Evaluating the Impact of Various Treatment Modalities on the Chewing Efficiency of Anterior Disc Displacements of Temporomandibular Joint Disorder Cases: A Comparative Study.

Aim: Internal disc displacement of the temporomandibular joint (TMJ) is identified by an anomaly between the condylar-disc assembly, which, in many cases, may lead to discomfort and malfunction of the chewing function. The study's objective was to assess the effects of four distinct treatment approaches on temporomandibular disorder cases with anterior disc displacements focusing on their chewing efficiency. Materials and Methods: One hundred participants suffering from reducible TMJ disc displacement were selected for enrollment in the study. Subjects were divided equally into four groups: group I patients were treated with behavioral therapy; group II patients were treated with low-level laser therapy (LLLT); group III patients were treated with anterior repositioning splints; and group IV patients were treated with flat plane splints. Chewing efficiency was assessed utilizing the fractional sieving method and a synthetic food substitute was created using silicon impression material. The statistical analysis encompassed comparisons of chewing efficiency between groups and between baseline and posttreatment within each group, employing analysis of variance (ANOVA) and paired t tests, respectively. Results: Using the paired t test, a significant difference in chewing efficiency values as expressed by the median particle size was observed between the baseline and 6-month values in all groups (P < 0.05), except for group I where no significant change was noted over the 6 months (P > 0.05). The one-way ANOVA test revealed a statistically significant difference among groups following therapies (P ˂ 0.05). The post hoc Tukey test was employed for pairwise comparisons and revealed statistically significant variances in the main values of chewing efficiency among all groups at a 95% confidence level (P ˂ 0.05). Conclusion: The study's results suggest that occlusal splints and LLLT are more effective in improving chewing efficiency than behavioral interventions.

Clinical effect of digitalized designed and 3D-printed repositioning splints in the treatment of anterior displacement of temporomandibular joint disc.

OBJECTIVE: To compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior displacement of the temporomandibular joint disc. METHODS: This retrospective study included 96 patients with disc displacement of the anterior temporomandibular joint. They were treated with either digitally designed and 3D-printed repositioning splints or traditional splints and followed up for at least six months. Changes in signs and symptoms such as pain and mouth opening before and after treatment were recorded to evaluate treatment outcomes. RESULTS: During the first month of treatment, both the digitally designed and 3D-printed repositioning splint groups (Group B) and the traditional repositioning splint group (Group A) showed significant increases in mouth opening, with increases of 4.93 ± 3.06 mm and 4.07 ± 4.69 mm, respectively, and there was no significant difference between the two groups. Both groups had a significant reduction in visual analog scale (VAS) pain scores, with Group B showing a greater reduction of 1.946 ± 1.113 compared to 1.488 ± 0.978 in Group A (P < 0.05). By the sixth month, Group B's mouth opening further improved to 38.65 ± 3.22 mm (P < 0.05), while Group A's mouth opening did not significantly improve. Regarding pain, Group A's VAS score decreased by 0.463 ± 0.778 after one month, and Group B's score decreased by 0.455 ± 0.715; both groups showed significant reductions, but there was no significant difference between the two groups. CONCLUSION: Compared with traditional repositioning splints, digitally designed and 3D-printed repositioning splints are more effective at reducing patient pain and improving mouth opening. 3D-printed repositioning splints are an effective treatment method for temporomandibular joint disc displacement and have significant potential for widespread clinical application.

Efficacy of Occlusal Splints and Low-Level Laser Therapy on the Mandibular Range of Motion in Subjects with Temporomandibular Joint Disc Displacement with Reduction.

Aims and Objectives: The study was carried out to evaluate the efficacy of four conservative therapeutic modalities on the mandibular range of motion (MRM) in subjects with anterior disc displacement with reduction (ADDwR) of the temporomandibular joint (TMJ). Materials and Methods: One hundred patients (64 women and 36 men) were selected, and randomly distributed into four groups. Group I: Subjects receiving behavioral therapy (BT). Group II: Subjects receiving low-level laser therapy (LLLT). Group III: Subjects receiving maxillary anterior repositioning splint (MARS). Group IV: Subjects receiving stabilization splint (SS). The MRM was evaluated for each patient before treatment and after 6 months. Paired t test and one-way analysis of variance (ANOVA) tests were used for statistical analysis followed by a post hoc Tukey test (P ≤ 0.05). Results: All groups showed significant improvement in MRM after 6 months of treatment (P ≤ 0.05) except for BT. There was a significant improvement for SS and MARS on the different movements of MRM, more than for LLLT and BT (P ≤ 0.05). Conclusion: The MARS and the SS are effective in increasing the MRM for patients with ADDwR.

