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Temporomandibuler eklem (TME) internal düzensizliği, diskin kondil ve glenoid fossa ile olan anormal ilişkisi olarak açıklanmaktadır. Bu rahatsızlık hastalarda subjektif olarak; kulak ve çevre bölgede ağrı, çene fonksiyonlarında zorluk, objektif olarak da; ağız açıklığında ve lateral hareketlerde kısıtlılık, ses ve deviasyon gibi belirti ve bulguların ortaya çıkmasına neden olmaktadır. Konservatif tedavilerle veya mümkün olan minimal invaziv cerrahi tedavi yöntemleriyle semptomların hafifletilmesi amaçlanır. Konservatif metodlar arasında sıklıkla kullanılan splint tedavisi internal düzensizliklerde özellikle kas hiperaktivitelerinin azaltılmasında olumlu sonuçlar vermektedir. TME internal düzensizliğin tanısı klinik muayene ile çeşitli görüntüleme metotlarının kombine kullanımıyla yapılmaktadır. Manyetik rezonans görüntüleme (MRG), internal düzensizliklerde sık olarak karşılaşılan disk deplasmanlarının tanısında tercih edilen görüntüleme yöntemidir. Kondil-disk bütünlüğünde meydana gelen dejeneratif değişiklikler, eğer hastalık başlangıç aşamasındaysa, MR görüntülerinde herhangi bir bulgu vermeyebilir. Bu nedenle kondil bölgesindeki sert dokunun patolojik durumlarını teşhis için kemik sintigrafisi ve MR kombine olarak kullanılabilir. Bu çalışmamızda amacımız TME internal düzensizliklerde uygulanan splint tedavisinin bölgede oluşturduğu olumlu ya da olumsuz değişiklikleri MR görüntülerinin yanı sıra kantitatif olarak sonuçlar elde ettiğimiz sintigrafik bulgular ile karşılaştırarak splint tedavisi konusunda literatüre katkıda bulunmaktır. Çalışmamıza TME internal düzensizliği bulguları olan (klik, ağız açmada kısıtlılık, ağrı vb) 30 hasta dahil edildi. Tüm hastalar okluzal splint ile 3 ay süresince tedavi edildi. Splint tedavisi öncesi ve 3 ay sonrası MR görüntüleri ile kemik sintigrafisi görüntüleri elde edildi. Hastaların plak öncesi ve 3 ay sonrası TME bölgesindeki, masseter ve temporal kastaki ağrı şiddetleri görsel analog skala (VAS=Visual Analogue Scale) ile belirlendi. Lateral hareketler ve interinsizal mesafeler ölçüldü. Hastaların sağ ve sol TME bölgelerindeki osteoblastik aktivite sayımları ve MR görüntüleri tedavi öncesi ve sonrası olarak değerlendirildi. Sonuç olarak temporomandibular eklem internal düzensizliklerinin tedavisinde amaçlanan, hastanın ideal fonksiyonunun (çiğneme, konuşma) ve TME’nin rehabilitasyonunun sağlanması gerçekleştirilmiştir. Ağız açma mesafelerindeki artış, kas palpasyon hassasiyetinde azalma değerleri bunu ortaya koymaktadır. Splint sonrası alınan MR görüntülerinde redüksiyonlu disk deplasmanı olan hastaların disk pozisyonlarında herhangi bir değişiklik olmadığı tespit edilse de sintigrafik görüntülerde yapılan osteoblastik aktivite sayım sonuçlarındaki azalma bölgede dejeneratif olarak değişiklik olmadığını ortaya koymaktadır. Anahtar Kelimeler : Temporomandibuler eklem internal düzensizlik, okluzal splint, kemik sintigrafisi,manyetik rezonans görüntüleme. Temporomandibular joint (TMJ) internal derangement is described as an abnormal relationship with disk-condyle and glenoid fossa. This illness can cause earache, pain, difficulty in mandibular functions as a subjective symptoms and also can lead limited mouth opening and lateral movements, clicking and deviation as objective sypmtoms in all patients. Minimum invasive surgery and conservative methods are used to ease the symtomps. Occlusal splints which is the one of conservative treatment method especially relieves pain and decreases masticator muscle hyperactivity. The internal derangement of TMJ diagnoses with combination of clinical examination and various imaging methods. Magnetic resonance imagining (MRI), frequently is a preffered imaginig method that used in the diagnosis of disk displacement. If the TMJ disorder is at the preliminary stage, degenerative changes of condyle-disk complex could not be seen on MRI. Therefore MRI and bone scinthigraphy are combined in the diagnosis of the hard tissue pathological changes of the condyle region. In this study we aimed that compare with MRI and scintigraphy findings of the splint treatment thus we contribute to literature about the efficacy of occlusal splints with quantative results. Thirty patients with signs and symtomps of TMJ internal derangement were enrolled in this study. All of the patients were treated by occlusal splint for three months. MRI and bone scintigraphy were performed before and after the treatment. For each patient with musculus(m.) temporalis, m.masstericus and TMJ pain were scored on VAS before and after occlusal splint therapy. Occlusal splint therapy was applied for three months. Interincisal distances and lateral movement were measured before and after the splint treatment. Osteoblastic activity counts and MRI of TMJ regions were evaluated before and after the splint therapy. In the conclusion, ideal function (mastication, phonation) and rehabilitation of TMJ provided after the splint treatment in all patient. Increased interincisal distances and decreased level of the muscle pain were proved this situation. On MRI, no changes were detected in patient with disk displacement after occlusal splints. However osteoblastic activity count were decreased after the treatment in all patient so that it was revelaed that there was no degenerative changes in TMJ. Keywords : Temporomandibular joint internal derangement, occlusal splint, bone scintigraphy, magnetic resonance imaging.

