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OcclusalSplintinT.M.J.Disorder:Doesittreats?

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Occlusal splint in TMJ Vikas Goyal et al

Journal of Oral Sign 2011, Vol 3, No 2 (May-Aug)

Short CommunicationShort CommunicationShort CommunicationShort Communication

Occlusal Splint in T.M.J Disorder: Does it treats?

Vikas Goyal 1, Neha Ajmera2

1Senior Lecturer, Orthodontics & Dentofacial Orthopedics, Daswani Dental College & Research Centre, Kota

(Rajasthan) 2Former Post Graduate Sudent, IDS, Bareilly, U.P.

(Received Nov 1, 2010 and Accepted Mar 19, 2011)

Abstract: Aim: To evaluate the effect of soft occlusal splint in Temporo-Mandibular joint disorder with restricted mouth opening to relieve pain and to increased restricted mouth opening Background: To a great extent treatment for TMJ disorder has been described by several authors. Few of them suggested the conservative method using oral splint. Case Description: A case reported with restricted mouth opening and TMJ pain were successfully treated using soft oral splint made by 2mm bioplast material using biostar machine. Summary: with the use of soft oral splint cases with TMJ Disorder (disk displacement without reduction) can be treated successfully as a conservative and an effective mode of treatment Clinical Significance: in the contemporary dental practice so many dentist frequently come across the TMJ disorders. A thorough understanding of TMJ disorder will lead to proper diagnosis of TMJ joint pain & dysfunction. Soft oral splint can be used as an effective means of treatment for such patient. Fabrication of appliance is easy and comfortable for patient. Keyword: A case report, TMJ disorder, occlusal splints, disc displacement without reduction.

JOOS 2011; 3 (2):

Interocclusal orthopedic appliances or splints are routinely used in the treatment of disorders of the Temporo-Mandibular Joint (TMJ) and masticatory system. Hard or soft removable acrylic appliances covering the teeth have been used to eliminate occlusal disharmonies1,2 prevent wear and mobility of the teeth,3,4 reduce bruxism and parafunction,5,6 treat masticatory muscle dysfunction,7-10 and correct derangements of the TMJ.11-13

Case History:

A 20 year old Female patient reported to the Department of Orthodontics & Dentofacial orthopedics with restricted mouth opening (23 mm). She complained about pain in left TMJ area radiating to head and numbness on the left side of the face since 10 days. On examination there was no clicking, crepitus & deviation of the mandible during opening and closing movement. Patient is having Angles class I molar relationship with complete deep bite. Pretreatment OPG & TMJ tomogram shows no hard tissue destruction. On clinical examination & examination of OPG & TMJ tomogram, case has been diagnosed as Disc displacement without reduction. It was decided that case to be treated conservatively using soft occlusal splint. Alginate Impression of the lower arch made. Working cast poured with dental stone. A 2mm Bioplast mandibular splint made from Biostar machine (Fig. 1). The patient was instructed to wear the appliance constantly for at least two

Fig 1: Soft splint 2mm Bioplast

weeks, removing it only for oral hygiene & having food. After two weak when patient reported there was increased in the mouth opening (28 mm) (Fig 2). Patient was still persevering during Chewing. After check up, patient was advised to continue the splint. After 1 month, there was increased mouth opening (32mm) (Fig.3). Patient was relieved from the pain completely during rest except slight amount of the pain during chewing. Patient advised to continue the appliance for another 1 month. On next visit patient was relieved from

Occlusal splint in TMJ Vikas Goyal et al

Journal of Oral Sign 2011, Vol 3, No 2 (May-Aug)

pain completely during rest as well as chewing. After 2.5 month, anterior bite plane was inserted in the patient for opening the bite. Bite was opened in posterior area by 2.5 mm. patient recalled at monthly interval. After two month there was opening of the bite 1mm; height of bite plane was increased by 1 mm to maintain opening in posterior region by 2.5 mm. appliance discontinued 4 month after insertion. 2mm of total bite opening was achieved. Total duration of treatment was 6.5 month. Patient advised to continue the appliance for retention.

