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PubMed1981

Influence of TMJ dysfunction on Bennett movement as recorded by a modified pantograph. Part III: Progress report on the clinical study.

The purpose of this investigation was to provide further insight into the characteristics of the induced and voluntary Bennett movement by determining the influence of TMJ dysfunction on the lateral side shift of the mandible as recorded by a modified pantograph. Twelve subjects were examined using pantographic tracings quantitated with the PRI to establish a baseline pattern of dysfunction for each subject. The PRI was used to categorize the subjects as to the degree of dysfunction. Following categorization, eight subjects were used as an experimental group and for subjects as a control group. On all subjects, induced and voluntary Bennett movement registrations were taken at the initial and final adjustment. Only the experimental subjects underwent an occlusal therapy consisting of an occlusal splint and an occlusal adjustment. Success of the therapy was monitored via the PRI. Following occlusal therapy, the reduction in PRI scores and categorization for the experimental group was significant to the 0.0042 level. There was no significant change inthe scores for the control group. Post-treatment Bennett movement registrations (voluntary and induced) indicated a statistically significant increase of the movement at the 0.043 level. The control group showed no significant change. Furthermore, on all subjects studied in this investigation, the voluntary Bennett movement was always within the borders of the induced Bennett movement, suggesting that the subject's neuromusculature was an important component in registering the lateral side shift of the mandible.

Adult↗
PubMed1990

A clinical study of joint sounds in subjects with restored occlusions.

It has been implied that temporomandibular joint sounds must be treated to eliminate the sounds before restorative treatments are attempted. This study explored the possibility that joint sounds do not present a problem when other symptoms are absent. A group of 35 subjects with restored occlusions were studied for the presence of temporomandibular joint dysfunction symptoms using clinical examination, questionnaires, and the pantographic reproducibility index. Forty-six percent had some degree of temporomandibular joint dysfunction. Seventeen of 18 subjects (94%) with joint sounds were free of other symptoms. Therefore, the use of joint sounds as a symptom of temporomandibular joint dysfunction is questionable when not accompanied by other clinical symptoms. Subjects who had temporomandibular joint dysfunction symptoms were treated with occlusal splint therapy and occlusal adjustments. The period of time to eliminate the symptoms was 2 to 16 weeks with an average of 7 weeks. This study concludes that the presence of only joint sounds does not seem to be a hindrance to restorative treatments.

Adult↗
PubMed1988

Occlusal equilibration and other stomatognathic treatment in patients with mandibular dysfunction and headache.

Thirty patients with craniomandibular disorders and headache were randomly divided into two groups. One received occlusal equilibration (O group) and the other (S group) routine stomatognathic treatment, including an occlusal splint. The outcome of treatment was evaluated by means of a questionnaire, visual analogue scales, and clinical examination. In both groups, the patients reported reduction of symptoms, but the clinical dysfunction score used was significantly diminished only in the S group. A combined treatment regimen, including an occlusal splint, was more effective than occlusal adjustment alone, especially with regard to clinical signs of dysfunction.

Acrylic Resins↗
PubMed1994

The efficacy of oral splints in the treatment of myofascial pain of the jaw muscles: a controlled clinical trial.

Oral splints are widely used in the treatment of myofascial pain of masticatory muscles, even though their mechanism of action is unknown. The present study evaluated the therapeutic efficacy of splints using a parallel, randomized, controlled and blind design. Following a sample size estimation, 63 subjects were recruited and assigned to 3 groups: (1) passive control: full occlusal splint worn only 30 min at each appointment; (2) active control: palatal splint worn 24 h/day; and (3) treatment: full occlusal splint worn 24 h/day. On each of 7 visits over 10 weeks, subjects rated on 100 mm visual analogue scales their pain intensity and unpleasantness at rest and after experimental mastication. The effect of pain on the quality of life was also rated on category scales. All pain ratings decreased significantly with time, and quality of life improved for all 3 groups. However, there were no significant differences between groups in any of the variables. These data suggest that the gradual reduction in the intensity and unpleasantness of myofascial pain, as well as the improvement of quality of life during the trial, was non-specific and not related to the type of treatment.

