Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement

Abstract

Objective:To evaluate the effect of bite positions characterizing different splint treatments (anterior repositioning and stabilization splints) on the disc-condyle relation in patients with TMJ disc displacement with reduction (DDwR), using magnetic resonance imaging (MRI).Material and Methods:37 patients, with a mean age of 18.8±4.3 years (7 male and 30 females) and diagnosed with DDwR based on the RDC/TMD, were recruited. MRI metrical analysis of the spatial changes of the disc/condyle, as well as their relationships, was done in three positions: maximum intercuspation (Position 1), anterior repositioning splint position (Position 2), and stabilization splint position (Position 3). Disc/condyle coordinate measurements and disc condyle angles were determined and compared.Results:In Position 1, the average disc-condyle angle was 53.4° in the 60 joints with DDwR, while it was −13.3° with Position 2 and 30.1° with Position 3. The frequency of successful "disc recapture" with Position 2 was significantly higher (58/60, 96.7%) than Position 3 (20/60, 33.3%). In Positions 2 and 3, the condyle moved forward and downward while the disc moved backward. The movements were, however, more remarkable with Position 2.Conclusions:Anterior repositioning of the mandible improves the spatial relationship between the disc and condyle in patients with DDwR. In addition to anterior and inferior movement of the condyle, transitory posterior movement of the disc also occurred.

Condylar repair and regeneration in adolescents/young adults with early‐stage degenerative temporomandibular joint disease: A randomised controlled study

“…Both ARS and SS moved the condyle forward‐downward and the disc backward. The movements were, however, more marked with ARS . This may explain, at least in part, the high incidence of bone repair and regeneration with ARS in the present study.…”

“…The presence of an audible TMJ click during mandibular manipulation was a clinical indication of successful TMJ closed‐lock reduction, which was confirmed with MRI . Anterior repositioning splints were subsequently fabricated on the upper arch with the mandible guided into a protrusive position (in an edge‐to‐edge relation), which made the majority (96.7%‐100%) of the reduced discs in a normal disc‐condyle relationship . Patients were instructed to wear their splints 24 hours a day for 3 months.…”

“…18,19 Anterior repositioning splints were subsequently fabricated on the upper arch with the mandible guided into a protrusive position (in an edge-to-edge relation), which made the majority (96.7%-100%) of the reduced discs in a normal disc-condyle relationship. 16,20 Patients were instructed to wear their splints 24 hours a day for 3 months. After the initial 3 months, patients were weaned off daytime wear and instructed to wear splints only during the night while sleeping.…”

Anterior repositioning splint treatment consideration for cases of disc displacement with reduction

“…6 TMJ complex to confirm DDWR can be examined using MRI as the gold standard. 2,5,[8][9][10] MRI can accurately show the morphology and the articular disc position in relation to the bone structures within TMJ. The specificity value is around 88-90% with sensitivity value between 78-83.3%.…”

Occlusive Therapy of Temporomandibular Disorders

“…В заключение следует отметить, что использование окклюзионных капп в комплексном лечении нарушений функции ВНЧС позволяет достичь нормализации пространственных взаимоотношений внутрисуставных структур и устранить хроническую механическую травму тканей ВНЧС [15,[61][62][63][64][65]. Выбор оптимального метода лечения внутренних нарушений ВНЧС проводится с учетом характера смещения суставного диска, болевого синдрома, возможных причин, его вызвавших, и наличия местных и общих отягощающих факторов.…”