Splint Therapy Research Articles

Long-Term Outcomes of Non-surgical versus Surgical Treatment for Carpal Tunnel Syndrome: An Observational Cohort Study

Background: Carpal Tunnel Syndrome (CTS) is a common condition that significantly impacts patients' quality of life and work productivity. While both non-surgical and surgical treatments are employed, there is a lack of consensus regarding the most effective management strategy.
 Objective: This study aims to compare the outcomes of non-surgical and surgical treatments for CTS, focusing on symptom severity, functional status, and patient satisfaction.
 Methods: This observational cohort study included 74 participants, with 37 in each treatment group (non-surgical and surgical). Demographic data, including age, gender, occupation, and hand dominance, were recorded. Clinical parameters assessed were duration and severity of CTS symptoms, previous treatments, and comorbid conditions. The non-surgical group underwent treatments like wrist splinting, NSAIDs, and physical therapy, while the surgical group underwent decompression surgery. Outcomes measured included frequency and severity of symptoms, impact on daily activities, and satisfaction with treatment outcomes. Data were analysed using descriptive statistics to compare between groups.
 Results: The average age was 50 ± 9 years in the non-surgical group and 52 ± 8 years in the surgical group, with a predominance of females in both. The non-surgical group showed higher frequency and severity of symptoms, with daily symptoms reported by 76.1% of patients, compared to 44.4% in the surgical group. Severity of pain was higher in the non-surgical group (5.8 out of 10) than in the surgical group (2.8 out of 10). Satisfaction with surgical outcomes was high, with all patients in the surgical group reporting satisfaction despite a 100% rate of postoperative complications.
 Conclusion: The study indicates that surgical treatment for CTS may be more effective in reducing symptom severity and improving patient satisfaction compared to non-surgical methods. However, the high rate of postoperative complications in the surgical group necessitates careful consideration and patient counselling regarding treatment choices.
 Keywords: Carpal Tunnel Syndrome, Non-surgical Treatment, Surgical Treatment, Patient Outcomes, Symptom Severity, Treatment Satisfaction

Orthodontic treatment of an open bite after splint therapy for a patient with idiopathic condylar resorption

In the treatment of orthodontic patients with idiopathic condylar resorption, symptoms of temporomandibular joint disorders and constantly changing occlusions caused by an instability of mandibular position make it difficult for orthodontists to confirm definitive orthodontic diagnosis and treatment plans. Therefore, these patients' temporomandibular joint (TMJ) structures need to be stabilized with splint therapy before active tooth movement to identify and maintain the true mandibular position. For some idiopathic condylar resorption patients, orthognathic surgery can cause further resorption on the vulnerable condyles of the mandible; thus, effective orthodontic camouflage treatment after joint stabilization should be considered. During the orthodontic camouflage treatment, adverse loads on the TMJ structures, which could change the position of condyles, should be avoided, and TMJ-friendly mechanics must be applied.

Temporomandibular disorders, occlusal splints, and treatment options: a survey-based investigation

Background: The term "temporomandibular disorders" (TMDs) refers to a group of painful conditions that affect both the hard and soft orofacial anatomical structures. The primary objectives of TMD treatment are to lessen pain and enhance mandibular movements, re-establishing proper functioning. One of the widely used treatment options for TMDs pathology is the occlusal splint. This non-invasive intraoral device, determines both the muscle relaxation and reversibly repositions the temporomandibular joint structures. The study aimed to compare the efficacy of different occlusal splint designs or materials in managing TMD symptoms. Methods: Twenty-six patients, nineteen of whom were female and seven of whom were male, ranging in age from twenty to seventy, met the criteria needed participate in this study. Two different questionnaires were formulated: a patient-focused and a clinician-focused questionnaire. The patient's data encompassed general health status and TMD signs and symptoms, whereas the clinician's questions addressed assessment and treatment alternatives, including the particularities of occlusal splint therapy. Results: The majority of the patients were diagnosed with disc displacement with reduction (61.5%), followed by myalgia (26.9%). The only form of treatment preferred by physicians was the Michigan occlusal splint, which was mainly used on the maxillary dental arch (84,6%). After the splint therapy was completed and the intended results were obtained, the treatment plan was finished using selective grinding, prosthetic dental restorations, orthodontic therapy, or a combination of these procedures. The patient was required to continue physical therapy (7,7%), wear a full-arch night guard (42.3%), and undergo rigorous periodic control sessions (34.6%) to maintain the final aesthetic and functional results. Conclusions: Occlusal splints are an efficient and reliable initial therapy preference for patients with temporomandibular disorders. In addition to improving symptoms in the temporomandibular joint, occlusal splints may determine mandibular repositioning, which also implies a variety of treatment approaches, ranging from the minimally invasive to the most complex, to achieve a functional occlusal status.

