Objective To evaluate clinical procedures and chair time required to seat and adjust hard, heat-cured acrylic occlusal splints and an alternative laminated appliance developed to simplify construction of migraine prevention appliances. Design and setting Single-centre study in the Oral Medicine Clinic, The Royal Hospitals, Belfast, Northern Ireland. Method Questionnaires were distributed, January-May 2003, to operators fitting occlusal splints for 100 consecutive patients selected for migraine prevention therapy. Half the appliances were made in heat-polymerised acrylic with the remainder using a novel combination of ethylene vinyl acetate and light-curing urethane dimethacrylate. Information on operator experience, the nature of any fitting surface and occlusal adjustments together with an estimate of the time taken to make alterations was recorded. Key findings The need for adjustment to seat appliances intraorally was significantly less for migraine prevention appliances made using an experimental laminating technique. Where modifications were necessary, there was no significant difference in the chair time required to fit either the heat-cured hard or experimental laminated migraine prevention appliance. Conclusion Provision of migraine prevention appliances may be more time efficient if the dental practitioner considers a laminated approach to construction.Migraine is a debilitating condition characterised by a throbbing headache and often accompanied by phonophobia, photophobia and nausea or vomiting. 1 Prevention and treatment of migraine attacks include conventional drug, complementary and alternative therapies. [2][3][4][5] The use of occlusal splints has been demonstrated to reduce the incidence of migraine attacks for selected patients 6 and in this context the design of the appliance is important. 7 Descriptions of rigid thermoformed, self-cured, and photopolymerised together with resilient and combination hard/resilient occlusal splints have been reported in the literature. 8,9 Hard heat-cured acrylic persists as a material of choice for occlusal splints not least because the materials and processes used are common in most general dental laboratories. [10][11][12] Appropriate eradication of undercuts when overlaying hard oral structures such as teeth with rigid materials during the construction process is difficult however and may cause problems when seating an appliance at the fitting stage.The aim of this investigation is to identify the extent and nature of problems encountered when fitting heat-cured occlusal splints of proven design for migraine prevention therapy. An experimental splint of similar design, using alternative materials and a novel construction process, is described and the intra-oral fitting experience of the two appliances compared.
MATERIALS AND METHODSOne hundred consecutive patients selected for migraine prevention therapy were prescribed alternately either a heat-cured or experimental laminated migraine prevention appliance. A sample size of 50 in each group ensured power of...