Efficiency of pivot splints as jaw exercise apparatus in combination with stabilization splints in anterior disc displacement without reduction: a retrospective study

Mehmet Muhtarogullari, Mehmet Avci, Bulem Yuzugullu, Mehmet Muhtarogullari, Mehmet Avci, Bulem Yuzugullu

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.

Figures

Figure 1
Figure 1
Exercise position with the pivot splint.

References

    1. Kaplan A, Assel LA. Temporomandibular Disorders: Diagnosis and Treatment. First. Philadelphia: W.B. Saunders Company; 1991.
    1. Vichaichalermvong S, Nilner M, Panmekiate S, Petersson A. Clinical follow-up of patients with different disc positions. J Orofacial Pain. 1993;7:61–67.
    1. Okeson JP. ‘Signs and symptoms of temporomandibular disorders’ in: Management of Temporomandibular Disorders and Occlusion. 7. St Louis: Elsevier; 2013. pp. 138–143.
    1. Mongini F. A modified extraoral technique of mandibular manipulation in disk displacement without reduction. J Craniomandib Pract. 1995;13:22–25.
    1. Chung SC, Kim HS. The effect of the stabilization splint on the tmj closed lock. J Craniomandib Pract. 1993;11:95–101.
    1. Yustin D, Kryshtalsky JB, Galea A. Use of hylan G-F 20 for viscosupplementation of the temporomandibular joint for the management of osteoarthritis: a case report. J Orofacial Pain. 1995;9:375–379.
    1. Tallents RH, Katzberg RW, Miler TL, Manzione J, Macher DJ, Roberts C. Arthrographically assisted splint therapy: Painful clicking with a non-reducing meniscus. Oral Surg Oral Med Oral Pathol. 1986;61:2–7. doi: 10.1016/0030-4220(86)90192-1.
    1. Stiesch-Scholz M, Kempert S, Wolter H, Tschernitschek H. Comparitave prospective study on splint therapy of anterior disc displacement without reduction. J Oral Rehabil. 2005;32:474–479. doi: 10.1111/j.1365-2842.2005.01452.x.
    1. Sears VH. Occlusal pivots. J Prosthet Dent. 1956;6:332–336. doi: 10.1016/0022-3913(56)90053-1.
    1. Sarnat BG, Laskin DM. The Temporomandibular Joint: A Biological Basis for Clinical Practice. Fourth. Philadelphia: W.B. Saunders Company; 1992.
    1. Yuasa H, Kurita K. Randomized clinical trial of primary treatment for temporomandibular joint disc displacement without reduction and without osseous changes: A combination of NSAISs and mouth-openning exercise versus no treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91:671–675. doi: 10.1067/moe.2001.114005.
    1. Minakuchi H, Kuboki T, Matsuka Y, Maekawa K, Yatani H, Yamashita A. Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disc displacement without reduction. J Dent Res. 2001;80:924–928. doi: 10.1177/00220345010800031501.
    1. Haketa T, Kino K, Sugisaki M, Takaoka M, Ohta T. Randomized clinical trial of treatment for TMJ disc displacement. J Dent Res. 2010;89:1259–1263. doi: 10.1177/0022034510378424.
    1. Clark GT, Townsend GC, Carey SE. Bruxing Patterns in man during sleep. J Oral Rehabil. 1984;11:123–128. doi: 10.1111/j.1365-2842.1984.tb00561.x.
    1. Moncayo S. Biomechanics of pivoting appliances. J Orofacial Pain. 1994;8:190–196.
    1. Boero RP. The physiology of splint therapy: a literature review. Angle Orthodontist. 1989;59:165–177.
    1. McNeill C. 2nd printing. Chicago: Quintessence Publishing Co. Inc; 1990. Craniomandibular Disorders Guidelines for Evaluation Diagnosis and management: The American Academy of Craniomandibular Disorders.
    1. Lundh H, Westesson PL, Eriksson L, Brooks SL. Temporomandibular joint disk displacement without reduction. Treatment with flat occlusal splint versus no treatment. Oral Surg Oral Med Oral Pathol. 1992;73:655–658. doi: 10.1016/0030-4220(92)90003-9.
    1. Okeson JP, Kemper JT, Moody PM. A study of the use of occlusion splints in the treatment of acute and chronic patients with craniomandibular disorders. J Prosthet Dent. 1982;48:708–712. doi: 10.1016/S0022-3913(82)80034-6.
    1. Carraro JJ, Caffesse RG. Effect of occlusal splints on TMJ symptomatology. J Prosthet Dent. 1978;40:563–566. doi: 10.1016/0022-3913(78)90094-X.
    1. Davis CL, Kaminishi RM, Marshall MW. Arthroscopic surgery for treatment of closed lock. J Oral Maxillofac Surg. 1991;49:704–707. doi: 10.1016/S0278-2391(10)80232-0.
    1. Stassen LFA, Currie WJR. A pilot study of the use of eminectomy in the treatment of closed lock. Br J Oral Maxillofac Surg. 1994;32:138–141. doi: 10.1016/0266-4356(94)90096-5.
    1. Fader KW, Grummons DC, Maijer R, Christensen LV. Pressurized infusion of sodium hyaluronate for closed lock of the temporomandibular joint. Part I: A Case Study. J Craniomandib Pract. 1993;11:68–72.
    1. Dimitroulis G, Dolwick MF, Martinez A. Temproromandibular joint arthrocentesis and lavage for the treatment of closed lock: a follow-up study. Br J Oral Maxillofac Surg. 1995;33:23–27. doi: 10.1016/0266-4356(95)90081-0.
    1. Murakami KI, Hosako H, Moriya Y, Segami N, Iizuka T. Short-term out come study for the management of temporomandibular joint closed-lock. A comparison of arthrocentesis to nonsurgical therapy and arthroscopic lysis and lavage. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;80:253–257. doi: 10.1016/S1079-2104(05)80379-8.
    1. McCarty WL, Darnell MW. Rehabilitation of the temporomandibular joint through the application of motion. J Craniomandib Pract. 1993;11:298–307.
    1. Choi BH, Yoo JH, Lee WY, Do K. Comparison of magnetic resonance imaging before and after nonsurgical treatment of closed lock. Oral Surg Oral Med Oral Pathol. 1994;78:301. doi: 10.1016/0030-4220(94)90058-2.
    1. Kirk W. Magnetic resonance imaging and tomographic evaluation of occlusal appliance treatment for advanced internal derangement of the temporomandibular joint. J Oral Maxillofac Surg. 1991;49:9–12. doi: 10.1016/0278-2391(91)90258-N.
    1. McNeill C. The optimum temporomandibular joint condyle position in clinical practice. Int J Perio Restor Dent. 1985;5:71–72.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera