Información del artículo
Resumen
Las férulas o planos oclusales han sido utilizadas desde hace más de un siglo, generando controversia acerca de su verdadero valor terapéutico. Esto motivó una revisión histórica y actualizada que permitiera evaluar sus efectos de acuerdo a la evidencia científica.
Se discuten múltiples aspectos como el concepto de relación céntrica y su determinación como punto de inicio de tratamiento en la rehabilitación oral; el uso de las férulas para deprogramar; su efecto sobre la conducta motora oral que conocemos como bruxismo; su efecto en la actividad electromiográfica tónica, durante la deglución y el máximo apriete en los músculos masticatorios y cervicales; su influencia en la eficiencia muscular; su efecto en la carga articular y las evidencias experimentales del uso de distintas férulas sobre signos y síntomas específicos como dolor y ruido articular.
Se plantean desafíos para la investigación sobre cambios degenerativos en las articulaciones, en la relación craneovertebral y en la curvatura e inclinación de la columna cervical.
Se concluye que es necesario utilizar una férula diseñada para el trastorno específico del paciente y que su verdadero valor terapéutico queda demostrado al mejorar algunos signos y síntomas, en músculos masticatorios y cervicales. El conocimiento parcial del mecanismo de acción de las férulas contribuye a que persista la controversia de su utilización en el tratamiento de ruidos articulares y para revertir cambios degenerativos en las articulaciones.
Persiste el desafío de nuevas investigaciones, que sustenten el uso de estos dispositivos como un método eficaz para tratar a nuestros pacientes, utilizando protocolos de manejo y controles periódicos.
Palabras clave:
Dispositivos oclusales
actividad electromiográfica
ruido articular
relación craneocervical
bruxismo
Abstract
Occlusal appliances or splints have been used for over a century, generating controversy about their real therapeutic value. This led to an updated review to assess their effects according to scientific evidence.
The concept of centric relation and its determination as a starting point of treatment; the use of splints to deprogram; their effect on the oral motor behaviour known as bruxism are discussed. Their effect on EMG activity during resting, swallowing and maximal clenching in the masticatory and neck muscles; their effect on muscular efficiency; their effect decreasing the joint overload; and experimental evidence of the use of several appliances on specific symptoms such as pain and joint noise, are also treated.
The true challenge is to generate new knowledge about joint degenerative changes, the craniocervical relationships, tilt and curvature of the cervical spine.
In conclusion, it‘s necessary to use an occlusal appliance designed for the specific condition of the patient, and its real therapeutic value is demonstrated by the improvement of some signs and symptoms in masticatory and cervical muscles. However, the action mechanisms of occlusal appliances are not fully understood. The lack of scientific support contributes to the persistent controversy of the use of these appliances in the treatment of temporomandibular joint sounds and reversing degenerative changes.
It is still a challenge to carry out new researches supporting the use of these appliances as an effective method to treat our patients using management protocols and periodic evaluations
Key words:
Occlusal appliance
electromyographic activity
joint sound
craniocervical relationships
bruxism
El Texto completo está disponible en PDF
Referencias bibliográficas
[1.]
J.S. DuPont Jr., C.E. Brown.
Occlusal Splints from the beginning to the present.
J Craneomandibular Pract, 24 (2006), pp. 141-145
[2.]
P.H. Dupas, B. Picart, C. Lefevre, E. Graux.
Centric relation and programming semiadjustable articulators with the universal Jig. Part I: Technique.
J Prosthet Dent, 64 (1990), pp. 134-138
[3.]
B.D. Hunter 2nd, R.W. Toth.
Centric relation registration using an anterior deprogrammer in dentate patients.
J Prosthodont, 8 (1999), pp. 59-61
[4.]
K. Holmgren, A. Sheikholeslam, C. Riise.
Effect of a full-arch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomadibular disorders.
J Prosthet Dent, 69 (1993), pp. 293-297
[5.]
C. Dubé, P.H. Rompré, C. Manzini, F. Guitard, P. de Grandmont, G.J. Lavigne.
Quantitative polygraphic controlled study on efficacy and safety of oral splint devices in tooth-grinding subjects.
