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BACKGROUND: This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response. METHODS: 23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion. RESULTS: The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8 mm; p < 0.001) and inferior (3.5 ± 1 mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response. CONCLUSION: MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.

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Abstract Occlusal stabilization splints are the most common treatment for controlling the deleterious effects of sleep bruxism. This study aimed to evaluate the effectiveness of a low-cost, mixed occlusal splint (MOS) compared to that of a rigid splint. A randomized clinical trial was performed on 43 adults of both sexes with possible sleep bruxism and satisfactory dental conditions. They were divided into rigid occlusal splint (ROS) (n = 23) and MOS (n = 20) groups. Masticatory muscle and temporomandibular joint (TMJ) pain intensity (visual analog scale), quality of life (WHOQOL-BREF), indentations in the oral mucosa, anxiety, and depression (HADS), number of days of splint use, and splint wear were evaluated. All variables were evaluated at baseline (T0), 6 months (T6), and 12 months (T12) after splint installation (T0), and splint wear was evaluated at T6 and T12. Student's t-test, Mann-Whitney U test, non-parametric Friedman's analysis of variance for paired samples and pairwise multiple comparisons, Pearson's chi-square test, two-proportion z-test, non-parametric McNemar's and Cochran's Q, and Wilcoxon tests were used (p < 0.05). In both groups, there was a decrease in TMJ pain and pain intensity over time and improvements in the quality of life scores. At T6, there was a higher rate of splint wear in the MOS group than in the ROS group (p = 0.023). The MOS showed a higher rate of wear than the rigid splint but had similar results for the other variables. Therefore, the use of a mixed splint appears to be effective in controlling the signs and symptoms of sleep bruxism.

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Crianças com paralisia cerebral usualmente necessitam de órtese no polegar para função manual. Objetivo: Analisar a associação entre tempo de espera para recebimento de órtese para polegar, habilidade manual e dificuldade de desempenho em atividades cotidianas de crianças com paralisia cerebral. Método: Estudo de métodos mistos, com uma coorte retrospectiva e avaliação transversal de crianças com paralisia cerebral e indicação de confecção de órtese para polegar. Foram coletadas informações socioeconômicas, mensuração das dificuldades para realizar atividades do cotidiano, função manual pelo Sistema de Classificação da Habilidade Manual (MACS) e tempo de espera pela órtese. Análises descritivas, coeficiente de correlação de Spearman e Teste Kruskal Wallis foram realizadas no software IBM SPSS®. Resultados: 17 crianças e seus pais/responsáveis foram avaliados, sendo a maioria menino (76,5%), com paralisia cerebral do tipo hemiparética (52,9%). O tempo médio de espera pela órtese foi 34,12 dias (DP= 39,01). Crianças com comprometimento motor mais severo (p= 0,038) e pior habilidade manual (p= 0,012) receberam órtese em menor tempo de espera. Não houve diferença estatística entre tempo de espera pela órtese e dificuldade para desempenhar atividades cotidianas. Conclusão: A correlação entre habilidade manual e tempo de espera reforça a importância da avaliação funcional para priorizar concessão de um dispositivo de Tecnologia Assistiva em um serviço público de reabilitação, direcionando o cuidado às necessidades mais específicas das crianças.

Children with cerebral palsy usually need orthoses in their thumbs for manual functions. Objective: Analyzing the association between the waiting time for receiving a thumb orthosis, the manual ability, and the difficulty in performing daily tasks of children with cerebral palsy. Method: Mixed-methods study, with a retrospective cohort and cross-sectional evaluation of children with cerebral palsy and the indication and confection of thumb orthoses. Data collection included socioeconomic information, waiting time for the orthoses, and assessments of the difficulty to carry out daily activities and of manual functioning according to the Manual Ability Classification System (MACS). Descriptive analysis, Spearman's coefficient and the Kruskal-Wallis test were calculated in the IBM software SPSS®. Results: 17 children and their parents/guardians were evaluated. Most were male (76.5%) with hemiplegic cerebral palsy (52.9%). Their mean time waiting for the orthosis was 34.12 days (SD= 39.01). Children with a more severe motor impairment (p= 0.038) or worse manual abilities (p= 0.012) waited to receive the orthosis for a shorter period. There was no statistical difference between the waiting time for the orthosis and the difficulty to perform daily tasks. Conclusion: The correlation between manual ability and the waiting time reiterates the importance of functional evaluations to prioritize the concession of Assistive Technology devices in public rehabilitation services, focusing the care on the more specific needs of each child.

