Occlusal interventions for managing temporomandibular disorders.

BACKGROUND: Temporomandibular disorders (TMD) are conditions related to the musculoskeletal structure of the temporomandibular joint, which may lead to muscle or joint pain and other health issues. TMD may present in muscles only (myogenous), joints only (arthrogenous), or both (mixed), and may affect one side or both sides of the face. Myogenous TMD may present with or without limited mouth opening. Arthrogenous TMD may present as disc displacement with or without reduction ('reduction' meaning the articular disc resumes its normal position when the jaw is moving). Occlusal interventions change the occlusal relationship of maxillary and mandibular teeth to improve the alignment of the tooth contact, with the aim of relieving pain, and improving psychosocial functioning and quality of life. Occlusal interventions include splints and adjustments. Occlusal splints are specially designed mouth guards; they are generally classified as stabilisation, reflex or repositioning splints. Occlusal adjustment is the grinding down of teeth to improve occlusion. OBJECTIVES: To assess the effects of occlusal interventions in people diagnosed with temporomandibular disorders (TMD), compared to other interventions or no treatment, on joint pain, muscle pain at rest and when chewing, quality of life, discomfort, and recurrence. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched following sources up to 9 August 2022: Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Embase via Ovid, and two trials registers. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of occlusal interventions (splints or adjustment) for managing TMD compared with no treatment, placebo, occlusal splint with a different mechanism of action, or other active treatments. DATA COLLECTION AND ANALYSIS: We adopted standard Cochrane methods to select studies, extract and analyse data, assess the risk of bias in the studies, and judge the certainty of the evidence. We reported outcomes as short term (three months or less) or long term (more than three months). MAIN RESULTS: We included 57 studies (2846 participants) that compared occlusal splints with no treatment, placebo, or another treatment. Most of the studies evaluated full hard stabilisation splint (FHSS) as the occlusal splint. We judged only one study to be at low risk of bias. Our key outcomes of interest were self-reported joint pain when chewing, muscle pain at rest and when chewing, discomfort, severity and frequency of joint noise, and recurrence rate. The duration of the studies ranged from 5 weeks to 84 months. The key results presented below were measured between 4.4 weeks and 4 months. It is important to note that we have very low certainty in the evidence for all comparisons and outcomes assessed. There may be little to no difference in self-reported joint pain when chewing between occlusal splint (FHSS) and placebo (non-occlusal splint) (RR 1.88, 95% CI 0.94 to 3.75; 1 study, 60 participants with mixed TMD), or pharmacological therapy (diclofenac) (RR 2.10, 95% CI 0.83 to 5.30; 1 study, 29 participants with osteoarthritis), but the evidence is very uncertain. Occlusal splint (FHSS) may reduce muscle pain when chewing compared to no treatment (MD -1.97, 95% CI -2.37 to -1.57; 1 study, 84 participants with disc displacement without reduction), but may have little to no effect when compared to physical therapy (low-level laser) (RR 0.17, 95% CI 0.02 to 1.26; 1 study, 40 participants) or acupuncture (with needles) (MD 0.10, 95% CI -0.80 to 1.00, 1 study, 40 participants) in people with myofascial pain TMD, but the evidence is very uncertain. There may be little to no difference in muscle pain at rest when occlusal splint (FHSS) is compared to no treatment (MD -11.63, 95% CI -29.37 to 6.11; 1 study, 37 participants) or physical therapy (physiotherapy) (MD -0.19, 95% CI -1.25 to 0.87; 1 study, 72 participants) in myofascial pain TMD, but the evidence is very uncertain. There may be little to no difference in severity of joint noise when occlusal splint (FHSS) is compared to no treatment, but the evidence is very uncertain (MD -0.58, 95% CI -7.09 to 5.93; 1 study, 20 participants). When FHSS is compared to physical therapy (specifically, orofacial myofunctional therapy), physical therapy may reduce severity of joint noise, but the evidence is very uncertain (MD 5.92, 95% CI 0.18 to 11.66; 1 study, 20 participants with mixed TMD). There may be little to no difference in frequency of joint noise when occlusal splint (FHSS) is compared to placebo (non-occlusal splint) (RR 1.18, 95% CI 0.63 to 2.20; 1 study, 60 myofascial pain TMD participants), occlusal splint with a different mechanism of action (RR 0.80, 95% CI 0.07 to 9.18; 1 study, 9 participants with disc displacement with reduction), or physical therapy (jaw exercise) (RR 1.50, 95% CI 0.32 to 6.94; 1 study, 18 participants with myofascial pain TMD), but the evidence is very uncertain. Discomfort and recurrence rate were not reported in any study. We judged the certainty of the evidence to be very low for all outcomes in all comparisons due to limitations in study design and imprecision. AUTHORS' CONCLUSIONS: This review included 57 RCTs with 2846 participants, but the final results are inconclusive, so the research questions remain unanswered. Occlusal splints of the FHSS type may reduce muscle pain when chewing compared to no treatment, but the evidence is very uncertain. Orofacial myofunctional therapy may reduce severity of joint noise compared to occlusal splint (FHSS), but the evidence is very uncertain. For all other comparisons and outcomes, there may be little or no difference between groups, although the evidence is also very uncertain for these findings. Overall, we found insufficient evidence to reach conclusions regarding the effectiveness of occlusal interventions for managing symptoms of TMD, despite the available studies including almost 3000 participants. To make a useful contribution to the debate about the best way to treat TMD, any further research must be well-designed, with enough participants to reach the optimal information size for meaningful results; it requires recruitment from primary care, consensus around key outcomes and measures, and, ideally, long-term follow-up of three to five years, plus inclusion of a cost-effectiveness component.

