Occlusal Equilibration Research Articles

The simple treatment of chronic facial pain due to trigeminal neuralgia with dental occlusal equilibration

BackgroundTrigeminal neuralgia (TN) is the most common cranial neuralgia in adults, with a slightly higher incidence in women than in man. This chronic pain condition affects the trigeminal nerve, also known as the 5th cranial nerve. Antiseizure drugs are the main biomedical treatment of TN. However, TN is not the only source of chronic facial pain (CFP). Background persistent idiopathic facial pain (PIFP) is also a chronic disorder. The underlying pathophysiologies of TN and PIFP are still unknown. Occlusal equilibration appliance (OEA) will stop bruxism by relaxing all mastication muscle especially, The Lateral Pterygoid muscle. The posterior trunk of the mandibular division of the trigeminal nerve normally descends deep to the lateral pterygoid muscle. In three of 52 dissections the three branches of the posterior trunk were observed to pass through the medial fiber of the lower belly of the lateral pterygoid muscle. Case descriptionA 70 year-old Thai female with left facial pain was diagnosed by a neurologist with TN 4 years prior to seeking occlusal equilibration. The cause of facial pain was treated with occlusal equilibration appliance. ConclusionA complete dissipation of pain was achieved after using occlusal equilibration appliance for 2 weeks and 3 days. The present article is the one of the first to demonstrate the efficacy of occlusal equilibration appliance treatment for chronic facial pain. As the present article shows, OEA treatment affects TN and CFP successfully. However, additional large-scale studies are necessary to validate the efficacy of OEA in TN and CFP treatment.

Comparison Of Patient Satisfaction & Occlusal Force Distribution pattern In CAD/ CAM and conventional Complete Dentures Using The T-Scan III Computerized Occlusal Analysis System. (RCT)

Purpose: This study was conducted to evaluate patient satisfaction & percentage of occlusal force distribution patterns in CAD/CAM and conventional dentures.Materials & Methods: Twenty completely edentulous patients were selected from the out-patient clinic, Faculty of dentistry, Cairo University. Patients were selected with moderately developed residual ridges, sufficient inter-arch space, no muscular disorders & with previous denture experience. Patients were randomly divided into two groups (I) & (II). Group (I): Patients had received CAD/ CAM complete dentures. Group (II): Patient had received conventionally constructed complete dentures. Patient satisfaction was evaluated in the two studied groups following certain items with the aid of a questionnaire after one week, one month & three months. T-scan device was utilized to evaluate occlusal force distribution in the two studied groups one week after denture insertion. Occlusal adjustment was made after occlusal forces analysis to re equilibrate occlusal force distribution. Mean values were recorded, tabulated & statistically analyzed. Results: The results of this study revealed that patients were more satisfied with CAD/ CAM complete dentures than conventional dentures. Occlusal force % was significantly decreased in anterior area of the dentures in both studied groups after occlusal equilibration made after occlusal adjustment. The % of occlusal force was better distributed on the posterior right & left areas in Group (I) & (II). However, CAD/CAM dentures had shown significantly less % force in the anterior area & better force distribution in the posterior areas than conventional ones especially after T scan analysis & occlusal re-equilibration.Conclusions: Within the limitations of the present study it may be concluded that:Patients may be more satisfied with CAD/ CAM than conventional dentures.CAD/CAM denture may provide better occlusal force distribution patterns than conventional ones. T- Scan computerized occlusal analysis helps to obtain bilateral balanced occlusion in complete dentures.

Restoration of normal occlusal relations in the complex treatment of patients with generalized periodontitis and bounded edentulous spaces

