A too-polite silence about shoddy science: dynamic strength testing and beyond.
Explore the source record for details and available documents.
Craniomandibular Disorders↗
SEARCH · Search PubMed
Results for “Occlusal Splints”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Conservative and successful treatment of temporomandibular dysfunction in a private rural practice.
This clinical study of 382 patients with temporomandibular dysfunction (TMD) details how successful treatment can be achieved in a rural area without the support and services of specialized TMD clinics. Successful treatment is within the scope of the general dentist, provided the practitioner understands the patient's total problem and treatment options. The study spanned a 10-year period, including follow-up at one, five, and eight-year intervals.
Adolescent↗
Anterior repositioning appliances when used for anterior disk displacement with reduction--a critical review.
Anterior repositioning appliances are commonly used for treating patients with an anterior disk displacement with reduction. The goal is to regain a proper disk to condyle relationship. Several questions immediately arise: Does the absence of joint noise indicate that the disk is properly positioned over the head of the condyle? Does this anterior position promote healing of the ligaments surrounding the disk?; and, is this anterior position merely therapeutic, or should the mandible be kept in this forward position? This review of the literature is intended to explore how anterior repositioning appliances are used in temporomandibular joint dysfunction (TMD) patients. Hopefully, it will answer questions and also raise more questions about our treatment objectives when dealing with dysfunctional patients.
Humans↗
The MRI study as a diagnostic and therapeutic indicator in the non-surgical management of temporomandibular joint disorders: phase I management--a case report.
The dental profession frequently points to occlusion, muscle disorders or psychological stress as principal causes of temporomandibular joint (TMJ) disorders. Diagnosis and management is confusing, and no general consensus exists. Recent advances in magnetic resonance imaging (MRI) have allowed a means of evaluating large numbers of patients for internal derangements in an objective non-invasive fashion. This has unequivocally confirmed prior arthrographic and surgical observation that partial or complete dislocation of the articular disk with condylar compression of sensitive superior posterior joint space neurovascular elements is the principal pathophysiologic mechanism of TMJ disorders. TMJ disorders have been shown to be a general progression of degenerative joint disease characterized by joint space compression with displacement and degeneration of articular hard and soft tissues, most commonly the result of trauma. This article illustrates how the author has combined several different dental and medical diagnostic procedures with clinical therapeutic measures to manage patients to improved function and remission of symptoms by controlling the position of the joint hard structures in an objective fashion.
Adult↗
Treatment of myofascial pain dysfunction syndrome with occlusal therapy to reduce lengthy disclusion time--a recall evaluation.
A recall study of 102 myofascial pain dysfunction syndrome-temporomandibular disorder (MPDS-TMD) patients, treated with disclusion time reduction therapy from 1983 to 1991, was undertaken to determine the long-term results of this treatment on symptom reductions. The patients were asked to fill out a symptom questionnaire which used ordinal number scales to determine their disease status (frequency and intensity of muscular, joint and dysfunctional symptoms; frequency of medication and appliance use) before and after they were treated with disclusion time reduction. The statistical results indicate that discluson time reduction therapy is a highly effective treatment regimen for MPDS and that it has lasting effects on symptom reduction. In addition, the results of this recall study indicate that occlusion, and more specifically, lengthy pretreatment disclusion time, does play a primary role in the symptomatology, and most probably, in the etiology of MPDS and TMD.
Adult↗
Modified functional distraction appliance. An appliance for chronic lock and ankylosis.
Explore the source record for details and available documents.
Ankylosis↗
Recapture of temporomandibular joint disks using anterior repositioning appliances: an MRI study.
