Occlusal Appliance Research Articles

Evaluation of craniocervical posture after myofascial pain treatment in adults with bruxism: A randomized clinical trial

BackgroundDespite numerous clinical studies on bruxism management, critical evaluation parameters, including the impact of bruxism pain on quality of life and secondary issues like changes in craniocervical posture, are often disregarded. Research questionEvaluate the effect of two treatments on the craniocervical posture of adult patients with myofascial pain. MethodsThis parallel randomized clinical trial included 60 patients with myofascial pain due to probable bruxism that fulfilled the study requirements. A computer-generated random sequence was used to allocate treatments: botulinum toxin-A or occlusal appliance. Follow-up time was 3 and 6 months. Kyphosis angle (α) and head posture measurement by cervical radiograph were assessed using two-way repeated measures ANOVA (alpha = 0.05). ResultsSixty patients were randomized (mean age 30 ± 7.6) and 6 were excluded from the analysis (did not attend follow-up). No statistically significant difference was observed for the head posture measure (p = 0.98) and kyphosis angle (p = 0.74). Mild pain was reported by one patient after botulinum toxin-A application. SignificanceResults indicate that craniofacial posture does not seem to be influenced by the treatment of pain in bruxers. If a better posture is desired, this should probably be targeted with other therapies. Trial registrationClinical Trials NCT03456154.

The role of nutraceuticals in the management of temporomandibular disorders.

Temporomandibular disorders (TMDs) are usually treated with occlusal appliances and supportive treatments such as physical therapy and drugs. Supplements can be included among potential supportive therapies, with the aim of reducing the use of drugs. To evaluate the efficacy of nutraceuticals' short-term treatment in subjects with temporomandibular disorders. The study started in January 2021 and ended in January 2022. Subjects with temporomandibular disorders and a verbal numeric scale >40 were recruited and randomly assigned to one of the following groups. If waiting to start a therapy, to the nutraceutical group or to the no treatment group, while if already undergoing splint therapy, to nutraceautical+splint group or to splint therapy group. Nutraceutical used was composed by Boswellia Serrata Casperome, Magnesium, Tryptophan and vitamins B2 and D with a posology of one tablet/day before sleep for 40days. Presence of temporomandibular pain, headache, neck pain and sleep/emotional disorders were assessed at T0 and at T1, after 40days. ANOVA was performed to compare treatments with nutraceuticals and theirrespective controls, as for the variables related to painful symptomatology. Chi- Squared was conducted to assess differences in sleep/emotional disorders between groups. The statistical significance was p<0.05. The groups using nutraceuticals showed statistically significant improvements over controls for most of the variables analyzed. The use of nutraceutical seems to be a valuable support for TMD therapy in the short term either alone or combined with occlusal splint therapy.

Minimally invasive techniques in the management of muscular temporomandibular joint disorders: A five-year observational study.

To evaluate the effectiveness of three minimally invasive techniques for managing patients with myofascial pain dysfunction, determine their association with sociodemographic factors, habits, medication usage, comorbidities, treatment history, pain duration, complaint intensity, and diagnosis limitations. This five-year observational study scrutinized 1,000 medical records from individuals treated at the TMD Orofacial Dental Research Center. TMD treatments were organized into Group 1 (thermotherapy, exercises, and CBT), Group 2 (Group 1 plus intramuscular manual therapy), and Group 3 (Group 1 and Group 2 plus occlusal appliances) and correlated with sociodemographic factors, habits, prior medication usage, comorbidities, history of prior treatments, duration of pain, intensity of complaint, and diagnosis limitations or without limitations regarding the symptoms of muscular temporomandibular disorders (TMD). Treatment durability was proportionally higher in Groups II and III (p<0.05). Although no significant differences were found for habits (p= 0.051) and pain duration (p= 0.001), clenching was more prevalent in Groups II n= 77 (57.0%) and III n= 39 (63.9%) and among those with therapy duration equal to or greater than 6 months for n=102 (59.3%). Statistically significant correlations were noted between age and education (rho=-0.198; p<0.001) and between pain duration and treatment durability (rho=0.317; p<0.001). Intraoral devices do not constitute the primary treatment for myofascial pain. For cases of prolonged pain, comorbidities, limited mouth opening, and a history of prior medication or treatments, a splint combined with other therapies is recommended for effective management. Key words:Temporomandibular disorders, myofascial pain, occlusal appliances, clinical diagnosis, thermotherapy, exercise therapy, cognitive behavioral therapy.