The effect of anterior repositioning splint therapy on maximum bite forces in patients with disc interference disorders.

OBJECTIVE: To evaluate the effect of anterior repositioning splint (ARS) on maximum bite force (MBF) values in patients with disc interference disorders (DID). MATERIAL AND METHODS: Twenty-two patients with disc interference disorders and 22 healthy subjects participated in to study. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I have been used to diagnose DID patients. All patients received ARS therapy for 6 weeks. The MBF measurement was performed with Flexi-Force piezo-resistive sensors for both healthy subjects and patients before and after ARS therapy. RESULTS: A significant difference was recorded by the increase of the mean MBF values after the use of the ARS in the patient with disc derangements (p < .05). CONCLUSIONS: APS therapy is efficient for eliminating pain and increasing MBF of the patients with DID. In addition, the use of FlexiForce sensors may be a practical solution to assess the bite force in the clinical setting.

An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders.

Anterior repositioning splint (ARS) therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders (TMDs), which account for a large proportion of TMD cases. Owing to the wide application of this therapy, the exact mechanism of remission has increasingly drawn attention. Given that practitioners have different views on ARS therapy, its indications are broadened, and operating methods diverged. This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods. Representative views in the past 10 years were summarised, and conclusions were drawn as follows: The mechanism of ARS therapy is mainly attributed to internal derangement correction, improvement of stress distribution and recently reported joint remodeling. It has an evident effect in the short term, and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3-6 months. However, long-term stability is not optimal, and thus indications should be selected carefully. Notably, most of the clinical studies in this field are case analyses with low-quality evidence. Well-designed RCTs are required to further validate relevant theories.

Effect of using Photobiomodulation, stabilization, and anterior repositioning splints on the pain level of subjects with temporomandibular joint disc displacement with reduction / Efeito do uso da terapia a laser de baixa potência, placas planas e placas reposicionadoras anterior, no nível de dor de indivíduos com deslocamento anterior do disco articular com redução

Objective: was to evaluate the effect of four conservative treatment modalities on the pain level of patients with temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Material and methods:100 subjects (64 females and 36 males) were selected, divided into four groups, 25 patients of each. Subjects of Group I have been treated with behavioral therapy. Subjects of Group II had been treated with Photobiomodulation therapy (PBMT). Subjects of Group III had been treated by anterior repositioning splint (ARS). Subjects of Group IV had been treated by a stabilization splint. The pain was evaluated by visual analog score (VAS) from 0 to 10. Statistical analysis was done using one-way ANOVA test for comparison between groups. Within each group, a comparison between baseline and after treatment was done using paired t-test (p<0.05). Results: There was a statistical difference between the pain scores of the different groups after treatment (p≤0.05). Also, there were statistical differences between all groups (p≤0.05) except that between group II and group III (p˃0.05). Conclusion: The use of stabilization splint and ARS are effective non-invasive methods for reducing the pain level in the treatment of TMJ ADDwR cases.(AU)

Objetivo: avaliar o efeito de quatro modalidades de tratamento conservador no nível de dor de pacientes com deslocamento anterior do disco articular com redução. Material e Métodos: foram selecionados 100 indivíduos(64 mulheres e 36 homens), divididos em quatro grupos, 25 pacientes cada. Os indivíduos do Grupo I foram tratados com terapia comportamental. Os indivíduos do Grupo II foram tratados com terapia de fotobiomodulação. Os indivíduos do Grupo III foram tratados com placa de reposicionamento anterior. Os indivíduos do Grupo IV foram tratados com uma placa de estabilização. A dor foi avaliada pelo escala visual analógica (EVA) de 0 a 10. A análise estatística foi feita usando o teste ANOVA de uma via para comparação entre os grupos. Dentro de cada grupo, uma comparação entre a linha de base e após o tratamento foi feita usando o teste t pareado (p <0,05). Resultados: Houve diferença estatística entre os escores de dor dos diferentes grupos após o tratamento (p ≤ 0,05). Além disso, houve diferenças estatísticas entre todos os grupos (p ≤0,05), exceto entre o grupo II e o grupo III (p˃0,05). Conclusão: O uso de placa de estabilização e reposicionadora anterior são métodos não invasivos eficazes para reduzir o nível de dor no tratamento de casos de deslocamento anterior de disco articular sem redução.(AU)

