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PubMed1995

The temporal/masseter co-contraction: an electromyographic and clinical evaluation of short-term stabilization splint therapy in myogenous CMD patients.

The short-term effect (3-6 weeks) of the use of a stabilization splint was investigated in a group of 35 myogenous craniomandibular disorder patients. The patients were clinically examined and surface EMG recordings of the temporal and masseter muscles were made during clenching in the intercuspal position (ICP), immediately after the insertion of the splint (SSP), and after at least 3 weeks of splint treatment (SSP 3). With the use of the error variance of the activity index changes in EMG activity were investigated. Three groups of patients were then recognized. One group showed a decrease in temporal muscle activity during splint treatment. Another group did not show any significant change during splint treatment. The third group showed an increase of temporal muscle activity. In general, significant reductions in the amount of static pain were found. In the group with a significant reduction of temporal muscle activity (n = 15) there was a greater decrease in the amount of static pain (P < 0.05) than in the group (n = 4) with a significant increase of temporal muscle activity. The results may indicate that the temporal muscle plays an important role in the perception of static pain in the masticatory system.

Adolescent↗
PubMed2005

Stabilization splint therapy for the treatment of temporomandibular myofascial pain: a systematic review.

The aim of this review is to establish the effectiveness of stabilization splint (SS) therapy in reducing symptoms in patients with myofascial pain. Searching of electronic databases, handsearching of relevant key journals, and screening of reference lists of included studies were undertaken. There was no language restriction, and unpublished research was sought. The selection criteria were randomized controlled trials comparing splint therapy to either no treatment or another active treatment. Data extraction and validity assessment were carried out independently and in duplicate. Studies were grouped according to treatment type. Twenty potentially relevant Randomized Controlled Trials (RCTs) were identified. Only twelve met the inclusion criteria. There is insufficient evidence either for or against the use of stabilization splint therapy over other active interventions for the treatment of temporomandibular myofascial pain. However, it appears that stabilization splint therapy may be beneficial for reducing pain severity at rest and on palpation and depression when compared to no treatment. The authors suggested the need for well conducted RCTs that pay attention to method of allocation, blind outcome assessment, sample size, and duration of follow-up. Various measures were adopted to assess the outcomes of treatment. Standardization of the methods used to measure outcomes of the treatment of myofascial pain should be established in future RCTs.

Acupuncture Therapy↗
PubMed1997

Obstructive sleep apnoea. Part II: Treatment with a customised dental appliance.

The use of dental appliances in the treatment of patients with snoring and obstructive sleep apnoea is an important treatment modality for those patients not severe enough for continuous positive airway pressure (CPAP) or who cannot tolerate this form of treatment. A mandibular advancement splint has been specifically designed to eliminate snoring and obstructive sleep apnoea. The appliance's design parameters included ease of insertion, comfort, and maximum effectiveness. Customised appliances have been designed for dentate, semi-dentate, and edentulous patients. To date, over 100 appliances have been used with a symptomatic improvement in snoring and well-being in over 80 percent of patients. Dental appliances for the treatment of snoring and obstructive sleep apnoea are simple, cost effective, and reversible.

Child↗
PubMed2001

A bibliographical survey of bruxism with special emphasis on non-traditional treatment modalities.

After proposing a common-sense definition of bruxism, this partial review distills its various symptoms and consequences from the literature. That literature suggests that the splint-the most popular treatment modality-falls short in some respects. The research literature is even less sanguine about the efficacy of such other traditional therapies as sound alarms and stress reduction. Given the limited success of traditional approaches, and given, moreover, the high incidence of bruxism and its harmful consequences, clinicians may occasionally be interested in experimenting with non-intrusive, safe, less widely known, treatment modalities. To meet this need, this review-unlike all other reviews of the subject-focuses on such comparatively unpopular or recent approaches.

Bruxism↗
PubMed1998

Evaluation of disk capture with a splint repositioning appliance: clinical and critical assessment with MR imaging.

OBJECTIVE: The purpose of this study was to evaluate disk repositioning clinically and through use of magnetic resonance imaging after the insertion of a disk repositioning appliance. STUDY DESIGN: Seventy-four patients with 82 temporomandibular joints showing middle to late opening movement click and closing movement click near maximum intercuspation were treated with a mandibular full-coverage repositioning splint. These joints were assessed clinically and by means of magnetic resonance imaging for disk recapture. RESULTS: According to clinical assessment, 75.6% (62/82) of the joints were treated successfully; no click was observed from the splinted mandibular position. When compared with the results of magnetic resonance imaging assessment, clinical assessment showed an accuracy rate of 91.5%, although the incidence of the false negatives was high (40%). CONCLUSIONS: The results of this study showed that about 70% of reducing displaced disks were captured with use of the disk repositioning appliance. And it was also suggested that magnetic resonance imaging is helpful to evaluate disk repositioning therapy.

