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PubMed1994

Temporomandibular disorders and occlusion: an appliance to treat occlusion generated symptoms of TMD in patients presenting with deficient anterior guidance.

Temporomandibular disorders (TMD) are of multifactorial origin. If it is determined that the patient's occlusal scheme is a contributing factor to their TMD symptoms, it is accepted that reversible, noninvasive procedures be instituted at the outset of treatment. Splint therapy conforms to this guideline, offering temporary, reversible alteration of the occlusal scheme in order to provide this relief. In a mutually protected occlusion, the posterior teeth accept the occlusal force of closure, while the anterior teeth separate the dentition during excursive movements. The purpose of the disclusion splint described in this article is to eliminate muscle hypertonicity, along with its ensuing problems. This is accomplished by establishing a mutually protected occlusion via the guide planes created by the acrylic portions of the splint, but not compromising the patient's "freeway" space.

Humans↗
PubMed2001

Occlusal stabilization appliances. Evidence of their efficacy.

BACKGROUND: There is substantial controversy regarding the value of occlusal appliances for managing temporomandibular joint disorders. This article specifically assesses whether the evidence is sufficient to judge occlusal appliances as being efficacious for the management of localized masticatory myalgia, arthralgia or both. A major confounder is that few studies have measured or evaluated whether subjects had strong, ongoing parafunctional activity (such as clenching or grinding) and whether appliances influenced this behavior. LITERATURE REVIEWED: The authors evaluated four placebo-controlled studies, several randomized wait-list controlled studies and several random-assignment treatment-comparison studies. Data from the wait-list condition studies vs. those from the occlusal appliance condition studies consistently suggested that the latter treatment's effect on patient symptom level is far more than that of no treatment on a wait-list group's condition. In contrast, the studies on placebo-controlled vs. occlusal appliance studies yielded a mix of data: two showed a positive benefit of occlusal vs. nonoccluding appliances, and two showed a null effect or no difference. CONCLUSIONS: Considering all of the available data (pro and con), the authors conclude that the use of occlusal appliances in managing localized masticatory myalgia, arthralgia or both is sufficiently supported by evidence in the literature. CLINICAL IMPLICATIONS: The mechanism of action by which occlusal appliances affect localized myalgia and arthralgia probably is behavioral modification of jaw clenching. However, if the behavior continues unabated, even the best splint will not work.

Arthralgia↗
PubMed1993

Application of porcelain veneers following orthodontic treatment.

To date, porcelain laminate veneers have been used primarily to solve esthetic problems. As bonding materials and veneer restoration techniques have improved, however, functional demand has now been accepted. Porcelain laminate veneers have been applied to compensate for the limitations of orthodontic treatment. In order to allow optimum functional movement of the mandible, anterior and lateral guidances are required in the maxillary dentition. These guidances provide pathways for the opposing mandibular teeth. Anterior and canine guidances have been established by means of veneer placement, and no broken restorations have been observed in the past four years. When diastema spaces have recurred subsequent to orthodontic space closure, they have been restored with porcelain veneers so effectively that no relapse has been observed. This paper also examines instances where small lateral incisors have caused a discrepancy in the tooth size ratio between the upper and lower arches. Porcelain veneers were placed to harmonize the tooth size and to stabilize the occlusion. Relapse sometimes occurs after orthodontic tooth alignment. Over correction, therefore, is usually applied for rotated teeth, anterior deep or open bite, and Class II or III molar relationships. Some malocclusions, however, cannot be over corrected. For example, the spacing between the teeth, such as diastema, can easily reopen because it is impossible to apply over correction once space closure has been achieved. The same is true of lateral open bites, because occlusal contact cannot be corrected properly. In these cases, the patient must wear a retainer for longer than usual, and/or permanent splints must be used to stabilize the occlusion. Another causal factor of relapse is dysfunctional occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Immediate effect of a stabilization splint on masticatory muscle activity in temporomandibular disorder patients.