J Dent Res, 83 (2004), pp. 398-403
[6.]
J. Van der Zaag, F. Lobbezoo, D.J. Wicks, C.M. Visscher, H.L. Hamburger, M. Naeije.
Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism.
J Orofac Pain, 19 (2005), pp. 151-158
[7.]
T. Harada, R. Ichiki, Y. Tsukiyama, K. Koyano.
The effect of oral splint devices on sleep bruxism: A 6-week observation with an ambulatory electromyographic recording device.
J Oral Rehabil, 33 (2006), pp. 482-488
[8.]
F. Alencar Jr., A. Becker.
Evaluation of different occlusal splints and counselling in the management of myofacial pain dysfunction.
J Oral Rehabil, 36 (2009), pp. 79-85
[9.]
D. Fitins, A. Sheikholeslam.
Effect of canine guidance of maxillary occlusal splint on level of activation of masticatory muscles.
Swed Dent J, 17 (1993), pp. 235-241
[10.]
R. Miralles, P. Zunino, H. Santander, A. Manns.
Influence of occlusal splints on bilateral anterior temporal EMG activity during swallowing of sliva in patients with craneomandibular dysfunction.
J Craneomandibular Pract, 9 (1991), pp. 129-136
[11.]
R. Miralles, C. Mendoza, H. Santander, C. Zuniga, H. Moya.
Influence of stabilization occlusal splints on sternocleidomastoid and masseter electromyographic activity.
J Craniomandibular Pract, 10 (1992), pp. 297-304
[12.]
S. Tecco, S. Tetè, M. D‘Attilio, L. Perilio, F. Festa.
Surface electromyographic patterns of masticatory, neck, and trunk muscles in temporomandibular joint dysfunction patients undergoing anterior repositioning splint therapy.
Eur J Orthod, 30 (2008), pp. 592-597
[13.]
A. Manns, R. Miralles, J. Valdivia, R. Bull.
Influence of variation in anteroposterior occlusal contacts on electromyographic activity.
J Prosthet Dent, 61 (1989), pp. 617-623
[14.]
M. Bakke, L. Michler.
Temporalis and masseter muscles activity in patients with anterior open bite and craniomandibular disorders.
Scand J Dent Res, 99 (1991), pp. 219-228
[15.]
W.K. Solberg, G.T. Clark, J.D. Rugh.
Nocturnal electromyographic evaluation of bruxism patients undergoing short term splint therapy.
J Oral Rehabil, 2 (1975), pp. 215-223
[16.]
W.C. Kovaleski, J. De Boever.
Influence of occlusal splints on jaw position and musculature in patients with temporomandibular joint dysfunction.
J Prosthet Dent, 33 (1975), pp. 321-327
[17.]
A. Manns, R. Miralles, H. Santander, J. Valdivia.
Influence of the vertical dimension in the treatment of myofascial pain-dysfunction syndrome.
J Prosthet Dent, 50 (1983), pp. 700-709
[18.]
A. Manns, R. Miralles, F. Cumsille.
Influence of vertical dimension on masseter muscle electromyographic activity in patients with mandibular dysfunction.
J Prosthet Dent, 53 (1985), pp. 243-247
[19.]
H. Santander, R. Miralles, A. Jiménez, C. Zúñiga, M. Rocabado, H. Moya.
Influence of stabilization occlusal splint on craniocaervical relationships. Part II: Electromyographic analysis.
J Craniomandibular Pract, 12 (1994), pp. 227-233
[20.]
G. Ormeño, R. Miralles, H. Santander, R. Casasassus, P. Ferrer, C. Palazzi, H. Moya.
Body position effects on sternocleidomastoid and masseter EMG pattern activity in patients undergoing occlusal splint therapy.
J Craniomandibular Pract, 15 (1997), pp. 300-309
[21.]
A. Manns, R. Miralles, J. Valdivia, H. Santander.
Influence of occlusal splint adjusted to different vertical dimension on electromyographic activity during maximum clenching in patients with MPD syndrome.
IRCS Medical Science, 9 (1981), pp. 848-849
[22.]
