An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders.

Anterior repositioning splint (ARS) therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders (TMDs), which account for a large proportion of TMD cases. Owing to the wide application of this therapy, the exact mechanism of remission has increasingly drawn attention. Given that practitioners have different views on ARS therapy, its indications are broadened, and operating methods diverged. This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods. Representative views in the past 10 years were summarised, and conclusions were drawn as follows: The mechanism of ARS therapy is mainly attributed to internal derangement correction, improvement of stress distribution and recently reported joint remodeling. It has an evident effect in the short term, and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3-6 months. However, long-term stability is not optimal, and thus indications should be selected carefully. Notably, most of the clinical studies in this field are case analyses with low-quality evidence. Well-designed RCTs are required to further validate relevant theories.

Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations.

BACKGROUND: Temporomandibular Disorders (TMD) may be characterized by pain and restricted jaw movements. In the absence of somatic factors in the temporomandibular joint, mainly myogenous, psychobiological, and psychosocial factors may be involved in the aetiology of myogenous TMD. An occlusal appliance (splint) is commonly used as a basic therapy of the dental practice. Alternatively, a type of physiotherapy which includes, apart from massage of sore muscles, aspects of cognitive-behavioural therapy might be a basic therapy for myogenous TMD. Treatment outcome of physiotherapy (Ph-Tx) was evaluated in comparison to that of splint therapy (Sp-Tx), using the index Treatment Duration Control (TDC) that enabled a randomized controlled trial with, comparable to clinical care, therapy-and-patient-specific treatment durations. METHODS: Seventy-two patients were randomly assigned to either Ph-Tx or Sp-Tx, with an intended treatment duration between 10 and 21 or 12 and 30 weeks respectively. Using TDC, the clinician controlled treatment duration and the number of visits needed. A blinded assessor recorded anamnestic and clinical data to determine TDC-values following treatment and a 1-year follow-up, yielding success rate (SR) and effectiveness (mean TDC) as treatment outcomes. Cohen's d, was determined for pain intensity. Overall SR for stepped-care was assessed in a theoretical model, i.e. a second of the two studied therapies was applied if the first treatment was unsuccessful, and the effect of therapy sequence and difference in success rates was examined. RESULTS: SR and effectiveness were similar for Ph-Tx and Sp-Tx (long-term SR: 51-60%; TDC: -0.512- -0.575). Cohen's d was 0.86 (Ph-Tx) and 1.39 (Sp-Tx). Treatment duration was shorter for Ph-Tx (on average 10.4 weeks less; p < 0.001). Sp-Tx needed 7.1 less visits (p < 0.001). CONCLUSIONS: Physiotherapy may be preferred as initial therapy over occlusal splint therapy in stepped-care of myogenous TMD. With a similar SR and effectiveness, physiotherapy has a shorter duration. Thus patients whose initial physiotherapy is unsuccessful can continue earlier with subsequent treatment. The stepped-care model reinforces the conclusion on therapy preference as the overall SR hardly depends on therapy sequence. TRIAL REGISTRATION: isrctn.com/ISRCTN17469828 . Retrospectively registered: 11/11/2016.

Precision occlusal splints and the diagnosis of occlusal problems in myogenous orofacial pain patients.

Myogenous orofacial pain is a common nondental pain. There is an unresolved debate on the etiology of this problem. Research has shown that occlusal interferences affect masticatory muscle comfort, coordination, and function. Resolution of these problems with precise occlusal correction indicates that dental occlusion is a causative or contributory factor in myogenous orofacial pain. However, some studies fail to confirm this and instead conclude that occlusion is unrelated to masticatory muscle pain or dysfunction. An explanation for this discrepancy in findings is that these nonconfirmatory studies had not documented any pretreatment or corrected occlusion. Diagnostic casts mounted in centric relation and precision occlusal splints are accurate modalities to diagnose the occlusal problem and its correction in a patient with myogenous orofacial pain. Computerized digital occlusal analysis provides objective data of occlusal contact time and force to accurately assess diagnosis and treatment. The rationale and requirements for proper occlusal splint fabrication with a verified therapeutic occlusion are presented.

A digital process for additive manufacturing of occlusal splints: a clinical pilot study.

The aim of this study was to develop and evaluate a digital process for manufacturing of occlusal splints. An alginate impression was taken from the upper and lower jaws of a patient with temporomandibular disorder owing to cross bite and wear of the teeth, and then digitized using a table laser scanner. The scanned model was repaired using the 3Data Expert software, and a splint was designed with the Viscam RP software. A splint was manufactured from a biocompatible liquid photopolymer by stereolithography. The system employed in the process was SLA 350. The splint was worn nightly for six months. The patient adapted to the splint well and found it comfortable to use. The splint relieved tension in the patient's bite muscles. No sign of tooth wear or significant splint wear was detected after six months of testing. Modern digital technology enables us to manufacture clinically functional occlusal splints, which might reduce costs, dental technician working time and chair-side time. Maximum-dimensional errors of approximately 1 mm were found at thin walls and sharp corners of the splint when compared with the digital model.