Influence of occlusal appliances on the masticatory muscle function in individuals with sleep bruxism: A systematic review and meta-analysis.

This systematic review answers the question: "Does occlusal appliance use influence masticatory muscle function of dentate individuals with sleep bruxism?". The literature search included six databases, grey literature, and manual search for articles. Randomized and non-randomized clinical trials were included comparing muscle function of sleep bruxers before and after receiving occlusal appliances. Risk of bias was assessed with risk of bias assessment for randomized and non-randomized clinical trials tool. Twelve studies, three represent randomized clinical trials, were included. Risk of bias was considered low, moderate, or serious. Meta-analyses indicated that soft and hard appliances did not influence muscle activity and bite force of bruxers. Qualitative analysis showed that occlusal appliance use did not influence masticatory performance and muscle volume. However, it was effective in reducing tongue force. Certainty of evidence was considered very low for muscle activity when evaluated with hard appliances, and for bite force evaluated with both appliance materials. Low certainty of evidence was observed for muscle activity with soft appliances. Based on the findings of this meta-analysis, occlusal appliances do not affect masticatory muscle function of sleep bruxers. Regardless of appliance material, the activity of masseter and temporal, and bite force of sleep bruxers was not influenced.

The deconstruction of chronic orofacial pain and a hiding inhibition pathway of orofacial pain: the trigeminal proprioceptive mesencephalic periaqueductal gray pathway.

Chronic orofacial pain has a significant negative impact that influences individuals' quality of life and our society. The prevalence is around 11.2% to 33.2% and remains high in females. Currently, there are two main diagnostic classification systems that are used internationally for chronic pain: the International Classification of Diseases, 11th Revision (ICD-11), which was published by the World Health Organization (WHO) in 2018, and the International Classification of Orofacial Pain, which was published by the International Association for the Study of Pain (IASP) in 2020. Deficits in ascending and descending pain modulation pathways may be involved in the chronic pain pathophysiology. A newly described "trigeminal proprioceptive mesencephalic periaqueductal gray pathway" is considered to be the mechanism of action of occlusal appliance in managing orofacial pain. The genetic basis of chronic orofacial pain is not yet fully understood, but a genetic susceptibility involving multiple genes among the peripheral nerves, brainstem and higher brain regions to regulate and suppress the transmission of pain signals, thereby modulating the perception of pain, is likely.

The efficacy of occlusal appliance with a moisturizing gel pocket on sleep quality in patients with nocturnal xerostomia: A case series.

A case series of five patients (mean age, 77.0 years) with complaints of nocturnal xerostomia were subjected to occlusal appliance treatment with a reservoir of moisturizing gel during the night. An occlusal appliance covers the dental arch and hard palate, providing space in the midline of the hard palate to hold the moisturizing gel. Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Questionnaire (PSQI-J) before and after treatment. The total PSQI-J scores decreased in all patients after treatment. The ESS score, sleep time, and sleep efficiency improved or remained unchanged and none of the patients' symptoms worsened. This study demonstrated the efficacy of occlusal appliance treatment in patients with dry mouth in improving self-reported sleep quality. Patients included those with nocturnal xerostomia and poor sleep quality on the PSQI-J. Treatment with xerostomia resulted in improved sleep quality, as assessed by the decrease in PSQI-J scores. This case series suggests that sleep quality may be worse in patients with xerostomia, and that treatment for nocturnal xerostomia using occlusal appliances may improve sleep quality.