Surface electromyography (EMG) allows the quantification of the occlusal equilibrium in dysfunctional patients, for instance in those with temporomandibular disorders (TMD). Fourteen patients (ten women, four men) with internal derangement type I were selected among the TMD patients referred to a private practice in Milan. A stabilization splint with posterior contacts was made for each patient. To verify the static neuromuscular equilibrium of occlusion, EMG activity of left and right temporal and masseter muscles was recorded in all patients and the activity (ratio between the activities of the temporal and masseter muscles) index was computed over a maximum voluntary clench test of 3 s. Muscular waveforms were also analysed by computing a percentage overlapping coefficient (POC, an index of the symmetric distribution of the muscular activity determined by the occlusion). The total electrical activity was measured by calculating the area under the entire muscular waveforms. In all patients EMG was performed just before and immediately after the insertion of the splint and data were compared by paired Student's t-tests. Overall, the splint reduced the electrical activity of the analysed muscles (P < 0.005) and made it more equilibrated both between the left and right side (larger symmetry in the masseter muscle POC, P < 0.05) and between the temporal and masseter muscles (activity index, P < 0.01).

Adult↗
PubMed1989

The immediate effect of splint-induced changes in jaw positioning on the asymmetry of submaximal masticatory muscle activity.

Maxillary full-arch splints in the retruded position (RP) and in a right lateral occlusion (1.0-1.5 mm to the right of the retruded contact position) were fabricated for ten subjects. Surface electromyography of the masseter and anterior temporal muscles was performed during submaximal clenching in order to investigate the immediate effects of the splints on the activity patterns of these muscles relative to the patterns found with the subjects occlusion in the inter-cuspal position. The splints in the RP were found to have no effect on the asymmetry of the activity of the masseter and the anterior temporal muscles, while the splints in a right lateral occlusion resulted in relative increases in right anterior temporal muscle activity (P less than 0.005).

Adult↗
PubMed1999

Periodontal trauma and mobility. Diagnosis and treatment planning.

With the dearth of well-controlled human clinical studies, it is still impossible to answer the question of whether occlusal trauma modifies the progression of attachment loss resulting from inflammatory periodontal disease and the companion questions related to the treatment of occlusal trauma and mobility. Teeth with stable mobility are apparently at no greater risk of attachment loss than nonmobile teeth. Increasing mobility is a concern that must be addressed by inflammatory control, occlusal adjustment, and perhaps some type of stabilization or splinting of the tooth in question. In addition, greater attachment gains have been noted when occlusal adjustment was included as part of surgical therapy. There is no question that aspects of occlusal therapy have an empiric base. It is incumbent on the clinician to examine for, diagnose, and treat trauma from occlusion to stabilize the dentition. Proper occlusal management assists in maintaining the patient's natural dentition in a state of health and comfortable function.

Dental Occlusion, Traumatic↗
PubMed1993

[The therapy of anterior disk dislocation in craniomandibular disorders. A clinical case report].

The authors discuss the outcomes of therapy for CMDs and present a clinical case reporting an alternative method for the treatment of disc displacement. The orthopaedic therapy for CMDs is based on the use of interocclusal splints. Two kind of splints are prescribed to patients with CMDs: stabilization or repositioning splint. The former is used for a conservative treatment, the latter for irreversible treatment. In view of the poor long-term success of repositioning therapy, the cost of subsequent dental treatment, and the great potential for iatrogenic occlusal and muscular problems, the authors believe that the initial treatment approaches should be, in any case, conservative, reversible, and non invasive. The authors prescribe to their patients the repositioning splint for use either part-time or full time use. Part-time use is effective for preventing disc displacement without reduction. If used full time, once joint noises, pain, and displacement are decreased, the appliance should be adjusted to/or replaced with a stabilization appliance to allow posterior positioning of the mandible into a more physiologically stable position. The authors present a clinical case, a 27 yo female with disc displacement with reduction was treated with stabilization splint. After 6 weeks of therapy she returned reporting a temporary closed lock and sharp pain in the left TMJ. An anterior repositioning splint was fabricated in order to position the mandible forward. After 10 weeks of this treatment the patient reported absence of joint/muscle symptoms and of joint noise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Temporomandibular joint osteoarthrosis and internal derangement. Part II: Additional treatment options.

In some cases of temporomandibular joint osteoarthrosis and internal derangement, the initial treatment needs to be supported by additional treatment modalities. In this paper, the basic principles of the most common additional modalities used are discussed. Orthopaedic appliances are used to either stabilize, or reposition the mandible. Consequently, there are two splint types: the stabilization splint and the repositioning splint. The major indication for applying the former is to decrease the load imposed on the joint. Secondary effects are stabilization of the occlusion and masticatory muscle relaxation. The repositioning splint may be used in some cases to reduce a displaced articular disc. Physical therapy is often used to mobilize the joint and to re-educate mandibular movement patterns. Based on the stages of temporomandibular joint osteoarthrosis and internal derangement, guidelines are given for the treatment strategy to be followed in the management of this common disorder.

