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PubMed2002

Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring.

The aim of the study was to evaluate the influence of a mandibular protruding device (MPD) after 2 years of nocturnal use on the upper airway and its surrounding structures. Lateral cephalograms in the upright position were taken of patients with obstructive sleep apnea (OSA) and of patients with snoring problems at the beginning of treatment and at the 2-year follow-up. Two computer programs were used to analyze the cephalograms. A total of 65 patients, 44 with OSA and 21 snorers, were analyzed. The linear distances in the pharynx had increased significantly at the 2-year follow-up; the calculated pharyngeal area had increased on average by 9% (mean, +58.3 mm(2)). The velum area had decreased (mean, -31.5 mm(2)), which accounts for about half the increase in the relative area of the pharynx. The average linear distances between the hyoid bone and the 2 reference lines, ie, nasal line (NL) and mandibular line (ML), had increased significantly. Mandibular protrusion (SNB) was slightly reduced, on average -0.4 degrees (P <.01), and the lower incisors were proclined (ILi/ML), on average +1.5 degrees (P <.05). In conclusion, nocturnal use of an MPD for 2 years increased the airway passage because of an increase in the relative area of the pharynx by a mean of 9% in OSA patients and snorers. A mandibular posterior rotation and a proclination of the lower incisors were observed but considered modest.

Adult↗
PubMed2002

Hypnorelaxation as treatment for myofascial pain disorder: a comparative study.

BACKGROUND: Hypnorelaxation has a potentially beneficial effect in the treatment of masticatory myofascial pain disorders (MPD). However, there are no data regarding the efficacy of hypnorelaxation in the treatment of MPD compared with other accepted modes of treatment (such as occlusal appliance) or with the mere effect of time. OBJECTIVE AND SUBJECTS: The purpose of the present study was to evaluate the effectiveness of hypnorelaxation in the treatment of MPD compared with the use of occlusal appliance and/or to minimal treatment. The study population consisted of 40 female patients with myofascial pain who were allocated to 1 of 3 possible treatment groups: (1) hypnorelaxation (n = 15), (2) occlusal appliance (n = 15), and (3) minimal treatment group (n = 10). RESULTS: Both active treatment modes (hypnorelaxation and occlusal appliance) were more effective than minimal treatment regarding alleviating muscular sensitivity to palpation. However, only hypnorelaxation (but not occlusal appliance) was significantly more effective than minimal treatment with regard to the patient's subjective report of pain on the Visual Analog Scale. CONCLUSION: Hypnorelaxation is an effective mode of treatment in MPD, especially with regard to some of the subjective pain parameters.

Adolescent↗
PubMed2002

Ten-year outcome of nonsurgical treatment for the internal derangement of the temporomandibular joint with closed lock.

OBJECTIVE: The objective of this study was to assess long-term 10-year results in comparison with the short-term outcomes of nonsurgical treatment for the internal derangement of the temporomandibular joint (TMJ) with closed lock. PATIENTS AND METHODS: The survey was conducted on 56 patients, 50 of whom responded. The age at first examination ranged from 13 to 75 years (mean, 33.2 years), and the pretreatment jaw opening was 30.3 mm on average. The short-term clinical outcome of nonsurgical treatment for 56 patients consisted of 42 successful and 14 unsuccessful cases. The mean follow-up period was 9 years and 10 months. All patients rated their pain level on a visual analog scale (VAS) and filled out a pain, jaw-dysfunction, and activities-of-daily-limiting (ADL) questionnaire before and at time of the survey. Jaw opening was also self-assessed. Pretreatment and post-treatment scores were compared and statistically tested, and the treatment outcome was judged according to our success criteria. The patients were also asked for a global rating of the subjective outcome at the survey. Last, long-term outcomes were compared with short-term clinical outcomes. RESULTS: VAS was significantly reduced from 4.91 to 0.17 (P <.01). Pain, dysfunction, and ADL scores also decreased from 5.89 to 1.07, from 5.34 to 2.0, and from 5.55 to 1.36, respectively (P <.01). Jaw opening also improved. Consequently, 40 patients were assessed as excellent, 10 patients as good, and none as poor. The overall success rate was 89.3% when the 6 nonrespondents were included. The patients' self-rated outcome showed that 31 patients rated good, 10 patients rated neither, and 9 patients did not rate, but none replied not good. Finally, the short-term clinical outcomes did not relate to the long-term outcomes. CONCLUSIONS: The long-term (10-year) outcomes of nonsurgical treatment for TMJ internal derangement with closed lock were considered to be acceptable and stable when compared with those of other treatment modalities. Short-term results had little effect on the long-term outcomes.

