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PubMed2002

Medical and physical therapy of temporomandibular joint disk displacement without reduction.

The objective of this study was to determine the influence of medical and physical therapy on long-term treatment outcome in 72 patients with anterior disk displacement without reduction. Patients were treated solely with occlusal splints (group I), with splints and supplementary medical therapy (group II), with splints and physical therapy (group III) or with splints, medical, and physical therapy (group IV). After therapy, the maintenance of improvement was objectively and subjectively assessed with an extensive clinical examination and a postal questionnaire. The percentage of pain free patients after therapy was 76% in group I, 88% in group II, 43% in group III, and 65% in group IV. There was a statistically significant higher increase of maximum jaw opening after therapy in group II than in the control groups (p<0.05). The improvement in mouth opening came to 9.7 mm in group I, 14.5 mm in group II, 7.3 mm in group III, and 11.2 mm in group IV. Medical therapy seems to have a positive influence on the treatment outcome of patients with anterior disk displacement without reduction.

Adolescent↗
PubMed2004

Short-term clinical outcomes and patient compliance with temporomandibular disorder treatment recommendations.

AIMS: To evaluate short-term patient compliance with 5 conservative temporomandibular disorder (TMD) treatments (jaw relaxation, jaw stretching, heat application, cold application, and occlusal splint use) and the association of compliance with changes in pain intensity, pain-related activity interference, and jaw use limitations. METHODS: Eighty-one TMD patients were given 1 to 5 treatment recommendations as part of usual care in a TMD specialty clinic. Compliance with each recommendation and pain, pain-related activity interference, and jaw use limitation measures were calculated from electronic interviews conducted 3 times daily for 2 weeks. RESULTS: Median compliance with individual treatment modalities ranged from 7.7% for heat application to 92.7% for jaw relaxation; median overall compliance was 54.8%. Participants with higher initial pain intensity and jaw use limitations were significantly more compliant with their recommended treatment regimen (P < .05). The authors controlled for age, gender, education, and initial jaw use limitations. Overall compliance was associated significantly and positively with 2-week jaw use limitations (P = .03). A trend toward a statistically significant positive association was found between compliance and 2-week pain intensity (P = .09). CONCLUSION: Compliance varied widely across patients and therapies. Patients with higher initial pain and jaw use limitation levels were more compliant with treatment recommendations. Although compliance was associated with slight increases in pain and jaw use limitations in this preliminary study, further research is needed to evaluate the longer-term effects of compliance with recommended therapies.

Adult↗
PubMed2003

Immediate loading of single-tooth implants in the anterior maxilla. Preliminary results after one year.

According to the standard protocol, a load-free healing period is one of the most emphasized requirements for implant integration. Recent studies have encouraged a progressive shortening of the healing period for single-tooth implants and immediate loading has been proposed for the aesthetic zone in the maxilla. The present study evaluated clinical outcomes of immediately loaded FRIALIT-2 Synchro implants 12 months after placement in the maxillary incisal region. In the course of our investigation, nine patients have been treated following an immediate loading protocol. The stepped-screw type implants were inserted with an increasing torque up to 45 Ncm, thus measuring the primary stability of the implants. All implants were immediately restored with unsplinted acrylic resin provisional crowns and the patients provided with occlusal splints. Regular controls were performed at monthly intervals, intraoral radiographs were taken directly after implant placement, 6 and 12 months post insertion. The survival rate, clinical stability (Periotest) and radiographic coronal bone defects (CBD) were evaluated at delivery of the definitive superstructures (CBD 6) and 6 months later (CBD 12). Twelve FRIALIT-2 Synchro stepped screws of 3.8, 4.5 and 5.5 mm diameter and 13 and 15 mm length were placed in the incisal maxillary region. The median Periotest value 6 months post insertion was -2 with a minimum of -5 and a maximum of +2. The mean coronal bone level changes (CBD) at 6 and 12 months were 0.45 and 0.75 mm. No implant failed up to 12 months after insertion, resulting in a 100% survival rate. The presented results showed promising data for immediately loaded single-tooth implants in the anterior maxilla. Periotest values were within the range published for submerged implants. The radiographic coronal bone resorption after 6 and 12 months was even less than evaluated for implants placed in a standard two-stage procedure. It is evident that successful immediate loading protocols require a careful and strict patient selection aimed at achieving the best primary stability and avoiding any excessive functional or non-functional loading. Additional research needs to be done to provide data in situations where problems of poor bone quality, multiple implants or augmentation procedures must be overcome.

