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Assessment of Occlusal Appliance for the Reposition of Temporomandibular Joint Anterior Disc Displacement With Reduction

Shen, Pei, MS; Chen, Xinwei, MS; Xie, Qianyang, MS; Zhang, Shanyong, MD; Yang, Chi, MD

Journal of Craniofacial Surgery: June 2019 - Volume 30 - Issue 4 - p 1140–1143
doi: 10.1097/SCS.0000000000005210
Clinical Studies

The aim of our study was to evaluate the success rates and prognoses of patients treated with occlusal appliances used to reposition the temporomandibular joint anterior disc displacement with reduction (ADDWR). A sample of 144 consecutive patients (210 joints) diagnosed with ADDWR based on MRI were included in our study. Disc recapture was confirmed in a mandible-anterior position to eliminate joint clicking based on magnetic resonance imaging (MRI). Anterior repositioning appliance (ARS) was applied to keep the mandible in this position. The occlusal surface of the ARS was ground down by 1 mm approximately every 4 weeks for bite reconstruction. MRI was carried out before treatment, 6 months after the start of treatment, at the end of the treatment, and at their last follow-up visit. A Cox regression model was used to estimate the risk of failure of the treatment. The mean treatment duration was 9.5±2.6 months. A total of 177 joints (84.3%) were successfully repositioned at the end of splint treatment according to MRI. Regular follow-up indicated that almost 53% of the patients had normal disc–condyle relationships after 2 years. Sex, age, treatment duration, and orthodontics used were included in the final Cox regression model, with hazard ratios of 1.375, 1.141, 0.396, and 0.364, respectively. ARS is inferior for recapturing ADDWR in the long-term. It is thus better to explore other more effective methods to reposition the displaced disc in patients with ADDWR.

Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China.

Address correspondence and reprint requests to Dr. Chi Yang, Department of Oral Surgery, Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhi Zao Ju Rd, 200011 Shanghai, People's Republic of China; E-mail:; Shanyong Zhang, E-mail:

Received 8 August, 2018

Accepted 31 October, 2018

This study was supported by the Youth Program of National Natural Science Foundation of China (81601915), doctoral Innovation Fund of Shanghai Jiaotong University School of Medicine (CBXJ201809), Science and Technology Commission of Shanghai Municipality Science Research Project (14DZ2294300), and the Project of Western Medicine Guidance of Shanghai Municipality (16411960800).

PS and XC contributed equally to the work.

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.