The Use of Oral Appliances in the Management of Temporomandibular Disorders

Condylar Remodeling and Skeletal Changes Following Occlusal Splint and Manual Therapy: A Cone Beam Computed Tomography Study in Temporomandibular Disorders

Background: Temporomandibular disorders (TMD) may be associated with degenerative disease of temporomandibular joint (TMJ), such as condyle erosion and subchondral cysts. Occlusal splint and cranio-mandibular manual therapy, or combined therapy, is recommended as a conservative treatment to alleviate pain-related signs and symptoms in TMD. This study aimed to assess osseous condylar changes and skeletal changes following occlusal splint and cranio-mandibular manual therapy in TMD using cone beam computed tomography (CBCT). Methods: A retrospective cohort study included 24 patients diagnosed with TMD. Combined therapy was performed until pain-related signs and symptoms disappeared. CBCT scans were performed before and after therapy. Osseous structure of condyles and their subsequent modifications were analyzed on CBCT images: flattening, erosion, and subchondral cyst. Sella-Nasion-A point (SNA), Sella-Nasion-B point (SNB), A point-Nasion-B point (ANB), Sella-Articulare-Gonion (Condylar angle), and anterior and posterior facial height (AFH, PFH) were measured on CBCT-generated lateral cephalograms. A paired t-test, Wilcoxon rank-sum test, McNemar test, and Stuart-Maxwell test were used for the statistical analyses. Results: The treatment period with combined therapy was 7.42 ± 3.27 months, and 21 out of 33 TMJ presenting degenerative disease (63.6%) had significant complete remodeling (p < 0.05). Following therapy, SNB significantly decreased from 75.61 ±3.47° to 74.82 ± 3.41° (p = 0.02), ANB significantly increased from 4.05° (3.35-4.9°) to 4.8° (3.3-6.12°) (p < 0.001), AFH significantly increased from 112.85 mm (109.28-118.72) to 115.3 mm (112.58-118.88) (p < 0.001), PFH/AFH significantly decreased from 64.17 (61.39-66.1) to 63 (59.68-64.51) (p = 0.012), and condylar angle significantly increased from 140.84 ± 8.18° to 144.42 ± 8.87° (p = 0.007). Conclusion: Combined therapy promoted significant condylar remodeling in TMJ degenerative disease, along with skeletal changes (mandibular retrusion and increase in facial height). Therapeutic strategies should consider condylar remodeling in TMD. Skeletal and dental parameters should be evaluated prior to occlusal splint therapy.

Myths surrounding vertical dimension of occlusion in restorative dentistry: A scoping review

OBJECTIVE

This scoping review aims to clarify the concept of vertical dimension of occlusion (VDO) in prosthetic dentistry, addressing prevalent myths, and controversies regarding its clinical management and impact on the stomatognathic system.

METHODS

This paper critically examines common beliefs about VDO alteration and its effects on temporomandibular disorders (TMD) through an extensive literature review and an international survey. The survey included 862 general dentists and prosthodontists and explored their approaches to altering VDO and their perceptions of the clinical implications. The literature review provided a thorough analysis of existing research on VDO modification techniques, the adaptability of the stomatognathic system, and the relationship between VDO changes and TMD.

RESULTS

The survey revealed insights into dentists' perspectives on VDO, showing that while many practitioners test a new VDO due to concerns about patient adaptation, a significant majority observed that patients typically adjust well to a new VDO regardless of the technique used. The survey highlighted differing beliefs about the need for a gradual process and trial phase for VDO alteration, as well as the stability of modified VDO. Literature review suggests the stability and adaptability of VDO changes due to muscle adaptability and indicates no direct causal or curative link between VDO changes and TMD. Traditional methods for determining VDO in complete dentures may not be suitable for worn dentition, underscoring the need for tailored approaches.

