than those who underwent splint therapy (p = .009). Overall, half of the patients showed overall improvement in their TMD symptoms from the treatment combinations. CONCLUSION: Despite several treatment modalities, only half of the patients showed improvement in their symptoms in the present study. A standardised assessment method encompassing all factors contributing to bruxism behaviours and their consequences is suggested.

Sleep bruxism in children and adolescents-A scoping review.

BACKGROUND AND OBJECTIVE: This review paper focuses on sleep bruxism (SB) in children and adolescents. It aims to assess the landscape of knowledge published in the last 20 years. METHODS: A total of 144 relevant publications from 386 previously identified through Medline were included, of which 83 were on possible SB, 37 on probable SB, 20 on definite SB and 4 were non-applicable. The review places emphasis on the recent evidence on prevalence, pathophysiology, diagnosis and management of SB in children and adolescents, with special focus on probable and definitive SB. RESULTS: The prevalence ranges from 5% to 50% depending on the age range and on the SB diagnosis (possible, probable or definitive). The pathophysiology is multifactorial, arousal associated and with behavioural problems and sleep disorders (obstructive sleep apnoea, snoring, nightmares) as risk factors, as well as respiratory conditions (allergies, oral breathing). Screening should include questionnaires and dental assessment. Instrumental recording is helpful to confirm diagnosis although more studies are needed to validate this approach in children. SB management includes controlling orofacial and dental consequences and assessing for any other comorbidity. Management options include occlusal splints, oral appliances (advancement mandibular), rapid maxillary expansion and some medications, although this last option is supported by limited evidences in children. CONCLUSION: Suggestions of future topics in research are delivered to better understand comorbidities, diagnosis and management with improved outcomes compared to what is currently available.

OCCLUSAL APPLIANCES MIGHT BE CLINICALLY EFFICIENT IN TREATING SLEEP BRUXISM.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Minakuchi H, Fujisawa M, Abe Y, Iida T, Oki K, Okura K, Tanabe N, Nishiyama A. Managements of sleep bruxism in adult: A systematic review. Jpn Dent Sci Rev. 2022; 58:124-36. SOURCE OF FUNDING: None was reported. TYPE OF STUDY/DESIGN: Systematic review.

¿Tiene mi paciente bruxismo de vigilia? ¿Cómo puedo tratarlo? / Does my patient have awake bruxism? How can i treat it?

En la actualidad, el bruxismo se ha convertido en un tema de gran interés para los profesionales de la salud, ya que nuestros estilos de vida se han vuelto agitados y estresantes. Estos factores estre santes, a veces, son la principal causa de apretamiento o contacto repetitivo y sostenido de los dientes o simplemente man tenimiento de una posición forzada de la mandíbula, sin contacto dentario durante las horas de vigilia, que definimos como bruxismo de vigilia. El diagnóstico se basa principalmente en la propia capacidad del paciente para identificarlo, además de un examen clínico intraoral en busca de daños en las estructuras dentales. Para manejar estas situaciones se recomienda seguir una estrategia terapéutica que incluya: educación y recomendaciones, férulas, fármacos, terapia psicológica y fisioterapia (AU)

Bruxism has currently become a topic of great interest for health professionals as our lifestyles have become hectic and stressful. These stress factors are sometimes the main cause of repetitive and sustained clenching or contact of the teeth or simply maintaining a forced jaw position without tooth contact while awake, which we define as awake bruxism. The diagnosis is mainly based on the patient’s own ability to identify it, in addition to an intraoral clinical examination to look for damage to dental structures. To manage these situations, it is recommended that a therapeutic strategy be followed including: education and recommendations, splints, medication, psychological therapy, and physiotherapy (AU)

The effect of sleep hygiene and physiotherapy on bruxism, sleep, and oral habits in children with sleep bruxism during the COVID-19 pandemic.