The preliminary study of the effects of individual musculoskeletally stable position in the treatment of temporomandibular disorders.

BACKGROUND: Temporomandibular Disorders (TMD) is the dysfunction of group of muscles and bones in the joint area, the main symptoms of TMD are the pain of the chewing muscles and (or) the temporomandibular joints, mandibular movement disorders and joint noise. This study was designed to explore the therapeutic effects following Individual Musculoskeletally Stable (IMS) position stabilization splint therapy for TMD patients using Fricton index, cone beam computed tomography (CBCT) and surface-Electromyogram (sEMG). METHODS: In this study, we enrolled 31 TMD patients (ranging from 18 to 26 years old, including 7 males and 24 females), first Fricton index was used to evaluate the clinical curative effect of TMD with the treatment of IMS stabilization splint; then CBCT was used to observe the TMJ condylar position changes of TMD before and after the treatment of IMS stabilization splint; finally sEMG was used to observe the changes of electromyography of anterior temporalis (AT) and masseter muscles (MM) of TMD before and after the treatment of IMS stabilization splint. RESULTS: The course of treatment was 6-8 months, with an average of 7.6 months. After the IMS stabilization splint treatment, TMD symptoms relieved, especially in pain, mandibular movement disorder, but still slightly inferior in the treatment of joint noise. And there was a statistically significant difference in the anterior and inner joint space, the condyle had the tendency of moving forward and outward. AT presented reduction significantly of EMG value at rest position after treatment. CONCLUSIONS: IMS stabilization splint is a therapeutic reversible treatment for TMD, especially for pain and mandibular movement disorder; it produces effects of forward and outward condylar movement and elimination of the masticatory muscles antagonism.

3D printed versus milled stabilization splints for the management of bruxism and temporomandibular disorders: study protocol for a randomized prospective single-blinded crossover trial.

BACKGROUND: Nowadays, stabilization splints for the management of bruxism and temporomandibular disorders (TMD) can be produced utilizing a digital workflow comprising a digital impression of the teeth, digital splint design, and computer-aided manufacturing of the splints. The latter is usually a milling process, however, more recently 3D printing gained popularity due to its better cost and time efficiency. It remains unknown whether 3D printed stabilization splints are inferior to milled splints regarding clinical outcomes. METHODS: This clinical trial assesses the non-inferiority of 3D printed occlusal splints compared to milled occlusal splints in a monocentric prospective randomized single-blinded crossover trial with two cohorts. One cohort includes 20 participants with bruxism, the other 20 participants with pain-related TMD, i.e., myalgia, myofascial pain, or arthralgia of the jaw muscles/the temporomandibular joint(s) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Michigan-type stabilization splints are fabricated in a digital workflow by milling or 3D printing using CE-marked materials within their intended purpose. The participants wear a milled and a 3D printed splint in a randomized order for 3 months each, with follow-up visits after 2 weeks and 3 months. Investigated outcome parameters are oral health-related quality of life (OHRQoL) evaluated by the Oral Health Impact Profile (OHIP-G14), participant satisfaction as rated on a visual analog scale, therapeutic efficacy, and technical result of the splints. In this context, therapeutic efficacy means antagonist wear and-in the TMD group-reduction of pain/disability assessed by the Graded Chronic Pain Scale (GCPS v2.0) and clinical assessment following the DC/TMD standard, while technical outcome measures splint fit, wear and fracture rate. DISCUSSION: The trial will provide important information on the clinical outcome of 3D printed stabilization splints in comparison to milled splints and will, therefore, enable an evidence-based decision in favor of or against a manufacturing process. This, in turn, will guarantee for a maximum of the patient's OHRQoL during splint therapy, therapeutic efficacy, and longevity of the splints. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00033904. Registered on March 15, 2024.

