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PubMed1995

Condylar condition and mandibular growth during early functional treatment of children with juvenile chronic arthritis.

TMJ involvement in children with Juvenile Chronic Arthritis (JCA) will frequently cause disturbance of the growth of the mandible. Orthodontic treatment of these patients often includes orthognathic surgery, and are complicated to handle with respect to the damaged joint and impaired function. The aim of this presentation is to suggest an early treatment with a functional splint appliance, a distraction splint, with the purpose of increasing function of the joint and ensuring continuous growth of the mandible.

Arthritis, Juvenile↗
PubMed2005

Condylar resorption during active orthodontic treatment and subsequent therapy: report of a special case dealing with iatrogenic TMD possibly related to orthodontic treatment.

A 28-year-old female underwent orthodontic treatment for approximately 22 months. During the later stages of this treatment, the patient reported right shoulder and neck-muscle pain. In addition, temporomandibular joint disorder (TMD) with a 'clicking' sound during mastication commenced 5 months prior to treatment completion. Specific medication to deal with these symptoms was suggested by medical specialists, as were some stress-relief methods, although the pain still progressed, and subsequent clinical and radiographical examinations were undertaken by another orthodontist. Right mandibular condylar resorption was observed from both the panorex and temporomandibular joint (TMJ) radiographs. No clinical signs of rheumatic disease were observed, although bruxism was noted. Following the termination of the orthodontic treatment by the second practitioner, the patient was treated with splint therapy 1 month subsequent to which, the previous symptoms of pain in the shoulder and neck, and the clicking sound during mastication had subsided. During the 14-month period of splint therapy and follow-up, new bone growth in the right condyle was observed from radiographs.

Adult↗
PubMed2002

Effect of stabilization-type splints on the asymmetry of masseter muscle sites during maximal clenching.

Patients with temporomandibular disorders may present with a cluster of joint and muscle disorders characterized primarily by pain, joint sounds and irregular or deviating jaw function. Maxillary stabilization-type splints represent the best standard therapy, so the purpose of this study was to evaluate changes in local maximal clenching-related asymmetry patterns of masseter muscle sites associated with the immediate 'application of splint therapy' using the diagnostic approach of high-resolution gray-scale ultrasonography. The study included 24 patients who had signs and symptoms of temporomandibular disorders. Ultrasonographic investigation was performed with a linear (B-scan) 7.5 Mhz small-part transducer to visualize the antero-superior, antero-inferior, medio-superior, medio-inferior, postero-superior, and postero-inferior sites of the masseter muscle. To assess local maximal clenching-related muscle asymmetry patterns and to evaluate the respective effect of occluding splints, the 'absolute asymmetry index' was used, with the mean maximum muscle diameter of the respective right and left sides calculated from three consecutive measurements before and after splint insertion. Comparing the values assessed before splint insertion with those after splint insertion revealed a significant decrease in local maximal clenching-related muscle asymmetry values for the antero-inferior masseter muscle site (P < 0.05). The results of this study suggest stabilization-type splints to have a site-specific effect in the immediate reduction of local maximal clenching-related muscle asymmetries. Further studies are warranted to evaluate muscle-site specific effects in patient and non-patient groups and to relate these effects to pre-treatment variables like bite force, preferred chewing side, facial morphology and occlusion.

Adult↗
PubMed1993

[Electroencephalographic study of bruxers during sleep].

A whole night recording of EEG, EMG and EOG of 7 bruxers during sleep with S-EEG equipment is made. Two of them have been evaluated after splint therapy. After analysing the sleep architecture, sleep progress and sleep index, it is found that: (1) S2 period is shorter, REM period is longer and the REM percentage is higher in comparison with the control group; (2) The total teeth grinding period is 213-691 secs and the frequency is 24-70 times per night, the occurrence of teeth grinding is scattered in different sleep stages; (3) The frequency and period of teeth grinding are decreased significantly after splint therapy; and (4) The occurrence of teeth grinding is a kind of functional disturbance of central nervous system rather than. The aroused response or transfer of sleep stages.

Adult↗
PubMedDate not supplied

The seventh key to facial beauty and TMJ health: proper condylar position. Part 3.

This is the eleventh article in a series of articles on orthodontic diagnosis. Only a proper diagnosis can lead to the correct treatment for an individual patient--leading to a balanced profile, a beautiful smile, and a healthy TMJ. This article is to document the first phase of TMJ treatment in patients who are being treated for TMJ Dysfunction related to posterior and/or superior TMJ displacement, and the change in the mandibular position and dental relationships that almost always occurs with proper treatment. The illusion of a posterior openbite "supposedly created" by the splint has led to much misunderstanding and unhappiness with both patients and family dentists. The real "cause" of this posterior openbite and treatment procedures to correct it will be discussed.

Adult↗
PubMed1996

Treatment of temporomandibular joint dysfunction with a visible light-cured resin overlay denture: a case report.