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PURPOSE: This study aimed to assess and compare the color stability, flexural strength (FS), and surface roughness of occlusal splints fabricated from heat-cured acrylic resin, milled polymethyl methacrylate (PMMA)-based resin, and 3D-printed (PMMA) based-resin. MATERIALS AND METHODS: Samples of each type of resin were obtained, and baseline measurements of color and surface roughness were recorded. The specimens were divided into three groups (n = 10) and subjected to distinct aging protocols: thermomechanical cycling (TMC), simulated brushing (SB), and control (without aging). Final assessments of color and surface roughness and three-point bending test (ODM100; Odeme) were conducted, and data were statistically analyzed (2-way ANOVA, Tukey, P <.05). RESULTS: Across all resin types, the most significant increase in surface roughness (Ra) was observed after TMC (P < .05), with the 3D-printed resin exhibiting the lowest Ra (P < .05). After brushing, milled resin displayed the highest Ra (P < .05) and greater color alteration (ΔE00) compared to 3D-printed resin. The most substantial ΔE00 was recorded after brushing for all resins, except for heat-cured resin subjected to TMC. Regardless of aging, milled resin exhibited the highest FS (P < .05), except when compared to 3D-printed resin subjected to TMC. Heat-cured resin exposed to TMC demonstrated the lowest FS, different (P < .05) from the control. Under control conditions, milled resin exhibited the highest FS, different (P < .05) from the brushed group. 3D-printed resin subjected to TMC displayed the highest FS (P < .05). CONCLUSION: Among the tested resins, 3D-printed resin demonstrated superior longevity, characterized by minimal surface roughness and color alterations. Aging had a negligible impact on its mechanical properties.

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Objetivo: Avaliar a influência de diferentes tipos de registros interoclusais e técnicas de montagem em articulador virtual no tempo de confecção clínico e laboratorial de placas oclusais estabilizadoras confeccionadas por fluxo de trabalho digital (CAD/CAM). Metodologia: Trata-se de um ensaio clínico, onde a amostra foi constituída por 30 pacientes com diagnóstico de um provável bruxismo do sono, os quais foram randomizados aleatoriamente em dois grupos de acordo com a técnica de montagem do modelo no articulador virtual: GP (grupo plano horizontal) e GM (grupo mesa de camper). Também foram avaliados três diferentes tipos de registros interoclusais para confecção de placas oclusais impressas, sendo: "máxima intercuspidação habitual" (MIH), "dispositivo anterior de registro" (DAR) e "palhetas oclusais"; e as técnicas de desenho das placas oclusais sendo essas etapas subdivididas em suavização e delimitação, montagem do modelo do modelo superior no articulador (variando em plano horizontal e mesa de camper), desenho da placa e ajustes finais. A partir disso, foram analisados os tempos (em minutos e segundos) necessários para a realização das etapas clínicas e laboratoriais (etapas CAD ­ obtenção dos arquivos e desenho da placa). Os dados foram avaliados estatisticamente pelos testes T, ANOVA e Tukey pelo software Statistical Package for Social Sciences 22.0. Resultados: Observou-se diferença estatística no tempo de registro interoclusal, onde MIH (47,94seg) e palheta (01:03,01min) foram realizados em um menor tempo quando comparado com o DAR (03:09,26min) (<0,001). O tempo da etapa de montagem no articulador foi estatisticamente maior quando o registro foi realizado em MIH e a montagem foi realizada levantando no pino no articulador (01:59,62min), comparando ao DAR (01:07,82min) e a palheta (01:06,43min) (<0,001), apresentando também diferença no tempo de desenho (p=0,045) e tempo total das etapas (p=0,033). Conclusão: Dentro das limitações do estudo, pode-se afirmar que utilizar a palheta oclusal ou registrar em MIH apresentaram um menor tempo clínico quando comparada à técnica do DAR. Levantar o pino no articulador levou a um maior tempo de montagem dos modelos, independente do modelo ter sido montado no plano horizontal ou na mesa de camper, aumentado o tempo na etapa CAD (AU).

Objective: To evaluate the influence of different types of interocclusal registrations and assembly techniques in a virtual articulator on the clinical and laboratory preparation time of stabilizing occlusal splints made by digital workflow (CAD/CAM). Methodology: This is a clinical trial, where the sample consisted of 30 patients diagnosed with sleep bruxism, who were randomly randomized into two groups according to the technique of mounting the model on the articulator virtual: GP (flat horizontal group) and GM (camper's table group). Three different types of interocclusal records were also evaluated for making printed occlusal plates, namely: "maximum habitual intercuspation" (MIH), "anterior recording device" (DAR) and "occlusal reeds"; and the techniques for designing the occlusal splints, these steps being subdivided into smoothing and delimitation, mounting the model of the upper model on the articulator (varying in the horizontal plane and camper's table), designing the plate and final adjustments. Based on this, the times (in minutes and seconds) required to perform the clinical and laboratory steps were analyzed. Data were statistically evaluated by T, ANOVA and Tukey tests using the Statistical Package for Social Sciences 22.0 software. Results: There was a statistical difference in the time of interocclusal registration, where MIH (47.94sec) and reed (01:03.01min) were performed in a shorter time when compared to the DAR (03:09.26min) (<0.001 ). The time of the assembly step on the articulator was statistically longer when the registration was performed in MIH and the assembly was performed by lifting the pin on the articulator (01:59.62min), comparing to the DAR (01:07.82min) and the reed (01:07.82min) 01: 06.43min) (<0.001), also showing difference in design (p=0.045) and total time of steps (p=0.033). Conclusion: Within the limitations of the study, it can be stated that using the occlusal palette or registering in MIH demonstrated a shorter clinical time when detected using the RAD technique. Lifting the pin on the articulator led to a longer time to assemble the models, regardless of whether the model was mounted in the horizontal plane or on the camper's table, it increased the time in the CAD step (AU).