Activities of Daily Living↗
PubMed2001

A vibratory stimulation-based inhibition system for nocturnal bruxism: a clinical report.

For the single subject tested to date, the bruxism-contingent vibratory-feedback system for occlusal appliances effectively inhibited bruxism without inducing substantial sleep disturbance. Whether the reduction in bruxism would continue if the device no longer provided feedback and whether the force levels applied are optimal to induce suppression remain to be determined.

Adult↗
PubMed2001

An evidence-based assessment of occlusal adjustment as a treatment for temporomandibular disorders.

STATEMENT OF PROBLEM: Occlusal adjustment therapy has been advocated as a treatment modality for temporomandibular disorders. In contrast to this position, a panel at the 1996 National Institute of Health technology assessment conference on TMD indicated that no clinical trials demonstrate that occlusal adjustment is superior to noninvasive therapies. PURPOSE: This article summarizes the published experimental studies on occlusal adjustments and temporomandibular disorders. MATERIAL AND METHODS: Eleven research experiments involving 413 subjects with either bruxism (n = 59), temporomandibular disorders (n = 219), headaches and temporomandibular disorders (n = 91), or chronic cervical pain (n = 40) were selected for critical review from the English dental literature. RESULTS: Three experiments evaluated the relationship between occlusal adjustment and bruxism. Six experiments evaluated occlusal adjustment therapy as a treatment for patients with primary temporomandibular disorders. One experiment looked at occlusal adjustment effect on headache/temporomandibular disorder symptoms; another looked at its effect on chronic neck pain. Most of these experiments used a mock adjustment or a comparison treatment as the control condition in adults who had an existing nonacute general temporomandibular disorder. Overall, the data from these experiments did not demonstrate elevated therapeutic efficacy for occlusal adjustment over the control or the contrasting therapy. CONCLUSION: The experimental evidence reviewed was neither convincing nor powerful enough to support the performance of occlusal therapy as a general method for treating a nonacute temporomandibular disorder, bruxism, or headache.

Adult↗
PubMed2001

A piezoelectric film-based intrasplint detection method for bruxism.

STATEMENT OF PROBLEM: An accurate, easy-to-use, long-term method other than EMG is needed to monitor bruxism. PURPOSE: This article presents pilot data on the reproducibility, validity, and utility of an intrasplint piezoelectric film method. MATERIAL AND METHODS: Simulated bruxism behaviors (steady-state and rhythmic clenching, grinding, and tapping) in 5 subjects were recorded with the use of both masseter EMG and an intrasplint piezoelectric film method. RESULTS: Correlation coefficients calculated for simulated bruxism event duration with the use of a masseter EMG or an intrasplint piezoelectric film method were 0.99 for tapping and steady-state clenching, 0.96 for rhythmic clenching, and 0.79 for grinding. CONCLUSION: Piezoelectric film has its limitations and does not faithfully capture sustained force magnitudes. However, for the target behaviors associated with bruxism (tooth grinding, clenching, and tapping), it appears to faithfully reproduce above-baseline events with durations statistically indistinguishable from those recorded with masseter EMG. Masseter EMG was poorest at detecting a simulated side-to-side grinding behavior.

Adult↗
PubMed2002

Oral device therapy for the upper airway resistance syndrome patient.