Recording the maxillomandibular relationship with the Aqualizer system prior to occlusal splint therapy for treating temporomandibular disorders: a randomized controlled trial

Temporomandibular disorders (TMD) present a public health issue and are one of the most common musculoskeletal conditions causing chronic pain. This study compares the outcomes of occlusal splint therapy in patients with TMD following two different maxillomandibular relationship (MMR) registration techniques. 40 TMD patients were randomly allocated to MMR registration with the Aqualizer system (AQU) or with chin point guidance (CPG) prior to fabricating occlusal splints. TMD symptoms, subjective pain intensity, and quality of life (QoL) were recorded at baseline and after 3 and 6 months. The treatment led to an overall reduction of TMD symptoms in both groups (Conover test, p < 0.00001). TMJ sounds, TMJ pain with palpation and muscle pain with palpation subsided regardless of the type of MMR registration method used (Cohen’s d > 0.8). AQU-based occlusal splints led to a better improvement of TMJ pain with maximum opening compared to CPG-based occlusal splints (Cohen’s d = 0.9; CPG d = 0.13). In both groups, occlusal splint treatment had little to no effect on correcting lateral mandible deviation or improving restricted jaw opening. After 6 months occlusal splints in both groups had a large effect on improving subjective pain intensity (Cohen’s d > 0.8), however, patients reported a higher QoL in the AQU group compared to the CPG group (Mann–Whitney-U-test, p < 0.05). The results of this study support the premise that occlusal splints are effective in relieving pain-related TMD symptoms. The Aqualizer can be considered for determining MMR in cases, where guided registration techniques are not possible.Trial registration: DRKS00031998.

COMPLEX TREATMENT OF INTERNAL TMJ DISORDERS IN PATIENTS WITH DIFFERENT BIT TYPES

Objective: To assess the impact of physiological and pathological types of occlusions on the effectiveness of the treatment of patients with internal disorders of the TMJ. Material and Methods: A comprehensive examination and treatment of 139 patients with internal TMJ disorders with subluxation and chronic dislocation of the articular disc was carried out. The patients were divided into three groups. All groups included patients with both physiological and pathological occlusion. The first group included 28 (20.1%) patients who were treated only with occlusal splint therapy; the second group included 95 (68.3%) patients who were treated with a combination of occlusal splint therapy and the use of arthrocentesis; in the third group (16 people (11.5%), along with splint therapy and arthrocentesis, TMJ arthroscopy was performed. The examination included a survey and examination of patients, a study of diagnostic models of the jaws to determine the types of occlusion and occlusal contacts, magnetic resonance imaging (MRI) and ultrasound examination (ultrasound) of the TMJ. Patients underwent a phased treatment, including occlusive splint therapy (stage I); with insufficient effectiveness - occlusive splint therapy and arthrocentesis (stage II); occlusive splint therapy and arthrocentesis in combination with arthroscopy (stage III of treatment). Results: As a result of the study, it turned out that the groups of patients differed significantly in the complexity and duration of the treatment. Thus, in patients with internal TMJ disorders and pathological type of occlusion, in 82.6% of cases, additional use of arthrocentesis was required and in 34.8% - arthroscopy (95 patients out of 139), while patients with physiological types of occlusions (orthognathic, progenic, biprogenic and direct) needed these treatments in 80.2% and 7.8% of cases, respectively In the groups of patients, the duration of therapy, as well as the number of arthrocentesis performed in patients at the second and third stages of treatment, significantly differed. In the first group, the duration of treatment was 6.2 months for patients with normal occlusion and 8.7 (p&lt;0.01) months for patients with pathological occlusion; additional methods of treatment (arthrocentesis and arthroscopy) were not used. In the second and third groups of patients, the duration of treatment for patients with occlusion pathology was also longer: in the second group 4.9 and 6.8 (p&lt;0.01) months for patients with physiological and pathological types of occlusions, respectively, in the third group with the use of splint therapy, arthrocentesis and arthroscopy in patients with normal occlusion was 13.1 (p&lt;0.05) months, and in patients with occlusion pathology 14.5 months Conclusion: Patients with internal TMJ disorders need a comprehensive examination for the timely detection of occlusion pathologies. The relationship between internal TMJ disorders and the type of occlusion must alway

