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PubMed1983

A 21/2-year follow-up of changes in headache and mandibular dysfunction after stomatognathic treatment.

A 21/2-year follow-up of the treatment results in 52 patients with mandibular dysfunction and recurrent headache has been compared with pretreatment and 1-year follow-up findings. It was shown that (1) the clinical and subjective improvement observed after 1 year was maintained in most patients after 21/2 years, (2) 13% of patients received no benefit from treatment, (3) 10% of patients had relapses during the follow-up period, (4) 8% of patients thought that they needed further treatment, and (5) nearly 50% of those treated continued to use an occlusal splint at regular or periodic intervals, but few continued use of therapeutic exercises for more than 3 months. It can be concluded that the long-term prognosis for treatment of mandibular dysfunction is good even when recurrent headache is considered a symptom of this complex syndrome.

Female↗
PubMed1985

Irreversible hydrocolloid impressions for full-banded orthodontic patients.

A technique has been described to obtain intact accurate irreversible hydrocolloid impressions in patients who are in the process of full-banded orthodontic therapy. When this technique is used, the maxillary and mandibular casts are produced with sufficient accuracy to make a maxillary occlusal splint that requires minimal adjustment.

Colloids↗
PubMed1986

Acupuncture compared with stomatognathic treatment for TMJ dysfunction. Part III: Effect of treatment on mobility.

The purpose of this study was to compare the effects of acupuncture and stomatognathic treatment on the mobility of the mandible in random samples of patients with TMJ dysfunction. One group of 25 patients was treated with acupuncture performed by a specialist in physical medicine and rehabilitation and a second similar group received standard stomatognathic treatment. All of the patients were evaluated in terms of the Helkimo dysfunction index by a dentist before treatment, within 1 week of treatment, and 3 months after treatment. No significant differences could be detected in painful movement of the mandible except in retrusive movement, wherein stomatognathic treatment was clearly superior immediately afterward. Acupuncture seems to be a useful early form of therapy in patients with TMJ disorders that are expected to be largely functional and reversible and with evidence of psychophysiologic or neuromuscular disturbances but not of any marked occlusal interference or joint damage. Acupuncture could well be complementary to stomatognathic treatment, either preceding or following it, to achieve full neuromuscular rehabilitation, to ease the treatment (for example, occlusal splints), or to eliminate other possible contributory factors.

Acupuncture Therapy↗
PubMed1988

Long-term prognosis for the clicking jaw.

Ninety-four patients who complained of clicking of the temporomandibular joint not associated with pain were followed up for varying lengths of time. Analysis of the follow-up indicates that approximately 70% of the patients who have a painless, clicking temporomandibular joint will eventually have pain and that the use of a nonrepositioning occlusal splint does not lessen the likelihood of pain ensuing.

Female↗
PubMed2004

Three-dimensional changes in the condyle during development of an asymmetrical mandible in a rat: a microcomputed tomography study.

A rapidly growing postnatal animal model was used to study changes in the calcified tissue of the mandibular condyle during altered muscle function. A maxillary occlusal splint was designed to shift the mandible laterally (left) during closure. Groups of 5 Wistar rats were killed at 5, 9, 15, 21, 30, and 40 weeks (n = 30), with an equal number of controls. The experimental animals developed shorter, asymmetrical mandibles compared with the control animals. The left condyle became larger and thicker than the right condyle. Microcomputed tomography assessment of the left and right condylar trabecular bone indicated that both had less bone volume than the control condyle. The right masseter muscle significantly lost fiber size and type IIA oxidative fibers, suggesting that the right masseter muscle was used with less tension development. In contrast, the left masseter maintained its fiber size and was similar to the control masseter fiber diameters. Comparison in the sequence of changes indicated that the morphologic changes occurred first in the ramus (age, 5 weeks), before the corpus (age, 15 weeks), and before changes in masseter fiber size and composition (age, 9 weeks). This study showed that both the mandible and the condyle modified their shape and size, as well as the trabecular bone of the condyle, during shifting of the mandible to one side as it closed.

Animals↗
PubMed2006

A novel approach to bite force measurements in a porcine model in vivo.