CONCLUSION

This paper suggests that the traditional belief in the need for a prolonged trial phase for VDO alterations may be reconsidered in light of evidence supporting the adaptability of the stomatognathic system. Moreover, it emphasizes the importance of distinguishing between methods suitable for complete dentures and those for managing cases of worn dentition. The purported link between VDO alterations and TMD is also found to lack scientific evidence, highlighting the need for individualized patient care based on current evidence and clinical judgment.

Physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: A randomised controlled trial

BACKGROUND

Myogenic temporomandibular disorders (M-TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT).

OBJECTIVES

To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M-TMD patients.

METHODS

In this double-blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post-treatment (T1) and 3 months post-treatment (T2).

RESULTS

Intention-to-treat analysis revealed significant improvements favouring EG (VAS rest = -1.50 cm [CI95%: -2.67, -0.32], p = .04; VAS open = -2.00 cm [CI95%: -3.23, -0.75], p < .01; VAS chew = -1.71 cm [CI95%: -2.90, -0.52], p = .01; ROM = 4.61 [CI95%: 0.93, 8.30], p = .04). Additionally, VAS measures were influenced by follow-up times (VAS rest = -0.73 cm [CI95%: -1.30, -0.17], p = 0.03; VAS open = -0.97 cm [CI95%: -1.57, -0.37], p < .01; VAS chew = -1.15 cm [CI95%: -1.73, -0.58], p < .01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ2(1) = 4.39, p = .04) and VAS chew (χ2(1) = 11.58, p < .01).

CONCLUSION

Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M-TMD.

TRIAL REGISTRATION NUMBER

NCT03726060.

Acute dental malocclusion associated with lateral pterygoid muscle partial tear: Case Report and literature review

BACKGROUND

The article presents a rare case of acute malocclusion produced by a unilateral partial tear of the lateral pterygoid muscle and an up-to-date literature review of the pathology.

CLINICAL PRESENTATION

A 37-year-old female was examined; her chief complaints were pain on the right side of the temporomandibular joint (TMJ) area and mastication impairment associated with major occlusal modifications and anterior open bite. After magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) of the TMJ and subsequent MRI for soft tissue, the final diagnosis was a partial right lateral pterygoid muscle tear.

CONCLUSION

The case shows the value of combined imaging in temporomandibular disorders (TMD) and the importance of soft tissue evaluation in addition to articular examination, as the primary pathology might lie outside the joint. The authors' review of the current literature did not hitherto reveal a similar case.

Recommendations on the Use of Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders: Current Evidence and Clinical Practice

Background

'Temporomandibular joint disorders (TMDs)' denote an umbrella term that includes arthritic, musculoskeletal and neuromuscular conditions involving the temporomandibular joint, the masticatory muscles, and the associated tissues. Occlusal devices are one of the common treatment modalities utilized in the conservative management of TMDs. The indications for the available 'oral splints' or 'oral orthotic occlusal devices' remain ambiguous.

Methods

A joint international consortium was formulated involving the subject experts at TMJ Foundation, to resolve the current ambiguity regarding the use of oral orthotic occlusal appliance therapy for the temporomandibular joint disorders based on the current scientific and clinical evidence.

Results

The recommendations and the conclusion of the clinical experts of the joint international consort has been summarized for understanding the indications of the various available oral orthotic occlusal appliances and to aid in the future research on oral occlusal orthotics.

Conclusion

The use of the oral orthotic occlusal appliances should be based on the current available scientific evidence, rather than the archaic protocols.

Efficacy of Occlusal Splints and Low-Level Laser Therapy on the Mandibular Range of Motion in Subjects with Temporomandibular Joint Disc Displacement with Reduction

Aims and Objectives

The study was carried out to evaluate the efficacy of four conservative therapeutic modalities on the mandibular range of motion (MRM) in subjects with anterior disc displacement with reduction (ADDwR) of the temporomandibular joint (TMJ).