BACKGROUND: Sleep bruxism has been associated with temporomandibular dysfunction, pain, fatigue, and poor sleep quality. OBJECTIVE: The aim of this study was to determine the gender and age distribution of sleep and oral habits of children with sleep bruxism and to examine the effect of a sleep hygiene and physiotherapy program. METHODS: In this cross-sectional study, 82 children aged 6-13 years with sleep bruxism were initially screened between March 2020 and June 2021, from which 37 of them voluntarily attended an 8-week sleep hygiene and physiotherapy program. Evaluations were made using a Visual Analogue Scale (VAS), the Children's Sleep Habits Questionnaire (CSHQ), and the Oral Habits Questionnaire (OHQ) at the beginning and at the end of the 8-week program. RESULTS: Statistically significant differences were determined between the 6-9 years and 10-13-year age groups in respect of the sleep habits subcategories of resistance to bedtime (p= 0.001), sleep anxiety (p= 0.043), parasomnia (p= 0.040), and sleep respiratory disorder (p= 0.041). Following the 8-week treatment program, a significant reduction was obtained in the VAS value (p< 0.05), CSHQ subcategories of resistance to bedtime (p= 0.001), sleep duration (p= 0.008), parasomnia (p= 0.000), and in the OHQ score (p= 0.000). CONCLUSION: There was no relationship between sleep bruxism and gender, but a relationship was found with age. The rate of bruxism was seen to decrease with an increase in age. It was determined that oral, sleep habits, and bruxism are closely related, and the rates at which bruxism is seen are affected by the oral habits. Sleep hygiene and physiotherapy have been effective in children with sleep bruxism.

Short-term effect of material type and thickness of occlusal splints on maximum bite force and sleep quality in patients with sleep bruxism: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the short-term effects of hard and soft splints of different thicknesses on maximum bite force (MBF) and sleep quality (SQ) in participants with sleep bruxism (SB). METHODS: One-hundred-fifteen patients were randomly allocated to five groups: Groups H2(Hard splint-2 mm), H3(Hard splint-3 mm), S2(Soft splint-2 mm), S3(Soft splint-3 mm), and C (control). Outcomes were MBF (assessed with a digital gnathodynamometer) and SQ (assessed with the Pittsburgh Sleep Quality Index). Measurements were performed at T0 (before the splints), T1 (1-month follow-up), and T2 (2-months follow-up). Data were analyzed using one-way analysis of variance(ANOVA), Tukey's HSD, and chi-square tests (alpha = 0.05). RESULTS: At T1, the highest MBF values were observed in group H3 (658.01 ± 22.6 N), while the lowest in group S2 (585.45 ± 8.68 N). For T2, the highest values were obtained in H3 group (676.85 ± 21.9 N), and the lowest in group S2 (565.65 ± 10.9 N) (p < 0.05).For SQ, groups S2 and S3 revealed the lowest PSQI values at T1 (9.1; 9.6) and T2 (9; 9.5) (p < 0.001). CONCLUSIONS: The short-term use of both 2 and 3-mm thick soft splints resulted in a decrease in MBF. Improvement in SQ in patients using soft splints was observed in the 1st month and was maintained in the 2nd month. CLINICAL RELEVANCE: This study provides insights on short-term clinical effects as regards to increased sleep quality and regulated maximum bite force as a function of splint material type and the thickness of the splint.

Effect of occlusal equilibration on masticatory muscle activity in females with sleep bruxism: a double-blind randomised controlled trial.

Masticatory muscle activity during sleep has been considered independent of variations in the structural characteristics of the dental occlusion. However, scientific evidence contradicting an occlusal causal role is missing. The purpose of this study was to test the null hypothesis that sleep bruxism (SB) is independent of the presence of occlusal interferences. A total of 17 healthy female subjects (mean [SD] age 24.9 [4.1] years) presenting with SB, and randomly divided into two groups, were evaluated after receiving either elimination of occlusal interferences (Test group) or elimination of sharp margins without change in occlusal contacts (Control group). Audio-video polysomnography (PSG) recordings were undertaken before and after treatment (mean [SD] duration 14.4 [3.8] months). Two subjects in each group (< 2 rhythmic masticatory muscle activity [RMMA]/h) were excluded for statistical analysis. During the total sleep time (TST), the Test group exhibited a higher reduction in frequency of episodes per hour than the Control group (p < 0.05). The reduction in duration of episodes was also higher in the Test group during the TST. The Test group presented an increase in sleep stage N3 (p < 0.05) at the final PSG when compared with the initial PSG, and a higher percentage of N3 (p < 0.05) at the final PSG when compared to the Control group. Elimination of occlusal interferences resulted in a significant reduction of masseter and temporal muscle activity during sleep in females presenting with SB. Based on these results, the null hypothesis is rejected. The hypothesis of occlusal interferences as a risk factor for SB is still patent.