Thirty consecutive patients seeking treatment for painful temporomandibular joint (TMJ) disease were enrolled in a prospective study to assess the relationship between the recapture of displaced disks by anterior repositioning appliances (ARA) and the relief of symptoms. After standard clinical workup including assessment of pain, maxillary and mandibular ARAs were constructed that repositioned condyles to the Gelb 4/7 position. Magnetic resonance imaging (MRI) was performed before and immediately after the insertion of ARAs. Initial MRI findings showed 26 joints with reducing disk displacements in 17 patients, seven partially-reducing joints in four patients, 14 nonreducing joints in 11 patients, and 13 normal joints in eight patients. Postinsertion MRI showed recapture of disks in 25 of 26 reducing displacements (96%), but no recapture in partially-reducing or nonreducing joints. All but one of the normal joints remained unchanged. Pain assessment showed significant relief of symptoms in all three categories. The degree of pain relief was significantly greater in recaptured reducing disks than the other categories (p < 0.05). ARA therapy provides effective pain relief regardless of disk status, although a greater degree of relief may be achieved in recaptured reducing internal derangements.
Facial Pain↗
The influence of postoperative treatment on the results of TMJ meniscectomy. Part II: comparison of chewing movement.
In order to evaluate the influence of different types of postoperative treatments on the results of TMJ surgery, chewing movement recorded postoperatively was compared in 32 patients with unilateral total meniscectomy, 42 patients with partial meniscectomy with disk repair, and 10 normal subjects. Postoperative treatment was of three different types depending on its strategy. It was found that postoperative treatment had a significant positive effect on the results of both total and partial meniscectomy. Postoperative treatment which included both physical medicine modalities and dental treatment demonstrated better results than only dental treatment or no postoperative treatment. However, none of these studied techniques could recover chewing movement to the normal range.
Adult↗
MRI study of a physiotherapeutic protocol in anterior disk displacement without reduction.
Disk displacement of the temporomandibular joint (TMJ) without reduction has been considered a fundamental pathophysiologic abnormality of the joint. In this paper there are supportive clinical and MRI evidence of a successful repetitive manipulative technique for the treatment of acute and chronic locking. In 1500 treated cases, documented on videotape, only five cases required surgical intervention. The success of the therapy was confirmed by 13 MRI images of the TMJ of patients with acute and chronic locking before and after therapy. In all cases the anteriorly dislocated disk in closing and opening position was recaptured and repositioned in a normal position in the temporomandibular fossa. Three complete cases are reported with complete clinical and MRI documentation.
Adult↗
A three-dimensional airway assessment for the treatment of snoring and/or sleep apnea with jaw repositioning intraoral appliances: a case study.
The purpose of this snoring/sleep apnea study was to assess the role of 3-D magnetic resonance imaging (MRI) of the airway correlated to jaw reposturing/intraoral appliance design. A clinical case is presented utilizing this technology, integrating a diagnostic baseline and follow-up sleep study/ polysomnograph. The baseline polysomnography, prior to jaw repositioning appliance design, indicated a respiratory disturbance index (RDI) of 21.5 hypopnea/apneas per hour. The follow-up sleep study, with use of an intraoral repositioning appliance, showed a 3.9 per hour RDI, an 82% RDI reduction/improvement. Magnetic resonance TMJ and airway images were done. The MRI enhanced airway assessment computer software program analyzed the 3-dimensional volume and cross sectional area changes from hard/soft palate junction to epiglottis. Imaged were the oropharynx nasopharynx and hypopharynx regional anatomy. The baseline, without mandibular positioning device, showed a total airway volume of 5,801.31 cubic mm, whereas with the mandibular positioning device in place, the total airway volume was increased to 8,657.22 cubic mm or a total increased volume of 32%. The largest improvement site in the airway was the mid-soft palatal uvula/nasopharynx region, with base of tongue moving forward. Along with traditional polysomnography, 3-dimensional MRI airway imaging should be considered as a diagnostic procedure in assessing sleep apnea patients. The necessity of a combined medical/dental team approach is emphasized.
Adult↗
Intraoral appliances in management of temporomandibular disorders, revised.
Explore the source record for details and available documents.
Decision Making↗
Effect of increased maxillo-mandibular relationship on isometric strength in TMD patients with loss of vertical dimension of occlusion.
