Assessment of occlusal appliance in repositioning of the temporomandibular joint anterior disc displacement with reduction: a 3 to 36 months follow-up

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Abstract

Rationale: Occlusal appliance is one of methods for temporomandibular joint anterior disc displacement with reduction (ADDWR). However, most studies have focused on the symptom reliefs rather than the disc-condyle positional relationship. Aim: To evaluate the success rate and the prognosis of occlusal appliances in repositioning of the disc in temporomandibular joint ADDWR. Materials and methods: One hundred and forty four (144) patients (210 joints) diagnosed with temporomandibular joint ADDWR based on magnetic resonance imaging (MRI) were consecutively included in our study. For all joints it was confirmed by MRI that the disc could be recaptured in a mandible anterior position. Occlusal appliances, including anterior repositioning appliance, twinblock or Herbst, were worn to keep the mandible in this position. MRI scanning was carried out before, 6 months later, at the end of treatment and at the follow-up visit. Logistic regression was used to analyze the risk factors for success. Cox regression model was applied to estimate the prospective risk of failure. Results: Among the occlusal appliances used, there were 100 anterior repositioning appliances, 23 twin-blocks, and 21 Herbst, with mean treatment duration of 9.5 ± 2.6 months. One hundred and seventy seven (177) joints (84.3%) were successfully repositioned at the end of splint treatment, according to MRI. Logistic regression showed that the appliance types were significantly associated with the success rate. At 2 years of regular follow-up, in almost 53% of the cases the disc-condyle relationship was normal. Gender, age, treatment duration and orthodontics were identified in the final Cox regression model with hazard ratios of 1.375, 1.141, 0.396 and 0.364 respectively. Conclusion: Occlusal appliance is one of the useful methods to recapture the disc in patients with temporomandibular joint ADDWR. However, the patient selection should be rigorous. 

About the authors

Ch. Yang

Shanghai Jiao Tong University School of Medicine

Author for correspondence.
Email: fake@neicon.ru

Yang Chi – DDS, MD, Professor, Head of Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology

Dr. Chi Yang: Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; 639 Zhi Zao Ju Road, Shanghai, 200011, Peoples' Republic of China. Tel.: +86 21 23271699 5218; +86 21 23271699 5705.

China

P. Shen

Shanghai Jiao Tong University School of Medicine

Email: fake@neicon.ru
Shen Pei – DDS, Attending, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology China