Effects of continuous positive airway pressure and mandibular advancement appliance therapy on sleep bruxism in adults with obstructive sleep apnea: a pilot study.

STUDY OBJECTIVES: This study aimed to investigate the effects of continuous positive airway pressure (CPAP) and mandibular advancement appliance (MAA) therapy on rhythmic masticatory muscle activity (RMMA), a biomarker of sleep bruxism (SB), and to compare the effects of CPAP with MAA in adults with obstructive sleep apnea (OSA). METHODS: This cohort study included individuals with OSA who received treatment with CPAP or MAA. Polysomnographic recordings with and without therapy were performed in each individual. Statistical analyses were performed with repeated measures ANOVA. RESULTS: A total of 38 individuals with OSA were enrolled, 13 on CPAP and 25 with MAA, mean age 52.6 ± 10.6 years, 32 men, mean baseline apnea-hypopnea index (AHI) 26.5 ± 15.2 events/hour, mean RMMA index 3.5 ±events/hour. In the total group, the RMMA index decreased significantly with CPAP and MAA therapies (P < 0.05). The changes in the RMMA index with therapy did not differ significantly between CPAP and MAA (P > 0.05). The RMMA index decreased in 60% of the individuals with OSA, and the changes ranged widely, with a median of 52% and an interquartile range of 107%. CONCLUSIONS: Both CPAP and MAA therapies significantly reduce SB in individuals with OSA. However, the interindividual differences in the effects of these therapies on SB are large. CLINICAL TRIAL REGISTRATION: https://trialsearch.who.int (NL8516); April 08, 2020.

Associated factors and treatment options for sleep bruxism in children: an umbrella review.

Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options.

Disocclusion guides in occlusal splints on temporomandibular disorders and sleep bruxism: a systematic review.

OBJECTIVE: To determine the best disocclusion guidance in occlusal splints (OSs) to manage and treat temporomandibular disorder (TMD) and sleep bruxism (SB). STUDY DESIGN: The research was conducted on 7 major electronic databases and 3 gray literature sources. We included randomized trials, nonrandomized clinical trials, and before-and-after studies. The risk of bias (RoB) was assessed by Joanna Briggs Institute of Critical Appraisal Tools. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to grade the certainty of evidence. RESULTS: Qualitative synthesis included 16 surveys reporting data from 620 participants. Canine guidance (CG) was widely searched. Bilateral balanced occlusion (BBO) and CG significantly decreased pain levels compared with the placebo splint. Comparing between OS and absence of therapy, only CG was assessed and showed significant improvements on mouth opening, pain, sleep quality, and muscle activity. When compared different guide types among themselves, no significant improvement was founded in any evaluated outcome. Three studies presented high RoB, 7 presented moderate RoB, and 6 presented low RoB. CONCLUSIONS: It is suggested there is not enough evidence to support that there are any specific kind of guidance responsible for improving evaluated outcomes on TMD and SB.

Sleep Quality and Comfort Reported by Sleep Bruxism Individuals Wearing the Occlusal Splint and Mandibular Advancement Splint: Revisiting Two Crossover Studies.

PURPOSE: To assess (1) whether an occlusal splint (OS) or mandibular advancement splint (MAS) allowed better sleep quality and was more comfortable in individuals with sleep bruxism (SB); and (2) the relationship between sleep quality, comfort, and reduction in RMMA related to SB. MATERIALS AND METHODS: Polysomnographic data from 21 SB subjects (mean ± SD age 25.6 ± 4.5 years) collected in two previous studies were compared. Morning self-reports on sleep quality and comfort of the oral device, polysomnographic data, and RMMA index data from no-device nights were compared to nights using an OS or MAS. The reduction ratio of the RMMA index was calculated for both devices. A responder to the oral device was identified when the RMMA index was less than 2 and when it showed a reduction of at least 50% from the no-device control night. RESULTS: Self-reports for sleep quality and comfort of the oral device showed a mild advantage of the OS when compared to the MAS (r2 = 0.47, r2 = 0.32; P ≤ .01). In responders, the MAS induced a greater reduction in the RMMA index (P = .03) than the OS. CONCLUSIONS: In the short term, the comfort of the oral device seemed to influence sleep quality in SB individuals. However, despite the slightly higher degree of comfort offered by the OS, the MAS induced a greater effect on the RMMA index. Int J Prosthodont 2022;36:138-147. doi: 10.11607/ijp.7525.