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BACKGROUND: Occlusal splints can protect teeth during bruxism, preventing tooth wear, as well as during sports activities, shielding them from impacts. OBJECTIVES: To verify the influence of thermal cycles and disinfection on the roughness, microhardness and color of polyethylene terephthalate glycol/thermoplastic polyurethane (PETG/TPU) and poly(methyl methacrylate) (PMMA). MATERIAL AND METHODS: Thirty-six PETG/TPU samples and 36 PMMA samples were prepared (ø10 mm × 3 mm). Six groups were created according to the material and the disinfection method used (n = 12 each): PETG/TPU (glister), PETG/TPU (hypochlorite), PETG/TPU (soap), PMMA (glister), PMMA (hypochlorite), and PMMA (soap). Roughness, Knoop microhardness and color evaluations were performed before the experiments (T1), after thermocycling (T2) and after disinfection (T3). Three-way repeated measures analysis of variance (ANOVA) and Tukey's test were used for statistical evaluations. RESULTS: For roughness and color, ANOVA showed statistical significance based on the interaction between thermal cycling, material and disinfectant factors. In terms of Knoop microhardness, ANOVA showed statistical significance based on the interaction between thermal cycling and material factors. CONCLUSIONS: Roughness results were clinically acceptable in all groups at all time points, except the PETG/TPU and PMMA groups disinfected with hypochlorite. Microhardness significantly increased for both materials after thermal cycling, and at all time points, the microhardness of PMMA was significantly higher than that of PETG/TPU. After thermal cycling, the color changes were clinically unacceptable in all groups.

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ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder-related headache (TMDH) is a very common clinical condition which manifests as pain around the temples. The treatment recommended in dentistry is occlusal splint. However, there is a device generally used in functional jaw orthopedics, called simple Planas indirect tracks (SPIT), which has been shown to be efficient in managing these headaches. This clinical trial aimed to compare SPIT and occlusal splints in the treatment of TMDH patients. METHODS: This randomized clinical trial included thirty-seven women who had TMDH for more than one year into three groups: GPIT treated with SPIT, GSPLINT treated with a Michigan splint, and a control group (CG) submitted to no treatment. The randomization was paired, that is, each new individual was assigned to a group sequentially. The number of headache days per month, average pain intensity, pain response to masseter and temporalis palpation, and days of pain drug use were collected and analyzed. The follow-up lasted for 3 months. RESULTS: Thirty-seven patients were included but 4 dropped out during treatment and 33 underwent intervention. Patients in GPIT exhibited superior results compared to GSPLINT and CG, with significant differences between groups for almost all variables. In GPIT, the number of headache days was reduced by 87.43%, pain intensity by 66.67%, and days of drug use by 88.42%, with significant improvement in all parameters compared to CG. In GSPLINT, the number of headache days decreased by 44.46% and days of drug use by 36.63%, while pain intensity increased by 46.67%; however, there was no significant difference in any of the parameters compared to CG. CONCLUSION: SPIT may be a good treatment option for patients with TMDH since these appliances have shown much more consistent results than occlusal splints. Further studies and with more individuals will be needed to confirm these findings.

RESUMO JUSTIFICATIVA E OBJETIVOS: A cefaleia secundária à disfunção temporomandibular (CDTM), é uma condição clínica muito comum, com dores nas têmporas. O tratamento padrão na odontologia são as placas miorrelaxantes, entretanto um aparelho da ortopedia funcional dos maxilares, chamado de Pistas Indiretas Planas Simples (PIPS), tem se demonstrado eficiente no controle dessas cefaleias. Este estudo clínico visou comparar as PIPS com as placas miorrelaxantes, no quadro álgico de CDTM. MÉTODOS: Este ensaio clínico randomizado incluiu 37 mulheres portadoras de CDTM há mais de um ano, que foram distribuídas aleatoriamente em três grupos: o GPIPS, no qual as pacientes foram tratadas com PIPS, o GPLACA, com uso de placas miorrelaxantes de Michigan e o grupo controle (GC), sem qualquer tratamento. A aleatorização foi pareada, sendo que cada participante era consecutivamente alocada em um grupo diferente. Foram coletados e analisados dias de cefaleia por mês, intensidade de dores, resposta álgica à palpação de masseter e temporal, bem como os dias de uso de fármacos. O acompanhamento foi de três meses. RESULTADOS: Das 37 pacientes iniciais, 4 desistiram do tratamento e apenas 33 foram submetidos a alguma intervenção. As pacientes do GPIPS apresentaram resultados muito superiores às do GPLACA e do GC, com diferenças significativas entre os grupos em quase todas as variáveis. No GPIPS, os dias de dor diminuíram 87,43%, a intensidade 66,67% e os dias de uso de fármacos analgésicos 88,42%, sendo estatisticamente significante a melhora em todos os parâmetros em relação ao GC. Já no GPLACA, os dias de dor diminuíram 44,46% e os dias de uso de fármacos 36,63%, mas a intensidade da dor aumentou 46,67%, porém sem diferença estatisticamente significante em nenhum parâmetro quando comparado ao GC. CONCLUSÃO: O uso do PIPS pode ser uma boa escolha de tratamento da CDTM, tendo apresentado resultados mais consistentes do que as placas miorrelaxantes. Mais estudos e com mais participantes são necessários para confirmar estes achados.