Physical therapy and non-surgical manual disc reduction combined with anterior repositioning splint for acute disc displacement without reduction of the temporomandibular joint in adolescents.

OBJECTIVES: Current studies on the treatment of adolescent patients with disc displacement without reduction (DDWOR) are limited by short follow-up periods and small sample sizes, and there are few comparative studies on the efficacy of conservative treatment with and without disc reduction for acute DDWOR. This study compared the therapeutic effects of two conservative treatment methods: physical therapy alone and physical therapy combined with non-surgical manual disc reduction and anterior repositioning splints (ARS), in adolescent patients with acute DDWOR. MATERIALS AND METHODS: This retrospective study included adolescent patients with DDWOR who underwent physical therapy at the Temporomandibular Joint Rehabilitation Department of the Shanghai Ninth People's Hospital from January 2018 to December 2021. Patient assessment data were collected before and after treatment. Patients were followed up through telephone and online questionnaires from March to August 2023. RESULTS: The results indicate that compared to physical therapy alone, the combination of physical therapy and non-surgical manual disc reduction with ARS showed better short-term efficacy, improved mouth opening, and better long-term pain control. Also, it may be effective in preventing degenerative joint disease. CONCLUSIONS: This combination therapy is recommended for clinical application in adolescent patients with acute DDWOR. CLINICAL RELEVANCE: The present research demonstrates the superior efficacy of physical therapy and non-surgical manual disc reduction combined with anterior repositioning splint in adolescent patients with acute DDWOR.

Impact of occlusal stabilization splints on global body posture: a prospective clinical trial.

OBJECTIVES: Body posture of patients with temporomandibular disorders (TMD) has been investigated using different methods, whereas outcome and conclusions were controversial. The present clinical trial aimed to investigate the effects of splint therapy on global body posture. MATERIALS AND METHODS: 24 subjects (20 females, 4 males; age 24.2 ± 4.0 years) with TMD symptoms were examined clinically (RDC/TMD) and subsequently, splint fabrication was initiated. Along with routine therapy, all subjects underwent three-dimensional pre- and post-treatment full body scans in standing and upright sitting posture using a Vitus Smart XXL 3D scanner. Each scan was acquired in triplicate and evaluated in duplicate, measuring twelve standing and nine sitting postural parameters. Influencing factors were analyzed using analysis of variance (ANOVA), and additional Bland-Altman analyses verified the significance of the ANOVA results. RESULTS: The increase of Forward Head angles and the decrease of Round Shoulders angles were consistent for both positions and sides. Forward Head angles were significantly influenced by limited mandibular mobility and myofascial pain. Round Shoulders angles showed a significant correlation with myofascial pain, joint noises and the absence of limited mandibular mobility. CONCLUSION: The influence of occlusal splints on global posture is limited and only small effects on cervicocranial parameters were found. In the present study, the average head position of post treatment measurements was more centered on the body's core, whereas the shoulders were tilted more anteriorly. CLINICAL RELEVANCE: Understanding the limited influence of occlusal splints on cervicocranial parameters underscores the need for multimodal treatment strategies for TMD patients.

Cameo and intaglio surface stability and variability of additively, subtractively, and conventionally manufactured occlusal devices after long-term storage.

STATEMENT OF PROBLEM: Additive and subtractive manufacturing have become alternative technologies for fabricating occlusal devices. However, knowledge of the long-term stability of occlusal devices fabricated using these recent technologies is limited. PURPOSE: The purpose of this in vitro study was to evaluate the cameo and intaglio surface stability and variability of additively, subtractively, and conventionally manufactured occlusal devices after 18 months of storage. MATERIAL AND METHODS: A standard tessellation language (STL) file of a dentate maxillary typodont was used to design a master occlusal device. The STL file of this design was used to fabricate occlusal devices additively either with a digital light processing (AM-1) or a continuous liquid interface production (AM-2) printer, subtractively with 2 different 5-axis milling units (SM-1 and SM-2), and conventionally (TM-HP) (n=10). STL files of each device's cameo and intaglio surfaces were generated using a laboratory scanner after fabrication and after 18 months of storage in a moist environment. These generated files were imported into an analysis software program (Geomagic Control X) to analyze the dimensional stability of tested devices by using the root mean square method. The average deviation values defined the variability of measured changes over time. Cameo and intaglio surface deviations were analyzed using the Kruskal-Wallis and Dunn tests, while the variability of measured deviations was analyzed with 1-way analysis of variance and the Tukey HSD tests (α=.05). RESULTS: Significant differences were observed among tested devices when the intaglio surface deviations and the cameo surface variability were considered (P<.001). SM-2 had significantly higher intaglio surface deviations than AM-1, SM-1, and AM-2 (P≤.036). Among the test groups, AM-1 had the greatest cameo surface variability (P≤.004). CONCLUSIONS: SM-2 resulted in lower intaglio surface stability than the additive and the other subtractive manufacturing technologies, while AM-1 led to the highest cameo surface variability among the test groups.