Temporomandibular joint (TMJ) sounds are important and common physical signs of temporomandibular disorders (TMD). The aim of this study was to evaluate the influence of the effect of the use of occlusal bite splints (stabilizing and repositioning) on the sounds produced in the TMJ, by means of the electrovibratography (EVG). Thirty-one patients with TMD from the Dental School of Ribeirão Preto, University of São Paulo, Brazil were selected for this study. Group 1 (n=23) wore stabilizing bite splints and Group 2 (n=8) used anterior repositioning splints. Before and after treatment with occlusal splints both groups were analyzed using the SonoPAK Q/S recording system (BioResearch System, Inc.). The treatments with stabilizing bite splints were satisfactory, since they reduced the total amount of the sound energies (p

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Svrha udžbenika „Temporomandibularni poremećaji i okluzija", je iznošenje logičnog i praktičnog pristupa istraživanju okluzije i mastikatorne funkcije. Udžbenik je podijeljen u četiri glavna dijela. Prvi dio se sastoji od šest poglavlja koja donose normalne anatomske i fiziološke karakteristike mastikatornog sustava. Razumijevanje normalnih okluzijskih odnosa i mastikatorne funkcije ključno je za razumijevanje disfunkcije. Drugi dio se sastoji od četiri poglavlja koja se bave etiologijom i prepoznavanjem čestih funkcijskih poremećaja mastikatornog sustava. U ovom je izdanju dodana znatna dokumentacija koja to potkrepljuje. Šest poglavlja u Trećem dijelu donose racionalne metode liječenja temporomandibularnih poremećaja u skladu sa signifikantnim etiološkim čimbenicima. Dodana su recentna istraživanja koja podupiru postojeće načine liječenja ali i otvaraju prostor novim promišljanjima. Četvrti dio donosi četiri poglavlja koja se bave specifičnim razmatranjima za trajnu okluzijsku terapiju. Namjera udžbenika Temporomandibularni poremećaji i okluzija" je razvijanje razumijevanja i racionalnog pristupa istraživanju mastikatorne funkcije i okluzije. Da bi olakšali čitatelju opisali smo određene tehnike. Treba shvatiti da je svrha tehnike postizanje određenih ciljeva liječenja. Postizanje tih ciljeva značajan je faktor, a ne tehnike same po sebi. Tehnika koja postiže cilj liječenja prihvatljiva je dok ostvaruje taj cilj na relativno konzervativan i jeftin način, imajući na umu najbolji interes pacijenta.