A woman presented with temporomandibular dysfunction caused by a marked overclosure of her mandible. She complained of pain and clicking noises in her temporomandibular joint. After initial assessment and treatment with a provisional occlusal acrylic resin splint, the patient was provided with a definitive overlay denture with visible light-cured resin as occlusal overlays. The denture was stable in the mouth and the occlusal resin material showed some occlusal wear at the 2-year examination.

Acrylic Resins↗
PubMed1992

The distribution of internal derangement in patients with temporomandibular joint dysfunction--prevalence, diagnosis, and treatments.

This study consisted of 355 patients referred to a surgical practice complaining of facial pain, temporomandibular joint (TMJ) sounds, and limited jaw opening. In 247 patients, 360 TMJs were evaluated by arthrography. While 72.2% of them had internal derangement, the remaining 27.8% had normal arthrograms (NID). Among the patients with internal derangement, meniscal displacement with reduction (MDR) was the largest group (47.3%), followed by meniscal displacement without reduction (MD) (32.3%), meniscal displacement without reduction associated with perforation (MDP) (15.4%), and perforation with normal disk position (P) (5.0%). The NID, MDR, and MD groups showed similar age distributions. The MDP and P groups showed a significantly older mean age. Gender distribution was biased toward females (82.0%). Of the total number of joints, 183 (50.8%) had a history of trauma, 69.9% of which had an internal derangement. In terms of treatment, 100% of the NID group was treated by splint therapy. The MDR group was mostly treated by partial meniscectomy (49.6%) and splint therapy (41.5%). The MD group was mostly treated by total meniscectomy (53.6%) followed by splint therapy (32.1%). The MDP or P groups mostly underwent total meniscectomy (72.5% and 61.5%, respectively).

Adolescent↗
PubMed2006

Silencing the snorers: no gain without pain?

OBJECTIVE: To compare the estimated effects of conservative surgery to those of a mandibular advancement splint (MAS) in the treatment of habitual snoring. METHOD: Prospective, observational, non-randomized cohort study. RESULTS: Adequate follow-up data were available for 88 participants (23 following coblation, 65 after provision of an MAS). The mean reduction in snoring symptoms inventory (SSI) score for the 23 subjects undergoing coblation was 9.83 (+/-standard deviation 11.43). Reported pain duration was greatest with uvula amputation, but uvula coblation did not always adequately reduce its bulk. Of the 65 MAS patients, 39 (60 per cent) used the device regularly, with a mean fall in SSI of 12 (+/-16.4, p=0.001). Approximately one in four patients in both groups achieved a significant fall in SSI (>15 points), and the measured effect sizes were close to 0.75 for both treatments. CONCLUSIONS: Mandibular advancement splints and coblation have similar efficacies. However, their efficacy does not match that of radical surgery.

Humans↗
PubMed2006

Intra-articular and muscle symptoms and subjective relief during TMJ internal derangement treatment with maxillary anterior repositioning splint or SVED and MORA splints: A comparison with untreated control subjects.

Discomfort associated with wearing an intraoral splint represents a problem in the management of temporomandibular joint (TMJ) internal derangement. This study evaluated whether the use of a mandibular splint during the day and a maxillary splint at night could be more comfortable and therefore as efficacious in internal derangement treatment as a maxillary splint (AR splint). Fifty (50) patients (average age 28.8; range 14-63) with confirmed internal derangement in at least one TMJ were divided into three groups: 20 patients treated with AR splint (Group I); 20 patients treated with a SVED (Sagittal Vertical Extrusion Device) and a MORA (Mandibular Anterior Repositioning Splint) (Group II); and 10 patients who underwent no treatment (Control Group). Joint noise, pain intensity and its character (as constant or chewing/biting pain), muscular pain, and subjective relief were evaluated monthly before treatment began (T0) and for six months thereafter. The following results were found: 1. Subjects in Group I and Group II displayed a significant decrease in joint pain (p<0.001), constant pain (p<0.001), chewing/biting pain (p<0.001), joint noise and muscle pain from the beginning through the sixth month follow-ups; 2. At T1 and T2, subjects in Group II reported significantly lower discomfort associated with the devices than subjects in Group I. The use of two splints seems to be as efficacious as the use of an AR maxillary splint; however an AR splint is considered more comfortable by patients, especially during the first months of therapy.

Adolescent↗
PubMedDate not supplied

[Postorthodontic retention with a rigid resin splint].

We have done a clinical review of 30 cases of post-orthodontic retention with resin splint, from canine to canine in both maxillary. We describe the procedure of making the splint, its placement, their incidence or clinical problems (inadequate adhesion, gingivitis...) and the psychologic or subjective patient aspects.

Adolescent↗
PubMed1995

Cephalometric analysis of changes produced by a modified Herbst appliance in the treatment of Class II division 1 malocclusion.

