Stabilization appliances (Michigan splints) are well studied and widely adopted for managing bruxism and temporomandibular disorders (TMDs). Traditionally, these appliances have been fabricated by wax modeling and pressing resin onto casts made from irreversible hydrocolloid or silicone impressions. This article provides a detailed description of an all-digital workflow that uses intraoral scanning and computer-aided design (CAD) software to design a stabilization splint on a digital cast that can be manufactured autonomously by a computer-aided manufacturing (CAM) grinding machine in a subtractive procedure. The workflow is applicable to both dental practitioners and technicians. Special attention is given to aspects and procedures that are important for the successful fabrication of the splint. Working without a cast can save time and money, and the use of CAD/CAM technology provides a homogenous splint material quality. Keywords: bruxism, CAD/CAM, digital, occlusal device, stabilization splint, temporomandibular disorders

Purpose: To investigate the effect of a universal adhesive on the bond strength of composite cements to a polymer-infiltrated ceramic network. Materials and Methods: Shear bond strength to a polymer-infiltrated ceramic network (Vita Enamic) and to its polymer and ceramic components was assessed on polished surfaces using either a conventional dual-curing resin (RelyX Ultimate) or self-adhesive composite cement (RelyX Unicem 2 Automix). Substrate surfaces were either not pretreated or a silane coupling agent (Vitasil), a universal adhesive (Scotchbond Universal Adhesive), or both were applied. Further, the shear bond strength to polymer-infiltrated ceramic network was evaluated after etching with 5% hydrofluoric acid (Vita Ceramics Etch) of 0, 15, 30, 60 or 120 s without or with application of silane, universal adhesive, or both (n = 10). Statistical analysis was performed using the Kruskal-Wallis test (p 0.05) followed by post-hoc comparisons with Bonferroni correction. Results: No bond (0 MPa) was formed to the polished polymer-infiltrated ceramic network or to its components for either cement. Application of silane resulted in low mean bond strengths (4 to 5 MPa) to the ceramic. The universal adhesive bonded mainly to the polymer part of the polymer-infiltrated ceramic network. The best bonding performance for both cements was achieved when silane and universal adhesive were applied on the polymer-infiltrated ceramic network. Etching for 30 s or 60 s resulted in the highest mean shear bond strengths for all pretreatment groups (p 0.05). Conclusion: The best bonding performance of the self-adhesive dual-curing composite cement RelyX Unicem 2 Automix was found on the HF-etched polymer-infiltrated ceramic network. The conventional dual-curing composite cement RelyX Ultimate with Scotchbond Universal Adhesive may bond chemically to the polymer part of the polymer-infiltrated ceramic network. To achieve the highest bond strengths for both cements, the polymer-infiltrated ceramic network should be etched for 30 to 60 s, followed by the application of silane and universal adhesive. Keywords: shear bond strength, polymer-infiltrated ceramic, universal adhesive, silane, hydrofluoric acid etching