Acrylic Resins↗
PubMedDate not supplied

Reduction of sleep bruxism using a mandibular advancement device: an experimental controlled study.

PURPOSE: The objective of this experimental study was to compare the effect on sleep bruxism and tooth-grinding activity of a double-arch temporary custom-fit mandibular advancement device (MAD) and a single maxillary occlusal splint (MOS). MATERIALS AND METHODS: Thirteen intense and frequent bruxors participated in this short-term randomized crossover controlled study. All polygraphic recordings and analyses were made in a sleep laboratory. The MOS was used as the active control condition and the MAD was used as the experimental treatment condition. Designed to temporarily manage snoring and sleep apnea, the MAD was used in 3 different configurations: (1) without the retention pin between the arches (full freedom of movement), (2) with the retention pin in a slightly advanced position (< 40%), and (3) with the retention pin in a more advanced position (> 75%) of the lower arch. Sleep variables, bruxism-related motor activity, and subjective reports (pain, comfort, oral salivation, and quality of sleep) were analyzed with analysis of variance and the Friedman test. RESULTS: A significant reduction in the number of sleep bruxism episodes per hour (decrease of 42%, P < .001) was observed with the MOS. Compared to the MOS, active MADs (with advancement) also revealed a significant reduction in sleep bruxism motor activity. However, 8 of 13 patients reported pain (localized on mandibular gums and/or anterior teeth) with active MADs. CONCLUSIONS: Short-term use of a temporary custom-fit MAD is associated with a remarkable reduction in sleep bruxism motor activity. To a smaller extent, the MOS also reduces sleep bruxism. However, the exact mechanism supporting this reduction remains to be explained. Hypotheses are oriented toward the following: dimension and configuration of the appliance, presence of pain, reduced freedom of movement, or change in the upper airway patency.

Adult↗
PubMed1987

Splinting.

The definitions of splinting, occlusal trauma, and mobility have been described. The history of splinting as a treatment for periodontal disease has been noted along with the current concepts of the indications and rationale for splinting. Splints have been classified according to their expected length of service: short-term splints, provisional splints, and long-term splints. The disadvantages of splinting have been enumerated, and examples of the various types of splints currently employed have been demonstrated.

Dental Occlusion, Traumatic↗
PubMed1999

Stability of the Le Fort I maxillary osteotomy after rigid internal fixation.

PURPOSE: The purpose of this study was to evaluate the postsurgical stability of the Le Fort I osteotomy with impaction in which rigid internal fixation was used for stabilization. MATERIALS AND METHODS: Lateral cephalograms of 19 patients were evaluated. Descriptive statistics were compiled that included absolute linear and angular measurements as well as absolute changes in measurements for successive cephalometric radiographs. Comparisons were made from 1) presurgery to immediate postsurgery, 2) immediate postsurgery to splint removal, 3) splint removal to longest follow-up, and 4) immediate postsurgery to longest follow-up. Repeated measures analysis of variance were used to describe significant differences for absolute changes in measurements. RESULTS: All surgical movements were significant except for horizontal position of dental structures, horizontal position of the posterior mandible, and posterior vertical facial height. All significant movement from immediate postsurgery to splint removal was secondary to removal of the occlusal splint. Changes were minimal from splint removal to longest follow-up, with only 3 of 24 measurements showing statistically significant differences. These measurements related to tooth position and were affected by postsurgical orthodontics. The data derived from this study were also compared with those found in similar studies in which fixation was by wire osteosynthesis. CONCLUSIONS: The magnitude of postoperative movement was considerably less with rigid internal fixation than that reported with the use of wire fixation. This is attributed to the increased stabilizing effect of rigid internal fixation.

Bone Plates↗
PubMed1994

Condylar resorption after orthognathic surgery. Evaluation of treatment in 8 patients.

