Occlusal Adjustment as Treatment for Chronic Orofacial Pain

Basis for an Etiological Diagnosis and Treatment of the Chronic TMD-pain: RCT Study

The purpose of this study is to determine whether occlusal adjustment by selective grinding and/or occlusal addition is an effective treatment of chronic temporomandibular joint disorders.

Temporomandibular disorders (TMD) are very common disorders in daily dentistry and oral and maxillofacial practice. The key symptoms are jaw joint pain and limited mouth opening. Other than trauma, the causes remain unknown; consequently, there are no treatments based on specific etiologies. In our experience, patients can usually receive beneficial occlusal adjustments if these are carefully planned and performed in two steps: (1) elimination of premature contacts, which reduces loads in the temporomandibular joints, and (2) individualized remodeling of lateral anterior guidance to facilitate unilateral alternate chewing. The study will use stratified blocking randomization to blindly assign patients to the real or placebo treatment groups in order to evaluate the null hypothesis (H0) that "Occlusal adjustment of sufficient quality has no effect on chronic pain and/or limited mouth opening in TMD patients."

Inclusion Criteria:

• People suitable for inclusion in the study are full dentate patients
• Aged between 18 and 65 years
• Patients with chronic TMD pain (and usually with associated limited mouth opening) for whom occlusal adjustment could achieve normal occlusion, both static and functionally equilibrated

Exclusion Criteria:

• Pregnancy
• Trauma
• Previous TMJ surgery
• Patient refusal to consent to participate in the study or significant concerns about the study
• Limited collaboration
• Concurrent active treatment with orthodontics, and active periodontal disease