The aim of the work is to restore occlusal relations during the orthopedic stages of complex treatment in patients with chronic course of generalized periodontitis (GP) of the І and ІІ degree and bounded edentulous spaces using the “T-Scan” system to achieve stable disease. Materials and methods. A total of 55 patients aged from 20 to 44 years old were examined, including 20 persons with oral health and occlusal equilibration and 35 patients with GP in its chronic phase of the I and II degree presenting with Kennedy classes III and IV partially edentulous situation (1–3). After evaluation of the dental occlusion relationships, all patients were performed a complex treatment of GP by selective grinding or occlusal surface adjustment with a composite material under the control of the apparatus “T-Scan III”, achieving the most correct distribution of occlusal contacts. At the same time, the local instrumental and medical treatment using antimicrobial and anti-inflammatory drugs and medicines with systemic effect orally to correct metabolic disorders. This was followed by the orthopedic treatment, restoring the dentition defects with fixed metal-ceramic structures under the control of the “T-Scan III” system. The results of therapy were evaluated immediately, after 6 and 12 months. Results. We have confirmed that the normal masticating pressure between the left and right parts of the dentofacial system is distributed evenly. However, we have found out, that there are not always ideal occlusion relationships, and the variation range is (48.7 to 51.3) ± 0.24 % in healthy persons. At the stages of orthopedic treatment, and especially fitting denture with the help of the “T-Scan III” system, we have reached the norm determined by us, striving for perfection. The state of periodontium and occlusion achieved after the complex treatment, remained for more than 12 months, that was confirmed by clinico-radiological data. Conclusions. Restoration of normal occlusal relations under the control of the “T-Scan III” system contributed to rapid GP remission during the orthopedic stages of complex treatment in patients with GP and bounded edentulous spaces after initial and medicamentous periodontal therapy and provided prevention of various complications and long-term stabilization of the pathological process in the periodontium.

Myofascial Pain Dysfunction Syndrome Treatment by Occlusal Equilibration Using T-Scan and Electromyography for the Precise Analysis of Muscle Activity

Myofascial Pain Dysfunction Syndrome Treatment by Occlusal Equilibration Using T-Scan and Electromyography for the Precise Analysis of Muscle Activity

Dental problems in rabbits and rodents

As the number of pet rabbits and rodents has raised lately, veterinarians have to cope with various medical conditions that affect them and especially those concerning their teeth in everyday practice. Rabbits', guinea pigs and chinchillas whole dentition and the incisors of the rest of the rodents are known as elodont teeth. Malocclusion, which is the most common dental condition seen in those animals occurs due to a combination of several factors and inappropriate diets. The owners frequently fail to recognize their pets' dental disease in time. Consequently, when they are finally presented to the vet, their condition is difficult to be treated and their life is in danger. The examination of the oral cavity should preferably be made under general anaesthesia. Radiological assessment is also essential in order to acquire valuable information about the teeth, roots and facial bones. As mentioned before, malocclusion is the most common dental problem that rabbits and small rodents experience whereas cheekteeth malocclusion is the most frequently recognized problem in guinea pigs and chinchillas. The common factors that contribute are: genetic predisposition (prognathism or brachygnathism), trauma and metabolic disorders. The symptoms vary from difficulty in mastication, bad breath, lesions of the tongue and oral mucosa to facial swelling, abscesses, fistulisation, ocular disease etc. Usually there are also symptoms regarding the animal's general health such as lack of appetite, emaciation and alternation of the feaces' composition. Treatment is both surgical and pharmaceutical. Occlusal equilibration may be accomplished by burring. If this is not possible, the extraction of all the incisors is recommended. In case of an abscess, debridement and extraction of the responsible tooth (usually affecting cheek teeth) is advised. Moreover, antibiotics and analgesics-antinflammatory drugs are of great help. The selection of the appropriate antibiotic should be based on aerobic and anaerobic culture and sensitivity, especially in case of an abscess. The most common antibiotics prescribed are enrofloxacin, Oxytetracycline, doxycycline, amicasin and metronidazole. The most common analgesics are opioids (e.g. fentanyl, buprenorphine, butorphanol) and NSAIDs (e.g. carprofen, meloxicam). Small mamals who are suffering from dental disease have to be treated very cautiously because of their being sensitive by nature. Especially rabbits and guinea pigs are very sensitive to the protracted loss of appetite. The preanaesthetic management is also critical. The complete blood count and serum biochemical analysis, especially in dehydrated and undernourished patients is imperative to be measured, as the iv administration of normal saline or dextrose serum and electrolytes is often needed. There is a positive correlation between feeding the animals on balanced diets (especially in calcium) and avoidance of dental problems. Therefore, prevention could be managed via the combination of appropriate diets and proper advising of the owners. The diet should consist of hay, straws and small quantities of cereals. The veterinarian should inform the owners about proper management of their pet, feeding and periodical examinations that should be done in order to prevent these pathological conditions.

