Resilient appliance therapy. Studies on subdiagnoses of TMD, sense of coherence and treatment outcome.
||Maria Nilner, Arne Petersson and Danila Vallon
||Napat Limchaichana, Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
||Faculty of odontology, Malmö University
||2000-07-01 -- 2010-05-28
||Faculty of Odontology
The overall aim of this thesis was to evaluate the efficacy of the resilent appliance in patients with TMD pain in a short and in a long term perspective and to test the influence of psychological factors and general health for the treatment outcome. Another aim was to study if clinical diagnoses could be confirmed by MRI findings in patients with TMD pain.
1). To examine two groups of patients with TMD pain, myofascial pain and atrhralgia/osteoarthritis in combination with myofascial pain, and compare the clinical subdiagnoses of TMD according to RDC/TMD with MRI findings.
2). To investigate the short-term efficacy of a resilient appliance in patients with TMD pain.
3). To investigate whether the lack of difference in treatment outcome between patients provided with a resilient appliance and a non-occluding control appliance was due to the treatment or whether other factors were of importance for the treatment outcome. Another aim was to study the association between SOC and grade of depression, and grade of somatisation, and general health.
4). To evaluate the long-term efficacy according to IMMPACT of a resilient appliance compared to a non-occluding control appliance. Another aim was to evaluate wear and durability of a resilient appliance.
The MRI findings of different kinds of disc displacement and structural bone changes were common in TMD patients. The clinical diagnoses for subdivision into myogenous only or combined arthrogenous and myogenous pain groups were not confirmed by MRI.
There was no statistically significant difference between the resilient appliance and the non-ocluding control appliance in reducing TMD pain from a short-term perspective.
None of the studied background variables (age, gender, SOC, depression, somatisation and general health) seemed to influence the short-term efficacy of intraoral appliances. No association was found for SOC compared to depression, somatisation and general health.
There was no statistically difference found between the resilient appliance and the non-occluding control appliance in reducing TMD pain, jaw function/activity, and headache in a 12 month perspective. Severe wear of the resilient appliance were found in only few patients. The risk of occlusal changes in the frontal region should be taken into consideration when using the non-occluding control appliance in a long-term perspective
Limchaichana N, Nilsson H, Ekberg EC, Nilner, M, Petersson A. Clinical diagnoses and MRI findings in patients with TMD pain. J Oral Rehabil 2007;34:237-45.
Nilsson H, Limchaichana N, Nilner M, Ekberg EC. Short-term treatment of a resilient appliance in TMD pain patients: a randomized controlled trial. J Oral Rehabil 2009;36:547-55.
Nilsson H, Ekberg EC. Do psychological factors and general health influence the short-term efficacy of resilient appliance therapy in patients with TMD pain? Acta Odontol Scand Accepted for publication.
Nilsson H, Vallon D, Ekberg EC. Long-term efficacy of a resilient appliance in TMD pain patients. A randomized controlled trial. Submitted.