The effect on isometric strength of the shoulders and limbs while biting in habitual occlusion, on a bite-elevating appliance and on a placebo appliance was analyzed. Twenty female volunteer patients, presenting with temporomandibular pain dysfunction syndrome and obvious loss of vertical dimension, served as subjects. All were weaker to the manual application of the isometric Deltoid Press (IDP) when biting, as opposed to maintaining the mandible in an unsupported rest position. Two intraoral appliances were fabricated for each subject: a bite-elevating appliance (BEA) set by a functional criterion of peak strength to the IDP and a placebo appliance which did not interfere with occlusion but was "set" with a mock IDP procedure. Testing was carried out by the Neuromuscular Research Testing Laboratory of the Neurology Department of Tufts New England Medical Center. Testing was independent of the dentist who fabricated and set the appliances. A standard neuromuscular test with the Maximal Voluntary Isometric Contraction apparatus was used to assess strength of right and left shoulder, elbow and knee flexion and extension as is routinely performed with all neuromuscular disease patients. Twelve strength tests were carried out for each of three conditions: 1. Baseline-biting in habitual occlusion; 2. Elevated-biting on the BEA; and 3. Placebo-biting with the placebo appliance inserted. The order of conditions 2 and 3 was counterbalanced without knowledge of the subjects. Twelve repeated measures ANOVAs (each subject as their own control) were conducted for each of the 12 strength measures. All F-tests indicated a significant main effect for treatment differences (p < 0.0001). Mean strength biting on the BEA was consistantly greater (p < 0.001) than Baseline or Placebo strength. Baseline and Placebo condition were equivalent. These findings confirmed previous observations at this TMD Center: individuals with loss of vertical dimension of occlusion respond to a bite raising appliance by increased isometric-strength.
Analysis of Variance↗
Anterior mandibular repositioning in a patient with temporomandibular disorders: a clinical and tomographic follow-up case report.
A 42 year old female with temporomandibular disorders (TMD) was treated by anterior mandibular repositioning which was followed-up clinically and tomographically. The authors tomographically reconfirmed the mandibular repositioning and discovered a type of condyle remodeling which they had not seen previously. Although clinical signs and symptoms of TMD were removed and the condyle was centered tomographically by the anterior repositioning, the MRI image indicated the disk was displaced anteriorly and laterally. The results suggest that image analysis of temporomandibular joint (TMJ) is beneficial and careful application of the treatment for anterior repositioning is recommended.
Adult↗
Cluster-like signs and symptoms respond to myofascial/craniomandibular treatment: a report of two cases.
Two cases with pain profiles characteristic of cluster-like headache, both within and outside the trigeminal system, are reported. One male patient would typically awaken from sleep with severe unilateral temporal head pain and autonomic signs of ipsilateral lacrimation and nasal congestion. A female patient exhibited severe unilateral boring temporal and suboccipital head pain with associated ipsilateral lacrimation and rhinorrhea. In addition, both patients presented with signs and symptoms of masticatory and/or cervical disorders. These two cases illustrate possible treatment alternatives, as well as possible influences from cervical and masticatory structures in the development of cluster or cluster-like headache.
Cluster Headache↗
Mandibular repositioning can be effective in treatment of reducing TMJ disk displacement. A long-term clinical and MR imaging follow-up.