Comparison of the efficacy of occlusal splint and botulinum toxin therapies in patients with temporomandibular disorders with sleep bruxism.

This study aims to evaluate the efficacy of occlusal splint and botulinum toxin (BTX) therapies for improving the pain scores and mouth opening in patients with temporomandibular disorders (TMD) with sleep bruxism (SB). Aretrospective cohort study was conducted based on clinical record reviews of patients with TMD symptoms (e.g., temporomandibular joint [TMJ] pain, masticatory muscle pain, TMJ internal derangements, joint sounds, and limited mouth opening) and SB. The patients were divided into two groups: occlusal splint group and BTX group. Maximum unassisted mouth opening (MMO) and pain score on avisual analogue scale (VAS) before treatment and at 1‑, 3‑, and 6‑month follow-up were analyzed to evaluate the clinical outcomes. Atotal of 60patients (49women and 11men, mean age 34.63 ± 11.85 years) were enrolled. Each group had 30patients. The comparisons of the groups at 1and 3months after treatment indicated that the BTX group had higher MMO values (P = 0.013 and 0.034, respectively) and lower VAS scores than the occlusal splint group (P = 0.000 and 0.001, respectively). No difference between the two groups was observed 6months after treatment (P > 0.05). Both occlusal splint and BTX treatment methods were successful in treating TMD with SB. BTX provided patients with rapid relief in the early period; therefore, BTX can be recommended as aprimary treatment option in patients with greater pain.

Developing a universal and reliable temporomandibular joint reference system for quantifying morphological and positional changes.

This study aimed to provide a universal and reliable reference system quantifying temporomandibular joint (TMJ) morphological and positional changes. Large field-of-view (FOV) cone-beam computed tomography (CBCT) images (20 TMJs) from 10 preorthognathic surgery patients and limited FOV CBCT images (40 TMJs) from 20 splint therapy-treated patients with temporomandibular disorders were collected. TMJ-specific reference system including a TMJ horizontal reference plane (TMJHP) and a local coordinate system (TMJCS) was constructed with landmarks on cranial base. Its application for TMJ measurements and its spatial relationship to common Frankfort horizontal plane (FHP) and maxillofacial coordinate system (MFCS) were evaluated. Five relevant landmarks were selected to optimally construct TMJ-specific reference system. General parallelism between TMJHP and FHP was demonstrated by minimal angular and constant distance deviation (1.714 ± 0.811º; 2.925 ± 0.817 mm). Additionally, tiny axial orientational deviations (0.181 ± 6.805º) suggested TMJCS rivaled MFCS. Moreover, small deviations in orientations and distances (1.232 ± 0.609º; 0.310 ± 0.202 mm) indicated considerable reliability for TMJCS construction, with intraclass correlation coefficients (ICCs) ranging from 0.999 to 1.000. Lastly, slight discrepancies in translations and rotations revealed high reliability for condylar positional and morphological measurements (ICC, 0.918-0.999). TMJ-specific reference system was merely tested in two representative FOVs. This study provides a universal and reliable reference system for TMJ assessment that is applicable to both limited and large FOV CBCT. It would improve comparability among diverse studies and enable comprehensive evaluations of TMJ positional and morphological changes during TMJ-related treatment follow-up such as splint therapy and disease progression.

The Effect of Arthrocentesis Treatment for Maximum Mouth Opening and Pain in Temporomandibular Joint Diseases and the Effect of Splint, Drug, and Physical Therapy on This Treatment.