Management of internal derangement of temporomandibular joint disc displacement with reduction using two different lines of treatment / Manejo do desarranjo interno do deslocamento de disco temporomandibular com redução utilizando dois tipos diferentes de tratamento

Objetive: This study was to compare the effectiveness of arthrocentesis versus the insertion of anterior repositioning splint (ARS) in improving the mandibular range of motion (MRM) for patients with the temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Methods: 36 patients diagnosed as ADDwR were recruited and divided randomly into two groups. The first group (G1) was treated by arthrocentesis, and the second (G2) was treated using ARS. All patients were reexamined after six months. Results: Except that for protrusive movement, there were significant differences between the two groups for the percentage changes of the MRM as measured by the amount of pain free opening, unassisted opening, maximum assisted opening, right lateral and left lateral movements (p < 0.05). Conclusion: Within the context of the current study, the non-invasive, lower cost ARS, provided better results in improving the MRM when managing ADDwR cases. (AU)

Objetivo: O presente estudo comparou a eficácia da Artrocentese em relação à inserção da Placa Reposicionadora Anterior (PRA) na melhoria da Amplitude de Movimento Mandibular (AMM) para pacientes que apresentam Deslocamento de Disco Anterior com Redução (DDAcR) da Articulação Temporomandibular (ATM). Método: 36 pacientes diagnosticados como DDAcR foram recrutados e divididos aleatoriamente em dois grupos. O primeiro grupo (G1) foi tratado através da Artrocentese e o segundo (G2), tratado com a PRA. Todos os pacientes foram reexaminados após seis meses. Resultados: Com exceção do movimento protrusivo, houve diferenças significativas entre os dois grupos para as mudanças percentuais das medidas de AMM pela quantidade de abertura sem dor, abertura sem assistência, abertura máxima com assistência, movimentos laterais direitos e laterais esquerdos (p < 0,05). Conclusão: Dentro do contexto do estudo atual, a PRA, não invasiva e de menor custo, proporcionou melhores resultados na melhoria da AMM no gerenciamento de casos de DDAcR (AU)

Temporomandibular disc displacement with reduction treated with anterior repositioning splint: a 2-year clinical and magnetic resonance imaging (MRI) follow-up.

Clicking may appear in the initial, middle, or final phase of mandibular opening. Magnetic Resonance Imaging (MRI) is the most appropriate diagnostic imaging for diagnosing disc position. With anterior repositioning splint (ARS), disc recapture is achieved through a change in the position of the condyle to encourage adaptation of the retrodiscal tissues. Three patients reported pain and sounds during movement and clicking in the final phases; also, the MRI confirmed anteriorized disc position and the treatments consisted of an ARS. The post-treatment examination confirmed a normal opening without deviations and deflections. After 2 years, the conditions were stable, and the MRI showed thickening of the retrodiscal tissues, including extra fibrous tissue, resulting in a pseudodisc. Treatment using ARS can stimulate tissue fibrosis and the formation of a pseudodisc. MRI is the gold standard for diagnosis and treatment planning of disc displacement cases.

Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials.