Common therapeutic approaches in sleep and awake bruxism - an overview.

Bruxism, a common medical condition characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible, can occur during sleep, when it is known as sleep bruxism (SB), or during wakefulness, when it is known as awake bruxism (AB). Although bruxism often causes headaches, temporomandibular joint pain, masticatory muscle pain, mechanical tooth wear, prosthodontic complications and cracked teeth, there is still not enough data to define and support a standardised approach to its treatment. The aim of this review was to present the pathophysiology, consequences, types and treatment methods of bruxism in order to increase readers' knowledge of this topic. Differences between awake and nocturnal bruxism are included, as well as risk factors and indicators visible during the clinical examination of affected patients. Among the causes we consider are genetics, stress, oral parafunctions and changes in the Central Nervous System (CNS). Potential and common methods of treatment are presented, along with suggested guidelines that should be followed when determining an appropriate treatment method. We draw attention to the notably dynamic development of bruxism in today's society and the importance of informational and preventive projects, especially those targeted at high-risk patients as well as those targeted at specialists, in order to better tackle the bruxism 'epidemic'.

Evaluation of intravascular irradiation of blood in children with sleep bruxism: Study protocol for a randomized controlled clinical trial.

BACKGROUND: The objective of this study will be to evaluate the effect of intravascular irradiation of blood (ILIB) combined with myofunctional exercises for sleep bruxism in pediatrics. METHODS: This study will be a randomized controlled clinical trial. A triage of individuals between 4 and 17 years old with a diagnosis of sleep bruxism will be carried out at the clinic of the Catholic University of Uruguay, and in a private office referred by different private care centers. The selected participants will be evaluated before and after treatment by means of questionnaires on bruxism, sleep quality and nocturnal oxygen saturation measurement. For this, 46 patients with sleep bruxism will be recruited, who will be divided into 2 groups: control group (CG), which will undergo an application of placebo ILIB and an orofacial myofunctional therapy (MFT) exercise protocol; and na ILIB group, which will carry out an active application of ILIB and an exercise protocol, this being once a week for 8 weeks. The laser treatment (808 nm) will be performed twice a week for 8 weeks. The values will be tested for normality by the Kolmogorov-Smirnov test. For the comparison between the groups, t test will be carried out, considering a level of significance of 0.5% (P < .05). DISCUSSION: Although local photobiomodulation (PBM), acupuncture PBM and physiotherapy have been studied in the treatment of bruxism, this is the first study to evaluate the effect of ILIB combined with myofunctional exercises for sleep bruxism in pediatrics.

A Comparison of Hard and Soft Occlusal Splints for the Treatment of Nocturnal Bruxism in Children Using the BiteSTRIP®.

OBJECTIVE: Bruxism is defined as a parafunctional activity. It could be in diurnal or nocturnal form, based on the time it occurs. The purpose of the study compares the effectiveness of occlusal splint treatments in children with nocturnal bruxism using the BiteStrip®. STUDY DESIGN: The muscle activity of children was measured using the BiteStrip®. The groups used occlusal splints during nighttime sleep for three months, at the end of which their muscle activity were measured again through the use of the BiteStrip®. RESULTS: Muscle pain in palpation and pain in the dynamic position of TMJ pain was significantly reduced in patients using soft occlusal splint (p=0.01). There was no significant change in the BiteStrip® score in both group I (p=0.11) and group II (p=0.61). CONCLUSION: Soft occlusal splints could reduce pain caused by nocturnal bruxism on muscle and TMJ. The relationship between treatment results and BiteStrip® scores of patients using soft occlusal splint or hard occlusal splint are not significantly.

