The thickness of the occlusal splint in TMJD treatment [Elektronische Ressource] / written by Al-Brad Bassel

Brad Woodberg

Sujets

• Gesundheit

Informations

• Publié par: universitat_hamburg
• Publié le: 01 janvier 2005
• Nombre de lectures: 24
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

From the Head Center
Clinic of Oral and Maxillofacial Surgery
Head: Prof. Dr. Dr. R. Schmelzle
Eppendorf Hospital
University of Hamburg






The Thickness of the Occlusal Splint in TMJD Treatment

Dissertation - Promotion Study
to acquire the Doctor Title in Dentistry
written by
Al-Brad Bassel
from Damascus





Hamburg 2004
Contents

1. Introduction 5
1.1. History and literature review 6
1.2. Biomechanism of TMJ 30
1.3. Anatomy of temporomandibular joint 34
1.3.1. Mandibular condyle 35
1.3.2. Articular disc 38
1.3.3. Articular capsule 42
1.3.4. Articular ligaments 43
1.4. Blood and nerve supply 45
1.5. Muscles 47
1.5.1. Masseter muscle 47
1.5.2. Temporal muscle 49
1.5.3. Medial pterygoid muscles 51
1.5.4. Lateral pterygoid muscle 52
1.5.5. Infra and suprahyoid muscles 54
1.6. Mandibular movement 54
1.7. TMJ movements 55
1.8. Occlusion 56
1.9. Disorder classification 57
1.10. Radiography 59
1.11. Occlusal splint 66
2. Material and methods 68
2.1. Patients 68
2.2.1. Diagnosis scheme 69
2.2.1. Components of an evaluation for patients with orofacial pain disorder 69
2.2.2. History of the presenting illness 69
22.2.3. Medical history 70
2.2.4. Component of personal history 70
2.2.5. Physical examination for temporomandibular disorders 71
2.2.6. Diagnostic studies 71
2.2.7. Physical examinations 71
2.3. Treatment scheme 80
2.3.1. Pharmaco-therapy 80
2.3.2. Physical therapy 81
2.3.3. The splint therapy 83
2.3.4. Temporomandibular joint disorders treatment 85
2.4. Artex articulator 93
3. Statistical Evaluation 94
3.1. Distribution of patients sex-wise 94
3.2. Distribution of patients age-wise 95
3.3. Occlusal changes 96
3.4. Diagnostic distribution of patients and relation to age 97
3.4.1. Myalgia 97
3.4.2. Deformation of the temporomandibular joint 99
3.4.3. Anterior disc dislocation stage 1 (ADD 1) 100
3.4.4. Anterior disc dislocation stage 2 (ADD2) 101
3.4.5. Hypermobility 103
3.4.6. Osteoarthritis 104
3.4.7. Anterior disc dislocation stage 3 acute (AADD3) 106
3.4.8. Anterior disc dislocation stage 3 chronic (CADD3) 107
3.5. Adherence to applying the occlusal splint 108
3.6. The impact of thickness of splint on the progress of symptoms 109
3.6.1. Pain 110
3.6.2. Clicking 110
3.6.3. Limitation of mouth opening 111
33.6.4. Muscle cramps 112
3.6. Bruxism 113
3.6.6. Parafunction 114
3.6.7. Stress 115
3.7. Adherence to wearing the splint round the clock for 6-month 116
3.8. Thickness of the splint and the success of treatment 118
4. Discussion 120
4.1. Gender distribution 120
4.2. Age distribution 121
4.3. Symptoms 121
4.4. Success of treatment 123
4.5. Effective elements for success of treatment 124
4.5.1. Patients adherence to use of the splint 125
4.5.2. Progress of symptoms and recovery 126
4.5.3. Success of treatment in general 127
4.6. Period of treatment 128
5. Conclusion 129
6. References 130
7. Thanks 141










4
Introduction
The occlusal splint is a movable devise composed of a hard acrylic material,
which separates the two dental arches and is fixed on one arch only.
It is considered a reverse biomechanics way to treat pain and TMJ dysfunction
in patients with myofacial pain. The presumed mechanism of action of an
intraoral splint is via the relaxation of muscle, either by a change in the muscle
itself or by a change in the patient’s function-parafunction when the teeth come
together.
The compliance with the occlusal splint required personal psychological
adaptation as well as physiological rehabilitation like pronunciation and all oral
activities, especially after the change of the vertical dimension, which affects
the relation between the maxilla and mandible, the swallowing activities, and
the tongue`s position in the oral cavity.
The social adaptation of the patient and his ability to continue his social
activities wearing the occlusal splint 24 hours a day for at least six months (at
school, university, work, or with his family) play an essential role for the
treatment success and depends on different factors.
In most cases, treatment of such health aware and educated patients faces
failures. When question ED many of them answer “The occlusal splint causes
social and speech problems, especially during visits, with friends and at work.
They are thick and inconvenient, which prompts us to lift it u