Evaluation of intra-articular injection of injectable platelet-rich fibrin, anterior repositioning splint and arthrocentesis in treatment of temporomandibular joint internal derangement.

The current research paper was designed to assess the impact of an intra-articular injection of injectable platelet-rich fibrin (I-PRF) following arthrocentesis and the use of an anterior repositioning splint (ARS) as a proposed treatment approach for addressing symptomatic internal derangement of the temporomandibular joint (TMJ). This study comprised thirty patients who presented with bilateral disc displacement without reduction. The patients were evenly distributed into two groups: Group I underwent treatment involving ARS and arthrocentesis alone, while Group II underwent treatment with ARS, arthrocentesis, and the injection of I-PRF. Clinical assessment of all patients was done postoperatively in the following intervals; first week, first month, third month, and six months for maximum mouth opening (MMO), right and left lateral excursion, and pain score. Magnetic resonance imaging (MRI) assessment for all joints was done at the sixth month postoperatively. Both groups demonstrated improvement in MMO, lateral excursion, and pain. Significant statistical differences were observed in the mean values of MMO and Visual Analogue Scale (VAS), favouring the I-PRF group. MRI postoperatively showed no significant changes in disk position or morphology at the end of the sixth month. Administering an intra-articular I-PRF injection subsequent to arthrocentesis demonstrates effectiveness as a treatment approach for alleviating the signs and symptoms associated with internal derangement of the TMJ.

Lifespan of Splints in a Sample of German Soldiers Hospitalised with Post-traumatic Stress Disorder (PTSD) in Combination with Sleep Bruxism and Painful Temporomandibular Disorder (TMD).

PURPOSE: This cross-sectional longitudinal observational study aimed to clarify the question of whether painful temporomandibular disorders (TMD) in psychiatrically confirmed patients hospitalised for post-traumatic stress disorder (PTSD) therapy after using splint therapy (ST) show long-term therapeutic effects in the case of functional disorders. MATERIALS AND METHODS: One hundred fifty-three (153) inpatients (123 male and 20 female soldiers, age 35.8 ± 9.2 years, 26.6 ± 2.2 teeth) with confirmed PTSD (Impact of Event Scale - Revised ≥33), grade 3 to 4 chronic pain according to von Korff's Chronic Pain Scale and the research diagnostic criteria of painful TMD (RDC-TMD) were recorded. All participants received a maxillary occlusal splint that was worn at night. Control check-ups of the therapeutic effect of the splint were conducted for up to 9 years during psychiatric follow-ups. RESULTS: TMD pain worsened in 22 (14.4%) patients within the first 6 weeks and led to the removal of the splint. The pain intensity (PI) at BL was reported to be a mean of VAS 7.7 ± 1.1. Six weeks after ST (n = 131), the average PI was recorded as VAS 2.6 ± 1.3. Based on the last examination date of all subjects, the average PI was recorded as 0.7 ± 0.9. Seventy-two (72) patients used a second stabilisation splint in the maxilla after 14.4 ± 15.7 months, and 38 patients used between 3 and 8 splints during their psychiatric and dental treatment time (33.7 ± 29.8 months). CONCLUSION: The presented data shows that therapeutic pain reduction remained valid in the long term despite continued PTSD. The lifespan of a splint seems to be dependent on individual factors. Long-term splint therapy appears to be accepted by the majority of patients with PTSD and painful TMD.

The development of a novel bidirectional fine-tuning mandibular advancement device.

OBJECTIVE: To develop a novel mandibular advancement device (MAD) with high comfort, good compliance, and bidirectional fine-tuning capability for patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and to evaluate the therapeutic efficacy of the new MAD. METHODS: The MAD, featuring upper and lower dental splints with a fine-tuning mechanism for mandibular adjustment, incorporates improved design elements such as partial dental coverage, shortened baffles, and memory resin lining. The novel MAD was used to treat 30 OSAHS patients in the study, comparing pre- and post-treatment scores on the Epworth Sleepiness Scale (ESS), the Apnea-Hypopnea Index (AHI), and the lowest oxygen saturation (LSO2). RESULTS: The novel MAD reduced size and side effects, enhancing comfort. All patients complied well, using it for an average of 95% over 30 days and ≥ 5 h nightly. After treatment, significant improvements were observed in ESS, AHI, and LSO2 (P < 0.05). CONCLUSIONS: This novel bidirectional adjustable MAD provides high comfort and compliance, improving treatment precision. It is an effective choice for mild to moderate OSAHS patients and an alternative for those intolerant to CPAP or averse to surgery.

