Effect of occlusal splints on TMJ symptomatology

Current concepts in the aetiology, diagnosis and treatment of TMJ and muscle dysfunction

The complexity of managing TMJ and muscle dysfunction is reflected in the variety of treatment modalities that are continually being advocated. The multidimensional nature of the problem is readily appreciated in a TMJ Oral-Facial Pain Clinic where most of the referred patients represent a broad spectrum of treatments that have failed. Where such a clinic has been present for several decades the introduction of new ideas, or the reintroduction of old forms of treatment, are readily seen as well as the quantity and quality of treatment successes and failures. A major shift in ideas concerning the natural history of TMJ/muscle dysfunction, and an explosion of treatment problems and failures related to mandibular repositioning appliances and surgery suggest the need to reconsider various approaches to the diagnosis and treatment of TMJ and muscle dysfunction. Guidelines for diagnosis and treatment of these disorders are discussed.

Protrusive positioners

Techniques were described for fabricating maxillary and mandibular protrusive positioners for treatment of disk-condyle derangements. Treatment time with the splints varies from 4 to 12 months depending on the age of the patient, the degree of existing symptoms, and patient motivation. At the end of the treatment period and after removal of the splints, the patient may have (1) no pain or internal derangement, (2) no pain but internal derangement with or without reduction, or (3) pain and internal derangement with or without reduction. If dental treatment is required, patients in the first two categories can be treated at a physiologically acceptable treatment position with existing treatment modalities. For patients in the third category, definitive, irreversible stabilization should be reevaluated. For these patients a mandibular cast splint can be changed to an interim splint by replacing the self-polymerizing resin with Isosit (Ivoclar-Vivadent, Schaan, Liechtenstein) or heat-processed acrylic resin.

Comparative study of two treatment methods for internal derangement of the temporomandibular joint

Orthopedic mandibular repositioning and flat plane occlusal splint therapy were compared in the treatment of 20 patients with internal TMJ derangement with reduction. The following conclusions can be drawn. Mandibular repositioning treatment produces significant subjective and objective improvement in the dysfunction of patients with internal joint derangements with reduction. Flat plane occlusal splint treatment produces no significant change in the dysfunction level of patients with internal joint derangements with reduction. Mandibular repositioning treatment may eliminate the reciprocal click of internal joint derangement with reduction. To realize improvement in dysfunction of internal joint derangement, it appears that the reciprocal click must be eliminated. Mandibular repositioning treatment produces a significant improvement in muscle pain associated with internal joint derangement.

A critical evaluation of orthopedic interocclusal appliance therapy: design, theory, and overall effectiveness

Orthopedic interocclusal appliances have been evaluated in a number of research papers and clinical reports over the years. Various theories have been proposed about the method of action of the different appliances, but at present no conclusive controlled testing of these theories has occurred. Certainly, when the potential influence of the nonspecific treatment factors is considered, as well as those cognitive awareness factors common to all appliances, the use of "symptom improvement" as the definitive proof of the need for mandibular realignment or repositioning must be questioned. Specific, well-controlled research using more quantifiable measures of the treatment effect is necessary to make valid comparisons between the different therapeutic approaches. The full-arch occlusal stabilizing appliance is the design that has the most valid evidence about its effectiveness. Partial coverage interocclusal appliances have significant irreversible complications with tooth intrusion or eruption when used on an extended basis. There is little or no experimental support at present about repositioning, realignment, and pivot appliances and their effectiveness. Therefore, these appliances must be considered experimental treatments. When used to treat TM dysfunction in a program along with other methods, such as occlusal adjustments, and prosthetic care, the effectiveness of this treatment method is between 70% and 90%. As a general approach to managing TM pain and dysfunction, interocclusal appliances appear to be a highly effective, commonly used method.

A critical evaluation of orthopedic interocclusal appliance therapy: effectiveness for specific symptoms

This paper reviews the effectiveness of occlusal splints on specific symptoms that are often associated with TM disorders. The research has shown the clicking TMJ is sometimes helped but not cured by the traditional stabilization interocclusal appliance and that TMJ clicking is the least responsive to treatment. Questions have been raised about the need to specifically treat the clicking joint; more research on this issue is necessary. Painful TMJs have been shown to respond to occlusal appliance therapy, but questions still exist about the effectiveness of interocclusal appliances for this symptom. There is little scientific proof available about the ability of splints to effectively slow down or reverse degenerative TMJ changes that are evident on radiographs. Masticatory muscle pain is by far the symptom that has the best experimental evidence to support occlusal splints as a highly effective method of treatment. These changes are probably mediated via an alteration in the patient's muscle activity patterns. Those patients with more severe symptoms are less likely to be helped with splints as a sole treatment modality. The effect of occlusal appliances in muscle trismus has been discussed but not effectively evaluated in the literature. Occlusal splints have been shown to have a distinct influence on improving mandibular muscle coordination. Inter-occlusal splints are a commonly used method of controlling attrition and adverse tooth loading, and few questions have been raised in the literature about this therapeutic application.

