Initial treatment of the temporomandibular joint disorder with stabilization splint

Abstract

Temporomandibularni poremećaji najčešći su bolni poremećaji žvačnog sustava nedentalnog porijekla, a zbog kompleksnosti dijagnoze, različitih etiologija te nedovoljno istraženih terapijskih postupaka liječenje takvih poremećaja i dalje se ne smatra dijelom opće kliničke stomatološke prakse. Bol kao glavni simptom i razlog traženja liječničke pomoći nalazimo u svim uzrocima temporomandibularnih poremećaja. Etiologija TMP-a ima bitnu ulogu u daljnjoj terapiji. Najčešćim uzrokom smatra se poremećaj u odnosu kondil-disk, gdje se uz bol pojavljuju i simptomi poput škljocanja, šuštanja ili zakočenosti zgloba. Također, uzroci miogenih bolova ili degenerativnih procesa slične su simptomatologije, zbog čega dolazi do izražaja kompleksnost liječenja TMP-a. Promjena okluzije nekad se smatrala glavnim terapijskim sredstvom koje je pacijentima davalo trenutno olakšanje, no novija istraživanja prednost daju reverzibilnim metodama poput udlaga, farmakoloških metoda i vježbi mišića. Stabilizacijska udlaga često je indicirana u slučajevima boli miogenog karatkera te parafunkcijskog škripanja zubima. Njezina je uloga smanjivanje hiperaktivnosti mišića te stabilizacija zgloba. Riječ je o jednostavnoj metodi s visokim postotkom uspješnosti i širokim spektrom indikacija, zbog čega se smatra metodom izbora kod velikog broja pacijenata s TMP-om. S obzirom na kompleksnost postavljanja dijagnoze, liječenje TMP-a treba usmjeriti k jednostavnijim, reverzibilnim metodama, a agresivniji pristup treba izbjegavati.Temporomandibular disorders are the most frequent painful disorders of the masticatory system of a non-dental origin, and because of the complexity of diagnosis, different etiologies and insufficiently researched therapeutic procedures treating these disorders is still not considered a part of general clinical practice. Pain as the main symptom and the reason of seeking medical help is found in all of the causes of temporomandibular disorders. Etiology of TMD has a significant role in further therapy. The most frequent cause is considered to be the disorder in the condyle-disc relationship, where pain comes along with symptoms such as clicking, rustling and joint stiffness. In addition to this, causes of the myogenic pain manifest similarly, which emphasizes the complexity of treating TMD. Occlusal change was once considered the main therapeutic instrument that provided instant relief for the patients, but latest research prioritize reversible methods like splints, pharmacological methods and muscular exercises. Stabilization splint is indicated very often in cases of myogenic pain and parafunctional teeth clicking. Its role is the reduction of muscular hyperactivity and the stabilization of the joint. It is a simple method with high success rates and wide spectrum of indications, because of which it is considered a method of choice with a large number of patients suffering from TMD. Considering the complexity of diagnosis, TMD treatments should be directed towards more simple, reversible methods, while the aggressive approach should be avoided