Adolescent↗
PubMed2004

A European Board of Orthodontics case report. Case category: severe skeletal discrepancy.

OBJECTIVES: this 18.1 year-old girl presented with a chief complaint of progressive worsening of facial and dental esthetics, crowding, headache and facial pain. MATERIALS AND METHODS: clinically, she was at the end of her growth and exhibited a severe facial asymmetry, but with normal sagittal and vertical cranial relationships. Clicking in the right TMJ was evident. This was accompanied by a deviation upon opening, and pain in the joint. The pain she experienced during jaw movement, and upon palpation, was significant. There was a shift to the right from centric relation to intercuspal position. Intraorally, the tissues were normal, with mild tetracycline staining, still present primary canines, impacted third molars and upper permanent canines. Her first molars had fillings. Orthodontically, her occlusion was a severe Class III subdivision left, with a severe right-side crossbite, lower midline deviation to the right 6 mm, and a 1 mm lateral shift in intercuspal position. She also exhibited severe crowding and asymmetry in both arches. The sequence of her treatment was as follows: (a) extraction of primary canines and impacted third molars, surgical exposure of impacted canines, (b) lower occlusal splint for TMJ dysfunction and an upper arch fixed appliance for ideal alignment and leveling, (c) upper occlusal splint for the maintenance of TMJ function and lower arch fixed appliance for ideal alignment and leveling, (d) surgical skeletal correction, (e) post-surgical orthodontic finishing, (f) post-treatment retention.

Adolescent↗
PubMed1998

Long-term outcomes of nonsurgical treatment in nonreducing anteriorly displaced disk of the temporomandibular joint.

OBJECTIVES: The aim of this study was to evaluate long-term outcomes of nonsurgical treatment in patients with persistent anterior disk displacement without reduction of the temporomandibular joint. STUDY DESIGN: Thirty-five patients were treated with occlusal splints, and 12 patients underwent additional occlusal treatments after splint treatment. These patients were evaluated clinically and radiographically. At least 2 years after the treatment, the 34 patients' symptoms were assessed with the use of a questionnaire. RESULTS: The mean maximal interincisal distance (MID) was 27.6 mm before treatment and 44.4 mm at the end of treatment (p < 0.001). Before the treatment, all 35 patients had complained of pain, and mild pain persisted in 9 patients at the end of treatment. Flattening of the condylar head and of the articular eminence increased in prevalence from 12.1% and 9.1%, respectively, before treatment to 54.5% and 51.5%, respectively, at the time of follow-up observation. At the time of the survey, the mean self-reported MID was 46.8 mm (p < 0.01). CONCLUSIONS: After the nonsurgical treatment, the clinical signs and symptoms improved significantly, although the prevalence of osteoarthrotic findings increased.

Adolescent↗
PubMed1987

Influence of group function and canine guidance on electromyographic activity of elevator muscles.

A comparative EMG study was done between two types of occlusal guidances: group function and canine guidance. The purpose was to determine which of the two occlusal schemes causes a greater reduction in muscle activity and thereby a decrease in muscle tension in eccentric mandibular positions. Full-coverage occlusal splints were made for six test subjects with normal function of the stomatognathic system. Left- and right-side integrated EMG recordings were made of the masseter and temporal muscles during static (clenching) and dynamic (lateral excursion and clenching) maximal contractions. The results showed an EMG activity reduction of the elevator muscles with group function relative to their activity in centric occlusion. A more marked reduction was observed on the mediotrusive side, mainly in the temporal muscle. With canine guidance, the reduction in elevator muscle activity is much greater, more significant, and mainly in the temporal muscle of the mediotrusive side. The clinical implications of this study suggest the use of canine guidance in laterotrusion for therapy with full-coverage occlusal splints.

Adolescent↗
PubMed1985

Comparative study of two treatment methods for internal derangement of the temporomandibular joint.

