Internal derangements of the temporomandibular joint. III. Anterior repositioning splint therapy

Abstract

Over a four-year period, anterior repositioning (REPO) splint therapy was used to treat 241 temporomandibular joint pain patients for whom a clinical diagnosis of anterior disc displacement had been made. Following an initial six months of active REPO therapy, the response to treatment over the ensuing twelve months was generally encouraging, control of joint noise and discomfort being achieved in 70 per cent of the treated sample. This figure had decreased to 53 per cent at the two-year follow-up and, by the end of three years, only 36 per cent were considered successfully treated.It is suggested that REPO splint therapy for anterior disc displacement should not be lightly undertaken by the general dental practitioner but that a more conservative approach should be adopted for the vast majority of TMJ pain patients.

Oral Splints: the Crutches for Temporomandibular Disorders and Bruxism?

“…In light of these results, the "Phase II" concept of therapy-where irreversible alterations of the dentition with occlusal equilibration, prosthodontics, orthodontics, or orthognathic surgery are performed to stabilize the recaptured disc-becomes totally unjustified. This is even more true considering the frequent return of signs and symptoms of DD after/during postsplint extensive oral reconstruction: For example, the disc was displaced again in 33% of the patients after 6 months' treatment with mandibular repositioning onlays , while joint noises recurred in 43% during or soon after the completion of major prosthodontic treatment (Moloney and Howard, 1986). In patients who received orthodontic intervention, 500o experienced a return in joint sounds, and in 35%, pain recurred during the treatment (Moloney and Howard, 1986).…”

“…This is even more true considering the frequent return of signs and symptoms of DD after/during postsplint extensive oral reconstruction: For example, the disc was displaced again in 33% of the patients after 6 months' treatment with mandibular repositioning onlays , while joint noises recurred in 43% during or soon after the completion of major prosthodontic treatment (Moloney and Howard, 1986). In patients who received orthodontic intervention, 500o experienced a return in joint sounds, and in 35%, pain recurred during the treatment (Moloney and Howard, 1986). These high relapse rates inspire caution against the use of invasive therapies.…”

Splint therapy for disc displacement with reduction of the temporomandibular joint. Part I: Modified mandibular splint therapy

“…Therefore, we asked the patients to wear the splint 24 hours a day (except when brushing teeth). However, it should be noted that the stabilization and distraction splint cannot be worn 24 hours a day, it is not suitable for DDwR; (2) The splint is to be worn on the mandible. The splints are highly exposed even in the rest position.…”

“…Previous research has shown that DDwR presents in about 15%e25 % of patients in a TMD clinic [1,2]. Although the treatment for TMJ sounds without other symptoms is still controversial, and DDwR symptoms include more than the joint sounds, it is always preferable to eliminate the sound and achieve the relocation of the disc to its proper position.…”

The Relationship Between Level of Mandibular Pain and Dysfunction and Stage of Temporomandibular Joint Internal Derangement

“…The determination of treatment needs must also be tempered by the fact that non-surgical (passive and active splint therapy, physical therapy modalities, and behavioral/psychological interventions) and surgical interventions (arthroscopic, plication/ repair procedures, and diskectomies) do not predictably result in "correction" of the disk-condyle relationship or resolve all signs of mandibular dysfunction (Mejersjb and Carlsson, 1985;Westesson, 1985, 1987;Silver, 1985;Moloney and Howard, 1986;Montgomery et al, 1989;Moses et al, 1989;Wilkes, 1991). Since present treatments for TMJ ID attempt only to improve patient adaptation to compromised TMJs, no treatment is needed if the individual already has adequate function.…”