The Effect of Occlusal Splint Pretreatment on

Mandibular Movements and Vertical Dimension of

Occlusion in Long-Term Complete Denture Wearers
Rita de Cassia Costa Ribeiro de Almeida, DDS, MScVWellington Luiz de Oliveira da Rosa, DDS, MSc1/
Noeli Boscato, DDS, MSc, PhD2

Purpose: This study evaluated the pretreatment influence of occlusal splints and relines
on mandibular movements (MM) and vertical dimension of occlusion (VDO) in long
standing complete denture wearers. M aterials and Methods: A total of 30 volunteers
were randomly assigned to three groups (n = 10): control (C), relining of old denture (RD)
and occlusal splints (OS). Individual extent of MM was assessed via intraoral Gothic arch
tracings and the VDO using posed frontal images taken at three time points. Results:
The OS group showed statistically significant differences when compared with the other
groups [P < .05). Conclusion: Both MM and VDO were significantly improved by use of
occlusal splints pretreatment. IntJ Prosthodont 2016;29:287-289. doi: 10.11607/ijp.4369

ong-term complete denture wearers often present Materials and Methods

L with loss of vertical dimension of occlusion (VDO),
prosthesis instability, and changes in the orientation of
the occlusal plane1 associated with wear of prosthetic
teeth and residual ridge reduction in both edentulous
jaws,1,2 changes that are also reported to adversely af
fect temporomandibular joint and masticatory muscle
functional integrity.2*" 6 Consequently, consideration
should be given to pretreatment interventions1'6 to im
prove mandibular movements (M M ) and VDO.
Occlusal splints are recommended to optimize har
monious occlusal plane levels and masticatory mus
cle function, while relines are prescribed to readapt
dentures intaglio to their supporting tissues. Both
interventions contribute to reestablishment of com
promised MM.1'7
The aim of this study was to evaluate the influence
of pretreatment with occlusal splints and denture re
lines in establishing optimal MM and VDO in long
term complete denture wearers. The null hypothesis
tested was that there is no relationship between the
pretreatment protocols and improved MM and VDO.
'PhD Student, Graduate Program in Dentistry, Federal University ofPelotas,
Pelotas, Rio Grande do Sul, Brazil.
2Professor, Graduate Program in Dentistry, Federal University ofPelotas,
Pelotas, Rio Grande do Sul, Brazil.
Correspondence to: Prof Noeli Boscato, Graduate Program in Dentistry,
Federal University ofPelotas, Rua Gongalves Chaves 457, 2nd floor,
96015-560, Pelotas, RS, Brazil. Fax: +55 53 32256741.
Email: noeliboscato@gmail.com
2016 by Quintessence Publishing Co Inc.
This randomized design clinical study was approved
by the Research and Ethics Committee, School of
Dentistry, Federal University of Pelotas, Brazil and
performed according to the CONSORT statement (Fig
1) and registered at ClinicalTrials.gov (NCT02915585).8
The volunteers inclusion criteria are listed in Table 1,
and subjects were evaluated regarding their VDO and
extent of MM at three different time points. Sample
size calculation (n = 8) was performed assuming that
statistical tests would be used with a study power of
80% (a =.05). To account for potential losses during
the experiment, 30 volunteers were selected.
The volunteers (6 men and 24 women; mean age:
70.4 years; mean time of use of complete denture:
14 years) were randomly assigned to three groups
(n = 10) according to the assigned interventions using
computer-generated random numbers. The interven
tion sequences were concealed in sealed envelopes:
control group (C) with no pretreatment; relining group
(RD),7 where the old dentures were managed with an
acrylic resin-based resilient liner (TruSoft, Bosworth);
and the occlusal splint group (OS), where thermopoly-
merized acrylic resin splints (JET, Ciassico) were made
on the old dentures. Splints were 3 mm thick with a
flat occlusal surface against the antagonist arch in
centric relation and without canine and anterior guid
ance in excursive movements.1 The volunteers used
the occlusal splints or the relined denture for 30 days
after a final adjustment appointment. Afterward, all
subjects received new complete dentures.
To assess VDO, posed frontal images were obtained
with a digital single lens reflex camera (EOS Rebel