K. Holmgren, A. Sheikholeslam, C. Riise, S. Kopp.
The effects of an occlusal splint on the electromyographic activities of the temporal and masster muscles during maximal clenching in patients with a habit of nocturnal bruxism and signs and symptoms of craniomandibular disorders.
J Oral Rehabil, 17 (1990), pp. 447-459
[23.]
I.Z. Alajbeg, M. Valentic-Peruzovic, I. Alajbeg, D. Illes.
Influence of occlusal stabilization splint on the asymmetric activity of masticatory muscles in patients with temporomandibular dysfunction.
Coll Antropol, 27 (2003), pp. 361-371
[24.]
H. Lundh, P.L. Westesson, S. Kopp, B. Tillström.
Anterior repositioning splint in the treatment of temporomandibular joints with reciprocal clicking: Comparison with a flat occlusal splint and an untreated control group.
Oral Surg Oral Med Oral Pathol, 60 (1985), pp. 131-136
[25.]
S. Tecco, F. Festa, V. Salini, E. Epifania, M. D‘Attilio.
Treatment of joint pain and joint noises associated with a recent TMJ internal derangement: A comparison of an anterior repositioning splint, a full-arch maxillary stabilization splint, and an untreated control group.
J Craniomandibular Pract, 22 (2004), pp. 209-219
[26.]
M. Stiesh-Scholz, J. Kempert, S. Wolter, H. Tschernitschek, A. Rossbach.
Comparative prospective study on splint therapy of anterior disc displacement without reduction.
J Oral Rehabil, 32 (2005), pp. 474-479
[27.]
M. Schmitter, M. Zahran, J.M. Duc, V. Henschel, P. Rammelsberg.
Conservative therapy in patients with anterior disc displacement without reduction using 2 common splints: A randomized clinical trial.
J Oral Maxillofac Surg, 63 (2005), pp. 1295-1303
[28.]
H. Lundh, P.L. Westesson, L. Eriksson, S.L. Brooks.
Temporomandibular joint disk displacement without reduction. Treatment with flat occlusal splint versus no treatment.
Oral Surg Oral Med Oral Pathol, 73 (1992), pp. 655-658
[29.]
W.S. Kirk Jr..
Magnetic resonance imaging and tomographic evaluation of occlusal appliance treatment for advanced internal derangement of the temporomandibular joint.
J Oral Maxillofac Surg, 49 (1991), pp. 9-12
[30.]
E. Tanaka, K. Kikuchi, A. Sasaki, K. Tanne.
An adult case of TMJ osteoarthrosis treated with splint therapy and the subsequent orthodontic occlusal reconstruction: Adaptive change of the condyle during the treatment.
Am J Orthod Dentofacial Orthop, 118 (2000), pp. 566-571
[31.]
H. Sato, T. Fujii, N. Yamada, H. Kitamori.
Temporomandibular joint osteoarthritis: A comparative clinical and tomographic study pre -and post-treatment.
J Oral Rehabil, 21 (1994), pp. 383-395
[32.]
C. Mejersjö, B. Wenneberg.
Diclofenac sodium and occlusal splint therapy in TMJ osteoarthritis: A randomized controlled trial.
J Oral Rehabil, 35 (2008), pp. 729-738
[33.]
P.E. Dawson.
Evaluation, diagnosis and treatment of occlusal problems.
The CV Mosby Co, (1974),
[34.]
H. Gelb.
Clinical management of head, neck and TMJ pain and dysfunction.
WB Saunder Co, (1977),
[35.]
J.P. Okeson.
Criterios de oclusión funcional óptima. Capítulo 5.
Oclusion y afecciones temporomandibulares, pp. 108-125
[36.]
H. Ohmure, S. Miyawaki, J. Nagata, K. Ikeda, K. Yamasaki, A. Al-Kalaly.
Influence of forward head posture on condylar position.
J Oral Rehabil, 35 (2008), pp. 795-800
[37.]
E.G. Katsavrias, D.J. Halazonetis.
Condyle and fossa shape in class II and class III skeletal patterns: A morphometric tomographic study.
Am J Orthod Dentofacial Orthop, 128 (2005), pp. 337-346
[38.]
