An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders

Abstract

Anterior repositioning splint (ARS) therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders (TMDs), which account for a large proportion of TMD cases. Owing to the wide application of this therapy, the exact mechanism of remission has increasingly drawn attention. Given that practitioners have different views on ARS therapy, its indications are broadened, and operating methods diverged. This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods. Representative views in the past 10 years were summarised, and conclusions were drawn as follows: The mechanism of ARS therapy is mainly attributed to internal derangement correction, improvement of stress distribution and recently reported joint remodeling. It has an evident effect in the short term, and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3–6 months. However, long-term stability is not optimal, and thus indications should be selected carefully. Notably, most of the clinical studies in this field are case analyses with low-quality evidence. Well-designed RCTs are required to further validate relevant theories.

Keywords

anterior repositioning splint / disc displacement / occlusal splint / temporomandibular joint disorders / therapeutics

References

[1] RibeiroRF, TallentsRH, KatzbergRW, et al.. The prevalence of disc displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years. J Orofac Pain, 1997, 11(1): 37-47

[2] SchiffmanE, OhrbachR, TrueloveE, et al.. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Groupdagger. J Oral Facial Pain Headache, 2014, 28(1): 6-27

[3] SummerJD, WestessonPL. Mandibular repositioning can be effective in treatment of reducing TMJ disk displacement. A long-term clinical and MR imaging follow-up. Cranio, 1997, 15(2): 107-120

[4] OkesonJPManagement of temporomandibular disorders and occlusion, 20137th ed.St. Louis, Mo, Elsevier/Mosby

[5] ShenP, ChenX, XieQ, et al.. Assessment of Occlusal Appliance for the Reposition of Temporomandibular Joint Anterior Disc Displacement With Reduction. J Craniofac Surg, 2019, 30(4): 1140-1143

[6] JiangX, FanS, CaiB, et al.. Mandibular manipulation technique followed by exercise therapy and occlusal splint for treatment of acute anterior TMJ disk displacement without reduction. Shanghai Kou Qiang Yi Xue (Chinese), 2016, 25(5): 570-573

[7] PihutM, GoreckaM, CeranowiczP, et al.. The Efficiency of Anterior Repositioning Splints in the Management of Pain Related to Temporomandibular Joint Disc Displacement with Reduction. Pain Res Manag, 2018, 2018: 1-6

[8] WilliamK, SolbergGTCTemporomandibular joint problems: Biological diagnosis and treatment, 19802nd ed.Chicago, Quintessence Publishing Co.

[9] ChenHM, FuKY, LiYW, et al.. Positional changes of temporomandibular joint disk and condyle with insertion of anterior repositioning splint. Hua Xi Kou Qiang Yi Xue Za Zhi (Chinese), 2009, 27(4): 408-412

[10] LiuMQ, LeiJ, HanJH, et al.. Metrical analysis of disccondyle relation with different splint treatment positions in patients with TMJ disc displacement. J Appl Oral Sci, 2017, 25(5): 483-489

[11] PathriaMN, ChungCB, ResnickDL. Acute and Stress-related Injuries of Bone and Cartilage: Pertinent Anatomy, Basic Biomechanics, and Imaging Perspective. Radiology, 2016, 280(1): 21-38

[12] MachonV, LevorovaJ, HirjakD, et al.. Temporomandibular joint disc perforation: a retrospective study. Int J Oral Maxillofac Surg, 2017, 46(11): 1411-1416

[13] LiuZ, QianY, ZhangY, et al.. Effects of several temporomandibular disorders on the stress distributions of temporomandibular joint: a finite element analysis. Comput Methods Biomech Biomed Engin, 2016, 19(2): 137-143

[14] TanakaE, RodrigoDP, MiyawakiY, et al.. Stress distribution in the temporomandibular joint affected by anterior disc displacement: A three-dimensional analytic approach with the finite-element method. J Oral Rehabil, 2000, 27(9): 754-759

[15] HollenderL, LindahlL. Radiographic study of articular remodeling in the temporomandibular joint after condylar fractures. Scand J Dent Res, 1974, 82(6): 462-465

[16] YanoK, NishikawaK, SanoT, et al.. Relationship between appearance of a double contour on the mandibular condyle and the change in articular disc position after splint therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(4): e30-34

