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

Head & Face Medicine

Bulem Yuzugullu²  Mehmet Avci¹  Mehmet Muhtarogullari³ 

[1] Private practice, Istanbul, Turkey;Department of Prosthodontics, Faculty of Dentistry, Baskent University, Ankara, Turkey;Department of Prosthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey

关键词: Stabilization splint;    Pivot splint;    Magnetic resonance imaging;    Anterior disc displacement without reduction;    Internal derangement;    Temporomandibular joint;   

Others  :  1136072
DOI  :  10.1186/1746-160X-10-42

 received in 2014-06-06, accepted in 2014-10-01,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Muhtarogullari et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kaplan A, Assel LA: Temporomandibular Disorders: Diagnosis and Treatment. Philadelphia: W.B. Saunders Company; 1991. [First edition]
• [2]Vichaichalermvong S, Nilner M, Panmekiate S, Petersson A: Clinical follow-up of patients with different disc positions. J Orofacial Pain 1993, 7:61-67.
• [3]Okeson JP: ‘Signs and symptoms of temporomandibular disorders’ in: Management of Temporomandibular Disorders and Occlusion. 7th edition. St Louis: Elsevier; 2013:138-143. 325
• [4]Mongini F: A modified extraoral technique of mandibular manipulation in disk displacement without reduction. J Craniomandib Pract 1995, 13:22-25.
• [5]Chung SC, Kim HS: The effect of the stabilization splint on the tmj closed lock. J Craniomandib Pract 1993, 11:95-101.
• [6]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.
• [7]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.
• [8]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.
• [9]Sears VH: Occlusal pivots. J Prosthet Dent 1956, 6:332-336.
• [10]Sarnat BG, Laskin DM: The Temporomandibular Joint: A Biological Basis for Clinical Practice. Fourth edition. Philadelphia: W.B. Saunders Company; 1992.
• [11]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.
• [12]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.
• [13]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.
• [14]Clark GT, Townsend GC, Carey SE: Bruxing Patterns in man during sleep. J Oral Rehabil 1984, 11:123-128.
• [15]Moncayo S: Biomechanics of pivoting appliances. J Orofacial Pain 1994, 8:190-196.
• [16]Boero RP: The physiology of splint therapy: a literature review. Angle Orthodontist 1989, 59:165-177.
• [17]McNeill C: Craniomandibular Disorders Guidelines for Evaluation Diagnosis and management: The American Academy of Craniomandibular Disorders. In 2nd printing. Chicago: Quintessence Publishing Co. Inc; 1990.
• [18]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.
• [19]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.
• [20]Carraro JJ, Caffesse RG: Effect of occlusal splints on TMJ symptomatology. J Prosthet Dent 1978, 40:563-566.
• [21]Davis CL, Kaminishi RM, Marshall MW: Arthroscopic surgery for treatment of closed lock. J Oral Maxillofac Surg 1991, 49:704-707.
• [22]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.
• [23]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.
• [24]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.
• [25]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.
• [26]McCarty WL, Darnell MW: Rehabilitation of the temporomandibular joint through the application of motion. J Craniomandib Pract 1993, 11:298-307.
• [27]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.
• [28]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.
• [29]McNeill C: The optimum temporomandibular joint condyle position in clinical practice. Int J Perio Restor Dent 1985, 5:71-72.