A novel device for a bite force measurement system in a porcine model is described. A single polyethylene layer was vacuum-formed into a splint, and a force sensor was fitted on to the splint occlusal surface and seated with a silicone layer. This design enabled the measurement of bite forces on selected teeth in a large animal model with either natural dentition or single implant crowns and could be used in assessing information on biomechanical adaptation of the bone-implant interface to masticatory loads. Preliminary recordings of force values obtained during mastication in the premolar region (200-560 N) and various limiting factors of the technical design are discussed.

Animals↗
PubMed1984

Alleviation of myofascial pain with ultrasonic therapy.

In recent years ultrasound has been used extensively in physical medicine with considerable success. Its use has not been advocated extensively, however, for MPDS. This article summarized the basic concepts of ultrasound and evaluated its effectiveness in the treatment of 28 patients with MPDS. In conclusion, it appears that therapeutic ultrasound can be used effectively to alleviate discomfort of MPDS that does not respond to occlusal splint therapy. Ultrasound is most successful in alleviating muscle symptoms and least effective in reducing symptoms associated with the disk. Age was not a significant factor in the efficacy of ultrasound.

Adolescent↗
PubMed1975

Surgical treatment for recurrent dislocation or chronic subluxation of the temporomandibular joint.

Recurrent dislocation or chronic subluxation of the temporomandibular joints may occur from long-term overclosure. Mandibular overclosure is due to loss of dentition. If the overclosure is not corrected by prosthetic rehabilitation of the proper vertical dimension, the result will be loosening of the temporomandibular capsule and stretching of the lateral ligament. The authors advocate capsule plication and ligamentorrhaphy via a preauricular or endaural approach. Occlusal splints are used during surgery to reestablish the vertical dimension. The patient is kept in intermaxillary fixation for 3 weeks. Postoperative prosthetic reconstruction is needed. Two cases are presented.

Adult↗
PubMed1988

Hemifacial atrophy and temporomandibular joint pain-dysfunction syndrome.

A case is described of a patient with progressive HA who presented because of left TMJ pain, jaw locking and ipsilateral masticatory muscle spasm. Several reports exist in the literature of masticatory muscle spasm associated with HA. A diagnosis of TMJPDS was made and an occlusal splint was provided which produced resolution of the TMJ pain and jaw locking and significantly reduced the masticatory muscle spasms.

Adult↗
PubMed1990

Factors contributing to skeletal relapse after surgical correlation of mandibular prognathism.

Postoperative follow-up and multiple regression analysis of skeletal relapse following mandibular setback were carried out to clarify the timing and causes of the relapse. The subjects were 24 mandibular prognathism patients. All patients underwent intraoral oblique sagittal splitting osteotomy with circumferential wiring and intermaxillary fixation for 8 weeks. Occlusal splints were not used. Postoperative positional changes of segments were evaluated by lateral cephalograms taken at appropriate intervals. Horizontal relapse was most evident within six months after surgery; vertical relapse seldom occurred. Multiple regression analysis revealed little association between preoperative morphological patterns and postoperative relapse. Although spatial changes of the proximal segment at operation and age of the patient were the best predictors for postoperative horizontal relapse, analysis indicated unsatisfactory prediction of vertical relapse because of its rare occurrence. Based on these results, the aetiology of relapse is discussed and two proposals are suggested for its prevention.

Adolescent↗
PubMed1989

Evaluation of gingival microcirculation by a laser-Doppler flowmeter. Preliminary results.

Up to now, only qualitative studies have been performed on gingival microcirculation whereas quantitative methods have been used in animal experiments, by the injection of microspheres for instance. The authors had the opportunity of using a Laser-Doppler Flowmeter (LDF) which had already served to explore the cutaneous microvascular blood flow. At first, it was necessary to modify an occlusal splint for good immobilisation of the probe on the gingival mucosa. Then they made a study on twenty healthy students with measurements of red cell velocity in superficial maxillary gingival mucosa. Each subject was tested twice at an interval of one-month. A statistical analysis shows very good reproducibility of the tests, especially for the pulsative velocity, despite a rather high variability between the subjects. The haemodynamic parameters (heart rate, systolic or diastolic blood pressure) do not seem to have a significant influence on the values obtained. The LDF is a very good instrument for the evaluation of gingival microvascular flow, as has been demonstrated for cutaneous microcirculation. A wide range of applications can be considered for this sensitive and harmless technique.