Background and Purpose: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular diseases involving the temporomandibular joint complex and the surrounding muscle and osseous structure. TMD can be classified as intra-articular or extra-articular. The aim of this study was to evaluate the effect of arthrocentesis in terms of maximum mouth opening (MMO) and pain in patients with TMD of intra-articular origin. In addition to this treatment, the effects of factors such as splints, medication, and physical therapy on arthrocentesis were examined. Material and methods: This retrospectively designed study was conducted with 79 patients who had previously undergone arthrocentesis. These patients were divided into three groups according to the Research Diagnostic Criteria for temporomandibular disorder: disc displacement (DD) with locking (Group 1), DD without locking (Group 2), and degenerative joint diseases (Group 3) groups. The maximum mouth opening (MMO) and visual analog score (VAS) values of the groups were recorded before arthrocentesis (Baseline: T0), on the third day after arthrocentesis (T1), and at the sixth month (T2) after arthrocentesis. Information about whether the patients received concurrent medical treatment, splint treatment, and physical therapy was also recorded. These data were compared between groups. Results: It was observed that the VAS scores in all three groups decreased from T1 compared to T0 (p < 0.05). Likewise, the MMO value increased in all groups at T1 compared to T0. (p < 0.05). It was observed that splint treatment, pain killer and muscle relaxant treatment, and physical therapy made no additional contribution to arthrocentesis in terms of reducing pain or increasing MMO value (p > 0.05). Conclusions: Arthrocentesis was observed to be effective in terms of pain and function in TMJ patients in this study. It was observed that splint therapy, physical therapy, and medical therapy made no additional contribution to arthrocentesis in terms of MMO or pain.

Effect of mandibular advancement splint therapy on cardiac autonomic function in obstructive sleep apnoea.

This study aimed to evaluate the effect of mandibular advancement splint (MAS) therapy on cardiac autonomic function in patients with obstructive sleep apnoea (OSA) using heart rate variability (HRV) analysis. Electrocardiograms (ECG) derived from polysomnograms (PSG) of three prospective studies were used to study HRV of patients with OSA before and after MAS treatment. HRV parameters were averaged across the entire ECG signal during N2 sleep using 2-min epochs shifted by 30s. Paired t-tests were used to compare PSG and HRV measures before and after treatment, and the percent change in HRV measures was regressed on the percent change in apnoea-hypopnea index (AHI). In 101 patients with OSA, 72% were Caucasian, 54% men, the mean age was 56±11 years, BMI 29.8±5.3 kg/m2, and treatment duration was 4.0±3.2 months. After MAS therapy, there was a significant reduction in OSA severity (AHI, - 18 ± 16 events per hour, p < 0.001) and trends towards increased low-frequency to high-frequency ratio, low-frequency power, and reduced high-frequency power (LF:HF, - 0.4 ± 1.5, p = 0.01; LF, - 3 ± 16 nu, p = 0.02, HF, 3.5 ± 13.7 nu, p = 0.01). Change in NN intervals correlated with the change in AHI (β(SE) = - 2.21 (0.01), t = - 2.85, p = 0.005). No significant changes were observed in the time-domain HRV markers with MAS treatment. The study findings suggestthat successful MAS treatment correlates with changes in HRV, specifically the lengthening of NN intervals, a marker for improved cardiac autonomic adaptability.

Three-dimensional evaluation of upper pharyngeal airway, hyoid bone, and craniocervical changes following stabilization splint therapy in adult patients with temporomandibular joint disorders and mandibular deviation: A retrospective study

