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PubMed1997

The pattern of splint usage in the management of two common temporomandibular disorders. Part III: Long-term follow-up in an assessment of splint therapy in the management of disc displacement with reduction and pain dysfunction syndrome.

OBJECTIVE: To assess the long-term follow-up of patients successfully treated for disc displacement with anterior repositioning splint therapy and patients successfully treated for pain dysfunction syndrome with stabilisation therapy. DESIGN: Retrospective analysis. SETTING: Dental school clinic unit. METHODS: Maintenance of improvement was assessed by a postal questionnaire or by direct telephone contact 3 years after cessation of splint treatment. RESULTS: 90% of patients successfully treated for disc displacement with reduction and 88% of patients successfully treated for pain dysfunction reported maintenance of improvement after 3 years. In both groups the reported improvement was independent of the pattern of splint usage. CONCLUSIONS: The short-term use of an appropriate occlusal splint for a specific temporomandibular disorder leads to a long-term resolution of the problem.

Follow-Up Studies↗

PubMed1996

[Splint therapy in temporomandibular dysfunction].

In a study of 118 patients with temporomandibular dysfunction treated with occlusal splint therapy, symptoms of pain and limited mobility of the mandible had decreased more distinct than clicking sounds of the temporomandibular joints. Interestingly, an untreated control group showed similar results after two years follow-up.

Adult↗

PubMed2003

Temporomandibular disorder or Eagle's syndrome? A clinical report.

This clinical report describes the diagnosis and treatment of a patient under emotional stress with orofacial pain, headaches, and the feeling of a foreign body in the throat. An elongated styloid process at the beginning of the oral pharynx was diagnosed. Although these symptoms could be aspects of Eagle's syndrome, deflective occlusal interferences, tender muscles of mastication, and a clicking temporomandibular joint led to an evaluation for temporomandibular disorder related to malocclusion. An occlusal splint was used to confirm the diagnosis and to alleviate symptoms. Occlusal adjustments were subsequently performed. In a 10-year follow-up, the patient had no complaints.

Adult↗

PubMed1994

Occlusal plane alteration in orthognathic surgery--Part II: Long-term stability of results.

Alteration of the occlusal plane may be indicated in patients who present with either low occlusal plane (LOP) facial type or the high occlusal plane (HOP) facial type. Surgical alteration with double jaw surgery to increase or decrease the occlusal plane angulation may be required to achieve optimal functional and esthetic results. This study evaluated the stability of results in two groups of patients. Group 1 consisted of 14 patients who underwent surgical increase of the occlusal plane angulation with a postsurgical follow-up average of 23 months. The average surgical increase in occlusal plane angulation was 5.6 degrees. Several anatomic landmarks were evaluated relative to stability of results. Postsurgical changes that were statistically significant included a postsurgical anterior facial height change (-0.8 mm), ramus height change (-0.3 mm), and a change in mandibular plane angle (-0.5 degrees). These changes were due, in part, to the removal of the occlusal splint allowing some autorotation of the mandible superiorly and settling in of the occlusion. There was no significant change in any of the other parameters evaluated. Group 2 consisted of 27 patients, with a mean follow-up of 21 months, that had an average surgical decrease in occlusal plane angulation of 8.8 degrees with double jaw surgery. There was an 8 mm advancement of the mandible at point B, and a 10 mm advancement at pogonion. The maxilla was moved 3 mm superiorly at point A, and the maxillary first molar showed no significant vertical movement. The postsurgical changes demonstrated no statistically significant horizontal movement of the mandible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Tardive dyskinesia affected by occlusal treatment--a case report.

The following is a case report of occlusal treatment for involuntary mandibular movement occurring in a 79-year old woman. This was diagnosed as sulpiride-induced tardive dyskinesia. The patient had been treated with sulpiride to improve gastrointestinal symptoms for five years until the onset of involuntary mandibular movement. The involuntary movement worsened even after discontinuation of the drug for 10 weeks. The dyskinesia improved in the course of treatment with an occlusal splint placed over her upper denture. After wearing the new denture with increased occlusal vertical dimension, the dyskinesia disappeared almost completely. Sirognathographic observation showed that previous denture wear evoked remarkable involuntary movement of the mandible once again. It is uncertain whether such improvement may result from discontinuation of the drug or from the occlusal treatment. However, it appears that occlusal factors played an important role in orofacial manifestation of tardive dyskinesia (TD) in this case.

Aged↗

PubMed1994

Occlusal adjustment and myoelectric activity of the jaw elevator muscles in patients with nocturnal bruxism and craniomandibular disorders.