Discussion: The success for a treatment of any disorder relies on two considerations: relieving of symptoms and treating the cause. In this view, various treatment modalities for TMD have been tried and tested over time. Till date, no single treatment modality has been proven to be better than any other for TMD. Choosing a specific conservative treatment modality for TMJ Disorder patients depends on clinician’s expertise, patient presentation, and elimination of possible etiologic factors.14

Fig 2 & 3 Pretreatment (23 mm) & post treatment (32mm) mouth

opening

When a splint is inserted, there is an adaptation to a new resting postural position. Occlusal splints that increase the occlusal vertical dimension beyond the freeway space, cause an immediate adaptation to a new freeway space at an increased vertical dimension. Thus, an occlusal splint allows a muscle to function more efficiently during contact and be less active during postural functions. Hence, as the vertical dimension increases from the occlusal contact on the insertion of an occlusal splint, muscular effort decreases resulting in the relaxing of the muscles and hence, the TMJ.15The result of the present case infers that a soft occlusal splint therapy can be used as conservativetreatment modalities and is useful in the reduction of pain and tenderness in the muscles and also in an improvement in mouth opening. This is in agreement with various studies supporting the usefulness of occlusal

splints in the management of TMJ disorder. Exact mechanism of occlusal splint in reduction of pain and tenderness in the muscles and in improvement in mouth opening is still debatable and study should be done using advanced diagnostics aids & large sample to conform the result. Conclusion: The conventional soft occlusal splint therapy is a much safer and effective mode of a conservative line of therapy in comparison to the other therapy for Temporo-Mandibular Joint disorders. It has better patient compliance, fewer side effects, and is more cost-effective than other treatment. References: 1. Ramfjord and Ash: Occlusion 2nd ed, Philadelphia, W.B. Saunders Co.,

1971. 2. Posselt: Physiology of Occlusion and Rehabilitation, 2nd ed,

Philadelphia, F.A. Davis Co., 1968. 3. Hanamura, et al.: Periodontal status and bruxism. J. Perio. 58:173, Mar

1987. 4. Pavone: Bruxism and its effect on natural teeth. J. Prosthet. Dent.

53:692, 1985. 5. Posselt: Treatment of bruxism by bite guards and bite plates. J. Can.

Dent. Assoc. 29(12):773, 1963. 6. Rugh and Solberg: EMG studies of bruxist behavior before and during

treatment. J. Cal. Dent. Assoc. 3:6:56, Sep 1975. 7. Okeson, Kemper and Moody: A study of the use of occlusion splints in

the treatment of acute and chronic patients with craniomandibular disorders. J. Pros. Dent. 48:708, Dec 1982.

8. Laskin and Block: Diagnosis and treatment of myofascial pain dysfunction syndrome. J. Prosthet. Dent. 56:75, Jul 1986.

9. Clark: Treatment of jaw clicking with temporomandibular repositioning: Analysis of 25 cases. Cranio. 2:246, Jun-Aug 1984.

10. Carraro and Caffesse: Effect of occlusal splints in TMJ symptomology. J. Prosthet. Dent. 40:563, Nov 1978.

11. Helms, Katzberg and Dolwick: Internal derangements of the TMJ, Research and Education Foundation, San Francisco, 1983.

12. Lundh, Westesson, Kopp and Tillstrom: Anterior repositioning splint in the treatment of temporomandibular joints with reciprocal clicking: comparison with a flat occlusal splint and an untreated control group. Oral Surg. Oral Med. Oral Pathol. 60:131, Aug 1985.

13. Clark, Townsend and Carey: Bruxing patterns in man during sleep. J. Oral Rehabil. 11:123, Mar 1984.

14. Venkatesh Naikmasur et al. Soft occlusal splint therapy in the management of myofascial pain dysfunction syndrome: A follow-up study. Indian J Dent Res, 19(3), 2008; 196-203

15. Boero RP. The physiology of splint therapy: A literature review. Angle Orthodont 1989; 59:165-80.

Corresponding Author: Dr. Vikas Goyal, Department of Orthodontics & Dentofacial Orthopedics Daswani Dental College & Research Centre, Kota (Rajasthan), Telephone: +91- 95099-76970 email: dr_goyal1982@yahoo.com

Occlusal splint in TMJ Vikas Goyal et al

Journal of Oral Sign 2011, Vol 3, No 2 (May-Aug)

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