The treatment of painful temporomandibular joint clicking with oral splints: a randomized clinical trial.
BACKGROUND
The authors compared the efficacy of bilateral balanced and canine guidance (occlusal) splints in the treatment of temporomandibular joint (TMJ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind, controlled randomized clinical trial.


METHODS
The authors randomly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint: bilateral balanced, canine guidance and nonoccluding. The authors followed the groups for six months using analysis of a visual analog scale (VAS), palpation of the TMJ and masticatory muscles, mandibular movements and joint sounds. They used repeated analysis of variance and a chi(2) test to test the hypothesis.


RESULTS
The type of guidance used did not influence the pain reduction, yet both occlusal splints were superior to the nonoccluding splint, on the basis of the VAS. Despite similar outcomes in relation to opening, left lateral and protrusive movements, TMJ and muscle pain on palpation, subjects who used the occlusal splints had improved clinical outcomes. The frequency of joint noises decreased over time, with no significant differences among groups. Subjects in the groups using the occlusal splints reported more comfort.


CONCLUSIONS
The type of lateral guidance did not influence the subjects' improvement. All of the subjects had a general improvement on the VAS, though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group.
Conti
Paulo César Rodrigues
PC
Bauru School of Dentistry, University of São Paulo, Brazil. pcconti@fob.usp.br
dos Santos
Carlos Neanes
CN
Kogawa
Evelyn Mikaela
EM
de Castro Ferreira Conti
Ana Claudia
AC
de Araujo
Carlos dos Reis Pereira
Cdos R
D000328:Adult; D018771:Arthralgia / Q000628:therapy; D003766:Dental Occlusion; D003767:Dental Occlusion, Balanced; D004311:Double-Blind Method; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy; D008297:Male; D008334:Mandible / Q000503:physiopathology; D008410:Masticatory Muscles / Q000503:physiopathology; D017090:Occlusal Splints / Q000145:classification; D010147:Pain Measurement; D010173:Palpation; D016059:Range of Motion, Articular / Q000502:physiology; D013016:Sound; D019224:Temporomandibular Joint Disc / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000628:therapy*; D016896:Treatment Outcome