Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs)

Sameh A Seifeldin, Khaled A Elhayes, Sameh A Seifeldin, Khaled A Elhayes

Abstract

Aim: To compare between soft and hard occlusal splint therapy for the management of myofacial pain dysfunction (MPD) or internal derangement (ID) of the temporomandibular joint (TMJ) with reciprocal clicking.

Patients and methods: This study included 50 patients (age range: 24-47 years) who had been diagnosed with MPD or ID of the TMJ in the form of reciprocal clicking. Patients were divided into two groups. They were treated for 4 months with either a vacuum-formed soft occlusal splint constructed from 2-mm-thick elastic rubber sheets (soft splint group) or a hard flat occlusal splint fabricated from transparent acrylic resin (hard splint group). Monthly follow-up visits were performed during the treatment period. Before treatment and 1, 2, 3 and 4 months after treatment, the dentist measured all parameters of TMJ function (pain visual analog scores, tenderness of masticatory muscles, clicking and tenderness of the TMJ, and range of mouth opening).

Results: All parameters of TMJ function showed significant improvement in both groups during the follow-up period, with a statistically significant difference between the two groups at the 4-month follow-up visit.

Conclusions: Both forms of occlusal splints (soft and hard) improved TMJ symptoms in patients with MPD or ID of the TMJ. However, the soft occlusal splints exhibited superior results after 4 months of use.

Keywords: Hard occlusal splint; Internal derangement; MPD; Soft occlusal splint; TMJ.

Figures

Figure 1
Figure 1
The final trimmed night guard & patient cast.
Figure 2
Figure 2
Night guard inside patient mouth.
Figure 3
Figure 3
Flat anterior bite plane hard splint inside patient mouth.
Figure 4
Figure 4
Occlusion with hard splint inside patient mouth.
Figure 5
Figure 5
Effect of time on mean values of mouth opening in both groups throughout study intervals.
Figure 6
Figure 6
Effect of time on mean values of pain scores in both groups throughout the study intervals.
Figure 7
Figure 7
Effect of time on mean values of clicking in both groups throughout the study intervals. Severe = 3, Moderate = 2, Absent = 1.
Figure 8
Figure 8
Effect of time on mean values of joint tenderness in both groups throughout the study intervals. Severe = 3, Moderate = 2, Absent = 1.
Figure 9
Figure 9
Effect of time on percent of negative signs of tenderness in masticatory muscles in both groups throughout the study intervals.
Figure 10
Figure 10
Effect of time on percent of negative signs of tenderness in neck muscles in both groups throughout the study intervals.