OCCLUSAL APPLIANCES MIGHT BE CLINICALLY EFFICIENT IN TREATING SLEEP BRUXISM.

Minakuchi H, Fujisawa M, Abe Y, Iida T, Oki K, Okura K, Tanabe N, Nishiyama A. Managements of sleep bruxism in adult: A systematic review. Jpn Dent Sci Rev. 2022; 58:124-36. None was reported. Systematic review.

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

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

SPLINTS IN PROSTHODONTICS – A LITERATURE REVIEW

Occlusal splints are also called as occlusal appliances, biteguards, mouthguards, orthotics, interocclusal appliances. Occlusal splint therapy is used as both diagnostic and treatment appliance for temporo-mandibular disorders and occlusion related disorders. The aim of this article is to provide an insight on various types of splints being used in the eld of prosthodontics, indications and the rationale for use.

Conservative Therapies for TMJ Closed Lock: A Randomized Controlled Trial.

Background. Acute anterior disc displacement without reduction (ADDWoR) is characterized by permanent TMJ disc displacement, pain and functional limitations. Occlusal appliances (OA) are among the therapies of choice. Methods. A single-blind randomized study was carried out to compare the therapeutic success of two different types of splints in patients with ADDWoR. A total of 30 subjects were eligible for the study out of the 330 screened. Group I (n = 15) received RA.DI.CA splint therapy and Group II (n = 15) received stabilization splint therapy. Temporomandibular pain, headache, neck pain and functional excursions were evaluated at baseline (T0), after 4 weeks (T1) and after 6 months (T2). Descriptive and inferential statistics were performed. Results. There was a significant increase in maximum jaw opening and a reduction in pain in both groups (p < 0.05), except for neck pain in Group II. Significant differences in between- and within-subject factors emerged in all of the parameters evaluated, especially between T1 and T2 scores, with a greater trend of improvement in Group I than Group II. Conclusion. RA.DI.CA splints were found to be more effective for the considered sample, especially in the treatment of comorbidities and functional movements, probably due to the greater orthopedic action and joint mobilization.

Digital occlusal splints for temporomandibular joint disorders: a systematic review

Objectives. This systematic review aimed at assessing the therapeutic efficacy of computer-assisted or digitally constructed occlusal splints in comparison to conventional splint treatment for temporomandibular disorders or bruxism. Material and methods. The study was prospectively registered in the Open Science Framework. Four electronic databases, PubMed, Embase, Web of Science, and Scopus, were searched comprehensively. The following keywords were employed: “3D-printed”, “additive manufacture”, “computer-aided design/computer-aided manufacturing”, “temporomandibular joint”, “temporomandibular joint dysfunction”, “bruxism”, “disc displacement”, “temporo-mandibular disorder”, “splint’, “oral splint”, “occlusal splint”, “occlusal device”, “bite splint”, “occlusal appliance”. Two risk of bias evaluation instruments were used to assess the quality of the included studies. Outcomes. Following the application of the search strategy, a total of 557 publications were identified in the electronic databases. Seven eligible articles were finally included in the analysis. Six publications (85.7%) compared digitally manufactured occlusal splints to conventionally created splints, while one examined if the use of a facebow influences the performance of digital splints. Visual assessment scores or numerical rating scales of pain, optical axiography, tooth wear, and bruxism frequency were reported as outcomes. Conclusions. Computer aided design occlusal splints provide equivalent outcomes to traditional splints. Some generated superior results, mainly probable as a result of the virtual articulator's greater precision and the splint materials' material qualities.