Tempo de confecção clínica e laboratorial de placas oclusais convencionais x fresadas em pacientes com bruxismo do sono: ensaio clínico / Clinical and laboratory production time of conventional x milled occlusal splints in patients with sleep bruxism: clinical trial

O objetivo desse estudo foi comparar o tempo de confecção clínica, laboratorial e ajustes clínicos para a instalação de placas oclusais termopolimerizáveis convencionais (PC) e confeccionadas por CAD/CAM fresadas (PF) em pacientes com bruxismo do sono. Para tanto, foi realizado um ensaio clínico controlado e não randomizado onde foram incluídos pacientes com diagnóstico de provável bruxismo do sono. Foram confeccionadas PC (n = 24) e PF (n = 24) sendo mensurados o tempo de confecção clínica (TCC), tempo de confecção laboratorial (TCL) e tempo de instalação (TI) para cada uma das placas. Foi utilizado o teste Mann-whitney com nível de confiança de 95% no programa SPSS IBM Statistics para analisar se existe diferença entre os tempos analisados e o tipo de placa confeccionada. Como resultado, verificou-se que a PC possuiu maior TCC total (média de 94,39 min) em relação à PF (17,85 min) (p<0,001). Entretanto, o TCL total da PC foi menor (164,80 min), que a PF (182,64min) (p=0,015). Para o TI, foi encontrado que PF obteve uma média 21, 26 min, enquanto PC obteve 37,19 min (p<0,001). Como conclusão, dentro as limitações do estudo, observou-se que as placas fresadas apresentaram menor tempo clínico tanto na etapa de confecção quanto de instalação. Entretanto, o tempo de confecção laboratorial das placas convencionais foi inferior (AU).

The aim of the study was to compare the clinical and laboratory preparation time and clinical adjustments for the installation of conventional thermopolymerizable resin splint (CS) and milled CAD/CAM (MS) occlusal splints in patients with sleep bruxism. For this purpose, a controlled and non-randomized clinical trial was carried out in which patients diagnosed with probable sleep bruxism were included. CS (n = 24) and MS (n = 24) were prepared and the clinical preparation time (CPT), laboratory preparation time (LPT) and installation time (IT) were measured for each of the splints. The Mannwhitney test with a confidence level of 95% was used in the SPSS IBM Statistics program to analyze whether there is a difference between the analyzed times and the type splint performed. As a result, it was found that CS had higher total CPT (mean of 94,39 min) in relation to MS (17,85 min) (p0<001). However, the total LPT of the CS was lower (164,80 min) than the MS (182,64min) (p=0.015). For the IT, it was found that the MS had an average of 21,26 min, while the CS had 37,19min (p0<001). In conclusion, within the limitations of the study, it was observed that the milled splint had a shorter clinical time both in the manufacturing and installation stages. However, the laboratory preparation time of the conventional splint was shorter (AU).

The effect of continuous positive airway pressure and mandibular advancement device on sleep bruxism intensity in obstructive sleep apnea patients.

We aimed to evaluate and compare the effects of continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) in reducing the intensity of sleep bruxism (SB) in patients with obstructive sleep apnea (OSA). Forty-eight adults with OSA were subjected to single-night full polysomnography (PSG) in the Sleep Laboratory of the Wroclaw Medical University. The respiratory events and bruxism episodes were scored according to the standards of the American Academy of Sleep Medicine. The patients were assigned to the CPAP treatment or the MAD treatment in accordance to apnea-hypopnea index (AHI). The second PSG examination was conducted during the MAD or CPAP treatment to assess the effect of treatment on bruxism episode index (BEI) and AHI. The mean AHI and mean BEI in the study material were estimated to be 30.05 ± 15.39 and 5.10 ± 5.31, respectively. The bruxism parameters were significantly decreased in both the CPAP and MAD groups. Compared to the MAD, the CPAP treatment was more effective in reducing AHI; however, there was no significant difference in effectiveness of CPAP and MAD treatment in BEI reduction. Both CPAP and MAD treatments were effective against SB coexisting with OSA. Due to the application of these treatment options, the risk of OSA should be estimated in patients with SB.