Quality Resource Guide l Intraoral Appliance Therapy in the Management of Temporomandibular Disorders 1st Edition 3 www.metdental.com foreign objects between the teeth (including gum chewing) can be extremely beneficial. Generally, mild pain relievers such as acetaminophen, non- steroidal anti-inflammatory medications, or aspirin provide appropriate relief. Muscle relaxant and sleep aid medications may also enhance treatment outcomes in select cases. Most importantly, TMDs are musculoskeletal disorders that are best managed by reversible and non-invasive forms of therapy. The majority of cases managed following a well- designed, case-specific approach will experience a very satisfactory outcome. 20 Intraoral Appliances: Overview One of the more commonly utilized approaches for management of TMDs is intraoral appliance therapy. 21 Intraoral appliances have been employed to manage a range of conditions such a sleep bruxism, myofascial pain, TMJ capsulitis, TMJ degenerative joint disease and tension-type headaches. 22-24 Essentially, an intraoral appliance is a removable The major functions of stabilization (flat plane) appliance therapy are muscle relaxation, dispersal of biting forces, enhanced TM joint stability and protection of the teeth from abnormal forces such as those associated with bruxism. The intraoral appliance is fabricated to cover all of the teeth in the arch. Figure 1 provides an example of a maxillary stabilization appliance. device, usually made of hard acrylic, that is custom made to fit over the occlusal surfaces of the teeth in one arch, either the maxilla or mandible. There are generally three types of intraoral appliances that may be used: the flat plane (stabilization) appliance, the anterior repositioning appliance, and the anterior bite plane device. 25,26 The effects of intraoral appliance therapy include: • Prevention/reduction in attrition to the dentition • Alteration of the motor pattern of the masticatory musculature by altering periodontal ligament proprioception • Alteration of muscle length • Enhanced patient awareness of masticatory parafunctional behavior • Alteration of the number, direction, location and quality of tooth contacts Table 1 provides a perspective regarding the most commonly used intraoral appliances. Table 1 Type of Oral Appliance Characteristics Pros Cons Material Full arch stabilization appliance Full arch: all teeth covered for either the maxilla or mandible. Stable: evenly spreads the occlusal loading over multiple posterior teeth. Takes clinician time to adjust over several appointments. Hard acrylic Anterior Segmental appliance: maxillary or mandibular Coverage of only a few anterior teeth. Easy to fabricate. Provides immediate disclusion of posterior teeth and often pain relief. Risk of extrusion/eruption of posterior teeth and/or intrusion of anterior teeth. Risk of pain in the TMJs. Hard acrylic Posterior segmental appliance Coverage of some teeth: all posterior teeth. None Significant risk of intrusion of posterior teeth and/or extrusion of anterior teeth. Hard acrylic Anterior full arch repositioning appliance Similar to the stabilization appliance: force that advances the mandible in an anterior direction. May provide pain relief in the TMJ when TMD is due to trauma. Long term utilization result in significant risk of TMJ dysfunction, orthodontic tooth movement and long- term skeletal misalignment. Hard acrylic Soft full arch appliance Full arch: all teeth covered for either the maxilla or mandible. Inexpensive and a rapid delivery of appliance to the patient. Risk of increasing masticatory muscle activity due to patient chewing on the appliance. The appliance can provide no occlusal stability since the appliance is compressible and the soft acrylic cannot be adequately adjusted. Soft acrylic Figure 1 Maxillary stabilization (flat plane) intra- oral appliance.