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(1) Background: This study aims to compare the effects of 3D-printed splints and conventional manufactured splints on sleep bruxism (SB) EMG activity. (2) Methods: Twenty-six patients (19 M, 7 F, 25.8 ± 2.6 years) were randomly allocated to a study group (3D splints) and a control group (conventional manufactured splints) and followed for a period of three months with night EMG-ECG recordings. Samples of the involved materials were analyzed for nanoindentation. The outcomes of interest considered were the overall SB index, the total amount of surface masseter muscle activity (sMMA), and general and SB-related phasic and tonic contractions. A statistical evaluation was performed with a confidence interval (CI) between 2.5% and 97.5%. (3) Results: Differences between groups with OAs were observed for general tonic contraction (p = 0.0009), while differences between recording times were observed for general phasic contractions (p = 0.002) and general tonic contractions (p = 0.00001). Differences between recording times were observed for the total amount of sMMA (p = 0.01), for general phasic contractions (p = 0.0001), and for general tonic contractions (p = 0.000009) during night recordings without OAs. (4) Conclusions: Three-dimensional splints seem to have a higher impact on SB-related electromyographic activity but not on the overall sleep bruxism index. The more regular surfaces offered by 3D splints could be related to phasic contraction stabilization.

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BACKGROUND: Different oral appliances (OAs) have been proposed to control sleep bruxism (SB) detrimental effects on the stomatognathic system. OBJECTIVE: The aim of the study was evaluate the effect of different OAs on SB activity and masticatory muscle activity (sMMA) measured by EMG. METHOD: This longitudinal cohort study was conducted on 51 patients (21 M, 30 F, mean age 26,5 ± 3,5) suffering from SB diagnosed with a validated portable EMG-ECG holter and wearing different OAs: occlusal splints, functional appliance with metallic bites and clear aligners followed after 1 week, 1 month, 3 months, 6 months and 12 months from delivery. A control group of 16 non-treated SB patients (6 M, 10 F mean age 27,1 ± 1,4) was used as reference. A multiple regression analysis was performed to estimate the differences between groups. Significance was set as P value <0,05. RESULTS: Occlusal splint reduced sleep bruxism index after 1 week, 3, 6 and 12 months from delivery while functional appliance only after 12 months. Occlusal splints reduced general phasic contractions only in the first week and sleep bruxism-related phasic contractions at 1 week, 3 and 6 months after delivery with no significant reductions after 12 months. Patients wearing clear aligners showed reduction in general tonic contractions after 6 and 12 months. CONCLUSION: Resin and metal bites can reduce sleep bruxism index, while resin bites can reduce sleep bruxism-related phasic contractions. Clear aligners do not influence sleep bruxism index but can reduce tonic contractions.

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OBJECTIVE: The aim of this article was to systematically review the literature to assess the relationship between risk factors and sleep bruxism (SB) in adults (age ≥18 years). DESIGN: A systematic search of the following databases was carried out: PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs and SciELO. Nine out of the 4583 initially identified articles were selected. This review was conducted according to the guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with reporting in agreement to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS: Among the nine analyzed articles, associations between SB and gastro-esophageal reflux disease (GERD) (OR=6.6, CI=1.4-30.9) was found in one randomized clinical trial (RCT). Four cross-sectional studies suggested history of SB during childhood (OR=8.1 CI=5.4-12-2), age (OR=3.1, CI=2.3-4.1) and chronic migraine (OR=3.8, C.I=1.8-7.8) as determinant factors for the development of SB. In one case-control study, patients with genetic polymorphisms were more likely to present SB (OR=4.3, CI=1.6-11.3). Smoking (OR=2.8, CI=2.2-3.5) and alcohol intake (OR=1.9, CI=1.2-2.8) showed moderate association in two case-control studies. CONCLUSIONS: History of SB during childhood, gastro-esophageal reflux disease and genetic polymorphisms seem to be important risk factors associated to SB in adults. Dry mouth on awakening seems to be a protective factor. Association does not infer with causality. Even if the evidence emerged from the considered studies was clinically relevant, further studies are requested to better understand the biological mechanisms behind the described associations.

