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

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Summary

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.

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References

  1. Ribeiro RF, Tallents RH, Katzberg RW, et al. The prevalence of disc displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years. J Orofac Pain, 1997,11(1):37–47

    CAS  PubMed  Google Scholar 

  2. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Groupdagger. J Oral Facial Pain Headache, 2014,28(1):6–27

    Article  PubMed  PubMed Central  Google Scholar 

  3. Summer JD, Westesson PL. Mandibular repositioning can be effective in treatment of reducing TMJ disk displacement. A long-term clinical and MR imaging follow-up. Cranio, 1997,15(2):107–120

    Article  CAS  PubMed  Google Scholar 

  4. Okeson JP. Management of temporomandibular disorders and occlusion. 7th ed. St. Louis, Mo: Elsevier/Mosby, 2013.

    Google Scholar 

  5. Shen P, Chen X, Xie Q, et al. Assessment of Occlusal Appliance for the Reposition of Temporomandibular Joint Anterior Disc Displacement With Reduction. J Craniofac Surg, 2019,30(4):1140–1143

    Article  PubMed  Google Scholar 

  6. Jiang X, Fan S, Cai B, et al. Mandibular manipulation technique followed by exercise therapy and occlusal splint for treatment of acute anterior TMJ disk displacement without reduction. Shanghai Kou Qiang Yi Xue (Chinese), 2016,25(5):570–573

    Google Scholar 

  7. Pihut M, Gorecka M, Ceranowicz P, et al. The Efficiency of Anterior Repositioning Splints in the Management of Pain Related to Temporomandibular Joint Disc Displacement with Reduction. Pain Res Manag, 2018,2018:1–6

    Google Scholar 

  8. William K, Solberg GTC. Temporomandibular joint problems: Biological diagnosis and treatment. 2nd ed. Chicago: Quintessence Publishing Co., 1980.

    Google Scholar 

  9. Chen HM, Fu KY, Li YW, et al. Positional changes of temporomandibular joint disk and condyle with insertion of anterior repositioning splint. Hua Xi Kou Qiang Yi Xue Za Zhi (Chinese), 2009,27(4):408–412

    Google Scholar 

  10. Liu MQ, Lei J, Han JH, et al. Metrical analysis of disccondyle relation with different splint treatment positions in patients with TMJ disc displacement. J Appl Oral Sci, 2017,25(5):483–489

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pathria MN, Chung CB, Resnick DL. Acute and Stress-related Injuries of Bone and Cartilage: Pertinent Anatomy, Basic Biomechanics, and Imaging Perspective. Radiology, 2016,280(1):21–38

    Article  PubMed  Google Scholar 

  12. Machon V, Levorova J, Hirjak D, et al. Temporomandibular joint disc perforation: a retrospective study. Int J Oral Maxillofac Surg, 2017,46(11):1411–1416

    Article  CAS  PubMed  Google Scholar 

  13. Liu Z, Qian Y, Zhang Y, et al. Effects of several temporomandibular disorders on the stress distributions of temporomandibular joint: a finite element analysis. Comput Methods Biomech Biomed Engin, 2016,19(2): 137–143

    Article  PubMed  Google Scholar 

  14. Tanaka E, Rodrigo DP, Miyawaki Y, et al. Stress distribution in the temporomandibular joint affected by anterior disc displacement: A three-dimensional analytic approach with the finite-element method. J Oral Rehabil, 2000,27(9):754–759

    Article  CAS  PubMed  Google Scholar 

  15. Hollender L, Lindahl L. Radiographic study of articular remodeling in the temporomandibular joint after condylar fractures. Scand J Dent Res, 1974,82(6):462–465

    CAS  PubMed  Google Scholar 

  16. Yano K, Nishikawa K, Sano T, et al. Relationship between appearance of a double contour on the mandibular condyle and the change in articular disc position after splint therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009,108(4):e30–34

    Article  PubMed  Google Scholar 

  17. Liu MQ, Chen HM, Yap AU, et al. Condylar remodeling accompanying splint therapy: a cone-beam computerized tomography study of patients with temporomandibular joint disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012,114(2):259–265

    Article  PubMed  Google Scholar 

  18. Moncada G, Cortes D, Millas R, et al. Relationship between disk position and degenerative bone changes in temporomandibular joints of young subjects with TMD. An MRI study. J Clin Pediatr Dent, 2014,38(3):269–276

    Article  CAS  PubMed  Google Scholar 

  19. Hu YK, Yang C, Cai XY, et al. Does condylar height decrease more in temporomandibular joint nonreducing disc displacement than reducing disc displacement?: A magnetic resonance imaging retrospective study. Medicine (Baltimore), 2016,95(35):e4715

    Article  Google Scholar 

  20. Lei J, Yap AU, Liu MQ, et al. Condylar repair and regeneration in adolescents/young adults with early-stage degenerative temporomandibular joint disease: A randomised controlled study. J Oral Rehabil, 2019,46(8): 704–714

