The effect of non-surgical management of TM disorders

One hundred and ninety-three patients with varying occlusal discrepancies were diagnosed as having TM disorders with orofacial pain. They were divided into five groups with similar clinical symptomatology. There were 84 patients with clicking, 45 with headaches, 13 with neckaches, 39 with tenderness in the TMJ bilaterally and masticatory muscles and 12 with uncomfortable occlusal relationships. All were given an anterior deprogrammer to wear for a period of one week in order to relax the masticatory muscles and allow the jaw to return to a physiologic position. The follow-up occlusal device therapy varied according to clinical symptoms. The group with clicking wore anterior repositioning orthopedic devices to recapture the displaced articular disc, followed by a gradual return to a centric relation position. The other groups wore centric relation appliances providing even posterior cusp tip contacts and anterior guidance. All patients wore the appliances for varying periods, up to one year, with monthly adjustments. The clinical symptoms significantly decreased, and all but 4 patients who had to be treated surgically, had the malocclusion corrected at the same treatment position of the centric relation appliances that were worn for one year. The results suggest that short-term occlusal device therapy is effective as an interim method towards the correction of occlusal discrepancies, but should be followed by a final treatment that will maintain the jaw in an asymptomatic and physiologic position. Four-year re-evaluations revealed no reoccurrence of chronic symptoms after finalization treatment.