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

Assessing the Efficacy of Anterior Repositioning Splints in the Management of Temporomandibular Disc Displacement: A Systematic Review and Meta-Analysis

Disc displacement (DD) occurs when the cushioning disc of the temporomandibular joint (TMJ), situated between the jawbone and the skull, is out of position. The condition can be of two kinds: disc displacement with reduction (ddwr) and disc displacement without reduction (ddwor). The present systematic review was undertaken to assess the efficacy of anterior repositioning splints (ARS) for ddwr and ddwor. Three online databases were searched for relevant studies using MeSH keywords and Boolean operators. Initial searches of the databases extracted 552 records. Twelve studies equally representing ARS with ddwr and ddwor were selected. No clear difference could be assessed regarding ARS usage in both conditions. The outcome assessed was the improvement in TMJ symptoms. The results suggested that both ddwr and ddwor were effective in improving temporomandibular joint (TMJ) symptoms in patients who received ARS therapy. Efficacy levels ranged from 71-83% and 50-95% for ARS in ddwr and ddwor, respectively; odds ratio (OR) values ranging from 0.30 and 0.36 were obtained for ARS in both therapies, respectively, indicating similar performance levels. Both ddwr and ddwor respond well to the use of ARS; however, more clinical trials are needed to ascertain and validate the role of ARS as a treatment modality in this regard.

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.

Efficacy of stabilisation splint and low-level laser therapy for patients with chronic closed lock from non-reducible displaced temporo-mandibular joint discs: A parallel randomised clinical trial

BACKGROUND

Stabilisation splint therapy (SST) and low-level laser therapy (LLLT) are effective-invasive treatment for temporo-mandibular disorder (TMD) patients. However, the specific efficacy of each therapy in patients with chronic closed lock (CCL) from temporo-mandibular joints (TMJ) disc displacement without reduction (DDwoR) remains unknown.

OBJECTIVES

The aim of this study was to assess and compare the efficacy of SST and LLLT alone or in combination in patients with CCL from TMJ DDwoR.

METHODS

This parallel randomised clinical trial included 42 patients who were diagnosed with CCL from TMJ DDwoR. Patients were allocated equally and randomly into three treatment groups: group I received combined SST and LLLT, group II received LLLT and group III received SST. Maximum mouth opening (MMO), visual analogue scale (VAS), muscle and joint palpation scores and time required to achieve normal state were evaluated at baseline, 1, 2, 4 weeks, 3 and 6 months after the intervention. Data were collected and analysed using SPSS software.

RESULTS

Regarding MMO and VAS, a statistically significant improvement was found between group I versus group II and versus group III at all evaluation times. Regarding muscle and joint palpation scores, a statistically significant difference was found between group I versus group III, while non-significant difference was found between group I and group II. A statistically significant faster improvement was found in group I versus group III and versus group II.

CONCLUSION

All treatment modalities can be effective in management of CCL from a TMJ DDwoR cases, but the combined SST and LLLT group seems to provide the best and quickest improvement.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05548894.

Disc-condyle relationship alterations following stabilization splint therapy or arthrocentesis plus hyaluronic acid injection in patients with anterior disc displacement: a retrospective cohort study

OBJECTIVE

The objective of this study was to quantitatively evaluate the efficacy of stabilization splint (SS) therapy or arthrocentesis plus hyaluronic acid (HA) injection in the treatment of anterior disc displacement (ADD) through magnetic resonance imaging (MRI).

METHODS

99 subjects were collected in this study. 46 subjects received SS treatment (SS group), 53 subjects received arthrocentesis plus HA injection (HA group). Joints with anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR) were compared separately. MRI before the beginning of the treatment and after a set of treatment were used for measurement. Disc-condyle relationship and positions of condyles and discs were determined by disc-condyle angles and X-Y coordinates.

RESULTS

The disc-condyle angles decreased significantly in the SS group (P < .0001). Whereas no significant change was found in the HA group. Substantial anteroinferior condyle movement was detected in the SS group, slight anterior movement of condyles was discovered in the HA group. Anterior shift of discs position was observed in HA group and joints with ADDwoR in the SS group.

CONCLUSIONS

SS was effective in improving the disc-condyle relationship in ADD subjects, while significant improvement of disc-condyle relationship cannot be achieved through arthrocentesis plus HA injection.