Physiotherapy and occlusal splint treatment in myalgia, cervi-cogenic headache, and arthralgia: a case report

Abstract: The purpose of this study was to describe a rare case of myalgia, cervicogenic headache, and arthralgia in which interaction of physiotherapy, relaxation techniques, cognitive and behavioral counseling, psychosocial support, and occlusal splint treatment resulted in a positive outcome. A 27-year-old woman presented to our clinic with myalgia of the right side of the face, right temporomandibular joint arthralgia, right and left temple pain, jaw elevator muscle pain, and head and neck muscle soreness. The right and left joints' magnetic resonance imaging revealed anterior disc displacement without reduction. The treatment strategy aimed for a non-invasive treatment approach to relieve pain and restore functions. An occlusal appliance with an anterior bite plane was selected, along with counseling, psychosocial support, physiotherapy, posture self-control, massage of the head and neck muscles, mouth opening exercises, and self-massage. A temporomandibular specialist oversaw the splint treatment's progress, a maxillofacial surgeon managed the clinical signs and symptoms of the muscles and joints, and a physiotherapist provided the physiotherapy. Muscle stability in the head and neck has been related to temporomandibular disorders and may have repercussions on craniofacial structure and function. Keywords: physiotherapy; massage; relaxation techniques; oral splint; temporomandibular dis-order

AN INSIGHT INTO THE OCCLUSAL SPLINT THERAPY FOR THE MANAGEMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

For many years the occlusal splint therapy has been practiced for the diagnosis and treatment of various temporomandibular joint disorders. Many designs have been discussed in the literature. Each of these occlusal appliances are used for specific conditions. A proper examination and diagnosis is essential for selecting the appropriate appliance for that particular situation. This article reviews about the types, designs and materials used for occlusal splint fabrication. The present article also familiarizes the individual application and uses of each occlusal splint.

The rationale for the algorithm of comprehensive digital diagnosis of patients with temporomandibular disorders using an intraoral occlusal appliance

Relevance. The study aimed to increase the effectiveness of comprehensive diagnosis and treatment of patients with TMD using an intraoral occlusal appliance.Materials and methods. All patients of the main group underwent a digital comprehensive functional examination, including TMJ magnetic resonance imaging, kinesiography, joint vibration analysis, surface myography and electrical stimulation of the masticatory muscles, followed by a bite registration of the optimal mandible position. According to the bite recorder, the models were mounted in the articulator and the intraoral occlusal appliance was fabricated. This occlusal appliance used the first-class lever principle, which acts on the condyle using a force applied to the mesial part of the canine and rests on the distal part of the upper second molar. After the diagnosis and treatment stage using an occlusal appliance, a digital comprehensive functional examinatio n was performed again.Results. Analysis of the digital comprehensive diagnosis data evidenced the restoration of the lower jaw movement, the elimination of intra-articular disorder and the normalization of the dentition functioning as a whole, using TENS appliance and an improved intraoral occlusal appliance (Patent # 273 0995, 26.08.2020) in patients with TMD.Conclusion. Treatment of patients with TMD using an intraoral occlusal appliance, which eliminates condyle compression and dislocation of the articular disc, allows restoring the lower jaw movement and the functioning of the dentition as a whole. Kinesiography at all stages of the prosthodontic treatment allows objectively monitoring the restoration of the mandibular movement pathways, taking into account time inte rvals.

Pediatric Chronic Orofacial Pain: A Narrative Review of Biopsychosocial Associations and Treatment Approaches.

Pediatric chronic orofacial pain (OFP) is an umbrella term which refers to pain associated with the hard and soft tissues of the head, face, and neck lasting >3 months in patients younger than 18 years of age. Common chronic pediatric OFP diagnoses include temporomandibular disorder, headaches, and neuropathic pain. Chronic OFP can adversely affect youth's daily functioning and development in many areas of well-being, and may be associated with emotional stress, depression, functional avoidance, and poor sleep, among other negative outcomes. In this mini-review, we will discuss common psychological comorbidities and familial factors that often accompany chronic pediatric OFP conditions. We will also discuss traditional management approaches for pediatric orofacial pain including education, occlusal appliances, and psychological treatments such as relaxation, mindfulness-based interventions, and cognitive-behavioral treatments. Finally, we highlight avenues for future research, as a better understanding of chronic OFP comorbidities in childhood has the potential to prevent long-term pain-related disability in adulthood.

