Effects of Prosthetic Rehabilitation on Temporomandibular Disorders: Protocol for a Randomized Controlled Trial

Assessing, categorizing and proposing the therapeutic effect of complete dentures on temporomandibular disorders analyzed by craniomandibular index: a prospective interventional study

BACKGROUND

Edentulism is a devastating condition that is often irreversible and considered a marker of a diseased state of oral health. The prevalence of edentulism globally is 22%, which is quite high. The long-term absence of complete dentures is thought to cause joint problems.

OBJECTIVES

To evaluate and categorize the effect of complete dentures on signs and symptoms of temporomandibular disorders (TMD) analyzed by the Craniomandibular Index (CMI) in completely edentulous patients.

METHODS

This interventional and prospective study was conducted. Preliminary screening of completely edentulous patients with the Anamnestic component of the Helkimos Index was done. 110 subjects with severe TMD, as per the preliminary screening, were included in the study. Secondary Screening for the Dysfunction and Palpation components of the CMI was done to obtain baseline measures. The complete denture was delivered. After three months, the CMI Score was re-evaluated. Descriptive and analytical statistics were done.

RESULTS

The mean CMI score before denture insertion was 1.50 ± 0.12, and after denture insertion, it was 0.45 ± 0.25. The test used for the analysis of the values was the student's paired t-test. A statistically significant difference in CMI at pre- and post-treatment with complete dentures (t = 57.90, p = 0.0001) was found.

CONCLUSION

The study results showed abate in the severity of the signs and symptoms of TMD among the complete denture wearers over 3 months. The result of current study established the remedial effect of complete dentures on TMD and also gave a new parameter to contemplate the line of treatment by categorizing the severity of TMD on the basis of the score obtained.

Radiological Associations between Posterior Edentulism and Condylar Bony Changes: A Retrospective Study

This retrospective study aimed to investigate the relationship between posterior edentulism and condylar bone changes in patients aged 35-60 years. The CBCT images of 259 patients, including 131 posterior edentulous and 128 posterior dentulous patients, were analyzed to identify the types of condylar bone changes. The frequency of flattening, sclerosis, erosion, and reduced joint space was found to be higher in posterior edentulous patients. Regression analysis revealed that combined premolar and molar loss and being female were significant predictors of condylar erosion (p = 0.006; OR: 3.264; 95% CI: 1.401 - 7.603, p=0.031; OR: 2.652; %95 CI: 1.095 - 6.424). The study provides support for the domino effect phenomenon in temporomandibular joint pathology, indicating that posterior edentulism can have a significant impact on the occurrence of erosive condylar changes. The findings suggest that prosthetic and temporomandibular joint treatment approaches should consider the association between posterior edentulism and condylar bone changes, particularly in female patients with combined premolar and molar loss. Therefore, close attention should be paid to the management of these patients to minimize the risk of temporomandibular joint pathology.

Prosthodontic Treatment in Patients with Temporomandibular Disorders and Orofacial Pain and/or Bruxism: A Review of the Literature

Temporomandibular disorders are a group of conditions affecting the temporomandibular joints, the jaw muscles, and related structures. Patients with temporomandibular signs and/or symptoms frequently present with indications for prosthetic treatment. The management of these patients aims to achieve patient comfort, occlusal stability, and the complex restoration of the teeth. The goal of this review is to provide an overview of the relationship between prosthodontics and temporomandibular disorders and/or bruxism with a focus on the cause-and-effect implications and the strategies for planning prosthetic treatments in patients with temporomandibular disorders and/or bruxism.

Assessment of the masseter stiffness in patients during conservative therapy for masticatory muscle disorders with shear wave elastography

Background

The complex structure of the stomatognathic system plays a vital role in chewing, digestion, speaking, breathing, facial expression and swallowing. Its complexity is the primary reason for creating multidisciplinary teams to manage temporomandibular disorders (TMD). We aimed to assess the masseter stiffness in patients undergoing conservative therapy for masticatory muscle disorders and evaluate the efficacy of manual therapy and stabilization occlusal splint in the treatment of masticatory muscle disorders.

Methods

This uncontrolled prospective cohort study included 35 patients with masticatory muscle disorders. The study lasted for eight weeks. The patients were treated with manual therapy and stabilization occlusal splint and evaluated using shear wave elastography of the masseter muscles and patient-reported outcome measures (PROMs) to assess pain, anxiety, quality of sleep, satisfaction with life and perceived stress.

Results

After the treatment, the stiffness of both masseter muscles decreased significantly (by 4.21 kPa). The patients reported a significant reduction in pain. At baseline, the median scores ranged from 5 to 8; after treatment, they ranged from 0 to 1 (p < 0.0001). The patients also reported significant improvement in terms of all patient-reported outcome measures. The reduction in stiffness corresponded to the improvement in pain and PROMs, as shown by correlations which were insignificant for all measures.

Conclusions

Conservative therapy of masticatory muscle disorders involving manual therapy and stabilization occlusal splint is effective. It reduces the masseter stiffness as objectively shown in shear wave elastography and improves subjective PROMs scores, including numerical pain assessment and selected questionnaires. Shear wave elastography has the potential for broad application in clinical practice to monitor masticatory muscle disorders treatment effects due to its objectivity and non-invasive character. Further research is recommended on larger patient populations and longer follow-up.

Trial registration

The study was registered at clinicaltrials.gov (NCT03844854). First posted date: 19/02/2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05392-9.