ObjectiveThis study aimed primarily to analyze the three-dimensional (3D) changes in the pharyngeal airway (PA), and secondarily, the hyoid bone (HB) and the craniocervical (CC) following stabilization splint (SS) therapy in adult patients with temporomandibular joint disorders (TMD) and mandibular deviation (MD). MethodsThirty-five adult patients with TMD and MD, who were treated using SS with a mean age of 25.14 ± 6.11 years, were enrolled in this retrospective clinical study. Pre- and post-therapeutic cone-beam computed tomography (CBCT) scans were analyzed. PA dimension,nasopharyngeal, oropharyngeal, hypopharyngeal, sub-hypopharyngeal, and total pharyngeal airway spaces were measured in surface area, volume, minimum constricted area (MCA) and width, HB position, and CC posture were analyzed three-dimensionally using InVivo 6.0.3 and Dolphin 11.95 software. Wilcoxon rank-sum or Paired t-test was conducted, and P < 0.05 was considered significant. ResultsSS therapy was administered for a period of 9.49 ± 4.02 months. The oropharyngeal airway space showed a significant decrease in sagittal width. The hypopharyngeal surface area, volume, MCA, and sagittal width decreased significantly. In terms of HB, hyoid–mandibular plane (H-MP), retrognathia–third vertebra's most inferior–anterior (RGN-C3ia), and retrognathia–Sella (RGN-S) distances significantly decreased. The Nasion–Sella line and the line that passes through C2ip to the odontoid process posterior tangent (NSL-OPT) angle in CC posture also decreased significantly. ConclusionSS therapy in TMD patients with MD mainly results in narrowing of the hypopharyngeal region, no change in HB position and improvement in head posture. These results undoubtedly assist in diagnosis and treatment of clinical conditions.

Tapping the potential of rapid prototyping techniques in creating a paradigm shift in the fabrication of occlusal splints

PurposeThis study aims to cover the overall gamut of rapid prototyping processes and biomaterials used for the fabrication of occlusal splints in a comprehensive manner and elucidate the characteristics of the materials, which are essential in determining their clinical efficacy when exposed to oral surroundings.Design/methodology/approachA collective analysis of published articles covering the use of rapid prototyping technologies in the fabrication of occlusal splints, including manufacturing workflow description and essential properties (mechanical- and thermal-based) evaluation of biocompatible splinting materials, was performed.FindingsWithout advances in rapid prototyping processes and materials engineering, occlusal splints would tend to underperform clinically due to biomechanical limitations.Social implicationsThree-dimensional printing can improve the process capabilities for commercial customization of biomechanically efficient occlusal splints.Originality/valueRapid technological advancement in dentistry with the extensive utilization of rapid prototyping processes, intra-oral scanners and novel biomaterial seems to be the potential breakthrough in the fabrication of customized occlusal splints which have endorsed occlusal splint therapy (OST) as a cornerstone of orthodontic treatment.

Results of diagnosis and treatment of temporomandibular joint dysfunction in patients with malocclusion

Temporomandibular joint dysfunction in patients with malocclusion is quite a widespread problem in modern dentistry. The study included: identification of patients with signs of TMJ dysfunction and malocclusion by pre-selection; diagnosis of dysfunctions in the main group of patients; preparation of the treatment plan using splint therapy and kinesiotherapy; assessment of the effectiveness of these treatment methods. Most of the subjects had a decrease in the tone of the masticatory muscles, pain sensitivity in the masticatory muscles and the TMJ area. Splint therapy, as well as kinesiotherapy, is the best choice in the treatment of these patients.

Awake bruxism in temporomandibular disorders patients referred to tertiary care: A retrospective study on its assessment and TMD management.

Bruxism is defined as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can occur during sleep (sleep bruxism, SB) or during wakefulness (awake bruxism, AB). To date, the effect of AB on the purported negative consequences of bruxism has remained unclear. The assessment of AB, its relation to temporomandibular disorders (TMD) treatment modalities, and their possible outcomes were investigated among TMD patients resistant to treatment in primary care and referred to a tertiary care clinic. The records of 115 patients were studied. Patients were referred to the Head and Neck Centre, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, for TMD treatment between 2017 and 2020. The data derived from the eligible patients' records included the following: background data (age and sex), referral data (reason and previous treatment), medical background (somatic and psychiatric), clinical and possible radiological diagnoses at a tertiary care clinic, treatment modalities for masticatory muscle myalgia, bruxism assessment, its possible treatment modalities and their outcomes, and overall management outcome. We analysed the outcomes of single treatment modalities and combined groups of modalities. For the demographic data, the Chi-squared test and Fischer's Exact test were used to determine the associations between the categorical variables. A Sankey-diagram was used to describe the flow of treatment. Temporomandibular joint-pain-dysfunction syndrome (K07.60) was the most frequent single reason to refer a patient to tertiary care (17.4%). At referral, men had myalgia (M79.1) significantly more often (p = .034) than women. Similarly, men had depression (p = .002) more often and other psychiatric diagnoses (p = .034). At tertiary care, the presence of AB was assessed in 53.9%, and self-reported AB was recorded in 48.7%. In patients with possible AB, those who were prescribed neuropathic pain medication showed significantly less improvement in symptoms (p = .021) than those who underwent splint therapy (p = .009). Overall, half of the patients showed overall improvement in their TMD symptoms from the treatment combinations. Despite several treatment modalities, only half of the patients showed improvement in their symptoms in the present study. A standardised assessment method encompassing all factors contributing to bruxism behaviours and their consequences is suggested.