Evaluation of the effects of performance dentistry on equine rideability: a randomized, blinded, controlled trial

ABSTRACTObjective: This study attempted to determine: (1) if degree of dental malocclusion assigned prior to dental treatment was associated with equine rideability, assessed using a standardized score and (2) if performance dentistry improved this score.Animals: Thirty-eight Franches-Montagnes stallions.Methods: All horses were examined and assigned a dental malocclusion score by a veterinary dentist and randomized into two groups: sham treatment (Group S) and performance dentistry including occlusal equilibration (Group D). The horses were ridden twice before and three times after treatment by a professional dressage rider (unaware of treatment allocation). The horses were assigned a rideability score using a 27-point scale. The malocclusion score was compared to the average of the first two rideability scores using Spearman's coefficient of rank. Change in rideability scores over time was assessed by repeated measures ANOVA. Statistical significance was set at P < 0.05.Results: There was no correlation between dental score and rideability score prior to treatment (rs = 0.06, P = 0.73). In addition, there were no differences in the rideability score between treatment groups or as an interaction of treatment group and time (P = 0.93, P = 0.83, respectively).Conclusions: In conclusion, we were unable to show that performance dentistry improved equine rideability assessed by rider scoring. The addition of more objective measurement tools and a longer assessment period may help to scientifically prove what is anecdotally believed.

Conservative interdisciplinary treatment of a case with multiple facial and condyle fractures

The purpose of this case report is to describe an interdisciplinary approach for a 51-year-old male who underwent multiple facial fractures including bilateral condyle fractures. The patient underwent emergency surgery, which included open reduction of the maxilla and mandibular symphysis and closed reduction of the bilateral condyle fractures. Although the patient recovered a comfortable range of mouth opening and alleviation of the temporomandibular joint (TMJ) symptoms after surgery, he suffered from a large anterior-posterior discrepancy due to less stability on the condyle-fossa relationships and from open bite with contacts only on both second molars and right second premolars. In this case, first, to increase the occlusal contact, comprehensive orthodontic treatment was completed. Second, occlusal equilibration was selectively performed to relieve the interferences and establish a stable range of mandibular movement without any changes in the vertical dimension. Third, both the upper central incisors and left lateral incisor were minimally restored with splinted and single zirconia crowns, which had modified lingual contours to provide adequate anterior guidance permitting the anterior-posterior discrepancy of the posterior teeth during protrusion. This conservative interdisciplinary treatment, including open and closed reduction, orthodontic treatment, occlusal adjustment, and minimal prosthetic restorations, resulted in a stable mandibular position and recovery of mastication function.

A Retrospective Study of the Effectiveness of Four Different Treatments of Periodontal Disease in Equine Cheek Teeth.

Periodontal disease of equine cheek teeth is common and may lead to tooth loss if left untreated. Limited information is available comparing the effectiveness of treatment methods. The objective of this study was to retrospectively compare the effectiveness of 4 commonly used treatments in reducing periodontal pocket depth (in addition to routine dental treatment and occlusal equilibration). The 4 treatments compared were (1) removal of feed material, lavaging the pocket with dilute chlorhexidine, and then rinsing the mouth with chlorhexidine-containing mouthwash (CL); (2) CL plus placement of metronidazole into the pocket (M); (3) M plus the addition of polyvinyl siloxane temporary filling over the diastema (PVS); and (4) diastema widening to increase the interdental space, then PVS (DW). Pocket measurements were compared before and 2 to 6 months after treatment. Treatment groups CL, M, and PVS showed statistically significant reductions in pocket depth following treatment. The mean pocket depth reduction was the greatest in the DW group (and this was the only group with no cases having an increase in pocket depth), but this was not significant due to the small sample size. Additional analysis to compare effectiveness revealed a confounding effect of initial pocket depth. After accounting for this, DW was associated with smaller improvements than the other treatments, however, this was also based on a small sample size. After accounting for confounders, differences between treatments CL, M and PVS were not found to be significant, although all were associated with statistically significant reductions in pocket depth.

