Physiotherapy and Anterior Repositioning Splint in the Treatment of Disk Displacement with Reduction - A Randomized Controlled Trial

BACKGROUND Treatment recommendations for symptomatic disk displacement with reduction (DDwR) range from conservative to aggressive and irreversible treatment. This study investigated and compared the effectiveness of self-care in combination with physiotherapy and anterior repositioning splint in treating patients with DDwR. METHODS This single (assessor) blinded randomized clinical trial comprised of three groups with 63 study subjects in each. Group I (SC/control group) received self-care instructions (jaw relaxation in the form of diet of soft food, avoiding gum chewing and reduction of oral parafunctional habits, thermal packs, jaw exercises and correcting bad posture). Group II (PT group) was advised US therapy 0.25 watts / cm 2 pulsed at two - 1, 2 - 3 minutes / application, 3 - 4 times a week for four weeks. Group III (ARS group) received clear and hard acrylic Anterior Repositioning Splint set to the upper teeth; additionally the PT and ARS groups were also advised similar TMD self-care procedures as SC group. The outcomes [TMJ pain, Tenderness Muscle of Mastication (TMoM), Comfortable Mouth Opening (CMO), Maximum Mouth Opening (MMO) and TM joint clicking] were measured at weekly (for 4 weeks) intervals for SC and PT group and monthly (for 3 months) interval for ASR group to measure short term benefits. While the long term benefits of all 3 groups were measured post treatment after 16 weeks post trial commencement. One-way ANOVA (for continuous data measures) was used to compare the treatment outcomes of all the 3 groups, chi(2) test was used to compare treatment proportions for categorical measures followed by the post hoc Tukey test. The level of significance for all the tests was fixed at P <= 5 (5 % probability). RESULTS All the study groups showed significant improvement in joint pain and TMoM. While the TMJ clicking significantly reduced in the ARS group only. Both CMO and MMO improved in all three groups, but was maximum in the ARS group. Post treatment (four months) follow-up showed a significant relapse of pain and mouth opening in SC and PT groups, which was comparatively less in the ARS group with regard to joint pain, muscle tenderness, mouth opening, and clicking. CONCLUSIONS Standalone all three treatment modalities were significantly effective in alleviating the signs and symptoms of DDwR. Equivalent improvement in the three groups implies encouraging clinical applications in terms of different treatment time, and cost involved to deliver them. Therefore, a comprehensive care of combination therapies rather than a monotherapy seems more suitable and practical choice to treat DDwR, especially, in view of the cost effectiveness and promptness of the treatment.