Adult↗
PubMed1994

Physiotherapy in the treatment of temporomandibular joint disorders: a comparative study of four treatment methods.

Temporomandibular joint pain dysfunction syndrome (TMJPDS) comprises of a constellation of signs and symptoms including joint tenderness and pain on function, restricted jaw movement, clicking, jaw locking and tenderness in the muscles of mastication. Headache may also be a feature. Physiotherapy is commonly employed in the treatment of this condition but there is little published material reporting the relative efficacy of the different types of treatment currently available. Further, no attempt seems to have been made to compare the costs of physiotherapy with other forms of treatment of this disorder such as occlusal splint therapy. This paper reports a comparative evaluation of four different physiotherapy treatments and placebo in the management of TMJPDS and comments on their cost benefit aspects compared with that of splint therapy. The four methods of physiotherapy tested were short-wave diathermy, megapulse, ultrasound and soft laser. There was no statistically significant difference in success rate between any of the four tested (range 70.4-77.7%) although each individually was significantly better than placebo treatment. The time of improvement appeared to vary between the four methods.

Chi-Square Distribution↗
PubMed2002

Skeletal stability of Le Fort I osteotomy in patients with isolated cleft palate and bilateral cleft lip and palate.

The skeletal stability of Le Fort I osteotomy was evaluated retrospectively in 14 patients with isolated cleft palate (CP, mean age 27.2 years) and 11 patients with bilateral cleft lip and palate (BCLP, mean age 23.7 years). The osteotomy was fixed with titanium plates and the osteotomy gap was grafted with autologous bone. Neither intermaxillary fixation nor occlusal splints were used postoperatively. Skeletal stability was analysed both horizontally and vertically by cephalograms taken shortly before operation, immediately afterwards, and at six months and at one year postoperatively. In the CP group the mean maxillary horizontal advancement (point A) was 4.7 mm (range 0.3-7.8) and the mean vertical lengthening 3.6 mm (range 0.7-6.1). One year postoperatively the mean relapse was 8.5% (0.4 mm) horizontally and 16.7% (0.6 mm) vertically. In the BCLP group the mean horizontal advancement was 5.3 mm (range 0.2-10.7) and the mean vertical lengthening 7.3 mm (range 0.6-11.8). The mean postoperative relapse was 9.4% (0.5 mm) horizontally and 17.8% (1.3 mm) vertically. The skeletal stability and relapse were similar in both cleft types although BCLP patients had more residual cleft problems and their mean surgical advancement was greater. There was great individual variation.

Adolescent↗
PubMed2000

Soft tissue profile changes after Le Fort I osteotomy in UCLP patients.

The changes in soft tissue profile after Le Fort I osteotomy were evaluated cephalometrically in 38 consecutive UCLP patients (25 males, 13 females) operated on between 1987 and 1995. Mean age at operation was 23.5 years. The one-piece Le Fort I osteotomy was fixed with titanium plates and the osteotomy site was bone grafted. Neither intermaxillary fixation nor occlusal splints were used postoperatively. Soft tissue changes were analyzed both horizontally and vertically by cephalograms taken shortly before surgery, 6 months and 1 year postoperatively. The mean maxillary skeletal advancement (point A) during surgery was 3.8 mm and mean vertical lengthening 4.4 mm. One year postoperatively the horizontal change in the upper lip profile (point a) was 80% of the skeletal change. Vertically, the soft tissue change in the upper lip was smaller 40%, but increased significantly (to 58%) if V-Y plasty was used. The V-Y plasty also increased the anteroposterior thickness of the upper lip. No significant soft tissue changes were observed between 6 months and 1 year postoperatively.

Adolescent↗
PubMed2004

Effects of sagittal split ramus osteotomy on temporomandibular disorders in seventy-two patients.