Coxalgia and temporomandibular disorders: a case report

Background: Although the occlusal equilibration in bite plate-induced occlusal position has been reported to be effective in resolving temporomandibular disorder (TMD)-related symptoms, it still remains unclear whether coxalgia is included in those TMD-related symptoms. Method and Findings: Occlusal equilibration was performed for a TMD patient with coxalgia. First, painful symptoms were relieved by appliance therapy. Subsequently, occlusal analysis was performed on the patient by mounting dental models mounted on an articulator and identifying a deviation of the occlusal position from the bite plate-induced occlusal position (BPOP). Occlusal equilibration to the BPOP was performed for the patient by selective tooth grinding. On treatment completion, the occlusal position was shifted 1 mm forward on the left side and 1 mm backward on the right side from the previous habitual occlusal position. The TMD-related symptoms (temporomandibular joint clicking and pain) were resolved, and left coxalgia disappeared. Conclusion: Coxalgia is thought to be included in TMD-related symptoms.

TMJ Splint Therapy; Then What?

Submit Manuscript | http://medcraveonline.com appliance, we have to make permanent changes to the patient’s occlusion so that; the occlusion without the splint is that same as it is with the splint in situ. Even the role of occlusion is still controversial, but the clinician should be careful in changing the patient’s occlusion irreversibly from the beginning. Occlusal disturbances can set off a chain of reaction radiating to the musculoskeletal system. This is manifested in typical symptoms such as headache, neck pain and back ache. The second stage of treatment (Occlusion Stage) can be moved to after improvement of the TMJ-ID with the splint therapy which should be evaluated by post-treatment MRI beside the clinical results. While; in some cases the combination of the minor occlusal adjustment in combination with the splint therapy can lead to rapid improvement. Occlusion Stage can be achieved by one of the following procedures which should be selected independent according to the patient occlusion state. Occlusal Equilibration Occlusal Equilibration is a term utilized to describe the procedures of selective adjustment of the biting surface of the teeth by grinding the enamel (outer layer of the tooth) so that the upper and lower teeth fit together (the intercuspal position) harmoniously. Occlusal equilibration can provide selected patients with the most conservative, predictable, and safest treatment possible. Moreover; occlusal equilibration can avoid the need for additional complex treatments. Occlusal Equilibration requires proper case selection with occlusal analysis. Occlusion analysis is the study of the relationship of the occlusal surfaces of opposing teeth and their associated functional harmonies. An impression of the upper and lower jaws was made and models were created. The wax impression was use to mount the upper and lower models on the articulator. The primary purpose of occlusion analysis is to reveal interferences in articulation which cannot be observed directly in the mouth. Recently; one of newest and most exciting technologies is the T-Scan Computerized Occlusal Analysis System. The heart of T-Scan technology is a disposable, extremely thin, flexible sensor. By biting and chewing against the sensor, a three dimensional view of your bite is displayed on computer screen. Then the bite can be easily adjusted and checked with the sensor. The process is repeated until the biting forces are equalized.

REABILITAREA EDENTAŢIEI DE CANIN MAXILAR PRIN AUTOGREFARE ŞI PROTEZARE CU SPRIJIN IMPLANTAR

Canine edentulous raises numerous aesthetic and functional problems, and rehabilitation with implant support require special attention during occlusal equilibration due to forces developed at this level. In this paper, we present a case of edentation of 23, prosthesis with a metal-ceramic crowns cemented on a dental implant. Because residual bone crest present inadequate size for implantation, we used an autograft of chin covered by a PRF membrane prior insertion of the implant.

Occlusal equilibration between option and clinical realty

Occlusal equilibration between option and clinical realty

Clinical outcome of subjective symptoms in myofascial pain patients treated by immediate complete anterior guidance development technique using digital analysis of occlusion (Tek-scan) and electromyography

Objectives: The purpose of this study is to evaluate the effect of occlusal equilibration using immediate complete anterior guidance development (ICAGD) technique by Kerstein. This technique is the most advanced verifiable and measurable way of digitally analysing the occlusion using T-scan technology and muscle activity using electromyography. Materials and Methods: This study is to assess the subjective symptoms of 75 patients diagnosed as myofascial pain patients and who were treated by ICAGD technique as described by Kerstein. The common complaints of the patients were pain in the masseter and temporal muscles, jaw tiredness in the mornings, night bruxing and difficulty in chewing. This technique involves occlusal equilibration to remove all posterior interferences and establish anterior guidance. The patients were treated over three visits 1-week apart and followed for 3 years. The symptoms reduction occurred for all the patients after the first correction in about 5-10 days. In about a period of 3 years review, no recurrence was seen of the chronic myofascial symptoms. Results: Regardless of the chronic nature of the patient's symptoms, symptom reduction occurred in a week's time. This agrees with the studies of Kerstein and others. Discussion: If free excursive mandibular movements are not established, may lead to muscle dysfunction at later years. Thus, equilibration should be done to establish good and free functional movements without any interference. Clinical relevance to interdisciplinary dentistry Using biometric tools like T scan helps dentists to 100% accurate diagnosis of TMD/ occlusion problems and to treat the case objectively. In the area of interdisciplinary practices, these gadgets help us to identify the issues precisely. Thus, a clinician will be at an advantage to locate the causative factor immediately with accuracy and treat the patient.

