Preliminary evaluation of Kovacs digital occlusal splint in the treatment of temporomandibular disorders: A single‐centre, cross‐sectional study

Abstract

Background: Digital occlusal splint is a novel approach in the treatment of temporomandibular disorders (TMD) and there is a lack of evaluation.Objective: To introduce Kovacs digital occlusal splint (KDOS) and evaluate its clinical and magnetic resonance imaging (MRI) outcomes and influencing factors in the treatment of TMD.Patients and Methods: Patients diagnosed of TMD by MRI and treated with KDOS from June 2020 to December 2021 were retrospectively reviewed. They were divided into three groups: anterior disc displacement with reduction (ADDwR), anterior disc displacement without reduction (ADDwoR) and ADDwoR + osteoarthritis (ADDwoR + OA). Visual analogue scales (VAS) scores of pain, diet, mandibular function, quality of life (Qol) and maximum interincisal opening were compared before and at least 8 weeks after treatment. Binary logistic regression was used to analyse the influence of four factors including age, gender, Wilkes stage and the severity of symptoms on treatment. MRI was used to evaluate the condylar bone status and disc length after at least 3 months treatment.Results: One hundred and eighty-four patients were included in the study. The average age was 30.9 ± 14.2 years and the average follow-up was 19.8 ± 10.0 weeks. Pain, diet, mandibular function and Qol were all significantly improved after KDOS treatment (p < .05), with the effective rates of 71.6%, 56.4%, 55.3% and 54.1%. Binary logistic regression showed that higher probabilities of improvement were related to the patients with older age, ADD without OA and higher VAS scores before treatment. MRI showed that 94.1% of the condylar bone status remained stable or improved and the disc length was unchanged after treatment. Conclusion:KDOS is effective for the treatment of TMD. Older age, ADD without OA and higher VAS scores before treatment had better results.

Evaluation of the efficacy and quality of life in patients with temporomandibular joint disorders treated with Kovacs digital occlusal splint: a pilot study

“…The second highest scoring domain was psychological disability (10.9 ± 2.8), which is supported by a bio-psychosocial model on TMD [ 29 ]. After KDOS treatment, the average physical pain score of the patients significantly reduced (10.2 ± 2.4, p < 0.001), and the improvement rate reached 69.8%, which was similar to the improvement rate (71.6%) in a previous KDOS study by Hua et al [ 13 ]. Consistent with their study, the pain improvement rate in the ADDwoR + OA group was the lowest among the three Wilkes stage groups, which may be related to greater tissue damage in the disease.…”

“…The binary logistic regression analysis revealed that patients with low QoL scores before treatment and those in the ADDwR and ADDwoR groups were likely to demonstrate a higher rate of improvement in the clinical symptoms following treatment with KDOS, which is similar to the results of Hua [ 13 ] and Clark et al [ 38 ] GHE et al [ 39 ] also reported that patients with joint pain or OA had lower QoL than those with myofascial pain or disc displacement. The present study concluded that the improvement rate of clinical symptoms was not associated with the age and sex of the patients; moreover, Emshoff et al [ 40 ] did not find any influence of age on the prognosis of stabilization occlusal splint treatment; however, Hua et al [ 13 ] demonstrated that the older the patient, the higher the possibility of improvement, which may be attributed to the difference in sample size and population characteristics.…”

“…Second, the stable therapeutic jaw position was recorded after wearing a balancer and performing muscle-deprogrammed movements, which were imported into the Exocad software (Version 3.0, Exocad GmbH, Darmstadt, Germany) for the design of the occlusal splint. Finally, a semi-anatomical occlusal splint made of resin discs (PMMA disk; Yamahachi Dental, Japan) was automatically ground using the SELECT five-axis engraving machine (Wieland, Germany) [ 13 ]. The KDOS production flow chart is shown in Fig.…”

“…Many inconveniences of the traditional methods can be solved with the help of digital technology [ 12 ]. Kovacs digital occlusal splint (KDOS) is an innovation of traditional occlusal splint technology, which obtains ideal jaw position after muscle deprogramming, and customizes complete digital and comfortable occlusal splints for patients with TMD [ 13 ]. It can standardize the production process, thereby saving time by reducing the influence of human factors and patient visits.…”

Three-dimensional evaluation of condylar morphology after orthodontic treatment in adult patients with Class II malocclusion by cone-beam computed tomography

“…Occlusion is often considered a major cause of TMD. Numerous etiological and therapeutic theories are based on this presumed association and have been applied to justify the use of several therapeutic approaches, such as occlusal splint [ 3 ]. Conversely, many TMD experts hold opposing views, and various kinds of dental interventions, including routine orthodontic treatment, have been reported as causes of TMD [ 4 , 5 ].…”