Adolescent↗
PubMed1995

A modified extraoral technique of mandibular manipulation in disk displacement without reduction.

A main reason for failure when manipulating a mandible in disk displacement without reduction is a lack of coordination, because of a sudden resistance on the patient's part when fingers are placed in his mouth. This work describes a new extraoral manipulation technique that avoids this problem. Basically, this technique involves three stages. In stage one, the patient performs rhythmic left and right sideways movements unassisted; in stage two, gentle finger pressure is applied by the clinician on the external aspect of the mandible in the same direction as the patient's movements; and in stage three, the mandible is forcefully pulled towards the non-lesion side in strict concomitance with the mandibular movement of the patient towards the same side (Figure 1). Usually a splint is then placed intra-orally for three-to-five months, and physical therapy and exercises are prescribed as needed. The technique described improves the rate of success in the management of permanently displaced disks, so that indication for surgery may drop to close to zero. The chronicity of the lesion does not seem to be an exclusion criteria, provided the lesion still has the characteristics of a disk displacement with reduction and no pseudodisk or degeneration has arisen. Treatment success is confirmed by the improvement of free mandibular and masticatory movements and by the absence of pain.

Chronic Disease↗
PubMed2005

The use of a removable appliance to relieve symptoms of burning lower lip in a dentate patient.

UNLABELLED: The treatment of burning mouth Syndrome, in all its forms, is a challenge to the management of some older patients. The multi-factorial aetiology of this problem requires careful diagnosis and treatment planning to address the major aetiological factors for a given individual. This case report describes the treatment given to an elderly dentate female patient, whose main symptom was intense burning of her lower lip. The patient was aware of tooth clenching and various splints had been provided in the past, with limited improvement in symptoms. A simple removable appliance to prevent trapping of the soft tissues of the lower lip was provided, which produced a rapid and sustained reduction in symptoms. CLINICAL RELEVANCE: Solutions to some common, yet distressing, problems may well be appropriate for use in the Primary Dental Care setting. This solution to the problem of burning lower lip, may be useful for other patients with similar symptoms. It may be adapted for different clinical situations and is relatively non-invasive and reversible.

Aged↗
PubMed1996

The reporting of pain, somatic complaints, and anxiety in a group of patients with TMD before and 2 years after treatment: sex differences.

The aim of this study was to assess possible gender differences regarding the reporting of pain, somatic complaints, and anxiety in a group of patients suffering from temporomandibular disorders (TMD). The group consisted of 40 females and 13 males who received conservative TMD treatment comprising counseling, muscle exercises, and a stabilization splint. Before and 2 years after treatment, the patients answered three questionnaires (McGill Pain Questionnaire [Norwegian version] including a six-point scale, the Present Pain Intensity; a Somatic Complaints Questionnaire; and the trait part of Spielberger's State-Trait Anxiety Inventory. Before treatment, females reported greater present pain intensity than did males. Two years after treatment, females reported less sensory and emotional pain than at the initial stage; males presented no reduction in these pain scores. There were no gender differences at either stage regarding somatic complaints or anxiety level scores.

Adult↗
PubMed1996

The relationship between jaw posture and muscular strength in sports dentistry: a reappraisal.

From the late 1970s until the early 1990s, there have been several reports of improved appendage muscle strength and athletic performance. Much of the criticism of using a mouthguard alone or in conjunction with a splint, such as a mandibular orthopedic repositioning appliance (MORA), to enhance athletic performance has been aimed at study designs, controls, periods of time, double blindness, and the placebo effect. Although it would appear that designing a study which pleases both clinician and researcher would be a difficult task, studies have been performed that do meet the "gold standard." The results favor the premise that jaw repositioning can enhance appendage muscular strength and athletic performance. Studies performed during the mid-1980s, and to which the scientific community refers to continually, on closer examination are flawed.

Bite Force↗
PubMed2003

Effect of oral appliance therapy on upper airway collapsibility in obstructive sleep apnea.

