Abstract
Background/Objectives: Occlusal splints are widely used for managing sleep bruxism (SB), providing uniform contact across the entire dentition in the centric relation. Nonetheless, different guidance schemes, such as bilateral balanced occlusion (BBO) and canine guidance (CG), are used during eccentric movements, and the optimal design remains unclear. This study compared the effects of BBO and CG on masticatory muscle activity, sleep architecture, and subjective outcomes during sleep. Methods: This non-blinded randomized crossover trial enrolled 24 healthy adults diagnosed with SB (16 men and 8 women; mean age, 26.1 years) who were randomly assigned to either a BBO-first or CG-first sequence. Individual splints of both types were milled from the polymethyl methacrylate discs. After a 5-night baseline period, each splint was worn for 33 nights in a home environment, and data from nights 29 to 33 were analyzed. Masseter muscle activity was assessed using single-channel electromyography (EMG), yielding EMG parameters, including integrated EMG per hour, number of episodes and bursts per hour, mean episode duration, and total episode duration per hour. Sleep architecture was assessed using portable polysomnography with automatic scoring, and subjective outcomes were assessed for sleep disturbance, morning symptoms, and splint comfort. Differences between splints were analyzed using Wilcoxon signed-rank tests (α = 0.05). Results: Twenty-three participants completed the study. No statistically significant differences were found between the BBO and CG splints for any EMG parameters, sleep variables, or subjective measures. Conclusions: Splint guidance design differences showed no significant effects; however, smaller, potentially clinically relevant effects cannot be excluded.