This study investigated treatment changes produced by the Herbst appliance in a sample of severe Class II division 1 cases, over a period of 8 months. The sample consisted of 16 girls, of whom eight were treated by the Herbst appliance, whilst eight served as controls. All cases were matched with respect to age, sex, skeletofacial morphology, and length of treatment/observation period. Twenty-two skeletal and 19 dental parameters were recorded on pre- and post-treatment cephalograms. The net treatment effect of Herbst therapy was evaluated, taking into account the growth that occurred in the control sample. The study revealed that during 8 months of Herbst therapy there was a significant increase in mandibular length, along with sagittal repositioning. The skeletal changes in the mandible were mainly responsible for overjet and molar relation correction. A slight, favourable forward rotation of the mandible was identified. Dentoalveolar features included flaring of lower incisors and distalization of upper molars. The appliance did not have any retrusive effect on the maxilla. The modified splint design differed from the original and was cemented rather than bonded.

Case-Control Studies↗
PubMed2001

Obstructive sleep apnoea: a review of the orofacial implications.

Obstructive sleep apnoea is a complex multifactorial condition produced by a combination of anatomical and physiological factors. There is a significant associated mortality and morbidity to obstructive sleep apnoea. There is an at least 25 per cent increased mortality from cardiovascular disease when obstructive sleep apnoea patients are compared to age and gender matched healthy people. Obstructive sleep apnoea sufferers also have a much higher industrial and motor vehicle accident rate. Management of the condition should be undertaken by a multidisciplinary team including respiratory physicians, sleep laboratory technicians, otorhinolaryngologists, oral and maxillofacial surgeons and dental specialists. The diagnostic and therapeutic interactions of team members are the key to successful treatment. The treatment regime utilises nasal continuous positive airway pressure devices, mandibular advancement splints and soft and hard tissue surgery. This review provides the dental practitioner with an introduction to obstructive sleep apnoea with particular emphasis on the orofacial aspects.

Cephalometry↗
PubMed2003

Is bruxism severity a predictor of oral splint efficacy in patients with myofascial face pain?

Both the efficacy and mechanism of any effect of oral splint therapy for patients with temporomandibular disorders (TMDs) are a matter of controversy. To address these issues, this study tested the hypothesis that oral splints produce the most marked pain relief for those TMD patients with myofascial face pain (MFP) who also brux (i.e. grind or clench) more than other MFP patients. In a 6-week randomized controlled clinical trial, 52 women with MFP were randomly assigned to receive either a full-coverage hard acrylic splint or a palatal-only splint. Bruxism was assessed both by self-report and by an objective assessment of molar microwear changes over a 2-week period prior to the start of the trial. Tested across multiple outcome measures, results indicated that those receiving the full-coverage splint had marginally better improvement on some pain-related measures than those receiving the palatal splint, but severity of bruxism did not moderate the therapeutic effect of the full-coverage splint. These findings strongly argue against the belief that oral splints reduce MFP by reducing bruxism and raise questions about the importance of bruxism in the maintenance of MFP.

Adult↗
PubMed2000

Arthrogryposis multiplex congenita in a patient with limited mouth opening: a case report.

This report describes a case of arthrogryposis multiplex congenita and concomitant bruxism with limited mouth opening and pain in the temporomandibular joints (TMJ). A conservative treatment with a myorelaxing splint and physiotherapeutic exercises was prescribed resulting in improvement to the muscular and joint conditions and a reduction in pain.

Arthrogryposis↗
PubMed1998

Splint therapy for skeletal Class III malocclusion in the primary dentition.

An orthopedic appliance for the correction of skeletal Class III malocclusion in the primary dentition is described. The appliance consists of two resin splints with hooks for Class III elastic intraoral traction. Construction features and biomechanical aspects of the device are described along with the clinical evaluation of treatment effects in two case reports.

Cephalometry↗
PubMed1998

Effect of muscle relaxation splint therapy on the electromyographic activities of masseter and anterior temporalis muscles.

The purpose of this study was to compare the effectiveness of splint therapy on the electromyographic activity of masticatory muscles (anterior temporalis and masseter) before and after the application of a muscle relaxation splint. Electromyography recordings from the masseter and anterior temporalis muscles were analyzed quantitatively during maximal biting in the intercuspal position both before and after treatment without a splint. Fourteen patients whose chief complaint was masticatory muscle pain were selected for the study. After the initial evaluations muscle relaxation splints were applied, and the patients were instructed to use the splints for 6 weeks. Surface electromyographic recordings were taken from each patient before the beginning of clinical therapy and after 6 weeks of wearing the splints. The data obtained were analyzed through paired sample t tests and Wilcoxon's signed rank tests. The results of the study were as follows: (1) the electromyographic activity of the two muscles during maximal biting was not markedly changed after the muscle relaxation splint was used; and (2) the changes observed in electromyographic activity of the involved and noninvolved sides were insignificant as well.

Adult↗