Can anterior repositioning splint effectively treat temporomandibular joint disc displacement?

Abstract

The aim of this study was to determine whether anterior repositioning splint (ARS) can effectively treat temporomandibular joint (TMJ) anterior disc displacement with reduction (DDwR) in juvenile Class II patients. This study investigated disc repositioning clinically and through use of MRI with 12-month follow up. Patients with skeletal Class II malocclusions and DDwR diagnosed by magnetic resonance imaging (MRI) were treated with ARS. The efficacy of ARS was assessed clinically and by means of MRI before treatment (T0), immediately after bite registration (T1), at the end of treatment (T2), and at 12 months after functional appliance treatment (T3). Improvement in TMJ pain, TMJ noises, and range of mandibular movement were assessed. MRI evaluation was based on disc-condylar relationship in parasagittal images. Seventy-two juvenile patients with 91 joints were included in this study. The average age was 15.7 years old (range, 10–20 years) at first visit. There were statistically significant reductions in TMJ pain, disability in daily life and TMJ clicking (P < 0.01). MRI at T2 indicated that the success rate was 92.31% (84/91), but decreased to 72.53% (66/91) at T3. The unsuccessful splint disc capture was mainly observed in late adolescence, especially over 18 years old. Using MRI results as the gold standard, we found that clinical assessment had an accuracy rate of 75.82% at 12-month follow-up. In conclusion, although success rate for ARS treatment decreased over time, both clinical findings and MRI examination indicate that the ARS is relatively effective in repositioning the DDwR, especially for patients in early puberty. However, further and larger studies are needed to evaluate the outcome with ARS.

Anterior repositioning splint treatment consideration for cases of disc displacement with reduction

“…DDWR is known to be the most common internal derangement of TMJ condition in the majority of the population. 6 When teeth occlude, articular disc is positioned more anterior than normal, and often reduced to normal position during mouth opening. This condition is thought to be caused by biomechanical pressure that the condyle receive against mandibula, which can cause progressive change in function and form.…”

“…2 Other researcher have found that an estrogen receptor within women's TMJ complex allows them to speculate that changes in metabolic function due to fluctuation in women's estrogen level can cause changes in flexibility of TMJ's ligament. 6 These findings are thought to contribute to the increasing number of women who suffers from DDWR when compared to men.…”

“…This conditions can be stimulated through the use of occlusal splint (Fig 2). 2,6,9 Figure 2A The condition of DDWR within TMJ complex before treatment, viewed using MRI; B TMJ complex after treatment with occlusal splint. Bone apposition can be seen in posterosuperior region of the condyle and the formation of retrodiscal fibrosis within the retrodiscal tissue.…”

“…Bone apposition can be seen in posterosuperior region of the condyle and the formation of retrodiscal fibrosis within the retrodiscal tissue. 6 TMJ complex to confirm DDWR can be examined using MRI as the gold standard. 2,5,[8][9][10] MRI can accurately show the morphology and the articular disc position in relation to the bone structures within TMJ.…”

“…The use of reverse incline on ARS in the anterior maxillary region will provide guidance to occlude in a more anterior position (Fig 4). 6 Figure 4A Full coverage ARS on anterior maxilla using the reverse incline plane bite block on palatal as guidance so that mandibula can be positioned more anterior; B-D occlusal re-establishment after the use of ARS. 6 The treatment mechanism of ARS as a mode of therapy is still debatable.…”