The effectiveness of combining ultrasound therapy with splinting and exercise therapy for patients with carpal tunnel syndrome

Background: Carpal tunnel syndrome (CTS) can cause patients to experience negative symptoms that can significantly affect their ability to use their hands to perform daily activities. This study aimed to compare the effectiveness of a combination of splinting and exercise therapy with or without ultrasound therapy in improving CTS symptoms and the functional status of patients.&#x0D; Methods: This randomized pre and post-test control group design study was conducted in private physiotherapy practices in the Denpasar area from August to September 2022. Twenty-four subjects with unilateral CTS were randomly divided into an Intervention Group (n=12; splinting, exercise therapy, and ultrasound therapy) and a Control Group (n=12; splinting and exercise therapy only). Splinting was used all day and night for four weeks. Exercise therapy was given three times per week for four weeks. Ultrasound therapy was given once a day, three times per week, for four weeks. The subject's symptoms and functional status before and after treatment were evaluated using the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), which consists of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS).&#x0D; Results: Significant improvements were found in SSS and FSS in Group 1 (SSS: p=0.000; FSS: p=0.000) and Group 2 (SSS: p=0.000; FSS: p=0.000), and a significant between-group difference was found in SSS (p=0.000) and FSS (p=0.001).&#x0D; Conclusion: The addition of ultrasound therapy to splinting and exercise therapy is more effective than that in improving the symptoms and functional status of patients with CTS.

Materials and manufacturing techniques for occlusal splints: A literature review.

To review the materials and fabrications methods of occlusal splints with their advantages and shortcomings and to clarify the indications for each. Temporomandibular joint disorders (TMDs) encompass a range of conditions affecting the masticatory system. Occlusal splints are currently recognized as a viable option for the management of TMDs when they are adopted in conjunction with additional approaches varying from conservative procedures (counseling, biofeedback, physical therapy, pharmacotherapy) to irreversible and less conservative ones (occlusal adjustments, orthodontics, arthroscopy, and surgery). These splints can vary in design, function, and material. The components used to fabricate the splints must withstand occlusal forces, be aesthetically pleasing, comfortable, and minimally interfering with function and phonetics. Traditional methods for fabricating splints include sprinkle-on, thermoforming, and lost wax techniques. However, with the advancement of CAD/CAM technology, additive (3D printing) and subtractive (milling) manufacturing methods expand the range of possibilities by introducing novel solutions for elaborating splints. An electronic search was conducted on PubMed using the following keywords: "occlusal splint", "guard and "materials", and "manufacturing". Thirteen in vitro publications were screened and they consisted of four clinical studies, nine reviews (three of them were systematic reviews), and five case reports. The choice of material is crucial for the success of splint therapy. Factors such as biocompatibility, ease of fabrication, adjustability, cost, and patient preference should be considered. Newer materials and techniques are emerging because of advancements in material science and manufacturing techniques. However, it should be noted that most of the evidence is based on in vitro studies with different methodologies, limiting their validity in daily practice.

RA.DI.CA. Splint Therapy in the Management of Temporomandibular Joint Displacement without Reduction.