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OBJECTIVE: To test whether two different materials used for occlusal splints would reduce the stress to the temporomandibular joint discs. METHODS: Geometric data from a young-adult male patient were obtained from computed tomography and magnetic resonance imaging. 3D biomodels and the finite element analyses were performed using specific software. RESULTS: The mandibular model presented the highest bone stress areas in the mandibular rami and insertion of the temporalis muscles. Regardless the material, the highest stress in the occlusal splints was located in the second molar regions on the occlusal splint surface and in the opposing mandibular second molars. Stress reduction was only observed in the internal surface of the occlusal splints embracing the maxillary teeth. No differences between occlusal splints were found in the stress intensity and distribution in either left or right TMJ discs, being concentrated more in the anterior portion of the disc. DISCUSSION: Hard acrylic OS should be preferred over soft EVA OS in the majority of cases, soft OS only for temporary use. Thinner OS (2-3 mm anterior thickness) should be preferred over thick ones (3-4 mm) in order to keep the stress concentrations in the center of the TMJ discs. Lighter contacts over heavier contacts should be preferred in the second molar OS contact surface area to prevent stress concentrations and fractures. Maxillary occlusal splints should be chosen if the teeth or implant are in the maxilla, and vice-versa.

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Objetivo: Avaliar o tempo de confecção dos diferentes tipos de registros interoclusais e sua precisão na obtenção da espessura planejada para a placa oclusal estabilizadora confeccionada pelo fluxo de trabalho digital. Metodologia: Consiste em um estudo in vivo, com 30 pacientes com diagnóstico de um provável bruxismo do sono. Individualmente, os pacientes tiveram a mordida registrada e escaneada com três diferentes tipos de registros oclusais: máxima intercuspidação habitual (MIH), dispositivo anterior de registro (DAR) e palhetas oclusais. O tempo necessário para obtenção e escaneamento de cada registro foi anotado (em minutos e segundos) e analisados posteriormente. A distância interoclusal correspondente à espessura planejada para as placas foi determinada em 2 mm. Para DAR e palheta oclusal, essa distância foi criada com a ajuda de palhetas oclusais posteriores com espessura de 2 mm. Para o registro em MIH, ela foi criada pelo aumento do pino incisal no articulador virtual. Em seguida, foi analisada nos modelos digitais obtidos por cada registro. Estatisticamente, os dados do tempo e espessura foram avaliados pelo teste ANOVA e pós teste de Tukey pelo software Statistical Package for Social Sciencies 22.0. Resultados: Observou-se diferença estatística no tempo de registro interoclusal, onde MIH (47,94seg) e palheta (01:03,01min) foram realizados em um menor tempo quando comparado com o DAR (03:09,26min) (p<0,001). No que se refere a espessura, houve diferença estatística entre os grupos pino incisal (1,85±0,33) e palheta (2,08±0,28) que apresentaram, respectivamente, a menor e a maior distância entre as arcadas (p<0,048), enquanto que a média de registro do grupo DAR (2,03±0,44) foi a que mais se aproximou dos 2mm previstos para a espessura da placa. Conclusão: Dentro das limitações do estudo, pode-se concluir que registrar usando a palheta oclusal ou em MIH apresenta um menor tempo clínico quando comparada à técnica do DAR, e que apesar das médias de espessuras serem próximas, o DAR foi o método que mais se aproximou da espessura estimada para as placas oclusais (AU).

Objective: To evaluate the time taken to make different types of interocclusal registrations and their precision in obtaining the planned thickness for the stabilizing splint made using the digital workflow. Methodology: It consists of an in vivo study with 30 patients diagnosed with probable sleep bruxism. Individually, the patients had their bite registered with three different types of occlusal registrations: maximum habitual intercuspation (MIH), anterior registration device (DAR) and occlusal reeds. The time required to obtain each record was recorded (in minutes and seconds) and analyzed later. The interocclusal distance corresponding to the planned thickness of the plates was determined to be 2 mm. For DAR and occlusal pick, this distance was created with the help of 2 mm thick posterior occlusal picks. For registration in MIH, it was created by enlarging the incisal pin in the virtual articulator. It was then analyzed using the digital models obtained for each record. Statistically, the and thickness data were evaluated using the ANOVA test and Tukey's post test using the Statistical Package for Social Sciences 22.0 software. Thickness data were analyzed as mean and standard deviation. Results: There was a statistical difference in the time of interocclusal registration, where MIH (47,94sec) and reed (01:03,01min) were performed in a shorter time when compared to the DAR (03:09,26min) (<0.001). Regarding thickness, there was a statistical difference between groups incisal pin (1,85±0,33) and reed records (2,08±0,28), which presented, respectively, the smallest and largest distance between the arches. The average registration with the DAR (2,03±0,45) (0,048) was the closest to the 2mm predicted for the thickness of the plate, followed by the technique with occlusal picks. Conclusion: Within the limitations of the study, it can be concluded that recording using the occlusal palette or in MIH presented a shorter clinical time when compared to the DAR technique. Despite the thickness averages being close, the DAR technique was the method that came closest to the estimated thickness for the occlusal splints (AU).

