Comparative efficacy of different thicknesses of soft and hard splints in reducing clinical symptoms in patients with temporomandibular disorders
,
Abstract
Introduction: The effectiveness of two soft and hard splint thicknesses in reducing temporomandibular joint (TMJ) pain and dysfunction was compared. Materials and Methods: Sixty patients with TMJ pain and dysfunction were randomly assigned to four groups (n=15); the patients treated with hard occlusal splints of 1 and 3mm thicknesses were assigned to Groups A and B, respectively, and those treated with soft occlusal splints of 1 and 3mm thicknesses were assigned to Groups C and D, respectively. Maximum mouth opening (MMO) and the severity of pain based on the visual analog scale (VAS) were assessed before treatment and after 7, 30 and 90 days. Results: After both 7 and 30 days, no significant differences were found between the groups for any variable (P>0.05). However, Group C had a significantly lower MMO compared to Groups A and B after 90 days (P=0.001). Additionally, and in relation to masticatory muscle pain, Group C had a significantly higher VAS score than other groups (P<0.05). The VAS score for TMJ pain at rest was also significantly higher in Group C compared to Groups A and B (P<0.05). Conclusion: A 3-mm hard occlusal splint seems to be the best treatment to reduce pain and dysfunction of the TMJ. Keywords: Temporomandibular disorders; Soft and hard occlusal splints; Pain; Dysfunction.
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[6] Manfredini D, Borella L, Favero L, Ferronato G, Guarda-Nardini L. Chronic pain severity and depression/somatization levels in TMD patients. International Journal of Prosthodontics. 2010; 23:529-534.
[7] Bono AE, Learreta JA, Rodriguez G, Marcos JC. Stomatognathic system involvement in rheuma- toid arthritis patients. CRANIO®. 2014; 32:31-37.
[8] Fernandes G, Goncalves DA, Siqueira JT, Cam paris CM. Painful temporomandibular disorders, self-reported tinnitus, and depression are highly associated. Arquivos de neuro-psiquiatria. 2013; 71:943-947.
[9] Walczynska-Dragon K, Baron S. The biomechani- cal and functional relationship between temporo- mandibular dysfunction and cervical spine pain. Acta of Bioengineering and Biomechanics. 2011; 13:93-98.
[10] Sipilä K, Suominen AL, Alanen P, Heliövaara M, Tiittanen P, Könönen M. Association of clinical findings of temporomandibular disorders (TMD) with self-reported musculoskeletal pains. Eur J Pain. 2011; 15:1061-1067.
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[12] Calixtre LB, Gruninger Bl, Chaves Tc, Olivei- ra AB. Is there an association between anxiety/ depression and temporomandibular disorders in college students?. J App Oral Sci. 2014; 22:15-21.
[13] Okeson JP, de Leeuw R. Differential diagnosis of temporomandibular disorders and other orofacial pain disorders. Dent Clin. 2011; 55:105-120.
[14] Sokalska J, Wieckiewicz W, Zenczak-Wieckiewicz D. Influence of habit of chewing gum on condi tion of stomatognathic system. Dent Med Probl. 2006; 43:567-570.
[15] Loster JE, Wieczorek A. Assessment of the effec- tiveness of treatment for temporomandibular joint dysfunctions. Dent Med Probl. 2014; 51:72-78.
[16] Grippo JO, Simring M, Schreiner S. Attrition, abrasion, corrosion and abfraction revisited a new perspective on tooth surface lesions. J Am Dent Assoc. 2004; 135:1109-1118.
[17] Grippo JO, Simring M, Coleman TA. Abfraction, abrasion, biocorrosion, and the enigma of non- carious cervical lesions: A 20‐year perspective. J Esthet Restor Dent. 2012; 24:10-23.
[18] Seifeldin SA, Elhayes KA. Soft versus hard occlu- sal splint therapy in the management of temporo mandibular disorders (TMD). Saudi Dent J. 2015; 27:208-214.
[19] Alqutaibi AY, Aboalrejal AN. Types of occlusal splint in management of temporomandibular dis orders (TMD). J Arthritis. 2015; 4:2.
[20] Gray RJ, Davies SJ. Occlusal splints and temporo- mandibular disorders: why, when, how?. Dent Up- date. 2001; 28:194-199.
