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A case report of the symptom-relieving action of an anterior flat plane bite plate for temporomandibular disorder.

Torii K, Chiwata I - Open Dent J (2010)

Bottom Line: The disappearance was associated with a decrease in the severity of the patient's symptoms; however, the discrepancy reappeared after 15 days, coinciding with the complete disappearance of the patient's symptoms.Thereafter, neither a discrepancy in the HOP and BPOP values nor any symptoms of TMD (right temporomandibular joint pain or limited jaw opening) reoccurred during a two-year follow-up period.This outcome supports previously reported conclusions that the effectiveness of stabilization splint therapy for reducing symptoms in patients with pain dysfunction syndrome does not differ significantly from that of other conservative therapies or of no treatment at all.

View Article: PubMed Central - PubMed

Affiliation: Torii Dental Clinic, 1-23-2 Ando, Aoi-ku, Shizuoka-shi, 420-0882 Japan.

ABSTRACT

Unlabelled: Splint therapy is a widely used modality for temporomandibular disorders (TMDs). However, questions remain regarding the mechanism of symptom relief. Recently, a relation between TMD and a discrepancy between the habitual occlusal position (HOP) and the anterior flat plane bite plate-induced occlusal position (BPOP) has been reported. Therefore, to understand the mechanism of the symptom relief associated with the use of a bite plate, the changes in both the HOP and BPOP values were observed during anterior bite plate treatment in a patient with TMD.

Case presentation: Anterior bite plate treatment was started in a patient complaining of arthralgia. A discrepancy between the HOP and BPOP values was recorded three days after the first visit; this discrepancy disappeared on day 6, and the disappearance was maintained between days 6 and 12. The disappearance was associated with a decrease in the severity of the patient's symptoms; however, the discrepancy reappeared after 15 days, coinciding with the complete disappearance of the patient's symptoms. Therefore, the effect of the bite plate on the resolution of the discrepancy between the HOP and BPOP values was interpreted as being unsustainable and occlusal equilibration for the BPOP was performed at 17 days. Thereafter, neither a discrepancy in the HOP and BPOP values nor any symptoms of TMD (right temporomandibular joint pain or limited jaw opening) reoccurred during a two-year follow-up period.

Conclusion: Within the limitations of the present study, the symptom-relieving action of an anterior flat plane bite plate on the resolution of occlusal discrepancy appeared to be temporary. This outcome supports previously reported conclusions that the effectiveness of stabilization splint therapy for reducing symptoms in patients with pain dysfunction syndrome does not differ significantly from that of other conservative therapies or of no treatment at all.

No MeSH data available.


Related in: MedlinePlus

Mean variations in the three axes on different days. x: mediolateral; y: anteroposterior; z: superoinferior. HOP: habitual occlusalposition; BPOP: bite plate-induced occlusal position.
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Figure 5: Mean variations in the three axes on different days. x: mediolateral; y: anteroposterior; z: superoinferior. HOP: habitual occlusalposition; BPOP: bite plate-induced occlusal position.

