Effects of centric mandibular splint therapy on orofacial pain and cerebral activation patterns
Abstract
Objectives
To investigate the effects on pain, movement kinematics, and cerebral representation by a 3-month mandibular splint therapy.
Material and methods
Thirteen
patients with temporo-mandibular joint disease (TMD) and moderate pain
intensity were investigated before (PRE), within (after 2 weeks, POST1)
and after a period of 12 weeks (POST2) using functional magnetic
resonance imaging (fMRI) of representation of occlusal movements on
natural teeth and on an individually fitted mandibular splint. In
addition, kinematic investigations of jaw movements, muscle
electromyography and pain ratings using a pain diary (VAS-scale 0–100)
were measured.
Results
Although
the patient’s pain ratings decreased about 60%, kinematic and
electromyographic characteristics over therapy were not significantly
altered. Over therapy, we observed a decrease of fMRI activation
magnitude in the primary somatosensory cortex (S1) and secondary
somatosensory cortex (S2) and insular cortex during occlusion. Left
hemispheric anterior insula and the cerebellar fMRI activation decrease
were associated with decrease in pain over time.
Conclusions
Within
the limitations of this pilot study, a reduction in both discriminative
(primary and secondary somatosensory cortex) and affective (anterior
insula) areas for pain processing suggest that altered pain anticipation
is critical for the therapeutic effects of mandibular splint therapy
after TMD.
Clinical relevance
A 3-month mandibular splint therapy moderately decreases pain and anticipatory anterior insular activation.
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