Volume 29, Number 3, 2016 287

Occlusal Splint Pretreatment in Long-Term Complete Denture Wearers

Fig 1 Study design according to CONSORT statement.8

Table 1 Inclusion and Exclusion Criteria
Inclusion
Individuals of either sex
Age a 50 y
Complete denture wearers who had
not changed their dentures for at
least 5 years
Loss of OVD and complete denture
with instability, lack of retention
and changes in the orientation of
occlusal plane
Exclusion
Inability to comply with
the experimental protocol
Presence of disease in
the oral mucosa
Poor general health
Presence of
temporomandibular
disorders
The images were imported into software [Image
Tool version 3.0, University of Texas Health Science
Center),9 and VDO and MM measurements were per
formed by a blind examiner at T0 [baseline), T, [30 days
after pretreatment with RD or OS), and T2 [after new
denture insertion). The C group was only evaluated
at T0 and T2, with a 6-week interval between evalu
ations. One-way analysis of variance with post hoc
Bonferroni test was used for intergroup and paired
t test for intragroup comparisons.
Results

Intragroup analysis found statistically significant dif

XTi, Carton) mounted on a tripod.9 The camera lens
was adjusted to be parallel to the Frankfort horizontal
plane to standardize the head position, allowing accu
rate repositioning. The vertical distance from the base
of the nose to the base of the chin was measured. To
assess MM, digital images of intraoral Gothic arch
trace were obtained, and anteroposterior [x axis) and
laterolateral [y axis) movement were measured. A ruler
with millimeter markings was included in the capture
area of each digital image to provide reliability in the
measurements.
ferences between VDO and MM measurements ob
tained at TQand T2 for all groups [P < .05) except for
MM in the C group [Table 2). In the intergroup com
parisons, the OS group showed statistically significant
differences when compared with other groups for
both VDO and MM [P < .05) [Table 3).
Discussion
All three groups showed significant differences in
VDO and MM measurements obtained before and

288 The International Journal of Prosthodontics

 de Almeida et al

Table 2 Intragroup Comparisons of MM and VDO Measurements

MM [mm)
x-axis y-axis VDO (mm)
To T t2 T T, t2 To T, t2
c 8.1 2.0a NA 8.3 2.0a 8.2 2.4a NA 8.4 1.7a 68.4 6.8a NA 69.9 7.2b
RD 8.6 + 2.4a 9.0 2.2b 9.2 2.1b 8.8 3.7a 9.2 3.7b 9.1 3.7b 68.7 7.1a 70.6 7.4b 70.7 7.3b
OS 8.5 1.5a 9.9 1.5b 9.8 1.6b 8.6 2.6a 9.8 3.3b 9.9 3.2b 69.3 8.1a 74.6 8.7b 74.9 8.7b
Different letters show significant differences [P < .05). MM = mandibular movement; VDO = vertical dimension of occlusion.

Table 3 Intergroup Comparisons of MM and VDO Measurements

MM
x-axis y-axis VDO
t 2- t VTo VT T,-T0 t 2- t V To
C 0.2 0.18 NA 0.2 0.1a NA 1.5 1.1s NA
RD 0.6 0.2a 0.4 0.2a 0.3 0.2a 0.4 0.2a 2.1 1.1a 1.9 1.0
OS 1.3 0.1b 1.4 0.1b 1.3 0.1b 1.2 0.1b 5.6 1.4b 5.3 1.4b
Different letters show significant differences CP < -05]. MM = mandibular movement; VDO = vertical dimension of occlusion.

after new complete denture insertion, except for MM Acknowledgments

in the C group. This could be because the lowest VDO
reestablishment was obtained in the group of patients
managed via the traditional technique. Likewise, re
sults showed that the use of occlusal splint as a pre
treatment for complete denture wearers provided the
highest VDO reestablishment and demonstrated the
highest increase in the extent of MM. The findings of
the present study highlight the role of occlusal splint
therapy in the reestablishment of VDO10 and muscu
lar stability .3 This is likely because the use of occlusal
splints over complete dentures provided appropriate
conditions for the mandible to achieve better vertical
and horizontal positioning.
The relining intervention improved denture stabil
ity and masticatory function but was not enough to
significantly enhance evaluated outcomes. However,
the health of inflamed mucosa improved as a result of
this nonsurgical and cost-effective adjunctive inter
vention .7 Therefore, the hypothesis tested in this study
was partially rejected.
The present findings should be interpreted with
caution because the presumed merits of the proposed
interventions may have been equally achieved via pre
scription of new complete dentures. Nonetheless, tra
ditional complete denture pretreatment protocols may
be enhanced by considering the findings of this study.
Conclusions
The use of occlusal splint pretreatment should be
considered for patients whose long-term denture-
wearing experience is associated with compromised
MM and VDO prior to prescribing new dentures.
The authors reported no conflicts of interest related to this study.
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