Temporary Hydrostatic Splint Therapy and Its Effects on Occlusal Forces.

Background and objectives: This study analyzed and compared the distribution patterns of occlusal forces using T-Scan III before and after the hydrostatic temporary oral splint (Aqualizer Ultra) therapy in healthy subjects and subjects with temporomandibular disorders (TMDs). Materials and Methods: Fifty-one subjects were divided into groups based on anamnesis and responses to the Fonseca questionnaire. The first group, non-TMDs group (n = 19), and the second group, TMDs group (n = 32), had mild-to-severe TMDs, as identified by the Fonseca questionnaire. The non-TMDs group had an average age of 25.4 years (SD = 4.8, range 20-38) with 15 females (78.95%) and 4 males (21.05%). The TMDs group had an average age of 27.4 years (SD = 7.0, range 22-53) with 25 females (78.125%) and 7 males (21.875%). T-Scan III device was used for occlusal analysis before and after hydrostatic splint usage. Results: Significant differences were observed in the TMDs group for anterior and posterior right percentages of forces before and after hydrostatic splint usage. The analysis of force distribution per sector before and after hydrostatic splint therapy showed no significant differences in the non-TMDs group. Analysis of force distributions in the entire study population before and after hydrostatic splint therapy showed significant differences in the anterior and posterior right regions. Occlusal force increased by 32-56% in the front region and decreased in the posterior area after hydrostatic splint usage. Conclusions: Hydrostatic splint therapy is recommended as a part of full-mouth rehabilitation treatment for all patients regardless of the severity of TMDs.

Stabilisation Splint versus Other Conservative Therapies for the Treatment of TMD: A Systematic Review.

The purpose of this systematic review was to compare the effectiveness of stabilisation splint (SS) with other conservative treatment modalities in the management of temporomandibular disorders (TMD). An electronic search in PubMed, Google Scholar, and Cochrane was conducted to find randomised control trials published on the management of temporomandibular disorders in English language from March 2000 to June 2023 along with manual search in the relevant Journal of Prosthetic Dentistry, the American Journal of Prosthodontics, and the Journal of Oral Rehabilitation. A total of 64 studies were initially considered, out of which eight studies fulfilled the inclusion criteria. Furthermore, RoB-2 analysis tool was used for checking the risk of bias in the included studies. On comparing the readings and outcomes, only one study showed that the SS was better than the comparators. The review identified that there is weak evidence of effectiveness of SS splint therapy over other conservative therapies for the treatment of TMD. Key Words: Splints, Conservative treatment, Pain measurement, Temporomandibular disorders.

Evaluation of the efficacy and quality of life in patients with temporomandibular joint disorders treated with Kovacs digital occlusal splint: a pilot study.

BACKGROUND: Few studies have been conducted on treating temporomandibular disorders (TMDs) with new digital occlusal splints, which has increasingly attracted wide attention. METHODS: To evaluate the clinical efficacy and quality of life (QoL) of Kovacs digital occlusal splint (KDOS) treatment in patients with TMD. MATERIALS AND METHODS: Eighty-nine patients with TMD who were treated using KDOS were analyzed. The patients were divided into three groups according to the Wilkes stage. The clinical symptoms and QoL scores of the patients in each group were recorded before and at least three months after treatment, and the data were statistically analyzed and compared. The relationships between the disease severity, sex, age, and level of QoL before treatment and improvement in the clinical symptoms were analyzed using binary logistic regression. RESULTS: The mean age and follow-up period of the patients were 28.0 ± 10.4 years and 4.9 ± 2.1 months, respectively. After KDOS treatment, the improvement rates of joint noise and pain were 80.4% and 69.8%, respectively. Additionally, the patients' maximum mouth opening and global QoL mean scores significantly improved compared to those before treatment (p < 0.001). Binary logistic regression analysis revealed that the factors affecting the improvement in the clinical symptoms were disease severity and level of QoL before treatment. CONCLUSIONS: KDOS can improve the clinical symptoms and QoL of patients with TMD. Moreover, patients without osteoarthritis and with low pretreatment QoL levels are more likely to demonstrate clinical improvement. TRIAL REGISTRATION: The trial was registered with Chinese Clinical Trial Registry (ChiCTR) (ID: ChiCTR2300076518) on 11/10/2023.

