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Effect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial.

ABSTRACT: OBJECTIVES:The purpose of the present study was to analyze treatment outcome with a full-occlusion biofeedback (BFB) splint on sleep bruxism (SB) and TMD pain compared with treatment with an adjusted occlusal splint (AOS). MATERIALS AND METHODS:Forty-one patients were randomly allocated to a test (BFB) or a control (AOS) group and monitored over a 3-month period. Output variables were frequency and duration of bruxing events (bursts) and various pain symptoms. RESULTS:The BFB group showed a statistically significant reduction in the frequency and duration of bursts and a statistically significant improvement in the patients' global well-being and the facial muscle pain parameter. After the treatment was stopped, the BFB group showed a statistically significant reduction in the average and maximum duration but no statistically significant change in the frequency of bursts. CONCLUSIONS:The tested BFB splint is highly effective in reducing SB at the subconscious level, i.e., without waking the patient, and in achieving improvements in global pain perception. The results suggest that the BFB splint also provides a better treatment option for bruxism-related pain than an AOS. However, further research is needed, and specifically studies with a larger patient population displaying higher levels of pain at baseline. CLINICAL RELEVANCE:By reducing burst duration and therefore the pathological load on the masticatory apparatus, the BFB splint reduces TMD and bruxism-related symptoms and improves patients' physical well-being. In the long term, this could prevent damage to the TMJ. This study confirms the effectiveness and safety of this splint. THE UNIVERSAL TRIAL NUMBER:U1111-1239-2450 DRKS-ID REGISTRATION: DRKS00018092.

SUBMITTER: Bergmann A

PROVIDER: S-EPMC7544753 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Effect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial.

Bergmann Alexander A Edelhoff Daniel D Schubert Oliver O Erdelt Kurt-Jürgen KJ Pho Duc Jean-Marc JM

Clinical oral investigations 20200519 11

<h4>Objectives</h4>The purpose of the present study was to analyze treatment outcome with a full-occlusion biofeedback (BFB) splint on sleep bruxism (SB) and TMD pain compared with treatment with an adjusted occlusal splint (AOS).<h4>Materials and methods</h4>Forty-one patients were randomly allocated to a test (BFB) or a control (AOS) group and monitored over a 3-month period. Output variables were frequency and duration of bruxing events (bursts) and various pain symptoms.<h4>Results</h4>The B ...[more]

PMID: 32430774

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Project description:BACKGROUND: Bruxism is a disorder of jaw-muscle activity characterised by repetitive clenching or grinding of the teeth which results in discomfort and damage to dentition. The two clinical manifestations of the condition (sleep and awake bruxism) are thought to have unrelated aetiologies but are palliated using similar techniques. The lack of a definitive treatment has prompted renewed interest in biofeedback, a behaviour change method that uses electronic detection to provide a stimulus whenever bruxism occurs. This systematic review aims to provide a comprehensive overview of the state of research into biofeedback for bruxism; to assess the efficacy and acceptability of biofeedback therapy in management of awake bruxism and, separately, sleep bruxism in adults; and to compare findings between the two variants. METHODS: A systematic review of published literature examining biofeedback as an intervention directed at controlling primary bruxism in adults. We will search electronic databases and the grey literature using a predefined search strategy to identify randomised and non-randomised studies, technical reports and patents. Searches will not be restricted by language or date and will be expanded through contact with authors and experts, and by following up reference lists and citations. Two authors, working independently, will conduct screening of search results, study selection, data extraction and quality assessment and a third will resolve any disagreements. The primary outcomes of acceptability and effectiveness will be assessed using only randomised studies, segregated by bruxism subtype. A meta-analysis of these data will be conducted only if pre-defined conditions for quality and heterogeneity are met, otherwise the data will be summarized in narrative form. Data from non-randomised studies will be used to augment a narrative synthesis of the state of technical developments and any safety-related issues. PROSPERO registration number: CRD42013006880. DISCUSSION: Biofeedback is not new, but its place in the clinical management of bruxism remains unclear. New research, and the availability of miniaturized consumer-grade devices, makes a systematic review timely to guide treatment decisions and inform future research.

