Temporomandibular joint disk displacement without reduction. Treatment with flat occlusal splint versus no treatment.

Lund University, Lund, Skåne, Sweden
Oral Surgery Oral Medicine Oral Pathology 07/1992; 73(6):655-8. DOI: 10.1016/0030-4220(92)90003-9
Source: PubMed

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.

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    ABSTRACT: Disc dislocation without reduction, as known as closed lock, is a clinical condition in which the disc is dislocated from the condyle and does not return to normal position during condylar movement When the condition of disc dislocation without reduction is acute, the initial therapy should include an attempt to reduce or recapture the disc by manual manipulation. When patients report a history of being locked for 1 week or less, manual manipulation is usually successful. In patients with a longer history, success rate tends to decrease rapidly. If the disc has been successfully recaptured, placing an anterior positioning appliance is recommended to prevent clenching on the posterior teeth, which would likely redislocated the disc. But it is hard to make an appliance immediately in the clinic because it takes too much time. And making an appliance using self-curing acrylic resin is not very popular because of its discomfort by odor and working time. Also, if the patient has resin allergy or is under orthodontic treatment, or if it is impossible to control behavior of the patient, it has been restricted to make an appliance immediately. Therefore, to supplement this disadvantages, we tried to confirm about successful short term use of temporary anterior positioning splint made by using putty impression material after manual manipulation in this study.
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    ABSTRACT: Arthrocentesis of the temporomandibular joint is a minimally invasive method of treatment located at the boundary between conservative and surgical therapy. It is usually performed on an out-patient basis under local anaesthesia. These days, arthrocentesis of the temporomandibular joint is used not only in cases of acute closed lock but also in the treatment of various temporomandibular disorders. The most frequent indication is acute anterior displacement of the articular disc without reduction. Treatment using occlusal splint is one of the most frequently used methods of conservative treatment. It is used mainly in the case of discopathies and myofascial pain.
    Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 08/2014; DOI:10.5507/bp.2014.044 · 1.66 Impact Factor
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    ABSTRACT: Objective To evaluate efficiency of pivot splints in jaw exercises, in combination with stabilization splints, in cases of anterior disc displacement without reduction of temporomandibular joint. Subjects and methods Twenty-three patients who referred to the prosthodontics clinic in 1995–1997 were included in the study, where anterior disc displacement without reduction of temporomandibular joint was diagnosed using magnetic resonance imaging and clinical examination. Pivot splints were used for jaw exercises for five minutes long; five times/day and stabilization splints were used at all other times. The patients were followed for 24 weeks. Lateral and protrusive excursions along with maximum mouth opening and were evaluated at each control. Bilateral palpation of temporal, masseter, sternocleidomastoid muscles and TMJ was assessed for pain perception before and after treatment. Data were statistically analyzed using Paired sample t-test and Independent Samples t-test (p < .05). Results Mean mandibular range of motion measurements increased from 28.74 mm prior to 49.17 mm on maximum opening; right/left lateral excursion from 7.61 mm to 12.04 mm and 4.09 mm to 7.3 mm on protrusion after treatment. All changes observed before and after treatment were found to be statistically significant. (p < .001) Pain symptoms were eliminated at the end of 24 weeks of treatment in all patients. Conclusion Using pivot splints as an exercise regimen along with a stabilization splint may be a viable treatment option for patients with anterior disc displacement without reduction; as normal mandibular range of motion was established and pain was eliminated.
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