Uso de overlays controlados electromiográficamente y su combinación con el tratamiento con alineadores / Use of electromyographically controlled overlays and their combination with and its combination with treatment with aligners

La dimensión vertical (DV) usualmente disminuye con el paso del tiempo y es uno de los objetivos más complicados en resolver en los casos de Ortodoncia, ya sea con brackets o con alineadores. Esta disminución de la DV tiene una influencia directa en el funcionamiento de la articulación temporomandibular (ATM). Las patologías de la ATM, que surgen por la pérdida de la DV, son usualmente tratadas en la fase I con placas que restablecen la posición articular y la función muscular. Luego de corregida la patología de la ATM, en la fase II hay que tratar en lo posible la oclusión, devolviendo al paciente un soporte fisiológico posterior. Aquí se presenta un caso clínico atendido con una Placa Neurofisiológica (PN) en la fase I, y en la fase II, el traslado de esta altura a los overlays (O) y su erupción posterior dentaria con alineadores. Controlando cada paso electromiográficamente para el restablecimiento y control de la función muscular.

The vertical dimension usually decreases over time and is one of the most complicated objectives to solve in Orthodontic cases, whether with braces or aligners. This decrease in vertical dimension has a direct influence on the physiology of the temporomandibular joint. TMJ pathologies that arise from the loss of vertical dimension are usually treated in Phase I with splints that restore joint position and muscle function. After correcting the TMJ pathology, in Phase II, the occlusion should be treated as much as possible, returning the patient to a physiological posterior support. A clinical case is presented involving treatment with a Neurophysiological Splint in the first phase, and in the second phase, the transfer of this height to overlays and subsequent dental eruption with aligners. Each step is electromyographically monitored for the restoration and control of muscle function.

Restablecimiento de guía anterior con restauraciones adhesivas / Reestablishing of anterior guidance with adhesive restorations

La estética ha llegado a formar una parte muy importante en la odontología actual. Sin embargo, no debemos sobreponer las necesidades estéticas sobre las necesidades funcionales. La pérdida de estructura dental asociada a bruxismo puede ser considerada patológica cuando compromete la guía anterior, la cual es la influencia en los movimientos mandibulares que proveen las superficies contactantes de los dientes maxilares anteriores con los mandibulares anteriores y evita contactos excéntricos dañinos en los dientes posteriores. El objetivo de este reporte de caso es presentar una alternativa conservadora para restablecer tanto la estética como la funcionalidad de una paciente de 34 años de edad que acudió a la Clínica de Prostodoncia de la Universidad Autónoma de Guadalajara en busca de rehabilitación estética de dientes anteriores. Una vez realizada su evaluación inicial se llegó al diagnóstico de pérdida de guía anterior por desgaste patológico asociado a bruxismo. El tratamiento incluyó tratamientos de conductos, remoción de caries y restauraciones mal ajustadas, coronas y carillas para restablecer la guía anterior. Se cumplieron con las expectativas estéticas que tenía la paciente al igual que con las necesidades funcionales que fueron objetivo desde el inicio, logrando un restablecimiento de la guía anterior de manera conservadora (AU)

Esthetics has become a very important part of dentistry today. However, we should not superimpose esthetic needs over functional needs. The loss of tooth structure associated with bruxism can be considered pathologic when it compromises the anterior guidance, which is the influence on mandibular movements that provides the contacting surfaces of the maxillary anterior teeth with the mandibular anterior teeth and avoids damaging eccentric contacts in the posterior teeth. The aim of this case report is to present a conservative way to restore both esthetics and function in a 34-year-old patient who came to the Prosthodontics Clinic of the Universidad Autónoma de Guadalajara in search of an esthetic appearance of her anterior teeth. After her initial evaluation, a diagnosis of anterior guide loss due to pathological wear associated with bruxism was made. Treatment included root canal treatment, removal of caries, and ill-fitting restorations, crowns, and veneers to reestablish the anterior guidance. The aesthetic expectations of the patient have met as well as the functional needs that were aimed from the beginning, achieving a conservative reestablishment of the anterior guidance system (AU)

Effectiveness of Ultrasound Therapy, TheraBite Device, Masticatory Muscle Exercises, and Stabilization Splint for the Treatment of Masticatory Myofascial Pain: A Randomized Controlled Trial.