[Some possibilities to assess maxillary-mandibular occlusion in fixed dental prosthesis]. / Posibilitati de înregistrare a relatiilor mandibulo-maxilare în tratamentul protetic fix.

Occlusion determination, registration and transfer represent an important phase of the fix prosthetic treatment. This goal can be achieved using different materials such as: silicon, special occlusal wax, ZOE paste, acrylic resin and occlusal rims. Specific techniques for specific clinical situations are described, together with some associated procedures: provisional restoration after tooth preparation and split wearing.

Effect of alteration in organic material of the occlusal caries on DIAGNOdent readings.

DIAGNOdent is a laser fluorescence device used for dental caries diagnosis in occlusal and smooth surfaces. Despite the promising preliminary results, the molecules involved in the increase of fluorescence in carious lesions remain unclear. The aim of this study was to compare the laser fluorescence readings before and after changes in the organic material of occlusal carious lesions in primary teeth. Twenty-four primary molars stored in saline solution with at least one site with occlusal caries were divided into two groups. The control group had 17 sites with caries and the experimental one had 16 sites. The carious lesions were measured with laser fluorescence. The experimental samples were then removed from the storage solution and immersed in a 2% sodium hypochlorite solution for 24 hours. After washing with water, the teeth were measured again with the laser fluorescence device. The teeth of the control group were submitted to the same procedures, but saline solution was used instead of the sodium hypochlorite solution. A statistically significant reduction in the mean of the readings after immersion in the two tested solutions compared with the initial readings was observed in both groups, but the decrease was statistically higher in the experimental group (p < 0.0001). In this study, the data indicate that changes in the fluorescence of carious lesions measured by the laser fluorescence are mainly due to the organic content alterations rather than to the mineral loss.

Effect of alteration in organic material of the occlusal caries on DIAGNOdent readings

DIAGNOdent é um aparelho de fluorescência a laser usado para o diagnóstico de lesões de cárie dentária em superfícies oclusais e lisas. Apesar dos resultados preliminares promissores, as moléculas envolvidas no aumento da fluorescência em lesões de cárie permanecem sem explicação. O objetivo deste estudo foi comparar as leituras com o aparelho de fluorescência a laser antes e depois de alterações no conteúdo orgânico de lesões de cárie oclusal em dentes decíduos. Vinte e quatro molares decíduos armazenados em soro fisiológico com pelo menos um sítio com lesão de cárie oclusal foram divididos em dois grupos. O grupo controle foi composto de 17 sítios com cárie, e o grupo experimental, 16 sítios. As lesões de cárie foram medidas com o aparelho de fluorescência a laser. As amostras do grupo experimental foram então removidas da solução de armazenamento e imersas em uma solução de hipoclorito de sódio a 2% por 24 horas. Depois da lavagem com água, os dentes foram medidos novamente com o aparelho de fluorescência a laser. Os dentes do grupo controle foram submetidos aos mesmos procedimentos, mas soro fisiológico foi usado em vez de hipoclorito de sódio. Uma redução estatisticamente significante na média das leituras depois da imersão nas duas soluções testadas comparadas às primeiras leituras de ambos os grupos foi observada, mas a porcentagem de redução foi estatisticamente maior no grupo experimental (p < 0,0001). Neste estudo, os dados indicam que alterações na fluorescência de lesões de cárie medidas pelo aparelho de fluorescência a laser ocorrem principalmente devido a alterações no conteúdo orgânico ao invés da perda mineral.

The effects of intraoral splints on the masticatory system of pigs.

While evidence exists to support the effectiveness of splints on conditions involving the masticatory musculature, few research projects have examined the results of long-term splint wear. The purpose of this study was to examine the function of the masticatory system over a 2-month time period of splint wear. Young adult female miniature pigs were divided into three groups: a control (C) group that wore no intraoral splint, a control splint (CS) group that wore a splint increasing bite height, and a protrusive splint (PS) group that wore a splint increasing bite height and moving the mandible anteriorly. Splints were worn constantly. Fine-wire needle EMG was performed prior to splint delivery and at 1 and 2 months post-splint delivery. Bilateral superficial masseters and zygomaticomandibularis (ZM, equivalent to deep masseter) muscles were monitored during normal feeding. Absolute EMG output, percentage output, and cycle timing were unaffected by chronic splint wear. However, chewing coordination was significantly changed in the splinted groups in both sessions post-splint delivery relative to baseline readings and to the C group (P < 0.005). Trends indicate that the coordination of the PS group was more greatly altered than that of the CS group.

Effects of interocclusal appliances on EMG activity during parafunctional tooth contact.