Orthopedic mandibular repositioning and flat plane occlusal splint therapy were compared in the treatment of 20 patients with internal TMJ derangement with reduction. The following conclusions can be drawn. Mandibular repositioning treatment produces significant subjective and objective improvement in the dysfunction of patients with internal joint derangements with reduction. Flat plane occlusal splint treatment produces no significant change in the dysfunction level of patients with internal joint derangements with reduction. Mandibular repositioning treatment may eliminate the reciprocal click of internal joint derangement with reduction. To realize improvement in dysfunction of internal joint derangement, it appears that the reciprocal click must be eliminated. Mandibular repositioning treatment produces a significant improvement in muscle pain associated with internal joint derangement.

Adolescent↗
PubMed1995

Comparative study of results of electronic axiography with results of magnetic resonance imaging including MRI-assisted splint therapy.

The most common temporomandibular joint disturbance is the internal derangement. Its prevalence has been shown to be as high as 28%. The purpose of this study was on one hand to compare the diagnostic efficiency of an electronic axiographic system with magnetic resonance imaging, and, on the other hand to evaluate the results of MRI-assisted treatment monitoring of occlusal splint therapy. The results of this survey clearly show that in evaluation of temporomandibular joint disorders, electronic axiography and magnetic resonance imaging should be used in conjunction with one another to increase the accuracy of positive and differentiated diagnoses. The medical concept of disc recapture involving the use of occlusal splints seems to be merely a clinical term which is not necessarily hinged on anatomical intraarticular changes.

Adult↗
PubMed1986

[Nocturnal sleep studies of bruxism].

Polygraphic recordings during two nights sleep in 7 selected outpatients prior to and following treatment of bruxism were carried out using EMG-, EEG and EOG-recordings to evaluate the activities of the masseter muscle and the different sleep stages. The results thus obtained were compared to those of an age-matched control group. Following treatment with occlusal splints the recordings were repeated eleven weeks later. The length and the amount of grinding and pressing activities were correlated with the total night sleep as well as with the different sleep stages. The highest incidence of muscle activity was found in stage two and during awakening. Furthermore muscle activities were observed immediately before the beginning of REM-sleep and in particular during the change from REM- to NREM-sleep and in sleep stage one. After treatment with occlusal splints there was a decrease of total muscle activity, thus indicating efficiency of the treatment.

Adult↗
PubMed1978

Correction of jaw deformities involving simultaneous osteotomy of the mandible and maxilla.

A one-stage surgical correction of gnathic deformities involving both jaws is described. It permits both the establishment of a normal occlusion and correct alignment of the occlusal plane to the skull. The osteotomy commences with the mandible. Its new position is oriented to the (as yet) untouched maxilla with the aid of an intermediate occlusal splint produced as a result of cephalometric evaluation and cast model surgery. The mandible is secured at its osteotomy sites by bone screws, in the correct final position. The maxilla is then oriented to the mandible, now correctly positioned with the aid of a second, preformed occlusal splint again produced on the basis of cast model surgery. Following intermaxillary fixation and internal wire suspension the splint is left in place until bony consolidation has taken place. External fixation is not required. The procedure enables the cephalometrically established measurements for the movements of both jaws to be easily reproduced with a high degree of accuracy. The technique is described in detail and discussed on the basis of clinical examples.

Cephalometry↗
PubMed1991

Treatment of root and alveolar bone resorption associated with bruxism.

This report describes root and alveolar bone resorption associated with a single tooth which had been subjected to occlusal trauma during bruxing activity. Management of this unusually severe case is described, including the provision of an occlusal splint, endodontic therapy and occlusal adjustment to the natural dentition.

Adolescent↗
PubMed1988

The effect of vacuum-mixed autopolymerizing acrylic resins on porosity and transverse strength.