BACKGROUND: Myofascial pain syndrome (MPS) is a particular type of temporomandibular joint disorder. Research findings comparing various treatment approaches are scarce and controversial. Therefore, this study aimed to compare the effectiveness of ultrasound therapy, stabilization splint, TheraBite device, and masticatory muscle exercises in reducing pain intensity and improving mandibular mobility in patients with MPS. METHODS: It was a single-blind, randomized, parallel-group, active-controlled trial that took place between April 2023 and October 2023 at the Department of Fixed Prosthodontics, Damascus University. Patients older than 18 years old with myofascial pain accompanied by limited jaw opening and pain lasting for at least 6 months were included. Eighty patients were randomly assigned into four groups using online randomization software: ultrasound therapy, stabilization splint, TheraBite device, and masticatory muscle exercises. Only outcome assessors were masked to treatment allocation. The exercise regimen was the exercise program for patients with TMD. The following primary outcome measures were considered at the baseline (t0), at the first (t1), second (t2), and fourth (t3) week of treatment, and at the second (t4) and fifth (t5) month of follow-up: pain intensity using the visual analogue scale, maximum interincisal opening, right lateral movement, and left lateral movement measured in millimeters. RESULTS: The pain level changed from severe to mild at t3 in ultrasound therapy, stabilization splint, and TheraBite device groups. In the masticatory muscle exercises group, it changed to moderate, with a significant difference between ultrasound therapy (p = 0.012) and stabilization splint (p = 0.013) groups. In addition, the mandibular mobility continued to improve at the subsequent follow-up periods (t4 and t5). CONCLUSIONS: All therapies are equally effective after 5-month follow-up. However, ultrasound therapy and stabilization splints have the benefit of achieving rapid improvement. TRIAL REGISTRATION: ISRCTN20833186.

Study of axiography changes in patients with temporomandibular joint dysfunction.

OBJECTIVE: Aim: To determine the effectiveness of treatment of temporomandibular joints muscle and joint dysfunction with occlusive splints based on the analysis of axiography data. PATIENTS AND METHODS: Materials and Methods: 274 (two hundred and seventy-four) patients aged 18 to 44 years with a diagnosis of temporomandibular joints dysfunction before and after treatment. RESULTS: Results: All patients with signs of temporomandibular joints dysfunction before treatment had a violation of the movement trajectory of the lower jaw: deviation - 68.7%, diflexion - 31.3%. When opening and closing the mouth, asymmetric shifts of the lower jaw of more than 2 mm were observed. After treatment with occlusive splints, the correct trajectory of opening and closing the mouth was noted: the number of patients with a trajectory violation decreased by 89.1%, and the amount of displacement of the lower jaw during opening and closing the mouth in 92.4% of patients decreased on average to 0.9 mm. When analyzing the movements of the lower jaw in the sagittal plane, deviations of the trajectory of the lower jaw were found in 79% of clinical cases. After the treatment using occlusive splints, 93.4% of cases of mandibular movement trajectory violations in the transversal plane were eliminated, and 78.1% of patients had a reduction in displacement volume to 0.9 mm. When analyzing the movements of the lower jaw in the sagittal plane, deviations of the trajectory of the lower jaw were found in 79% of clinical cases. After the treatment using occlusive splints, 93.4% of cases of mandibular movement trajectory violations in the transversal plane were eliminated, and 78.1% of patients had a reduction in displacement volume to 0.9 mm. CONCLUSION: Conclusions: Movement trajectories of the lower jaw in the sagittal plane improved in 80.1% of patients, normalization of the position of the lower jaw in relation to the neuromuscular trajectory was achieved in 93.4% of clinical cases. According to the analysis of the parameters, this treatment should be considered effective.

Arthrocentesis versus occlusal coverage splints in the management of disc displacement without reduction: a systematic review and meta-analysis.

Disc displacement without reduction (DDwoR) can cause pain and limitations in mouth opening, with a significant impact on function. The optimal management strategy for DDwoR is unclear. Treatments include conservative management such as mandibular manipulation, occlusal splints, and patient education/self-management, as well as arthrocentesis, which is a minimally invasive procedure. The aim of this systematic review and meta-analysis was to ascertain whether there is a role for arthrocentesis in the management of DDwoR. Studies analysing the outcomes pain and maximum mouth opening (MMO) in patients with DDwoR treated by arthrocentesis or occlusal coverage devices were eligible for inclusion. Following a database search, six studies with a total of 343 participants were found to be eligible for analysis (three prospective observational studies, one retrospective observational study, one non-randomized single-blind clinical trial, and one unblinded randomized clinical trial). When compared to occlusal coverage splints, arthrocentesis demonstrated a slight improvement in pain, although this was statistically non-significant (standardized mean difference (SMD) -0.50, 95% confidence interval (CI) -1.04 to 0.05, P = 0.07; I2 = 81%), and a significant improvement in MMO (SMD 0.79 mm, 95% CI 0.24-1.35 mm, P = 0.005; I2 = 79%). However, due to the significant heterogeneity between studies and the high risk of bias, along with the paucity of double-blind randomized controlled clinical trials, definitive conclusions cannot be drawn for this clinical question.