The occlusal splint constitutes a resource frequently used on temporomandibular dysfunction (TMD) and orofacial pain treatment, including the denture-wearing patients. Considering the active participation of lips in the functions of the stomatognathic system, the aim of this study was to verify the influence of occlusal splints on electromyography activity (EMG) of two portions – upper (OBU) and lower (OBL) of orbicularis oris muscle, during the yogurt suction. EMG was accomplished before and 70 days after the use of these splints, in 8 edentulous denture-wearing patients and that had signs and symptoms of TMD. The myoeletric signs were recorded by a electromyography (*Lynx Eletronics) with Butterworthtype band pass filter (20-500 Hz) with gain of 100 times and A/D converter board. The signs were caught by Ag/AgCl surface electrodes (Medi Trace) and displayed through by Aqdados Software installed in an Ibm-pc 486 DX2. The EMG sign was processed by Matlab® Software and the averages of the non-normalized amplitude envoltories (NNA) were statistically analyzed using Mann-Whitney test (p < 0,05). The NNA values found on pre-treatment was 60,11 ± 4.28 and 86,15 ± 6.15 μV and in the post-treatment was 106,0 ± 4.80 and 103,71 ± 3.83 μV for the portions OBU and OBL respectively. The verified statistical difference was highly significant (p < 0,0001) when compared the same muscular portion before and after use of splints. The results of this study, on those experimental conditions used, may conclude that the use of occlusal splints promoted a significant increase of the electric activity of the orbicularis oris. UNITERMS: occlusal splint; orofacial pain; electromyography. A placa oclusal constitui um recurso freqüentemente utilizado no tratamento das disfunções temporomandibulares (DTM) e dores orofaciais, inclusive em pacientes portadores de próteses totais. Considerando a participação ativa dos lábios nas funções do sistema estomatognático, o objetivo deste estudo foi verificar a influência das placas oclusais na atividade eletromiográfica (EMG) das duas porções – superior (OBS) e inferior (OBI) do músculo orbicular da boca, durante sucção de iogurte. A EMG foi realizada antes e 70 dias após o uso destes aparelhos, em 8 pacientes edêntulos, portadores de prótese total e que apresentavam sinais e sintomas de DTM. O sinal mioelétrico foi coletado por um eletromiógrafo (*Lynx Eletronics), com filtro tipo Butterworth (20-500 Hz) com ganho de 100 vezes e placa conversora A/D. Os sinais foram captados por eletrodos de superfície de Ag/AgCl (Medi Trace) e registrados por meio do software Aqdados instalado em um computador Ibm-pc 486 DX2. O sinal EMG foi processado pelo software Matlab® e as médias das amplitudes não normalizadas (ANN) foram testadas estatisticamente pelo teste Mann-Whitney (p < 0,05). Os valores encontrados das ANN no prétratamento foram de 60,11 ± 4.28 e 86,15 ± 6.15 μV e no pós-tratamento de 106,0 ± 4.80 e 103,71 ± 3.83 μV para as porções OBS e OBI, respectivamente. A diferença estatística verificada foi altamente significativa (p < 0,0001) quando comparada à mesma porção muscular antes e após o uso das placas. Os resultados deste estudo, nas condições experimentais utilizadas, permitem concluir que o uso das placas oclusais promoveu um aumento significativo da atividade elétrica do orbicular da boca. UNITERMOS: placa oclusal; dor orofacial; eletromiografia.

