Pre-orthodontic splint therapy in adult TMD patients: a retrospective CBCT study
TL;DR
In this small retrospective uncontrolled sample, splint therapy was associated with reductions in selected self-reported symptoms and changes in the first centric-relation contact point, while most CBCT joint-space measurements showed no statistically significant pre-post differences.
Abstract
Objective. Temporomandibular disorders (TMDs) involve the temporomandibular joint (TMJ), occlusion, and masticatory muscles. Common symptoms include joint sounds, pain, and restricted or deviated mouth opening. Condylar morphology may undergo physiological or pathological changes over time. Cone-beam computed tomography (CBCT) is widely used to assess these changes. Material and methods. Fifteen adult patients with TMDs and no prior orthodontic history who received splint therapy for 6-8 months were evaluated. Cone-beam computed tomography (CBCT) images obtained before and after therapy were analyzed to measure joint-space distances in the sagittal plane, anterior joint space (AJS), superior joint space (SJS), and posterior joint space (PJS), and in the coronal plane, lateral joint space (LJS), superior joint space (SJS), and medial joint space (MJS). Self-administered questionnaires using a 0–10 visual analog scale assessed subjective symptom severity. First occlusal contact points were evaluated using articulated cast models. Paired t-tests/Wilcoxon signed-rank tests and Fisher’s exact tests were used for statistical analysis. Results. In the CBCT analysis, no statistically significant post-treatment differences were observed for most joint-space parameters. Significant changes were observed for left coronal LJS (p = 0.0426) and left coronal SJS (p = 0.0279). In the questionnaire analysis, TMJ pain (p = 0.0048) and morning muscle fatigue (p = 0.0070) decreased significantly; radiating facial muscle pain did not reach statistical significance (p = 0.0537). The first occlusal contact point in centric relation changed in 14 of 15 patients (93.3%). Conclusion. In this small retrospective uncontrolled sample, splint therapy was associated with reductions in selected self-reported symptoms and changes in the first centric-relation contact point, while most CBCT joint-space measurements showed no statistically significant pre-post differences. The radiographic findings should be regarded as exploratory and require confirmation in larger controlled studies.