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PubMed1997

Midline mandibular osteotomy: an analysis of functional outcomes.

Although the oncologic validity and perioperative complications of midline mandibular osteotomy are well described, little attention has been directed toward the long-term functional problems that may be associated with its use. Thirty-one patients who had undergone this procedure were examined to assess postoperative sensation, temporomandibular joint (TMJ) function, occlusion, and cosmesis. The majority (27 of 31) patients had some sequelae but these were minor in nature. Twenty of 31 patients had abnormal sensation, 24 of 31 noted a changed occlusion, and 15 of 31 had signs or symptoms of TMJ myofascial pain. Although patients should be advised of the potential for functional problems with this procedure, they can be reassured that these are likely to be relatively minor in significance. If technically feasible and if an exact restoration of occlusion is a priority, a prefabricated lingual splint should be used.

Dental Occlusion↗
PubMed1998

Reflections on the Michigan splint and other intraocclusal devices.

It seems obvious in retrospect that the treatment of disorders by interocclusal devices followed two paths: stabilization splints and functional orthopedic appliances. The dividing line between them is not always clear. Both have some function related to the position of the mandible. They may not differ significantly in their control of occlusal stability (e.g., telescoping devices anchored to stabilization splints). The stabilization splint, as well as other conservative measures, will play an increasing role in accepted therapy for TMD. The use of anterior repositioning devices for TMD, including MPD syndrome, will decrease. Research may provide answers that allow them to be used more specifically and predictably. Perhaps there will be but little change in their use where there is an association of TMD and Class II malocclusion. There will be an increase in the use of interocclusal devices for the treatment of snoring and obstructive apnea. Some additional directions seem to have emerged in the late 1980s and early 1990s: In the absence of pain and significant debilitation, treatment for TMD, if any, is to be reversible. Prevention or aggravation of TMD should be practiced to the extent possible during dental procedures. One long-term, well-designed, prospective study indicated that the incidence and severity of TMD could be reduced by appropriate occlusal adjustment. There is a small, but nevertheless important minority of patients with TMD who progress to persistent pain and/or dysfunction. Initial management of the vast majority of patents with TMD should be use of noninvasive reversible therapies. Surgery is indicated in only a relatively small percentage of cases of TMD. Research on interocclusal devices should not terminate simply because they are in part dental devices (i.e., biomechanical forms of treatment). The diagnosis and treatment of TMD has been called a dilemma, especially for those patients with chronic pain for whom no treatment has been effective. However, it would be ill-advised to abandon what treatment is already known to be effective by allowing those few but psychosocially important patients with chronic pain to determine what should be done for the vast majority of patients with TMD: reversible forms of treatment, including physiotherapy, pharmacologicals, and the stabilization occlusal bite plane splint.

Humans↗
PubMed1975

[Diagnostic-therapeutic aids in the reconstruction of frontal occlusion].

Two methods are recommended as diagnostic-therapeutic means for controlling frontal interlocking: 1. Composite materials for temporary onlays on canines, 2. incorporation of a miniplast splint with individually shaped occlusal surfaces made of cold curing acrylics in cases of isolated interferences in protrusion as well as interferences in both protrusion and lateral movement of the front teeth.

Humans↗
PubMed1993

The effect of the stabilization splint on the TMJ closed lock.

The mandibular manipulation technique and anterior repositioning splint are considered acceptable conservative therapies for an acute temporomandibular joint (TMJ) closed lock. However, an anterior repositioning splint will result in a corresponding change in occlusion, such as posterior open-bite. Furthermore, invasive treatments such as surgery have many complications. This article describes the effect of the stabilization splint with more conservative therapies, including the manipulation technique, wherein the complications are minimal. In this study, the authors used the stabilization splint instead of the anterior repositioning splint. They obtained acceptable results, including the increase of interincisal distance, a decrease in Fricton's craniomandibular index, and a decrease in Helkimo's clinical dysfunction index. Therefore, the treatment method that is composed of a stabilization splint, manipulation, moist heat, and exercise should be considered as the first choice of treatment for TMJ closed lock, as opposed to a repositioning splint.

Adolescent↗
PubMed1995

Interocclusal splint designed to reduce tenderness in lateral pterygoid and other muscles of mastication.

When a patient has discomfort in the muscles of mastication, a palpation test of the lateral pterygoid muscles is positive, and a stress test is positive, the dental occlusion may be a partial cause. The resin splint described here is designed to permit interocclusal contact exclusively at the center of the arches. This device has been shown to reduce tenderness in the lateral pterygoid and other muscles of mastication quickly, usually in 5 to 10 minutes. The splint and its advantages and disadvantages are described.

Contraindications↗
PubMed1992

A preliminary investigation into the effect of increased occlusal vertical dimension on mandibular movement during speech.

Current methods of determining whether a patient will accommodate to an increased occlusal vertical dimension rely on a largely subjective assessment of the mandibular rest position and capacity to adapt whilst wearing a temporary appliance. The purpose of this preliminary study was to establish if mandibular movement during speech may provide an objective criterion in the assessment of adaptation to increases in occlusal vertical dimension. The closest speaking space, measured as the vertical distance between an incisor point and centric occlusion, as determined during pronunciation of sibilant speech sounds was chosen to depict mandibular movement. The closest speaking space was determined using a Sirognathograph for six young adult subjects and varied from a mean of 1.0 to 3.3 mm. An acrylic splint covering the entire occlusal surface of the lower arch, designed to increase the occlusal vertical dimension by 4 mm in the incisor region, was then cemented on each subject's mandibular arch. The closest speaking space was again determined after 5 days continuous wear of the splint and the mean values found to have decreased to a range of 0.0-1.0 mm. The differences between the mean values for the closest speaking space for each subject before and after splint wear were statistically significant. It was postulated that this method may lead towards an objective basis for deciding if patients will adapt to an increase in occlusal vertical dimension.

