Original Contribution  |   June 2019
Evaluation of the Use of a Force Diagram in the Management of Temporomandibular Joint Sounds: A Prospective Cross-sectional Study
Author Notes
  • From the School of Dentistry at Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) in Porto Alegre, Brazil (Mr N.S. Saueressig); Clínica Proral – Prevenção e Reabilitação Oral in Porto Alegre, Brazil (Ms Saueressig Hickert); Information Technology at PUCRS (Dr de Andrade); the Department of Statistics in the School of Mathematics at PUCRS (Dr Bittencourt); the Department of Physics at PUCRS (Mr Basso); and the Orthodontics and Oral Implantology at the Clínica Proral – Prevenção e Reabilitação Oral in Porto Alegre, Brazil (Mr N.G. Saueressig). 
  • Financial Disclosure: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Nilton Sodi Saueressig, MSc, Alameda Emílio de Menezes, 75/601, Três Figueiras, 91340-360 - Porto Alegre, RS Brazil. Email: niltonsaueressig@gmail.com
     
Article Information
Neuromusculoskeletal Disorders
Original Contribution   |   June 2019
Evaluation of the Use of a Force Diagram in the Management of Temporomandibular Joint Sounds: A Prospective Cross-sectional Study
The Journal of the American Osteopathic Association, June 2019, Vol. 119, 349-356. doi:10.7556/jaoa.2019.063
The Journal of the American Osteopathic Association, June 2019, Vol. 119, 349-356. doi:10.7556/jaoa.2019.063
Web of Science® Times Cited: 1
Abstract

Context: Occlusal splints are widely used in clinical practice as a noninvasive treatment for patients with temporomandibular disorders (TMDs) and for reduction of TMD-related symptoms. A force diagram allows a health care professional to evaluate the interactions of loads caused by muscular effort, which are sensed by the teeth and the temporomandibular joint during the protrusive movement of the mandible.

Objective: To evaluate the efficacy of occlusal splints combined with occlusal adjustment (OA) based on a force diagram in the management of joint sounds (clicking and crepitation).

Methods: Patients were examined clinically and administered a questionnaire for the diagnosis of TMD and orofacial pain. Patients were then assigned to 1 of 2 splint therapies: (1) an anterior bite plane of the front-plateau type (FP) or (2) a maxillary muscle relaxation appliance (MRA), both combined with OA based on a force diagram performed at 6 visits, with an interval of 24 to 48 hours between each visit. To measure the effects of treatment, at each of the 6 visits, patients also rated the severity of their TMD-related symptoms on a visual analog scale. Data were dichotomized into presence and absence of symptoms and compared using the McNemar test.

Results: A total of 199 patients were included in the study. At baseline, 38 patients (19.1%) had crepitation and 161 (80.9%) had clicking. A total of 150 patients were treated with FP+OA, with a statistically significant reduction in the number of patients reporting clicking (42.6%, P<.001) and crepitation (42.9%, P<.001). Among patients treated with MRA+OA (n=49), there was a statistically significant reduction in the number of patients reporting clicking (50%, P<.001). All 3 patients with crepitation in the MRA+OA group reported total remission (P>.05).

Conclusion: The 2 treatment strategies, FP+OA and MRA+OA, improved both clicking and crepitation. Both strategies prioritize the concept of mutually protected occlusion, in which all jaw and temporomandibular joint movements must synchronize, which may be conveniently done using the force diagram.

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