The role of occlusal splints (soft and hard)‎ in the management of myofascial pain dysfunction syndrome

Abstract EN

Background : The term temporomandibular disorders (TMDs) are a collective term embracing a number of clinical problems that involve the masticatory muscles, the temporomandibular joints (TMJ) and associated structures, or both.

The TMDs can be broadly divided into masticatory muscle disorders (TMJ dysfunction syndrome) and TMJ disorders.

Dysfunction of the masticatory muscles or myofascial pain dysfunction syndrome (MPDS) is relatively common.

The occlusal interferences theory and psycho physiological theory are the major causes of MPDS.

The soft and hard occlusal splints (OSs) used in the management of MPDS had been controversial.

The aim of study was to test the role of OSs as a treatment modality for myofascial pain dysfunction syndrome of TMJ caused by spasm of masseter and temporalis muscles by the use of surface electromyography (EMG) and Helkimo index criteria, and to compare between the efficacy of soft and hard occlusal splints in the management of myofascial pain dysfunction syndrome.

Patients and methods : This study was carried out through clinical examinations for a sample of sixty patients with MPDS, by use of Helkimo index criteria.

The ages ranged from 20 to 53 years, the gender distributed as 20 males and 40 females.

The patients divided into group A and group B, subjected to soft OS and hard OS respectively.

Each patient subjected to three visits of measurements by EMG for superficial masseter and temporalis muscles and Helkimo index criteria records.

The primary visit was for diagnosis and impression taking, then the first visit called pretreatment visit, then two weeks, and four weeks after insertion of OS.

Results and discussion of this study showed that the clinical dysfunction index (type 2 Helkimo index) which was more reliable index in the assessment of TMJ dysfunction syndrome that related to masticatory muscles, since 1974 to nowadays.

This study gave this index its reliability and accuracy by approximately coincidence between the EMG and Helkimo index results, this fact encourage by the reliability of the use of EMG in the researches of TMDs and MPDS.

This study also showed that the records of Helkimo index criteria for patients managed with soft OS had more significant differences from patients managed with hard OS in the second visit after treatment, while the differences were not significant in the third visit after treatment.

The results of EMG measurements of masseter muscle are of highly significant differences in soft OS group compared with the hard OS group in third visit after treatment, but no significant differences in the second visit after treatment.

The results of EMG records for temporalis muscle were highly significant differences in the soft OS group comparing with hard OS group in the third visit after treatment, but it was significant in the second visit after treatment.

Conclusion : The OS play a major role in the management of MPDS by reducing the symptoms associated with this syndrome which are pain, muscle spasm, TMJ sounds, and limitation of mandible movements in different degrees.

The use of soft OS was more effective than hard OS in the management of MPDS.