Treatment prostheses in TMJ dysfunction-pain syndrome. 1978

L A Weinberg

Various types of acrylic resin therapeutic prostheses commonly used in the treatment of TMJ dysfunction-pain syndrome were described. Each design was related to recent data concerning optimum condylar positions in the fossae, the physiologic condylar suspension system, and individual treatment objectives for repositioning the mandibular condyles. For example, alteration of the vertical dimension of occlusion is a popular treatment procedure that is empirical in nature and is usually used without TMJ radiographs or a differential diagnosis. It can violate the physiologic requirements of the interocclusal distance or the speaking space and does not necessarily move the condyles forward as has been commonly thought. The dangers of empirical treatment procedures for a multicausal dysfunction syndrome have been pointed out. An example was cited where the mandible was moved forward for a long period of time with a repositioning prosthesis; this produced pathologic TMJ remodeling and continued pain. It was recommended that specific mandibular repositioning be based on the type of condylar displacement observed on the radiographs. Sometimes the condyles should be retruded, and other times they should be repositioned anteriorly or occasionally inferiorly on one side. Long-standing use of any acrylic resin repositioning prosthesis is contraindicated, particularly without close supervision. Acrylic resin anterior bite plates (with a minimum opening of 1 mm) were recommended for the relief of acute trismus or intractable pain. Usually the prosthesis is used in conjunction with heat and drug therapy. This type of prothesis can also be utilized to deprogram the muscles when a strong habit of eccentric occlusion develops as a result of missing teeth. (This should be confirmed by TMJ radiographs.) Occasionally atypical pain is present and a differential diagnosis can be established between TMJ dysfunction or neurologic etiology by the physiologic response to bite plate therapy. When it is necessary to reposition the mandibular condyles anteriorly the occlusion is adjusted to provide the planned anterior movement without increasing the vertical dimension of occlusion. A temporary acrylic resin prosthesis is used to retrain the muscle programming to the anterior therapeutic mandibular position. When the symptoms are relieved and the corrective condylar position is confirmed with TMJ radiographs, a more permanent repositioning prosthesis is made. The treatment of TMJ dysfunction-pain syndrome should be based on documented data including the pain history, TMJ radiographs, condylar position in the fossae, electromyographic evidence, and occlusal analysis. This information will help determine if the patient's centric relation is functional or dysfunctional and will indicate the recommended treatment procedures.

UI MeSH Term Description Entries
D008335 Mandibular Condyle The posterior process on the ramus of the mandible composed of two parts: a superior part, the articular portion, and an inferior part, the condylar neck. Condyle, Mandibular,Condyles, Mandibular,Mandibular Condyles
D008410 Masticatory Muscles Muscles arising in the zygomatic arch that close the jaw. Their nerve supply is masseteric from the mandibular division of the trigeminal nerve. (From Stedman, 25th ed) Masticatory Muscle,Muscle, Masticatory,Muscles, Masticatory
D008437 Maxilla One of a pair of irregularly shaped bones that form the upper jaw. A maxillary bone provides tooth sockets for the superior teeth, forms part of the ORBIT, and contains the MAXILLARY SINUS. Maxillae,Maxillary Bone,Bone, Maxillary,Bones, Maxillary,Maxillary Bones,Maxillas
D010148 Pain, Intractable Persistent pain that is refractory to some or all forms of treatment. Refractory Pain,Intractable Pain,Intractable Pains,Pain, Refractory,Pains, Intractable,Pains, Refractory,Refractory Pains
D010347 Patient Care Planning Usually a written medical and nursing care program designed for a particular patient. Nursing Care Plans,Goals of Care,Plans, Nursing Care,Care Goal,Care Goals,Care Plan, Nursing,Care Planning, Patient,Care Plans, Nursing,Nursing Care Plan,Plan, Nursing Care,Planning, Patient Care
D011859 Radiography Examination of any part of the body for diagnostic purposes by means of X-RAYS or GAMMA RAYS, recording the image on a sensitized surface (such as photographic film). Radiology, Diagnostic X-Ray,Roentgenography,X-Ray, Diagnostic,Diagnostic X-Ray,Diagnostic X-Ray Radiology,X-Ray Radiology, Diagnostic,Diagnostic X Ray,Diagnostic X Ray Radiology,Diagnostic X-Rays,Radiology, Diagnostic X Ray,X Ray Radiology, Diagnostic,X Ray, Diagnostic,X-Rays, Diagnostic
D003766 Dental Occlusion The relationship of all the components of the masticatory system in normal function. It has special reference to the position and contact of the maxillary and mandibular teeth for the highest efficiency during the excursive movements of the jaw that are essential for mastication. (From Jablonski, Dictionary of Dentistry, 1992, p556, p472) Canine Guidance,Occlusal Guidance,Occlusal Plane,Occlusion, Dental,Dental Occlusions,Guidance, Canine,Guidance, Occlusal,Occlusal Guidances,Occlusal Planes,Occlusions, Dental,Plane, Occlusal,Planes, Occlusal
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000180 Acrylic Resins Polymers of high molecular weight which are derived from acrylic acid, methacrylic acid or other related compounds and are capable of being molded and then hardened to form useful components. Acrylic Resin,Resin, Acrylic,Resins, Acrylic

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