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Abstract This study aimed to compare the mechanical properties of various occlusal plate materials by analyzing surface roughness, Knoop microhardness, flexural strength, and modulus of elasticity. Fifty samples were prepared and classified as SC (self-curing acrylic resin), WB (heat-cured acrylic resin), ME (acrylic resin polymerized by microwave energy), P (resin print), and M (polymethylmethacrylate polymer block for computer-aided design/computer-aided manufacturing). The data were analyzed using a one-way analysis of variance and Tukey's honestly significant difference test. Surface roughness was the same in all groups. The surface hardness of group M was statistically superior. The samples from groups P and M had higher flexural strength than other samples. The modulus of elasticity of group SC was statistically lower than that of other groups. The mechanical properties of the materials used to make the occlusal plates differed, and group M achieved the best results in all analyses. Therefore, clinicians must consider the material used to manufacture long-lasting and efficient occlusal splints.

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Objetivo: Este estudo avaliou as propriedades de polimento dos materiais de splint oclusal obtidos usando métodos de fabricação subtrativos e aditivos com os procedimentos de polimento laboratorial (LP) e polimento em consultório (CP). Material e Métodos: As amostras (N=180, n=60 para cada grupo) foram fabricadas usando um dos seguintes métodos: método de fabricação subtrativo (SMM) (M-PM Disc, Merz Dental GmbH), método de fabricação aditivo (AMM) (Freeprint Splint 2.0, DETAX GmbH & Co. KG) e o método de fabricação convencional (CMM) (Promolux HC, Merz Dental GmbH). Seguindo os procedimentos de LP e CP, a rugosidade da superfície dos espécimes foi medida usando um perfilômetro de superfície digital. Um espécime representativo foi selecionado de cada grupo, e uma imagem de microscópio eletrônico de varredura (SEM) foi obtida. Resultados: Tanto o método de fabricação quanto os procedimentos de polimento afetaram significativamente os resultados (P<0,01). Os termos de interação também foram significativos (P<0,001). Conclusão: Com ambos os métodos de polimento, a rugosidade superficial do grupo AMM foi a maior e a do grupo CMM a menor. Embora o procedimento CP tenha sido mais eficaz do que LP com ambos os métodos, a rugosidade da superfície ficou abaixo do limite de 0,2 µm após ambos os procedimentos de polimento testados (AU)

Objective: This study evaluated the polishing properties of the occlusal splint materials obtained using subtractive and additive manufacturing methods with the laboratory-type polishing (LP) and chairside-type polishing (CP) procedures. Material and Methods: Specimens (N=180, n=60 each group) were manufactured using one of the following methods: subtractive manufacturing method (SMM) (M-PM Disc, Merz Dental GmbH), additive manufacturing method (AMM) (Freeprint Splint 2.0, DETAX GmbH & Co. KG), and the conventional manufacturing method (CMM) (Promolux HC, Merz Dental GmbH). Following LP and CP procedures, surface roughness of the specimens was measured using a digital surface profilometer. One representative specimen was selected from each group, and a scanning electron microscope (SEM) image was made. Results: Both the manufacturing method and the polishing procedures significantly affected the results (P<0.01). Interaction terms were also significant (P<0.001). Conclusion: With both polishing methods, surface roughness of the AMM group was the highest and the CMM group the least. Although the CP procedure was more effective than LP with both methods, surface roughness was below the 0.2 µm threshold after both polishing procedures tested. (AU)