Materials and Methods

One hundred patients (64 women and 36 men) were selected, and randomly distributed into four groups. Group I: Subjects receiving behavioral therapy (BT). Group II: Subjects receiving low-level laser therapy (LLLT). Group III: Subjects receiving maxillary anterior repositioning splint (MARS). Group IV: Subjects receiving stabilization splint (SS). The MRM was evaluated for each patient before treatment and after 6 months. Paired t test and one-way analysis of variance (ANOVA) tests were used for statistical analysis followed by a post hoc Tukey test (P ≤ 0.05).

Results

All groups showed significant improvement in MRM after 6 months of treatment (P ≤ 0.05) except for BT. There was a significant improvement for SS and MARS on the different movements of MRM, more than for LLLT and BT (P ≤ 0.05).

Conclusion

The MARS and the SS are effective in increasing the MRM for patients with ADDwR.

Three dimensional evaluation of the skeletal and temporomandibular joint changes following stabilization splint therapy in patients with temporomandibular joint disorders and mandibular deviation: a retrospective study

BACKGROUND

Three-dimensional (3D) detailed evaluations of the mandibular mediolateral position, mandibular condylar position, and temporomandibular joint (TMJ) spaces following stabilization splints (SS) therapy in patients with temporomandibular joint disorders (TMD) and mandibular deviation (MD) have not been reported in the available literature. Accordingly, this study aimed to three-dimensionally analyze the skeletal and bony temporomandibular joint changes following stabilization splint therapy in adult patients with temporomandibular joint disorders and mandibular deviation.

METHODS

This study is a retrospective clinical study that enrolled 26 adult patients with TMD and MD with a mean age of 24.86 years. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) was used to diagnose TMD. SS was adjusted weekly until occlusal contact stabilization occurred, and then adjusted monthly, patients were instructed to wear it at night for at least 10 h. The SS was removed after the elimination of TMD symptoms (TMJ/muscle pain on palpation, muscle spasm, and clicking) and having both condyles completely seated in a musculoskeletally stable position. Pre- and post-therapeutic Cone Beam Computed Tomography (CBCT) was analyzed. Mandibular mediolateral position, TMJ spaces, and mandibular condyle position were analyzed three-dimensionally using Mimics 21.0 software. Paired t-test or Wilcoxon rank-sum test was performed, and the significance level was considered at P < 0.05.

RESULTS

The treatment period with SS therapy was 10.07 ± 3.1 months. The deviated chin was improved in 69.23% of the sample; the range of improvement was > 0 mm ≤ 3.9 mm. The mandibular rotation was significantly decreased from 3.58 ± 2.02° to 3.17 ± 1.60. The deviated side's superior and posterior joint TMJ spaces were significantly increased from 2.49 ± 0.88 mm and 1.25 ± 0.79 mm to 2.98 ± 1.02 mm and 1.86 ± 0.72 mm, respectively. The value of the difference from the bilateral condyle head position to the X and Z axes significantly decreased from 2.50 ± 1.56 mm and 2.30 ± 1.57 mm to 1.64 ± 1.58 mm and 1.82 ± 1.11 mm, respectively.

CONCLUSION

The main positional effect of the stabilization splint treatment in TMD patients with MD includes considerable correction of mandibular deviation, improving facial asymmetry, and moving the condyle into a stable condylar position; these were done by promoting the mandible to rotate around the Z (roll) and Y (yaw) axes and by forward, downward, and outward condylar movement on the deviated side, respectively.

Oral splints in the management of nociceptive pain and migraines: A scoping review

