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Effects of centric mandibular splint therapy on orofacial pain and cerebral activation patterns

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Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

To investigate the effects on pain, movement kinematics, and cerebral representation by a 3-month mandibular splint therapy.

Material and methods

Thirteen patients with temporo-mandibular joint disease (TMD) and moderate pain intensity were investigated before (PRE), within (after 2 weeks, POST1) and after a period of 12 weeks (POST2) using functional magnetic resonance imaging (fMRI) of representation of occlusal movements on natural teeth and on an individually fitted mandibular splint. In addition, kinematic investigations of jaw movements, muscle electromyography and pain ratings using a pain diary (VAS-scale 0–100) were measured.

Results

Although the patient’s pain ratings decreased about 60%, kinematic and electromyographic characteristics over therapy were not significantly altered. Over therapy, we observed a decrease of fMRI activation magnitude in the primary somatosensory cortex (S1) and secondary somatosensory cortex (S2) and insular cortex during occlusion. Left hemispheric anterior insula and the cerebellar fMRI activation decrease were associated with decrease in pain over time.

Conclusions

Within the limitations of this pilot study, a reduction in both discriminative (primary and secondary somatosensory cortex) and affective (anterior insula) areas for pain processing suggest that altered pain anticipation is critical for the therapeutic effects of mandibular splint therapy after TMD.

Clinical relevance

A 3-month mandibular splint therapy moderately decreases pain and anticipatory anterior insular activation.

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Acknowledgements

We would like to thank “Fundamental” for preparing the individual adjusted splints. L.M. and K.B. were supported by the “Deutsche Forschungsgemeinschaft” (LO 795/25-1; KO 1598/6-1).

Funding

Fundamental prepared the individual adjusted splints. L.M. and K.B. were supported by the “Deutsche Forschungsgemeinschaft” (LO 795/25-1; KO 1598/6-1).

Author information

Author notes

  1. Marius Ernst, A. Elisa Schenkenberger, Bernd Kordass and Martin Lotze contributed equally to this work.

Authors and Affiliations

  1. Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17489, Greifswald, Germany

    Marius Ernst, Martin Domin & Martin Lotze

  2. Department of Dental Radiology, Centre of Dentistry and Oral Health, University Medicine Greifswald, 17489, Greifswald, Germany

    A. Elisa Schenkenberger & Bernd Kordass

  3. Department of Clinical Dental CAD/CAM and CMD-Treatment, Centre of Dentistry and Oral Health, University Medicine Greifswald, 17489, Greifswald, Germany

    Bernd Kordass

Authors
  1. Marius Ernst
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  2. A. Elisa Schenkenberger
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  3. Martin Domin
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  4. Bernd Kordass
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  5. Martin Lotze
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Corresponding author

Correspondence to Martin Lotze.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ernst, M., Schenkenberger, A.E., Domin, M. et al. Effects of centric mandibular splint therapy on orofacial pain and cerebral activation patterns. Clin Oral Invest 24, 2005–2013 (2020). https://doi.org/10.1007/s00784-019-03064-y

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  • DOI: https://doi.org/10.1007/s00784-019-03064-y

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