Case 20: Stabilisation splint- Management of TMD pain
Case 20: Stabilisation splint- Management of TMD pain
Temporo-mandibular joint disorders and its related masticatory muscle pain management is a challenging field on its own. Diagnosis of such cases are very tricky and one might take it for granted and miss the diagnosis if we fail to understand the concept of Occlusion. Referral practise in such situations take an upper hand and its advisable to refer the case to a specialist in TMD management.
This case was giving a history of chronic pain in the pre-auricular region and was having radiating neck and head aches. After a thorough examination of intra-oral and radiographic findings, we proceeded with TMJ and its Muscular assessment.
While doing so the patient had pain on palpation of disto-buccal to hamular notch region in the maxillary arch on one side. This gave us a hint on Pterygoid muscle soreness. Hence to rule out the discomfort caused by the Pterygoid sorenes, which is a major muscle in holding the joint in Centric relation, a stabilisation splint was fabricated immediately.
Within a couple of days the patient's symptoms vanished and then we referred for a thorough assessment with a TMD specialist for further management.
Temporo-mandibular joint disorders and its related masticatory muscle pain management is a challenging field on its own. Diagnosis of such cases are very tricky and one might take it for granted and miss the diagnosis if we fail to understand the concept of Occlusion. Referral practise in such situations take an upper hand and its advisable to refer the case to a specialist in TMD management.
This case was giving a history of chronic pain in the pre-auricular region and was having radiating neck and head aches. After a thorough examination of intra-oral and radiographic findings, we proceeded with TMJ and its Muscular assessment.
While doing so the patient had pain on palpation of disto-buccal to hamular notch region in the maxillary arch on one side. This gave us a hint on Pterygoid muscle soreness. Hence to rule out the discomfort caused by the Pterygoid sorenes, which is a major muscle in holding the joint in Centric relation, a stabilisation splint was fabricated immediately.
Within a couple of days the patient's symptoms vanished and then we referred for a thorough assessment with a TMD specialist for further management.
A stabilisation splint will deprogram the mandible and eventually makes the TMJ rest in centric relation. Its a viable treatment in TMD when the cause is related to a muscular origin. The canine guidance ramps in the stabilisation splint puts the least amount of load on to the masticatory muscles with only the temporalis muscle being tested during eccentric motion. In this way the lateral pterygoids which are most commonly affected in such TMD muscular problems will be completely rested and the soreness can be managed immediately.
Once the patient becomes comfortable, further occlusal analysis, facebow transfer and assessment of occlusal interference and need for an occlusal rehab can be planned on a definitive basis.
This case was done by me during my Post graduation.
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