[21] Mona F, El-Mangoury NH, El-Bokle DN, Belal AI. Occlusal splint therapy and magnetic reso nance imaging. World J Orthod. 2004; 5:133-140.
[22] Wright E, Anderson G, Schulte J. A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain. J Orofac Pain. 1995; 9:192-199.
[23] Okesson JP. Management of temporomandibular disorders and occlusion. 7th ed. Mosby, St Louis. 2013:260.
[24] Ramfjord SP, ASH MM. Reflections on the Mich igan occlusal splint. J Oral Rehabil. 1994; 21:491- 500.
[25] Dylina TJ. A common-sense approach to splint therapy. J Prosthet Dent. 2001; 86:539-545.
[26] Dworkin SF. LeResche L. Research diagnostic cri teria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992; 6:301-355.
[27] Poveda Roda R, Bagán JV, Díaz Fernández JM, Hernández Bazán S, Jiménez Soriano Y. Review of temporomandibular joint pathology: Part I: Classification, epidemiology and risk factors. Med Oral Patol Oral Cir Bucal. 2007; 12:292-298.
[28] Nilsson IM, List T, Drangsholt M. Prevalence of temporomandibular pain and subsequent dental treatment in Swedish adolescents. J Orofac Pain. 2005; 19:144-150.
[29] Soni A, Wanjari PV, Warhekar A. Role of soft oc- clusal splint therapy in the management of tem- poromandibular disorders: A 6-month follow-up study. J Indian Acad Oral Med Radiol. 2018; 30:355-360.
[30] Daif ET. Correlation of splint therapy outcome with the electromyography of masticatory muscles in temporomandibular disorder with myofascial pain. Acta Odontol Scand. 2012; 70:72-77.
[31] Amin A, Meshramkar R, Lekha K. Comparative evaluation of clinical performance of different kind of occlusal splint in management of myofas- cial pain. J Indian Prosthodont Soc. 2016; 16:176- 181.
[32] Lin SL, Wu SL, Ko SY, Yen CY, Yang JW. Effect of flat-plane splint vertical thickness on disc dis placement without reduction: a retrospective matched-cohort study. J Oral Maxillofac Surg. 2017; 75:1627-1636.
[33] Pita MS, Ribeiro AB, Garcia AR, Pedrazzi V, Zuim PR. Effect of occlusal splint thickness on electri- cal masticatory muscle activity during rest and clenching. Braz Oral Res. 2011; 25:506-511.
[34] Abekura H, Yokomura M, Sadamori S, Hamada T. The initial effects of occlusal splint vertical thick ness on the nocturnal EMG activities of mastica tory muscles in subjects with a bruxism habit. Int J Prosthodont. 2008; 21:116-120.
[35] Krogh-Poulsen W. Treatment of oro-mandibular dysfunction by means of occlusal splints. Scano dont. 1981; 1:5-13.
[36] Okeson JP. The effects of hard and soft occlusal splints on nocturnal bruxism. J Am Dent Assoc. 1987; 114:788-791.
[37] Alencar Jr F, Becker A. Evaluation of different oc clusal splints and counselling in the management of myofascial pain dysfunction. J Oral Rehabil. 2009; 36:79-85.
[38] Nilsson H, Vallon D, Ekberg E. Long‐term effi cacy of resilient appliance therapy in TMD pain patients: a randomised, controlled trial. J Oral Re habil. 2011; 38:713-721.
[39] Suvinen T, Reade P. Prognostic features of value in the management of temporomandibular joint pain-dysfunction syndrome by occlusal splint therapy. J Prosthet Dent. 1989; 61:355-361.
[40] Lundh H, Westesson PL, Jisander S, Eriksson L. Disk-repositioning onlays in the treatment of temporomandibular joint disk displacement: comparison with a flat occlusal splint and with no treatment. Oral surg Oral Med Oral Pathol. 1988; 66:155-162.
[41] Chen HM, Liu MQ, Yap AU, Fu KY. Physiologi- cal effects of anterior repositioning splint on tem poromandibular joint disc displacement: a quanti-tative analysis. J Oral Rehabil. 2017; 44:664-672.