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O aprimoramento da tecnologia CAD/CAM permitiu a confecção de placas estabilizadoras digitais, no entanto, há lacunas acerca do comportamento desses dispositivos frente a variáveis mecânicas e biológicas ainda desconhecidas. Dessa forma, o objetivo desse trabalho foi verificar se as resinas utilizadas na tecnologia digital das placas fresadas e impressas são capazes de influenciar na resistência à fratura e na adesão de micro-organismos em detrimento das resinas empregadas na confecção das placas termopolimerizáveis convencionais e se as propriedades testadas se relacionam com a variação da espessura desses dispositivos. Para tanto, foi realizado um estudo in vitro que contou com as fases mecânica e microbiológica, sendo cada uma composta pelos grupos Convencional (GC) (n=30), Fresado (GF) (n=30) e Impresso (GI) (n=30), de acordo com o método de confecção, possuindo cada um três subgrupos (n=10) que variaram a espessura dos espécimes de 1 a 3 mm. Na fase mecânica, as amostras, com formato de barras de 65 mm, foram testadas quanto à resistência à fratura na máquina de ensaios universal, com célula de carga de 500 kgf e velocidade de 1 mm/min; na microbiológica, a forma foi de discos com 15 mm de diâmetro, submetidos à adesão de micro-organismos à superfície com a exposição a Streptococcus mutans e mantidos por 24h a 35 °C em estufa para sucessiva contagem de UFC, com controle positivo. Os testes foram feitos em triplicata e os dados foram armazenados no SPSS 22.0 e a análise estatística contou com a ANOVA e o pósteste de Tukey. Nos resultados da fase mecânica, o ANOVA identificou diferenças estatisticamente significativas entre os grupos (p≤0,005), mostrando que GC e GF apresentaram melhores resultados. O pós-teste de Tukey considerou diferença estatisticamente significativa entre GF e GI (p=0,031), elencando GF como superior. Para a fase microbiológica, não foram verificadas diferenças estatísticas entre os grupos (p>0,005) em nenhuma das análises. Observou-se que para a resistência a fraturas, as resinas do modo fresado descreveram resultados superiores e/ou próximos aos da técnica convencional; e que as resinas da técnica digital e convencional, quanto à adesão superficial de micro-organismos, não diferiram entre si (AU).

CAD/CAM technology allowed the stabilizing splints manufacture, however there are gaps about these devices' behavior in face of mechanical and biological variables that are still unknown. Thus, the objective of this project was to verify if the resins used in digital technology of milled and printed stabilizer splints can influence fracture resistance and microorganism adhesion, in detriment of the resin applied in manufacture of conventional thermopolymerizable splints and if the tested properties are related to thickness variation of these devices. The method included mechanical and microbiological steps, each one composed by Conventional (CG) (n=30), Milled (MG) (n=30) and Printed (PG) (n=30) groups, according to the method of preparation, each one having three subgroups (n=10) that varied the specimen thickness from 1 to 3 mm. In the mechanical step, the samples, in the form of 65 mm bars, were tested for fracture resistance in a universal testing machine, with load cell of 500 kgf and speed of 1 mm/min; in the microbiological step, the shape was in form of 15 mm diameter discs, subjected to microorganism adhesion to the surface with exposure to Streptococcus mutans and kept for 24 hours at 35 °C in oven for successive CFU counting, with positive control. The tests were performed in triplicate and data were stored in SPSS 22.0 and statistical analysis used ANOVA and Tukey's post hoc. In the results of mechanical step ANOVA had identified statistically significant differences between the groups (p≤0,005), showing CG and MG had presented better results. Tukey´s post hoc had considered statistically significant difference between MG and PG (p=0,031), listing MG as superior. For the microbiological step, they did not show statistical differences between the groups (p>0.005) in any analysis. It was observed milled resins described superior results and/or close to the conventional technique one, for fracture resistance; and resins of digital and conventional technique, regarding the microorganism adhesion to the surface, did not differ from each other (AU).

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Objetivo: Evaluar los efectos de la aplicación de un dispositivo intraoral de uso permanente en el comportamien- to de los cóndilos con hiperplasia condilar (HC) confirmada por tomografía computarizada de emisión por fotón único (SPECT), estableciendo una comparación con un grupo de pacientes con HC que no utilizó el dispositivo. Materiales y métodos: 30 pacientes con una edad promedio de 21,7 años (+/-5,56) con HC confirmada con SPECT fueron asignados al azar a dos grupos: a los del grupo I (n=18) se les colocó un dispositivo intraoral de uso perma- nente para modificar la posición de la mandíbula, mientras que a los del grupo II (n=12) no se les colocó ningún dispo- sitivo. Se realizaron evaluaciones de dolor, del desvío de la línea media, de la apertura máxima y del disconfort al inicio del estudio y a los 2, 4, 6, 10, 12 y 14 meses. A los 19 meses promedio, la actividad osteoblástica (AO) fue reevaluada me- diante SPECT. Resultados: En el grupo I, la AO en los cortes coro- nales y transversales cesó o disminuyó (p<0,001) respecto a la condición inicial, mientras que en el grupo II la AO au- mentó (p<0,001). Los datos fueron analizados utilizando el test de Wilcoxon de rangos signados. Al ajustar un modelo de ANCOVA robusto utilizando el valor inicial como covariable también se observa que el efecto del grupo fue estadística- mente significativo en ambos cortes (p<0,001). Conclusiones: La aplicación de un dispositivo intrao- ral de uso permanente mejora la evolución de la hiperplasia condilar, lo que lo puede convertir en un tratamiento de uti- lidad para el tiempo que se aguarda para realizar una condi- lectomía alta de cuello de cóndilo, o incluso para evitar este procedimiento (AU)

