Srpski arhiv za celokupno lekarstvo 2023 Volume 151, Issue 3-4, Pages: 165-171
https://doi.org/10.2298/SARH220227028D
Full text (
1837 KB)
Assessment of condylar position in asymptomatic individuals before and after neuromuscular deprogramming with a stabilization splint
Demirović Kenan 
(Demirović Private Practice for Orthodontics and Dentofacial Orthopedics, Sarajevo, Bosnia and Herzegovina), kenandirovic@hotmail.com
Demirović Elma (Prim. dr. Abdulah Nakas General hospital, Emergency Department, Sarajevo, Bosnia and Herzegovina)
Džemidžić Vildana (University of Sarajevo, School of Dental Medicine, Department of Orthodontics, Sarajevo, Bosnia and Herzegovina)
Nakas Enita (University of Sarajevo, School of Dental Medicine, Department of Orthodontics, Sarajevo, Bosnia and Herzegovina)
Introduction/Objective. Deprogramming of the neuromuscular system with the use of stabilization splint might provide more precise evaluation of the centric relation (CR) – maximum intercuspation (MI) discrepancy. The study aimed to evaluate the differences between the bite registrations obtained in the CR before and after the application of the stabilization splint therapy. Methods. The sample included 48 non-deprogrammed individuals without any apparent signs and symptoms of temporomandibular disorders (TMDs). The neuromuscular system was deprogrammed by employing stabilization splint therapy. A condylar displacement evaluation was performed on vertical, horizontal, and transverse planes of space, with the assistance of a condylar position indicator. Results. The mean values of condylar displacements, which were obtained after the deprogramming of the neuromuscular system, were significantly greater than those obtained before neuromuscular deprogramming for vertical condylar displacement (p < 0.0001). A greater degree of condylar distraction was observed on the left side of the vertical plane before (p < 0.01) and after neuromuscular deprogramming (p < 0.05). The highest level of condylar displacement occurred in the postero-inferior direction subsequent to the muscle deprogramming. Conclusion. It was observed that the level of average condylar displacements was significantly higher following the deprogramming of the neuromuscular system compared to that recorded before neuromuscular deprogramming using stabilization splint therapy. A more precise orthodontic diagnosis could have been obtained if the condyles were placed in a more exact CR position by muscle deprogramming.
Keywords: centric relation, maximum intercuspation, stabilization splint, condylar displacement
Show references
Kattadiyil MT, Alzaid AA, Campbell SD. The relationship between centric occlusion and the maximal intercuspal position and their use as treatment positions for complete mouth rehabilitation: Best evidence consensus statement. J Prosthodont. 2021;30(S1):26-33. [DOI: 10.1111/jopr.13316] [PMID: 33783091]
Cordray FE. Three-dimensional analysis of models articulated in the seated condylar position from a deprogrammed asymptomatic population: a prospective study. Part 1. Am J Orthod Dentofacial Orthop. 2006;129(5):619-30. [DOI: 10.1016/j.ajodo.2004.10.015] [PMID: 16679202]
Crawford SD. Condylar axis position, as determined by the occlusion and measured by the CPI instrument, and signs and symptoms of temporomandibular dysfunction. Angle Orthod. 1999;69(2):103-16. [DOI: 10.1043/0003-3219(1999)069<0103:CAPADB>2.3.CO;2] [PMID: 10227550]
Slavicek R. Clinical and instrumental functional analysis and treatment planning. Part 4. Instrumental analysis of mandibular casts using the mandibular position indicator. J Clin Orthod. 1988;22(9):566-75. [PMID: 3267702]
Lee G-H, Park JH, Lee S-M, Kim E-J, Lim S-W, Moon D. An orthodontic treatment case of a TMD patient with maxillary posterior intrusion using TSADs. Applied Sciences. 2022;12(23):12098. [DOI: 10.3390/app122312098]
Okeson JP. Management of Temporomandibular Disorders and Occlusion. 8th ed. St Louis, Mo: CV Mosby; 2020.
Fantini SM, Paiva JB, Rino Neto J, Dominguez GC, Abrao J, Vigoritto JW. Increase of condylar displacement between centric relation and maximal habitual intercuspation after occlusal splint therapy. Braz Oral Res. 2005;19(3):176-82. [DOI: 10.1590/s1806-83242005000300004] [PMID: 16308604]
Park JH, Lee SM, Moon DN, Lee GH. Clinical application of a maximum intercuspal position-centric relation occlusion conversion of a lateral cephalogram in the treatment of orthodontic patients. Am J Orthod Dentofac Orthop Clin Companion. 2021;1(2):127-35. [DOI: 10.1016/j.xaor.2021.04.001]
Proffit WR. Contemporary Orthodontics. St Louis, Mo: CV Mosby; 1986. p. 134.