In order to evaluate the long term clinical and morphologic results of recapture of a displaced TMJ disk, we recalled for follow-up MR imaging 75 patients who had been treated by attempted disk recapture based on pre-treatment MR imaging 1-6 years earlier. The treatment included a day appliance with inclines to guide the mandible into the therapeutic position and a telescopic night appliance which prevented retrusion of the mandible during sleep. Appliance treatment was followed by rebuilding or resurfacing the posterior teeth of one arch to permanently support the mandible in the therapeutic position. After treatment of 115 joints with displaced disks, 52% of the disks were normally positioned, 23% were improved in position, and 25% showed persistent disk displacement. Symptom relief was 92% in patients with normalized (recaptured) disks, 84% in patients with improved disk position, and 49% in patients with persistent disk displacement. Failure to improve disk position occurred in 7% of the joints with anterior disk displacement and in 44% of the joints with a transverse (sideways) component to the displacement. Forty-five percent of the recaptured-disks improved in contour. We concluded that anterior mandibular repositioning was effective in the treatment of patients with reducing displaced disks primarily when the disks were displaced only in an anterior direction. This treatment can be recommended in anterior disk displacements if the patient has failed more conservative treatment measures, permanent occlusal reconstruction can be justified, and the patient understands that long-term use of a night appliance may be necessary. Anterior mandibular repositioning appears much less effective in cases with a transverse component to the disk displacement.
Adolescent↗
The relationship of tinnitus to craniocervical mandibular disorders.
Patients with craniocervical mandibular (TMD) disorders can present with tinnitus as a primary or secondary complaint. The embryology and functional anatomy of the middle ear, temporomandibular joint, muscles of mastication and associated tendons, ligaments, blood vessels, nerves and lymphatics was found to be helpful in establishing etiologic concepts which relate tinnitus to these temporomandibular disorders. In addition to etiologic concepts, treatment modalities are described. The authors relate their experiences as well as those of others with different patient populations.
Female↗
Increase of the vertical occlusal dimension by means of a removable orthodontic appliance and its effect on craniocervical relationships and position of the cervical spine in children.
The aim of this study was to determine the effect of the increase in the occlusal vertical dimension by means of an orthodontic appliance on craniocervical relationships and position of the cervical spine. Thirty children presenting malocclusion were divided into two groups of 15 (a study and a control group). Those in the study group wore an orthodontic appliance to correct cross-bite. The children in the control group had no treatment during the experimental period. Two lateral craniocervical radiographs were taken for each child. The first one was taken in the intercuspal position in both groups. The second radiograph was taken of the study group after four months of wearing the appliance and also of the control group after four months. Cephalometric analysis in the study group showed a significant forward cervical spine position. There were no significant changes in the control group. The changes found in the study group suggest that when there are signs and symptoms of cervical dysfunction in children undergoing long-term orthodontic treatment, it is necessary to make an evaluation of the cervical column position after the insertion of any orthodontic appliance which increases the occlusal vertical dimension.
Case-Control Studies↗
Initial TMJ disk recapture with anterior repositioning appliances and relation to dental history.
Fifty-eight consecutive patients in a referral based practice seeking treatment for complex chronic painful temporomandibular joint (TMJ) disease were enrolled in a prospective study to assess the recapture of displaced disks by anterior repositioning appliances (ARA) and the improvement in disk position in those disks that did not fully recapture. After standard clinical workup, including assessment of pain, maxillary and mandibular ARAs were constructed which repositioned condyles to the Gelb 4/7 position as determined by cephalometrically-corrected linear tomograms. Multi-planar magnetic resonance imaging (MRI) was performed immediately before and after insertion of the mandibular ARA, showing three-dimensional recapture of disks in 85% and improved disk position in 6% of reducing displacements. Disk position was improved in 28% of nonreducing joints, but none were totally recaptured. Recapture or improvement was achieved in 91% of reducing, 28% of nonreducing, and 63% of all joints with internal derangements. Initial disk position, reduction on opening and recapture by ARA were statistically independent of patient age, number of teeth missing, number of third molars missing, malocclusion (Angle's class), overjet, overbite, prosthetic appliances, and previous orthodontic treatment. It was concluded that ARA therapy provided effective recapture of displaced TMJ disks that reduce upon mouth opening. In this population of patients with chronic TMJ pain, previous dental treatment had no statistically significant effect on the incidence of internal derangement or on disk recapture by ARA therapy. There was no evidence of adverse effect from orthodontics, prosthetics, or any other dental care.
Adult↗