The Efficiency of Anterior Repositioning Splints in the Management of Pain Related to Temporomandibular Joint Disc Displacement with Reduction

Abstract

Background and Objective Intra-articular temporomandibular disorders are often related to pain in the area of the temporomandibular joint, ear, and temple. The aim of the study was to investigate the efficiency of anterior repositioning splints in decreasing pain related to temporomandibular joint disc displacement with reduction. Methods The research material consisted of 112 patients, aged 24 to 45 years, of both genders, who reported for treatment at the Consulting Room of Temporomandibular Joint Dysfunctions at the Jagiellonian University in Cracow between 2014 and 2016 due to pain in the area of the temporomandibular joint(s) and noise(s) of temporomandibular joint(s) present during jaw movements with comorbid contracture of masticatory muscles. Subjects were examined according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol and, after diagnosis of painful disc displacement with reduction and masticatory muscle contracture, they were assigned randomly to either the study or control groups (56 patients in each). In the study group, we used an anterior repositioning splint on the full lower arch for about 20 hours usage over a 4-month period. In the control group, a noninvasive therapy was applied using a biostimulation laser over 12 sessions performed every second day on the area of both temporomandibular joints with mouth open and while performing muscle self-exercises with a dominant protrusive position of the mandible. Pain intensity was evaluated using the Verbal Numerical Rating Scale (VNRS) immediately before the treatment and then after 4 and 16 weeks. The obtained data were analyzed using the Mann–Whitney U test (p ≤ 0.005). Results The VNRS values reported during the final examination for the study group were significantly lower than for the control group (p=0.0004). Conclusions The anterior repositioning splint is an efficient tool in decreasing pain related to disc displacement with reduction. This trial is registered with Clinicaltrials.gov NCT03057262.

Occlusive Therapy of Temporomandibular Disorders

“…An important therapeutic effect is also the restoration of the normal tone of muscular mastication. When treating with splits, the new position and trajectory of the mandible movement are programmed, in which the pain in the TMJ and the pathological tension (spasm) of the muscles of mastication decrease or disappear [18] or the teeth normal closing is reproduced in the positions closest to the physiological central occlusion [19][20][21]. The use of occlusal splits to treat the TMJ disorders is pathogenetically justified, as they, by regulating the neuromuscular coordination, reduce associated muscle pains and ensure the desired position of the mandible, by distributing loads in bruxism and thereby contributing to improved functioning of the affected joint [22][23][24].…”

“…Важным терапевтическим эффектом является также восстановление нормального тонуса жевательной мускулатуры. При лечении каппами программируется новое положение и траектория движения НЧ, при которых уменьшаются или исчезают боль в ВНЧС и патологическое напряжение (спазм) жевательной мускулатуры [18] или же воспроизводится нормальное смыкание зубов в позициях, максимально приближенных к физиологической центральной окклюзии [19][20][21]. Применение окклюзионных капп для лечения дисфункции ВНЧС патогене-тически обосновано, так как они, регулируя нейромышечную координацию, уменьшают сопутствующие мышечные боли, обеспечивают нужное положение НЧ, распределяют нагрузки при бруксизме, способствуя тем самым улучшению функции пораженного сустава [22][23][24].…”

An Innovative Protocol Of Physiokinetotherapy For The Treatment Of Temporomandibular Disorder

“…There are four types of articular disc displacements, according to the Diagnostic Criteria for Temporomandibular Disorders: disc displacement with reduction, disc displacement with reduction with intermittent locking, disc displacement without reduction with limited opening and disc displacement without reduction without limited opening (Pihut, Gorecka, Ceranowicz, & Wieckiewicz, 2018).…”

Features of Occlusal Therapy in Functional Disorders of Temporomandibular Joints

“…Важливим терапевтичним ефектом також є відновлення нормального тонусу жувальної мускулатури. При лікуванні капами програмується нове положення і траєкторія рухів нижньої щелепи, при яких зменшується або зникає біль у СНЩС та патологічна напруга (спазм) жувальних м'язів [18]; відтворюється нормальне змикання зубів у позиціях максимально наближених до фізіологічної центральної оклюзії [19,20,21].…”