W.H. Noble.
Anteroposterior position of “Myo-Monitor centric”.
J Prosthet Dent, 33 (1975), pp. 398-402
[39.]
M. Azarbal.
Comparison of Myo-Monitor centric position to centric relation and centric occlusion.
J Prosthet Dent, 38 (1977), pp. 331-337
[40.]
I. Glickman, A.W. Haddad, M. Martgnoni, N. Mehta, F.W. Roeber, R.E. Clark.
Telemetric comparison of centric relation and centric occlusion reconstructions.
J Prosthet Dent, 31 (1974), pp. 527-536
[41.]
O. Hidaka, S. Adachi, K. Takada.
The difference in condylar between centric relation and centric occlusion in pretreatment japanese orthodontic patients.
Angle Orthod, 72 (2002), pp. 295-301
[42.]
P.J. Karl, T.F. Foley.
The use of a Deprogramming appliance to obtain centric relation records.
Angle Orthod, 69 (1999), pp. 117-125
[43.]
S.J. Donegan, A.B. Carr, L.V. Christensen, G.J. Ziebert.
An electromyographic study of aspects of deprogramming of human jaw muscles.
J Oral Rehabil, 17 (1990), pp. 509-518
[44.]
G.J. Lavigne, S. Khoury, S. Abe, T. Yamaguchi, K. Raphael.
Bruxism physiology and pathology: An overview for clinicians.
J Oral Rehabil, 35 (2008), pp. 476-494
[45.]
G.D. Klasser, C.S. Greene, G.J. Lavigne.
Oral appliances and the management of sleep bruxism in adults: A century of clinical applications and search for mechanisms.
Int J Prosthodont, 23 (2010), pp. 453-462
[46.]
F. Lobbezoo, G.J. Lavigne.
Do bruxism and temporomandibular disorders have a cause-and-effect relationship?.
J Orofac Pain, 11 (1997), pp. 15-23
[47.]
S.P. Ramfjord.
Bruxism, a clinical and electromyographic study.
J Am Dent Assoc, 62 (1961), pp. 21-44
[48.]
S.P. Ramfjord.
Dysfunctional temporomandibular joint and muscle pain.
J Prosthet Dent, 11 (1961), pp. 353
[49.]
A.V. Newton.
Predisposing causes for temporomandibular joint dysfunction.
J Prosthet Dent, 22 (1969), pp. 647-651
[50.]
R.A. Hicks, C. Chancellor.
Nocturnal bruxism and type A-B behavior in college students.
Psychol Rep, 60 (1987), pp. 1211-1214
[51.]
G. Pingitore, V. Chrobak, J. Petrie.
The social and psychologic factors of bruxism.
J Prosthet Dent, 65 (1991), pp. 443-446
[52.]
J. Ahlberg, A. Savolainen, M. Rantala, H. Lindholm, M. Könönen.
Reported bruxism and biopsychosocial symptoms: A longitudinal study.
Community Dent Oral Epidemiol, 32 (2004), pp. 307-311
[53.]
G.J. Lavigne, T. Kato, A. Kolta, B.J. Sessle.
Neurobiological mechanisms involved in sleep bruxism.
Crit Rev Oral Biol Med, 14 (2003), pp. 30-46
[54.]
H. Hanamura, F. Houston, H. Rylander, G.E. Carlsson, T. Haraldson, S. Nyman.
Periodontal status and bruxism. A comparative study of patients with periodontal disease and occlusal parafunctions.
J Periodontol, 58 (1987), pp. 173-176
[55.]
S. Miyawaki, Y. Tanimoto, Y. Araki, A. Katayama, A. Fujii, T. Takano-Yamamoto.
Association between nocturnal bruxism and gastroesophageal reflux.
Sleep, 26 (2003), pp. 888-892
[56.]
B.W. Pavone.
Bruxism and its effect on the natural teeth.
J Prosthet Dent, 53 (1985), pp. 692-696
[57.]
A. De Laat, F. Lobbezoo.
Bruxism: Well known, but difficult to fathom.
Ned Tijdschr Tandheelkd, 107 (2000), pp. 271-274
[58.]