[2] Kobs G, Bernhardt O, Kocher T, Meyer G. Oral parafunctions and positive clinical examination findings. Stomatologija. 2005; 7:81-83.
[3] Kijak E, Lietz-Kijak D, Śliwiński Z, Frączak B. Muscle activity in the course of rehabilitation of masticatory motor system functional disorders. Postepy Hig Med Dosw. 2013; 67:507-516.
[4] Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Den- tal Clinics. 2013; 57:465-479.
[5] Miettinen O, Lahti S, Sipilä K. Psychosocial as- pects of temporomandibular disorders and oral health-related quality-of-life. Acta Odontologica Scandinavica. 2012; 70:331-336.
[6] Manfredini D, Borella L, Favero L, Ferronato G, Guarda-Nardini L. Chronic pain severity and depression/somatization levels in TMD patients. International Journal of Prosthodontics. 2010; 23:529-534.
[7] Bono AE, Learreta JA, Rodriguez G, Marcos JC. Stomatognathic system involvement in rheuma- toid arthritis patients. CRANIO®. 2014; 32:31-37.
[8] Fernandes G, Goncalves DA, Siqueira JT, Cam paris CM. Painful temporomandibular disorders, self-reported tinnitus, and depression are highly associated. Arquivos de neuro-psiquiatria. 2013; 71:943-947.
[9] Walczynska-Dragon K, Baron S. The biomechani- cal and functional relationship between temporo- mandibular dysfunction and cervical spine pain. Acta of Bioengineering and Biomechanics. 2011; 13:93-98.
[10] Sipilä K, Suominen AL, Alanen P, Heliövaara M, Tiittanen P, Könönen M. Association of clinical findings of temporomandibular disorders (TMD) with self-reported musculoskeletal pains. Eur J Pain. 2011; 15:1061-1067.
[11] De Souza Barbosa T, Miyakoda LS, de Liz Poczta ruk R, Rocha CP, Gavião MB. Temporomandib ular disorders and bruxism in childhood and adolescence: review of the literature. Int J Pediatr Otorhinolaryngol. 2008; 72:299-314.
[12] Calixtre LB, Gruninger Bl, Chaves Tc, Olivei- ra AB. Is there an association between anxiety/ depression and temporomandibular disorders in college students?. J App Oral Sci. 2014; 22:15-21.
[13] Okeson JP, de Leeuw R. Differential diagnosis of temporomandibular disorders and other orofacial pain disorders. Dent Clin. 2011; 55:105-120.
[14] Sokalska J, Wieckiewicz W, Zenczak-Wieckiewicz D. Influence of habit of chewing gum on condi tion of stomatognathic system. Dent Med Probl. 2006; 43:567-570.
[15] Loster JE, Wieczorek A. Assessment of the effec- tiveness of treatment for temporomandibular joint dysfunctions. Dent Med Probl. 2014; 51:72-78.
[16] Grippo JO, Simring M, Schreiner S. Attrition, abrasion, corrosion and abfraction revisited a new perspective on tooth surface lesions. J Am Dent Assoc. 2004; 135:1109-1118.
[17] Grippo JO, Simring M, Coleman TA. Abfraction, abrasion, biocorrosion, and the enigma of non- carious cervical lesions: A 20‐year perspective. J Esthet Restor Dent. 2012; 24:10-23.
[18] Seifeldin SA, Elhayes KA. Soft versus hard occlu- sal splint therapy in the management of temporo mandibular disorders (TMD). Saudi Dent J. 2015; 27:208-214.
[19] Alqutaibi AY, Aboalrejal AN. Types of occlusal splint in management of temporomandibular dis orders (TMD). J Arthritis. 2015; 4:2.
[20] Gray RJ, Davies SJ. Occlusal splints and temporo- mandibular disorders: why, when, how?. Dent Up- date. 2001; 28:194-199.
[21] Mona F, El-Mangoury NH, El-Bokle DN, Belal AI. Occlusal splint therapy and magnetic reso nance imaging. World J Orthod. 2004; 5:133-140.
[22] Wright E, Anderson G, Schulte J. A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain. J Orofac Pain. 1995; 9:192-199.
[23] Okesson JP. Management of temporomandibular disorders and occlusion. 7th ed. Mosby, St Louis. 2013:260.
