ABSTRACT:

Disorders of the temporomandibular joint (TMJ) are chronic conditions that involve pain, muscle spasm, and dysfunction of the joint and surrounding structures. Occlusal appliances have come to be regarded as essential tools in the non-surgical treatment of these disorders as they help in the management of symptoms and protection of teeth and the structures of the TMJ. In various types of reviews of occlusal appliances, including stabilization splints, anterior and posterior bite planes, repositioning devices, and soft appliances, are discussed in detail with regard to their mechanism of action, indications, and limitations. Improvements in the material and the fabrication method, such as printing, have enhanced CAD/CAM systems accuracy and comfort, as well as the patients’ cooperation in the use of these appliances. Thus, combining occlusal appliances with other treatments, including physiotherapy and Botox, offers a systemic approach to TMJ treatment, dealing with both appliances mechanical help and muscular factors. reduction Although there are certain risks involved, like occlusal changes and discomfort, which need close observation and patient counselling, of occlusal pain, muscle hyperactivity, and joint loading. This review focuses on the need to choose the right appliance, make the right fabrication and to ensure that there is a follow up to check on the progress of the patient. Further developments and multi-disciplinary work will continue to improve the effectiveness and applicability of occlusal appliances in the treatment of TMJ disorders.

REFERENCES :

1) González-Sánchez B, García Monterey P, Ramírez-Durán MDV, Garrido-Ardila EM, Rodríguez-Mansilla J, Jiménez-Palomares M. Temporomandibular Joint Dysfunctions: A Systematic Review of Treatment Approaches. J Clin Med. 2023 Jun 20;12(12):4156. doi: 10.3390/jcm12124156. PMID: 37373852; PMCID: PMC10299279.
2) Nazir O, Sonali, Singh R, Tantray M, Farhaan D. Occlusal appliance therapy: A review. IP Ann Prosthodont Restor Dent. 2021; 7:84-86. doi: 10.18231/j.aprd.2021.017.
3) Ferreira GF, Carletti TM, Gama LT, Magno MB, Maia LC, Rodrigues Garcia RCM. Influence of occlusal appliances on the masticatory muscle function in individuals with sleep bruxism: A systematic review and meta-analysis. Eur J Oral Sci. 2024 Apr;132(2): e12979. doi: 10.1111/eos.12979. Epub 2024 Feb 29. PMID: 38421263.
4) Singh BP, Singh N, Jayaraman S, Kirubakaran R, Joseph S, Muthu MS, et al. Occlusal interventions for managing temporomandibular disorders. Cochrane Database Syst Rev. 2024 Sep 16;9(9):CD012850. doi: 10.1002/14651858.CD012850.pub2. PMID: 39282765; PMCID: PMC11403706.
5) Rodrigues D, Berto R, Oliveira A, Bérzin F. Does masticatory muscle hyperactivity occur in individuals presenting temporomandibular disorders? Braz J Oral Sci. 2008;7(24). doi: 10.20396/bjos. v7i24.8643020.
6) Thomas DC, Singer SR, Markman S. Temporomandibular Disorders and Dental Occlusion: What Do We Know so Far? Dent Clin North Am. 2023 Apr;67(2):299-308. doi: 10.1016/j.cden.2022.11.002. Epub 2023 Feb 1. PMID: 36965932.
7) Baeshen HA. Malocclusion trait and the parafunctional effect among young female school students. Saudi J Biol Sci. 2021 Jan;28(1):1088-1092. doi: 10.1016/j.sjbs.2020.11.028. Epub 2020 Nov 11. PMID: 33424403; PMCID: PMC7783814.
8) Alkhutari AS, Alkhulayfi B, Moreno-Hay I, de Leeuw R, Alrayyes S, Christidis N. Is the therapeutic effect of occlusal stabilization appliances more than just placebo effect in the management of painful temporomandibular disorders? A network meta-analysis of randomized clinical trials. J Prosthet Dent. 2021;126(1):24-33.
9) Kreiner M, Betancor E, Clark GT. Occlusal stabilization appliances. Evidence of their efficacy. J Am Dent Assoc. 2001 Jun;132(6):770-7. doi: 10.14219/jada.archive.2001.0274. PMID: 11433856.
10) Türp JC, Komine F, Hugger A. Efficacy of stabilization splints for the management of patients with masticatory muscle pain: a qualitative systematic review. Clin Oral Investig. 2004 Dec;8(4):179-95. doi: 10.1007/s00784-004-0265-4. Epub 2004 Jun 4. PMID: 15179561.
11) Conti PC, dos Santos CN, Kogawa EM, de Castro Ferreira Conti AC, de Araujo Cdos R. The treatment of painful temporomandibular joint clicking with oral splints: a randomized clinical trial. J Am Dent Assoc. 2006 Aug;137(8):1108-14. doi: 10.14219/jada.archive.2006.0349. PMID: 16873326.
