Occlusal splints in reversible occlusal therapy of craniomandibular dysfunction

Abstract

Craniomandibular dysfunction (CMD) is a set of structural and functional disorders of different etiology that affects temporomandibular joint (TMJ) and orofacial muscles. The most common etiologic factors are psychogenic, occlusal, trauma and congenital anomalies of craniofacial structures. About 75% of the examined population have mild symptoms of CMD while 3-4% have more severe symptoms which require medical attention. The main symptoms why people seek for medical attention are: facial pain which increases with chewing and irradiates in surrounding areas and pain in TMJ which irradiates in the ear canal, temporal area or neck. Painful restriction of mandible during mouth opening and eccentric movements is frequent as well as mandible deviation or deflection. Sound effects in TMJ such as popping or clicking during mouth opening are common. Initial and least invasive therapeutic procedure is reversible occlusal therapy using splints. There are two main types of occlusal splints: stabilization and relaxation. First type of splints works on condyle stabilization in orthopedically stable position; it is superoanterior condylar position in articular fossa with position of intercondylar discs between condyle and articular fossa when working cusps of the antagonists are in maximal contact with the splint. Another type of splint causes disocclussion of posterior teeth and eliminates negative effects of occlusal interference in the intercuspal position or during eccentric mandibular movements. During therapy, occlusal splint temporarily changes occlusal relationships as well as relations within TMJ, causing reduction of CMD symptoms. The best therapeutic effect for reduction of CMD symptoms is achieved by combination of physical therapy and medication.

Kraniomandibularne disfunkcije (KMD) jesu skup strukturnih i funkcijskih poremećaja različite etiologije koji zahvataju temporomandibularne zglobove (TMZ) i orofacijalnu muskulaturu. Najčešći etiološki faktori su psihogeni; slede okluzalni faktori, povrede i kongenitalne anomalije u predelu lica i vilica. Rasprostranjenost blagih simptoma KMD je oko 75%, dok 3-4% ispitanika ima teže simptome i potrebna im je lekarska pomoć. Glavne tegobe zbog kojih se osobe sa KMD javljaju lekaru jesu bol u predelu lica koji se pojačava pri žvakanju i širi se u okolne delove i bol u predelu TMZ koji se širi u ušni kanal, temporalno ili u vrat. Česta su i bolna ograničenja pokreta mandibule pri otvaranju usta i ekscentričnim kretnjama sa devijacijom ili defleksijom sredine donje vilice. Neretko se čuju i zvučni efekti preskakanja ili kliktanja u TMZ pri pokretanju donje vilice. Inicijalna i najmanje invazivna terapijska mera je reverzibilna okluzalna terapija splintovima. Okluzalni splintovi mogu biti stabilizacioni i relaksacioni. Prvi imaju zadatak da stabilizuju kondile u ortopedski stabilnom položaju - superoanteriorni položaj kondila u fosi artikularis sa pravilno interponiranim diskusima, kada se potporne kvržice antagonista nalaze u maksimalnom kontaktu sa pločom splinta. Drugi splintovi dovode do disokluzije bočnih zuba i eliminacije štetnog efekta okluzalnih interferenci u interkuspalnom položaju ili pri ekscentričnim kretnjama mandibule. Tokom terapije okluzalnim splintom privremeno se menjaju okluzalni i odnosi unutar TMZ do smanjenja simptoma KMD. Najbolji terapijski efekat suzbijanja simptoma KMD postiže se u kombinaciji s određenim vidovima fizikalne i medikamentne terapije.