Oral appliance therapy is emerging as an alternative to continuous positive airway pressure for the treatment of obstructive sleep apnea (OSA). However, its precise mechanisms of action are yet to be defined. We examined the effect of a mandibular advancement splint (MAS) on upper airway collapsibility during sleep in OSA. Ten patients with proven OSA had a custom-made MAS incrementally adjusted during an acclimatization period until the maximum comfortable limit of mandibular advancement was reached. Polysomnography with the splint was then performed. After a 1-week washout period, upper airway closing pressures during sleep (with and without MAS) were determined. Significant improvements with MAS therapy were seen in the apnea/hypopnea index (25.0 +/- 3.1 vs. 13.2 +/- 4.5/hour, p < 0.03) and upper airway closing pressure in Stage 2 sleep (-1.6 +/- 0.4 vs. -3.9 +/- 0.6 cm H2O, p < 0.01) and in slow wave sleep (-2.5 +/- 0.7 vs. -4.7 +/- 0.6 cm H2O, p < 0.02) compared with no therapy. These preliminary data indicate that MAS therapy is associated with improved upper airway collapsibility during sleep. The mediators of this effect remain to be determined.

Adult↗
PubMed1995

Relationship of muscular strength to jaw posture in sports dentistry.

From the late 1970s until the early 1990s there have been several reports of improved appendage muscle strength and athletic performance. Much of the criticism of using a mouthguard alone or in conjunction with a splint, such as a mandibular orthopedic repositioning appliance (MORA), to enhance athletic performance has been aimed at study designs, controls, periods of time, double blindness and the placebo effect. Although it would appear that designing a study that would please both clinician and researcher would be a difficult task, studies have been performed that do meet the "gold standard"; and the results favor the premise that jaw repositioning can enhance appendage muscular strength and athletic performance. Previous studies performed in the mid-1980s, and to which the scientific community refers to continually, on closer examination are flawed.

Dentistry↗
PubMed1999

Elastic retracted oral appliance to treat sleep apnea in mentally impaired patients and patients with neuromuscular disabilities.

STATEMENT OF PROBLEM: Various oral appliances have been successfully used in the treatment of sleep apnea. However, it is difficult for mentally impaired patients and patients with neuromuscular disabilities to insert and remove the appliance and to maintain it intraorally through the night. PURPOSE: This study described the fabrication of an elastic retracted-type oral appliance to treat sleep apnea in mentally impaired patients and patients with neuromuscular disabilities and to evaluate its efficiency. MATERIAL AND METHODS: Five patients, 3 with cerebral palsy and 2 with Down's syndrome, with sleep apnea were included in this study. Maxillary and mandibular splints were molded individually on casts by using copolyester foils. The splints were retracted forward by elastics, attached to wire hooks in the maxillary and mandibular incisal areas. The effect of the appliance was examined polysomnographically. RESULTS: The apnea index was decreased significantly (P <.03) by the appliance. The appliance was easily inserted and removed, and the elastic force and mandibular position could be adjusted. The appliance, as used in this study, allowed free mandibular movement and maintained its correct position during sleep despite involuntary or voluntary mandibular movements. CONCLUSIONS: The oral appliance was useful as an alternative to relieve the sleep apnea of patients with mental deficiencies and neuromuscular disabilities.

Adolescent↗
PubMed2002

The incidence of reoperation after temporomandibular joint arthroscopic surgery: a retrospective study of 450 consecutive joints.

PURPOSE: The purpose of this study was to investigate the incidence of reoperation after temporomandibular joint arthroscopic surgery in 315 consecutive patients (488 joints). STUDY DESIGN: The clinical data and operative reports of all patients who underwent arthroscopic procedures from 1995 to 2000 were reviewed retrospectively. Patients had a preoperative clinical and panoramic radiographic evaluation. Most of the patients had disk displacement without reduction. In the remaining patients, the intra-articular pathologic conditions ranged from disk displacement with reduction to degenerative joint disease. The outcome assessment was based on reduction in pain, improvement in vertical dimension of mouth opening, and mandibular excursions. The same surgical team performed all arthroscopic procedures. Before surgery, all patients received at least 3 to 6 months of nonsurgical therapy consisting of anti-inflammatory medications, muscle relaxants, splint therapy, physiotherapy, exercise, moist heat, cold laser, ultrasound, and soft diet or a combination thereof. Patients were monitored postoperatively for as long as 5 years. RESULTS: Results showed that approximately 20% of those patients who had temporomandibular joint arthroscopic surgery underwent further temporomandibular joint procedures ranging from repeat arthroscopic surgery to open-joint arthrotomy. CONCLUSION: Temporomandibular joint surgical arthroscopy is an appropriate therapeutic modality for patients with temporomandibular joint internal derangements, with reoperation required for only 20% of patients.

Adolescent↗
PubMed1994

Craniomandibular dysfunction: patient characteristics related to treatment outcome.