12) Schmitter M, Zahran M, Duc JM, Henschel V, Rammelsberg P. Conservative therapy in patients with anterior disc displacement without reduction using 2 common splints: a randomized clinical trial. J Oral Maxillofac Surg. 2005 Sep;63(9):1295-303. doi: 10.1016/j.joms.2005.05.294. PMID: 16122593.
13) Ahila S, Anitha KV, Thulasingam C. The scope of bite plane on the prospective of TMJ disorders: Case reports. Res J Pharm Biol Chem Sci. 2015; 6:1423-1429.
14) Guo YN, Cui SJ, Zhou YH, Wang XD. An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders. Curr Med Sci. 2021 Jun;41(3):626-634. doi: 10.1007/s11596-021-2381-7. Epub 2021 Jun 25. PMID: 34169428.
15) Seifeldin SA, Elhayes KA. Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs). Saudi Dent J. 2015 Oct;27(4):208-14. doi: 10.1016/j.sdentj.2014.12.004. Epub 2015 Jun 25. PMID: 26644756; PMCID: PMC4642186.
16) Lei Q, Lin D, Liu Y, Lin K, Huang W, Wu D. Neuromuscular and occlusion analysis to evaluate the efficacy of three splints on patients with bruxism. BMC Oral Health. 2023 May 25;23(1):325. doi: 10.1186/s12903-023-03044-5. PMID: 37231466; PMCID: PMC10214705.
17) Akat B, Görür SA, Bayrak A, Eren H, Eres N, Erkcan Y, et al. Ultrasonographic and electromyographic evaluation of three types of occlusal splints on masticatory muscle activity, thickness, and length in patients with bruxism. Cranio. 2023 Jan;41(1):59-68. doi: 10.1080/08869634.2020.1820685. Epub 2020 Sep 16. PMID: 32936747.
18) Rugh JD, Solberg WK. Psychological implications in temporomandibular pain and dysfunction. Oral Sci Rev. 1976; 7:3-30. PMID: 775369.
19) Dalewski B, Chruściel-Nogalska M, Frączak B. Occlusal splint versus modified nociceptive trigeminal inhibition splint in bruxism therapy: a randomized, controlled trial using surface electromyography. Aust Dent J. 2015 Dec;60(4):445-54. doi: 10.1111/adj.12259. PMID: 25439631.
20) Babiuc I, Ciur L, Păuna M, Burlibașa M, Tanase G, Burlibasa L, et al. Fabrication of an Occlusal Appliance Using a Fully Digital Protocol: A Technical Report. Acta Med Transilvanica. 2020; 25:69-71. doi: 10.2478/amtsb-2020-0036.
21) Srivastava R, Jyoti B, Devi P. Oral splint for temporomandibular joint disorders with revolutionary fluid system. Dent Res J (Isfahan). 2013 May;10(3):307-13. PMID: 24019797; PMCID: PMC3760352.
22) Albagieh H, Alomran I, Binakresh A, Alhatarisha N, Almeteb M, Khalaf Y, et al. Occlusal splints-types and effectiveness in temporomandibular disorder management. Saudi Dent J. 2023 Jan;35(1):70-79. doi: 10.1016/j.sdentj.2022.12.013. Epub 2022 Dec 28. PMID: 36817028; PMCID: PMC9931504.
23) Amorim CF, Vasconcelos Paes FJ, de Faria Junior NS, de Oliveira LV, Politti F. Electromyographic analysis of masseter and anterior temporalis muscle in sleep bruxers after occlusal splint wearing. J Bodyw Mov Ther. 2012 Apr;16(2):199-203. doi: 10.1016/j.jbmt.2011.04.001. Epub 2011 May 24. PMID: 22464117.
24) Ram HK, Shah DN. Comparative evaluation of occlusal splint therapy and muscle energy technique in the management of temporomandibular disorders: A randomized controlled clinical trial. J Indian Prosthodont Soc. 2021 Oct-Dec;21(4):356-365. doi: 10.4103/jips.jips_332_21. PMID: 34810363; PMCID: PMC8617449.
25) Zhang C, Wu JY, Deng DL, He BY, Tao Y, Niu YM, et al. Efficacy of splint therapy for the management of temporomandibular disorders: A meta-analysis. Oncotarget. 2016; 7:84043–53. doi: 10.18632/oncotarget.13059.
26) Poorna TA, John B, EK J, Rao A. Comparison of the effectiveness of soft and hard splints in the symptomatic management of temporomandibular joint disorders: A randomized control study. Int J Rheum Dis. 2022 Sep;25(9):1053-9. doi: 10.1111/1756-185X.14379. Epub 2022 Jul 4. PMID: 35785423.
27) Al-Ibrahemy AA, Saka SM, Abdulla HI. The role of occlusal splints (soft and hard) in the management of Myofascial Pain Dysfunction Syndrome. Journal of baghdad college of dentistry. 2011;23(2).
28) Zhang FY, Wang XG, Dong J, Zhang JF, Lü YL. Effect of occlusal splints for the management of patients with myofascial pain: A randomized, controlled, double-blind study. Chin Med J (Engl). 2013; 126:2270–5.