Do the Mandibular Condyles Change Their Positions within Glenoid Fossae after Occlusal Splint Therapy Combined with Physiotherapy in Patients Diagnosed with Temporomandibular Joint Disorders? A Prospective Case Control Study

Abstract

The research question was: do the mandibular condyles change their position within glenoid fossae after treatment combining occlusal splint therapy and physiotherapy in patients diagnosed with temporomandibular disorders (TMD)? Forty patients with TMD were included into the study. They underwent initial physiotherapy, and a six-month treatment of occlusal splint therapy with physiotherapy. Cone-beam computed tomography images of temporomandibular joints (TMJs) were taken before and after the treatment. The control group consisted of 15 asymptomatic patients, who did not receive any type of occlusal treatment. The changes in the dimension of anterior, superior, posterior, and medial joint spaces after the end of the treatment in patients with TMD were statistically insignificant. The average value of condylar ratio was significantly higher after the end of the treatment (p = 0.025). The changes in the condylar sagittal position were statistically insignificant. Occlusal splint therapy with physiotherapy did not change significantly the dimension of joint spaces, nor placed the mandibular condyles into the centric relation. Treatment of patients with TMD should not aim at gnathological concept of placing the mandibular condyles into centric relation, because centric relation appears not to be mandatory to achieve successful results of treatment in patients with TMD.

Craniovertebral and Craniomandibular Changes in Patients with Temporomandibular Joint Disorders after Physiotherapy Combined with Occlusal Splint Therapy: A Prospective Case Control Study

“…This research is part of the larger scientific project related to the changes that can be observed in patients diagnosed with TMD and treated with occlusal splint therapy combined with physiotherapy. This manuscript is the continuation and further evaluation of our recently published study, regarding the changes in the positions of the mandibular condyles within the glenoid fossae in patients diagnosed with TMD and treated with occlusal splint therapy combined with physiotherapy [ 20 ].…”

“…The participants were at least 18 years old and not older than 65 years old. The exclusion criteria were: rheumatic disease, history of oncology treatment, traumas in the area of head and neck, pregnancy, age below 18 years old and above 65 years old, history of previous orthodontic treatment, and lack of willingness to participate in the study [ 20 ].…”

“…Because of the long time that had passed since the initial examination to the recall appointment, patients underwent another set of X-rays. In the meantime, the patients did not start or complete any orthodontic or prosthodontic treatment [ 20 ].…”

“…The initial examination was performed by one of the researchers (MD) and consisted of: anamnesis, extraoral examination (palpation of: TMJs, masticatory muscles, trapezius muscles, suboccipital muscles, sternocleidomastoid muscles, and floor of the mouth), and intraoral examination (analysis of occlusion and its stability, palpation of masticatory muscles, and floor of the mouth) [ 20 ]. Lateral cephalograms were taken in all participants in maximum intercuspation, in natural head position, and with respect to the ALARA principle (as low as reasonably achievable).…”

“…Maximum mouth opening was measured intraorally with a digital caliper as a distance between the incisal edges of upper and lower central incisors in maximum opening. Both pain in the area of TMJ and maximum mouth opening were assessed twice: before and after the end of the treatment [ 20 ].…”