Preoperative and postoperative temporomandibular disorders (TMDs) were observed in 72 patients before surgical-orthodontic treatment and about 2 years after bilateral sagittal split osteotomy. Prevalence and degree of TMD were assessed using the modified clinical dysfunction index of Helkimo. A total of 49 women and 23 men (mean age 32 years) were included in the study. To find out which patients benefit most from the treatment, the sample was classified into subgroups--myogenous, arthrogenous, or both components of TMD. The prevalence of clicking and headache decreased significantly with the treatment, while the incidence of crepitation increased. In general, severity of the dysfunction was greatly reduced. Furthermore, multiple regression analysis showed that patients with excessive overjet and previous occlusal splint therapy benefit most from orthognathic treatment. In addition, patients with signs of mainly myogenous origin got more relief from their dysfunction than patients with mainly arthrogenous components of TMD. The results suggest that in patients with severe maxillomandibular discrepancy surgical-orthodontic therapy is a good choice of treatment for reducing myogenous TMD pain and discomfort.

Adolescent↗
PubMed2001

Skeletal stability of Le Fort I osteotomy in patients with unilateral cleft lip and palate.

The skeletal stability of Le Fort I osteotomy was evaluated cephalometrically in 40 consecutive patients with unilateral cleft lip and palate (UCLP) (27 male and 13 female) who were operated on between 1987-1995. Their mean age at the time of operation was 23.7 years (range 16.3-40.4). The one-piece Le Fort I osteotomy was fixed with titanium plates and the osteotomy line was bone-grafted. Neither intermaxillary fixation nor occlusal splints were used postoperatively. Skeletal stability was analysed both horizontally and vertically on cephalograms taken shortly before operation, immediately afterwards, and at six months and at one year postoperatively. The mean maxillary advancement (point A) during the Le Fort I was 3.9 mm (range 0-8.9) and mean vertical lengthening 4.5 mm (range -0.6-10.5). One year postoperatively the mean maxillary horizontal relapse was 20.5% (0.8 mm, range 0-3.7) whereas the mean vertical relapse was 22.2% (1 mm, range 0-5.7). The vertical relapse reduced from 38% to 8.3% between 1987 and 1995, and there was a positive correlation between the amount of maxillary advancement and relapse both horizontally and vertically.

Adolescent↗
PubMed1989

A multidisciplinary approach to the evaluation and treatment of temporomandibular joint and cervical spine dysfunction.

This article presents a multidisciplinary approach to the management of temporomandibular joint (TMJ) and cervical spine dysfunction in a heterogeneous population of patients. A methodology for the systematic evaluation and treatment of patients is outlined; case histories are used to illustrate the workings of the model. A study to assess the efficacy of treatment was performed on 27 female and three male adult patients. Results indicated that patients achieved an 87% recovery rate at discharge with an 83% success rate six months after discharge. A control study was undertaken using 16 female and three male adults to establish indications for TMJ occlusal splint therapy in patients who present with questionable TM dysfunction. The multidisciplinary model presented in this article provides a system of patient evaluation and treatment that can be easily adopted by clinicians involved in a team approach to TMJ and cervical spine dysfunction.

Adult↗
PubMed1993

Pressurized infusion of sodium hyaluronate for closed lock of the temporomandibular joint. Part I: A case study.

Patients with temporomandibular joint disorders (TMD) report a myriad of problems including headaches, facial pain, limited mouth opening capacity, and clicking and/or grating sounds from the temporomandibular joints. Although conservative therapy with an occlusal splint can bring relief for many of these patients, a small number of subjects must be treated by means of surgical procedures. Direct injections of either air or fluids (saline, local anesthetic, corticosteroid, hyaluronate) into the superior and/or inferior temporomandibular joint (TMJ) cavities have gained popularity. The injection of a local anesthetic and hyaluronic acid can provide relief for patients with persistent, painful nontranslatory closed-lock conditions of the TMJs. As documented through objective electronic and computer-enhanced measurements, this case report describes the effect of sodium hyaluronate on a closed lock condition of the TMJ. This case report explains the methodology employed for a larger group of closed lock patients treated and monitored for over one year. The results of that larger group will be reported at a later time after long-term efficacy is confirmed.

Adult↗