Adaptation, Physiological↗
PubMed1996

[Occlusion and temporomandibular dysfunction].

The role of occlusion in the etiology of temporomandibular disorders is questionable. Therefore, preventive selective grinding is not advised. In the presence of signs and symptoms of overloading of structures of the masticatory system, grinding can be a therapy of choice. This procedure should be preceded by splint therapy in order to test the occlusal changes.

Dental Occlusion↗
PubMed1981

Increased occlusal vertical dimension in adult monkeys.

Splints which opened the vertical dimensions on all posterior teeth in five rhesus monkeys were studied over a period of 3 to 36 months. Findings were as follows: 1. The increased vertical dimension of occlusion did not have a pathologic effect on the TMJs. 2. The posterior teeth attached to the splint and the teeth opposing the splint were intruded into the alveolar processes. 3. The nonoccluding incisor teeth extruded, but the epithelial attachment remained close to the cementoenamel junction. 4. The vertical dimension as measured between the markers in the bones of the mandible and maxillae gradually returned toward the pretreatment vertical dimension, although complete closure to this position was not accomplished during the time period of the experiment. 5. The relationship between the epithelial attachment and the cementoenamel junction remained undisturbed by the experiment. 6. After completion of growth, there appeared to be a definite tendency for rebound to the normal pretreatment vertical dimension following increase of the vertical dimension. This was recorded by measurable movements of the teeth.

Animals↗
PubMed1992

Electromyographic parameters related to clenching level and jaw-jerk reflex in patients with a simple type of myogenous cranio-mandibular disorder.

A discriminant analysis has been applied on several electromyographic (EMG) parameters of the masseter and the anterior temporal muscles, related to clenching and the jaw-jerk reflex, to characterize jaw muscle function of patients with craniomandibular disorder (CMD) with respect to controls. The subject samples, matched for age, consisted of 20 females with myogenous CMD, and 20 symptom-free females. The jaw-jerk reflex was elicited by a downward-directed mandibular load, transmitted by a bite-fork causing a similar occlusion and bite-rise as a splint. The patients differed mainly from the controls by smaller maximum EMG activity in both muscle groups (P less than 0.05 with the bite-fork inserted). This finding was related to a smaller muscle strength as the EMG level did not improve with pain-free jaw muscles after therapy using a relaxation splint. Discriminating factors of secondary importance were an enhanced bilateral asymmetry in the muscle activity of the patients, and in the reflex amplitude normalized for background EMG activity. In all subject samples, the activity of the anterior temporal muscles decreased with respect to the masseter muscles when the bite-fork was inserted (P less than 0.05-0.001). The therapeutic effect of a relaxation splint may, in part, be related to a relief of the temporal muscles.

Adult↗
PubMed2002

A new approach to evaluating occlusal support by analyzing the center of the bite force.

The aim of this study was to create a standard for occlusal support in the diagnosis and evaluation of prosthetic treatment. In experimental occlusion, the maximal bite force of eight normal dentates was measured by pressure-sensitive film over the whole dentition using splints divided into nine pieces. The occlusal contact was altered by exchanging splint pieces according to the shortened dental arch concept. The occlusal load center (OLC) was located on a graph set up with reference to the size of the individual dental arch. The occlusal supporting index (SI) and the rehabilitation index (RI) were calculated from the locations of the OLC corresponding to each occlusal contact. Differences in numbers and distribution of occlusal stops could clearly be distinguished by the location of the OLC. Though the SI showed a strong positive correlation with maximal bite force, it is proposed that the number of occlusal stops, or occlusal units, provides the most effective index for quantitative parameters of occlusal support in clinical use. From the standpoint of bite force, analysis of the RI is suggested as a useful method of objectively evaluating the recovery of occlusal support with prosthetic treatment.

Adult↗
PubMed1994

[Headgear-free molar distalization].

The difficulty in treating dentoalveolar class II disharmonies is briefly outlined. An innovative treatment method is presented which makes possible a distalization without the use of headgear. In the treatment method bands are cemented on the first molars, next impressions are made of the upper and lower dental arch, and then the impressions are poured with plaster. Following this the models are mounted in centric relationship in an articulator and the bite is opened 2 mm to 3 mm, so that the molars can be moved without making occlusal contact. The apparatus, an acrylic splint, is constructed in such a fashion as to cover the palatal surfaces from 2nd premolar to 2nd premolar. In addition, the premolars are also covered occlusally and buccally and the canine tips and the incisal edges are covered labially. A headgear tube is attached at the buccal surface in the premolar region of the acrylic splint. This acrylic splint, which is itself retentive, is cemented using glass ionomer cement. Combining this apparatus with a modified Nance Button makes it possible to establish an anchoring segment which is able to retain its position in the face of molar distalization. Molar distalization is then performed using a 0.032 inch stainless steel wire, which is placed between the headgear tube of the acrylic splint and the headgear tube of the band of the first molar. Highly elastic nickel-titanium open coil springs are used as the force elements.

Acrylates↗