Objective: To evaluate the effects of the application of an intraoral device for permanent use on the behavior of con- dyles with condylar hyperplasia (CH) confirmed by single photon emission computed tomography (SPECT), establish- ing a comparison with a group of patients with CH that did not use the device. Materials and methods: Thirty patients with an aver- age age of 21.7 years (+/-5.56) with CH confirmed by SPECT were randomly divided into two groups: the ones in group I (n=18) received an intraoral device for permanent use to align the mandible, while those in group II (n=12) did not get any device. Pain, midline shift, maximum opening, and discomfort were evaluated at the beginning of the study and at 2, 4, 6, 10, 12, and 14 months. At an average of 19 months, osteoblastic activity (AO) was reassessed by SPECT. Results: In group I, the AO in the coronal and trans- verse sections ceased or decreased (p<0.001) in comparison to the initial condition, while in group II the AO increased (p<0.001). The data was analyzed by the Wilcoxon signed rank test. Adjusting a robust ANCOVA model using the ini-tial value as a covariate made it possible to observe that the effect of the group was statistically significant in both cuts (p<0.001). Conclusions: The application of an intraoral device for permanent use improves the evolution of condylar hyperpla- sia, which can make it a useful treatment until a high condylectomy of the neck of the condyle is performed, or even to avoid this procedure (AU)

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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).

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La elaboración de férulas de descarga con la utilización de la técnica convencional, basada en la mezcla de un monómero y polímero con el posterior curado de la mezcla, puede dejar restos de monómero que generen reacciones de hipersensibilidad en algunas personas sensibles a estos químicos. Así, el uso de la tecnología CAD-CAM (Diseño Asistido por Ordenador - Fabricación Asistida por Ordenador), puede mejorar el ajuste y confort relacionado con el uso del dispositivo por el paciente. En el siguiente artículo se presenta un método de elaboración de férulas basado en esta tecnología.

The production of occlusal splints using the conventional technique based on a monomer and polymer mixing with subsequent curing of the mixture may leave traces of monomer that generate hypersensitivity reactions in allergic people to these chemicals. Hence, the use of CAD-CAM technology can improve the fit and comfort related to the use of the device on the patient. In this article a splint elaboration method is shown based on this technology.

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Introduction Orthognathic surgeries require the use of surgical splints (SS) to stabilize the occlusion and the segments fixed with plates and screws. Technological advances in the field of computing and the possibility of generating three-dimensional (3D) images have brought different possibilities for making SS, which has generated greater predictability and customization of surgical plans. The bibliometric study can have a qualitative character through the scope of articles in a certain area of knowledge. It is a selection process that can track a topic or scientific production. Methods The present study aimed to carry out a bibliometric literature review, in order to assess the evolution of the use of SS and the different planning protocols in orthognathic surgery. The Scopus database was used, with the terms "splint" and "orthognathic surgery." Results A total of 331 articles were found. These were exported to Rayyan for application of the inclusion and exclusion criteria and selection of articles. A total of 76 references were selected and exported to the VOSviewer application for the analysis of bibliometric data. Conclusions Orthognathic surgery was initially not associated with any computerized technological resource; however, it underwent updates between the years 2010 to 2012. These advances allowed surgical planning to become faster, cheaper, and more accurate.

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RESUMEN Fundamento: Existen modalidades de tratamiento para los trastornos temporomandibulares, una de ellas es la Ortopedia funcional de los maxilares. Objetivo: Evaluar la efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares. Metodología: Se realizó estudio experimental, abierto, controlado y aleatorizado en el servicio de Prótesis Estomatológica de la Clínica Estomatológica de Fomento en el período de septiembre de 2019 a septiembre de 2021. Se seleccionaron 60 pacientes con trastornos temporomandibulares que cumplieron los criterios de selección, mediante asignación aleatoria se establecieron los grupos: Estudio (tratado con Bionator de California) y control (tratado con férula neuromiorrelajante). Se utilizaron métodos del nivel teórico, empírico y estadístico. La variable de respuesta principal fue: Efectividad del Bionator de California en el grado de severidad del trastorno temporomandibular. Resultados: Al inicio del estudio predominó la severidad moderada de trastornos temporomandibulares en ambos grupos, pero a los 6 meses de tratamiento predominaron los asintomáticos (66.7 %) en el grupo estudio y 36.7 % en el grupo control, con diferencia estadísticamente significativa entre ambos grupos. Conclusiones: El tratamiento con el Bionator de California fue efectivo porque se logró disminuir el grado de severidad de los trastornos temporomandibulares.

ABSTRACT Background: There are treatment modalities for temporomandibular disorders, one of them is functional orthopedics of the jaws. Objective: To evaluate the effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders. Methodology: An experimental, open, controlled and randomized study was carried out in the Dental Prosthesis service at Fomento Dental Clinic from September 2019 to September 2021. 60 patients with temporomandibular disorders who met the selection criteria were selected. The groups were established by random assignment: Study (treated with Bionator from California) and control (treated with a neuromyorelaxant splint). Method theoretical, empirical and statistical levels were used. The main response variable was: Effectiveness of the California Bionator in the degree of severity of the temporomandibular disorder. Results: At the beginning of the study moderate severity of temporomandibular disorders prevailed in both groups, but after 6 months of treatment asymptomatic predominated (66.7%) in the study group and 36.7% in the control group, with a statistically significant difference between both groups. Conclusions: The treatment with the California Bionator was effective because the degree of severity of temporomandibular disorders was reduced.

