Managing Temporomandibular Joint Disorders: Treatment Stages and Essential Aspects

Abstract

Introduction. Meniscus displacement in the temporomandibular joint (TMJ) is known to provoke the development of TMJ dysfunction, thereby impairing the quality of life. Managing TMJ disorders is divided into three stages, the first of which is intermediate in determining the prognosis and further tactics. The aim of the study is to evaluate the effectiveness of occlusal splint systems and to assess the different stages of TMJ dysfunction management. Materials and methods. The study included 54 patients. Based on the findings of magnetic resonance imaging, patients were divided into two groups: group I included patients with dysfunctional changes in the TMJ (n=38), group II involved patients with dysfunctional changes in the joints and concomitant osteoarthritic changes (n=16).
 Results and discussion. The first stage of treatment was carried out using a Michigan occlusal splint. During this time, the myotatic reflex was restructured and clinical symptoms of the TMJ disorder disappeared. The treatment outcomes were as follows: the subjects of the 1st group reported about health improvement in a month since the treatment started, 20 individuals out of 38 patients had no symptoms of TMJ dysfunction. The treatment course of these patients was completed. The other 18 patients were referred for the orthodontic treatment. After the end of the splint treatment, no longer than in 2 weeks, the patients of the II group reported bout the recurrence of some symptoms that indicated a relapse of the disease; therefore, patients were recommended to continue the treatment. In the second stage of the treatment, we used occlusal plates on the lower unprepared teeth. At the third stage of treatment, radical prosthetics was carried out, which includes temporary fixation of polymethyl methacrylate prototypes on specially prepared teeth, and then the final fixation of permanent structures in the new medical condition of the lower jaw.
 Conclusion. Bite-sized intraoral guards that allow mesialisation of the lower jaw and increase the height of the bite, in particular, the Michigan occlusal splint have been found as effective appliances. Patients who had only dysfunctional TMJ changes (group I) over the course of treatment need only restructuring of the myotonic reflex, rather than those who suffer from osteoarthritic changes (group II), and therefore should undergo radical orthopaedic treatment.