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cerecdoctors.com
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quarter 4
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2013
more precisely because digitally
printed models are more accurate
due to the elimination of temperature,
humidity and mixture measurement
variables found in the production of
stone models that cause model shrink
and distortion.
• Dreamgard splints are ultra-thin and
low profile (30 percent to 50 percent
thinner than typical splints), which
improves comfort and compliance.
• The cost of the splints is affordable.
The relative low cost can improve
acceptance of treatment.
CASE STUDY
The following case study demonstrates
the process for sending a case to Dream-
gard for night guard fabrication. The
patient, a 40-year-old female, presented
with wear on the teeth and complaints
of pain from nocturnal clenching and
grinding due to hyperactivity of the oral
musculature.
After initial examination, different
treatment options were discussed with
the patient ranging from simple to more
complex. It was decided to provide
the patient with a simple solution to
treat the nightly discomfort as a result
of his clenching. The presented treat-
ment plan was a splint manufactured
with a CEREC scan and sent digitally
to Dreamgard for fabrication of the
appliance.
A full upper scan was completed
using the CEREC Omnicam in the
CEREC Connect software. The CEREC
Omnicam can scan a full upper arch in
a matter of minutes resulting in a full-
color digital model. The splint manu-
facturer does not require an opposing
scan or bite scan for this process due to
the fact that the splints they create are
self-equilibrating. Once the scan was
captured in the CEREC Connect soft-
ware, the prescription was completed
and the scan was sent digitally via the
Connect portal to Dreamgard. If a clini-
cian needs further detailed instructions
on the digital process, they can consult
the Dreamgard website under the
“Education and Resources” section.
Once the scan is received in the
Dreamgard facility, Dreamgard prepares
the digital model and then produces
a model using SLA technology. The
Dreamgard splint can then be fabri-
cated using a proprietary pressure-ther-
moforming process. The benefit of the
production process is that the practice
receives a night guard that provides
excellent fit and a balanced bite without
the need for fitting or adjusting after the
in-mouth self-equilibration process is
complete.
The Dreamgard splints are ultra-thin
and low profile, utilizing an advanced
multi-layer soft/hard construction.
The soft inner layer provides comfort
and cushioning while the hard outer
layer provides protection and durability.
This design offers a combination of fit,
comfort, protection and effectiveness.
There are three different models
to meet the preferences of the indi-
vidual and to treat the differing levels
of bruxism severity, all of which have
a full-occlusal, flat-plane design. The
models are:
• REM-SOFT: Designed primarily for
restoration protection
• REM-LITE: Intended for light to
moderate bruxing and about 1.5 mm
thick at points of contact
• REM-ULTRA: Designed for moderate
to heavy bruxing, with a hard outer
layer that is 70 percent thicker than
that of the REM-LITE
Once the night guard is fabricated at
Dreamgard’s FDA-regulated lab, it is
shipped back to the practice in approxi-
mately seven to 10 days. Inside the
patient package, the clinician will find
the Dreamgard night guard and storage
case, care and use instructions for the
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p u r i
patient and equilibration instructions
for the dentist.
In our case study, the guard was
received from the manufacturer after
seven days, and the patient appointed
for delivery. The guard was placed in
boilingwater for 10 seconds, andallowed
to soften and placed in the patient’s
mouth. The guard self equilibrated to
the patient’s occlusion as the patient bit
down into the night guard for approxi-
mately one minute. The hard outer layer
is not affected by the heat and provides
protection, as well as a smooth, low-fric-
tion surface for the lower jaw and teeth
to slide freely on without interference.
The guard is then removed from the
patient’s mouth and placed in cool water
for approximately five minutes.
While a digitally fabricated night
guard is not the only solution for the
treatment of bruxism, it does offer
an effective and inexpensive tool in
the clinician’s restorative tool belt to
help patients. No doubt the process
will continue to be developed so that
additional types of appliances can be
fabricated from a digital CEREC scan,
allowing for faster and more accurate
treatment for patients.
For questions and more information,
Dr. Puri can be reached at
REFERENCES
1
Br Dent J.
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Needham R, Davies SJ.
2
J Oral Rehabil.
2008 Jul;35(7):476-94. Bruxism
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Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K.
3
J Prosthet Dent.
2013 Sep 4. pii: S0022-3913(13)
00099-1. doi: 10.1016/j.prosdent.2013.05.002. [Epub
ahead of print] Association between sleep bruxism
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Dalberto CD, Scheeren B, Silva de Barros SG.
4
J Orthod.
2013 Jun;40(2):163-71. doi: 10.1179/
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Feu D, Catharino F, Quintão CC, Almeida MA.
5
J Oral Rehabil.
2008 Jul;35(7):509-23. Principles
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