Stabilization Splint Fabrication Using Computer-Aided Design/Computer-Aided Manufacturing and Three-Dimensional Printing JOMP

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pISSN 2288-9272 eISSN 2383-8493 J Oral Med Pain 2019;44(2):74-76 https://doi.org/10.14476/jomp.2019.44.2.74

Stabilization Splint Fabrication Using Computer-Aided Design/

Computer-Aided Manufacturing and Three-Dimensional Printing

Byung-Jin Sohn ¹ , Wook Kim ² , Jea-Hong Kim ³ , Un-Bong Baik ⁴

1 Seoul M Dental Clinic, Seoul, Korea

2 TMD Dental Clinic, Uijeongbu, Korea

3 Seoul Top Dental Clinic, Namyangju, Korea

4 Smilewith Orthodontic Clinic, Seoul, Korea

Received June 11, 2019 Revised June 17, 2019 Accepted June 17, 2019

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.

Key Words: Computer-aided design/computer-aided manufacturing; Digital scanner; Stabi- lization splint; Three-dimensional printing

Correspondence to:

Wook Kim

TMD Dental Clinic, 80 Simin-ro, Uijeongbu 11651, Korea

Tel: +82-31-841-2875 Fax: +82-31-841-2864 E-mail: wkkk007@hanmail.net

https://orcid.org/0000-0002-3958-3894

Brief Communication

JOMP Journal of Oral Medicine and Pain

Copyright Ⓒ 2019 Korean Academy of Orofacial Pain and Oral Medicine. All rights reserved.

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This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

INTRODUCTION

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

Recently, computer-aided design/computer-aided manu- facturing (CAD/CAM) and three-dimensional (3D) print- er 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 im- pressions, 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, Den mark)

• 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)

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

75 Byung-Jin Sohn et al. Stabilization Splint Fabrication Using CAD/CAM and 3D Printing

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3) 3Shape design software setting splint form

Splint design requires the determination of several pa- rameters, 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 (in- Coris PMMA Guide 22)

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

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

DISCUSSION

Conventional additive methods for making stabiliza- tion splints require several steps, such as impression taking, modeling, articulator mounting, resin pouring and polish- ing; which consumes a lot of time and consumable materi- als. But, designed on digital scan and PC, milling or print- ing 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].

A B C D

E F G H

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).

A B C

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.

76 J Oral Med Pain Vol. 44 No. 2, June 2019

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In the future, this might reduce costs, dental technicians’

working and chair-side time. Accuracy can also be im- proved, 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.

ORCID

Byung-Jin Sohn

https://orcid.org/0000-0002-0641-615X Wook Kim

https://orcid.org/0000-0002-3958-3894 Jea-Hong Kim

https://orcid.org/0000-0001-8040-1493 Un-Bong Baik

https://orcid.org/0000-0002-9038-9229

REFERENCES

1. Alencar F Jr, Becker A. Evaluation of different occlusal splints and counselling in the management of myofascial pain dysfunc- tion. J Oral Rehabil 2009;36:79-85.

2. Al-Ani MZ, Davies SJ, Gray RJ, Sloan P, Glenny AM. Stabilisa- tion splint therapy for temporomandibular pain dysfunction syn- drome. Cochrane Database Syst Rev 2004;(1):CD002778.

3. Warunek SP, Lauren M. Computer-based fabrication of oc- clusal splints for treatment of bruxism and TMD. J Clin Orthod 2008;42:227-232.

4. Felle A, Jacobsson S, Wänman A, Söderström S. Accuracy of digitally produced stabilization splints [Thesis]. Umeå, Sweden;

University of Umeå; 2017.

5. Algabri RS, Alqutaibi AY, Abo-Alrejal H, et al. Effect of comput- er-aided design/computer-assisted manufacture versus conven- tional occlusal splints on the management of temporomandibular disorders: a systematic review and meta-analysis. Int Dent Med J Adv Res 2017;3:1-9.

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/

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