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Abstract
Introduction
Limited mouth opening is a representative clinical symptom of temporomandibular disorders (TMD) with anterior disc displacement without reduction (ADDWOR). Various treatment methods have been proposed for patients with ADDWOR. This study examined the clinical effectiveness of template therapy for patients with mouth opening difficulty due to the ADDWOR.
Material and Methods
A total of 14 patients (female 12, male 2, average age: 29.1±14.4), who had been treated in the template clinic, Sooncheonhyang University Bucheon Hospital, from January of 2006 to December of 2008, were enrolled in this study. The subjects were selected according to the following criteria: more than 2 weeks after the onset of locking, mouth opening range < 35 mm, and confirmed ADDWOR without a synovial pathology by magnetic resonance imaging (MRI). All patients were treated with the template appliance, instructed to wear it while sleeping and exercise for at least 10 hours per day. The maximum mouth opening (MMO) range and pain recognition scores before and after template therapy were recorded and compared. A paired t-test and Wilcoxon's signed rank test were used for statistical analysis.
Results
After the periodical follow up, significant improvement in the opening range was observed in the template treatment group. The average MMO range before treatment was 30.2±3.5 mm and the average MMO after treatment and follow up was 47.1±4.7 mm. The mean amount of mouth opening increment was 16.9±5.4 mm (P<0.01) and the pain recognition scores before and after treatment was also improved.(P=0.001)
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Fig. 2.
Template appliance, which is located at the posterior segment of occlusal arch, reduces the pressure to the temporomandibular joint according to the 2nd principle of lever action.
Table 1.
Clinical data of patients treated by template
| Case No. | MMO (mm) | Elapsed time | ||||
|---|---|---|---|---|---|---|
| Before | After | Changes (Δ) | Locking period (W) | Until 40 mm (W) | Overall F/U (M) | |
| 1 | 34 | 46 | 12 | 4 | 4 | 6 |
| 2 | 35 | 52 | 17 | 3 | 2 | 10 |
| 3 | 32 | 46 | 14 | 4 | 1 | 17 |
| 4 | 30 | 44 | 14 | 4 | 4 | 16 |
| 5 | 31 | 47 | 16 | 4 | 4 | 6 |
| 6 | 32 | 53 | 21 | 3 | 2 | 9 |
| 7 | 23 | 50 | 27 | 12 | 1 | 7 |
| 8 | 30 | 55 | 25 | 16 | 24 | 6 |
| 9 | 29 | 45 | 16 | 4 | 24 | 24 |
| 10 | 30 | 44 | 14 | 12 | 4 | 22 |
| 11 | 35 | 47 | 12 | 12 | 16 | 27 |
| 12 | 26 | 37 | 11 | 3 | 12 | 22 |
| 13 | 26 | 51 | 25 | 3 | 20 | 18 |
| 14 | 30 | 43 | 13 | 4 | 8 | 11 |
| Avg | 30.2±3.5 | 47.1±4.7 | 16.9±5.4* | 6.3±4.5 | 10.9±8.6 | 14.3±7.4 |
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