B. Stegenga, F. Lobbezoo.
Bruxism and temporomandibular disorders.
Ned Tjdschr Tandheelkd, 107 (2000), pp. 285-288
[59.]
F. Lobbezoo, M. Naeije.
Bruxism is mainly regulated centrally, not peripherally.
J Oral Rehabil, 28 (2001), pp. 1085-1091
[60.]
N. Huynh, G.J. Lavigne, P.A. Lanfranchi, J.Y. Montplaisir, J. de Champlain.
The effect of 2 sympatholytic medications-propanolol and clonidine-on sleep bruxism: Experimental randomized controlled studies.
Sleep, 29 (2006), pp. 307-316
[61.]
J.P. Okeson.
Tratamiento de los trastornos de los músculos masticatorios. Capítulo 12.
Oclusion y afecciones temporomandibulares, pp. 337-395
[62.]
K. Nishigawa, K. Kondo, H. Takeuchi, G.T. Clark.
Contingent electrical lip stimulation for sleep bruxism: A pilot study.
J Prosthet Dent, 89 (2003), pp. 412-417
[63.]
A. Manns, M. Rocabado, P. Cadenasso, R. Miralles, M.A. Cumsille.
The inmediate effect of the variation of anteroposterior laterotrusive contacts on the elevator EMG activity.
J Craneomandibular Pract, 11 (1993), pp. 184-191
[64.]
J.P. Okeson.
Tratamiento con férulas oclusales. Capítulo 15.
Oclusion y afecciones temporomandibulares, pp. 456-484
[65.]
G.T. Clark.
A critical evaluation of orthopedic interocclusal appliance therapy: Effectiveness for specific symptoms.
J Am Dent Assoc, 108 (1984), pp. 364-368
[66.]
R.P. Boero.
The physiology of splint therapy: A literature review.
Angle Orthod, 59 (1989), pp. 165-180
[67.]
D.W. Nitzan.
Intraarticular pressure in the functioning human temporomandibular joint and its alteration by uniform elevation of the occlusal plane.
J Oral Maxillofac Surg, 52 (1994), pp. 671-680
[68.]
G.T. Clark.
A critical evaluation of orthopedic interocclusal appliance therapy: Design, theory, and overall effectiveness.
J Am Dent Assoc, 108 (1984), pp. 359-364
[69.]
T.T. Dao, G.J. Lavigne.
Oral splints: The crutches for temporomandibular disorders and bruxism?.
Crit Rev Oral Biol Med, 9 (1998), pp. 345-361
[70.]
J. Garnik, S.P. Ramfjord.
Rest Position. An electromyographic and clinical investigation.
J Prosthet Dent, 12 (1962), pp. 895
[71.]
A. Manns, R. Miralles, F. Guerrero.
The changes of the postural muscles of the mandible upon varying the vertical dimension.
J Prosthet Dent, 45 (1981), pp. 438-445
[72.]
J.D. Rugh, C.J. Drago.
Vertical Dimension: A study of clinical rest position and jaw muscle activity.
J Prosthet Dent, 45 (1981), pp. 670-675
[73.]
A. Michelotti, M. Farella, S. Vollaro, R. Martina.
Mandibular rest position and electrical activity of the masticatory muscle.
J Prosthet Dent, 78 (1997), pp. 48-53
[74.]
A. Manns, R. Miralles, H. Santander, J. Valdivia.
Masseter Electromyographic changes as a function of vertical dimension in patients with MPD syndrome.
IRCS Medical Science, 9 (1981), pp. 354-355
[75.]
A. Manns, M. Spreng.
EMG amplitude and frequency at different muscular elongations under constant masticatory force or EMG activity.
Acta Physiol Lat Am, 27 (1977), pp. 259-271
[76.]
A. Manns, R. Miralles, C. Palazzi.
EMG, bite force, and elongation of the masseter muscle under isometric voluntary contractions and variations of vertical dimension.
J Prosthet Dent, 42 (1979), pp. 674-682
[77.]
S.J. Lindauer, T. Gay, J. Rendell.
