TL;DR: A University of Freiburg crossover trial published in the Journal of Dentistry in October 2026 found no significant differences between 3D-printed and milled stabilization splints in quality of life, antagonist wear, splint wear or retention over three months of wear each. Most of the 17 participants preferred the 3D-printed splint for comfort, but the authors credit that to the splint design used, not the printing process, and call for longer trials.
3D printing is increasingly used to make occlusal splints, but clinical head-to-head data against milled splints has been limited. As of October 2026, a new randomized crossover trial from Germany adds a small piece of that evidence. For practices in Toronto and across the GTA that prescribe night guards and stabilization splints for patients with bruxism, the study is a useful reference point when a lab offers both manufacturing routes.
What did the Freiburg study look at?
The paper, "Clinical Evaluation of 3D-Printed Stabilization Splints for Probable Bruxism: An Exploratory Cohort Analysis of a Randomized Prospective Single-Blinded Crossover Trial," was first published online in the Journal of Dentistry on 24 October 2026. First author Rabel and senior author Spies are in the Department of Prosthetic Dentistry at the Center for Dental Medicine, Medical Center – University of Freiburg; co-authors include a member of the university's Institute of Medical Biometry and Statistics.
The authors frame the question plainly: 3D printing is increasingly used alongside established milling to fabricate stabilization splints, yet comparative clinical evidence remains limited. That gap matters in practice: lab-bench studies can measure fit and wear of materials, but they cannot tell you whether a patient will actually wear the appliance, whether it needs chairside adjustment, or how it behaves against natural opposing teeth over months of use.
Who took part
Participants had probable bruxism, diagnosed through case history and clinical examination using the German Bruxism Screening Index. Seventeen participants completed the trial. That number matters for how you read the results, and we return to it below.
How the crossover worked
Each participant wore both a milled splint and a 3D-printed splint, in a randomized order, for three months each. Follow-ups were scheduled after two weeks and after three months. Because every participant served as their own comparison, differences between people (bite force, parafunction intensity, oral hygiene) are less likely to distort the comparison than in a parallel-group design of the same size.
What outcomes were measured?
The team looked at four groups of outcomes, which map closely to the questions a clinician asks when choosing an appliance:
- Oral health-related quality of life (OHRQoL) — how the appliance affected participants' day-to-day experience.
- Treatment efficacy — measured as antagonist wear, meaning wear on the opposing teeth.
- Technical result — splint fit at insertion, splint wear and fracture.
- Participant satisfaction — wearing comfort, splint retention and which splint participants preferred.
The analysis used t-tests, Wilcoxon signed-rank tests and regression models.
What did the trial find?
The headline result is a null one, and that is useful in itself. The authors report no significant differences between 3D-printed and milled splints for OHRQoL, antagonist wear, splint wear and splint retention.
Two differences did appear. The 3D-printed splints required less adjustment before insertion, and most participants preferred them because of higher wearing comfort.
Here is the part that is easy to miss in a quick read. The authors attribute the adjustment and comfort findings to the specific splint design used in this trial rather than to the manufacturing process. In other words, the study does not show that printing as a method produces a more comfortable splint. It shows that this particular printed design was more comfortable for these participants.
Pro Tip: When a lab quotes both a printed and a milled option, ask whether the two share the same digital design and thickness. Based on this paper's own explanation, design may matter as much as the manufacturing route for chairside adjustment time and patient comfort.
How strong is the evidence?
The authors are careful about the limits, and readers should be too. They describe the work as an exploratory cohort analysis. Seventeen completers is a small group, and three months per splint is a short window for an appliance meant for ongoing use.
The paper's conclusion is measured: outcomes observed over three months per splint were compatible with the clinical use of both manufacturing approaches. The authors state that evaluating long-term results requires trials with extended follow-up and splint designs specific to each manufacturing process. Their clinical-significance statement says the short-term findings suggest 3D-printed stabilization splints are a clinically feasible alternative to milled splints for patients with probable bruxism, while noting that long-term performance requires further investigation.
A non-significant difference in a small trial is not proof that two options are identical. It means this study did not detect a difference. That distinction matters if a patient asks you whether a printed guard will last as long as their old one.
What does this mean for practices in Ontario?
For general dentists in Toronto, Mississauga, Markham and the wider GTA, the study supports a pragmatic stance rather than a switch in protocol.
- Short-term, both routes look reasonable. Over three months of wear each, this trial found no significant differences in quality of life, antagonist wear, splint wear or retention.
- Long-term durability is still an open question. The authors themselves ask for longer follow-up, so durability claims for either route should be held loosely.
- Design deserves attention. The comfort and adjustment differences were attributed to design, which suggests a conversation with your lab about the digital design is worth having regardless of the manufacturing route.
- Document your follow-up. The trial checked splints at two weeks and three months. Building similar recall points into your own appliance follow-up gives you your own record of fit, wear and fracture over time.
Pro Tip: Record the manufacturing route and material in the patient chart when you deliver a splint. If a fracture or wear issue appears a year later, you will know which appliance type it was, and your own records become a small evidence base over time.
EBIKO Dental will continue monitoring clinical research on digital and printed appliances and report on longer-term data as it is published. For dental supplies across Canada, visit ebiko.ca.
Sources
- Rabel K, Linke M, Linke T, et al. Clinical Evaluation of 3D-Printed Stabilization Splints for Probable Bruxism: An Exploratory Cohort Analysis of a Randomized Prospective Single-Blinded Crossover Trial. Journal of Dentistry, published online 24 October 2026. doi:10.1016/j.jdent.2026.107133 · Europe PMC record
Frequently Asked Questions
Q: Are 3D-printed night guards as good as milled ones?
In a small University of Freiburg crossover trial published in October 2026, 3D-printed and milled stabilization splints showed no significant differences in quality of life, antagonist wear, splint wear or retention over three months of wear each. The authors describe the analysis as exploratory and say long-term performance still needs study.
Q: Why did patients prefer the 3D-printed splint in this study?
Most participants preferred the 3D-printed splint for its higher wearing comfort, and it needed less adjustment before insertion. The authors attribute both findings to the specific splint design used in the trial rather than to the printing process itself.
Q: How many patients were in the Freiburg splint trial?
Seventeen participants with probable bruxism completed the trial. Each wore a milled and a 3D-printed splint in a randomized order for three months each, with follow-ups after two weeks and three months.