Discussion
TMD, anterior tooth, myalgia, TMDs, sleep splints, TMJ pain, displacement disorders, TMD-related, pain, subluxation, muscle pain, headache, myogenous TMD, arthralgia
MYOFASCIAL PAIN, TMJ, TMJ PAIN, MYOFASCIAL PAIN WITH REFERRAL, DEGENERATIVE JOINT DISEASE, SECONDARY, TSS
This study examined whether the Aqualizer is a suitable patient-guided method for determining MMR prior to occlusal splint treatment. Occlusal splints are a frequently used non-invasive treatment approach for patients with TMD. However, there is conflicting evidence for the efficacy of occlusal splints, with some studies finding effectiveness in pain reduction and others finding no symptom alleviation regarding pain, clicking of the TMJ, and functional restrictionsFor this study, we focused primarily on patients reporting pain-related TMD symptoms correspondent to the twelve common TMD conditions described by the DC/TMD: arthralgia, myalgia, local myalgia, myofascial pain, myofascial pain with referral, disk displacement disorders, degenerative joint disease, subluxation, and headache attributed to TMDTo ensure similar wearing times among all study participants, the occlusal splints were mainly used as sleep splints in this study. Since occlusal splints with anterior tooth coverage usually impair articulatory phonetics, the average wearing time during the day would have severely varied depending on the participants’ profession. There are indications that the treatment period of occlusal splint therapy may be an important parameter for treating TMD. This is based on the observation that the effect sizes for the reduction of symptoms increased between 3 and 6 months in both groups. In fact, this increase in effectiveness led to a significant difference between the total number of symptoms (TSS) at 3 and 6 months in the AQU group. Furthermore, AQU-based splint treatment had no significant effect on relieving TMJ pain with maximum opening and pain with muscle palpation after 3 months, whereas after 6 months, both symptoms seemed to have improved significantly in nearly all patients. This implies that the occlusal splints based on the condyle-fossa relation provided by the Aqualizer exhibited their therapeutic effect later than splints fabricated on the basis of CPG. After 6 months of treatment, TMJ pain with palpation and muscle pain with palpation seemed to have subsided sufficiently regardless of the registration method. While TMJ pain with maximum opening improved for all patients in the AQU group, only one patient in the CPG group was free of this symptom at the end of the treatment. Interestingly, the presence of TMJ sounds improved after 3 months in both groups, but there was no further reduction of this symptom after another 3 months of treatment. This is also in agreement with a previous 6-months clinical trial, where joint sounds subsided in approximately 30% of the patients receiving occlusal splint treatment after a treatment time of 3 months, but no further reduction was observed after 6 monthsThe secondary outcomes of this study were to assess the patients’ perception of their QoL before, during and after the treatment, the patients’ general satisfaction with the treatment and the accuracy of the occlusal fit. The occlusal splint treatment led to an improved QoL in most participants, but QoL in the AQU group was significantly higher compared to the CPG group. After 6 months of treatment, there were more participants in the AQU group than in the CPG group reporting that their TMD-related symptoms did not affect their QoL at all. Similar results were also obtained from the PSQ. In both groups, all patients were generally satisfied with the entire treatment and found the occlusal splint comfortable to wear, implying that occlusal splints are a treatment method well-received by most patients. In both groups, the occlusal splints showed an overall good occlusal fit. The occlusal fit, judged by the number of interfering contacts, can be viewed as an indirect measure of the accuracy of the registration technique or the level of comfort of the MMR. Upon insertion, most patients required occlusal adjustments in both groups, however, fewer patients in the AQU group needed further adjustments at the follow-up visits. The fact that occlusal interferences were removed presents a limitation for purely comparing the success of occlusal splint treatment in the CPG and AQU group. Nonetheless, interfering contacts are considered a potential co-factor for causing or aggravating TMDs in susceptible patients, which is why we chose to eliminate all potential sources of further discomfortAs far as the choice of splint material is concerned, there are conflicting opinions as to which type of material is the most suitable for occlusal splints. Soft splints are advocated by some researchers because they were found to be effective in alleviating myogenous TMD symptomsIn general, the findings of this study must be interpreted in the light of several limitations. When studying TMD treatment strategies, it should be noted, that further conservative methods, such as home exercises and physical therapy, can be just as effective as occlusal splints in terms of symptom alleviation in the acute phase, possibly making occlusal splint treatment redundant