To evaluate the effectiveness of Lingual Ring Splint For Management of Anterior Disc Displacement With Reduction

To evaluate the effectiveness of Lingual Ring Splint For Management of Anterior Disc Displacement With Reduction.

PICO P- Patient with symptomatic anterior disc displacement with reduction . I- use of Michigan splint C- use of anterior repositioning splint (ARS) . O- Clinical outcome. Pain relief and improvement of mouth opening , lateral excursion and protrusion

Outcome:

• 1ry outcome: Patients' subjective pain experience. Each patient will be asked to rate his or her current and worst pain intensity on numerical rating scale (NRS) of 0-10 with zero being no pain and ten corresponds to the worst pain that the patient ever had.

• 2ry outcome:

  1. Maximum mouth opening (MMO). Assessment of MMO will be performed by measuring the distance in mm between the incisal edges of the upper and lower central incisors using a ruler.
  2. lateral excursion . Assessment of lateral excursion will be performed by measuring the distance in mm between midline of upper and lower jaws
  3. protrusion. The distance in mm from the incisal edge of the maxillary central incisor to the incisor edge of the mandibular incisor will measured in the maximum protruded position.

Inclusion Criteria:

• Adult patient from 15 to 50 years old.
• Report of pain in preauricular region, in the last 30 days, worsened by functional activities, such as chewing and talking.
• Presence of disc displacement with reduction, arthralgia and joint clicking that occurred at both middle to late opening and late closing (near maximum cuspation) and pain in the TMJ area aggravated by jaw movement and function.
• positive diagnosis of unilateral or bilateral anterior disc displacement with reduction by means of magnetic resonance imaging (MRI).

Exclusion Criteria:

• Individuals with a recent history of trauma in the face and/or neck area.
• Individuals with systemic diseases that can affect TMJ.
• History of TMJ surgery.
• Individuals with dental pain.
• Individuals with myofascial pain, disc displacement with reduction or osteoarthritis.
• Individuals under dental or TMD management.
• Individuals wearing full or partial dentures.
• Individuals with major psychological disorders.
• Nonreducing dislocations of the articular disk in the acute form of TMD
• Consequences of condoyle fractures and/or fracture of another maxillofacial zone.
• In therapy for the same pathologies.
• Articular pathologies of systemic nature (e.g., rheumatoid arthritis, arthrosis, psoriasis arthritis).
• Well-known pathologies of neurologic and/or psychic nature and other forms of migraine.