Degenerative osteoarthritis (OA) of temporomandibular joint (TMJ) is a form of arthrogenic temporomandibular disorders (1, 2). The purpose of this study is to determine the success of short-term occlusal splint treatment at patients with OA of TMJ. 16 patients (median of age 41.5, 69% women) with OA collected in the period 2001-2006 on the basis of clinical examinations and by magnetic resonance imaging (MRI), computerized tomography and conventional radiography of TMJ (Figure 1). The temporomandibular pain was evaluated with analogous visual scale. Psychological status of the patients was confirmed by State-Trait Anxiety Inventory (STAI) (3). Occlusal splint treatment was followed during 3-6 months (Figure 2). Results. OA was diagnosed in 62.5% of all TMJs, in 25% of the patients bilaterally. Clinical diagnostics and MRI findings of OA were matching in 12 (75%) patients. The most frequent symptoms felt by the patients were pain (95%) and crepitation (80%) in TMJs. 19% of the patients had acute pain (duration ≤ 3 months), 37% had subacute pain (≤ 12 months) and 44% of the patients experienced chronic pain (>12 months). The median of pain evaluated by analogous visual scale was 7 (range 9.8– 3.0) before and 1 (range 6-0) after splint treatment. The mean score in STAI 1 was 40.69 and STAI 2 was 42.44. Conclusion. Applying the occlusal splint resulted in painless TMJs (also painless crepitation) in 63% patients. A higher average level of anxiety was determined by STAI for all examined patients.

International audience; Reçu le 5 décembre 2012-Accepté le 16 mai 2013 Résumé. Objectif-Le but de ce travailétait de quantifier l'influence du bruxisme sur les réponses posturales et de définir l'influence du port d'une orthèse occlusale de relaxation neuromusculaire sur les valeurs de centre de pression plantaire (CPP). Méthode-Neuf sujets témoins et sept sujets bruxomanes composaient la population soumise aux tests stabilométriques les yeux ouverts (YO) et les yeux fermés (YF) sur sol dur, en PIM (Position d'Intercuspidie Maximale), en PR (Position de Repos) et POgt (Position d'Occlusion avec gouttière). Résultats-Les principaux résultats ont révélé une absence d'influence significative du bruxisme sur les valeurs de CPP mesurées les yeux ouverts et les yeux fermés, sujets en PIM et sujet en PR. Pour ce qui est de l'influence du port d'une orthèse occlusale, nous observons une absence systématique de différences significatives entre la position d'intercuspidie maximale (PIM) et la position d'occlusion avec gouttière (POgt). Après 15 jours de port de l'orthèse, nous n'observons pas de différence manifeste, tandis que 30 jours de port entraînent des différences significatives en position de repos, les yeux ouverts, pour la position médio-latérale (p < 0,01), et en position d'intercupidie maximale pour la position antéro-postérieure, les yeux fermés (p < 0,02).

18歳女,咬合に起因した顎機能異常者に対し,スタビリゼイション型オクルーザルスプリントの装着と運動療法としてのEMGバイオフィードバックを応用した開口訓練の併用療法を試みた.1)治療開始2ヵ月,開口制限と顎関節雑音は消失し,開口度は18.7 mmから46.8 mmとなった.2)疼痛のない運動制限のある顎機能異常者に対し,運動療法としてのEMGバイオフィードバックにより巧緻性開口訓練をしたところ開口制限は改善し,特にオクルーザルスプリントとの併用で,治療効果の有効性を認めた.3)最終補綴処理で,咬合の形態的・機能的回復を行い,3年8ヵ月経過しているが良好である