Trends of Occlusal Appliance Therapy among Resident Dental Surgeons

Objective: Current study was planned to assess the trends of occlusal appliance construction and selection, among the resident dental surgeons. Method: Data was collected from 51 residents at Fatima Memorial Dental Hospital, which were given a questionnaire that had 20 questions. The frequency of each answer was calculated and compared between residents of different departments and was analyzed by SPSS version 20. Results: The selection and construction of occlusal appliances among the residents was inappropriate. Soft occlusal appliances were the most selected and practiced appliance. Occlusal appliances need to be revisited in the literature with easy to practice guidelines. Keywords: Occlusal appliances, Soft occlusal appliances, Temporo-mandibular joints.

Occlusal appliance therapy for temporomandibular disorders

Occlusal appliance is a removable device which fits over the occlusal surfaces of the teeth in one arch, devised to provide precise occlusal contact with the opposing teeth. Occlusal appliance is usually made of hard acrylic resin and allows optimum dentition in which condyle may assume in its most orthopedically stable position. Oc-clusal appliance is used to treat various kinds of temporomandibular disorders, including joint and muscle pain, disc derangements, parafunctional habits like bruxism and clenching, and degenerative joint diseases of TMJ.There are various types of occlusal appliances, but stabilization appliance and anterior positioning appliance are most frequently used. Stabilization appliance is fabricated to provide optimum occlusal relationship for the patient. This appliance is indicated for muscle and joint pain disorders and helpful for reducing parafunctional habits like bruxism. Anterior positioning appliance is designed to protrude mandible to a position that is more anterior than the intercuspal position. It is primarily used to treat disc displacement with reduction, intermittent lock and joint noises but some inflammatory disorders including retrodiscitis can be managed with this appli-ance. Occlusal appliance therapy is a successful treatment in reducing symptoms, and many previous reports indi-cates that its success rate is 70-90%. However, controversy exists over the exact mechanism by which occlusal appliance reduce symptoms. Occlusal appliance therapy is reversible, non-invasive therapy and effective therapeutic modalities for tem-poromandibular disorders. For the successful outcome, careful selection of the patient is needed. Also, it should be monitored regularly for the improvement of the disorder and the occurrence of side effects.

The hierarchy of different treatments for myogenous temporomandibular disorders: a systematic review and network meta-analysis of randomized clinical trials.

The best treatment modality for the management of painful temporomandibular disorders of muscular origin (M-TMD) with predictable outcomes based on solid evidence is still not well defined. Thus, the aim of this network meta-analysis (NMA) was to identify the best treatment for adult patients with M-TMD. An electronic search was undertaken from the inception of each database to August 2018, to identify randomized clinical trials (RCTs), which are comparing two or more of the following treatment modalities in patients with M-TMD: counseling therapy; occlusal appliances; manual therapy; laser therapy; dry needling; intramuscular injection of local anesthesia (LA) or botulinum toxin-A (BTX-A); muscle relaxants; hypnosis/relaxation therapy; oxidative ozone therapy; and placebo or no treatment. Primary outcome variables were the reduction of pain and mechanical sensitivity. The secondary outcome was the maximal mouth opening (MMO). The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Standardized mean difference was used to analyze via frequentist network meta-analysis (NMA), using STATA software.52 RCTs were included in this NMA. At the most follow up moments, manual therapy, counseling therapy, occlusal splints therapy, and needling using BTX-A or LA as well as dry needling significantly decreased post-treatment pain intensity in M-TMDs, when compared to placebo. At short term (≤5 months), the four highest-ranked treatments for post-treatment pain reduction were manual therapy (83.5%, low quality evidence), ozone therapy (75.7%, very low quality evidence),counseling therapy (71.2%, moderate quality), and occlusal appliances (71.7%,moderate quality evidence). When intermediate term (≥6 months)was considered, BTX-A (85.8%, very low quality evidence) , counseling therapy(80%, low quality evidence), occlusal appliances (62.8%, low quality evidence) and hypnosis (50.6%, very low quality evidence) were the four highest-ranked treatments. This NMA reveals that manual therapy can be considered the most effective treatment for M-TMD, followed by counseling treatment, intramuscular injection of LA, and occlusal appliances . However, considering the limitations of the studies included, and the scarce of strong evidence, the present findings should be interpreted cautiously.

