Comparison of modified occlusal splint, standard splint protocol, and conventional physical therapy in management of temporomandibular joint disc displacement with reduction and intermittent locking: a randomized controlled trial

Background: Temporomandibular joint disc displacement with reduction is one of the most common types of TMJ arthropathy. This single-blinded, randomized clinical study aimed to evaluate the effectiveness of three different therapeutic methods. Methods: Standard splints (Group 1), modified occlusal splint (Group 2), and conventional physical therapy with exercises (Group 3). A total of 48 patients were randomly assigned by a computer-generated allocation sequence to receive rehabilitation. The outcome was defined as improvements in pain and intermittent locking episodes. The follow-up visits were scheduled as one month and a long-term evaluation at one (T1), two (T2), three (T3), and four years (T4). Magnetic resonance images were also taken to evaluate each patient before treatment and at one year. Image analysis involved the evaluation of morphology and the function of intra-articular structures. Variables such as age, gender, and pre- vs. post-treatment values of VAS and TMJ locks between the three intervention categories were compared for statistical evaluations. p values ≤ 0.05 were taken as being significant. Results: A total of 16 subjects were allocated to each group. At T1, a decrease in pain and TMJ locking episodes was observed, which was maintained throughout the course of the study for four years of follow-ups, with no statistically significant differences. However, there was a tendency for better outcomes in favor of Group 2, with less clicking of the TMJ at opening. Conclusions: The modified mandibular splint seems to be successful as an effective alternative for the management of temporomandibular joint disc displacement with reductions in intermittent locking.