The influence of immediate complete anterior guidance development technique on subjective symptoms in Myofascial pain patients: Verified using digital analysis of occlusion (Tek-scan) for analysing occlusion: A 3 years clinical observation.

Objectives:The purpose of this study is to evaluate the effect of occlusal equilibration using immediate complete anterior guidance development (ICAGD) technique by Kerstein and Farrell on the subjective symptoms of myofascial pain. This technique is the most advanced verifiable and measurable way of digitally analyzing the occlusion using T-scan technology. The primary objective is to reduce the anterior disclusion time to <0.4 s and the secondary objective is to reduce the signs and symptoms of myofascial pain.Materials and Methods:This study is to assess the reducing effects of subjective symptoms of 100 patients diagnosed as myofascial pain patients treated by ICAGD technique as described by Kerstein and Farrell. The common complaints of the patients were a pain in the masseter and temporal muscles, jaw tiredness in the mornings, night bruxing and difficulty in chewing. In this technique occlusal equilibration involves removal of posterior interferences and establish anterior guidance. The patients were treated over three visits 1-week apart and followed for 3 years with an interval of 3 months for the subsequent visits. A visual analog ordinal scale is used to rate the symptoms. The symptoms reduction occurred for all the patients after the first correction in about 5–10 days. In about a period of 3 years review, no recurrence was seen of the chronic myofascial symptoms.Results:In spite of the chronic nature of the patient's symptoms, symptom reduction occurred in a week's time. This was assessed by the results of the ordinal scale values. This agrees with the studies of Kerstein and Farrell.Conclusion:Equilibration of occlusion using digital analysis by T-scan in which force is quantified against time, should be done to establish free functional movements without any interference; otherwise the disturbances in the excursive movements may lead to muscle dysfunction at later years.

Thinking of a maladaptive occlusion as an orthopedic cumulative trauma disorder

Aim:The authors review the possible connection between a dental malocclusion and a temporal mandibular disorder (TMD).Methodology:The authors have reflected on several patient case histories to remind us that there may be instances when a simple case of dental malocclusion could be blamed for instigating the signs and symptoms of TMD. The common denominator for this discussion is the situation of joint pain, dysfunction and/or myalgia. Patient-reported signs and symptoms, along with treatment results and progress notes were evaluated.Results:The onset of TMD signs could be traced to an altered dental occlusion, which, upon maximum closure drives the mandible in a posterior direction, forcing the condylar head to now impinge upon retrodiscal tissue and the resultant muscle reflex protective response. Correction for the dentally induced malocclusion obviated the symptoms of TMD with patient-reported improved health.Conclusions:When a patient presents with signs consistent with those of a TMD, the clinician should include a review of recently placed dental restorations or occlusal equilibration to assess the patient’s adaptive occlusion. Overlooking this quick evaluation on the exam checklist may lead to the clinician missing a simple treatment modality to address a TMD.

An Appeal for a Rational Approach to TMD and Orofacial Pain

• They have seen a number of prior dentists/physicians (orthodontists, oral surgeons, otolaryngology, chiropractic etc.). Many have spent thousands of dollars with no benefit [2-5]. • They have been given no diagnosis other than “TMJ”. • Unfortunately most patients present with orthotics that are ill fitting, poorly adjusted, and have little chance of success. There are even reports of occlusal changes occurring with these splints [6]. The efficacy of splint therapy for TMD is still controversial [3,4] and further research is needed with well-designed randomized controlled trials. However, there is still enough supporting evidence for use of stabilization splints to recommend their use. • OFP patients have been treated with occlusal equilibration, orthodontics, TMJ surgery, with no benefit or often an increase in pain [7]. They have never had adequate reversible conservative therapy. • Many patients have no insurance coverage for conservative orofacial pain management. These results in them not appointing due to financial limitation.

