Repositioning Splint Therapy Research Articles

Evaluation of functional interaction masseter and sternocleidomastoid muscles affected by TMJ dysfunction.

Aim: To evaluate the functional connection and the bioelectrical state of the m.masseter and m. sternocleidomastoid using functional tests before and after treatment. Materials and Methods: The sample consisted of 21 individuals with temporomandibular joint dysfunction. Examinations were carried out before and after treatment using repositioning splint therapy and in seated/standing positions. Results: M. masseter - p=0.072 before treatment and p=0.821 after treatment. Symmetry is also maintained after treatment. After treatment, a significant difference is noted at the level of significance p<0.001 for the right chewing muscle. In seated and standing positions before treatment did not reveal a statistically significant difference (p=0.07, p=0.143) and after (p=0.272, p=0.623).M. sternocleidomastoid- p<0.001 when comparing right and left sides. After treatment, there was no difference between the right and left sides (p=0.169). No statistical difference was found when assessing indicators separately for the right and left muscles in seated and standing positions (p=0.304, p=0.611, p=0.089, p=0.869). When comparing the bioelectric potentials of the right muscle before, after treatment, a statistically significant difference was found p=0.001. Conclusions: Biostatistical analysis of the indicators of bioelectrical activity of m. masseter and sternocleidomastoid indicates no changes in muscle microvolt indicators with changes in body position in patients. However, repositioning splint therapy is associated with reduced muscle tone in initially more spasmodic muscles. It is worth noting that the symmetry of interaction between muscles improves.

Efficacy of Arthrocentesis and Anterior Repositioning Splints in Treatment of Internal Derangement of TMJ: A Prospective Clinical Study.

The aim of this study is to assess the efficacy of double puncture arthrocentesis and anterior repositioning splints in the treatment of internal derangement of temporomandibular joint. 35 patients with mean age of 36.6 years±10.2 years diagnosed with unilateral TMD who fell into Wilkes stage 2 and disc displacement with reduction with intermittent locking described by RDC/TMD were treated with Nitzan's double puncture arthrocentesis and were given a anterior repositioning hard splint. The parameters following parameters were assessed at intervals of 1 week, 2 weeks, 1 month, 3 months and 6 months: pain, maximum inter-incisal mouth opening, Joint noise/click. Statistically significant (p < 0.001) improvements were seen at all recorded intervals in all observed parameters. Simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.

The effect of anterior repositioning splint therapy on maximum bite forces in patients with disc interference disorders

Objective To evaluate the effect of anterior repositioning splint (ARS) on maximum bite force (MBF) values in patients with disc interference disorders (DID). Material and methods Twenty-two patients with disc interference disorders and 22 healthy subjects participated in to study. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I have been used to diagnose DID patients. All patients received ARS therapy for 6 weeks. The MBF measurement was performed with Flexi-Force piezo-resistive sensors for both healthy subjects and patients before and after ARS therapy. Results A significant difference was recorded by the increase of the mean MBF values after the use of the ARS in the patient with disc derangements (p < .05). Conclusions APS therapy is efficient for eliminating pain and increasing MBF of the patients with DID. In addition, the use of FlexiForce sensors may be a practical solution to assess the bite force in the clinical setting.

Evolutionary Spectral Analysis of Temporomandibular Joint Sounds Before and After Anterior Repositioning Splint Therapy in Patients with Internal Derangement.

To determine the effectiveness of anterior repositioning splint (ARS) therapy on elimination of temporomandibular joint (TMJ) sounds in patients with internal derangement. A total of 26 patients with 44 TMJs with internal derangement according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were selected. These patients used an ARS for 6 weeks. The sounds of both the right and left TMJs were recorded with a specifically developed sound recording system before and after ARS therapy. The evaluation of sound was performed using evolutionary spectral analysis on the program MATLAB. Parameters such as sound type, amplitude, duration, and energy were evaluated in a time-frequency analysis. Changes in mean amplitude levels of opening/closing TMJ sounds before therapy and 6 weeks after insertion of splints were compared using paired-samples t test. The level of significance was set at 5%. The patients showed a decrease in the mean amplitude and energy values of opening/closing sounds after 6 weeks of ARS use (P < .05). According to evolutionary spectral analysis, the use of ARS was efficient for 7 of 19 right joints (37%) and 11 of 25 left joints (44%). The results suggest that the use of 6-week ARS reduced amplitude and energy parameters of TMJ sounds; however, it did not completely eliminate TMJ sounds.

Residents' journal review

Residents' journal review

Orthodontic Treatment for the TMJ Patient Following Splint Therapy to Stabilize a Displaced Disk(s): A Systemized Approach. Part I, TMJ Orthodontic Diagnosis

Orthodontic treatment for a patient who has had a displaced disk or disks and has been stabilized by anterior repositioning splint therapy presents the dentist with a difficult orthodontic problem. Frequently, there is a posterior open bite present, with the anterior teeth only occluding in the stabilized TMJ position upon removal of the splint. The current articles (Part I of II presented here) will present an organized TMJ/orthodontic diagnosis (Part I) and orthodontic treatment method (Part II, to be presented in the next journal) to properly treat these patients to a consistent stabilized occlusion compatible with the TMJ splint stabilized position.