Effect of jaw opening on masticatory muscle EMG-force characteristics.
J Dent Res, 72 (1993), pp. 51-55
[78.]
T. Morimoto, H. Abekura, H. Tokuyama, T. Hamada.
Alteration in the bite force and EMG activity with changes in the vertical dimension of edentulous subjects.
J Oral Rehabil, 23 (1996), pp. 336-341
[79.]
A. Chandu, T.I. Suvinen, P.C. Reade, G.L. Borromeo.
The effect of an interocclusal appliance on bite force and masseter electromyography in asymptomatic subjects and patients with temporomandicular pain and dysfunction.
J Oral Rehabil, 31 (2004), pp. 530-537
[80.]
W.W. Wood, D.L. Tobias.
EMG response to alteration of tooth contacts on occlusal splints during maximal clenching.
J Prosthet Dent, 51 (1984), pp. 394-396
[81.]
J.C. Türp, F. Komine, A. Hugger.
Efficacy of stabilization splints for the management of patients with masticatory muscle pain: A qualitative systematic review.
Clin Oral Investig, 8 (2004), pp. 179-195
[82.]
S. Öz, B. Gökçen-Röhlig, A. Saruhanoglu, E.B. Tuncer.
Management of myofascial pain: Low-level laser therapy versus occlusal splints.
J Craniofac Surg, 21 (2010), pp. 1722-1728
[83.]
C.M. de Felicio, M.M. de Oliveira, M.A. da Silva.
Effects of orofacial myofunctional therapy on temporomandibular disorders.
J Craniomandib Pract, 28 (2010), pp. 249-259
[84.]
Greene Ch, D. Laskin.
Splint therapy for myosfacial pain dysfunction (MPD) syndrome: A comparative study.
J Am Dent Assoc, 84 (1972), pp. 624-628
[85.]
S.P. Ramfjord, J.R. Blankenship.
Increased occlusal vertical dimension in adult monkeys.
J Prosthet Dent, 45 (1981), pp. 74-83
[86.]
T. Haketa, K. Kino, M. Sugisaki, M. Takaoka, T. Ohta.
Randomized clinical trial of treatment for TMJ disc displacement.
J Dent Res, 89 (2010), pp. 1259-1263
[87.]
R.E. Bates Jr., H.A. Gremillion, C.M. Stewart.
Degenerative joint disease. Part I: Diagnosis and management considerations.
J Craneomandibular Pract, 11 (1993), pp. 284-290
[88.]
Y. Sim, D.S. Carlson, J.A. McNamara Jr..
Condylar adaptation after alteration of vertical dimension in adult rhesus monkeys, Macaca mulatta.
J Craneomandibular Pract, 13 (1995), pp. 182-187
[89.]
M. Urbanowicz.
Alteration of vertical dimension and its effect on head and neck posture.
J Craneomandibular Pract, 9 (1991), pp. 174-179
[90.]
C. Zúñiga, R. Mirralles, B. Mena, R. Montt, D. Moran, H. Santander, H. Moya.
Influence of variation in jaw posture on sternocleidomastoid and trapezius electromyographic activity.
J Craneomandibular Pract, 13 (1995), pp. 157-162
[91.]
H. Moya, R. Mirralles, C. Zúñiga, R. Carvajal, M. Rocabado, H. Santander.
Influence of stabilization occlusal splint on craniocervical relationships. Part I: Cephalometric analysis.
J Craneomandibular Pract, 12 (1994), pp. 47-51
[92.]
V.A. Baräo, A.K. Gallo, P.R. Zuim, A.R. García, W.G. Assunção.
Effect of occlusal splint treatment on the temperature of different muscles in patients with TMD.
J Prosthodont Res, 55 (2011), pp. 19-23
[93.]
D.T. Brown, E.L. Gaudel Jr., C. Phillips.
Changes in vertical tooth position and face height related to long term anterior repositioning splint theraphy.
J Craneomandibular Pract, 12 (1994), pp. 19-22
Copyright © 2011. Sociedad de Periodoncia de Chile, Sociedad de Implantología Oral de Chile y Sociedad de Prótesis y Rehabilitación Oral de Chile