Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Stabilization Splint Fabrication Using Computer-Aided Design/Computer-Aided Manufacturing and Three-Dimensional Printing

  • Received : 2019.06.11
  • Accepted : 2019.06.17
  • Published : 2019.07.01
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Abstract

A conservative treatment approach to temporomandibular disorder (TMD) is recommended as the first line of management, usually with a stabilization splint. Recently, computer-aided design/computer-aided manufacturing and three-dimensional printer has been widely used in the dentistry since several years ago. The authors apply digital dentistry in oral medicine fields to make stabilization splint for TMD treatment.

Keywords

INTRODUCTION

A conservative treatment approach to temporomandibular disorder (TMD) is recommended as the first line of management, usually with a stabilization splint [1]. This may produce an optimal stabilization and unload for the temporomandibular joint and the jaw muscles, and may lead to a reduced abnormal muscle activity [2].

Recently, computer-aided design/computer-aided manufacturing (CAD/CAM) and three-dimensional (3D) printer has been widely used in the dentistry for several years. Zirconia crown restorations, ceramic inlays, implant guide surgery templates, and multiple provisional restorations have been improved in precision and physical properties compared to conventional techniques [3].

In this communication, we apply digital dentistry in oral medicine fields, use a digital scanner to create digital impressions, then design and process special files (***.stl) in a PC design program to make stabilization splint for TMD treatment. Finally, digital splint was made by milling and 3D printing.

CASE REPORT

1. Materials (see Fig. 1)

• Digital scanner : OmniCam (Sirona, Bensheim, Germany)

• Design program : 3Shape (3Shape, Copenhagen, Denmark)

• CAM: inLab MC X5 (Sirona)

• Polymethyl methacrylate (PMMA) disc: inCoris PMMA Guide 22 (Sirona)

• 3D printer: Kulser-CARA (Heraus, Hanau, Germany)

• Printing material: Dima Print Guide (Heraeus)

GGNGBC_2019_v44n2_74_f0001.png 이미지

Fig. 1. Overview of digital workflow. (A) Digital scanner (OmniCam), (B) scan image, (C, D) digital articulator (3Shape), (E) milling machine (inLab MC X5), (F) polymethyl methacrylate (PMMA) disc for milling (inCoris PMMA Guide 22), (G) three-dimensional printer (Kulser-CARA, Heraeus, Hanau, Germany), (H) printing material (Dima Print Guide).

2. Methods

1) Digital scanning

A digital image with an intraoral scanner was produced with OmniCam (Sirona) in the upper and lower jaw.

2) 3Shape design software preparing virtual articulator

3) 3Shape design software setting splint form

Splint design requires the determination of several parameters, including the occlusal opening, contact points, shelf width, ramp positions, and perimeter or shape of the splint [3].

4) Milling or 3D printing

Milling uses inLab MC X5 (Sirona) with PMMA Disc (inCoris PMMA Guide 22)

3D printing uses Kulser-CARA (Heraus) with Dima Print Guide

5) Polishing and finishing of final digital splint (see Fig. 2)

GGNGBC_2019_v44n2_74_f0002.png 이미지

Fig. 2. Comparison of three kinds of stabilization splints. (A) Conventional additive method splint. (B) Polymethyl methacrylate disc milling splint. (C) Three-dimensional printing splint.

DISCUSSION

Conventional additive methods for making stabilization splints require several steps, such as impression taking, modeling, articulator mounting, resin pouring and polishing; which consumes a lot of time and consumable materials. But, designed on digital scan and PC, milling or printing time can be drastically shortened, use of consumable material can be minimized, and splint fit was found as good as the best conventional splints [4].

The meta-analysis revealed that the CAD/CAM occlusal splint has statistically potential in reduction of pain in jaw joint, face tension, and time needed for adjustment when compared to conventional occlusal splints [5].

In the future, this might reduce costs, dental technicians’ working and chair-side time. Accuracy can also be improved, since manual work phases are reduced [6].

Thus, Digital scanners and milling/3D printing will be widely used in oral medicine fields.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.​​​​​​​

References

  1. Alencar F Jr, Becker A. Evaluation of different occlusal splints and counselling in the management of myofascial pain dysfunction. J Oral Rehabil 2009;36:79-85. https://doi.org/10.1111/j.1365-2842.2008.01913.x
  2. Al-Ani MZ, Davies SJ, Gray RJ, Sloan P, Glenny AM. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database Syst Rev 2004;(1):CD002778.
  3. Warunek SP, Lauren M. Computer-based fabrication of occlusal splints for treatment of bruxism and TMD. J Clin Orthod 2008;42:227-232.
  4. Felle A, Jacobsson S, Wanman A, Soderstrom S. Accuracy of digitally produced stabilization splints [Thesis]. Umea, Sweden; University of Umea; 2017.
  5. Algabri RS, Alqutaibi AY, Abo-Alrejal H, et al. Effect of computer-aided design/computer-assisted manufacture versus conventional occlusal splints on the management of temporomandibular disorders: a systematic review and meta-analysis. Int Dent Med J Adv Res 2017;3:1-9. https://doi.org/10.11648/j.ijdm.20170301.11
  6. ModernDental NETWORK. How to use 3D printing to simplify occlusal splints [Internet]. Dental Products Report [cited 2018 Sep 14]. Available from: http://www.dentalproductsreport.com/dental/article/how-use-3d-printing-simplify-occlusal-splints?page=0,0