This somewhat surprising conclusion comes from a recent study published in Cranio (The Journal of Craniomandibular Practice) – here: http://tiny.cc/NzyA2

“The use of a fixed orthodontic appliance seems to be as efficacious as the use of an AR maxillary splint in the treatment of joint pain and muscle pain, but not in the treatment of joint noise.”

It’s interesting to speculate why there isn’t a direct link between the pain from a joint and the noises it makes, but I suspect this is something many of us have already noticed. It’s the reason why we don’t treat noises alone of course. The concept of using a fixed appliance in place of an ARA is definitely food for thought and worthy of further study.

Fixed Orthodontic Therapy in Temporomandibular Disorder (TMD) Treatment: An Alternative to Intraoral Splint
Simona Tecco D.D.S., Ph.D.; Stefano Teté, D.D.S.; Vito Crincoli, D.M.D.;Mario Armando Festa, M.A.; Felice Festa, M.D., D.D.S., M.S., Ph.D.
Volume 28 Issue 1 January 2010
Abstract:
This study evaluated the use of a fixed orthodontic appliance in treatment of temporomandibular disorder (TMD) compared to the use of an intra-oral splint. Fifty (50) adult patients, with confirmed anterior disk displacement with reduction in at least one temporomandibular joint (TMJ), were divided into three groups: 20 patients treated with AR splint (Group I); 20 patients treated with a fixed orthodontic appliance (Group II) and 10 patients who underwent no treatment (Control Group). Joint pain, joint noise, muscle pain, and subjective relief were evaluated monthly before the treatment began (T0) and for six months thereafter. Subjects in Group I and Group II displayed a significant decrease in joint pain (p<0.01) from T2 and in muscle pain from T1 (p<0.01)  to T6. Subjects in Group I showed a higher decrease in the frequency of joint noise (p<0.05) from T1  to T6, compared with Group II. At T2 and T3, the patients in Group II reported a significantly lower discomfort level associated with the devices than subjects treated with the AR splint (p<0.05). However, at T5 and T6, this observation was inverted.  The use of a fixed orthodontic appliance seems to be as efficacious as the use of an AR maxillary splint in the treatment of joint pain and muscle pain, but not in the treatment of joint noise. These results are valid, at least for the short-term clinical results (first six months of treatment). Clinical implications for  long-term use are not clarified by these results.

An interesting and thought-provoking position paper on the thorny question of the how, when and by how much we can change the Vertical Dimension of Occlusion (VDO) appeared in the International Journal of Stomatology & Occlusion Medicine recently.

Written by a group of dentists from the South of France, there is an excellent discussion and some great illustrations of treated cases, both involving a decrease in VDO and a couple of cases requiring significant increase.

The full text of the article is here http://www.springerlink.com/content/980×123746515623/fulltext.pdf

Here’s a case I completed last year that nicely illustrates the issue of just how much you can increase VDO when you really have to, and it’s a lot more than most of us were taught was possible as undergraduates!

They don't get much more over-closed than this, so a huge increase in VDO is unavoidable

The finished case - you'll have to attend our ARS Course if you want to learn how to do this!

A 4-year study comparing 2 groups of Finnish females, one of which had occlusal equilibration and a control group that had adjustments to non-occluding tooth surfaces, has been published in the European Journal of Orthodontics.

The equilibrated group requested significantly less treatment for problems affecting the head and neck region compared with the control group over the four years of the study.

This result is at odds with conventional wisdom and supports the use of occlusal equilibration as a preventative measure.

European Journal of Orthodontics. 2009 Oct;31(5):490-5.

Health risk from occlusal interferences in females.

Kirveskari P, Jämsä T

Institute of Dentistry, University of Turku, Finland. penkir@utu.fi

The purpose of the present study was to test the effect of elimination of occlusal interferences on the incidence of requests for treatment of symptoms in the head and cervicobrachial region. One hundred and twelve females 45 years of age or under, were randomly divided into a treatment group (n = 54) and a control group (n = 58). The former underwent occlusal adjustment and the latter grinding that did not affect occlusal contacts. The treatments were repeated every 12 months over a period of 4 years. The outcome variable was a spontaneous request for treatment. Statistical analyses included chi-square tests for categorical variables and a t- or Wilcoxon ranked sum test for continuous variables. Poisson regression was used to compare the risk of seeking treatment between the groups. The cumulative incidence rate of treatment requests was 2/54 in the treatment group and 11/58 in the control group. The relative risk was 5.12. The 95 per cent confidence limits were 1.14 and 23.1, respectively. The difference between groups was statistically significant (P = 0.0336). Systematic elimination of occlusal interferences significantly reduced the incidence of requests for treatment of symptoms in the head and cervicobrachial region. This is in contrast with the view that there is no, or at best, an insignificant health risk from occlusal interferences.

Optident have announced that the Kois Dento-Facial Analyzer (DFA) Facebow System is now available in the UK once again, having been briefly withdrawn from the market whilst a potential trademark issue was being investigated.

Kois Dento-Facial Analyzer

We think this is great news and a very happy outcome because SDS courses now use the Kois DFA as our primary facebow for recording the relationship between the condyles and the upper jaw. For more information you can view the full instructions here.

SDS are planning to organise a series of evening seminars in conjunction with Optident Ltd to introduce dental professionals to the benefits of using this system in diagnosis, treatment planning and aesthetics.

For more information please contact Optident.

This is where we will be posting regular updates and information regarding our occlusion courses, instructor profiles, course dates and venues, interesting articles and papers, materials, technique and equipment reviews, and anything else you ask for.

Just leave a comment any time.

Warm regards, Andy Lane