STATEMENT OF PROBLEM: Upper airway resistance syndrome (UARS) is characterized by repeated increases in resistance to airflow within the upper airway; this resistance results in arousal from sleep and excessive daytime sleepiness. There is no safe and efficacious therapy with good compliance for UARS. PURPOSE: The effects of an anterior mandibular positioning device on respiratory function and sleep quality were evaluated polysomnographically in patients with UARS. MATERIAL AND METHODS: Thirty-two patients (15 women, 17 men; mean age 38.4 +/- 6.4 years) were diagnosed with UARS based on a combination of clinical complaints. To be included in the study, all subjects had to demonstrate a score of <5 on the apnea-hypopnea index, a score of >10 on the Epworth sleepiness scale, and a score of >10 on an arousal index. An oral device was fabricated for each subject with copolyester foil and autopolymerizing resin. Subjects were scheduled for 2 separate overnight sleep stays, one before treatment with the oral device and one after a habituation period of 14 to 60 days. Respiratory function and sleep quality variables were recorded and compared before and after insertion of the device with the paired t test (P >.01) RESULTS: Patient scores on the Epworth sleepiness scale (P<.0001), multiple sleep latency test (P<.0005), and arousal index (P<.0001) and recorded values for minimal oxygen saturation (P<.005) and sleep efficiency (P<.005) improved significantly after insertion of the device. No major side effects were noted with use of the oral device. CONCLUSION: Within the limitations of this study, the results suggest that an oral device may be an attractive initial treatment for UARS.

Adult↗
PubMed2002

Planning restorative treatment for patients with severe Class II malocclusions.

This article describes a clinical protocol for the occlusal rehabilitation of patients with severe Angle skeletal Class II malocclusions. Within this protocol, an occlusal device is used for 2 purposes: first, to locate the most suitable maxillary-mandibular relationship for function and range of motion at an established vertical dimension of occlusion; and second, to accurately transfer this relationship to an articulator for fabrication of provisional and definitive restorations. The theory behind this protocol and its associated clinical procedures is presented along with a discussion of the protocol's advantages and disadvantages.

Centric Relation↗
PubMed2003

Treatment of temporomandibular disorders among adolescents: a comparison between occlusal appliance, relaxation training, and brief information.

In a randomized trial the effects of occlusal appliance and relaxation therapy, each combined with brief information, were compared with brief information only, in adolescents with temporomandibular disorder (TMD) pain. One-hundred-and-twenty-two adolescents (93 F and 29 M aged 12-18 years) were randomly assigned to one of the following 3 groups: brief information + occlusal appliance (BI + OA), brief information + relaxation therapy (BI + RT), or brief information (BI). Included were subjects reporting pain once a week or more often, in addition to receiving a diagnosis of TMD according to the Research Diagnostic Criteria (RDC/TMD). They were evaluated before and after treatment and at a 6-month follow-up by means of self-reports and clinical assessment. The result revealed a significantly higher reduction in frequency of pain, in pain intensity (visual analog scale [VAS]), and in a composite pain index (intensity x frequency) for patients treated with BI + OA compared with those treated with BI alone. In the BI + OA group, 60% of the patients attained a clinically significant improvement (at least 50% or more) on the pain index, a significantly higher proportion compared to that obtained in the other 2 treatment groups. Analgesic consumption was also significantly more reduced in the BI + OA group compared to the BI group. However, no significant differences were found between the treatment groups in jaw opening or in muscle and TMJ tenderness scores. Occlusal appliance was found to be superior to both relaxation therapy and brief information regarding pain reduction and can therefore be recommended when treating adolescents with TMD pain.

Adolescent↗
PubMed2003

Two different degrees of mandibular advancement with a dental appliance in treatment of patients with mild to moderate obstructive sleep apnea.