Mentions: The patient was instructed to wear the plate during the day, except when eating or speaking. This appliance therapy was continued until the symptoms were alleviated; meanwhile, the HOP and BPOP were measured as follows. The HOP (first) and BPOP (second) were recorded over time. The HOP, obtained by voluntary jaw closing while the patient was seated in an upright position with the occlusal plane parallel to the floor, was assumed to be the mandibular position imposed by the motor program of the central nervous system, and was defined as the stable (intercuspal) position. The BPOP, attained during voluntary jaw closing while the patient was seated in an upright position after the patient had worn an anterior flat plane bite plate for five minutes, was assumed to be the muscular position achieved by altering or deprogramming the motor program. This procedure to obtain the muscular position was established in a previous study [15]. To record the HOP, a vinyl polysiloxane bite registration material (GC, Tokyo, Japan) was applied over the occlusal surfaces with a syringe and the patient was asked to swallow and then close his mouth to maximum intercuspation, then hold that position until the material set (approximately one minute). To standardize the BPOP recording method, the patient was conditioned neuromuscularly using an anterior flat-plane bite plate, against which the patient tapped and slid his anterior lower teeth for a period of five minutes. After conditioning, the bite plate was removed and the registration material was applied over the occlusal surface; the patient was then asked to close his mouth until the upper and lower teeth just came into contact with each other and to hold that position. Three inter-occlusal recordings were made for each of the occlusal positions at each visit. A dentist who was not involved in the recording and who was unaware of the patient’s status performed the following measurements and analysis. The trimmed intraoral records were interposed between the cast on the three-dimensional apparatus of a modified articulator (Fig. 3), and occlusal papers of different colors were interposed between the recording surfaces and the recording needles, marking the positions. All registrations were read under a measuring microscope (Pika Seiko, Tokyo Japan) with a resolution of 0.01 mm. The statistical significance of the differences between the HOP and BPOP measurements recorded on each day and between two HOP and two BPOP recordings made on different days were calculated using an analysis of variance (ANOVA) for a two-factor experiment with repeated measurements for both position factors. The statistical significance of the differences in the variations of the two positions recorded on two different days was also calculated using an ANOVA. Significance levels of p<0.05, p<0.01, and p0.005 were established. In addition, the maximum unassisted opening and the pain score on a 10-point Visual Analogue Scale (VAS), where 0 denoted “no pain” and 10 denoted “worst pain” were recorded over time. The changes in the symptoms, the discrepancy between the HOP and BPOP values, and the variations in the HOP and BPOP values are shown in Figs. 4 and 5. On day one, the difference between the HOP and the BPOP was not statistically significant (Fig. 4). On day 3, however, the difference between the HOP and the BPOP at this time-point was significant (p<0.005). The difference between B1 and B2 was also significant (p<0.05), while that between H1 and H2 was not (p>0.1). The mean differences between the HOP and BPOP were 0.18±0.14 mm (mediolateral), 0.71±0.68 mm (anteroposterior) and 0.45±0.34 mm (superoinferior). On day 15, the patient’s maximum unassisted opening increased to 45 mm, the VAS score remained zero, and the difference between H6 and B6 was significant (p<0.01), while that between B5 and B6 was not significant (p>0.1)(Fig. 4). If this discrepancy had been left untreated, the symptoms would have recurred. Therefore, for ethical reasons, occlusal equilibration was performed for the BPOP after obtaining the patient’s informed consent. The discrepancy between the HOP and BPOP values was significant on day 25, and the patient reported cheek biting on his left side. However, the discrepancy disappeared by day 33, and the cheek biting ceased. The difference in the BPOP between the visits on day 3 and day 110 was not significant (p>0.1). The variations in the BPOP values measured on days 25, 33, 50 and 110 were significantly smaller than those measured on day 15 (p<0.01) (Fig. 5). The HOP shifted anterolaterally to the left after occlusal adjustment. The patient’s symptoms (right TMJ pain while eating and limited jaw opening) did not recur during a two-year follow-up period.


A case report of the symptom-relieving action of an anterior flat plane bite plate for temporomandibular disorder.

Torii K, Chiwata I - Open Dent J (2010)

Mean variations in the three axes on different days. x: mediolateral; y: anteroposterior; z: superoinferior. HOP: habitual occlusalposition; BPOP: bite plate-induced occlusal position.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3020490&req=5

