TMJ Repositioning

Using a hydrostatic oral appliance can help treat head, face, and neck pain.

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The Temporomandibular joint (TMJ) repositioning by use of interocclusal splints has become a popular treatment for head, neck and facial pain. There is a growing feeling that the proper use of occlusal appliances with the resultant correct positioning and stability of the mandible, affects total head posture to bring about proper alignment of the cervical vertebrae.1-2 Improper TMJ biomechanics will have a negative effect on the skeletal frame in general, and the relatively large neural and vascular component in the TMJ region in particular.3 For those with a TMJ imbalance, proponents of repositioning appliances maintain that the proper occlusal splint will reduce tension, alleviate negative neural and vascular input from the oro-facial area to the brain, improve muscle balance and performance, and augment blood flow in major areas of the body.4-9

Occlusal splints are removable interocclusal appliances that are usually fabricated out of hard acrylic. The objectives of splint use in the treatment of temporomandibular disorders (TMD) and myofascial pain dysfunction (MPD) include: eliminating occlusal interferences, stabilizing tooth and joint relationships, passive stretching of the musculature to reduce abnormal muscle activity, decreasing parafunctional habits, protecting against tooth abrasion and decreasing joint loading. Splints also function diagnostically as an indirect method of altering occlusion.

Major theories covering the mechanism of action of splints include: occlusal disengagement theory, vertical dimension theory, maxillo-mandibular realignment theory, TM joint repositioning theory and the cognitive awareness theory. Each has multiple proponents with many variations.

The occlusal disengagement theory proposes that the placement of an appliance, with proper occlusal relationships, replaces previously faulty occlusal relationships. This eliminates the stimulus causing muscular hypertrophy and in turn allows for proper joint and mandibular function.

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David CoreComment