"RA.DI.CA." Splint for the Management of the Mandibular Functional Limitation: A Retrospective Study on Patients with Anterior Disc Displacement without Reduction

The study aimed at assessing the effectiveness of the RA.DI.CA. splint in the management of temporomandibular joint disc displacement without reduction (ADDwoR) and jaw functional limitation. The authors developed a retrospective clinical study. A total of 2739 medical records were screened. One hundred and forty-one patients with chronic unilateral disc displacement without reduction and jaw limitation, treated with a multifunctional RA.DI.CA. splint, were enrolled. Temporomandibular pain, headache, familiar pain, neck pain, and emotional strain, maximum spontaneous mouth opening, and lateral excursions were evaluated at baseline (T0), after therapy (T1), and during the follow-up (T2). Descriptive statistical analysis was performed. Wilcoxon test assessed changes in symptomatology and functional aspects before and after treatment and between T1 and T2, with p < 0.05. Ninety-nine patients (70%) declared themselves "healed" from jaw functional limitation with no residual painful symptoms, 31 (22%) improved their symptoms and jaw function, 11 (8%) reported no changes compared to T0 and no one worsened. As for all parameters analyzed, the comparison between the ones before and after treatment was statistically significant (p < 0.05). The RA.DI.CA. splint proved to be highly performing and promoting functional and symptomatologic recovery, also in the medium and long term, through the restoration of the functional disc-condyle relationship and the healing of joint tissues.

Effect of simultaneous application of arthrocentesis and occlusal splint versus splint in management of non-reducing TMJ disc displacement

Background/Purpose

This study aimed to compare the effect of four approaches in the treatment of TMJ disc displacement without reduction (DDwoR).

Materials and methods

Thirty-two patients (40 joints) with mean age 28.025 ± 7.18 (23 female patients and nine male patients) were assigned randomly into four groups (10 joints in each group). Group I, patients were treated by centric splint. Group II, patients were treated by distraction splint. Group III, patients were treated by arthrocentesis and centric splint, while group IV patients were treated by arthrocentesis and distraction splint. The groups were compared in terms of joint function (mouth opening), joint pain through joint palpation, and use of visual analog scale (VAS). These records were taken preoperatively, two weeks, one month, three, and six months postoperatively. Also, the presence of disc recapture was evaluated in all patients on MRI at the end of the treatment period.

Results

Significant improvements in all parameters were recorded in all groups. At two weeks postoperatively, there was a significant improvement in all parameters in group III and group IV than group I and group II, while there was no statistical difference between group III and group IV. Regarding mouth opening and joint palpation, there was a significant improvement in group III than group I and group II. Also, there was a significant improvement in group IV than group II at the subsequent follow-up periods. Regarding VAS, at one and three months postoperatively, there was a significant improvement in group III than other groups.

Conclusion

However, both types of splints provide better results without a statistical difference; the simultaneous application of arthrocentesis and occlusal splint decreases pain and improving the function effectively and more rapidly.

Magnetic resonance and sonographic imagings of masticatory muscle myalgia in temporomandibular disorder patients

This article reviews recently published studies investigating the MRI and sonographic diagnosis of masticatory muscle myalgia in temporomandibular disorder patients. The MRI and sonographic features of muscle after treatment are also discussed. Literature published within the last 15 years was obtained from the PubMed database using the following Mesh terms: magnetic resonance imaging (MRI) or sonography, masticatory muscle pain, and treatment. MRI and sonography enable accurate visualization and evaluation of the masticatory muscles, thereby increasing our understanding of pathology and cause of pain associated with these muscles. Although therapeutic efficacy is often evaluated based on clinical findings, MR and sonographic imaging studies may also be valuable.

Assessment of functional improvement with temporalis myofascial flap after condylectomy in elderly patients with anterior disc displacement without reduction and an erosive condylar surface

Background

The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ).

Methods

A total of 15 joints from 11 elderly patients (71–78 years old) were included. The patients had pain, mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface of the TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomy was also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateral movements, were evaluated.

Results

No patient experienced serious complications. Most measurements improved significantly after surgery compared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported serious pain during the follow-up period.

Conclusion

Although nonsurgical therapy is often the first treatment choice for ADD without reduction of the TMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be a reasonable first option for elderly patients with an erosive condylar surface of the TMJ.