Step‐back anterior repositioning splint retraction for temporomandibular joint disc displacement with reduction in adult patients

Abstract

BackgroundAnterior repositioning splint (ARS) is used to treat temporomandibular joint (TMJ) disc displacement with reduction (DDwR). However, high recurrence rate remains a problem especially in patients with unstable occlusions.ObjectiveThis study optimised standard ARS therapy and proposed a step‐back ARS retraction (SAR) method in adult patients with DDwR.MethodsDental examinations and magnetic resonance imaging of TMJ were obtained before treatment (T0), 1 to 3 months (T1), 3 to 6 months (T2) and 6 to 12 months (T3) during treatment in 48 adults (average age 27.1 ± 5.7 years). After 3 months of basic ARS wearing, personalised treatment for patients with normal disc–condyle relationship was prescribed depending on bilaminar zone adaptations and severity of molar openbite. SAR which required sequential ARS wearing was designed for patients with deep overbite/overjet until retrodiscal tissue adaptations and stable occlusions were achieved.ResultsThe maximum interincisal opening was increased from 44.3 ± 6.9 to 45.3 ± 6.3 mm (p < .01), and joint pain was alleviated after ARS treatment. The overall success rate of ARS wearing was 92.1% (58/63) featured by a recaptured disc. Fifteen patients who underwent SAR therapy all showed bilaminar zone adaptations in the end, and one patient had positive condylar bone remodelling.ConclusionsARS treatment could improve mouth opening and joint symptoms in adult DDwR patients. SAR method was suitable for treating DDwR patients with deep overbite and overjet and improved retrodiscal tissue adaptations and condylar bone remodelling.

Clinical and MRI-Based Assessment of Patients with Temporomandibular Disorders Treated by Controlled Mandibular Repositioning

“…A strength of our study was that during the control appointments, there was no “walking back” of the condyles. There was no need for the step-back anterior repositioning splint retraction method [ 40 ], as, in our study, the ThP was calculated individually by the CMR method. Stabilizer adjustments were only made to maintain the final therapeutic position.…”

“…Once the disc is recaptured, then the disc–condyle complexes are subsequently ‘walked back’ along the posterior slope of the articular eminence by periodic modification, i.e., by grinding of the splint [ 37 , 38 , 39 ]. In a recent study, this walking back of the condyle was termed step-back anterior repositioning splint [ 40 ]. A long-term clinical trial with MRI evaluation demonstrated that mandibular repositioning can be effective in reducing disk displacement, particularly on anteriorly displaced disks.…”

A Comparative Study of Condylar Bone Pathology in Patients with and without Temporomandibular Joint Disorders Using Orthopantomography

“…Research by Al-Saleh et al (2020) [ 19 ] and Li et al (2021) suggests that properly fitted splints can help reduce parafunctional habits, minimize joint loading, and provide pain relief. Different types of splints, such as stabilization splints and anterior repositioning splints, have shown promising results in various TMD subtypes [ 20 ].…”