Efficacy of Splints in TMD

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Presentation transcript:

Efficacy of Splints in TMD DR KAMAL SHIGLI PROF & HEAD BHARTI VIDYAPEETH DEEMED UNIVERSITY DENTAL COLLEGE & HOSPITAL, SANGLI, MAHARASHTRA.

Splint (GPT-8): A rigid or flexible device that maintains in position a displaced or movable part; also used to keep in place and protect an injured part. Glossary of prosthodontic terms. J Prosthet Dent. 2005; 94:10–92.

Etiology and interrelationships of many TMDs are often complex- the initial therapy should be reversible and noninvasive. Since the etiology and interrelationships of many TMDs are often complex, the initial therapy should generally be reversible and noninvasive. Occlusal appliances can offer such therapy while temporarily improving the functional relationships of the masticatory system.

Successful in reducing symptoms in 70% to 90% of TMDs Boero RP. The physiology of splint therapy: a literature review. Angle Orthod. 1989 Fall; 59(3):165-80. Beard CC, Clayton JA. Effects of occlusal splint therapy on TMJ dysfunction. J Prosthet Dent. 1980 Sep; 44(3):324-35. Klasser GD, Greene CS, Lavigne GJ. Oral appliances and the management of sleep bruxism in adults: a century of clinical applications and search for mechanisms. Int J Prosthodont.2010 Sep-Oct; 23(5):453-62. Okeson JP. Occlusal appliance therapy. In: Okeson JP. Management of Temporomandibular Disorders and Occlusion. 7th ed. St Louis, Mo: Elsevier Mosby Inc; 2013:375-398.

Appliances decrease muscle activity (particularly parafunctional activity) Myogenous pain decreases Forces placed on the TMJ and other structures within masticatory system lessened The associated symptoms decrease. In earlier studies, many authors concluded that these appliances decrease muscle activity (particularly parafunctional activity). When muscle activity is decreased, myogenous pain decreases. The reduced muscle activity also lessens the forces placed on the TMJs and other structures within the masticatory system. When these structures are unloaded, the associated symptoms decrease. Some controversy still exists over which specific features of an appliance decrease muscle activity.

Explanations for the Efficacy of OAs Dental and Oropharyngeal reasons for efficacy Nondental reasons for efficacy 1. Alteration of the occlusal condition (EB: low) 1. Cognitive awareness (HD only) 2. Alteration of the condylar position (EB: low) 2. Placebo effect (EB) 3. Increase in the vertical dimension of occlusion (EB: low) 3. Increased peripheral sensory inputs to the CNS resulting in decreased motor activity (EB: low) 4. Improved breathing during sleep due to reduction of airflow and retracted tongue and jaw position (HD only) 4. Regression to the mean (eg, natural fluctuation of symptoms) Klasser GD, Greene CS, Lavigne GJ. Oral appliances and the management of sleep bruxism in adults: a century of clinical applications and search for mechanisms. Int J Prosthodont. 2010 Sep-Oct; 23(5):453-62. Okeson JP. Occlusal appliance therapy. In: Okeson JP. Management of Temporomandibular Disorders and Occlusion. 7th ed. St Louis, Mo: Elsevier Mosby Inc; 2013:375-398.

Alteration of the occlusal condition Occlusal appliances Alter existing occlusal condition Stable condition Decrease muscle activity Reduction of symptoms Conti PC, de Alencar EN, da Mota Correa AS, Lauris JR, Porporatti AL, Costa YM. Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation. J Oral Rehabil.2012 Oct; 39(10):754-60. Okeson JP. Occlusal appliance therapy. In: Okeson JP. Management of Temporomandibular Disorders and Occlusion. 7th ed. St Louis, Mo: Elsevier Mosby Inc; 2013:375-398.

Alteration Of The Condylar Position Dylina TJ. A common-sense approach to splint therapy. J Prosthet Dent. 2001 Nov; 86(5):539-45. Dylina TJ. The basics of occlusal splint therapy. Dent Today. 2002 Jul; 21(7):82-7. Okeson JP. Occlusal appliance therapy. In: Okeson JP. Management of Temporomandibular Disorders and Occlusion. 7th ed. St Louis, Mo: Elsevier Mosby Inc; 2013:375-398.