Temporomandibular disorders (TMDs) are characterized by numerous pain manifestations. Their treatment often involves the use of an oral splint. Recent research has found a relationship between migraines, nociceptive pain and TMDs. The aim of the present study was to perform a scoping review of studies in order to evaluate the effectiveness of the various types of oral splint in the treatment of migraine or nociceptive pain. Publications were retrieved from seven databases (PubMed, Web of Science, EMBASE, Scopus, ProQuest, SpringerLink and Ovid). Out of the 15 included publications, three studies were before and after studies, with no control group, whereas the other twelve studies were clinical trials, among which two publications were crossover studies. A clear, single distinction of pain was difficult to describe. Therefore, numerous publications focused on a combination of various types of pains, including myofascial, temporomandibular joint, headaches and migraine-like symptoms, all of which mimicked TMD pain. Overall, six studies used the stabilization splint (SS), three explored the comparison between the SS and the nociceptive trigeminal inhibition splint (NTIS) and two the NTIS. The majority of publications reported a positive outcome of splint therapy. Regarding the type of oral splint usage, the most commonly used one was the SS, followed by the NTIS. The definition and assessment of pain were heterogenous in the identified articles. The findings of the current study showed that occlusal splints may help with pain management, and that effective treatment of TMD-related pain at an early stage can enhance the quality of life of patients.

Nonsurgical Management of Temporomandibular Joint Arthropathy

Arthropathy is a broad diagnostic term for any pathologic condition afflicting one or more joints of the body. Temporomandibular joint (TMJ) arthropathy is an umbrella term that may be applied to mechanical dysfunction or disease of one or both TMJs. This article provides evidence-based recommendations for conducting a patient evaluation, initiating a diagnostic workup, formulating an assessment, and instituting various nonsurgical modalities for the treatment of TMJ arthropathies.

[Lower jaw virtual reposition accuracy research]

OBJECTIVE

The aim is to study of the accuracy of the virtual reposition of the mandible (LF) by comparing the virtual and real position of the LF heads, as well as the analysis of factors contributing to the occurrence of errors.

MATERIAL AND METHODS

An experimental model of a human skull with a movable LF was made of radiopaque material. The resulting computed tomogram (CT) of the upper and lower jaws and temporomandibular joint (TMJ) was combined with dental scans of dental rows and CT scans and a report on the position of the heads of the LF was obtained. Then the LF was shifted to another position and this position was fixed. Optical bite recorders were obtained using an intraoral scanner. An experimental model with a fixed new position of the LF was placed in a tomograph and repeated CT was obtained. In the program, according to optical registers, a virtual reposition of the LF was carried out. The correspondence of the virtual and real position of the mandibular heads was compared.

RESULTS

The absolute difference of glenoid fossa space between the actual and virtual reconstruction was 0.542±0.3354 mm in the anterior joint section (M±δ, M - average mean, δ - standard deviation); for the upper joint section - 0.309±0.2246 mm; and 0.260±0.1862 mm for the posterior section. The integral indicator of surface coincidence (q) when the virtual and actual position are directly compared was 0.296±0.1254 (s.u.).

CONCLUSION

The total margin of error depends on the following factors: repeated scanning error (teeth arches and bite scans), repeated CBCT error, a combination of scan and CBCT error, a combination of teeth arch scan and bite scan error, error of TMJ separation. The latter two factors were the most significant.

Assessment of anterior positioning splint in conjunction with lateral pterygoid BTX injection to treat TMJ disc displacement with reduction - a preliminary report

Objective

Treatment of temporomandibular disc displacement with reduction is controversial. This study assesses the use of an anterior positioning splint with botulinum toxin in the lateral pterygoid muscle (BTX) for such cases.

Methods

Twelve joints were included; groups I and II received BTX injection while group II also received an anterior positioning splint. Pain scores and clicking status were recorded at regular intervals then a postoperative MRI was done after 4 months.

Results

Clinical improvement was noted in both groups. Mean pain scores dropped significantly and clicks in the twelve joints disappeared in 83% of group I and 33% of group II. MRIs showed significant disc position improvement with the higher mean change (1.33 ± 0.76) in group I.

Group I showed better improvement of discal position and only one joint regained a click. Patients of group II reported discomfort from the splint which may have caused psychological distress and so worst pain scores.

Conclusions

Group I  showed slightly better results but the cost of BTX injections and the complications of the splint should be kept in mind and the decision of treatment selection made according to each condition.

Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis

Background

Based on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been elucidated.

Methods

This paper describes known vulnerability factors that make individuals susceptible to developing temporomandibular disorders (TMDs), as well as those that contribute to the perpetuation of such problems. In addition, the topic of iatrogenesis is discussed as a major contributor to the negative outcomes that can be seen in this field.

Results

At the patient level, anatomical, psychosocial and genetic factors may contribute to individual vulnerability. The anatomy and pathophysiology of muscles, joints, disc and nerves may all be involved in predisposing to TMD symptoms, especially when the patients have pain elsewhere in the body. Among the psychosocial factors, some features may be elucidated by the DC/TMD axis II, while others (eg illness behaviour, Munchausen syndrome, lack of acceptance of non‐mechanical approaches) require careful evaluation by trained clinicians. Genetic predisposition to first onset TMDs and to chronification of symptoms has been identified for individuals with certain psychological traits, presence of comorbid conditions and certain abnormal clinical manifestations. Regarding iatrogenesis, sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment. Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification of TMDs. The patients who present with massive occlusal and jaw repositioning changes combined with persistent severe orofacial pain are not a rarity within TMD and orofacial pain canters; these patients are the most difficult ones to manage because of this horrific combination of negative factors.

Conclusions

The information presented in this paper will help clinicians to understand better why some individuals develop temporomandibular disorders, why some of them will progress to becoming chronic patients, and what the appropriate responses may be.

Are occlusal splints effective in reducing myofascial pain in patients with muscle-related temporomandibular disorders? A randomized-controlled trial

Objectives

This study aims to evaluate the effectiveness of upper Michigan occlusal splint (OS) compared to mandibular OS in terms of pain, range of motion (ROM), and muscle activity as assessed by surface electromyography (sEMG) in patients affected by muscle-related temporomandibular disorders (TMD).

Patients and methods

In this randomized-controlled trial, a total of 40 adult patients (13 males, 27 females; mean age: 47.2±12.8 years; range, 22 to 56 years) with a diagnosis of myofascial pain, lasting from at least three months on at least one masseter muscle. The patients were randomly allocated into two groups: Group 1 (n=20) using upper Michigan OS and Group 2 (n=20) using mandibular OS. At baseline (T0), at one (T1), three (T2), and six months (T3), the following outcomes were assessed: myofascial pain by Visual Analog Scale (VAS) and ROM of mandible movements, activity of the main masticatory muscles through sEMG.

Results

There were no significant intra-group differences in the outcome measures assessed in both groups. However, Group 2 had a significantly higher right lateral mandibular ROM at T2 (7.1±3.1 vs. 9.8±2.3, respectively; p<0.05) and a significantly higher left lateral mandibular ROM at T3 (7.6±3.5 vs. 10.5±2.1, respectively; p<0.05). We found no significant difference in none of the sEMG parameters.

Conclusion

Our study results suggest that OS, independently from being built on the upper or lower arch, seems to not have significant effects in reducing pain over a six-month period in TMD patients.

Incobotulinum toxin type A for treatment of chronic myofascial pain

PURPOSE

This study assessed the effectiveness of incobotulinum toxin type A (IBTx) for chronic myofascial pain affecting the masseter and temporal muscles.

METHODS

Twenty two patients who received a diagnosis of chronic masseter and temporalis myofascial pain were evaluated by using a visual analog pain scale (VAS), digital pressure algometry, and the SF-36 Health Survey at baseline (T0), before IBTx injection. Patients were again evaluated at 2 months (T1) and 7 months (T2) after IBTx injection.

RESULTS

VAS scores for pain significantly differed (P = 0.029, Friedman test). Post-hoc tests showed a significant reduction in pain at 2 months (T0-T1) and 7 months (T0-T2) (P = 0.011 and P = 0.028, respectively; Wilcoxon test) but not between 2 and 7 months (P = 0.676; Wilcoxon test). There was no significant difference in pressure algometry values (P = 0.385, Friedman test). Quality of life (QOL) assessment showed a significant difference (P = 0.002, Friedman test). Post-hoc tests showed a significant improvement in QOLat 2 months, but no significant difference at 7 months (P = 0.004 and P = 0.260, Wilcoxon test).

