Citation Information :
Goel R, Jain V, Gupta C, Srivastava AK, Pruthi G. Effect of Hard and Soft Occlusal Splints on Electromyographic Activity of Masseter and Anterior Temporalis in Patients with Moderate to Severe Occlusal Wear: A Randomized Controlled Trial. Int J Prosthodont Restor Dent 2023; 13 (3):137-144.
Purpose: To compare the effect of hard and soft splints on muscle activity and self-reported clinical outcomes in patients with moderate to severe tooth wear at different intervals.
Materials and methods: Participants within the age range of 18–45 years having moderate to severe wear of teeth were allocated into group IHS (n = 8) receiving hard splints and group IISS receiving soft splints. Electromyography (EMG) activity of masseter and anterior temporalis were recorded during postural rest position (PRP) and maximum voluntary clenching (MVC) at baseline (T0), 24 hours (T1), 4 weeks (T2) and at 8 weeks (T3) with and without splint. EMG activity of controls with no or minimal tooth wear was recorded only at baseline. Nonparametric tests were used for within-group and intergroup comparisons, followed by post hoc analysis with Bonferroni correction.
Results: Baseline EMG activity was higher in experimental groups than that of controls, but the difference was nonsignificant (p > 0.05). At 24 hours, both the groups showed significantly lower (p < 0.05) EMG activity with the splint as compared to without the splint. Hard splints led to decreased muscle activity, while soft splints led to an increase at 4 and 8 weeks as compared to baseline EMG activity of controls, and the difference was nonsignificant except for anterior temporalis during MVC in group IHS. The intergroup comparison revealed insignificant differences at all time intervals (p > 0.05), while it was significant for anterior temporalis in MVC at 4 and 8 weeks (p < 0.05).
Conclusion: Muscle activity varied with different materials of the splint and duration of use. Both splints helped in the adaptation of muscles to new vertical dimensions of occlusion at 8 weeks with lesser variation between with and without splint position. The effect of the splint was more pronounced on the activity of the anterior temporalis than the masseter muscle.
Abduo J. Safety of increasing vertical dimension of occlusion: a systematic review. Quintessence Int 2012;43(5):369–380.
Holmgren K, Sheikholeslam A, Riise C. Effect of a full-arch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders. J Prosthet Dent 1993;69(3):293–297. DOI: 10.1016/0022-3913(93)90109-2
Roark AL, Glaros AG, O’Mahony AM. Effects of interocclusal appliances on EMG activity during parafunctional tooth contact. J Oral Rehabil 2003;30(6):573–577. DOI: 10.1046/j.1365-2842.2003.01139.x
Hugger S, Schindler HJ, Kordass B, et al. Surface EMG of the masticatory muscles. (Part 4): effects of occlusal splints and other treatment modalities. Int J Comput Dent 2013;16(3):225–239. PMID: 24364194.
Savabi O, Nejatidanesh F, Khosravi S. Effect of occlusal splints on the electromyographic activities of masseter and temporal muscles during maximum clenching. Quintessence Int 2007;38(2):e129–e132. PMID: 17510715.
Nanda A, Jain V, Srivastava A. An electromyographic study to assess the minimal time duration for using the splint to raise the vertical dimension in patients with generalized attrition of teeth. Indian J Dent Res 2011;22(2):303–308. DOI: 10.4103/0970-9290.84309
Truelove E, Huggins KH, Mancl L, et al. The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial. J Am Dent Assoc 2006;137(8):1099–1107; quiz 1169. DOI: 10.14219/jada.archive.2006.0348
Singh BP, Berry DC. Occlusal changes following use of soft occlusal splints. J Prosthet Dent 1985;54(5):711–715. DOI: 10.1016/0022-3913(85)90256-2
Wright E, Anderson G, Schulte J. A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain. J Orofac Pain 1995;9(2):192–199. PMID: 7488989.
Kolcakoglu K, Dogan S, Tulga Oz F, et al. A comparison of hard and soft occlusal splints for the treatment of nocturnal bruxism in children using the BiteSTRIP®. J Clin Pediatr Dent 2022;46(3):219–224. DOI: 10.17796/1053-4625-46.3.8
Al-Quran FA, Lyons MF. The immediate effect of hard and soft splints on the EMG activity of the masseter and temporalis muscles. J Oral Rehabil 1999;26(7):559–563. DOI: 10.1046/j.1365-2842.1999.00421.x
Narita N, Funato M, Ishii T, et al. Effects of jaw clenching while wearing an occlusal splint on awareness of tiredness, bite force, and EEG power spectrum. J Prosthodont Res 2009;53(3):120–125. DOI: 10.1016/j.jpor.2009.02.006
Karakis D, Dogan A, Bek B. Evaluation of the effect of two different occlusal splints on maximum occlusal force in patients with sleep bruxism: a pilot study. J Adv Prosthodont 2014;6(2):103–108. DOI: 10.4047/jap.2014.6.2.103
Raval C, Jadeja N, Soni A, et al. Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs). J Pharm Negat 2022; 3183–3187. DOI: 10.47750/pnr.2022.13.S08.393
Seifeldin SA, Elhayes KA. Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs). Saudi Dent J 2015;27(4):208–214. DOI: 10.1016/j.sdentj.2014.12.004
Pettengill CA, Growney MR Jr, Schoff R, et al. A pilot study comparing the efficacy of hard and soft stabilizing appliances in treating patients with temporomandibular disorders. J Prosthet Dent 1998;79(2):165–168. DOI: 10.1016/s0022-3913(98)70211-2
Poorna T A, John B, E K J, et al. Comparison of the effectiveness of soft and hard splints in the symptomatic management of temporomandibular joint disorders: A randomized control study. Int J Rheum Dis 2022;25(9):1053–1059. DOI: 10.1111/1756-185X.14379
Schulz KF, Altman DG, Moher D, et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010;152(11):726–732. DOI: 10.7326/0003-4819-152-11-201006010-00232
Pergamalian A, Rudy TE, Zaki HS, et al. The association between wear facets, bruxism, and severity of facial pain in patients with temporomandibular disorders. J Prosthet Dent 2003;90(2):194–200. DOI: 10.1016/s0022-3913(03)00332-9
Lobbezoo F, Ahlberg J, Glaros AG, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013;40(1):2–4. DOI: 10.1111/joor.12011
Rickham PP. Human experimentation. code of ethics of the World Medical Association. Declaration of Helsinki. Br Med J 1964;2(5402):177. DOI: 10.1136/bmj.2.5402.177
Okeson JP. Management of temporomandibular disorders and occlusion. 4th ed. St. Louis, MO: Mosby; 1998. 480.
Naikmasur V, Bhargava P, Guttal K, et al. Soft occlusal splint therapy in the management of myofascial pain dysfunction syndrome: a follow-up study. Indian J Dent Res 2008;19(3):196–203. DOI: 10.4103/0970-9290.42950
Yuen SW, Hwang JC, Poon PW. EMG power spectrum patterns of anterior temporal and masseter muscles in children and adults. J Dent Res 1989;68(5):800–804. DOI: 10.1177/00220345890680050901
Dylina TJ. A common-sense approach to splint therapy. J Prosthet Dent 2001;86(5):539–545. DOI: 10.1067/mpr.2001.118878
Pita MS, Ribeiro AB, Garcia AR, et al. Effect of occlusal splint thickness on electrical masticatory muscle activity during rest and clenching. Braz Oral Res 2011;25(6):506–511. DOI: 10.1590/s1806-83242011000600006