[24] Ramfjord SP, ASH MM. Reflections on the Mich igan occlusal splint. J Oral Rehabil. 1994; 21:491- 500.
[25] Dylina TJ. A common-sense approach to splint therapy. J Prosthet Dent. 2001; 86:539-545.
[26] Dworkin SF. LeResche L. Research diagnostic cri teria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992; 6:301-355.
[27] Poveda Roda R, Bagán JV, Díaz Fernández JM, Hernández Bazán S, Jiménez Soriano Y. Review of temporomandibular joint pathology: Part I: Classification, epidemiology and risk factors. Med Oral Patol Oral Cir Bucal. 2007; 12:292-298.
[28] Nilsson IM, List T, Drangsholt M. Prevalence of temporomandibular pain and subsequent dental treatment in Swedish adolescents. J Orofac Pain. 2005; 19:144-150.
[29] Soni A, Wanjari PV, Warhekar A. Role of soft oc- clusal splint therapy in the management of tem- poromandibular disorders: A 6-month follow-up study. J Indian Acad Oral Med Radiol. 2018; 30:355-360.
[30] Daif ET. Correlation of splint therapy outcome with the electromyography of masticatory muscles in temporomandibular disorder with myofascial pain. Acta Odontol Scand. 2012; 70:72-77.
[31] Amin A, Meshramkar R, Lekha K. Comparative evaluation of clinical performance of different kind of occlusal splint in management of myofas- cial pain. J Indian Prosthodont Soc. 2016; 16:176- 181.
[32] Lin SL, Wu SL, Ko SY, Yen CY, Yang JW. Effect of flat-plane splint vertical thickness on disc dis placement without reduction: a retrospective matched-cohort study. J Oral Maxillofac Surg. 2017; 75:1627-1636.
[33] Pita MS, Ribeiro AB, Garcia AR, Pedrazzi V, Zuim PR. Effect of occlusal splint thickness on electri- cal masticatory muscle activity during rest and clenching. Braz Oral Res. 2011; 25:506-511.
[34] Abekura H, Yokomura M, Sadamori S, Hamada T. The initial effects of occlusal splint vertical thick ness on the nocturnal EMG activities of mastica tory muscles in subjects with a bruxism habit. Int J Prosthodont. 2008; 21:116-120.
[35] Krogh-Poulsen W. Treatment of oro-mandibular dysfunction by means of occlusal splints. Scano dont. 1981; 1:5-13.
[36] Okeson JP. The effects of hard and soft occlusal splints on nocturnal bruxism. J Am Dent Assoc. 1987; 114:788-791.
[37] Alencar Jr F, Becker A. Evaluation of different oc clusal splints and counselling in the management of myofascial pain dysfunction. J Oral Rehabil. 2009; 36:79-85.
[38] Nilsson H, Vallon D, Ekberg E. Long‐term effi cacy of resilient appliance therapy in TMD pain patients: a randomised, controlled trial. J Oral Re habil. 2011; 38:713-721.
[39] Suvinen T, Reade P. Prognostic features of value in the management of temporomandibular joint pain-dysfunction syndrome by occlusal splint therapy. J Prosthet Dent. 1989; 61:355-361.
[40] Lundh H, Westesson PL, Jisander S, Eriksson L. Disk-repositioning onlays in the treatment of temporomandibular joint disk displacement: comparison with a flat occlusal splint and with no treatment. Oral surg Oral Med Oral Pathol. 1988; 66:155-162.
[41] Chen HM, Liu MQ, Yap AU, Fu KY. Physiologi- cal effects of anterior repositioning splint on tem poromandibular joint disc displacement: a quanti-tative analysis. J Oral Rehabil. 2017; 44:664-672.
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| Issue | Vol 10, No 2 (Spring 2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jcr.v10i2.14053 | |
| Keywords | ||
| Temporomandibular disorders; Soft and hard occlusal splints; Pain; Dysfunction. | ||
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How to Cite
1.
Madani A, Mirmortazavi A, Bagheri Iraj M. Comparative efficacy of different thicknesses of soft and hard splints in reducing clinical symptoms in patients with temporomandibular disorders. J Craniomaxillofac Res. 2023;10(2):58-68.