The purpose of this study is to report clinical and instrumental changes after RA.DI.CA splint therapy for temporomandibular joint disc displacement without reduction. Subjects affected by disc dislocation without reduction were recruited between July 2020 and May 2022 based on inclusion and exclusion criteria and treated with RA.DI.CA. splints over a period of 6 months. Clinical data were collected at each phase of the study (T0, T1, T2). Magnetic resonance imaging and electrognathography data were recorded at the beginning (T0) and at the end (T2) of the study. ANOVA with post-hoc contrasts was performed to assess differences in outcome measures over time. The Wilcoxon test was used to evaluate changes in disc-condyle angle between before- and after-treatment MRI. A two-tailed value of p < 0.05 was regarded as significant. Ten patients completed the study. There were statistically significant differences over time for arthralgia, headache, neck pain, and mouth opening. Disc recapture and an improved quality of mandibular movement were recorded in 70% of subjects. The clinical and instrumental improvements are probably due to the orthopedic action of RA.DI.CA splint treatment, which allows for a greater degree of joint mobilization. The purpose of this therapy is to recover the disc position if possible and achieve an adequate joint functional adaptation that avoids the progression of the structural damage and the recurrence of symptoms.

Haglund's Disease with Clinical and Radiological Findings: 3 Case Reports

Objective: Haglund's Deformity is a variation of the posterosuperior region enlargement of the Os Calcaneus (OC) in the form of exostosis. It is associated with Haglund's Disease (HD), which encompasses Achilles tendinitis, retrocalcaneal bursitis, supra calcaneal bursitis, and inflammation of the Kager fat pad. Diagnosis is based on clinical findings and radiological methods, such as lateral ankle radiographs, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). This study aims to present three cases of ankle pain diagnosed with HD using radiological imaging. The mean age of our cases was 44.6 years, with two females and one male. Patients commonly present with complaints of pain and swelling behind the heel. Results: Physical examination revealed pain and tenderness upon palpation over the left OC and Achilles tendon insertion. Radiological examination showed osseous protrusion in the posterosuperior part of the OC, indicating Haglund's Deformity. Edema was observed at the bony prominence of the posterosuperior OC, Kager fat pad, and heel area. The treatment plan for all three patients included leg rest splint, anti-inflammatory medication, and physical therapy. Conclusion: In cases of heel pain where traumatic events such as acute fractures are ruled out, MRI should be performed, and Haglund's Syndrome should be investigated if osseous protrusion in the posterosuperior calcaneus is observed on radiographs, along with other findings suggestive of HS.

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.

Technical approaches and clinical outcomes of the treatment of temporomandibular dysfunction with prostheses: a systematic review

Introduction: Temporomandibular joint (TMJ) replacement is usually a last resort in the surgical treatment of end-stage joint disease. For all this gear to work efficiently, occlusion, articulation, musculature, ligaments, and psychological factors must be in complete harmony. As a treatment, implantation of a total alloplastic TMJ prosthesis. Objective: It was to demonstrate, through a systematic review, the main considerations and clinical outcomes of the treatment of temporomandibular disorders with different types of prostheses. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to April 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2013 to 2023. Results and Conclusion: A total of 127 articles were found, 60 articles were evaluated and 31 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 33 studies that did not meet GRADE. Based on the results, temporomandibular disorders (TMD) treatment is diverse and depends on the type of disease, as well as the duration and subjective level of pain. Alloplastic reconstruction can be advantageous in obtaining a rapid improvement in symptoms and rapid rehabilitation of masticatory function. Treatment of functional TMD is commonly based on conservative therapy, including physical therapy, pain therapy, and splinting therapy. Depending on the severity of TMD, treatment varies according to the degree of surgical invasion. Thus, the TMJ prosthesis seems to be reserved for patients with persistent pain, bone or fibrous ankylosis, or osteomyelitis after primary closed or open treatment of mandibular condyle fractures. Quality of life, mouth opening, and daily eating improved significantly after total TMJ prosthesis.

Treatment of TMJ Osteoarthritis

Osteoarthritis (OA) is common disease that can lead to severe pain and dysfunction in any joint, including the temporomandibular joint (TMJ). The treatment strategy for TMJ OA aims at reducing pain, preventing the progression of condylar bone destruction, and restoring joint function. Conservative therapy including nonste-roidal anti-inflammatory drugs, occlusal splint, and physical therapy, and arthrocentesis are the most common treatments for TMJ OA. These therapies are effective in most cases in relieving the signs and symptoms.