Pivot appliances ? is there a distractive effect on the temporomandibular joint?

Changes in condylar position using different types of splints with and without a chinstrap: a case-control study

The aim of this case-control study was to analyze and quantify if there is a different mechanical effect of stabilization and pivot splints with uni- or bilateral pivot of different heights and with and without an additional chinstrap, on the vertical, sagittal, and horizontal condyle position. A stabilization splint and splints with unilateral or bilateral posterior pivot support of 0.6 mm or 1.9 mm height were used with and without a chinstrap individually adjusted to 5N per side. Electronic-condylar-position-analysis was performed using an ultrasound-based jaw-tracking system with an accuracy of 0.1 mm. Manual guided central position served as the reference point. Participants were 40 functional, asymptomatic volunteers with a mean age of 33.9 years. Main effect splint design (stabilization, uni-, bilateral pivot) was not significant. Pivoting height was reported as significant (p < or = 0.02) in all axes. Use of the chinstrap was significant (p < or = 0.03) in the X- and Y- axis, but not significant in the Z-axis. A post-hoc test revealed that use of a chinstrap led to significantly (p = 0.003) less anterior and significantly (p = 0.002) more inferior condyle displacement. Results indicate that the use of pivot splints only in combination with a chinstrap lead to a distractive effect of the condyles.

Oral appliances in the management of temporomandibular disorders

Various types of oral appliances (OAs) have been used for over half a century to treat temporomandibular disorders (TMDs), but there has been considerable debate about how OAs should be designed, how they should be used, and what they actually do therapeutically. However, there is enough information in the scientific literature at this time to reach some evidence-based conclusions about these issues. The main focus of this review is on the materials and designs of various OAs in terms of their proposed mechanisms of action and their claimed clinical objectives. Based on current scientific evidence, an analysis is presented regarding the role that OAs can or cannot play in the management of TMDs. Finally, the concept that OAs may be an effective treatment modality for some TMDs owing to their potential for acting as an elaborate placebo rather than any specific therapeutic mechanism is considered.