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BACKGROUND: Multiple risk factors have been associated to sleep bruxism (SB). Nevertheless, there are still many unsolved issues concerning the etiology of SB that have consequences on the clinical management strategies. OBJECTIVE: Systematically review the literature to assess the relationship between risk factors and SB symptoms in adolescents (age 11-19 years). SEARCH METHODS AND SELECTION CRITERIA: PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs, and SciELO were searched to identify all peer-reviewed articles potentially relevant to the review. DATA COLLECTION AND ANALYSIS: The risk of bias was assessed according to the guidelines from the Cochrane handbook for systematic reviews of interventions, with reporting in agreement to the preferred reporting items for systematic reviews and meta-analyses guidelines. RESULTS: Four out of the 4546 initially identified articles were selected. According to the grading of recommendations assessment, development and evaluation assessment (GRADE), the magnitude of agreement was almost perfect for all checklist items. Sleep disturbances, and snoring in particular, headache, jaw muscle fatigue, and tooth wear seem to be associated to SB in adolescents from 11 to 19 years old. LIMITATIONS: Despite the large interest of the scientific community in the field of oral parafunctions, only four articles met the eligibility criteria. Furthermore only associations and not definite cause-effect relationships were highlighted in the selected articles. CONCLUSIONS: Sleep disturbances presented the strongest association with SB while very few occlusal features had a moderate association. As a common sense the investigation of sleep respiratory disorders could be of great help in the management of SB in adolescents.

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OBJECTIVE: The aim of this article was to systematically review the literature to identify papers dealing with risk factors associated with sleep bruxism (SB) in children. DESIGN: A systematic search was carried out based on the following databases: PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs, SciELO. Studies investigating risk factors related to SB after multiple regression analysis and bruxism symptoms assessed with clinical diagnosis or specific questionnaires were searched. Six out of the 4546 initially identified studies were selected. This review was conducted according to the guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with reporting in agreement to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS: Among the six analyzed articles, one randomized clinical trial (RCT) suggested the increase of SB in heavily exposed patients to second hand smoke (SHS) (OR=4.5, CI=2.2-9.4), two cross-sectional studies suggested neuroticism as determinant factor for the development of sleep bruxism (OR=1.9, CI=1.3-2.6), among children and three case-control studies suggested that children with sleep disturbances were more likely to have SB (OR=3.3, CI=1.6-6.6). Parafunctional behaviours (OR=2.3, CI=1.2-4.3) had a moderate association. CONCLUSIONS: SHS and sleep disturbances presented the strongest association with SB. The most recurrent source of bias was the lack of blinding procedures. Furthermore, the use of reliable SB diagnostic procedures should be recommended to increase the quality of future studies. The evidence emerged from the considered studies was clinically relevant.

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OBJECTIVES: The aim of the study was to assess the repeatability in detecting sleep bruxism (SB) episodes by combined surface electromyography and heart rate (HR) signals recorded by a compact portable device (Bruxoff®). SB episodes are preceded by a sudden HR change. Thus, HR detection increases the precision of automatic detection of SB. MATERIALS AND METHODS: Ten healthy subjects (five women and five men; 30.2 ± 11.02 years) were selected for the study. Rhythmic masseter muscle activities, constituting the basic pattern of SB, were detected during three nights of recording during three different weeks with the Bruxoff device. RESULTS: The two-way ANOVA was not significant for SB episodes per night, SB episodes per hour, and heart frequency: no significant differences were observed during the three different nights of recording for each of the abovementioned variables (P > 0.05). The intraclass correlation coefficient showed a good reproducibility for SB episodes per night (69 %), SB per hour (74 %), and heart frequency (82 %). A poor reproducibility was revealed for the number of masseter contractions (53 %). The Pearson analysis showed the absence of a significant correlation between the number of masseter contractions per night and the number of SB episodes per night (r = -0.02, P = 0.91). CONCLUSIONS: The Bruxoff device showed a good reproducibility of measurements of sleep bruxism episodes over time. CLINICAL RELEVANCE: These findings are important in the light of the need for simple and reliable portable devices for the diagnosis of SB both in the clinical and research settings.

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