CONCLUSION

IBTx injection resulted in safe, effective short-term pain relief for patients with chronic facial pain affecting the masseter and temporalis muscles.

Evaluation of masticatory muscle response to clear aligner therapy using ambulatory electromyographic recording

INTRODUCTION

Patients undergoing clear aligner therapy (CAT) report muscle tenderness and produce wear facets on their aligner trays. However, little is known about the masticatory muscle response to clear aligners. Here, we measured the activity of the masseter during CAT using ambulatory electromyography. We also explored whether psychological traits modulate the masticatory muscle response to CAT.

METHODS

Using portable data loggers, we recorded the electromyographic (EMG) activity in the right masseter muscle of 17 healthy adults without temporomandibular disorder (16 females, 1 male; mean age ± standard deviation, 35.3 ± 17.6 years) commencing treatment with CAT over 4 weeks, under the following conditions: week 1 without aligners (baseline), week 2 with a passive aligner (dummy), week 3 with their first active aligner (active1), and week 4 with their second active aligner (active2). We used a mixed-effect model to test differences in EMG activity over the 4-weeks and a general linear model to test the effect of psychological traits on EMG activity.

RESULTS

The EMG activity of the masseter increased significantly with aligners compared with baseline. The largest relative increase in EMG activity was seen during the dummy (152%; P <0.001) and active1 (155%; P <0.001) stages. During active2, the activity of the masseter decreased significantly toward baseline levels. Participants' trait anxiety was positively associated with increases in EMG activity (P = 0.027).

CONCLUSIONS

CAT is associated with a transient increase in masticatory muscle activity, possibly because of an increase in wake-time parafunctional tooth clenching. Temporomandibular disorder-free patients adapt well to CAT as the masticatory muscle activity decreases toward baseline levels after 2 weeks.

Effectiveness of physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: protocol of a randomised controlled trial

INTRODUCTION

Temporomandibular disorders (TMDs) are considered a collection of musculoskeletal conditions involving the masticatory muscles, the temporomandibular joint and associated structures. The myogenous group appears to represent the most frequently diagnosed category. In the context of a multimodal approach, splint therapy and musculoskeletal physiotherapy are often considered as a preferred therapy. The purpose of this study will be to investigate the effects of musculoskeletal physiotherapy combined with occlusal splint and education versus occlusal splint and education alone in the treatment of chronic myogenous TMD on pain and mandibular range of motion.

METHODS AND ANALYSIS

All consecutive adults complaining of TMDs presented to the Department of Biomedical and Neuromotor Sciences of the University of Bologna will be considered eligible. Inclusion criteria shall be based on the presence of myogenous TMDs, as diagnosed through clinical examination in reference to the international diagnostic criteria of TMDs. Randomisation, concealed allocation, blinded assessment and intention-to-treat analysis will be employed. The splint therapy will consist of the use of the splint every night and concurrent delivery of an educational programme; the protocol shall have a duration of three consecutive months. The combined musculoskeletal physiotherapy, splint therapy and education will additionally consist of manual therapy techniques and exercise; such protocol shall consist of a duration of three consecutive months, inclusive of 10 sessions for the enhanced elements. All outcome measures will be collected at baseline, after treatment and at a 6 months follow-up.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Independent Ethic Committee in Clinical Research of AUSL Bologna-Italy (47/2018/SPER/AUSLBO). Pursuant to applicable rules,we will obtain informed consent from each participant and collect data anonymously to maintain privacy. Results will be disseminated to clinicians and researchers through peer-reviewed publications and conferences.

TRIAL REGISTRATION NUMBER

NCT03726060.