A network meta-analysis (NMA) of randomized controlled trials (RCTs) was performed to assess the effectiveness of various types of occlusal splint in the management of temporomandibular disorders (TMDs) and to rank them according to their effectiveness. An electronic search was undertaken to identify RCTs published until August 2019. Predictor variables were control, non-occluding splint, hard stabilization splint (HSS), soft stabilization splint (SSS), prefabricated splint, mini-anterior splint, anterior repositioning splint (ARS), and counselling therapy (CT) with or without HSS. Outcome variables were pain improvement, post-treatment pain intensity, improvement in mouth opening, and disappearance of temporomandibular joint (TMJ) sounds. Forty-eight RCTs were included. There was a significant decrease in post-treatment pain intensity in arthrogenous TMDs after ARS (low quality evidence), CT+HSS (moderate quality evidence), mini-anterior splints (very low quality evidence), and HSS alone (low quality evidence), when compared to the control. There was a significant decrease in post-treatment pain intensity in myogenous TMDs with mini-anterior splints (very low quality evidence), SSS (very low quality evidence), CT alone (moderate quality evidence), CT+HSS (moderate quality evidence), and HSS alone (moderate quality evidence), when compared to control. ARS and CT were superior in decreasing TMJ clicking than control and HSS alone. The three highest-ranked treatments for post-treatment pain reduction in arthrogenous TMDs were ARS (92%, very low quality evidence), CT+HSS (67.3%, low quality evidence), and HSS alone (52.9%, moderate quality evidence). For myogenous TMDs, they were mini-anterior splints (86.8%, low quality evidence), CT+HSS (61.2%, very low quality evidence), and HSS alone (59.7%, moderate quality evidence). Based on this NMA of 48 RCTs, there is moderate to very low quality evidence confirming the effectiveness of occlusal splint therapy in the treatment of TMDs. Multimodal therapy consisting of CT+HSS may produce the maximum improvement for TMD patients.

Clinical protocol for managing acute disc displacement without reduction: a magnetic resonance imaging evaluation.

This study investigated the efficacy of a sequential combination of arthrocentesis, mandibular manipulation, and anterior repositioning splint (ARS) in the management of acute temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). Twenty-one consecutive patients diagnosed with acute DDwoR by Diagnostic Criteria for Temporomandibular Disorders and magnetic resonance imaging (MRI) were recruited and managed with this method. Clinical and MRI data were obtained before and at 1 week after treatment. The disc-condyle relationship was determined by disc-condyle angle measurement. Condyle/disc positions were described as x-y coordinates with the summit of the articular fossa as the coordinate origin. Statistical analyses including independent/paired samples t-tests were conducted; significance was set at P<0.05. Clinical success was observed in 95.2% of patients (20/21) with 22 joints affected by acute DDwoR. After combined treatment and ARS insertion, TMJs with DDwoR showed (a) normal disc-condyle relationships with substantial forward and downward condyle movement and significant disc reduction in closed position, and (b) discs with an intermediate zone located between the condylar head and articular eminence in open position. The combined approach was highly effective in 'unlocking' acute TMJ DDwoR and achieving spatial full disc reduction and a normal disc-condyle relationship. The duration of acute DDwoR appears to be critical for success.

Condylar repair and regeneration in adolescents/young adults with early-stage degenerative temporomandibular joint disease: A randomised controlled study.

BACKGROUND: Anterior repositioning splint (ARS) can facilitate regenerative condylar remodelling. OBJECTIVE: To determine the effect of ARS on osseous condylar changes in adolescents/young adults with early-stage degenerative joint disease (DJD). METHODS: Sixty-nine patients with early-stage temporomandibular joint (TMJ) DJD based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and cone beam computed tomography (CBCT) imaging were recruited and randomly allocated to two treatment groups: (a) conservative therapy with ARS and (b) conservative therapy without ARS. Subjects with acute TMJ closed-lock had their displaced discs physically reduced by mandibular manipulation prior to ARS therapy. Clinical and CBCT data of 59 patients (86.4% females, mean age 17.95 ± 4.53 years, 67 joints) were attained pre- and at 6 or 12 months post-treatment. Osseous changes after treatment were categorised into (a) progressed, (b) unchanged, (c) repaired (remodelled without new bone formation) and (d) regenerated (remodelled with new bone formation). Statistical analysis including chi-square test, independent samples t test or Mann-Whitney U test was conducted. RESULTS: About 85.5% of patients (59/69) completed the study, with 28 subjects (32 joints) in the splint group and 31 (35 joints) in the control group. The occurrence of condylar repair and regeneration was significantly higher with ARS (78.1%/[25/32] of joints) when compared to control group (48.6%/[17/35]) (P < 0.05). Moreover, condylar regeneration was exclusively observed in 50%/(16/32) of joints with ARS. For the 14 joints in splint group that received physical TMJ closed-lock reduction, 85.7%/(12/14) exhibited condylar regeneration. The splint group (3.1%/[1/32]) also had significantly lower incidence of progressive TMJ degeneration than the control (37.1%/[13/35]) (P < 0.001). CONCLUSION: Condylar repair and regeneration in early-stage TMJ DJD are possible, and ideal spatial disc-condyle relationship appears important. The possibility of restoring TMJ form/structure by ARS therapy presents an attractive area of new basic science and clinical research (Bone defect repair in early osteoarthrosis of temporomandibular joint by joint distraction therapy: A randomized controlled trial/ChiCTR-TRC-14005172).

Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis.

Anterior repositioning splints (ARS) are used primarily for the management of temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). However, the exact physiological effects of ARS are still unclear. This study investigated the short and long-term effects of ARS on disc and condyle angles/positions by metric analysis. Twenty-two subjects diagnosed with ADDwR were recruited. Maxillary full-coverage ARS were fabricated, and MRI of TMJs was obtained before splint treatment, immediate post-insertion and 6 months after splint treatment. Disc-condyle relationship was determined by disc-condyle angle measurement. Disc and condyle positions were described as X-Y coordinates with the summit of glenoid fossa as the origin of the coordinates. Thirty-two TMJs were classified as ADDwR and 12 were normal. Upon ARS insertion, all TMJs with ADDwR got normal disc-condyle relationships. The condyles moved significantly forward and downward, while the discs moved significantly backward and upward. MRI at 6 months after treatment (without ARS insertion) indicated that only 40·6% (13/32) of the joints were maintained in the normal disc-condyle relationship. The majority of condyles returned to their pre-treatment positions, while the discs generally moved anteriorly again. The use of ARS resulted in forward and downward condyle movement, and a concurrent backward movement of the disc resulting in ideal spatial disc-condyle relationship. The stability of this relationship, however, could not be maintained in the majority of TMJs upon ARS removal. Findings explain the good short-term clinical outcomes with ARS and their relatively lower efficacy in the long term.

Analysis of the clinical symptoms and the temporomandibular joint disk by magnetic resonance imaging after conservative treatment with anterior repositioning splint

Clinical Features of the Temporomandibular Disorder Patients with Occlusal Splint Therapy / 영남의대학술지

This study was performed to evaluate the clinical features and treatment results on 55 temporomandibular disorder patients who had treated by conservative treatment using occlusal splint. The results were as follows; 1. The ratio of men to women was about 1:2.2 and most of the patients were second and third decades. 2. Pain was the most frequent symptom, followed by clicking and mouth opening limitation. 3. The number of acute and chronic groups on the basis of 6 months duration of symptoms were similar. 4. Most of patients had Angle's Class 1 molar relationships(78.2%), followed by Class 3 and Class 2. 5. Centric Relation splints were used alone for treatment of 34 patients and 21 patients were treated with Centric Relation splints and Anterior Repositioning splints. The treatment duration of the patients who had complained pain was average 9.8 weeks and 6 patients of them had slight pain continuously during follow-up. 6. Eleven patient's maximum mouth opening who had mouth opening limitation was improved from 30.7mm to 43.0mm during procedures.

The effects of changes of mandibular position on temporomandibular joint in adult rabbits whose retrodiscal tissues were incised / 대한치과교정학회지

The purpose of this experiment was to study the effects of changes of mandibular position on temporomandibular joint in internal derangement patients. Twenty-four female New Zealand White Rabbits, weighing over 3.5kg, were utilized in this study. Bilateral temporomandibular joint surgery was performed in twenty one of the rabbits to displace disc anteriorly through incising the retrodiscal tissue 1-2mm posterior to the disc, thus inducing internal derangement. They were divided into three groups: nine were left untreated after surgery, six were fitted with functional protrusive appliances 4 weeks after surgery, and six wore collar appliances to apply 4 ounces of mandibular retractive force per side 4 weeks after surgery. The remaining three served as the control group. Histologic examinations were performed after sacrificing them by threes at 4-week intervals. The results were as follows: 1. Histologic findings similar to internal derangement were observed in the rabbits whose retrodiscal tissues had been incised. 2. In the rabbits untreated after surgery, articular surface on condylar process and articular eminence showed severe erosion and deformation, and displaced disc manifested changes in both shape and internal architecture. 3. Functional protrusion after surgery resulted in progressive remodeling on posterosuperior portion of condyle and glenoid fossa, while it also brought about erosion on articular eminence and anterior portion of condyle. 4. Mandibular retraction after surgery resulted in compression of retrodiscal tissue and regressive remodeling of posterior portion of condyle.