World journal of orthodontics
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Randomized Controlled Trial Comparative Study
A clinical, MRI, and EMG analysis comparing the efficacy of twin blocks and flat occlusal splints in the management of disc displacements with reduction.
Internal derangement of the temporomandibular joint (TMJ) is characterized by an abnormal disc-condyle relationship. Of all the various treatment modalities used in the management of disc displacements, flat occlusal and anterior repositioning splints are the most commonly used. ⋯ The sample consisted of 20 subjects between 12 and 20 years of age, who were randomly divided into two groups of 10 patients each: Group 1 was treated with twin blocks, while group 2 was treated using maxillary flat occlusal splints. The twin block is more effective in relieving joint pain, diminishing joint dysfunction, reducing joint clicking, and eliminating muscle tenderness in patients with anterior disc displacement with reduction as compared to the occlusal splint.
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Much has been written in support of systematic reviews and the randomized clinical trials and meta-analyses upon which they are based. Clearly, the medical profession (as opposed to the dental profession) has been the leader in publishing the benefits of systematic reviews over the traditional, qualitative narrative reviews. ⋯ That said, there are a number of inherent problems with systematic reviews, as well as the randomized clinical trials and meta-analyses that back them up. To better facilitate evidence-based decision making, this article discusses the shortcomings of systematic reviews so that practitioners are fully aware of their drawbacks, as well as their benefits.
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The treatment of an adult patient with a skeletal Class II Division 1 malocclusion, retrognathic mandible with downward and backward rotation, anterior open bite, and temporomandibular disorders is presented. Treatment objectives included establishing a stable occlusion with normal respiration, eliminating temporomandibular disorder symptoms, and improving facial esthetics through nonextraction and nonsurgical treatment. ⋯ The excessive posterior vertical occlusal dimension was significantly reduced, creating a small clearance between the posterior maxilla and mandible. The occlusal interferences in the posterior area were eliminated by the expansion of the maxillary dentoalveolar arch. As a result, the mandible moved forward, creating a more favorable jaw relationship. Distal movement of the maxillary arch was also achieved. The functional occlusal plane was reconstructed and a normal overjet and overbite were created. Adequate tongue space for normal respiration was established during the early stage of treatment. A stable occlusion with adequate posterior support and anterior guidance was established in a treatment time of 25 months, without orthognathic surgery, extraction, or headgear; this result was maintained at more than 1 year 8 months posttreatment.