Temporomandibular joint disk displacement without reduction. Treatment with flat occlusal splint versus no treatment.
ABSTRACT A flat occlusal splint has been extensively used in the treatment of patients with temporomandibular joint disk displacement without reduction, but no studies with untreated controls have assessed its effect. We randomly assigned 51 patients with temporomandibular joint pain and arthrographically verified disk displacement without reduction to be treated with a flat occlusal splint or to serve as untreated control subjects in a 12-month clinical trial. Pain symptoms disappeared in about one third of the patients in each group. Another third of the patients in the control group improved. Sixteen percent of the patients in the control group and 40% of the patients treated with a flat occlusal splint were worse at the end than at the beginning of the study. Joint pain and muscle tenderness decreased more frequently in the nontreatment controls than in the treatment group. A statistically significant benefit of a flat occlusal splint over nontreatment control subjects could not be identified in this study of patients with painful disk displacement without reduction. The use of a flat occlusal splint in this patient group should therefore be reconsidered.
- SourceAvailable from: Akira Nishiyama[Show abstract] [Hide abstract]
ABSTRACT: In 2010 and 2012, the clinical practice guidelines committee of the Japanese Society for the temporomandibular joint published clinical guidelines for the primary treatment of temporomandibular disorders (TMDs) using the principles of evidence-based medicine (EBM) and the grading of recommendations assessment, development and evaluation (GRADE) approach. In the present review, we provide the results of our search and summation of the relevant TMD studies and the updated treatment guidelines.1.Splint therapy: for masticatory muscle pain patients, we recommend the use of a maxillary stabilization splint (a thin and full occlusal coverage appliance made from hard acrylic resin), after informed consent is obtained from the patient by disclosing sufficient information on the appropriate indications, purpose, possible harm and burden, and any alternatives to the treatment (Grade 2C).2.Physical therapy: for TMD This article is based on a study first reported in Japanese in the Japanese Society for the temporomandibular joint website [http:// kokuhoken.net/jstmj/].Japanese Dental Science Review 05/2013;
- [Show abstract] [Hide abstract]
ABSTRACT: This study sought to evaluate the effect of simultaneous application of arthrocentesis and occlusal splint. A retrospective study of 43 patients (3 males, 40 females) whose symptoms had improved was conducted at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital between 2008 and 2010. Subjects were divided into three groups: Group A (17 patients with arthrocentesis and occlusal splints simultaneously applied), Group B (13 patients whose symptoms did not improve with occlusal splints, undergoing arthrocentesis after occlusal splint use for 8 weeks), and Group C (13 patients that only used occlusal splints). We compared these groups in maximum comfortable opening (MCO) and the visual analogue scale of pain and noise. Follow-up was performed at 1 week, 1 month, 3 months, and 6 months. The improvement of symptoms was noted in all three groups, but Group A had a quicker improvement than the other groups, in terms of pain reduction and MCO increases. The simultaneous application of arthrocentesis and occlusal splints can reduce patient discomfort more quickly.Journal of the Korean Association of Oral and Maxillofacial Surgeons. 02/2013; 39(1):14-20.
- [Show abstract] [Hide abstract]
ABSTRACT: Temporomandibular joint (TMJ) 'closed lock' (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be 'acute' or 'chronic' depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid-August 2013 were conducted for English-language studies of any design investigating the effects of non-surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor-quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high-quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by 'unlock' mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.Journal of Oral Rehabilitation 01/2014; · 2.34 Impact Factor