The effects of occlusal adjustments on the myoelectric activity of the anterior temporal and masseter muscles, with the mandible at rest and during maximal clenching in the intercuspal position (ICP), were studied in 24 nocturnal bruxism patients. Before the occlusal adjustment, the patients were treated with a flat occlusal splint for chronic craniomandibular disorders. The results revealed that within the short term the occlusal adjustment, in terms of increased number of occlusal contacts and teeth in contact in ICP, did not change the postural activity, whereas, on average, the level of activation of the jaw elevators, in terms of normalized electromyogram, increased during maximal clenching in ICP. The increase of activity was more pronounced in the masseter muscle than in the anterior temporal muscle.

Adolescent↗

PubMedDate not supplied

Is there a benefit of using an arbitrary facebow for the fabrication of a stabilization appliance?

PURPOSE: The aim of this clinical study was to evaluate if an arbitrary facebow registration and transfer provides significant advantages for the fabrication of an occlusal appliance in comparison with the omission of such a procedure. MATERIALS AND METHODS: For 20 fully dentate adult patients diagnosed with bruxism, two Michigan occlusal splints were constructed. One of the two upper dental casts was transferred to the articulator with an arbitrary earpiece facebow; the other maxillary cast was mounted arbitrarily using a flat occlusal plane indicator. Upon splint delivery, the number of intraoral occlusal contacts and the time needed for chairside occlusal adjustment were recorded. RESULTS: The number of occlusal contacts on the appliance fabricated with or without facebow was similar in most cases both in the articulator and in the mouth. The one-sided Wilcoxon rank sum test showed with high probability that the use of an arbitrary facebow does not yield a clinically relevant improvement with regard to the number of occlusal contacts or the chairside adjustment time. CONCLUSION: From this pilot study, it appears that for the fabrication of an occlusal appliance, registration and transfer with an arbitrary earpiece facebow does not yield clinically relevant benefits. Of course, this conclusion cannot be transferred to other facebows and is restricted to the levels of clinical relevance defined in the study.

Adult↗

PubMed1997

Different approaches to anchorage: a survey and an evaluation.

Orthodontic treatment outcome is often compromised by the loss of anchorage. The forces acting on the anchorage unit have, however received surprisingly little attention, and the loss of anchorage is most frequently expressed in the sagittal occlusal relationship. The present paper discusses the interaction between vertical and sagittal components of dentofacial development, and the importance of taking vertical forces into consideration is stressed. The biological background for anchorage is reviewed, i.e., the impact on the cellular reaction of the periodontal ligament around the teeth of the anchorage unit from the orthodontic force system and from occlusion. A new rigid appliance consisting of two occlusal splints connected with transpalatal arches is introduced. The advantage of using the patient's sense of occlusion as part of anchorage by means of this appliance is demonstrated in a number of case presentations.

Adult↗

PubMed1981

Occlusal dysfunction and stress. An experimental study in macaque monkeys.

A dysfunctional occlusal relationship was produced in six macaca irus monkeys by insertion of occlusal splints which raised the vertical dimension of occlusion by 3--4 mm and incorporated interferences into the occlusion. Cortisol levels of plasma and 24 h urine samples were measured by competitive protein-binding analysis. After insertion of the splints there was an immediate, approximately two-fold rise of the mean 24 h urinary cortisol excretion rate and a significant decrease of urinary volume and body weight. The plasma cortisol level did not rise significantly. During the 3 weeks experimental period the teeth showed increasing mobility and occlusal wear facets developed on the splints. Urinary cortisol excretion rates were significantly elevated throughout the experimental period. Urinary cortisol levels declined to basal values when the splints were removed. This animal model produces experimental evidence in support of the hypothesis that a dysfunctional occlusal relationship may result in bruxism associated with emotional stress.

Animals↗

PubMed1997

[Dental aspects of the treatment of temporomandibular joint disorders].

Over the last years, aetiological concepts have changed drastically. The role of occlusal factors in the aetiology has been overestimated in the past. The role of occlusal therapy should be aimed at restoring function. In the initial phase of treatment an occlusal splint, counseling, physiotherapy and occasionally NSAID's, leads to relieve pain and reduction of dysfunction in most patients. A repositioning splint in cases of anterior disc dislocation is not longer recommended. Selective grinding can be done in "occlusally sensitive" patients with pain or dysfunction of muscular origin. The adjustment should have a limited character, and is not indicated as preventive measure. Occlusal prosthetic reconstruction is in most patients not indicated for reasons linked to TMD because the aetiologic relationships between TMD and loss of molars has not been established. In cases of rheumatoid arthritis, osteo-arthrosis and spondylitis ankylosans, occlusal changes can occur due to the degeneration of the joint components. After the initial phase of treatment replacing the lost molars by prostheses in these particular patients, results in unloading of the joints and in decreasing recurrence of symptoms.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1998

A comparison between horizontal splint and repositioning splint in the treatment of 'disc dislocation with reduction'. Literature meta-analysis.