Three brands of autopolymerizing acrylic resin were mixed and polymerized three different ways and tested for transverse strength and porosity. The procedures tested were bench-curing at ambient temperatures, vacuuming the mix before bench-curing, and curing in a pressure device. The data indicate that both vacuuming the mix and pressure-curing are successful in reducing porosity and increasing transverse strength. These improved properties would be valuable in the fabrication of provisional restorations and occlusal splints. The following conclusions can be drawn: 1. Use of a pressure device decreases porosity and increases the transverse strength in samples of autopolymerizing acrylic resin. 2. Use of a vacuum device on the mixed acrylic resin works as well as pressure polymerizing. 3. Use of either technique is indicated to improve the quality and longevity of autopolymerizing acrylic resin restorations, orthodontic appliances, and occlusal splints.

Chemical Phenomena↗
PubMed1985

Occlusal wear. A follow-up study of 18 subjects with extensively worn dentitions.

Eighteen patients with moderate to severe dental wear were re-examined 6-10 years after a treatment period that included use of occlusal splints at night. The splints were used with various intensities for an average of 2 years. The methods of evaluation comprised a questionnaire, clinical examination, comparison of dental casts, salivary analysis, and bite force measurements. The changes in dental wear during the follow-up period were small, the typical finding being an increase of facets but no measurable reduction of tooth length. The results indicate that many variables apart from occlusal parafunctions, such as acid regurgitation and salivary and dietary factors, may contribute to loss of tooth substance diagnosed as dental wear. In most patients, the continuing wear process was slow after long-term treatment with occlusal splints.

Adolescent↗
PubMed1984

A critical evaluation of orthopedic interocclusal appliance therapy: effectiveness for specific symptoms.

This paper reviews the effectiveness of occlusal splints on specific symptoms that are often associated with TM disorders. The research has shown the clicking TMJ is sometimes helped but not cured by the traditional stabilization interocclusal appliance and that TMJ clicking is the least responsive to treatment. Questions have been raised about the need to specifically treat the clicking joint; more research on this issue is necessary. Painful TMJs have been shown to respond to occlusal appliance therapy, but questions still exist about the effectiveness of interocclusal appliances for this symptom. There is little scientific proof available about the ability of splints to effectively slow down or reverse degenerative TMJ changes that are evident on radiographs. Masticatory muscle pain is by far the symptom that has the best experimental evidence to support occlusal splints as a highly effective method of treatment. These changes are probably mediated via an alteration in the patient's muscle activity patterns. Those patients with more severe symptoms are less likely to be helped with splints as a sole treatment modality. The effect of occlusal appliances in muscle trismus has been discussed but not effectively evaluated in the literature. Occlusal splints have been shown to have a distinct influence on improving mandibular muscle coordination. Inter-occlusal splints are a commonly used method of controlling attrition and adverse tooth loading, and few questions have been raised in the literature about this therapeutic application.

Bruxism↗
PubMed1984

The temporomandibular joint in ankylosing spondylitis. Correlations between subjective, clinical, and radiographic features in the stomatognathic system and effects of treatment.

One hundred individuals with ankylosing spondylitis (AS) and a comparison group comprising 57 individuals without joint symptoms or disease were studied for correlations between subjective, clinical, and radiographic features in the stomatognathic system and the short-term effect of occlusal splint therapy. There was a correlation between radiographic findings in the temporomandibular joint (TMJ) and subjective and clinical symptoms from the stomatognathic system in individuals with AS but not in the comparison group. There were also more and stronger correlations between clinical signs of TMJ involvement and subjective and other clinical symptoms from the stomatognathic system in the individuals with AS than in the comparison group. There are thus strong indications that the subjective symptoms, the clinical signs, and the radiographic findings in the TMJ of the individuals with AS were caused mainly by this joint disease. The short-term effect of treatment with occlusal splints was investigated in seven of the individuals with AS, who had clinical dysfunction index II or more in accordance with Helkimo. No statistically significant improvement of the subjective or clinical symptoms from the stomatognathic system was found, although a reduction of clinical symptoms was noted in five of the seven individuals.

Adult↗