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PubMed2002

Efficiency of occlusal appliance therapy in secondary otalgia and temporomandibular disorders.

In clinical practice, it is commonly assumed that occlusal splints have therapeutic value in the treatment of temporomandibular disorders CTMD), but the evidence based on randomized controlled trials is scarce. This study evaluated the short-term (10-week) efficacy of a stabilization splint in subjects with recurrent secondary otalgia and active TMD treatment need using a randomized, controlled, double-blind design. Thirty-six subjects were randomly allocated to the two treatment groups: the stabilization splint and the control splint group. After 10 weeks' treatment, the intensity of secondary otalgia, measured on a VAS scale (from 0 to 100 mm), decreased statistically significantly in the stabilization splint group (t 2.12; P 0.006), but not in the control group. Improvement in active TMD treatment need in subjects showing moderate or severe signs and symptoms of TMD was reported significantly more often in the stabilization splint group than in the control splint group (chi2 5.71; P.017). A statistically significant decrease in the Helkimo clinical dysfunction index was seen in the subjects with stabilization splint (Z-2.63; P.009), but not in the subjects with control splint. The results indicate that the use of a stabilization splint is beneficial with regard to secondary otalgia and active TMD treatment need.

Adult↗

PubMed1992

Stability of surgical maxillary expansion.

Stability after transverse expansion of the maxilla via Le Fort I osteotomy with segments was evaluated in 39 patients. The average expansion was 5.4 mm at the second molars, decreasing almost linearly to 2.8 mm at the first premolars. Postsurgical relapse also was greatest at the second molars, averaging 2.6 mm. The percentage of relapse was greatest posteriorly, decreasing from 49% at the second molars to 30% at the first premolars. Considerable variability in stability followed surgery: Three-fourths of the patients had some relapse at the first molars (greater than 3 mm in 28%), but one fourth were stable. Sixty-two percent of the patients had a net posttreatment gain in arch width at the first molars. No correlation was found between transverse relapse and the type of presurgical orthodontic tooth movement, the use of rigid fixation, or the use of an auxiliary stabilizing arch wire. The amount of postsurgical relapse was significantly greater in those who had concurrent mandibular surgery. To improve clinical results with surgical expansion, we recommend (1) moderate overexpansion at surgery for major transverse changes, (2) maintenance of the occlusal splint for at least 6 weeks, and (3) use of a lingual arch wire or auxiliary labial arch wire to maintain molar width during postsurgical orthodontics.

Adult↗

PubMed1994

Aetiology of maxillofacial fracture.

The aetiological factors associated with maxillofacial fractures, and the trends in these factors over a 13 year period are reported. The First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University, managed 695 patients with maxillofacial fractures between 1977 and 1989. The male to female ratio was 3.2:1 and the majority of patients were aged between 10 and 30 years old. Road traffic accidents and accidental falls were the main causes of fractures throughout the 13 year study period. Mandibular fractures occurred in 477 patients (68.6%). A high percentage of patients were treated by closed reduction and maxillo-mandibular fixation, or occlusal splinting.

Accidental Falls↗

PubMed2005

Modified Thurow appliance: a clinical alternative for correcting skeletal open bite.

Open bite malocclusion is frequently discussed in orthodontics; diagnosis, treatment, and retention can be difficult because this malocclusion has numerous correlated etiological factors. The earlier this malocclusion is corrected, the better the prognosis will be, especially when the problem is skeletal. This article presents a patient with skeletal open bite who was treated in the mixed dentition with an orthodontic appliance that included an acrylic occlusal splint and an expansion screw, based on the original Thurow appliance, to guide the vertical force against the posterior teeth and the alveolar process.

Alveolar Process↗

PubMed2006

The coexistence of temporomandibular disorders and styloid process fracture: a clinical report.

This clinical report describes the diagnosis and treatment of a patient with both temporomandibular disorders (TMD) and styloid process fracture. The presence of tender muscles of mastication, facial pain, especially upon awakening, frequent grinding sounds, and tooth attrition indicated a diagnosis of TMD with bruxism as a possible etiological factor. However, the preliminary diagnosis of styloid process fracture based on the patient's sensation of a foreign body in the throat and some discomfort when turning the head was confirmed using radiography. The styloid process fracture was treated using conservative nonsurgical therapy, and an occlusal splint was used to treat the TMD. The patient's symptoms were significantly reduced at the 12-month follow-up visit.

Adult↗

PubMed1995

[Effects of occlusal trauma on temporomandibular joints in rabbits: a scanning electron microscopic study].

Six rabbits with unilateral occlusal splints on the mandibular left molars for one month, three months or five months were examined to study the ultrastructure of the surface of the temporomandibular joint. Four rabbits were used as control. The results showed that the surface layer of the disk and articular cartilage were damaged. Severe fibrillation with sheets of fibers, collagen fibrils and collagen bundles inside fissures and craters were observed. These changes were seen in all rabbits with occlusal trauma and also in control rabbits for five months. The findings suggested that occlusal trauma could result in degenerative changes of the temporomandibular joint.

Animals↗

PubMed2003

Instrumental functional diagnostics with the ROSY simulator.

