ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Splint Therapy is the Most Conservative Treatment for Idiopathic Condylar Resorption (ICR)
Clinical Question In adult patients with idiopathic condylar resorption, what treatment would provide the most conservative effective therapy?
Clinical Bottom Line Splint therapy would be the most conservative manner for treating idiopathic condylar resorption in an adult. After the TMD symptoms and occlusal changes have resolved, the patient could choose to have orthodontics to reestablish the occlusal contacts; this may require orthognathic surgery.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26460272Catherine/2015210 cases evaluatedSystematic Review
Key resultsA total of 210 cases were analyzed to determine how often surgical therapy is implemented compared to more conservative treatment for condylar resorption. In 42% of cases reported, surgical intervention involving either the entire mandible or parts of it was deemed necessary. For some patients, about 19%, the combination of both orthognathic surgery as well as TMJ surgery was implemented to correct the articular disc and improve the quality of retrodiscal tissues. However, non-invasive treatment methods were not as commonly used (9%), which included the most conservative treatment of an occlusal splint.
#2) 25270187Sansare/2015178 cases analyzed based on information from 17 reportsSystematic Review
Key resultsThis systematic review compares the use of an occlusal splint to surgical management at treating idiopathic condylar resorption. While only two studies include the use of an occlusal splint, no relapses of the condition was noticed during the time period of the research, which was 24-27 months. On the other hand, the surgical treatments depict a range of relapse rates with various follow-up periods, so this evidence does not seem conclusive. Based on this systemic review, the use of orthognathic surgery to treat condylar resorption showed a high rate of relapse with follow-up periods of 1-39 months based on the table of information from the article itself.
Evidence Search Management[Title] AND dentoskeletal[Title] AND deformity[Title] AND condylar[Title] AND resorption[Title] AND literature[Title] AND review[Title] idiopathic[All Fields] AND condylar[All Fields] AND resorption[All Fields] AND ("mandible"[MeSH Terms] OR "mandible"[All Fields])
Comments on
The Evidence
The current best evidence is from these systematic reviews, but the sample size for the conservative therapy was quite small and the studies lacked meta-analyses. Additional studies with larger sample sizes are needed to further investigate the conservative manner for treating ICR with conservative TMD therapies.
Applicability The most conservative therapy for idiopathic condylar resorption (ICR) would be resolving the TMD symptoms and progression of the occlusal changes through conservative TMD therapies. Continued occlusal changes could be determined by observing whether the patient is able to maintain consistent occlusal contacts against the splint. This could be determined over time by observing for changes of Accufilm contact marks on the splint and opposing teeth that are able to hold shim stock against the splint. After the TMD symptoms and occlusal changes have resolved, the patient can determine whether she would like orthodontics to reestablish the occlusion with her opposing teeth; this may require orthognathic surgery.
Specialty/Discipline (General Dentistry)
Keywords Idiopathic condylar resorption, occlusal changes, anterior open bite.
ID# 2986
Date of submission: 02/16/2016spacer
E-mail raouf@livemail.uthscsa.edu
Author Sandra Raouf
Co-author(s) Monica Attia
Co-author(s) e-mail attiam@livemail.uthscsa.edu
Faculty mentor/Co-author Edward Wright, DDS
Faculty mentor/Co-author e-mail wrighte2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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