The objective of this study was to evaluate the effect of 2 different degrees of mandibular advancement, 50% vs. 75% of maximum protrusive capacity, on somnographic variables after 1 year of dental appliance treatment in patients with mild to moderate obstructive sleep apnea (OSA). A further purpose was to compare the number of adverse events on the stomatognathic system. In a prospective study, 74 male patients were randomly allocated to receive a dental appliance with either 50% (38 patients) or 75% mandibular advancement (36 patients). After 1 year of treatment, 55 patients completed the follow-up. Somnography was performed to measure treatment effects before and 12 months post-treatment. The apnea, apnea/hypopnea, and oxygen desaturation indices decreased significantly in both groups after 1 year (P < 0.001); however, there were no differences between the groups. Normalization (apnea index < 5 and apnea/hypopnea index < 10) was observed in 79% in group 50 and in 73% in group 75. Few patients (< 5%) reported symptoms from the stomatognathic system except for headache (> once a week), which was reported in one-third of the patients. Headache was significantly more infrequent after 1 year of treatment in both groups (P < 0.001). No serious complications were observed except for 2 patients who reported a painful condition from the temporomandibular joint in either group. In conclusion, mandibular advancement with a dental appliance effectively reduces the sleep-breathing disorder measured as frequency of apneas, and a pronounced mandibular advancement did not show a greater improvement of the medical problem compared to less advancement for patients with mild to moderate OSA. On the basis of few adverse events in the stomatognathic system or other complications we can recommend dental appliance treatment and, for patients with mild to moderate obstructive sleep apnea, not starting treatment by more than 50% mandibular advancement.

Follow-Up Studies↗
PubMed2004

Patients referred to a specialist clinic because of suspected temporomandibular disorders: a survey of 3194 patients in respect of diagnoses, treatments, and treatment outcome.

The aims were to study the patient population at a temporomandibular disorders (TMD) specialist clinic over time, and to try to find variables of importance for treatment outcome. The material consisted of 3194 consecutive patients who were referred to the clinic and underwent a clinical examination during the period 1995-2002. A number of patient and treatment-related variables that had been collected in an electronic database were analyzed retrospectively. The age and sex distribution of the present patient material was in line with several previous investigations of TMD patients. The mean age of both men and women was 42 years, and there was a large preponderance of women. A vast majority of the patients responded positively, and in few visits, on traditional conservative treatment methods. In line with previous studies, no strong predictors for treatment outcome were found. However, the diagnoses of disk displacement without reduction, arthritis in TMJs, and myalgia in masticatory muscles were predictors for a significant improvement, while the diagnosis orofacial pain of unspecified origin predicted a poorer prognosis.

Adolescent↗
PubMed2004

Treatment outcome of appliance therapy in temporomandibular disorder patients with myofascial pain after 6 and 12 months.

AIM: To compare the long-term effect of treatment with a stabilization appliance (group T) and treatment with a control appliance (group C) in temporomandibular disorder (TMD) patients with myofascial pain. METHODS: In this controlled trial, 60 patients (mean age 29 years) with myofascial pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. All 60 patients were then assigned to 1 of 3 groups according to demand for treatment. Seventeen patients from group C requested another appliance and were given a stabilization appliance, thus creating a mixed group (group M). RESULTS: A significant difference in improvement of overall subjective symptoms in an intent-to-treat analysis between groups T and C was found at the follow-ups. In a survival analysis of treatment compliance, a significant difference was found between groups T and C. At the 6- and 12-month follow-ups, a significant reduction in myofascial pain, as measured on a visual analog scale, was found in all three groups. A significant decrease in frequency and intensity of myofascial pain was found in group T at the follow-ups. A significant decrease in number of tender sites on the masticatory muscles was found in group T at the follow-ups. CONCLUSION: The results support the conclusion that the positive treatment outcome obtained by use of a stabilization appliance to alleviate the signs and symptoms in patients with myofascial pain persisted after 6 and 12 months. Most patients in groups T and M reported positive changes in overall subjective symptoms in this trial. We therefore recommend use of the stabilization appliance in the treatment of TMD patients with myofascial pain.

Adult↗
PubMed2006

Long-term effect on tinnitus by treatment of temporomandibular disorders: a two-year follow-up by questionnaire.

