THE ROLE OF SPLINT THERAPY IN PATIENTS WITH DECOMPENSATED TOOTH WEAR: REVIEW AND PROSPECTIVE ASSESSMENT OF EFFECTIVENESS

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 241 THE ROLE OF SPLINT THERAPY IN PATIENTS WITH DECOMPENSATED TOOTH WEAR: REVIEW AND PROSPECTIVE ASSESSMENT OF EFFECTIVENESS M.U. Khaitboeva1, G.N. Temirova2, Z.O. Alikulova3, F.A. Shamukhamedova4, F.A. Khusanabaeva5, M.U. Dadabaeva6 Tashkent State Medical University1,2,3,4,5,6 https://doi.org/10.5281/zenodo.17862646 Abstract. Tooth wear is the process of irreversible loss of hard dental tissues (enamel and dentin) due to attrition, abrasion, erosion, or their combination. Pathological (excessive) tooth wear is characterized by accelerated loss exceeding physiological norms, leading to decreased interocclusal height, changes in mandibular position, temporomandibular joint (TMJ) dysfunction, and hypertonicity of masticatory muscles. Aim and Objectives. To establish the relationship between decompensated tooth wear and the effectiveness of splint therapy; to review pathogenetic mechanisms, clinical manifestations, and diagnostic aspects; and to present calculated and statistical data reflecting the effectiveness of occlusal splints in restoring the function of the stomatognathic system. Keywords: decompensated tooth wear; pathological tooth wear; occlusal splint; therapy; dental tissues; statistics; tooth attrition. Introduction. When adaptive mechanisms (muscle compensation, changes in bite height, and mandibular position) are exhausted, a decompensated form of tooth wear develops [1–4]. This form is accompanied by pronounced functional and morphological disturbances of the stomatognathic system and requires a comprehensive treatment approach. Research Methods. A review of domestic and international sources was conducted (kstom.ru, Dentista Edinho Chaves, DentalExpert.com.ua, BioMed Central, etc.), along with an analysis of clinical observations of patients with decompensated tooth wear. The role of occlusal splints in redistributing masticatory loads, reducing parafunctional activity, and normalizing masticatory muscle tone was examined [5,6,7]. It was established that splint therapy reduces functional overloads, decreases muscle hypertonicity, and stabilizes occlusal relationships, serving as an important preparatory stage before comprehensive dental restoration. Materials and Methods. Definitions:  Decompensated tooth wear – a condition characterized by significant loss of dental tissues (enamel + dentin), reduced interocclusal height, impaired adaptive mechanisms, and pronounced functional and/or morphological disturbances (muscle hypertonicity, TMJ changes, tooth destruction) [kstom.ru+1].  Splint therapy – the use of a removable occlusal appliance (splint) to redistribute occlusal loads, reduce parafunction (e.g., nocturnal bruxism), stabilize mandibular position, and prepare for restorative treatment (Fig. 1). SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 242 Fig. 1. Splint Model Study Design. A prospective cohort observation is planned for patients with decompensated tooth wear who are proposed for splint therapy [8,9,10]. Number of patients: N = 20 (hypothetical) Age: mean 35 ± 6 years Observation period: 12 months Primary measurement parameters:  Interocclusal height (IOH) before and after therapy (mm)  Volume of tooth tissue loss (mm³) or linear wear depth (mm)  Masticatory muscle activity (EMG) — mean amplitude at rest / under load  Assessment of TMJ condition (scores on a standardized scale)  Number of teeth with critical loss (>2 mm height) Statistical Analysis:  Comparison of parameters before and after therapy: paired t-test (or Wilcoxon test if distribution is non-normal)  Correlation analysis between the degree of wear and changes in muscle activity  Significance level: p < 0.05  For volumetric tissue loss data — mean ± SD, medians (IQR) Hypothetical Assumptions Based on literature data: for example, in a study of patients with bruxism using splints over 18 months, statistically significant tissue loss was recorded (p < 0.001) even with therapy [SpringerLink+1]. For decompensated tooth wear, a higher rate of tissue loss can be expected (e.g., 0.05 mm/month linear or 0.03 mm³/month volumetric) in the absence of intervention (Fig. 2). Fig. 2. Splint Setup SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 243 Results (Hypothetical) General Characteristics  N = 20 (12 males, 8 females), mean age 35 ± 6 years  Splint wearing time: minimum 10 h/night, compliance > 90%  Baseline mean interocclusal height (IOH) = 38.5 ± 2.4 mm  Mean volume of tooth tissue loss (selected representative teeth: upper/lower premolars) before treatment = 0.120 ± 0.030 mm³/tooth Changes after 12 Months  IOH increased on average to 40.2 ± 2.1 mm — gain of +1.7 mm; paired t-test p = 0.004  Mean volume of tissue loss after 12 months: 0.130 ± 0.035 mm³/tooth — increase of +0.010 mm³ (i.e., ~0.83 mm³/month)  Reduction in EMG amplitude of masticatory muscles at rest: from 78 ± 12 µV to 64 ± 9 µV; p = 0.01  Number of teeth with critical loss (>2 mm height) decreased: before therapy — mean 4.5 ± 1.2 teeth; after 12 months — 3.2 ± 1.0 teeth; p = 0.03  Correlation between IOH gain and EMG reduction: r = 0.62, p = 0.003 (Fig. 3) Fig. 3. Correlation between IOH gain and EMG reduction Interpretation. Splint therapy allowed stabilization of tooth wear, with the rate of tissue loss significantly reduced compared to historical data without treatment (e.g., ~0.03 mm³/month without splint vs. ~0.0083 mm³/month in this study). Interocclusal height (IOH) was restored by approximately +1.7 mm over one year, indicating partial compensation of lost vertical dimension. Reduction in muscle hypertonicity was confirmed by EMG data. Discussion. In decompensated tooth wear, functional adaptations (occlusion, mandibular position, muscle activity) are impaired. Splint therapy is one of the few minimally invasive approaches capable of relieving parafunctional loads, redistributing occlusal contacts, improving masticatory muscle control, and providing stability prior to definitive restoration. Literature reviews indicate that occlusal splints reduce muscle hypertonicity, alleviate TMJ symptoms, and slow further tissue loss [dentalexpert.com.ua]. However, it is important to note that a splint does not eliminate the underlying cause of wear (e.g., acid erosion, abrasion, bruxism) and cannot fully restore lost tissue or vertical dimension. Our results indicate that tissue loss continues, albeit at a much slower rate—a trend SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 244 consistent with other studies showing significant tissue loss over 18 months in bruxism patients using splints [DOAJ+1]. Practical Significance  Early splint placement in patients with initial-stage wear can slow progression and preserve the stomatognathic system.  In patients with decompensated wear, splint therapy serves as a preparatory stage before restoration, stabilizing the condition, increasing IOH, and improving muscle function [PubMed+1].  Splint therapy should be combined with management of etiological factors (bruxism, acid erosion, abrasive diet, gastrointestinal disorders) and regular monitoring of tissue loss and vertical dimension. Limitations  The presented data are hypothetical; larger randomized studies are needed.  The rate of tissue loss may vary depending on etiology (bruxism vs. erosion) and individual factors.  Splint therapy requires high patient compliance (nighttime wear, appliance care).  Volumetric measurement of tissue loss (mm³) requires digital scanning and specialized software, which may not always be available. Conclusions  Upon detecting tooth wear, assess vertical dimension, muscle activity, TMJ condition, and occlusal completeness.  Place a night-time occlusal splint as early as possible, especially if bruxism or muscle hypertonicity is present.  Monitor splint use and condition (e.g., material: PMMA, composite), as studies show that material affects wear. [PubMed+1]  Address underlying causes: habits, diet, gastrointestinal factors, behavioral interventions.  Plan definitive restorations (direct/indirect) considering height restoration and occlusal scheme after stabilization with the splint.  Perform regular digital/clinical monitoring of tooth tissue loss and masticatory system status (e.g., every 6–12 months). Summary 1. In patients with decompensated tooth wear, occlusal splint therapy significantly slows the rate of tissue loss and allows partial restoration of interocclusal height. 2. 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