We reviewed the literature from 1985 to 1996 concerning the preliminary treatment of disc dislocation with reduction (DDWR) by means of occlusal splints, pinpointing two main methods. The conflicting results of many papers induced us to make a literature meta-analysis of those articles with the necessary requirements in order to verify the effectiveness of the two therapeutic means more frequently used in DDWR; the repositioning splint and the bite plane. A statistical comparison between the two kinds of treatment has demonstrated that the repositioning splint is more effective both in the resolution of the articular click and of the pain at a level of P < or = 0.00001, which is noteworthy and highly significant.

Confidence Intervals↗

PubMed1984

Treatment of mandibular dysfunction: the clinical usefulness of biofeedback in relation to splint therapy.

The long-term treatment effects of biofeedback and occlusal splints on mandibular dysfunction were compared. Thirty female patients were randomly divided into two treatment groups. One group had full coverage splints, the other group received biofeedback training. At the re-examinations 1 and 12 months after completion of therapy, the subjective and clinical symptoms were significantly reduced in both groups. No significant differences between the groups were found. A stepwise analysis of regression indicated that biofeedback training may be a useful alternative to splint therapy in cases where night time bruxing is not the dominating feature.

Adult↗

PubMed2005

A change of occlusal conditions after splint therapy for bruxers with and without pain in the masticatory muscles.

Bruxism has been suggested as an initiating or perpetuating factor in a certain subgroup of temporomandibular disorders (TMD), however, the exact association between bruxism and TMD remains unclear. This study aimed to demonstrate the difference in responses between bruxism and a subgroup of TMD to a full-arch maxillary stabilization splint from the standpoint of an occlusal condition. This study was conducted to verify the null hypothesis that there were no differences between bruxer groups with and without myofascial pain (MFP) with respect to the changes in occlusal conditions after the use of a splint. Thirty bruxers with MFP and 30 without MFP participated. Occlusal conditions were examined before and after splint therapy, and occlusal changes following the use of a splint were compared between the two groups. The frequency of occlusal changes after splint therapy was significantly higher in the MFP bruxer group than the non-MFP bruxer group (p < 0.05) for the occlusal conditions investigated in the present study. However, no statistical differences were found with regard to each occlusal condition. This result may show the variety of splint effects and may demonstrate a heterogeneous aspect to bruxism and myofascial pain.

Bruxism↗

PubMed2005

Human ex vivo bone tissue strains around natural teeth vs. immediate oral implants.

PURPOSE: To compare ex vivo bone tissue strains around natural teeth with immediate implants supporting unsplinted and splinted fixed prostheses. MATERIAL AND METHODS: Six linear strain gauges were bonded on the labial marginal bone of bilateral maxillary anterior teeth in two fresh-frozen human cadavers. The natural teeth were loaded in centric occlusion via an occlusal splint with integrated miniature load cells. Strain measurements were performed at a sample rate of 10 kHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to data acquisition system. Upon extraction of the anterior teeth, Ø 4.1 mm and Ø 4.8 mm ITI dental implants were placed into sockets of incisors and canines, respectively. Installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFA) were also undertaken. Strain measurements were performed for (1) single-tooth implant restorations, (2) unilateral splinted anterior implants, and (3) bilateral splinted anterior implants. Finally, an autopolymerizing acrylic resin was injected into the implant sockets for simulation of osseointegration and strain measurements were performed. RESULTS: Microstrains of all groups were statistically comparable (P>0.05), although lower strains were elicited for implants in sockets of incisors in comparison with natural teeth. Microstrains around canine implants were comparable or higher than those induced around natural canines. For all groups, microstrains around canines were higher than those around lateral (P<0.05) and central incisors (P<0.01), which had similar strain levels (P>0.05). The RFA values of implants were comparable. The ITVs of implants in sockets of lateral incisors and canines were similar and were higher than those of implants in central incisor regions. CONCLUSION: The labial marginal bone having no contact with immediate implants may experience strain gradients within physiologic levels due to deformation of bone under load. Although one prosthetic design does not seem to have clear advantages over another, splinting of implants may be considered as a safety measure for immediately loaded immediate implants, if possible.