[17] LiuMQ, ChenHM, YapAU, et al.. Condylar remodeling accompanying splint therapy: a cone-beam computerized tomography study of patients with temporomandibular joint disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 114(2): 259-265

[18] MoncadaG, CortesD, MillasR, et al.. Relationship between disk position and degenerative bone changes in temporomandibular joints of young subjects with TMD. An MRI study. J Clin Pediatr Dent, 2014, 38(3): 269-276

[19] HuYK, YangC, CaiXY, et al.. Does condylar height decrease more in temporomandibular joint nonreducing disc displacement than reducing disc displacement?: A magnetic resonance imaging retrospective study. Medicine (Baltimore), 2016, 95(35): e4715

[20] LeiJ, YapAU, LiuMQ, et al.. Condylar repair and regeneration in adolescents/young adults with early-stage degenerative temporomandibular joint disease: A randomised controlled study. J Oral Rehabil, 2019, 46(8): 704-714

[21] RabieAB, SheTT, HaggU. Functional appliance therapy accelerates and enhances condylar growth. Am J Orthod Dentofacial Orthop, 2003, 123(1): 40-48

[22] RabieAB, XiongH, HaggU. Forward mandibular positioning enhances condylar adaptation in adult rats. Eur J Orthod, 2004, 26(4): 353-358

[23] SunL, ZhaoJ, WangH, et al.. Mechanical stress promotes matrix synthesis of mandibular condylar cartilage via the RKIP-ERK pathway. J Mol Histol, 2017, 48(5–6): 437-446

[24] TonlorenziD, BrunelliM, ContiM, et al.. An observational study of the effects of using an high oral splint on pain control. Arch Ital Biol, 2019, 157(2–3): 66-75

[25] GlarosAG, MarszalekJM, WilliamsKB. Longitudinal Multilevel Modeling of Facial Pain, Muscle Tension, and Stress. J Dent Res, 2016, 95(4): 416-422

[26] DaifET. Correlation of splint therapy outcome with the electromyography of masticatory muscles in temporomandibular disorder with myofascial pain. Acta Odontol Scand, 2012, 70(1): 72-77

[27] Nitecka-BuchtaA, MarekB, BaronS. CGRP plasma level changes in patients with temporomandibular disorders treated with occlusal splints — a randomised clinical trial. Endokrynol Pol, 2014, 65(3): 217-223

[28] HeSS, LiF, SongF, et al.. Spontaneous neural activity alterations in temporomandibular disorders: a crosssectional and longitudinal resting-state functional magnetic resonance imaging study. Neuroscience, 2014, 278: 1-10

[29] GarciaAR, FolliS, ZuimPR, et al.. Mandible protrusion and decrease of TMJ sounds: an electrovibratographic examination. Braz Dent J, 2008, 19(1): 77-82

[30] WrightEFManual of Temporomandibular Disorders, 2007, 209(6): 322

[31] LeiJ, YapAUJ, LiY, et al.. Clinical protocol for managing acute disc displacement without reduction: a magnetic resonance imaging evaluation. Int J Oral Maxillofac Surg, 2020, 49(3): 361-368

[32] ContiPC, MirandaJE, ContiAC, et al.. Partial time use of anterior repositioning splints in the management of TMJ pain and dysfunction: a one-year controlled study. J Appl Oral Sci, 2005, 13(4): 345-350

[33] TeccoS, CaputiS, TeteS, et al.. Intra-articular and muscle symptoms and subjective relief during TMJ internal derangement treatment with maxillary anterior repositioning splint or SVED and MORA splints: A comparison with untreated control subjects. Cranio, 2006, 24(2): 119-129

[34] MaZ, XieQ, YangC, et al.. Can anterior repositioning splint effectively treat temporomandibular joint disc displacement?. Sci Rep, 2019, 9(1): 534

[35] ChenHM, LiuMQ, YapAU, et al.. Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis. J Oral Rehabil, 2017, 44(9): 664-672

[36] ContiPC, CorreaAS, LaurisJR, et al.. Management of painful temporomandibular joint clicking with different intraoral devices and counseling: a controlled study. J Appl Oral Sci, 2015, 23(5): 529-535

[37] KurtH, MumcuE, SulunT, et al.. Comparison of Effectiveness of Stabilization Splint, Anterior Repositioning Splint and Behavioral Therapy in Treatment of Disc Displacement with Reduction. Turk Fiz Tip Rehab D, 2011, 57(1): 25-30

[38] MadaniAS, MirmortazaviA. Comparison of three treatment options for painful temporomandibular joint clicking. J Oral Sci, 2011, 53(3): 349-354

[39] TeccoS, TeteS, CrincoliV, et al.. Fixed orthodontic therapy in temporomandibular disorder (TMD) treatment: an alternative to intraoral splint. Cranio, 2010, 28(1): 30-42

[40] TallentsRH, KatzbergRW, MacherDJ, et al.. Use of protrusive splint therapy in anterior disk displacement of the temporomandibular joint: A 1- to 3-year follow-up. J Prosthet Dent, 1990, 63(3): 336-341

[41] TeccoS, FestaF, SaliniV, et al.. Treatment of joint pain and joint noises associated with a recent TMJ internal derangement: a comparison of an anterior repositioning splint, a full-arch maxillary stabilization splint, and an untreated control group. Cranio, 2004, 22(3): 209-219

[42] HersekN, UzunG, CindasA, et al.. Effect of anterior repositioning splints on the electromyographic activities of masseter and anterior temporalis muscles. Cranio, 1998, 16(1): 11-16

[43] ShiT, YingL, GuoY, et al.. Efficacy Evaluation of Anterior Repositioning Splint in the Treatment of Temporomandibular Joint Disc Intermittent Locking. J Oral Sci Res (Chinese), 2018, 34(03): 282-285

[44] JungYW, ParkSH, OnSW, et al.. Correlation between clinical symptoms and magnetic resonance imaging findings in patients with temporomandibular joint internal derangement. J Korean Assoc Oral Maxillofac Surg, 2015, 41(3): 125-132

[45] KuritaH, KurashinaK, OhtsukaA, et al.. Change of position of the temporomandibular joint disk with insertion of a disk-repositioning appliance. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998, 85(2): 142-145

[46] RoyleD. TMJ Disorders — Management of the cranio-mandibular complex. Physiotherapy, 1988, 74(11): 590

[47] FuKY, ZhangHB, ZhaoYP, et al.. Comparative study on the clinical appearances between acute and chronic anterior disc displacement without reduction. Zhonghua Kou Qiang Yi Xue Za Zhi (Chinese), 2004, 39(6): 471-474

[48] WestessonPL, LundhH. Temporomandibular joint disk displacement: Arthrographic and tomographic follow-up after 6 months’ treatment with disk-repositioning onlays. Oral Surg Oral Med, Oral Pathol, 1988, 66(3): 271-278

[49] OkesonJP. Long-term treatment of disk-interference disorders of the temporomandibular joint with anterior repositioning occlusal splints. J Prosthet Dent, 1988, 60(5): 611-616

[50] AidarLA, DominguezGC, YamashitaHK, et al.. Changes in temporomandibular joint disc position and form following Herbst and fixed orthodontic treatment. Angle Orthod, 2010, 80(5): 843-852

[51] JoondephDR. Long-term stability of mandibular orthopedic repositioning. Angle Orthodontist, 1999, 69(3): 201-209

[52] SchuppW, HaubrichJ, NeumannI. Invisalign(®) treatment of patients with craniomandibular disorders. Int Orthod, 2010, 8(3): 253-267

[53] Al-MoraissiEA, FareaR, QasemKA, et al.. Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg, 2020, 49(8): 1042-1056

[54] OrensteinES. Anterior repositioning appliances when used for anterior disk displacement with reduction—a critical review. Cranio, 1993, 11(2): 141-145

[55] LakshmiM, KalekhanS, MehtaR, et al.. Occlusal Splint Therapy in Temporomandibular Joint Disorders: An Update Review. J Int Oral Health, 2016, 8: 639-645

[56] LotzeM, LucasC, DominM, et al.. The cerebral representation of temporomandibular joint occlusion and its alternation by occlusal splints. Hum Brain Mapp, 2012, 33(12): 2984-2993

[57] PitaMS, RibeiroAB, GarciaAR, et al.. Effect of occlusal splint thickness on electrical masticatory muscle activity during rest and clenching. Braz Oral Res, 2011, 25(6): 506-511