    PubMed  Google Scholar 

  21. Rabie AB, She TT, Hagg U. Functional appliance therapy accelerates and enhances condylar growth. Am J Orthod Dentofacial Orthop, 2003,123(1):40–48

    Article  CAS  PubMed  Google Scholar 

  22. Rabie AB, Xiong H, Hagg U. Forward mandibular positioning enhances condylar adaptation in adult rats. Eur J Orthod, 2004,26(4):353–358

    Article  CAS  PubMed  Google Scholar 

  23. Sun L, Zhao J, Wang H, et al. Mechanical stress promotes matrix synthesis of mandibular condylar cartilage via the RKIP-ERK pathway. J Mol Histol, 2017,48(5–6):437–446

    Article  CAS  PubMed  Google Scholar 

  24. Tonlorenzi D, Brunelli M, Conti M, et al. An observational study of the effects of using an high oral splint on pain control. Arch Ital Biol, 2019,157(2–3):66–75

    CAS  PubMed  Google Scholar 

  25. Glaros AG, Marszalek JM, Williams KB. Longitudinal Multilevel Modeling of Facial Pain, Muscle Tension, and Stress. J Dent Res, 2016,95(4):416–422

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Daif ET. Correlation of splint therapy outcome with the electromyography of masticatory muscles in temporomandibular disorder with myofascial pain. Acta Odontol Scand, 2012,70(1):72–77

    Article  PubMed  Google Scholar 

  27. Nitecka-Buchta A, Marek B, Baron S. CGRP plasma level changes in patients with temporomandibular disorders treated with occlusal splints — a randomised clinical trial. Endokrynol Pol, 2014,65(3):217–223

    Article  PubMed  Google Scholar 

  28. He SS, Li F, Song F, et al. Spontaneous neural activity alterations in temporomandibular disorders: a crosssectional and longitudinal resting-state functional magnetic resonance imaging study. Neuroscience, 2014, 278:1–10

    Article  CAS  PubMed  Google Scholar 

  29. Garcia AR, Folli S, Zuim PR, et al. Mandible protrusion and decrease of TMJ sounds: an electrovibratographic examination. Braz Dent J, 2008,19(1):77–82

    Article  PubMed  Google Scholar 

  30. Wright EF. Manual of Temporomandibular Disorders. 2007,209(6):322

    Google Scholar 

  31. Lei J, Yap AUJ, Li Y, et al. Clinical protocol for managing acute disc displacement without reduction: a magnetic resonance imaging evaluation. Int J Oral Maxillofac Surg, 2020,49(3):361–368

    Article  CAS  PubMed  Google Scholar 

  32. Conti PC, Miranda JE, Conti AC, et al. Partial time use of anterior repositioning splints in the management of TMJ pain and dysfunction: a one-year controlled study. J Appl Oral Sci, 2005,13(4):345–350

    Article  PubMed  Google Scholar 

  33. Tecco S, Caputi S, Tete S, et al. Intra-articular and muscle symptoms and subjective relief during TMJ internal derangement treatment with maxillary anterior repositioning splint or SVED and MORA splints: A comparison with untreated control subjects. Cranio, 2006,24(2):119–129

    Article  PubMed  Google Scholar 

  34. Ma Z, Xie Q, Yang C, et al. Can anterior repositioning splint effectively treat temporomandibular joint disc displacement? Sci Rep, 2019,9(1):534

    Article  PubMed  PubMed Central  Google Scholar 

  35. Chen HM, Liu MQ, Yap AU, et al. Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis. J Oral Rehabil, 2017,44(9):664–672

    Article  PubMed  Google Scholar 

  36. Conti PC, Correa AS, Lauris JR, et al. Management of painful temporomandibular joint clicking with different intraoral devices and counseling: a controlled study. J Appl Oral Sci, 2015,23(5):529–535

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kurt H, Mumcu E, Sulun T, et al. Comparison of Effectiveness of Stabilization Splint, Anterior Repositioning Splint and Behavioral Therapy in Treatment of Disc Displacement with Reduction. Turk Fiz Tip Rehab D, 2011,57(1):25–30

    Google Scholar 

  38. Madani AS, Mirmortazavi A. Comparison of three treatment options for painful temporomandibular joint clicking. J Oral Sci, 2011,53(3):349–354

    Article  PubMed  Google Scholar 

  39. Tecco S, Tete S, Crincoli V, et al. Fixed orthodontic therapy in temporomandibular disorder (TMD) treatment: an alternative to intraoral splint. Cranio, 2010,28(1):30–42

    Article  PubMed  Google Scholar 

  40. Tallents RH, Katzberg RW, Macher DJ, et al. Use of protrusive splint therapy in anterior disk displacement of the temporomandibular joint: A 1- to 3-year follow-up. J Prosthet Dent, 1990,63(3):336–341

