Do the Mandibular Condyles Change Their Positions within Glenoid Fossae after Occlusal Splint Therapy Combined with Physiotherapy in Patients Diagnosed with Temporomandibular Joint Disorders? A Prospective Case Control Study

Marcin Derwich, Elzbieta Pawlowska, Marcin Derwich, Elzbieta Pawlowska

Abstract

The research question was: do the mandibular condyles change their position within glenoid fossae after treatment combining occlusal splint therapy and physiotherapy in patients diagnosed with temporomandibular disorders (TMD)? Forty patients with TMD were included into the study. They underwent initial physiotherapy, and a six-month treatment of occlusal splint therapy with physiotherapy. Cone-beam computed tomography images of temporomandibular joints (TMJs) were taken before and after the treatment. The control group consisted of 15 asymptomatic patients, who did not receive any type of occlusal treatment. The changes in the dimension of anterior, superior, posterior, and medial joint spaces after the end of the treatment in patients with TMD were statistically insignificant. The average value of condylar ratio was significantly higher after the end of the treatment (p = 0.025). The changes in the condylar sagittal position were statistically insignificant. Occlusal splint therapy with physiotherapy did not change significantly the dimension of joint spaces, nor placed the mandibular condyles into the centric relation. Treatment of patients with TMD should not aim at gnathological concept of placing the mandibular condyles into centric relation, because centric relation appears not to be mandatory to achieve successful results of treatment in patients with TMD.

Keywords: CBCT; condylar ratio; cone-beam computed tomography; occlusal splint; physiotherapy; temporomandibular joint disorders; temporomandibular joints.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Axial view of the mandibular condyle with marked points and lines presented in Table 2. LP—lateral pole of mandibular condyle, MGF—medial wall of glenoid fossa, MJS—medial joint space, MP—medial pole of mandibular condyle.
Figure 2
Figure 2
Sagittal view of the mandibular condyle with marked points and lines presented in Table 2. A—anterior, AAL—auxiliary anterior line, AJS—anterior joint space, APL—auxiliary posterior line, PJS—posterior joint space, SJS—superior joint space, RGF—roof of glenoid fossa, T—top.
Figure 3
Figure 3
Flow of the participants during the study. DC/TMD—diagnostic criteria for temporomandibular joint disorders; TMJ—temporomandibular joint; TMD—temporomandibular joint disorders.
Figure 4
Figure 4
The distribution of condylar sagittal positions within the glenoid fossae in the control group during initial and second examination.
Figure 5
Figure 5
The distribution of condylar sagittal positions within the glenoid fossae in the study group before and after the treatment.
Figure 6
Figure 6
The values of condylar ratio before and after the end of the treatment, as well as the results of Student t-test for dependent samples in the study group.
Figure 7
Figure 7
The correlation between the changes in the dimension of different joint spaces within right and left TMJs (correlation diagrams, correlation coefficient, and regression straight line equation) in the study group: (a) Anterior joint space; (b) Posterior joint space; (c) Superior joint space; (d) Medial joint space.
Figure 8
Figure 8
The correlation between the changes in the dimension of different joint spaces in all (right and left) TMJs (correlation diagrams, correlation coefficient, and regression straight line equation) in the study group: (a) Superior vs. Anterior joint spaces; (b) Superior vs. Posterior joint spaces; (c) Medial vs. Posterior joint spaces.

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