To test the hypothesis that a flat plane interocclusal appliance affects the electromyographic (EMG) activity of the temporalis and masseter muscles in pain-free individuals, maxillary splints were fabricated for 20 individuals who reported no history, signs or symptoms of myofascial pain or arthralgia as determined by two trained, independent examiners. Subjects were instructed to establish light tooth contact, maximum clenching, and moderate clenching with/without the splint in place (as determined by random assignment) while EMG data from the left and right temporalis and masseter muscles were recorded. A 5-min biofeedback training session to relax the masticatory muscles was followed by a repetition of the tooth contact/clenching tasks with/without the splint in place. With the splint in place, the activity of the temporalis muscles decreased for all tasks, significantly for the left and right temporalis under maximal clenching and for the right temporalis under moderate clenching. In contrast, the activity of the masseter muscles increased under light and moderate clenching (significantly for the left masseter under moderate clenching) and decreased slightly under maximal clenching. The effectiveness of interocclusal appliances may be due to mechanisms other than redistribution of adverse loading.

Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion.

To evaluate the clinical usefulness and tolerability of an oral jaw-positioning appliance in the treatment of obstructive sleep apnea syndrome in children, we studied 32 patients (mean age, 7.1 +/- 2.6 yr; 20 males) with symptoms of obstructive sleep apnea, malocclusion, and a baseline apnea index > 1 event/h. A group of 19 subjects was randomly assigned to a 6-mo trial of an oral appliance; the remainder acted as control subjects. At baseline and after the trial all patients underwent physical examination, a standard polysomnography, and orthodontic assessment. A modified version of the Brouillette questionnaire related to obstructive sleep apnea symptoms was administered to parents before and after the trial and a clinical score was calculated. Of the 32 subjects enrolled, 4 treated subjects and 5 control subjects were lost to follow-up. Polysomnography after the trial showed that treated subjects all had significantly lower apnea index (p < 0.001) and hypopnea index values (p < 0.001) than before the trial, whereas in untreated control subjects these values remained almost unchanged. Clinical assessment before and after treatment showed that in 7 of the 14 subjects (50%) the oral appliance had reduced (a fall of at least 2 points in the respiratory score) and in 7 had resolved the main respiratory symptoms, whereas untreated patients continued to have symptoms. In conclusion, treatment of obstructive sleep apnea syndrome with an oral appliance in children with malocclusion is effective and well tolerated.

Occlusal stabilization appliances. Evidence of their efficacy.

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

A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea.

Although there is increasing interest in the use of oral appliances to treat obstructive sleep apnea (OSA), the evidence base for this is weak. Furthermore, the precise mechanisms of action are uncertain. We aimed to systematically investigate the efficacy of a novel mandibular advancement splint (MAS) in patients with OSA. The sample consisted of 28 patients with proven OSA. A randomized, controlled three-period (ABB/BAA) crossover study design was used. After an acclimatization period, patients underwent three polysomnographs with either a control oral plate, which did not advance the mandible (A), or MAS (B), 1 wk apart, in either the ABB or BAA sequence. Complete response (CR) was defined as a resolution of symptoms and a reduction in Apnea/Hypopnea Index (AHI) to < 5/h, and partial response (PR) as a > or = 50% reduction in AHI, but remaining > or = 5/h. Twenty-four patients (19 men, 5 women) completed the protocol. Subjective improvements with the MAS were reported by the majority of patients (96%). There were significant improvements in AHI (30 +/- 2/h versus 14 +/- 2/h, p < 0.0001), MinSa(O(2)) (87 +/- 1% versus 91 +/- 1%, p < 0.0001), and arousal index (41 +/- 2/h versus 27 +/- 2/h, p < 0.0001) with MAS, compared with the control. The control plate had no significant effect on AHI and MinSa(O(2)). CR (n = 9) or PR (n = 6) was achieved in 62.5% of patients. The MAS is an effective treatment in some patients with OSA, including those patients with moderate or severe OSA.

CONTENEDOR O FERULA DE OSAMU

Con el presente trabajo de tesis se ofrece una alternativa para el tratamiento de contención; el aparato se conoce con el nombre de contenedor de férula de osamu, éste aprato protético removible, tiene la particularidad de colocarse sobre las superficies oclusales de los dientes y rebasa u poco las superficies bucal y lingual, el contenedor presenta un grosor de tan solo 0.3 mm. evitando de esta manera grande apertura de la mordida. Es cómodo por liviano, gracias a su transparencia que se utiliza es el acrílico transparente. El tratamiento ortodóntico con este contenedor es importante, ya que mediante el cual se mantienen en posición a los dientes que han sido sometidos a un movimiento individual o de conjunto en esta especialidad, porque tiene la misión de mantener y conservar los resultados obtenidos durante mucho tiempo de tratamiento, o sea estabiliza la alineación obtenida

Disfunción craneomandibular / Craniomandibular dysfunction

Se presenta un caso clínico que presenta dolor muscular, articular y chasquido en la ATM derecha concomitante a un desvío mandibular hacia el mismo lado. En la Rx se observa posición retrusiva del cóndilo derecho en la cavidad glenoidea. El tratamiento incial se realiza a través de un intermediario oclusal de reposición mandibular que permite su centralización simultáneamente a la normalización de la relación cóndilo disco y consecuente desaparición del chasquido y el dolor. A continuación se indica el tratamiento ortodóncico para lograr la estabilización oclusal de la posición terapéutica mandibular, a partir de la extrusión del sector posteroinferior