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Treatment of TMJ
arthropathy
There are three levels to address in the treatment of
dysfunctional TMJ conditions:
- Treatment of pain
- Treatment of
the pathology (degenerative arthropathy)
- Treatment of function (functional
reconditioning)
For the
treatment of pain we refer you back to the previous paragraph.
The treatment
of the underlying pathology (degenerative inflammatory arthropathy), should aim
at controlling predisposing and contributing factors, as well as those
considered the cause (etiological), in each single case (parafunctional habits, hypermobility,
malocclusion, occlusal discrepancies, etc.).
It is evident therefore,
that each of these factors will require specific treatment according to what
seems most appropriate. This could be: orthodontic treatment, orthognathic
surgery, exercises to improve active control of movement, minimal occlusal
remodelling, etc.
Treatment should not follow any pre-ordained
scheme, but should provide a personalized programme of rehabilitation for
occlusal masticatory function that will aim at re-educating the function of the
joints and muscles.
The treatment of function
(functional reconditioning), is based on the practice under supervision of a
physical therapist, at least twice weekly, of a personalized set of therapeutic
exercises for the mandible. These should be programmed according to the specific
needs of the case, and the effects of the prescribed exercises should be
carefully monitored. (Fig. 23 - 26).
The intermittent application
of occlusal splints permits decompression and the redistribution of the
intra-articular loading, as well as the stabilisation of positive results
achieved with the programme of therapeutic exercise.
The bite plane types of
occlusal splints proposed by different authors are very varied as are also the
materials used in their manufacture. (Fig. 28)
However, of these, the
fundamental appliance types that in our experience, are the best in terms of
efficacy, and comfort over a long period of use, can be reduced to the following
three, that we have named for the sake of simplicity:
- FLOS (Flat Occlusal Splint);
- MARES (Mandible
Repositioning Splint);
- STAS (Stabilization Splint).
The
more salient characteristics of these splints are described as follows:
1. FLOS (Flat
Occlusal Splint)
- Resin appliance covering the entire occlusal surface and
applied to the superior arch;
- Buccal extension up to the midline of the
dental crowns;
- Lingual extension for circa 1 - 1.5cms from the cervical
edge of the palatal gums in the direction of the palate;
- Smooth occlusal
surface with point contact for each tooth of the opposing arch;
- Canine
guidance for lateral movements with a minimal incline so as to disocclude the
posterolateral groups;
- Anterior guidance for movements of protrusion with a
minimal incline so as to disocclude the posterolateral groups.
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FLOS |
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| Occlusal
Splint (FLOS type as described by Ciancaglini et al. from Notions of
Mandibular Orthopaedics and Dentistry in Infancy and Growth. Ed. CPA 1992)
at the last stage of manufacture (in the laboratory). |
Occlusal
Splint (FLOS type) positioned in the patientīs mouth, teeth in contact (in
occlusion). |
2. MARES
(Mandibular Repositioning Splint);
- Resin appliance covering the
entire occlusal surface and applied to the inferior arch;
- Buccal extension
to the midline of the dental crowns;
- Lingual extension for circa 0.5cms
lingually from the marginal crest of the gums in the direction of the mouth
floor;
- Interlocking occlusal surface with slight indentations for each
tooth cusp of the opposing arch;
- Canine guidance for lateral movements with
just sufficient incline to disocclude the lateral groups;
- Anterior guidance
for protrusion movements with just enough incline to disocclude the
posterolateral groups;
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MARES
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| MARES type occlusal
splint (applied to the inferior arch). |
3. STAS
(Stabilization Splint)
- Resin appliance covering the entire occlusal surface
and applied to the superior arch;
- Buccal extension up to the midline of the
dental crowns;
- Lingual extension for circa 1 - 1.5cms from the cervical
margin of the palatal gums in the direction of the palate;
- Interlocking
occlusal surface with slight indentations for each tooth cusp of the opposing
arch;
- Canine guidance for lateral movements with just enough incline to
disocclude the posterolateral groups;
-Anterior guidance for protrusion
movements with just enough incline to disocclude the posterolateral
groups.
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STAS |
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| STAS type occlusal
splint (applied to the superior arch). |
The FLOS type appliance is
indicated where there is a need to decompress and promote intracapsular healing
in a severely arthrotic joint. It will assist functional reconditioning.
The
MARES type appliance is indicated where there is the need to promote a correct
realignment of the condyle with the meniscal and temporal components of the
joint, and at the same time, healing of the synovial tissues.
The STAS type
appliance is indicated where there is the need to readjust muscle and joint
function to a new occlusal setting, at the end of occlusal, orthopaedic and
orthopaedic - mandibular treatments. In this way a progressive adaptation of
function is achieved.
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