Surface electromyographic patterns of masticatory, neck, and trunk muscles in temporomandibular joint dysfunction patients undergoing anterior repositioning splint therapy

The aim of this study was to investigate the surface electromyographic (sEMG) activity of neck, trunk, and masticatory muscles in subjects with temporomandibular joint (TMJ) internal derangement treated with anterior mandibular repositioning splints. sEMG activities of the muscles in 34 adult subjects (22 females and 12 males; mean age 30.4 years) with TMJ internal derangement were compared with a control group of 34 untreated adults (20 females and 14 males; mean age 31.8 years). sEMG activities of seven muscles (anterior and posterior temporalis, masseter, posterior cervicals, sternocleidomastoid, and upper and lower trapezius) were studied bilaterally, with the mandible in the rest position and during maximal voluntary clenching (MVC), at the beginning of therapy (T0) and after 10 weeks of treatment (T1). Paired and Student's t-tests were undertaken to determine differences between the T0 and T1 data and in sEMG activity between the study and control groups. At T0, paired masseter, sternocleidomastoid, and cervical muscles, in addition to the left anterior temporal and right lower trapezius, showed significantly greater sEMG activity (P = 0.0001; P = 0.0001; for left cervical, P = 0.03; for right cervical, P = 0.0001; P = 0.006 and P = 0.007 muscles, respectively) compared with the control group. This decreased over the remaining study period, such that after treatment, sEMG activity revealed no statistically significant difference when compared with the control group. During MVC at T0, paired masseter and anterior and posterior temporalis muscles showed significantly lower sEMG activity (P = 0.03; P = 0.005 and P = 0.04, respectively) compared with the control group. In contrast, at T1 sEMG activity significantly increased (P = 0.02; P = 0.004 and P = 0.04, respectively), but no difference was observed in relation to the control group. Splint therapy in subjects with internal disk derangement seems to affect sEMG activity of the masticatory, neck, and trunk muscles.

Comparative Study of Repositioning Splint Therapy and Passive Manual Range of Motion Techniques for Anterior Displaced Temporomandibular Discs with Unstable Excursive Reduction

Summary Background The purpose of this study was to compare two treatment methods: Mobilisation with active exercises, and soft repositioning splinting, as treatment protocols for relief of symptoms secondary to anterior displaced temporo- mandibular disc (ADTMD) syndrome. Methods Thirty-six individuals between 19 and 43 years old with ADTMD participated in this study. Eighteen patients were chosen randomly to receive four weeks of treatment with a soft repositioning splint, and the other 18 received passive mobilisation and active exercises. All subjects were assessed for active range of motion for maximum mouth opening and pain levels, which were measured according to the pain-physiopathology instrument, before and after treatment. Results The manual mobilisation with exercises group demonstrated a significant decrease in total pain level (p Conclusion This study suggests that manual mobilisation and active exercises are more effective for treatment of pain and range of motion deficits associated with ADTMD, than soft repositioning splint therapy. These improvements do not necessarily mean that the disorder is cured.

Changes in vertical tooth position and face height related to long term anterior repositioning splint therapy.

This study evaluates whether extended full-time wear of a partial coverage mandibular anterior repositioning splint (MORA) causes intrusion of posterior teeth and determines the effect on jaw position. Sixty-four patients from two private orthodontic practices were studied using cephalometric radiographs to measure vertical change in position of the anterior and posterior teeth and the mandible. The splint wear time ranged from a minimum of one half year to a maximum of 4.8 years, with a mean of 1.33 years. No significant change was recorded in the distance from the mandibular molar to the mandibular plane. On average, the maxillary incisor and maxillary molar extruded about 1 mm, while the mandibular molar was unchanged and the mandibular incisor intruded about 0.6 mm. Posterior face height increased an average of 1.6 mm, and anterior face height increased an average of 2.7 mms. In 20% of the patients, intrusion of the mandibular molars of 1 mm or more occurred. In 41%, extrusion of the maxillary incisors of 1 mm or more was noted. Intrusion of the upper molars or extrusion of the lower incisors occurred in only 5% of the patients. The data indicates that only a very small proportion of patients having long term splint therapy using the MORA have clinically significant molar intrusion. Change in mandibular position was expressed in a vertical increase in posterior and anterior face height. Only very small changes occurred in antero-posterior position.

Long-term treatment of disk-interference disorders of the temporomandibular joint with anterior repositioning occlusal splints

Forty patients with three different types of symptomatic disk-interference disorders were treated with anterior repositioning splint therapy for 8 weeks. At the end of that period 80% of the patients were free of joint sound and pain. Each patient's splint was then gradually modified until the patient's original occlusal condition was reestablished. Each patient was then allowed to function in that position. The patients were reevaluated an average of 2 1/2 years later. Seventy-five percent of the patients had no joint pain and 66% had a return of joint sounds. Sixty-six percent of the patients did not find the need to seek additional treatment for jaw pain and dysfunction.