Several articles have been published on the subject of condylar resorption as a complication of orthognathic surgery. However, since there is little reference to treatment, the frequency of this phenomenon and the results of therapy are evaluated in a retrospective study. 8 patients out of a group of 329 who underwent sagittal split osteotomy in a 10-year period (251 bilateral, 73 Le Fort I + bilateral and 5 unilateral), were treated actively following the development of condylar resorption. 4 patients were operated upon a second time while others underwent occlusal rehabilitation. The results for the patients who underwent revisional surgery were unsatisfactory, with poor aesthetics and occlusal stability. The patients treated with an occlusal splint (+/- orthodontics and/or prosthetic therapy) had a functional occlusion and tolerable temporo-mandibular-joint complaints.

Adult↗
PubMed1980

A 3-month study in monkeys of occlusal dysfunction and stress.

A dysfunctional occlusal relationship was produced in six Macaca irus monkeys by insertion of occlusal splints in the maxilla which raised the vertical dimension of occlusion by 3-4 mm and incorporated interferences into the occlusion (test side). Cortisol levels of plasma and urine were measured by competitive protein binding analysis. At week 1 and week 3 after insertion of the splints there was a significant increase of 24 h urinary cortisol excretion rate and plasma cortisol concentration, indicating emotional stress. Furthermore, there was evidence of acute trauma from occlusion of the mandibular teeth of the test side, including a significant increase of tooth mobility and GI; radiographically there were signs of breakdown of margial and interradicular alveolar bone. One animal developed periodontal pockets of 4-5 mm adjacent to the teeth of the test side. At week 6 and week 12 urinary and plasma cortisol levels had declined to basal values whereas tooth mobility, GI and PI remained elevated. There was no clinical or radiographic evidence of further loss of bone or increase of pocket depth adjacent to the teeth of the test side during the latter part of the experimental period. The results suggest that emotional stress may be involved in periodontal reactions associated with acute trauma from occlusion.

Animals↗
PubMed1980

Jaw muscle silent periods: the effect of acrylic splints.

Jaw muscle silent periods were recorded in response to a chin tap during maximal clench in asymptomatic subjects. The insertion of a palatal splint did not change the silent period duration. However, an occlusal splint, or part of it, caused a significant increase in the duration of the silent period.

Acrylic Resins↗
PubMed1990

Treatment of reciprocal clicking of the temporomandibular joint with a repositioning appliance and occlusal adjustment--results after four and six years.

A follow-up study was performed on 12 subjects with unilateral and five subjects with bilateral reciprocal clicking and symptoms of craniomandibular disorders. After treatment for, on average, three months with a repositioning appliance, followed by occlusal adjustment, patients were examined every six months initially and, after the first two years, once a year. During the follow-up period, occlusal stability was maintained by readjustment and use of full occlusal splints at night, when needed. After four years there was a 57% success rate with regard to treated joints. After six years, the success rate had decreased to 41%. However, even the eight unsuccessful cases, with persistent clicking and adjusted occlusion, managed well with regard to other clinical findings and subjective symptoms. It is concluded that repositioning splint therapy followed by occlusal adjustment seems appropriate for elimination of subjective symptoms and clinical signs even though repositioning may subsequently fail. Results seem to remain relatively unchanged for several years but some decline in the success rate may occur with time.

Adolescent↗
PubMed1979

Myofacial pain dysfunction: a manifestation of the short-face syndrome.

The practitioner who treats patients with MPD should be aware that certain anatomic variations may predispose a patient to developing the syndrome. We feel that the newly described entity, the short-face syndrome, is such an example. Patients exhibiting short-face syndrome are overclosed. Their condition appears to be improved by establishing an increased vertical dimension of occlusion. This is first accomplished with the use of a processed acrylic resin occlusal splint. If a patient has been asymptomatic at the new occlusal relationship, a maxillary osteotomy is recommended to achieve a more permanent functional and cosmetic result.

Face↗
PubMed1991

Long-term results of appliance therapies in anterior disk displacement with reduction: a review of the literature.