References

  1. Rammelsberg P, Pospiech PR, Jager L, Pho Duc JM, Bohm AO, Gernet W. Variability of disk position in asymptomatic volunteers and patients with internal derangements of the TMJ. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(3): 393–9. doi: http://dx.doi. org/10.1016/S1079-2104(97)90248-1.
  2. Leibur E, Jagur O, Muursepp P, Veede L, Voog-Oras U. Long-term evaluation of arthroscopic surgery with lysis and lavage of temporomandibular joint disorders. J Craniomaxillofac Surg. 2010;38(8): 615–20. doi: 10.1016/j.jcms.2010.02.003.
  3. Miernik M, Więckiewicz W. The basic conservative treatment of temporomandibular joint anterior disc displacement without reduction – review. Adv Clin Exp Med. 2015;24(4): 731–5. doi: 10.17219/acem/35165.
  4. Hu YK, Abdelrehem A, Yang C, Cai XY, Xie QY, Sah MK. Changes in temporomandibular joint spaces after arthroscopic disc repositioning: a self-control study. Sci Rep. 2017;7:45513. doi: 10.1038/srep45513.
  5. Lin SL, Wu SL, Ko SY, Yen CY, Yang JW. Effect of flat-plane splint vertical thickness on disc displacement without reduction: a retrospective matched-cohort study. J Oral Maxillofac Surg. 2017;75(8): 1627–36. doi: 10.1016/j.joms.2016.12.047.
  6. Zhang C, Wu JY, Deng DL, He BY, Tao Y, Niu YM, Deng MH. Efficacy of splint therapy for the management of temporomandibular disorders: a meta-analysis. Oncotarget. 2016;7(51): 84043–53. doi: 10.18632/oncotarget.13059.
  7. Haketa T, Kino K, Sugisaki M, Takaoka M, Ohta T. Randomized clinical trial of treatment for TMJ disc displacement. J Dent Res. 2010;89(11): 1259–63. doi: 10.1177/0022034510378424.
  8. Kurita H, Ohtsuka A, Kurashina K, Kopp S. A study of factors for successful splint capture of anteriorly displaced temporomandibular joint disc with disc repositioning appliance. J Oral Rehabil. 2001;28(7): 651–7. doi: 10.1046/j.1365-2842.2001.00710.x.
  9. Zhang S, Yang C, Chen M, Fan X, Yun B, Peng Y, Yuan D. Magnetic resonance imaging in the diagnosis of intra-articular adhesions of the temporomandibular joint. Br J Oral Maxillofac Surg. 2009;47(5): 389–92. doi: 10.1016/j.bjoms.2008.09.007.
  10. Zhang SY, Liu XM, Yang C, Cai XY, Chen MJ, Haddad MS, Yun B, Chen ZZ. New arthroscopic disc repositioning and suturing technique for treating internal derangement of the temporomandibular joint: part II – magnetic resonance imaging evaluation. J Oral Maxillofac Surg. 2010;68(8): 1813–7. doi: 10.1016/j.joms.2009.08.012.
  11. Iasonos A, Schrag D, Raj GV, Panageas KS. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol. 2008;26(8): 1364–70. doi: 10.1200/JCO.2007.12.9791.
  12. Ribeiro RF, Tallents RH, Katzberg RW, Murphy WC, Moss ME, Magalhaes AC, Tavano O. The prevalence of disc displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years. J Orofac Pain. 1997;11(1): 37–47.
  13. Ikeda K, Kawamura A, Ikeda R. Prevalence of disc displacement of various severities among young preorthodontic population: a magnetic resonance imaging study. J Prosthodont. 2014;23(5): 397–401. doi: 10.1111/jopr.12126.
  14. Jeon DM, Jung WS, Mah SJ, Kim TW, Ahn SJ. The effects of TMJ symptoms on skeletal morphology in orthodontic patients with TMJ disc displacement. Acta Odontol Scand. 2014;72(8): 776–82. doi: 10.3109/00016357.2014.906650.
  15. Emshoff R, Moriggl A, Rudisch A, Brunold S, Neunteufel N, Crismani A. Cephalometric variables discriminate among magnetic resonance imaging-based structural characteristic groups of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(1): 118–25. doi: 10.1016/j.tripleo.2011.02.021.
  16. Schellhas KP, Pollei SR, Wilkes CH. Pediatric internal derangements of the temporomandibular joint: effect on facial development. Am J Orthod Dentofacial Orthop. 1993;104(1): 51–9. doi: http://dx.doi.org/10.1016/08895406(93)70027-L.
  17. Xie Q, Yang C, He D, Cai X, Ma Z. Is mandibular asymmetry more frequent and severe with unilateral disc displacement? J Craniomaxillofac Surg. 2015;43(1): 81–6. doi: 10.1016/j.jcms.2014.10.013.
  18. Xie Q, Yang C, He D, Cai X, Ma Z, Shen Y, Abdelrehem A. Will unilateral temporomandibular joint anterior disc displacement in teenagers lead to asymmetry of condyle and mandible? A longitudinal study. J Craniomaxillofac Surg. 2016;44(5): 590–6. doi: 10.1016/j.jcms.2016.01.019.
  19. Eberhard D, Bantleon HP, Steger W. The efficacy of anterior repositioning splint therapy studied by magnetic resonance imaging. Eur J Orthod. 2002;24(4): 343–52. doi: https://doi.org/10.1093/ejo/24.4.343.
  20. Huang IY, Wu JH, Kao YH, Chen CM, Chen CM, Yang YH. Splint therapy for disc displacement with reduction of the temporomandibular joint. Part I: modified mandibular splint therapy. Kaohsiung J Med Sci. 2011;27(8): 323–9. doi: 10.1016/j.kjms.2011.03.006.
  21. Kurita H, Kurashina K, Baba H, Ohtsuka A, Kotani A, Kopp S. Evaluation of disk capture with a splint repositioning appliance: clinical and critical assessment with MR imaging. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(4): 377–80. doi: http://dx.doi.org/10.1016/S1079-2104(98)90060-9.
  22. Ma Z, Xie Q, Yang C, Zhang S, Shen Y, Cai X. Changes in the temporomandibular joint space after functional treatment of disk displacement with reduction. J Craniofac Surg. 2015;26(2):e78–81. doi: 10.1097/SCS.0000000000001392.

Copyright (c) 2017 Yang C., Shen P.

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