Effect of occlusal splint therapy on the temporalis muscle activity during sleep bruxism

Abstract

Çalışmanın amacı, oklüzal apareylerin uyku sırasında temporal kasın elektromyografik aktivitesi üzerine kısa dönem etkisinin incelenmesidir. Çalışmaya uyku bruksizmi tanısı konmuş, 21-37 yaşlar arasındaki (ortalama yaş: 28.29±5.16) 31 hasta dahil edilmiştir. 20 hasta tedavi grubunda (64.5%) ve 11 hasta kontrol grubunda (35.5%) yer almıştır. Anket, bruksizmin klinik bulguları değerlendirilerek bruksizm tanısı konmuştur. Bruksizm aktivitesi asitle pürüzlendirme ve EMG kayıt cihazı kullanımı ile onaylanmıştır. Tedavi grubundaki hastalar için 3 mm kalınlığındaki sert akrilik oklüzal aparey alt çeneye uygun olarak hazırlanmıştır. Tüm oklüzal apareyler sentrik ilişkide bilateral posterior diş teması, lateral harekette kanin koruyuculu oklüzyon olacak şekilde uyumlandırılmıştır. Uyku sırasındaki elektromyografik aktivite, 12 gece boyunca portatif EMG cihazı kullanılarak sağ temporal kasın aktivitesi ölçülerek saptanmıştır. İlk 6 gün boyunca, oklüzal aparey kullanılmamıştır. Oklüzal aparey kullanıldığı durumlarda temporal kasın EMG aktivitesinde anlamlı azalma saptanmıştır. Oklüzal aparey kullanan 2 hastada, bruksizm aktivitesinde artış saptanmıştır. Sonuç olarak, oklüzal apareyler çiğneme kaslarının hızlı relaksasyonu için kullanılabileceği göz önünde bulundurulmalıdır. Bruksizmin bulgu ve belirtileri, oklüzal aparey kullanımından önce mutlaka değerlendirilmelidir.

The aim of our study was to investigate the effect of the short term occlusal appliances therapy on the nocturnal electromyographic activity of the temporalis muscle during Sleep bruxism. This study performed on 37 patients Over 18 years of age that had sleep bruxism. Subjects varied in age between 21 and 37 years with a mean age of 28.29±5.16 years, 12 (38.7 %) females and 19 (61.3 %) male. However, 6 subjects were excluded from the statistical analysis because there is loss of electrode skin contact. The final statistical sample of subjects was reduced to 31 patients were divided into two groups; Treatment group 20 patients (64.5 %), and untreated control group 11 patients (35.5 %). The subjects are selected on the basis of questionnaire and clinical signs and the activity of bruxism was confirmed with acid etching technique and by using portable EMG recording device. For all subjects in treatment group, a full arch heat cure acrylic resin interocclusal appliance covering all of the mandibular teeth were fabricated on the mandibular casts with 3 mm thickness of acrylic between the maxillary and mandibular posterior teeth. All interocclusal appliance have bilateral anterior-posterior simultaneous contacts in centric relation with anterior and canine guidance in lateral and protrusive excursions. Electromyographic activity during sleep was recorded from the right side of anterior temporalis muscle with portable Electromyographic recording device. The patients were instructed to wear it every night over the 12 days of the study. During the first 6 consecutive nights, all patients used the device during sleep without the occlusal appliance to record the pre-treatment baseline data (number of EMG events/hour). During the next 6 consecutive nights, all patients in treatment group used the device during sleep with the occlusal appliance in, to record the treatment data (number of EMG events/hour). Our result showed a significant reduction in the EMG activity of temporalis muscles during sleep with occlusal appliances in situ. An individual variation in changes of sleep bruxism activities by wearing splints was observed in this study; 13 of 20 subjects showed statistical significant reduction in the sleep bruxism activity, 3 of 20 subjects showed reduction in the sleep bruxism activity however this reduction was not statistical significant, and 2 of 20 subject showed no difference between pre-treatment and post treatment sleep bruxism activity. On the contrary, 2 subjects showed increase in sleep bruxism activities while using occlusal appliance as compared to baseline data. From our study, we could conclude that, that the occlusal appliance should be regarded as a management for rapidly relaxing masticatory muscles. However since some individual variations have been observe, the splint is not always effective in all bruxism patients, and the clinicians should always monitor the signs and symptoms reported by the patient when using an oral device for the management of sleep bruxism