Temporomandibular joint disfunction syndrome and myofascial pain dysfunction syndrome: a critical review

Temporomandibular joint (TMJ) dysfunction syndrome and myofascial pain dysfunction (MPD) syndrome have been primarily viewed as dental problems and have only recently received close attention by psychologists. The literature reviewed in the present paper reveals that a substantial portion of the population is affected by these disorders. There is, however, a great deal of confusion that exists in relation to the aetiology and treatment of these syndromes. In an attempt to clarify the current understanding of these disorders, the present review first presents a discussion of the symptoms which comprise each of these syndromes and the proposed physiological mechanisms associated with each symptom. Next, the aetiological theories for each of these syndromes are reviewed and critically evaluated. Treatments which have been derived from the theoretical models are then discussed. Finally, methodological considerations involving classification, assessment and treatment issues are presented and future research needs are outlined.

Evaluation of occlusal splint therapy and relaxation procedures in patients with temporomandibular disorders

Twenty-four patients were selected to participate in this study. Twelve patients were randomly selected to receive occlusal splint therapy and the other 12 to receive a simplified relaxation therapy technique. Observable pain scores, maximum comfortable interincisal distance, and maximum interincisal distances were recorded for each group before and after treatment. The occlusal splint group showed a significant decrease in total mean observable pain scores (decrease score of 10.5, t = 3.124; P less than 0.1). The relaxation group showed no significant decrease in total mean observable pain scores (decrease score of 1.8, t = 0.888; P = ns). The occlusal splint group showed a significant increase in the mean maximum comfortable opening (an increase of 12.4 mm, t = 5.085; P less than .01). The relaxation group showed no significant increase in the mean maximum comfortable opening (an increase of 2.3 mm, t = 0.734; P = ns). The occlusal splint group showed a significant increase in the mean maximum opening (an increase of 6.0 mm, t = 2.471; P less than .05). The relaxation group showed no increase in the mean maximum opening (decrease of 0.7 mm, t = 0.343; P = ns). This study suggests that occlusal splint therapy is a more effective treatment for the pain, tenderness, and limited mandibular opening associated with temporomandibular disorders than relaxation therapy. In this study, the relaxation technique used had no significant effect on the patients' pain, tenderness, or limited opening.

A study of the use of occlusion splints in the treatment of acute and chronic patients with craniomandibular disorders

Thirty-three patients were treated for a 4-week period with splint therapy. Fourteen muscle and joint regions were palpated before and after treatment, and observable pain scores were recorded. Maximal comfortable interincisal distance and maximal interincisal distance were recorded before and after treatment. The following results were observed. 1. Of the 33 patients, 28 showed improvement in observable pain scores. The mean decrease was 4.4 (p less than .01). 2. Of the 33 patients, 27 showed increase in maximal comfortable interincisal distance. The mean increase in interincisal distance was 5.3 mm (p less than .01). 3. Of the 33 patients, 21 showed an increase in maximal mandibular opening; however, the increase of 1.7 mm was not statistically significant. 4. When the patients were divided into two groups according to the duration of symptoms, there was no significant difference between the groups' symptoms or their responses to treatment.

The evaluation of facial, head, neck, and temporomandibular joint pain patients

The purposes of this paper are 1) to present an evaluation procedure for patients with signs and symptoms of temporomandibular joint (TMJ) pain dysfunction syndrome (PDS) and 2) to describe the findings of the evaluation procedure on 12 patients with TMJ PDS. The evaluation emphasizes the collection of subjective and objective data. Records from 12 patients with facial, head, and neck pain were reviewed. The most frequent symptoms were: headache (1 00%), neckache (83.3%), and ear pain (58.3%). The most frequent signs were: muscle tenderness (100%) and mandibular deviation on opening (66.7%). Subjects with lateral pterygoid muscle tenderness had digastric muscle tenderness as well. Subjects with medial pterygoid muscle tenderness had masseter and hyoid muscle tenderness. Masseter muscle tenderness was strongly related to sternocleidomastoid and mylohyoid muscle tenderness and neckache. J Orthop Sports Phys Ther 1982;3(4):193-199.

Prognostic stratification for the mandibular pain dysfunction syndrome

Combinations of the symptoms and signs of the mandibular pain dysfunction syndrome (MDS) provoked by movements of the mandible are complex and patients are treated as a homogeneous group. The process of prognostic stratification applied to an inception cohort of 169 MDS patients, separated groups of patients according to affected movements of the mandible associated with similar outcomes of treatments. From the data, two staging systems for the dysfunction were derived and evaluated. It is suggested that further analyses of more data would distinguish groups of patients with comparable prognoses enabling universal and valid comparisons of treatment of the dysfunction to be made.

Effect of occlusal retainers on temporomandibular joint and facial pain

The etiology of TMJ syndrome is usually multifactorial. The anatomic structures which may be involved are the dentition, the masticatory muscles, and the TMJ itself. The etiologic region is usually the dentition and its occlusal relationships. The symptoms are usually minimized during treatment, and a high percentage are eliminated. Among the diagnostic symptoms, the deviation of the mandible to the opposite side from the occlusal interference is the most frequent objective symptoms. The lateral pterygoid muscle is usually involved if the patient has (1) occlusal interference and (2) lateral deviation of the mandible. The clinical response in this study to the occlusal splint and occlusal adjustment indicate that 88% of muscle involvement improved and that 84% of the TMJ syndrome responded favorably to the occlusal splint.