A case report of the symptom-relieving action of an anterior flat plane bite plate for temporomandibular disorder

Abstract

Splint therapy is a widely used modality for temporomandibular disorders (TMDs). However, questions remain regarding the mechanism of symptom relief. Recently, a relation between TMD and a discrepancy between the habitual occlusal position (HOP) and the anterior flat plane bite plate-induced occlusal position (BPOP) has been reported. Therefore, to understand the mechanism of the symptom relief associated with the use of a bite plate, the changes in both the HOP and BPOP values were observed during anterior bite plate treatment in a patient with TMD.

Case presentation: Anterior bite plate treatment was started in a patient complaining of arthralgia. A discrepancy between the HOP and BPOP values was recorded three days after the first visit; this discrepancy disappeared on day 6, and the disappearance was maintained between days 6 and 12. The disappearance was associated with a decrease in the severity of the patient's symptoms; however, the discrepancy reappeared after 15 days, coinciding with the complete disappearance of the patient's symptoms. Therefore, the effect of the bite plate on the resolution of the discrepancy between the HOP and BPOP values was interpreted as being unsustainable and occlusal equilibration for the BPOP was performed at 17 days. Thereafter, neither a discrepancy in the HOP and BPOP values nor any symptoms of TMD (right temporomandibular joint pain or limited jaw opening) reoccurred during a two-year follow-up period.

Conclusion: Within the limitations of the present study, the symptom-relieving action of an anterior flat plane bite plate on the resolution of occlusal discrepancy appeared to be temporary. This outcome supports previously reported conclusions that the effectiveness of stabilization splint therapy for reducing symptoms in patients with pain dysfunction syndrome does not differ significantly from that of other conservative therapies or of no treatment at all.

Keywords: Anterior flat plane bite plate; bite plate-induced occlusal position; occlusal discrepancy..

Fig. (1)

Tomograph of the patient. The right TMJ shows no evidence of degeneration.

Fig. (2)

Anterior flat plane bite plate. The plate covers the six upper anterior teeth and the first premolar teeth on both sides.

Fig. (3)

Mandibular position analyzer and measuring microscope. The apparatus added to an articulatorfor the three-dimensional analysis of the mandibular position consists of right and left recording arms with pins in the condylar post holes. The recording frame is attached to the upper cast. The mandibular positions are recorded on the frame by the pins on both sides.

Fig. (4)

HOP and BPOP positions and TMD symptoms on different days.

Fig. (5)

Mean variations in the three axes on different days. x: mediolateral; y: anteroposterior; z: superoinferior. HOP: habitual occlusal position; BPOP: bite plate-induced occlusal position.