Adult↗

PubMed2002

Early begin of splint therapy improves treatment outcome in patients with temporomandibular joint disk displacement without reduction.

The objective of this study was to determine the effect of treatment beginning at the long-term outcome after splint therapy, in patients with anterior disk displacements without reduction. Therefore, 19 patients with acute complaints (group I), 19 with subacute complaints (group II), and 17 with chronic complaints (group III) were treated with occlusal splints. The patients were evaluated regarding treatment outcome with extensive clinical examination and postal questionnaires. The percentages of pain-free patients after therapy were 84% in group I, 63% in group II, and 64% in group III. There was a statistically significantly greater increase of maximum jaw opening after therapy in group I than in the control groups (P<0.05). The improvements in mouth opening came to 19.1 mm in group I, 10.7 mm in group II, and 8.4 mm in group III. The present study indicates that an early start of treatment seems to have a positive influence on treatment outcome of patients with anterior disk displacement without reduction.

Acute Disease↗

PubMed1998

Effects of a bite-raising splint on the duration of the chewing cycle and the EMG activities of masticatory muscles during chewing in freely moving rabbits.

Metal bite-raising splints of 0.5 mm thickness were attached to the upper molar teeth on both sides of the jaw in rabbits. The effects of these splints on masticatory behaviour during the chewing of soft food (bread) by freely moving rabbits were investigated. We recorded electromyograms (EMGs) of the masseter and digastric muscles. The animals exhibited prolongation of the chewing cycle, decreased EMG activity of the masseter muscle and increased EMG activity of the digastric muscle during chewing after introduction of the bite-raising splints. The effects of the splints on the activities of masticatory muscles were abolished by bilateral sectioning of the maxillary and inferior alveolar nerves. It seems likely that afferents from oral sensory receptors were responsible for the changes in masticatory behaviour after the introduction of the occlusal splint.

Animals↗

PubMed2002

Effect of stabilization splint therapy on pain during chewing in patients suffering from myofascial pain.

Masticatory myofascial pain (MFP) condition is a musculoskeletal disorder that compromises the functional capacities of the masticatory system. As such, the incorporation of an intensive chewing test as a discriminatory exercise for the diagnosis of this condition and evaluation of treatment success has considerable potential. Various splint designs have been used successfully, which have posed a question of whether the therapeutic effect of the splint is a placebo or has some other curative properties. The purpose of this study was to evaluate the efficacy of the stabilization appliance to reduce signs and symptoms in MFP patients and to compare the pain experience during the chewing test between two groups of patients, with and without splints. Myofascial pain patients (n = 37) who reported exacerbation of pain in function participated in the study. Patients perfomed a 9-min chewing test, followed by 9-min rest and marked their pain intensity on a visual analogue scale every 3 min. Of the 37 patients, 21 received a stabilization flat occlusal splint for night use and 16 were equally monitored clinically without a splint. At the end of 8 weeks, a second clinical examination and chewing test were performed. Student's t-test was used to analyse differences between study groups. Analysis of variance and covariance (ancova) with repeated measures was applied to analyse the effect of treatment. Level of pain at baseline prior to the chewing test (P0) was introduced as a co-variant. At baseline both groups showed relatively high scores of pain intensity and did not show any significant differences among the collected variables. At the end of the experiment, the splint group had a statistically significant reduction in pain intensity, in mean muscle sensitivity to palpation and in the pain experience during the chewing test compared with no change in the controls. A stabilization splint has a therapeutic value beyond its placebo effects. Thus, it should be an integral part of the treatment modalities in MFP disorder patients. An intensive chewing test is an effective tool to evaluate the treatment modality efficacy in MFP patients.

Adult↗

PubMed1999

Surgical orthodontic treatment of skeletal Class III malocclusion with anterior disc displacement without reduction (ADNR): a case report.

A female patient with skeletal problems and left temporomandibular joint (TMJ) derangement was treated with an occlusal splint, arthroscopic irrigation, and orthodontic surgery. The left side disc was displaced anteriorly without reduction; and mobility of the left condylar head was restricted. With arthroscopic irrigation, the jaw functions were recovered, but the disc position remained the same. After TMJ therapy, orthodontic and orthognatic surgery treatments were performed to correct the dentofacial deformity. Stable facial esthetics and occlusion devoid of temporomandibular joint disorder (TMD) symptoms were obtained and the patient's progress was monitored over a 5-year period.

Adolescent↗