SPLINTS IN TMJ DYSFUNCTION . HOW EFFECTIVE ? A REVIEW
grinding some of its surface points , since the lower jaw will adopt a new position as a result of wearing the splint ) over several visits as the masticatory muscles relax until a consistent jaw relationship is reached . The patients then should be reviewed at regular intervals . After a period of successful splint therapy ( normally between two and three months ), patients can be weaned off the splint . 8
3 . Outcomes
There are various ways of evaluating the effectiveness of occlusal splint therapy such as : 1 . Visual analogue scale ( VAS ). 2 . Clinical stomatognathic examination 3 . Initiative on Methods , Measurement , and Pain
Assessment in Clinical Trials ( IMMPACT ) 4 . Research diagnostic criteria . RDC / TMD 5 . Clinical and anamnestic index 6 . Radiographs and CT-scans 7 . MRI scans 8 . Real-time ultrasonography 9 . Vibratography 10 . Electromyography 11 . Jaw tracking device Most of the patients who suffer from TMD problems of mainly muscular origin benefit from stabilization splints , but there is not enough evidence that they are better than placebo splints , soft splints or other conservative treatment methods . 21 Recently , randomized clinical trials ( RCT ) have found that stabilization splints are more effective than other treatments . 22 , 23 However , there are studies that have yielded contradictory results . 24 , 25 Because of these diverse opinions , there obviously is a strong need for further RCTs to identify if a stabilization appliance is really effective . Walczynska-Dragon and Baron 8 have proven that occlusal splint therapy using the SVED ( Sagittal Vertical Extrusion Device ) appliance decreases not only aches in the head and all parts of the spine but also disc displacements within 3 weeks of treatment . The next decrease in frequency of unwanted , unfavorable symptoms was observed after 3 months of treatment with splints . When properly performed , these splints also unblock a limited mouth opening . Research performed by Lee et al . 19 in a group of 59 patients with somatic TMJ dysfunction showed that intraoral appliance could improve cervical spine alignment and alleviate symptom severity . Meyer et al . 26 designed a special type of occlusal splint in which , the condyle-disc unit is largely intact and the interarticular space should not be constricted . The therapeutic approach consists in eliminating centric and eccentric occlusal disturbances , rebuilding lost support zones , and changing the mandibular motion pattern in order to improve muscle tone and neuromuscular coordination . As a rule , it also leads to a more physiological positioning of TMJ structures with a positive , therapeutic effect . If TMJ pain persists nonetheless , targeted , geometric decompression of the very probably compressed articular structures should be performed . The splint described can be modified into a decompression splint by inserting an approximately 0.8 mm space holder craniodorsally into the condylar box of the articulator on the side of the joint requiring decompression ( also possible bilaterally ). This yields a corresponding vertical increase of the splint , which in the patient can produce a ventrocaudal decompression of the compressed articular structures . Most comparative studies of different splint designs have relied only on medical history and clinical examination to diagnose disk displacement . 27 Soft splints , which are more convenient for patients than hard splints , can be used immediately after provisional diagnosis with TMD . 28 The rationale for using soft splints is that the soft resilient material may help in distributing the heavy load associated with parafunctional habits . 29 Hard splints are thought to reduce TMD symptoms by altering the occlusal equilibrium , changing the afferent impulses to the central nervous system , improving the vertical dimension , correcting the condylar position , and aiding cognitive awareness . 30 Littner et al . reported that hard splints offer more successful outcomes than soft splints for patients with functional disorders of the masticatory system . 31 However , other studies have shown that both soft and hard appliances are equally beneficial in improving masticatory muscle pain in the short term . The findings of one of the randomized controlled study show that stabilization splint treatment in combination with counseling and masticatory muscle exercises has no additional benefit in relieving facial pain and increasing the mobility of the mandible than counselling and masticatory muscle exercises alone over a 6-months ’ time interval . However , the efficacy of the stabilisation splint treatment on TMD in long-time follow-up remains to be confirmed . 32 A systematic review which has included a total of 47 publications citing 44 RCTs with 2,218 subjects suggest Hard stabilization appliances , when adjusted properly , have good evidence of modest efficacy in the treatment of TMD pain compared to non-occluding appliances and no treatment . Other types of appliances , including soft stabilization appliances , anterior positioning appliances , and anterior bite appliances , have some RCT evidence of efficacy in reducing TMD pain . However , the potential for adverse events with these appliances is higher and suggests the need for close monitoring in their use . 33 Because headache causes are manifold , diagnostics and therapy require an interdisciplinary medical approach . From the dental and maxillofacial standpoint , diseases and disorders of the teeth , periodontium , other craniofacial hard and soft tissues , as well as craniomandibular dysfunction
78 STOMA . EDUJ ( 2016 ) 3 ( 1 )