Cordray FE. Articulated dental cast analysis of asymptomatic and symptomatic populations. Int J Oral Sci. 2016;8(2):126-32. [DOI: 10.1038/ijos.2015.44] [PMID: 27357324]
Roth RH. Functional occlusion for the orthodontist. J Clin Orthod. 1981a;15(1):32-51. [PMID: 6940863]
Utt TW, Meyers CE Jr, Wierzba TF, Hondrum SO. A three-dimensional comparison of condylar position changes between centric relation and centric occlusion using the mandibular position indicator. Am J Orthod Dentofacial Orthop. 1995;107(3):298-308. [DOI: 10.1016/s0889-5406(95)70146-x] [PMID: 7879763]
Nokar S, Sadighpour L, Shirzad H, Shahrokhi Rad A, Keshvad A. Evaluation of signs, symptoms, and occlusal factors among patients with temporomandibular disorders according to Helkimo index. Cranio. 2019;37(6):383-8. [DOI: 10.1080/08869634.2018.1449781] [PMID: 29602287]
Ramachandran A, Jose R, Tunkiwala A, Varma RB, M Shanmugham A, Nair PK, et al. Effect of deprogramming splint and occlusal equilibration on condylar position of TMD patients - A CBCT assessment. Cranio. 2021;39(4):294-302. [DOI: 10.1080/08869634.2019.1650216] [PMID: 31451061]
Nemes B, Frank D, Puigdollers A, Martin D. Occlusal splint therapy followed by orthodontic molar intrusion as an effective treatment method to treat patients with temporomandibular disorder: A Retrospective study. Appl Sci. 2021;11:7249. [DOI: 10.3390/app11167249]
Al-Moraissi EA, Farea R, Qasem KA, Al-Wadeai MS, Al-Sabahi ME, Al-Iryani GM. Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: Network metaanalysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2020;49(8):1042-56. [DOI: 10.1016/j.ijom.2020.01.004] [PMID: 31982236]
Yoon YJ, Kim KW. The influence of stabilization splint on condylar position and craniofacial morphology. Korea J Orthod. 1995;25(6):675-88.
Wood DP, Korne PH. Estimated and true hinge axis: a comparison of condylar displacements. Angle Orthod. 1992;62(3):167-75. [DOI: 10.1043/0003- 3219(1992)062<0167:EATHAA>2.0.CO;2] [PMID: 1416235]
Utz KH, Luckerath W, Schwarting P, Noethlichs W, Buttner R, Gruner M, et al. Is there “a best” centric relation record? Centric relation records, condyle positions, and their practical significance. Int J Prosthodon. 2022;14(4):291-316. [DOI: 10.11607/ijp.7786] [PMID: 36484682]
Padala S, Padmanabhan S, Chithranjan AB. Comparative evaluation of condylar position in symptomatic (TMJ dysfunction) and asymptomatic individuals. Indian J Dent Res. 2012;23(1):122. [DOI: 10.4103/0970-9290.99060] [PMID: 22842268]
Oh JW, Ahn YW, Jeong SH, Ju HM, Song BS, Ok SM. Prediction of anterior open-bite development after stabilization splint treatment in patients with temporomandibular disorder. Cranio. 2022;40(4):324-33. [DOI: 10.1080/08869634.2020.1792220] [PMID: 32657259]
Lim WH, Choi B, Lee JY, Ahn SJ. Dentofacial characteristics in orthodontic patients with centric relation-maximum intercuspation discrepancy. Angle Orthod. 2014;84(6):939-45. [DOI: 10.2319/123013-949.1] [PMID: 24673658]
Parreiras Ferreira R, Isaias Seraidarian P, Santos Silveira G, Campolina Rebello Horta M, Martin Palomo J, Andrade I Jr. How a Discrepancy Between Centric Relation and Maximum Intercuspation Alters Cephalometric and Condylar Measurements. Compend Contin Educ Dent. 2020;41(4):e1-e6. [PMID: 32250125]
Zhao M, Wang P, Wang H, Li X, Bai D, Tian Y. Diagnostic and treatment protocol for a patient with temporomandibular disorder using a stabilization splint and temporary anchorage devices. Am J Orthod Dentofacial Orthop. 2021;159(5):666-81. [DOI: 10.1016/j.ajodo.2020.05.015] [PMID: 33653641]
Lee GH, Park JH, Lee SM, Moon DN. Orthodontic Treatment Protocols for Patients with Idiopathic Condylar Resorption. J Clin Pediatr Dent. 2019;43(4):292-303. [DOI: 10.17796/1053-4625-43.4.12] [PMID: 31094632]
He S, Wang S, Song F, Wu S, Chen J, Chen S. Effect of the use of stabilization splint on masticatory muscle activities in TMD patients with centric relation-maximum intercuspation discrepancy and absence of anterior/lateral guidance. Cranio. 2021;39(5):424-32. [DOI: 10.1080/08869634.2019.1655861] [PMID: 31429383]
Đorđević I, Todorović A, Lazić V, Obradović-Đuričić K, Milekić B, Stamenković D. Occlusal appliances - an alternative in pain treatment of temporomandibular disorders. Srp Arh Celok Lek. 2019;147(9-10):541-6. [DOI: 10.2298/SARH190118064D]
Vrbanović E, Alajbeg IZ. Long-term effectiveness of occlusal splint therapy compared to placebo in patients with chronic temporomandibular disorders. Acta Stomatol Croat. 2019;53(3):195-206. [DOI: 10.15644/asc53/3/1] [PMID: 31749451]
Milojević-Šamanović A, Zdravković D, Veličković S, Jovanović M, Milosavljević M. Non- invasive approach in the treatment of temporomandibular joint osteoarthritis. Srp Arh Celok Lek. 2021;149(1-2):97-101. [DOI: 10.2298/SARH200611079M]
He SS, Deng X, Wamalwa P, Chen S. Correlation between centric relation-maximum intercuspation discrepancy and temporomandibular joint dysfunction. Acta Odontol Scand. 2010;68(6):368-76. [DOI: 10.3109/00016357.2010.517552] [PMID: 209426]