Increase in the vertical dimension Adaptation to new freeway at increased vertical dimension Allows muscle to function more efficiently during contact and less active during postural functions Relaxing of muscles and TMJ Boero RP. The physiology of splint therapy: a literature review. Angle Orthod. 1989 Fall; 59(3):165-80. Naikmasur V, Bhargava P, Guttal K, Burde K. Soft occlusal splint therapy in the management of myofascial pain dysfunction syndrome: a follow-up study. Indian J Dent Res. 2008 Jul-Sep; 19(3):196-203. Conti PC, de Alencar EN, da Mota Correa AS, Lauris JR, Porporatti AL, Costa YM. Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation. J Oral Rehabil.2012 Oct; 39(10):754-60. Amin A, Meshramkar R, Lekha K. Comparative evaluation of clinical performance of different kind of occlusal splint in management of myofascial pain. J Indian Prosthodont Soc. 2016 Apr-Jun; 16(2):176-81.

Appliance acts as a reminder. Cognitive awareness Appliance acts as a reminder. Glaros AG, Owais Z, Lausten L. Reduction in parafunctional activity: a potential mechanism for the effectiveness of splint therapy. J Oral Rehabil.2007 Feb; 34(2):97-104. Conti PC, de Alencar EN, da Mota Correa AS, Lauris JR, Porporatti AL, Costa YM. Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation. J Oral Rehabil.2012 Oct; 39(10):754-60. Okeson JP. Occlusal appliance therapy. In: Okeson JP. Management of Temporomandibular Disorders and Occlusion. 7th ed. St Louis, Mo: Elsevier Mosby Inc; 2013:375-398. Adibi SS, Ogbureke EI, Minavi BB, Ogbureke KU. Why use oral splints for temporomandibular disorders (TMDs)?Tex Dent J. 2014 Jun; 131(6):450-5.

Change in peripheral input to CNS Occlusal appliance Change in peripheral sensory input Decrease in CNS-induced bruxism Klasser GD, Greene CS, Lavigne GJ. Oral appliances and the management of sleep bruxism in adults: a century of clinical applications and search for mechanisms. Int J Prosthodont. 2010 Sep-Oct; 23(5):453-62. Okeson JP. Occlusal appliance therapy. In: Okeson JP. Management of Temporomandibular Disorders and Occlusion. 7th ed. St Louis, Mo: Elsevier Mosby Inc; 2013:375-398. Singh PK, Alvi HA, Singh BP, Singh RD, Kant S, Jurel S, Singh K, Arya D, Dubey A. Evaluation of various treatment modalities in sleep bruxism . J Prosthet Dent. 2015 Sep; 114(3):426-31.

Natural musculoskeletal recovery Muscles that are overused can develop pain. With rest, the natural course of this painful muscle condition is toward recovery. Zhang FY, Wang XG, Dong J, Zhang JF, Lü YL. Effect of occlusal splints for the management of patients with myofascial pain: a randomized, controlled, double-blind study. Chin Med J (Engl). 2013 Jun; 126(12):2270-5. Okeson JP. Occlusal appliance therapy. In: Management of Temporomandibular Disorders and Occlusion. 7th ed. St Louis, Mo: Elsevier Mosby Inc; 2013:375-398.

Placebo effect Approximately 40% of patients suffering from certain TMDs respond favourably to placebo treatments. Conti PC, de Alencar EN, da Mota Correa AS, Lauris JR, Porporatti AL, Costa YM. Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation. J Oral Rehabil.2012 Oct; 39(10):754-60. Okeson JP. Occlusal appliance therapy. In: Management of Temporomandibular Disorders and Occlusion. 7th ed. St Louis, Mo: Elsevier Mosby Inc; 2013:375-398.

Fluctuation of symptoms. Question the reduction of symptoms. Regression to the mean Fluctuation of symptoms. Question the reduction of symptoms. Conti PC, de Alencar EN, da Mota Correa AS, Lauris JR, Porporatti AL, Costa YM. Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation. J Oral Rehabil.2012 Oct; 39(10):754-60. Okeson JP. Occlusal appliance therapy. In: Management of Temporomandibular Disorders and Occlusion. 7th ed. St Louis, Mo: Elsevier Mosby Inc; 2013:375-398.

Summary Oral Splints are a reversible, correctable, temporary appliance to be used till the final treatment is decided. They are often indicated, in initial and in some long-term treatments of TMDs. They help restore lost vertical dimension within tissue tolerance.