References

    1. Block S.L., Apfel M., Laskin D.M. The use of a resilient rubber bite appliance in the treatment of MPD syndrome. J. Dent. Res. 1978;57:92.
    1. Boero R.P. The physiology of splint therapy: a literature review. Angle Orthod. 1989;59:165–180.
    1. Daif Emad T. Correlation of splint therapy outcome with electromyography of masticatory muscles in temporomandibular disorders with myofascial pain. Acta Odontol. Scand. 2012;70(1):72–77. (6)
    1. Dworkin S.F., Truelove E. In: Conn’s Current Therapy. Rakel R., editor. WB Saunders; Philadelphia: 1997. pp. 1006–1011.
    1. Dworkin S.F., Huggins K.H., LeResche L., Von Korff M., Howard J., Truelove E., Sommers E. Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J. Am. Dent. Assoc. 1990;120:273–281.
    1. Dylina T.J. A common-sense approach to splint therapy. J. Prosthet. Dent. 2001;86:539–545.
    1. Fearon C.G., Serwatka W.J. A common denominator for nonorganic TMJ pain-dysfunction. J. Prosthet. Dent. 1983;49:805–808.
    1. Greene C.S. Managing TMD patients: initial therapy is the key. J. Am. Dent. Assoc. 1992;123:43–45.
    1. Harkins S., Marteney J.L., Cueva O., Cueva L. Application of soft occlusal splints in patients suffering from clicking temperomandibular joints. J. Cranio. Pract. 1988;6:71–75.
    1. Kafas P., Leeson R. Assessment of pain in temporomandibular disorders: the bio-psychosocial complexity. Int. J. Oral Maxillofac. Surg. 2006;35:145–149.
    1. Kafas P., Chiotaki N., StavrianosCh Stavrianou I. Temporomandibular joint pain: diagnostic characteristics of chronicity. J. Med. Sci. 2007;7:1088–1092.
    1. Kafas P., Kalfas S., Leeson R. Chronic temporomandibular joint dysfunction: a condition for a multidisciplinary approach. J. Med. Sci. 2007;7:492–502.
    1. Kovaleski W.C., Beaver De J. Influence of occlusal splints on jaw position and musculature in patients with temporomandibular joint dysfunction. J. Prosthet. Dent. 1975;33:321–327.
    1. Lavigne G.J., Khoury S., Abe S., Yamaguchi T., Raphael K. Bruxism physiology and pathology: an overview for clinicians. J. Oral Rehabil. 2008;35(7):476–494.
    1. List T., Helkimo M., Karlsson R. Pressure pain thresholds in patients with craniomandibular disorders before and after treatment with acupuncture and occlusal splint therapy: a controlled clinical study. J. Orofac. Pain. 1993;7:275–282.
    1. Littner D., Perlman-Emodi A., Vinocuor E. Efficacy of treatment with hard and soft occlusal appliance in TMD. Refuat Hapeh Vehashinayim. 2004;21(3):52–58. 94.
    1. Lundh H., Westesson P.-L., Koop S., Tillstrom B. Anterior repositioning splint in the treatment of temporomandibular joints with reciprocal clicking: comparison with flat occlusal splint and an untreated controlled group. Oral Surg. Oral Med. Oral Pathol. 1985;60:131–136.
    1. Lundh H., Westesson P.L., Jisander S., Eriksson L. Disc-repositioning onlays in the treatment of temporomandibular joint disc displacement: comparison with a flat occlusal splint and with no treatment. Oral Surg. Oral Med. Oral Pathol. 1988;66:155–162.
    1. Mohl N.D., Ohrbach R.K., Crow H.C., Gross A.J. Devices for the diagnosis and treatment of temporomandibular disorders. Part III: Thermography, ultrasound, electrical stimulation, and electromyographic biofeedback. J. Prosthet. Dent. 1990;63(4):472–477.
    1. Mona F., Nagwa E., Dalia E., Adel B. Occlusal splint therapy and magnetic resonance imaging. World J. Orthod. 2004;5:133–140.
    1. Naikmasur V., Bhargava P., Guttal K., Burde K. Soft occlusal splint therapy in the management of myofascial pain dysfunction syndrome: follow-up study. Indian J. Dent. Res. 2008;19:196–203.
    1. Okeson, J.P., 2003. Management of Temporomandibular Disorders and Occlusion. 5th ed. Mosby, St. Louis. p. 260. Oral Surg. Oral Med. Oral Pathol. 1991, 71:529-534.
    1. Peltola M.K., Pernu H., Oikarinen K.S., Raustia A.M. The effect of surgical treatment of the temporomandibular joint: a survey of 70 patients. Cranio. 2000;18:120–126.
    1. Pettengill Craig A., Growney Maurice R., Jr., Schoff Robert, Kenworthy Christian R. A pilot study comparing the efficacy of hard and soft stabilizing appliances in treating patients with temporomandibular disorders. J. Prosthet. Dent. 1998;79:165–168.
    1. Pollmann L. Sounds produced by the mandibular joint in a sample of healthy workers. J. Orofac. Pain. 1993;7(359):361.
    1. Pullinger A.G., Seligman D.A. Trauma History in Diagnostic Groups of Temporomandibular Disorders. Oral Surg. Oral Med. Oral Pathol. 1991;71(5):529–534.
    1. Raphael K.G., Marbach J.J., Klausner J.J., Teaford M.F., Fischoff D.K. Is bruxism severity a predictor of oral splint efficacy in patients with myofascial face pain? J. Oral Rehabil. 2003;30:17–29.
    1. Reisine S.T., Weber J. The effects of temporomandibular joint disorders on patients’ quality of life. Community Dent. Health. 1989;6:257–270.
    1. Seligman D.A., Pullinger A.G., Solberg W.K. The prevalence of dental attrition and its association with factors of age, gender, occlusion, and TMJ symptomatology. J. Dent. Res. 1988;67:1323–1333.
    1. Suvinen T., Reade P. Prognostic features of value in the management of temporomandibular joint pain-dysfunction syndrome by occlusal splint therapy. J. Prosthet. Dent. 1989;61:355–361.
    1. Tolvanen M., Oikarinen V.J., Wolf J. A 30-year follow-up study of temporomandibular joint meniscectomies: a report on five patients. Br. J. Oral Maxillofac. Surg. 1988;26(4):311–316.
    1. Tsuga K., Akagawa Y., Sakaguchi R., Tsuru H. A short-term evaluation of the effectiveness of stabilization-type occlusal splint therapy for specific symptoms of temporomandibular joint dysfunction syndrome. J. Prosthet. Dent. 1989;61:610–613.
    1. Wright E., Anderson G., Schulte J. A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain. J. Orofac. Pain. 1995;9:192–199.

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