Temporomandibular joint disk displacement without reduction. Treatment with flat occlusal splint versus no treatment
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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- "Nonetheless, Major and Nebbe21 reported that the use of occlusal splint resulted in the effective reduction of headache and muscle pain, but that it had a limitation in the reduction of TMJ pain. According to Lundh et al.22, occlusal splint had no advantage in treating disc dislocation without reduction. "
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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.
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- "Over years of studying this condition , we have learned that surgery may not be needed for most patients. Studies             have revealed that over time many patients achieve relatively normal joint function even with the disc permanently dislocated. With these studies in mind, it would seem appropriate to follow a more conservative approach that would encourage adaptation of the retrodiscal tissues. "
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ABSTRACT: The treatment goals for managing intracapsular disorders of the temporomandibular joint have changed over the past 20 years. There is no longer an attitude that all discs must be properly positioned to maintain a healthy joint. Therapies for re-establishing disc position, for the most part, have failed. On the other hand, patients seem to adapt to abnormal disc positions and function relatively normally. Intracapsular disorders seem to follow a natural course that is influenced by many factors. Therapy does not seem to radically change this course. However, therapy can reduce the suffering that accompanies some of the stages of these disorders. It is the therapist's role to intervene when possible to decrease suffering. Reversible therapies are often adequate and should be attempted first. Only when reversible therapies fail to adequately reduce suffering should more aggressive therapies be considered. When suffering continues, re-evaluation of the clinical condition is necessary to assure that more aggressive therapy effectively alters the symptoms.
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- "Unfortunately, the above studies were not based on a randomized controlled clinical trial but were essentially uncontrolled case series studies. Only one randomized controlled clinical trial has been reported, and it used only visual analogue scale measures of pain as the only outcome measure (Lundh et al., 1992). For these reasons, we designed a randomized controlled clinical trial to compare the efficacy of two conservative treatments with that of no-treatment control. "
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ABSTRACT: The common methods for treating anterior disk displacement without reduction (ADDwor) are not based on randomized controlled clinical trials. Our study evaluated non-surgical treatments in 69 MRI-confirmed ADDwor subjects (m/f = 6/63). Subjects were randomly assigned to a control group and one of two treatment groups. Outcomes included maximum mouth opening, visual analogue scale of pain, and daily activity limitation. Calibrated examiners collected data at the initial interview and at 0, 2, 4, and 8 weeks of treatment. At the eight-week point, within-group improvements were present for all variables, for all groups. Between-group differences were not highly evident, with only mean daily activity limitation for the self-care/NSAID group being significantly lower than that of the occlusal appliance/jaw mobilization + self-care/NSAID group at the two- and four-week time-points. These results suggest that ADDwor subjects will improve with only minimal treatment intervention, and no significant difference was evident for the treatments tested and the control condition.
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