Occlusal splint plays a great role in the treatment of internal derangement of temporomandibular joint. Temporomandibular disorders affect 25 % of the population of the world. The purpose of the study was to elucidate the effectiveness of occlusal splint in reduction of pain, increase mouth opening, elimination of clicking sound. This randomized controlled clinical trial was done on 26 patients in two groups. Group A received occlusal splint and Group B received medications with supportive care. Monthly follow-up was done for a period of four months. In Group A and Group B, preoperative mean of mouth opening were 36.31 mm; and 39.77 mm. pain score 4.54 cm, clicking in 76.9% and 84.6% patients respectively. After 4 months of follow- up mouth opening 50.69 mm and 43.15 mm, pain score 0.154 cm and 0.69 cm, clicking 30.8% and 76.9% patients in both groups respectively. It may be conclude that the occlusal splint is highly efficient than medication and supportive care for managing of internal derangement of temporomandibular joint.

Key words:Temporomandibular Joint disorder, Internal Derangement, Occlusal Splint.

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Introduction:

The prevalence of clinically significant TMJ related jaw pain is 5% among the general population. Approximately 2% of the general population seeks treatment for TMJ-related symptoms.¹ The temporomandibular joint is an important part of lower jaw except which mastication is impossible and temporomandibular system consists of temporomandibular joint (TMJ) and the associated neuromuscular system.² The most frequent structural cause of temporomandibular joint disorder is internal derangement.³ The term Internal Derangement (ID) of TMJ has been de-fined as an abnormal relationship between the articular disc and the mandibular condyle, the fossa and the articular eminence.⁴ Signs and symptoms of ID affect between 4% and 28% of the adult population, with a higher frequency found in women. The factors responsible for this predominance are not known.⁵

If the disc slips out of place or is displaced, it can prevent the proper movement of the condyle and cause dysfunction. The disc can degenerate, becoming misshapen or even torn. Because the deranged joint will continue to try to function, even in an impaired manner. Internal derangement disorders often get progressively worse with time.⁶

Aetiology of these disorders includes Trauma (such as injuries from eating, excessive jaw opening and during dental treatment); bruxism, malocclusion (causes inappropriate pressure on the joint); stress and psychiatric illness.⁷

Internal Derangement (ID) can cause a wide range of pain in the jaw joints which is the most frequently taking place symptom.⁶ In disc dis-placement with reduction, clinically there is rela-tively normal range of movement with restriction only associated with pain. Discal movement can be felt by palpation of the joints during opening and closing. Deviation in the opening pathway are common.⁸ Internal derangement of TMJ was diagnosed by the research diagnostic criteria for temporomandibular disorders (RDC/TMD) established by a group of American researchers in 1992⁹ such as a) Disc displacement with reduction: manifested by absent of pain in the joint; reproducible click on excursion with either opening or closing click, with click on opening and closing (unless excursive click confirmed): i) click on opening occurs at ≥5 mm interincisal distance than closing, ii) clicks eliminated by protrusive opening; b) Disc displacement without reduction with limited opening: characterized by-history of locking or catching that interfered with eating; absence of TMJ clicking; unassisted opening (even painful) ≤35mm and passive stretch ≤4mm; and contralateral excursion < 7mm or uncorrected ipsilateral deviation on opening; and c) Disc displacement without reduction without limited opening characterized by history of locking or catching that interfered with eating , the presence of TMJ sounds excluding DDR clicking unassisted opening (even painful)> 35mm and passive stretch > 4mm, and contrala-teral excursion ≥7mm (Dworkin SF. LeResche L.1992). Different treatment modalities have been advocated. Conservative treatment includes homecare practices (soft diet, jaw exercises, physical therapy, steam baths, muscle mas-sage).¹⁰ Occlusal adjustment (repositioning the mandible in a centric position by prosthodontic or orthodontic means and/or occlusal equilibra-tion),¹¹ analgesia and psychotropic medication (such as NSAIDs and diazepam),¹² splint therapy¹³ and other treatment modalities (ultrasound, soft laser, diathermy, infrared).¹⁴ Surgical treatment (irreversible) includes three different treatments for internal derangement of TMJ i.e. discoplasty, discectomy with or without replacement of the disc with a Proplast-Teflon interpositional implant.¹⁵

An acrylic splint is a useful device for the treat-ment of ID. It is relatively simple to manufacture and use, reversible, non-invasive and costs less than other treatments, portable and generally have a low complication rate and it has also diagnostic value. However, the mechanism by which occlusal splints work in alleviating signs and symptoms of such a disorder is still controversial.¹⁶ Some theories that tried to explain its mechanism include alteration or improvement of occlusal condition, change in peripheral (motor or afferent) impulses to the central nervous system, alteration or raise in the vertical dimension, alteration of the temporo-mandibular joint (TMJ) condylar position and increase in the cognitive awareness.¹⁷

Aim of the study was to elucidate the effective-ness of acrylic occlusal splint therapy in the treatment of Internal Derangement of Temporo-mandibular joint over other nonsurgical proce-dure (Analgesic, muscle relaxant and supportive care).

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