An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders

Anterior repositioning splint(ARS)therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders(TMDs),which account for a large proportion of TMD cases.Owing to the wide application of this therapy,the exact mechanism of remission has increasingly drawn attention.Given that practitioners have different views on ARS therapy,its indications are broadened,and operating methods diverged.This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods.Representative views in the past 10 years were summarised,and conclusions were drawn as follows:The mechanism of ARS therapy is mainly attributed to internal derangement correction,improvement of stress distribution and recently reported joint remodeling.It has an evident effect in the short term,and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3-6 months.However,long-term stability is not optimal,and thus indications should be selected carefully.Notably,most of the clinical studies in this field are case analyses with low-quality evidence.Well-designed RCTs are required to further validate relevant theories.

Orthodontic retreatment of an adult woman with mandibular backward positioning and temporomandibular joint disorder:A case report

BACKGROUND The role of occlusal factors on the occurrence of temporomandibular joint disorders(TMDs)is still unclear and it is tricky for orthodontists to treat malocclusions in patients with TMDs.We report the case of the second orthodontic treatment of an adult female with Class II division 2 malocclusion associated with TMD.With the removal of anterior occlusal interference,TMD symptoms were alleviated and cone beam computed tomography(CBCT)images showed the bilateral condyles shifted forward.CASE SUMMARY This case report presented an orthodontic retreatment of an adult female with TMD and mandibular backward positioning based on CBCT examination and Joint Space Index(JSI)analysis.The left and right JSI values of-38.5 and-52.6 indicated that the position of bilateral condyles had posterior displacement.Ten years prior to this evaluation,she underwent orthodontic treatment resulting in the extraction of two upper premolars and one lower central incisor.The joint symptoms,including pain and sounds,were alleviated along with verified mandibular forward repositioning by extraction of another lower central incisor.CONCLUSION Mandibular backward positioning could be associated with TMD.JSI analysis based on CBCT is a convenient way to examine condylar positions quantitatively.

Management of disorder of temporomandibular joint syndrome using elastic resin occlusal pad: a clinical observation

Objective To investigate the possibility of occlusal pad in treating disorder of temporomandibular joint syndrome.Methods We treated 25 patients with disorder of temporomandibular joint syndrome using occlusal pad made of elastic resin,and evaluated the effects.Results Total effective rate was 96%.Clicking and pain dissappeared in all patients.Conclusion Occlusal pad made of elastic resin could be used for treating disorder of temporomandibular joint syndrome in clinic.

Effect of Disc Position for Acute Closed Lock of the Temporomandibular Joint

In this manuscript, the authors have studied the Disc Displacement (DD) status of patients with acute Closed Lock (CL) to determine differences between DD with Reduction (DDwR) and DD without Reduction (DDwoR). Among the acute CL patients who visited our hospital within 2 weeks of the onset of CL, we studied 10 patients whose CL was released (DDwR) and 13 patients whose CL was not released (DDwoR). The DDwoR group was significantly older than the DDwR group. Although the mouth opening distance was significantly greater in the DDwoR group than in the DDwR group, the two groups were identical in the duration of CL. Sagittal MRI images showed no significant differences between the two groups in disc length and disc thickness (anterior band, intermediate zone, and posterior band). Multisection sagittal and coronal images identified lateral DD in 7 of the 10 patients in the DDwR group, although no specific direction of the DD was observed in the DDwoR group. Furthermore, deformation of the medial disc was common in the DDwoR group but uncommon in the DDwR group.

Expression of Dickkopf-related Protein 1 in Patients with Temporomandibular Osteoarthritis after Treatment with Hyaluronic Acid

We previously reported that the increased expression of Dickkopf-related protein 1(DKK1)is positively related to vascular endothelial growth factor in the synovial fluid from patients with temporomandibular joint disorders(TMDs).DKK1 is involved in angiogenic activities in the TMD synovium in vitro,but the expression of DKK1 after treatment of TMD-osteoarthritis(TMD-OA)with hyaluronic acid(HA)remains unknown.In this study,we assessed the expression of DKK1 in the synovial fluid of TMD-OA patients before and after treatment with HA via enzyme-linked immunosorbent assay.We also investigated the role of DKK1 in TMD-OA via immunohistochemical staining.The relationship between the expression of DKK1 and the clinicopathological characteristics was determined by Pearson analysis.The results showed that the expression of DKK1 was significantly decreased after treatment with HA.Correlation analyses indicated that the expression of DKK1 in the TMD-OA samples was closely correlated with mouth opening and pain.These findings suggest that DKK1 could play an important role in the pathogenesis and treatment of TMD.Reduction of the pain by HA treatment may be correlated with the decreased expression of DKK1.