Effectiveness of bruxism treatment in young adults.

OBJECTIVE: Aim: This study aimed to assess the effectiveness of the developed algorithm for treatment and prevention measures aimed at eliminating clinical manifestations of bruxism in young people. PATIENTS AND METHODS: Materials and Methods: A cohort of 377 individuals aged 25 to 44 years underwent examination. Based on identified etiological factors, three distinct groups were delineated. Treatment and preventive strategies were then implemented and evaluated. Tailored treatment algorithms were devised for each group: Group one received selective grinding of supracontacts (up to 0.5-0.75 mm) and treatment for orthodontic issues utilizing removable and fixed orthodontic structures. Group two underwent finger self-massage of masticatory muscles, fabrication of biting dental splints, and anti-inflammatory drug therapy. Group three received sedative drug therapy in conjunction with psychiatric consultation, based on indications. Treatment efficacy was assessed 12 months post-initiation. Statistical analyses were conducted using Statistica 10.0 (StatSoft, Inc., USA) and Microsoft Office Excel 2010. RESULTS: Results: In cases where orthodontic pathology and supracontacts predominated (r=0.99, p<0.05), employing selective grinding and orthodontic treatment according to specific indications yielded significant efficacy. This approach resulted in a notable reduction in bruxism severity, corroborated by occludogram results 12 months post-treatment initiation. Notably, 90.0% of occludogram indicators fell within the 90-100% range, accompanied by a decrease in the BruxChecker abrasion facets area (p<0.05). Further, there was a substantial enhancement in occlusal contacts (Ck=0.68, Ck =0.71, Ck =0.93). In instances where TMJ pathology predominated with high reliability (r=0.98, p<0.05), effective normalization of masticatory muscle tone and alleviation of temporomandibular joint issues were observed. After 12 months, palpation revealed minimal tenderness in specific muscle areas and normalization of electromyography readings from initial indicators (p<0.05). Moreover, when the psycho-emotional factor primarily contributed to bruxism etiology (r=0.97, p<0.05), medical intervention proved effective. This approach led to bruxism disappearance and normalization of the psycho-emotional state within 12 months (p<0.05). CONCLUSION: Conclusions: The conducted studies provide high-confidence evidence of the effectiveness of bruxism treatment when diagnosing the prevailing etiological factor and targeting its specific impact, leading to the normalization of all other factors, a reduction in bruxism intensity, and its complete disappearance.

Is there a superiority between arthrocentesis and stabilizing occlusal splint for the treatment of anterior disc displacement with reduction and intermittent block and anterior disc displacement without reduction in TMJ? Randomized clinical trial.

INTRODUCTION: Anterior displacement of the temporomandibular joint (TMJ) disc is a disorder in which the articular disc is dislocated from its correct position relative to the mandibular condyle and mandibular fossa. Traditionally, the initial treatment of disc displacements involves various conservative measures, including the use of a stabilizing interocclusal splint. However, in cases where there is associated limited mouth opening, as in the case of anterior disc displacement with reduction and intermittent block (ADDwRIB), and anterior disc displacement without reduction (ADDw/oR), arthrocentesis has been suggested as another modality of initial treatment due to its faster effect in preventing disease progression to a more advanced stage, as well as reducing the chances of pain chronification and central sensitization. OBJECTIVES: This study aimed to analyze whether there is a preponderance in efficacy between treatments with a stabilizing interocclusal splint or arthrocentesis in these patients. METHODS: A randomized, prospective, longitudinal clinical trial was conducted. The sample was obtained by convenience, between June 2021 and January 2023. Twenty-four patients with diagnoses of ADDwRIB and ADDw/oR were included. The diagnosis and clinical evaluations followed the DC/TMD criteria, and TMJ MRI was performed. Patients were randomly allocated to 2 treatment groups. Group 1 (n = 13): stabilizing interocclusal splint. Group 2 (n = 11): arthrocentesis. Patients were evaluated after 1, 2, 3, and 6 months for clinical parameters of pain, functionality, and psychosocial status. RESULTS: Both treatments were effective in reducing pain levels, with no statistically significant differences. Group 1 showed significantly greater mouth-opening levels compared to Group 2 (P = .041). CONCLUSION: Both groups showed significant improvements in various parameters evaluated throughout the study, indicating they are equally effective in pain control and most functional and quality of life parameters. However, the stabilizing interocclusal splint treatment was superior in restoring mouth opening.