The diagnosis and management of temporomandibular disorders (TMD) have been a source of controversy in the dental community for decades. This controversy has been especially acute in the management of patients with anteromedial disk displacement (ADD) with reduction. This article presents a review of the literature specifically concerning the long-term results of appliance therapy in ADD with reduction patients. The literature review identified the failure of many past investigators to conduct scientifically well-designed studies or to use comparable criteria. However, from the evidence examined, both appliances seem to be able to decrease muscle and joint pain and increase mandibular function. The anterior repositioning splint seems to be superior to the flat-plane occlusal splint in eliminating reciprocal clicking and palpatory tenderness of the temporomandibular joint. The recapture of the disk is permanent in only a small percentage of patients suggesting that the use of irreversible procedures must be carefully evaluated.

Facial Pain↗
PubMed1990

Control of vertical position of the maxilla in orthognathic surgery: clinical application of the sandwich splint.

The Le Fort I osteotomy can be used to change the position of the maxilla in all three dimensions. A presurgically fabricated occlusal splint is used to reproduce the planned sagittal and transverse position of the maxilla. Various methods for determining the proper vertical position have been described. The major difficulty in vertical control when these techniques are used is the sagittal change of the lower reference point as the maxilla is advanced. The relative error in the vertical plane increases with larger sagittal movements. The sandwich splint technique, with two stable intraoral reference points, can be used to ensure proper vertical positioning of the maxilla. This method enables exact measurement of the vertical dimension during cast surgery and in the operating room. Vertical measurements are based on the relationship between the mandible and skull base. This distance remains constant during splint fabrication and when the splint is used at surgery. Postoperatively, the mandible can be rotated into the new centric occlusion.

Dental Occlusion, Centric↗
PubMed1990

[Clinical application of intermaxillary traction for temporomandibular disorders].

Occlusal splint has been usually used for TMJ arthrosis as a conservative treatment, but the range of its application is narrow and less effective. This study is to evaluate the effect of the pivoting splint with intermaxillary rubber traction, to report the results of the pivoting splint with intermaxillary rubber traction which was used 24 patients.

Animals↗
PubMed1989

The bonded visible light cured appliance intermediate splint therapy for the temporomandibular joint patient.

The purpose of this article is to trace the history of cemented segmental occlusal splints and to show how the visible light cured (VLC) materials available today remove the disadvantages caused by the material used in the past. The author felt that the advantages of these VLC materials make this appliance a viable choice when repositioning appliances are part of a treatment plan. Because of the technique sensitivity of all procedures involving VLC materials, a step by step technique outline was included in the article. Three cases are shown to help the reader visualize the use of this generation of fixed TMJ appliances.

Dental Bonding↗
PubMed1988

The role of the general practitioner in restoring patients with temporomandibular joint dysfunction.

Treatment of temporomandibular joint pain, resulting from occlusal dysfunction, is divided into two phases. First, occlusal splint therapy is used to eliminate the initial signs and symptoms and to achieve stability in centric relation. In the second phase of treatment the occlusion is adjusted and, if indicated, restored by means of crown and bridge procedures. Casts, properly mounted in a semi-adjustable articulator, with the lower cast mounted in centric relation, can be extremely helpful for an occlusal analysis and a diagnostic occlusal adjustment in the articulator. Each occlusal adjustment procedure in the mouth should be preceded by an initial study, occlusal analysis and occlusal adjustment on articulator mounted casts. The two main criteria for restoring the occlusion are: maximum intercuspation occurring in centric relation and disocclusion of the posterior teeth during excursive movements by means of anterior guidance. Patients with a history of temporomandibular joint pain and dysfunction usually have a limited adaptive capacity of even the smallest occlusal imperfection. In order to cope with the occlusal restoration of patients with such a low level of occlusal tolerance the final crowns and bridges should be cemented temporarily for a period of at least 3 months. A matt gold surface will be very helpful to locate undesirable occlusal contacts during temporary cementation.

Dental Articulators↗
PubMed2005

Mandibular displacement related to simulated loss of posterior occlusal support.

Mandibular displacement related to simulated loss of posterior occlusal support was investigated. Twenty-four volunteers with natural dentitions were selected. To change the posterior occlusal support, occlusal splints fitted to maxillary dental arches were cut in sequence from the most posterior to anterior. The more the absence of posterior occlusal support increased, the more both condylar displacements were increased (R: 0.97mm, L: 0.94mm). Moreover, subjects could be divided into two groups depending upon their condylar mobility following with reduced occlusal support. These results suggest that individual adaptability to the imbalanced occlusal condition should be always considered.

Adult↗