Reflections on the Michigan splint and other intraocclusal devices.

It seems obvious in retrospect that the treatment of disorders by interocclusal devices followed two paths: stabilization splints and functional orthopedic appliances. The dividing line between them is not always clear. Both have some function related to the position of the mandible. They may not differ significantly in their control of occlusal stability (e.g., telescoping devices anchored to stabilization splints). The stabilization splint, as well as other conservative measures, will play an increasing role in accepted therapy for TMD. The use of anterior repositioning devices for TMD, including MPD syndrome, will decrease. Research may provide answers that allow them to be used more specifically and predictably. Perhaps there will be but little change in their use where there is an association of TMD and Class II malocclusion. There will be an increase in the use of interocclusal devices for the treatment of snoring and obstructive apnea. Some additional directions seem to have emerged in the late 1980s and early 1990s: In the absence of pain and significant debilitation, treatment for TMD, if any, is to be reversible. Prevention or aggravation of TMD should be practiced to the extent possible during dental procedures. One long-term, well-designed, prospective study indicated that the incidence and severity of TMD could be reduced by appropriate occlusal adjustment. There is a small, but nevertheless important minority of patients with TMD who progress to persistent pain and/or dysfunction. Initial management of the vast majority of patents with TMD should be use of noninvasive reversible therapies. Surgery is indicated in only a relatively small percentage of cases of TMD. Research on interocclusal devices should not terminate simply because they are in part dental devices (i.e., biomechanical forms of treatment). The diagnosis and treatment of TMD has been called a dilemma, especially for those patients with chronic pain for whom no treatment has been effective. However, it would be ill-advised to abandon what treatment is already known to be effective by allowing those few but psychosocially important patients with chronic pain to determine what should be done for the vast majority of patients with TMD: reversible forms of treatment, including physiotherapy, pharmacologicals, and the stabilization occlusal bite plane splint.

Reflections on the Michigan occlusal splint.

Specific features related to the development, design and use of the Michigan splint have been described. Additional benefits from the Michigan splint beyond what can be expected from conventional stabilization splints and bite planes have been suggested. Important aspects of corrections and maintenance care of the Michigan splint have been stressed.

Maintenance care and supportive periodontal therapy.

This paper presents a review of the literature and clinical observations concerning the long-term professional care of all dental patients. Gingivitis, ubiquitous in the adult population, is often without significant consequences to the dentition; however, gingivitis may develop into periodontitis. Patients with gingivitis, therefore, should be monitored professionally, especially those patients with other risk factors (attachment loss, age, smoking, and abnormal tooth mobility). In patients without substantial attachment loss, professional examination, prophylaxis, and oral hygiene instruction should be provided once or twice a year, depending on the presence of other risk factors. All patients who have been treated for periodontitis should be recalled, after completion of treatment and a healing phase, every 3 to 4 months. Sites with active periodontitis should be re-treated. Topical use of fluorides is recommended.

A randomized trial of occlusal adjustment in the treatment of periodontitis patients.

The purpose of the randomized clinical trial was to test; (1) the influence of occlusal adjustment (OA) in association with periodontal therapy on attachment levels, pocket depth, and tooth mobility, (2) whether OA was of greater significance in non-surgically treated periodontal defects, and (3) whether initial tooth mobility or disease severity had an affect on post-treatment attachment levels following OA. After hygienic-phase therapy, 50 patients received OA/No OA according to random assignment; 22 patients received an OA and 28 were not adjusted. 2 months after OA, either modified Widman flap surgery or scaling and root planing by a periodontist were done according to random assignment within each patient in a split-mouth design. Following active treatment patients were maintained with prophylaxis done every 3 months and scored annually. For the analysis of this two-year data, a repeated measures analysis of variance was performed using attachment level change and pocket depths as outcome indicators. There was significantly greater gain of clinical periodontal attachment in patients who received an OA compared to those who did not. Both the surgically and non-surgically treated sides of the mouth responded similarly to OA. There was no affect of OA on the response in pocket depth, nor did initial tooth mobility or initial periodontal disease severity influence the response to OA.

Long-term assessment of periodontal surgery versus curettage or scaling and root planing.

The various treatments for periodontal disease must be assessed in light of the recently articulated goals of periodontal therapy to preserve teeth for a lifetime and to enhance esthetics and comfort as well as oral health. This article examines the long-term comparisons of periodontal surgery, curettage, and scaling and root planing in improving attachment levels instead of the more traditional pocket depth.

Maintenance care for treated periodontitis patients.

This paper is a review of current literature combined with clinical observations. Well-controlled maintenance care is a key consideration in the long-term prognosis of treated periodontitis patients. Periodic professional tooth cleaning every 3 to 4 months often is recommended. Furthermore, recent studies indicate a potential need for selected retreatment in problem areas, since minute residual accretions may be left behind during active therapy--even with "open" surgery. While efficient plaque control is essential for optimal results during the healing phase of periodontal therapy, periodic prophylaxis may prevent loss of clinical attachment over long periods of time even for patients with less than perfect oral hygiene.

4 modalities of periodontal treatment compared over 5 years.

The purpose of the present study was to assess in a clinical trial over 5 years the results following 4 different modalities of periodontal therapy (pocket elimination or reduction surgery, modified Widman flap surgery, subgingival curettage, and scaling and rool planing). 90 patients were treated. The treatment methods were applied on a random basis to each of the 4 quadrants of the dentition. The patients were given professional tooth cleaning and oral hygiene instructions every 3 months. Pocket depth and attachment levels were scored once a year. 72 patients completed the 5 years of observation. Both patient means for pocket depth and attachment level as well as % distribution of sites with loss of attachment greater than or equal to 2 mm and greater than or equal to 3 mm were compared. For 1-3 mm probing depth, scaling and root planing, as well as subgingival curettage led to significantly less attachment loss than pocket elimination and modified Widman flap surgery. For 4-6 mm pockets, scaling and root planing and curettage had better attachment results than pocket elimination surgery. For the 7-12 mm pockets, there was no statistically significant difference among the results following the various procedures.

Changing concepts in periodontics.

This article has concentrated on aspects of periodontics where research over the last decade has demonstrated that old concepts are outmoded and for the patient's benefit should be changed in clinical practice. The following statements were made. Periodontal pockets do not need to be reduced surgically to a 3 mm limit to save teeth. Bone and soft tissues do not need to be sculptured to uniform horizontal atrophy at the level of the deepest pocket. Treated teeth can be maintained without loss of periodontal support with less than perfect plaque control if professional tooth cleaning every 3 months is practiced. Furcation involvement complicates the treatment of periodontitis, but such teeth have a better prognosis than has been commonly thought. Deep pockets have a relatively good prognosis after treatment. The problem is access for efficient root planing. Advanced periodontitis can be stopped in most patients. Gingival curettage does not improve the results of scaling and root planing. Support for teeth can be maintained without attached gingiva. Gingival blanching in response to lip pull is meaningless. Splinting is not needed for most teeth with increased mobility after periodontal therapy. It was acknowledged that in other controversial aspects of periodontics scientific information still is not available to support firm concepts that may guide clinical practice. One problem in dentistry is the lag that often exists between the publication of research findings and their application in clinical practice if there is no inherent economic reward in the new procedure.(ABSTRACT TRUNCATED AT 250 WORDS)