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OBJECTIVE: To assess effects of stabilization splints on signs and symptoms of temporomandibular disorders of muscular origin compared to other treatments. METHODS: A search for articles via six electronic databases and gray literature was conducted. The risk of bias was evaluated with the Cochrane Collaboration tool. The Grading of Recommendations Assessment, Development and Evaluation approach determined the certainty of evidence. RESULTS: Ten articles were included. Stabilization splints (n = 160 subjects) were reported to be as effective as other treatments (n = 209 patients) on analyzed outcomes (pressure pain threshold, pain during chewing, mouth opening, spontaneous pain intensity and by palpation). Five studies were judged at low and five at some concerns of risk of bias. The certainty of evidence was very low for all outcomes. CONCLUSION: Positive effect on signs and symptoms of temporomandibular disorders of muscular origin, when managed with stabilization splint, could not be confirmed or refuted.

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RESUMEN: El objetivo de este estudio fue determinar las actitudes y la conciencia de los odontólogos y especialistas médicos sobre la provisión de dispositivos de avance mandibular (DAM) para el tratamiento de los ronquidos y la apnea del sueño. Se llevó a cabo un estudio observacional descriptivo de corte transversal, donde se seleccionaron por conveniencia 53 odontólogos (generales y especialistas) y 5 médicos especialistas en medicina del sueño en la ciudad de Guadalajara, México. Quienes respondieron un cuestionario específico desarrollado por Jauhar et al. (2008) dirigido a conocer la actitud de los odontólogos y médicos especialistas para la provisión de los DAM y otros aspectos relacionados con el ronquido y la apnea obstructiva del sueño (AOS). El 94 % de los odontólogos respondió estar interesado en capacitarse en ronquido y AOS. Y en el grupo de los médicos especialistas se encontró que el 80 % cree que los odontólogos sí tienen un papel para ayudar a los pacientes con ronquido y AOS, el 60 % cree que los odontólogos pueden contribuir con la realización de DAM y el 40 % considera que los odontólogos deben remitir a un especialista del sueño. Existe una actitud muy positiva de los odontólogos para ser parte del grupo interdisciplinario para el tratamiento del ronquido y de la apnea obstructiva del sueño, pero este estudio nos muestra además que a pesar de la disposición para utilizar los DAM, la formación y capacitación no es suficiente. Por otra parte, hay una actitud positiva de los médicos especialistas que consideran que los odontólogos juegan un papel importante en ayudar a los pacientes con ronquidos o con apnea del sueño, pero se evidencia que en su gran mayoría no usan los DAM como parte de un posible tratamiento.

ABSTRACT: The objective of this study was to determine the attitudes and awareness of dentists and medical specialists on the provision of mandibular advancement devices (MAD) for the treatment of snoring and sleep apnea. This is a cross-sectional descriptive observational study, where 53 dentists (general and specialists) and 5 sleep medicine specialists in the city of Guadalajara, Mexico were selected for convenience. The selected group answered a specific questionnaire developed by Jauhar et al., to know the attitude of dentists and medical specialists for the provision of MAD and other aspects related to snoring and obstructive sleep apnea (OSA). 94 % of dentists responded to be interested in training in snoring and OSA. And of the group of medical specialists, 80 % consider that dentists have a role in helping patients with snoring and OSA, 60 % believe that dentists can contribute to MAD and 40 % believe that dentists should refer a sleep specialist. There is a very positive attitude by the dentists to be part of the interdisciplinary group for the treatment of snoring and obstructive sleep apnea, but this study also shows that despite the willingness to use MAD, education and training is not enough. There is a positive attitude of specialist doctors who consider that dentists play an important role in helping patients with snoring or with sleep apnea, but it is evident that the majority do not use MAD as part of a possible treatment.

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OBJECTIVE: To compare the effect of a rapid low-level laser therapy (LLLT) protocol to Michigan occlusal splint in the treatment of myofascial pain, as well as to evaluate their impact on Oral Health-Related Quality of Life (OHRQoL). METHODS: Thirty participants were randomly allocated into three groups: G1: occlusal splint (n = 11), G2: LLLT (n = 10), and G3: LLLT placebo (n = 9). LLLT and placebo were applied in the points of pain upon palpation. RESULTS: G1 presented improvement in pain (p = 0.014) and in the diagnosis of myofascial pain (p = 0.008), while G2 and G3 did not. Regarding OHRQoL, G1 and G2 presented significant improvement (p = 0.005, in both), whereas, G3 did not. CONCLUSION: Michigan occlusal splint was effective in reducing pain and improving OHRQoL. Treatment with the rapid LLLT protocol only provided an improvement in OHRQoL.

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