Effectiveness of occlusal splints with low-level laser therapy on anterior disc displacement of the temporomandibular joint

ABSTRACT Objective: This study was designed to evaluate and compare between the using of oral appliance therapy alone and using of oral appliance with laser therapy for management of anterior disc displacement of the temporomandibular joint. Subjects and methods: randomized clinical study was done on 18 patients complaining of TMJ Anterior disc displacement. They were divided into 2 equal groups. Group A:occlusal appliance group Those patients worn the hard acrylic occlusal appliance covering the maxillary teeth (anterior repositioning splint) at night for two months. Group B: laser therapy group Those patients worn the hard acrylic occlusal appliance covering the maxillary teeth (anterior repositioning splint) at night and receive laser applications on the region of temporalis muscle, masseter muscle and mandibular condyle three times a week for 4 weeks. full clinical TMJ examination was done at 0 baseline,one week, one month and two months postoperatively. The examination was done to evaluate T.M.J pain intensity by (VAS), TMJ clicking Sounds and Maximum mouth opening .Magnetic resonance imaging(MRI) performed before and after treatment period. Results There was high percentage of improvement in all symptoms of anterior disc displacement either with or without reduction by using of double action of splint and laser rather than the improvement by using splint only. Conclusion :The using of splint only is acceptable and successful but the using of the laser with splint is better and more successful in treatment of the patients complained from anterior disc displacement of the temporomandibular joint.

English

BACKGROUND Temporomandibular joint(TMJ)is the third most common site of pain in the orofacial area, while the masseter muscle was the primary painful masticatory muscle. The temporal and frontal region were pain areas indicated by temporomandibular joint disorder (TMDs) patients. The purpose of this study was to compare two different treatment modalities, physical therapy and occlusal appliance to treat myofascial pain. METHODS This retrospective study comprises of all orofacial pain patients attending orofacial pain clinics of Dental University Hospital, King Saud University in Riyadh, Saudi Arabia. Patients were categorized into two groups, the first group: patients treated by the occlusal appliance (hard type). The second group: patients treated by physiotherapy home exercises, including posture position modification. Physical therapy included muscle stretching and isometric tension against resistance exercises and guided jaw movements. Methods of clinical examination was based on the research diagnostic criteria for temporomandibular disorders (RDC/TMD) criteria. The data of pain level was collected based on the visual analog scale (VAS). RESULTS 16.1 % of patients were male, and 83.9 % of the patients were female. With the mean age being 31.1 years old. 92.9 % were Saudi patients and 7.1 % were non-Saudi. 50 % of the patients were using an occlusal appliance, and 50 % went for physiotherapy. The independent t-test showed a highly significant difference between different management methods with a P – value of 0.038 and a mean difference of 0.32143. 80.5 % of the patients reported masseter muscle pain as one of their main complaints. CONCLUSIONS A significant difference was observed between physiotherapy and occlusal appliances with education in treating patients with myofascial pain. Patients using the occlusal appliances showed a high percentage of pain reduction (85.7 %) compared to physiotherapy treatment (57.1 %) in a short period of time. Henceforth, patient’s education plays a significant role in pain reduction. KEY WORDS Temporomandibular Joint Disorder, Occlusal Appliance, Myofascial Pain, Physiotherapy