Introduction Temporomandibular disorder (TDM) is the most common source of orofacial pain of a non-dental origin. Sleep bruxism is characterized by clenching and/or grinding the teeth during sleep and is involved in the perpetuation of TMD. The aim of the present study was to investigate the effects of massage therapy, conventional occlusal splint therapy and silicone occlusal splint therapy on electromyographic activity in the masseter and anterior temporal muscles and the intensity of signs and symptoms in individuals with severe TMD and sleep bruxism. Methods Sixty individuals with severe TMD and sleep bruxism were randomly distributed into four treatment groups: 1) massage group, 2) conventional occlusal splint group, 3) massage + conventional occlusal splint group and 4) silicone occlusal splint group. Block randomization was employed and sealed opaque envelopes were used to conceal the allocation. Groups 2, 3 and 4 wore an occlusal splint for four weeks. Groups 1 and 3 received three weekly massage sessions for four weeks. All groups were evaluated before and after treatment through electromyographic analysis of the masseter and anterior temporal muscles and the Fonseca Patient History Index. The Wilcoxon test was used to compare the effects of the different treatments and repeated-measures ANOVA was used to determine the intensity of TMD. Results The inter-group analysis of variance revealed no statistically significant differences in median frequency among the groups prior to treatment. In the intra-group analysis, no statistically significant differences were found between pre-treatment and post-treatment evaluations in any of the groups. Group 3 demonstrated a greater improvement in the intensity of TMD in comparison to the other groups. Conclusion Massage therapy and the use of an occlusal splint had no significant influence on electromyographic activity of the masseter or anterior temporal muscles. However, the combination of therapies led to a reduction in the intensity of signs and symptoms among individuals with severe TMD and sleep bruxism. Trial registration This study is registered in August, 2014 in the ClinicalTrials.gov (NCT01874041). Electronic supplementary material The online version of this article (doi:10.1186/s12998-014-0043-6) contains supplementary material, which is available to authorized users.

The possible effects on sleep bruxism (SB) of clear aligners in orthodontics are unknown. This study was conducted to analyze the effects of clear aligners on SB. Sixty subjects needing orthodontic treatment and affected by SB (33 m, 27 f, 20±;5 years) were enrolled in the study and randomly assigned to one of the following three groups: 20 were given clear aligners (CAT) (12 m, 8 f, 19±5 years), 20 occlusal splint (MOS) (9 m, 11 f, 22±5 years) and 20 a placebo splint (PMS) (12 m, 8 f, 24±3 years). All groups were followed for 6 consecutive months and monitored for SB with a portable electromyographic-electrocardiographic (EMG-ECG) device (Bruxoff®, OT Bioelettronica, Torino, Italy). MOS subjects reduced masseter contractions after 6 months of treatment (t3) (MD=-29.11, std. error 11.74, p=0.017) but increased phasic contractions related to SB after 3 months of treatment (t2) (MD=4.73, std. error 2.36, p=0.048) and tonic contractions related to SB during all the six months of treatment (t1, t2, t3) when compared to PMS. CAT subjects increased phasic contractions related to SB during the first (t1) (MD=3.94, std. error 2.27, p=0.04) and the third month (t2) of treatment (MD=4.62, std. error 2.36, p=0.046) when compared to PMS. No significant differences were found for SB index at any time for all the three groups. Although MOS and CAT affected EMG signals during sleep time differently, they did not influence the overall SB index.

The aim of the study was to evaluate changes in pain intensity and self-perceived quality of life in patients with temporomandibular disorders (TMD ) during stabilization splint therapy. The hypothesis was that the clinical subtype of TMD , depending on whether pain is of muscular or temporomandibular joint origin, and pain chronicity (acute vs. chronic pain) differently affect treatment response. Thirty patients were included and treated with a stabilization splint in a 6-month clinical trial. Treatment outcomes included pain-free maximal mouth opening (MO), assisted maximal MO, path of MO, asymmetry in lateral excursions, spontaneous pain intensity (visual analog scale, VAS), and self-perceived quality of life (Oral Health Impact Profile, OHI P- 14). Overall, VAS and OHI P-14 scores changed significantly over time (VAS: F=80.85, p