Mathematical methods for assessing the prognostic of fixed partial dentures resulting from evaluating a group of dental patients in Romania.

Based on some mathematical and statistical approaches, our study leads to some conclusions concerning the procedures related to the orodental prosthetics. Occlusal equilibration in orodental prosthetics is a major issue because besides motivating patients for a regular daily oral hygiene, it could significantly increase the longevity of FPR. More dental hygiene information should be given after prosthetic treatment and patients should be motivated to attend recalls on a regular basis for professional teeth-cleaning. Interdental cleaning aids should be explained and the patients have to be motivated to use them at least once a day and the using technique should be individualized. Regarding the application of the deformable models theory, implemented in the context of an expert type software environment, it is known that the fact that modelling by advanced methods and techniques based on the deformable surfaces theory increases the efficiency of the dentofacial prosthetics procedures is a domain of great interest in the actual medical research.

Mandibular Implant-supported Overdenture as an Occlusion-guide for Maxillary Fixed Implant Prosthesis: A Clinical Report

Unlike natural teeth, osseointegrated implants react bio mecha­ nically in a different fashion to occlusal load due to lack of the periodontal ligament. Hence, the dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri­implant bone loss and failure of the implant/implant prosthesis. Stability of the intercuspal position and reduction of lateral forces are impor­ tant aspects when providing occlusal equilibration for implant­ supported prosthesis. Multiple missing teeth in maxillary and mandibular arches with disturbed occlusal plane due to long­term edentulous condition and overeruption of remaining teeth into the edentulous spaces is the challenging clinical situation. This article describes the management of a patient with multiple missing teeth in both the arches with mandibular implant­supported overdenture and maxillary implant supported fixed prosthesis. The sequence of the treatment planning is highlighted to manage the complex situation to achieve the best predictable occlusion.

Use of the Grindcare® device in the management of nocturnal bruxism: a pilot study

Bruxism may be described as a diurnal or nocturnal parafunction, characterised by clenching, bracing, gnashing or grinding of the teeth and jaws. The aim of the management of bruxism should be to control or reduce the level of activity where possible. A variety of treatment strategies have been employed to achieve this including hypnosis, occlusal equilibration, splint therapy, physiotherapy and acupuncture. A more recent approach is the use of biofeedback. Nineteen consecutive patients were recruited from the temporomandibular joint dysfunction (TMD) clinic at Manchester Dental Hospital, all of whom were known bruxists. They were supplied with the Grindcare® device (Medotech) and instructed to wear it every night over the five-week observation period. By monitoring electromyographic (EMG) muscle activity, the device is able to emit low-voltage electrical impulses as it senses a clenching or grinding episode, bringing about muscle relaxation. Eleven of the nineteen patients (58%) reported a major reduction in the occurrence of headaches and discomfort of the masticatory muscles on waking. Female and younger subjects responded more favourably than male and older subjects respectively. The use of biofeedback could reduce the level of parafunctional activity and bring about meaningful symptomatic improvement. No adverse effects occurred throughout the study period.

Summary of: Use of the Grindcare® device in the management of nocturnal bruxism: a pilot study

Background Bruxism may be described as a diurnal or nocturnal parafunction, characterised by clenching, bracing, gnashing or grinding of the teeth and jaws. The aim of the management of bruxism should be to control or reduce the level of activity where possible. A variety of treatment strategies have been employed to achieve this including hypnosis, occlusal equilibration, splint therapy, physiotherapy and acupuncture. A more recent approach is the use of biofeedback. Method Nineteen consecutive patients were recruited from the temporomandibular joint dysfunction (TMD) clinic at Manchester Dental Hospital, all of whom were known bruxists. They were supplied with the Grindcare® device (Medotech) and instructed to wear it every night over the five-week observation period. By monitoring electromyographic (EMG) muscle activity, the device is able to emit low-voltage electrical impulses as it senses a clenching or grinding episode, bringing about muscle relaxation. Results Eleven of the nineteen patients (58%) reported a major reduction in the occurrence of headaches and discomfort of the masticatory muscles on waking. Female and younger subjects responded more favourably than male and older subjects respectively. Conclusion The use of biofeedback could reduce the level of parafunctional activity and bring about meaningful symptomatic improvement. No adverse effects occurred throughout the study period.