The ROSY robot system has been developed to simulate movements of the jaw under stepper motor control. The areas of indication comprise functional diagnostics and production of designed occlusal splints. Moreover, this device can also be extended for use in other areas. The computer-assisted design of OR templates has become possible. The simulator also permits the production of implant-borne restorations with optimum implant loading.

Computer Simulation↗

PubMed1993

The effects of induced dental malocclusion on the fibrocartilage disc of the adult rabbit temporomandibular joint.

Unilateral cast occlusal splints were fitted to the mandibular posterior teeth of adult rabbits, for periods of 1-28 days. The reactivity of the mandibular disc was examined by the effect on cell proliferation across the anterior, intermediate and posterior discal bands, as measured by metaphase arrest using vincristine sulphate. The effect on the disc was to activate cell proliferation on the splinted side. Intensity of response varied according to the length of time after fitting the splint, and the site involved. The findings suggested that the adult mandibular disc may participate in compensatory change at a cellular level and thus respond to changing functional loads placed upon the adult temporomandibular joints.

Adaptation, Physiological↗

PubMed1994

Traumatically induced posterior disk displacement without reduction of the TMJ--a case report.

A case of posterior disk displacement (PDD) without reduction of the temporomandibular joint (TMJ) was observed in this case report. The disk position was altered by using an occlusal splint and intermaxillary elastic traction for 10 days. An anterior displaced disk with reduction (ADDw/R) resulted from this therapy. Proposed criteria for diagnosing the PDD without reduction of the TMJ will be discussed in this study.

Adult↗

PubMedDate not supplied

Rehabilitating a patient with bruxism-associated tooth tissue loss: a literature review and case report.

Tooth tissue loss from bruxism has been demonstrated to be associated with various dental problems such as tooth sensitivity, excessive reduction of clinical crown height, and possible changes of occlusal relationship. A literature search revealed a number of treatment modalities, with an emphasis on prevention and rehabilitation with adhesive techniques. Rehabilitating a patient with bruxism-associated tooth tissue loss to an acceptable standard of oral health is clinically demanding and requires careful diagnosis and proper treatment planning. This article describes the management of excessive tooth tissue loss in a 43-year-old woman with a history of bruxism. The occlusal vertical dimension of the patient was re-established with the use of an acrylic maxillary occlusal splint, followed by resin composite build-up. Full-mouth oral rehabilitation ultimately involved constructing multiple porcelain veneers, adhesive gold onlays, ceramo-metal crowns, and fixed partial dentures.

Adult↗

PubMed2001

Changes in gait stability induced by alteration of mandibular position.

The purpose of this study was to investigate the effect of different mandibular positions on the body equilibrium by measuring the gait rhythm. Twelve young healthy subjects volunteered to participate in this study. Subjects were instructed to walk for a 18m distance with the mandible guided at six different positions by occlusal splints. The gait was recorded at fast, ordinary and slow walking speeds under occluded condition. Gait cycle, coefficient of variation for gait cycle and gait velocity were calculated during the 10m-walk. One-way ANOVA with repeated measures demonstrated significant differences among the six mandibular positions for the gait cycle at all gait speeds, for the coefficient of variation at fast speed and ordinary speed and for the gait velocity at fast speed (P<0.05). Regarding these variables, multiple comparison tests were also performed between the mandibular position without instruction for occlusion and other five mandibular positions. Gait cycle, coefficient of variation and gait velocity changed significantly in 5mm opening position from the intercuspal position, and in 5 mm left and 5mm right position from the 3mm opening position at fast speed (P<0.05). The result of this study suggests that the change of mandibular position could affect the gait stability.

Adult↗

PubMed1992

Radiographic signs of temporomandibular disorders to predict outcome of treatment.

In 32 consecutive patients with temporomandibular disorders radiographic changes were correlated with the patients' assessment of treatment outcome. The patients had been referred for tomographic examination because the clinical signs and anamnestic data were inadequate for definite clinical diagnosis. Initially all patients were treated conservatively with a flat occlusal splint. Surgery was advised in appropriate cases. The subjective effect of treatment was assessed using a questionnaire, and the material was divided into responder and nonresponder groups. Seventy-eight percent (25) of the patients experienced a positive subjective response to the treatment. No radiographic sign was found to be statistically correlated to the outcome of treatment.

Adult↗

PubMed2004

Evaluation of aural manifestations in temporo-mandibular joint dysfunction.

Thirty patients with temporo-mandibular joint dysfunction were selected to investigate the changes in otoacoustic emissions before and after conservative treatment of their temporo-mandibular joints. Pure tone audiometry, transient-evoked otoacoustic emissions (TEOAE), distortion-product otoacoustic emissions (DPOAE) as well as a tinnitus questionnaire were administered to all patients before and after therapy. Therapy was conservative in the form of counselling, physiotherapy, anti-inflammatory agents, muscle relaxants, and occlusal splints. Results indicated insignificant changes in the TEOAEs, whereas there were significant increases in distortion product levels at most of the frequency bands. These results were paralleled to subjective improvement of tinnitus.

