Efficacy of canine-guided and bilateral balanced occlusion appliances in managing TMJ disc displacement with Reduction-A randomised clinical trial

Abstract

Background

Among the intracapsular disorders of the temporomandibular joint (TMJ), disc displacement with reduction (DDwR) occurs most frequently. Canine-guided orthotic appliances may increase loading on the contralateral TMJ during eccentric movements due to the leverage effect generated on the working side whereas bilateral balanced occlusion appliances may promote uniform force distribution, reducing contralateral joint stress in patients with DDwR. Evidence comparing the effectiveness of canine-guided and bilateral balanced occlusion orthotic appliances in the management of DDwR remains limited.

Aim

This study compared the effectiveness of canine-guided and bilateral balanced occlusion orthotic appliances in reducing pain, assessed using the Visual Analog Scale (VAS), in patients with DDwR.

Material and methods

This study included 68 patients with painful TMJ DDwR (RDC/TMD Group IIa). Participants were randomly assigned to two groups: Group 1 received a canine-guided orthotic appliance, and Group 2 received a bilateral balanced occlusion orthotic appliance. Pain intensity was assessed using the VAS at baseline, 15, 30, and 90 days.

Results

Mann-Whitney U test was used for group comparisons which demonstrated Group 2 achieved significantly lower VAS scores during early assessments, while Group 1 exhibited more notable reductions between 30 and 90 days. Wilcoxon test was used to assess improvement within groups which demonstrated significant improvement in both the groups with p value < 0.001.

Conclusions

The bilateral balanced occlusion appliance produced faster pain reduction with lower VAS scores, particularly between 15 and 30 days. The canine-guided appliance showed greater pain reduction between 30 and 90 days. Both interventions effectively reduced pain.