Project description:Introduction: The diagnosis of sleep bruxism is challenging due to the difficulties involved. Sleep bruxism can lead to clinical consequences, including pain in masticatory muscles, limitation of jaw mobility, headache, and the spectrum of symptoms associated with damage to the teeth and oral mucosa. Currently, only video-polysomnography can definitely diagnose sleep bruxism. Due to the risk of painful temporomandibular disorders (TMD) in sleep bruxers, early diagnosis of pain in the temporomandibular region using questionnaires is recommended. Therefore, this study aimed to assess the relationship between the intensity of sleep bruxism and the occurrence of pain related to TMD. Materials and Methods: This study was conducted on the patients of the Clinic of Prosthetic Dentistry operating at the Department of Prosthetic Dentistry at the Wroclaw Medical University. Based on a positive medical history, a thorough examination for the diagnosis of probable sleep bruxism was carried out in the enrolled patients. Eligible patients were then subjected to a video-polysomnographic study. Each patient was asked to complete the TMD Pain Screener questionnaire to assess the occurrence of pain in jaw and temple area. Results: The results of the study showed that increased bruxism episode index (BEI) was statistically significantly correlated with increase of all types of bruxism episodes-phasic, tonic, and mixed-in all the studied patients; a significant correlation was also found with respect to division of patients into studied and control groups. The study also showed that there was no statistically significant difference between BEI values and scores of TMD Pain Screener. In all the studied patients, a higher BEI was not found to be correlated with the occurrence of TMD-related pain assessed by TMD Pain Screener; similarly, no correlation was found with respect to division of patients into studied and control groups. Conclusions: The occurrence of TMD-related pain is not related to the intensity of sleep bruxism. TMD Pain Screener may be used as an auxiliary tool in the diagnosis or risk of occurrence of TMD-related pain, whereas in the case of sleep bruxism, it has only limited diagnostic value. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03083405.

Project description:Temporomandibular disorder (TDM) is the most common source of orofacial pain of a non-dental origin. Sleep bruxism is characterized by clenching and/or grinding the teeth during sleep and is involved in the perpetuation of TMD. The aim of the present study was to investigate the effects of massage therapy, conventional occlusal splint therapy and silicone occlusal splint therapy on electromyographic activity in the masseter and anterior temporal muscles and the intensity of signs and symptoms in individuals with severe TMD and sleep bruxism.Sixty individuals with severe TMD and sleep bruxism were randomly distributed into four treatment groups: 1) massage group, 2) conventional occlusal splint group, 3) massage?+?conventional occlusal splint group and 4) silicone occlusal splint group. Block randomization was employed and sealed opaque envelopes were used to conceal the allocation. Groups 2, 3 and 4 wore an occlusal splint for four weeks. Groups 1 and 3 received three weekly massage sessions for four weeks. All groups were evaluated before and after treatment through electromyographic analysis of the masseter and anterior temporal muscles and the Fonseca Patient History Index. The Wilcoxon test was used to compare the effects of the different treatments and repeated-measures ANOVA was used to determine the intensity of TMD.The inter-group analysis of variance revealed no statistically significant differences in median frequency among the groups prior to treatment. In the intra-group analysis, no statistically significant differences were found between pre-treatment and post-treatment evaluations in any of the groups. Group 3 demonstrated a greater improvement in the intensity of TMD in comparison to the other groups.Massage therapy and the use of an occlusal splint had no significant influence on electromyographic activity of the masseter or anterior temporal muscles. However, the combination of therapies led to a reduction in the intensity of signs and symptoms among individuals with severe TMD and sleep bruxism.This study is registered in August, 2014 in the ClinicalTrials.gov (NCT01874041).

Dataset Information

Effect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial.

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Effect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial.

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