    Article  CAS  PubMed  Google Scholar 

  41. Tecco S, Festa F, Salini V, et al. Treatment of joint pain and joint noises associated with a recent TMJ internal derangement: a comparison of an anterior repositioning splint, a full-arch maxillary stabilization splint, and an untreated control group. Cranio, 2004,22(3):209–219

    Article  PubMed  Google Scholar 

  42. Hersek N, Uzun G, Cindas A, et al. Effect of anterior repositioning splints on the electromyographic activities of masseter and anterior temporalis muscles. Cranio, 1998,16(1):11–16

    Article  CAS  PubMed  Google Scholar 

  43. Shi T, Ying L, Guo Y, et al. Efficacy Evaluation of Anterior Repositioning Splint in the Treatment of Temporomandibular Joint Disc Intermittent Locking. J Oral Sci Res (Chinese), 2018,34(03):282–285

    Google Scholar 

  44. Jung YW, Park SH, On SW, et al. Correlation between clinical symptoms and magnetic resonance imaging findings in patients with temporomandibular joint internal derangement. J Korean Assoc Oral Maxillofac Surg, 2015,41(3):125–132

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kurita H, Kurashina K, Ohtsuka A, et al. Change of position of the temporomandibular joint disk with insertion of a disk-repositioning appliance. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998,85(2):142–145

    Article  CAS  PubMed  Google Scholar 

  46. Royle D. TMJ Disorders — Management of the cranio-mandibular complex. Physiotherapy, 1988,74(11):590

    Article  Google Scholar 

  47. Fu KY, Zhang HB, Zhao YP, et al. Comparative study on the clinical appearances between acute and chronic anterior disc displacement without reduction. Zhonghua Kou Qiang Yi Xue Za Zhi (Chinese), 2004,39(6):471–474

    Google Scholar 

  48. Westesson PL, Lundh H. Temporomandibular joint disk displacement: Arthrographic and tomographic follow-up after 6 months’ treatment with disk-repositioning onlays. Oral Surg Oral Med, Oral Pathol, 1988,66(3):271–278

    Article  CAS  Google Scholar 

  49. Okeson JP. Long-term treatment of disk-interference disorders of the temporomandibular joint with anterior repositioning occlusal splints. J Prosthet Dent, 1988,60(5):611–616

    Article  CAS  PubMed  Google Scholar 

  50. Aidar LA, Dominguez GC, Yamashita HK, et al. Changes in temporomandibular joint disc position and form following Herbst and fixed orthodontic treatment. Angle Orthod, 2010,80(5):843–852

    Article  PubMed  Google Scholar 

  51. Joondeph DR. Long-term stability of mandibular orthopedic repositioning. Angle Orthodontist, 1999,69(3):201–209

    CAS  Google Scholar 

  52. Schupp W, Haubrich J, Neumann I. Invisalign(®) treatment of patients with craniomandibular disorders. Int Orthod, 2010,8(3):253–267

    PubMed  Google Scholar 

  53. Al-Moraissi EA, Farea R, Qasem KA, et al. Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg, 2020,49(8):1042–1056

    Article  CAS  PubMed  Google Scholar 

  54. Orenstein ES. Anterior repositioning appliances when used for anterior disk displacement with reduction—a critical review. Cranio, 1993,11(2):141–145.

    Article  CAS  PubMed  Google Scholar 

  55. Lakshmi M, Kalekhan S, Mehta R, et al. Occlusal Splint Therapy in Temporomandibular Joint Disorders: An Update Review. J Int Oral Health, 2016,8:639–645

    Google Scholar 

  56. Lotze M, Lucas C, Domin M, et al. The cerebral representation of temporomandibular joint occlusion and its alternation by occlusal splints. Hum Brain Mapp, 2012,33(12):2984–2993

    Article  PubMed  Google Scholar 

  57. Pita MS, Ribeiro AB, Garcia AR, et al. Effect of occlusal splint thickness on electrical masticatory muscle activity during rest and clenching. Braz Oral Res, 2011,25(6):506–511

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, 100081, China

    Yan-ning Guo, Sheng-jie Cui, Yan-heng Zhou & Xue-dong Wang

  2. National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, 100081, China

    Yan-ning Guo, Sheng-jie Cui, Yan-heng Zhou & Xue-dong Wang

  3. Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China

    Yan-ning Guo, Sheng-jie Cui, Yan-heng Zhou & Xue-dong Wang

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  1. Yan-ning Guo
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Correspondence to Xue-dong Wang.

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Guo, Yn., Cui, Sj., Zhou, Yh. et al. An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders. CURR MED SCI 41, 626–634 (2021). https://doi.org/10.1007/s11596-021-2381-7

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  • DOI: https://doi.org/10.1007/s11596-021-2381-7

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