Figure 5: Mean variations in the three axes on different days. x: mediolateral; y: anteroposterior; z: superoinferior. HOP: habitual occlusalposition; BPOP: bite plate-induced occlusal position.
Mentions: The patient was instructed to wear the plate during the day, except when eating or speaking. This appliance therapy was continued until the symptoms were alleviated; meanwhile, the HOP and BPOP were measured as follows. The HOP (first) and BPOP (second) were recorded over time. The HOP, obtained by voluntary jaw closing while the patient was seated in an upright position with the occlusal plane parallel to the floor, was assumed to be the mandibular position imposed by the motor program of the central nervous system, and was defined as the stable (intercuspal) position. The BPOP, attained during voluntary jaw closing while the patient was seated in an upright position after the patient had worn an anterior flat plane bite plate for five minutes, was assumed to be the muscular position achieved by altering or deprogramming the motor program. This procedure to obtain the muscular position was established in a previous study [15]. To record the HOP, a vinyl polysiloxane bite registration material (GC, Tokyo, Japan) was applied over the occlusal surfaces with a syringe and the patient was asked to swallow and then close his mouth to maximum intercuspation, then hold that position until the material set (approximately one minute). To standardize the BPOP recording method, the patient was conditioned neuromuscularly using an anterior flat-plane bite plate, against which the patient tapped and slid his anterior lower teeth for a period of five minutes. After conditioning, the bite plate was removed and the registration material was applied over the occlusal surface; the patient was then asked to close his mouth until the upper and lower teeth just came into contact with each other and to hold that position. Three inter-occlusal recordings were made for each of the occlusal positions at each visit. A dentist who was not involved in the recording and who was unaware of the patient’s status performed the following measurements and analysis. The trimmed intraoral records were interposed between the cast on the three-dimensional apparatus of a modified articulator (Fig. 3), and occlusal papers of different colors were interposed between the recording surfaces and the recording needles, marking the positions. All registrations were read under a measuring microscope (Pika Seiko, Tokyo Japan) with a resolution of 0.01 mm. The statistical significance of the differences between the HOP and BPOP measurements recorded on each day and between two HOP and two BPOP recordings made on different days were calculated using an analysis of variance (ANOVA) for a two-factor experiment with repeated measurements for both position factors. The statistical significance of the differences in the variations of the two positions recorded on two different days was also calculated using an ANOVA. Significance levels of p<0.05, p<0.01, and p0.005 were established. In addition, the maximum unassisted opening and the pain score on a 10-point Visual Analogue Scale (VAS), where 0 denoted “no pain” and 10 denoted “worst pain” were recorded over time. The changes in the symptoms, the discrepancy between the HOP and BPOP values, and the variations in the HOP and BPOP values are shown in Figs. 4 and 5. On day one, the difference between the HOP and the BPOP was not statistically significant (Fig. 4). On day 3, however, the difference between the HOP and the BPOP at this time-point was significant (p<0.005). The difference between B1 and B2 was also significant (p<0.05), while that between H1 and H2 was not (p>0.1). The mean differences between the HOP and BPOP were 0.18±0.14 mm (mediolateral), 0.71±0.68 mm (anteroposterior) and 0.45±0.34 mm (superoinferior). On day 15, the patient’s maximum unassisted opening increased to 45 mm, the VAS score remained zero, and the difference between H6 and B6 was significant (p<0.01), while that between B5 and B6 was not significant (p>0.1)(Fig. 4). If this discrepancy had been left untreated, the symptoms would have recurred. Therefore, for ethical reasons, occlusal equilibration was performed for the BPOP after obtaining the patient’s informed consent. The discrepancy between the HOP and BPOP values was significant on day 25, and the patient reported cheek biting on his left side. However, the discrepancy disappeared by day 33, and the cheek biting ceased. The difference in the BPOP between the visits on day 3 and day 110 was not significant (p>0.1). The variations in the BPOP values measured on days 25, 33, 50 and 110 were significantly smaller than those measured on day 15 (p<0.01) (Fig. 5). The HOP shifted anterolaterally to the left after occlusal adjustment. The patient’s symptoms (right TMJ pain while eating and limited jaw opening) did not recur during a two-year follow-up period.

Bottom Line: The disappearance was associated with a decrease in the severity of the patient's symptoms; however, the discrepancy reappeared after 15 days, coinciding with the complete disappearance of the patient's symptoms.Thereafter, neither a discrepancy in the HOP and BPOP values nor any symptoms of TMD (right temporomandibular joint pain or limited jaw opening) reoccurred during a two-year follow-up period.This outcome supports previously reported conclusions that the effectiveness of stabilization splint therapy for reducing symptoms in patients with pain dysfunction syndrome does not differ significantly from that of other conservative therapies or of no treatment at all.

View Article: PubMed Central - PubMed

Affiliation: Torii Dental Clinic, 1-23-2 Ando, Aoi-ku, Shizuoka-shi, 420-0882 Japan.

ABSTRACT

Unlabelled: Splint therapy is a widely used modality for temporomandibular disorders (TMDs). However, questions remain regarding the mechanism of symptom relief. Recently, a relation between TMD and a discrepancy between the habitual occlusal position (HOP) and the anterior flat plane bite plate-induced occlusal position (BPOP) has been reported. Therefore, to understand the mechanism of the symptom relief associated with the use of a bite plate, the changes in both the HOP and BPOP values were observed during anterior bite plate treatment in a patient with TMD.

Case presentation: Anterior bite plate treatment was started in a patient complaining of arthralgia. A discrepancy between the HOP and BPOP values was recorded three days after the first visit; this discrepancy disappeared on day 6, and the disappearance was maintained between days 6 and 12. The disappearance was associated with a decrease in the severity of the patient's symptoms; however, the discrepancy reappeared after 15 days, coinciding with the complete disappearance of the patient's symptoms. Therefore, the effect of the bite plate on the resolution of the discrepancy between the HOP and BPOP values was interpreted as being unsustainable and occlusal equilibration for the BPOP was performed at 17 days. Thereafter, neither a discrepancy in the HOP and BPOP values nor any symptoms of TMD (right temporomandibular joint pain or limited jaw opening) reoccurred during a two-year follow-up period.

Conclusion: Within the limitations of the present study, the symptom-relieving action of an anterior flat plane bite plate on the resolution of occlusal discrepancy appeared to be temporary. This outcome supports previously reported conclusions that the effectiveness of stabilization splint therapy for reducing symptoms in patients with pain dysfunction syndrome does not differ significantly from that of other conservative therapies or of no treatment at all.

No MeSH data available.


Related in: MedlinePlus