RESUMEN
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.
Asunto(s)
Avance Mandibular , Bruxismo del Sueño , Adulto , Humanos , Adulto Joven , Estudios Cruzados , Músculos Masticadores , Ferulas Oclusales , Polisomnografía , Bruxismo del Sueño/terapia , Calidad del SueñoRESUMEN
OBJECTIVES: Sleep bruxism (SB) is associated with physiological activities including sympathetic autonomic system dominance and sleep micro-arousal. While oral appliances (OA) are used to prevent SB harmful effects, the influence of OAs physiological mechanisms during sleep is unknown. The aim of this study is to assess whether heart rate variability (HRV) changes, as a marker of autonomic nervous system activity, would be associated with the OA mechanism of action on SB using occlusal splint (OS) and mandibular advancement splint (MAS). MATERIALS AND METHODS: A retrospective analysis, from data previously collected in 21 participants with SB (25.6 ± 4.5 years) with polysomnographic recordings, was done. HRV data were compared between a reference night (no-device) and ones during which OS or MAS was used in a crossover study design. Rhythmic masticatory muscle activity (RMMA) index was compared between nights. HRV was evaluated using autoregressive model analysis for three sections: baseline (distance from RMMA), immediately before, and after RMMA period. RESULTS: A significant reduction in RMMA index, when wearing OA during sleep, was observed (P < 0.01), but was not associated with HRV parameters change. HRV significantly changed after RMMA onset for nights with OA during non-REM sleep in comparison with baseline (P < 0.02). CONCLUSIONS: The usage of OAs for SB participants reduced RMMA, but most likely independently of changes in HRV linked to the mechanism associated with SB genesis. CLINICAL RELEVANCE: Wearing OA seems to reduce grinding noise and protect from dental injuries but does not seem to influence SB genesis.
Asunto(s)
Bruxismo del Sueño , Estudios Cruzados , Frecuencia Cardíaca , Humanos , Músculos Masticadores , Polisomnografía , Estudios Retrospectivos , Bruxismo del Sueño/complicacionesRESUMEN
PURPOSE: The objective of this experimental study was to compare the effect on sleep bruxism and tooth-grinding activity of a double-arch temporary custom-fit mandibular advancement device (MAD) and a single maxillary occlusal splint (MOS). MATERIALS AND METHODS: Thirteen intense and frequent bruxors participated in this short-term randomized crossover controlled study. All polygraphic recordings and analyses were made in a sleep laboratory. The MOS was used as the active control condition and the MAD was used as the experimental treatment condition. Designed to temporarily manage snoring and sleep apnea, the MAD was used in 3 different configurations: (1) without the retention pin between the arches (full freedom of movement), (2) with the retention pin in a slightly advanced position (< 40%), and (3) with the retention pin in a more advanced position (> 75%) of the lower arch. Sleep variables, bruxism-related motor activity, and subjective reports (pain, comfort, oral salivation, and quality of sleep) were analyzed with analysis of variance and the Friedman test. RESULTS: A significant reduction in the number of sleep bruxism episodes per hour (decrease of 42%, P < .001) was observed with the MOS. Compared to the MOS, active MADs (with advancement) also revealed a significant reduction in sleep bruxism motor activity. However, 8 of 13 patients reported pain (localized on mandibular gums and/or anterior teeth) with active MADs. CONCLUSIONS: Short-term use of a temporary custom-fit MAD is associated with a remarkable reduction in sleep bruxism motor activity. To a smaller extent, the MOS also reduces sleep bruxism. However, the exact mechanism supporting this reduction remains to be explained. Hypotheses are oriented toward the following: dimension and configuration of the appliance, presence of pain, reduced freedom of movement, or change in the upper airway patency.