In a previous study it was concluded that only a few changes in symptoms related to craniomandibular dysfunction (CMD) could be attributed to therapy. It was suggested that psychosocial and socio-demographic variables, as well as symptom characteristics, could be responsible for the unconvincing treatment outcome in patients treated with a splint. The present study was performed to investigate whether socio-demographic characteristics, symptom characteristics and various psychosocial variables are associated with treatment outcome in patients with CMD treated with a splint. Treatment outcome was determined by using self-reported follow-up data. Results showed that patients with a negative treatment outcome were older, reported more and more severe symptoms and correlates of CMD, reported fewer stressors and more frequently considered health to be determined by external factors than patients who were treated successfully. The two groups could not be differentiated with regard to anxiety and depression. Results are interpreted with regard to the prediction of treatment outcome.

Adult↗
PubMed2001

A study of factors for successful splint capture of anteriorly displaced temporomandibular joint disc with disc repositioning appliance.

The purpose of this study was to analyse the factors which influenced the success of disc recapture by the insertion of a disc repositioning appliance. Fifty-one joints with joint clicking that occurred at both middle to late opening and late closing (near maximum cuspation) of the mandible were splinted with a mandibular full-coverage repositioning appliance. The clinical and MR findings were compared between the joints with successful and unsuccessful splint disc capture. Thirty-two clicking joints with reducibly displaced discs (DDWR) had successful disc recapture, while six of 19 joints with displaced disc without reduction (DDWOR). Unsuccessful joints with DDWOR had significantly higher prevalence of deformed disc and joint effusion, higher VAS quantitative pain score, and severe disc displacement especially in medial part of the joint (P < 0.05). From the results of this study joints with DDWR can be expected to have successful disc recapture with the insertion of the appliance. In joints with DDWOR, presence of inflammatory conditions, changed disc morphology and extensive disc displacement in medial part of the joint are negative factors.

Adolescent↗
PubMed1999

A clinical study of specific signs and symptoms of CMD in bruxers classified by the degree of severity.

Two hundred and seventy-six CMD patients referred consecutively for diagnosis and treatment over a period of four years were assessed. Two hundred and eleven were classified as bruxers according to the use of a questionnaire and clinical examination. One hundred (47.39%) presented clinical characteristics of mild bruxers, 66 (31.27%) presented moderate bruxism and 45 (21.32%) demonstrated severe bruxism. Severe bruxers presented the lowest degree of jaw opening (39.21 mm) and highest prevalence of capsulitis (97.77%), retrodiskal pain (84.44%) and disk-attachment pain (48.88%). As compared to the mild and moderate groups, severe bruxers also demonstrated significantly higher prevalence of protective splinting and transient locking or recent history of intermittent locking, masticatory pain, reciprocal clicking and signs and symptoms of Myofascial Pain Dysfunction Syndrome (MPDS). Because higher prevalence of specific muscle and joint disorders were observed in bruxers and such prevalence was progressive from the mild to the moderate and severe group, it may be concluded that bruxing behavior is a significant factor in the etiology and progression of muscle and joint disorders. Based on the review of the literature, the analysis of our data in comparison to other studies allowed us to conclude that severe bruxers are more impaired by muscular and joint disorders as compared to mild and moderate bruxers.

Adolescent↗
PubMed1993

The acrylic-splint Herbst appliance: a cephalometric evaluation.

The purpose of this study was to investigate the skeletal and dental effects of the removable acrylic-splint Herbst appliance cephalometrically. Radiographs of 46 patients were collected, traced, digitized, and analyzed. Cephalometric measurements indicated that the treatment group was Class II before treatment and Class I after treatment, with no change in the vertical skeletal pattern. There was significantly more mandibular growth (Co-Gn) than in an untreated Class II control sample (P < or = 0.001), and less forward maxillary growth (nasion perpendicular to A) (P < 0.05). Molar correction was obtained by 21% more skeletal change and overjet correction by 25% more skeletal change than reported for the banded Herbst. Patients with higher mandibular plane angles had greater correction of Class II indicators than did patients with low angles. There was no significant change in the sagittal position of the condyle.

Adolescent↗
PubMed1996

Long-term results in patients with disk displacement without reduction treated conservatively.

Sixty-eight patients (seven men, 61 women) treated for disk displacement without reduction with extraoral mandibular manipulation followed by splint insertion, physical and drug treatment as needed, were re-examined at the end of treatment and after a subsequent period, ranging from 18 to 147 months. Two parameters were considered: 1. degree of spontaneous mandibular opening; and 2. presence of pain (score 1-4). Mean opening was 28.78 mm before treatment, 42.85 mm after treatment and 43.5 mm at long-term (P < .001 after paired T-test and one-way ANOVA). Mean pain level dropped from 2.91 before treatment to 1.22 after treatment and 1.38 at long-term (P < .001 after Friedman non-parametric test). It was concluded, that in the majority of cases, disk displacement without reduction can successfully be treated by conservative means.

Adolescent↗