Does Repositioning of Temporomandibular Joint Disc With Bone Anchors Provide Better Clinical Outcomes Than Conventional Disc Plication Procedures for Anterior Disc Displacements Without Reduction in Patients Refractory to Nonsurgical Treatments?

PURPOSE

Although open temporomandibular joint arthroplasty with discopexy is a common treatment for patients with anterior disc displacements without reduction (ADDWo) unresponsive to medical management, there are no studies comparing disc repositioning with bone anchors and conventional discopexy procedure. The purpose of the study was to compare the efficacy between disc repositioning with bone anchors and the conventional discopexy procedure for ADDWo of temporomandibular joint refractory to medical management.

PATIENTS AND METHODS

A randomized controlled trial was conducted in patients with ADDWo. The primary objective was to compare the improvement in mouth opening (primary outcome variable) between the 2 treatment (primary predictor variable) groups-disc repositioning with bone anchors versus conventional disc plication. Secondary outcome variables were pain measured by visual analog scale, lateral excursions, and position of the disc evaluated by magnetic resonance imaging (MRI). Other variables of interest were age, gender, and duration of symptoms. The parameters were evaluated at preoperative, postoperative day 1, and 1-, 6-, and 12-month postoperative period. Categorical variables were compared with χ² test and continuous variables with analysis of variance and adjusted for multiple comparisons with Bonferroni test.

RESULTS

The study sample comprised 14 patients (7 in each group) with MRI-proven ADDWo. Statistically significant differences were found in the improvement of mouth opening between the 2 groups, showing better improvement with bone anchors (14.42 ± 5.96 vs 7.57 ± 7.25 mm; P < .05). The reduction in visual analog scale also showed statistically significant difference with better pain reduction achieved with bone anchor (4.57 ± 1.61 vs 3.28 ± 0.75; P < .05). There was no statistically significant difference in lateral excursions and postoperative position of the disc evaluated by MRI between the groups at the 12-month follow-up period.

CONCLUSIONS

Disc repositioning with bone anchors provides better clinical outcomes in terms of maximal mouth opening and pain scores compared with conventional disc plication.

Different Treatments in Patients with Temporomandibular Joint Disorders: A Comparative Randomized Study

BACKGROUND AND OBJECTIVES

Temporomandibular joint disorders (TMJDs) are associated with pain and reduced jaw mobility. The aim of this study was to compare the outcome of patients with TMJ arthralgia when submitted to four different treatment modalities, in some cases using intra-articular injections of substances with anti-inflammatory properties and in others, a more conservative approach consisting only of a bite splint. Materials and Methods: The sample was made up of 80 patients, randomly distributed into 4 groups of 20 patients each. Each patient was given a nocturnal bite splint. One of the groups was treated with the bite splint only, while each patient in the other 3 was injected with betamethasone, sodium hyaluronate, or platelet-rich plasma in addition to using the bite splint. Two variables were assessed, namely pain intensity between 0 to 10 according to the visual analogue scale and maximum pain-free mouth opening in mm. The patients were evaluated at four different points: at the beginning of the treatment, as well as one week, one month and six months after initiation.

RESULTS

The results showed that maximum pain-free mouth opening improved in all the groups that made up the sample, with either a reduction in pain severity or with no pain. However, the group injected with platelet-rich plasma yielded the best results after six months, while patients treated with sodium hyaluronate or betamethasone obtained the best results at the end of the first week.

CONCLUSIONS

We concluded that all the treatments used caused a reduction in pain and increased pain-free mouth opening. The splint combined with the platelet-rich plasma injection achieved long-term success.

Adhesive dentistry sensory stimulus technique as a neuromechanism for the treatment of orofacial pain associated to temporomandibular disorders: Case study

Purpose

The authors intend, by presenting a case study, emphasize the neuromodulation process of orofacial pain induced by the stimulation of the sensory and motor stimulation of the trigeminal nerve, which can play an important role on pain modulation.

