ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Partial Coverage Occlusal Appliances Are Effective In Maintaining Occlusal Harmony
Clinical Question In an adult patient suffering from TMD symptoms apparently related to nighttime para-functional habits, is a full coverage occlusal splint superior to a partial coverage appliance in terms of maintaining occlusal harmony?
Clinical Bottom Line Although it would seem that full coverage occlusal appliances might offer much greater occlusal stability, partial coverage splints may maintain tooth position relatively well for at least a few years. This is contrary to some published expert opinion. (See Comments on the CAT below)
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) 8181083Brown/199464 orthodontic patients with partial-coverage anterior repositioning splintsCase Series
Key resultsOver a mean span of 1.33 years, no significant change was recorded in the distance from the mandibular molar to the mandibular plane. On average, the maxillary incisor and maxillary molar extruded about 1 mm, while the mandibular molar was unchanged and the mandibular incisor intruded about 0.6 mm. Only a very small proportion of patients having long-term splint therapy using the partial coverage (MORA) have clinically significant molar intrusion.
#2) 19138639Klasser/2009focus on TMD patientsNarrative Review
Key resultsAlthough this review cites studies concerning differences in symptom relief, it only offers an unsupported/uncited statement that use of a partial coverage (miniature appliances) has many inherent dangers including potential for over eruption of the unopposed posterior teeth resulting in an anterior open bite or intrusion of teeth also resulting in an open bite.
Evidence Search (”Temporomandibular Joint Disorders”[Mesh] AND “Occlusal Splints”[Mesh]) AND “partial coverage” ...view in PubMed
Comments on
The Evidence
The case series by Brown and colleagues evaluated orthodontic patients, rather than patients with temporomandibular disorder, for a mean treatment time of 1.3 years (range from 0.5 to 4.8 years). Of 215 consecutive patients with MORA splints, only 86 had pre-and post-treatment cephalometric radiographs, and 64 of these were selected for analysis.
Applicability Patients were selected from two orthodontic practices. Article introduction implied that the patients had temporomandibular disorder, but the Methods did not describe TMD diagnosis procedures nor TMD status of the patients.
Specialty/Discipline (General Dentistry)
Keywords Occlusal splints, splints, partial coverage, temporomandibular joint disorders, TMD
ID# 819
Date of submission: 03/15/2011spacer
E-mail patrickd@livemail.uthscsa.edu
Author Dustin Patrick
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail deahl@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?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
post a comment
by Moncrief, Dionte; Liporoni, Priscila (San Antonio, TX) on 08/18/2013
We conducted a search in PubMed; the articles listed in the CAT are still of the highest level and most current on this topic. The publications mentioned are the most applicable to the clinical question asked.
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