Adolescent↗

PubMed1998

Electromyographic study of the temporal, masseter and suprahyoid muscles in the mandibular rest position.

The temporal muscles (anterior position), and the masseter and suprahyoid muscles were studied electromyographically in 15 subjects with ages ranging from 18 to 35 years, showing normal occlusion (Class I of angle), complete dentition and no dysfunction of the stomatognathic system. The volunteers sat comfortably in a chair, keeping the Frankfurt plane parallel to the floor; the muscles were analysed in the mandibular resting position through a number of stages: with minimum exteroceptive stimuli, relaxation with soft music, abolition of the intrabuccal negative pressure through a plastic tube, stress provoked by an electronic game, disocclusion of posterior teeth using the occlusal splint and finally withdrawal of this device. The electromyographic results were analysed statistically. The samples, were analysed for all of the frequencies of motor units, in a 1-min period. It was found that there were statistically significant difference between the relaxation stages as compared with the withdrawal of negative intraoral pressure and mainly with the stress phase, being this only on the suprahyoid muscles, with 5% significance.

Adolescent↗

PubMed1993

Temporomandibular joint and orofacial pain: clinical and medicolegal management problems.

Idiopathic pain in the face, temporomandibular joint (TMJ), and teeth is common but varied in its duration and severity. Many cases respond to informed reassurance or simple physical therapy using an occlusal splint. Those that do not should be referred for specialist management by medication, and where necessary, arthroscopy or occasionally arthrotomy. Awareness of the underlying psychogenic factors is important at all levels of management, particularly as some patients will benefit from the support of a liaison psychiatrist. The failure to recognise these factors, together with prolonged unsuccessful physical or surgical therapy can render the pain intractable or incite certain patients to seek relief through litigation.

Antidepressive Agents, Tricyclic↗

PubMed1994

Comparison of magnetic resonance imaging before and after nonsurgical treatment of closed lock.

Ten temporomandibular joints with the closed lock in 10 patients who were successfully treated clinically nonsurgically with the occlusal splint, were studied with magnetic resonance imaging. In all patients, the pretreatment images of temporomandibular joints showed anteriorly dislocated disks that failed to recapture together with various changes in disk morphology. Three to four months after the treatment, all patients could open their mouths more than 47 mm at the incisor position and were asymptomatic. But the follow-up magnetic resonance images showed that the disks were still anteriorly displaced and deformed and their relationships with the condyles were unchanged. The reestablishment of mouth opening appeared to occur not by recapturing of the disks but by improvement in condylar mobility and the adaptation of the posterior attachment.

Adolescent↗

PubMed2000

Intraoral distraction osteogenesis in the baboon mandible using a tooth and bone-anchored appliance.

PURPOSE: The purpose of this study was to determine the feasibility of using an intraoral, bone and tooth-anchored appliance to distract baboon mandibles using the principles of distraction osteogenesis (DO). MATERIALS AND METHODS: Seven juvenile baboons were used in this study. Mandibular corticotomies were made in the ramus of the mandible unilaterally (n = 5) or bilaterally (n = 2), and a "pin-in-tube" (PIT) distraction appliance was applied. The device was secured to the mandibular ramus posterior to the cortical cut with a bicortical screw and anteriorly to an occlusal splint. The appliance was activated an average of 0.86 mm/d (0.5 to 1.3 mm/d) for an average of 12.4 days (10 to 14 days). Predistraction and postdistraction measurements were made between metallic markers placed in the distraction area, in the dental midline, and of the overjet and overbite. RESULTS: Bone healing was complete in all mandibles. The average mandibular lengthening measured between the metallic markers was 7.9 mm. The mandibular midlines showed an average of 4.25 mm of lateral movement in the unilaterally distracted mandibles. There were no infections. CONCLUSIONS: The results of this study indicate that an intraoral bone and tooth-anchored distraction appliance is an effective method to produce lengthening in the mandible by distraction osteogenesis.

Animals↗

PubMed2006

A preliminary protocol for multi-professional centers for the determination of signs and symptoms of temporomandibular disorders.

The objective of the present study was to test a protocol for the quantification of the frequency and severity of signs and symptoms of temporomandibular disorders (TMD) according to patient perception during two phases of investigation. The protocol was developed based on the signs and symptoms most frequently reported in the literature and on the circumstances in which they produce discomfort. Eighty-four patients diagnosed with TMD by functional examination of the masticatory system responded to the protocol questions and indicated the severity of signs and symptoms using an eleven point numerical scale (Phase 1). Forty-two patients were fitted with an occlusal splint (treated group) and the remaining participants did not use a splint (control group). The protocol questions were asked after 50 days of treatment (Phase 2). Based on the results of nonparametric statistical analysis, the incidence of signs and symptoms was high in Phase 1 and significant, with no difference between the groups, whereas the treated and control groups differed in Phase 2. A comparison between Phases 1 and 2 showed that only the treated group presented a reduction in the severity of signs and symptoms. The study showed that using this protocol, it is possible to define the frequency and severity of symptoms as well as the effect of the treatment. The advantage of this protocol is that it would complement the data obtained using clinical examination with information provided by the patient in a measurable manner.

Epidemiologic Methods↗