OBJECTIVE: The aim of the study was to investigate the presence of symptoms and signs of temporomandibular disorders (TMD) in patients with tinnitus and to evaluate the effect of TMD treatment on tinnitus in a long-term perspective in comparison with a control group of patients on a waiting list. MATERIAL AND METHODS: One-hundred-and-twenty patients with tinnitus were subjected to a clinical examination of the masticatory system and whether they had co-existing TMD to TMD treatment. Ninety-six patients had TMD, most frequently localized myalgia. Seventy-three of these completed the treatment and responded to a questionnaire 2 years later. Fifty patients with tinnitus who were on the waiting list served as a control group. RESULTS: Eighty percent of the patients had signs of TMD, most commonly myofascial pain. Forty-three percent of the patients reported that their tinnitus was improved at the 2-year follow-up, 39% that it was unchanged, and 17% that it was impaired compared to before the treatment. Twelve percent of the subjects in the control group reported that their tinnitus was improved compared to 2 years previously, 32% that it was unchanged, and 56% that it was impaired. The difference between groups was significant (chi(2): p<0.001). CONCLUSION: The results of this study showed that TMD symptoms and signs are frequent in patients with tinnitus and that TMD treatment has a good effect on tinnitus in a long-term perspective, especially in patients with fluctuating tinnitus.

Adolescent↗
PubMed2006

Subjective reactions to intervention with artificial interferences in subjects with and without a history of temporomandibular disorders.

In a previous double-blind randomized controlled study, subjects with a history of temporomandibular disorder (TMD) reacted to artificial interference with more signs of TMD than did subjects with no TMD history. In the present study, we analysed the subjective reactions of these individuals on several symptom scales. Every day during the 2-week follow-up period, the subjects rated the intensity of their symptoms on 9 VAS scales (occlusal discomfort, chewing difficulties, tender teeth, fatigue in the jaws, headache, facial pain, opening difficulty, bruxism, ear symptoms). Subjects with a history of TMD and true interferences reported stronger symptoms than subjects with no TMD history and placebo interferences. The most prominent symptoms were occlusal discomfort and chewing difficulties. The difference in outcome between the groups with and without a TMD history suggests that there are individual differences in vulnerability to occlusal interferences. It is likely that the etiological role of occlusal interferences in TMD has not been correctly addressed in previous studies on artificial interferences.

Adult↗
PubMed1998

Clinical aspects of orthodontic treatment for children with juvenile chronic arthritis.

Growth abnormalities as a consequence of temporomandibular joint arthritis in children with juvenile chronic arthritis are difficult and complicated problems to treat. The diagnosis of the inflammatory condition in the joint is difficult but important to the success of the interceptive treatment. The diagnostic problems, treatment objectives, and treatment suggestions are discussed in this article.

Activator Appliances↗
PubMed1998

Occlusal appliance therapy in patients with temporomandibular disorders. A double-blind controlled study in a short-term perspective.

Stabilization appliances are commonly used in the treatment of temporomandibular disorders (TMD), although the treatment effects are not fully understood. This study evaluated the short-term efficacy of a stabilization appliance in patients with TMD of arthrogeneous origin, using a randomized, controlled, and double-blind design. Sixty patients were assigned to two equally sized groups: a treatment group given a stabilization appliance and a control group given a control appliance. Improvement of overall subjective symptoms was reported in both groups but significantly more often in the treatment group than in the control group (P = 0.006). Frequency of daily or constant pain showed a significant reduction in the treatment group (P = 0.02) compared with the control group. The results of this short-term evaluation showed that both the stabilization appliance and the control appliance had an effect on temporomandibular joint (TMJ) pain. It is improbable that the difference observed between the groups is due to chance alone.

Adolescent↗
PubMed1992

Strength and bite, Part 2: Testing isometric strength using a MORA set to a functional criterion.

The effect on isometric strength of biting on three intraoral devices and habitual occlusion was analyzed. Only subjects who showed a relative weakness to the Isometric Deltoid Press (IDP) when biting as opposed to maintaining the mandible in an unsupported rest position were included in the study. Both in the original 35 subjects and the 23 subjects returning on the second day, performance wearing the appliance set by a functional criterion of peak strength (locking) to the IDP was significantly greater than wearing a placebo appliance and a bite raising appliance that deflected the mandible 1 mm to the left. Strength biting on the appliance set by a functional criterion was significantly greater than all these conditions. Strength biting in habitual trials that were matched with the deflection condition was found to be significantly greater than that biting in the placebo condition. It was concluded that a relationship does exist between bite and isometric strength. Previous speculation about the role of placebo effect was not substantiated by the data gathered in this experiment.

Adolescent↗