Cartilage, Articular↗
PubMedDate not supplied

[New methods for splint construction for dysfunctional patients].

The use of the splint is a very important step in the treatment of the dysfunctional patient. Considering the construction of the bite, beside the two usual procedures: a direct and indirect method with the different steps of the laboratory, we can realize a mixed one which all the advantages without the defects of both. That is made possible by the use of the new photopolimerizing resins, and by using the articulator with rapidity in the manufacturing and high quality of the splint, avoiding the steps of the laboratory. The methods are described in the different aspects until the final preparation of a repositioning splint.

Acrylic Resins↗
PubMed1979

A new reinforced intracoronal composite resin splint. Clinical results after 1 year.

An intracoronal technique for semipermanent splinting of mobile or migrating teeth is described and clinically evaluated. Circumferential grooves of 1 to 1.5 mm depth were cut into the enamel in the occlusal third of the teeth to be splinted. The teeth were splinted by placing a polyester ligature in two or more figure-8 loops along the grooves, and sealing the grooves and interproximal contact areas with an acid-etch composite resin system. A total of 51 splints involving 183 teeth and 132 interproximal contact areas were placed in 34 patients. One year after insertion, 46 splints were found intact. Five splints presented with one fractured interdental element, each. Average mobility of the splinted teeth was 51% below the preoperative level. Splinting improved the masticatory comfort. The esthetic results were satisfactory.

Acid Etching, Dental↗
PubMed1998

Oral splints: the crutches for temporomandibular disorders and bruxism?

Despite the extensive use of oral splints in the treatment of temporomandibular disorders (TMD) and bruxism, their mechanisms of action remain controversial Various hypotheses have been proposed to explain their apparent efficacy (i.e., true therapeutic value), including the repositioning of condyle and/or the articular disc, reduction in the electromyographic activity of the masticatory muscles, modification of the patient's "harmful" oral behavior, and changes in the patient's occlusion. Following a comprehensive review of the literature, it is concluded that any of these theories is either poor or inconsistent, while the issue of true efficacy for oral splints remains unsettled. However, the results of a controlled clinical trial lend support to the effectiveness (i.e., the patient's appreciation of the positive changes which are perceived to have occurred during the trial) of the stabilizing splint in the control of myofascial pain. In light of the data supporting their effectiveness but not their efficacy, oral splints should be used as an adjunct for pain management rather than a definitive treatment. For sleep bruxism, it is prudent to limit their use as a habit management aid and to prevent/limit dental damage potentially induced by the disorder. Future research should study the natural history and etiologies of TMD and bruxism, so that specific treatments for these disorders can be developed.

Behavior Therapy↗
PubMedDate not supplied

Immediate provisional restoration of Osseotite implants: a clinical report of 18-month results.

PURPOSE: The purpose of this study was to assess the survival rates and interproximal bone levels for Osseotite implants that were restored with fixed provisional crowns without occlusion immediately after implant placement. MATERIALS AND METHODS: Ninety-three implants were placed in 38 partially edentulous patients. All implants were immediately restored with prefabricated abutments and cement-retained provisional crowns without centric or eccentric occlusal contacts. The implants were restored with definitive restorations approximately 8 to 12 weeks after implant placement. All patients included in the study were followed for at least 18 months after implant placement (average 20.3 months). RESULTS: Seventy-seven of the 93 implants satisfied the inclusion criteria. Seventy-five implants became osseointegrated. The overall survival rate was 97.4%. Radiographic bone loss 18 months after implant placement (the mean of both interproximal surfaces) was 0.76 mm. The exact binomial confidence interval was 0.32% to 9.07%. For the exact binomial test with the null hypothesis proportion = .05, P was .3334 and was not statistically significant. DISCUSSION: Immediate nonocclusal loading of single-unit dental implants differs from immediate loading of multiple, splinted implants. Unsplinted, restored implants without occlusal loading may still be subject to lateral and occlusal loads secondary to the proximate location of the food bolus. Immediate restoration of dental implants significantly reduces treatment time and may be beneficial in reducing the morbidity associated with loss of teeth, contraction of the alveolus, and loss of interdental papillae associated with the traditional method of treatment following tooth loss. CONCLUSIONS: The results of this study suggest that immediate restoration of Osseotite implants can be accomplished with results that are similar to the results obtained with the traditional 1- or 2-stage surgical, unloaded healing protocols.

Adolescent↗