Materials and methods

A 25 year-old woman presenting orofacial pain was referred to the stomatology service at the Centro Hospitalar do Porto. After collecting the patient's anamnesis, the thermographic camera FLIR i7 was used to record the thermal status of the orofacial structures, before the adhesive dentistry sensory stimulus protocol, after 45 minutes, and after one week.

Results

This study suggests the relation of adhesive dentistry sensory stimulus technique in the neuromodulation of orofacial pain and its association with the temporomandibular disorders . As the tongue senses the stimulus of the resin composite placed on the palatal surface of the 1^st premolar, 2^nd premolar and 1^st molar of the maxilla, this can promote and induce an effect regarding a peripheral nerve neuromodulation resulting in a blockage of the nociceptive trigeminal pathway from temporomandibular disorders.

Conclusion

Orofacial pain is a common complaint among the patients that come to a dentistry appointment, which may have different diagnosis and treatments. A positive effect on the patient's symptomatology was confirmed clinically on subsequent dental appointments and monitored by infrared thermography.

Effect of arthrocentesis on the clinical outcome of various treatment methods for temporomandibular joint disorders

Background

We evaluated the improvement of pain and the increase in mouth opening after temporomandibular joint arthrocentesis and the possible association with various factors such as previous splint treatment, medication, and diagnosis.

Results

We studied 57 temporomandibular joint disorder patients who underwent arthrocentesis at Korea University Anam Hospital. These patients (24 males and 33 females, aged between 15 and 76 years) underwent arthrocentesis that was performed by one surgeon. The degree of mouth opening (assessed using the maximum mouth opening: MMO) and pain (assessed using the visual analog scale: VAS) were assessed pre- and post-arthrocentesis. The study also investigated whether treatment modalities other than arthrocentesis (medication and appliance therapy) were performed. Statistical analysis revealed that there was a significant difference in mouth opening and pain after temporomandibular joint arthrocentesis. Preoperative appliance therapy affected the results of arthrocentesis, but it was not statistically significant. With regard to pain relief, preoperative diagnosis did not show a significant difference. However, with regard to maximum mouth opening, patients with disc displacement without reduction with limited mouth opening (closed lock) showed the highest recovery (11.13 mm).

Conclusion

The average of MMO increase after arthrocentesis was 9.10 mm, and patients with disc displacement without reduction with locking (closed lock) showed most recovery in maximum mouth opening and it was statistically significant. The average pain relief of patients after arthrocentesis was 3.03 in the VAS scale, and patients using anterior repositioning splint (ARS) preoperatively showed the most pain relief.

Application of a Systematic Protocol in the Treatment of TMDs With Occlusal Appliances: Effectiveness and Efficiency in a Longitudinal Retrospective Study With Medium-Term Follow-Up

Objectives:

This study aimed to assess effectiveness, efficiency, and feasibility of a systematic protocol for the choice and management of occlusal splints (OA) in the treatment of temporomandibular disorders (TMDs).

Materials and Methods:

A longitudinal retrospective study was conducted. Two different samples, G1 + G2 (337 patients), between January 2011 and January 2014, were selected according to inclusion and exclusion criteria. G1 was composed of patients visited at Policlinico Umberto I, Head-Neck Department, Sapienza University of Rome, Italy, and patients in G2 visited at a private structure in Rome. Pain records and functionality were compared before (T0) and at the end of therapy (T1). A follow-up group, composed of 100 patients randomly selected among those who completed treatment for at least 1 year (T2), was analyzed and symptomatology records were compared. Descriptive statistical analysis was performed.

Results:

In the entire sample, joint and muscular pain, joint noises and mandibular functionality, headache, and neck pain improved from T0 to T2. The average time for articular and muscular recovery was 6.4 months. Comparing treatment outcomes, there were not statistically significant differences between the two groups.

Conclusions:

Treatment outcomes using this setting of protocol showed a positive trend also in the medium term. The use of a systematic protocol seems to reduce operator-dependent factors.