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8/2/2019 Roura & Clayton. Pan to Graphic Records on TMJ Dysfunction Subjects Treated With Occlusal Splints - A Progress Re

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P an t o g r ap h i c r ec o r d s o n T M J d ys fu n c t io n su b jec tst r ea t ed w i th o c c l u sa l sp l in t s : A p r o g r ess r ep o rtNe ls on R oura , D .M.D . , M .S . , * a nd J os eph A . C la y ton , D .D .S . , M .S . * *Th e University o/M ichig an, School o~ Dentistry, An n A rbor, M ich.

R e p r o d u c i b l e m a n d i b u l a r b o rd e r m o v e m e nt s ca n . be r e c o rd e d gr a ph ic a ll y, b ym e a n s o f a p a n t o g r a p h , o n s u b je c ts w i t h a p p a r e n t l y " n o r m a l " m u s c le a n d t e m p o r o -m a n d i b u l a r jo i n t ( T M J ) f u n c t io n . 1"~ I f a s u b j e c t c a n n o t r e p r o d u c e t h e b o r d e rm o v e m e n t s , o n e c a u s e m i g h t b e T M J d y s f u n ct io n . G's

A s u b j ec t ' s ab i l i t y t o co n t ro l m u s c l e s i s i n v o lv ed i n m ak in g b o rd e r m o v em en t s .O n e a s p ec t o f T M J d y s fu n c t io n m ay a l s o i n v o lv e m u s c l e co n t ro l , an d t h e re fo re ,m u s c l e d y s f u n c ti o n a n d b o r d e r m o v e m e n t s m a y b e i n t e r r e la t e d .

E l ec t ro m y o g rap h y (E M G ) re fl ect s t h e ac t i v i t y i n a m u s c l e an d t h e re l a t i v e t im eo f ac t i v a t i o n o f d i f f e ren t m u s c l e s. E M G h as b een u s ed a s an a id t o d i ag n o s e m u s c l edy sfu nc tion . 9"~

O c c l u s a l b i t e s p li n ts h a v e b e e n r e c o m m e n d e d a s a p o ss ib le t r e a t m e n t f o r T M Jdysfunct ion.7 , s , 10, 14, 1 ;- to Th e effect iveness of b i te -sp l int the ra py has be en s tu die dby seve ral inv est igato rs , 4, ts, 20, 21 an d resul ts ha ve va rie d widely .

T h e p u r p o se s of t hi s s t u d y w e r e : ( 1 ) t o o b s er v e m a n d i b u l a r m o v e m e n t s o ns u bj e ct s w i t h T M J d y s f u n c t io n a s r e c o r d e d b y a p a n t o g r a p h a n d ( 2 ) t o o b se r veth e e f f ec t o f t h e rap y wi th o cc lu s a l b i t e s p li n ts o n t h e s u b j ec ts ' T M J d y s fu n c t io na n d o n t h e i r a b il i ty t o r e p r o d u c e b o r d e r m o v e m e n t s .M A T E R IA L S A N D M E T H O D S

F i v e s u b je c ts w i t h T M J d y s f u n c t io n a n d o n e " n o r m a l " s u b j e c t w e r e s e le c te dacco rd in g t o c l in i ca l ly d em o n s t r ab l e s i g ns an d s y m p to m s .

Presented before the American Academy of Crown and Bridge Prosthodontics, Chicago,Ill. Condensed from a the sis presented in pa rtial fulfillment for the degree of Master o!Science in Restorative Dentistry at The University of Michigan.This study vas supported in part by U nited State s Public Hea lth S ervice Grants No.DE-0231-01s GR S N o. 012713 , and R R No. 0521-13.~Assistant Professo r, Restorative Sciences Div ision, University of Pue rto Rico, S cho ol ofDentistry.**Professor, Crown & B ridge De partm ent, Th e U niversity of Michigan, Schoo l ofDentistry.

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V o l u m e 3 3 T M ] dys [unct ion t rea ted w i th occlu sa l sp lints 443Number 4

F ig . 1 . P h o to g r a p h s o f t h e t y p e o f o c c lu s a l b i t e s p l i n t u s e d f o r 3 0 d a y t h e r a p y i n t h i s s t u d y . ( A )T h e s p l i n t i s d e s ig n e d s o t h a t a l l t h e m a n d ib u l a r t e e th c o n t a c t ( b u c c a l c u s p t i p s o r i n c i s a le d g e s ) t h e s p l i n t i n c e n t r i c p o s i t i o n . G u id a n c e r a m p s a r e p l a c e d f r o m c a n in e t o c a n in e t osepara te the pos te r io r occ lus ion in excurs ive movements . ( B ) The sp l in t i s des igned to s tab i l izeth e m a x i l l a r y t e e th . T h e t e e th c a n n o t e r u p t o r s h if t d u r in g t h e 3 0 d a y t h e r a p y . T h e s p l i n t i sad jus ted to r i l l -mand ibu la r pos i t ions .Table I. T h e r e p r o d u c i b il i ty of t h e b o r d e r m o v e m e n t t r a c i ng s w a s e v a l u a t e d a c c o r d i n gt o t he n u m b e r o f p o in t s" ,o f m e a s u r e m e n t ( l oc i ) a t w h i c h m o re t h a n o n e l in e w a so b s e rv e d . A n a rb i t r a ry e v a l u ' a t i o n s c a l e w a s m a d e t o f a c i l i t a t e a c o m p a r i s o n : e x c e l l e n t(0 ) , g o o d ( 1 t o 2 ) , f a i r ( 3 to ~ 9) , p o o r (1 0 to 1 9 ) , a n d v e ry p o o r (2 0 + ) T h e re a r e3 6 p o ss ib le l o c i f o r a s e t o f m a n d i b u l a r m o v e m e n t t r a c i n g s ( se e F i g . 2 )

. . . . S u b j e c t i" N o r m a l " E x c e l l e n t

I Poor2 F a i r3 F a i r4 F a i r5 F a i r

Visi t 1 Vis i t 2 Vis i t 3 (4 to 7( ini t ial ) ( inserted spl int) days [rom spl int)E x c e l l e n t E x c e l l e n tV e r y p o o r V e r y p o o rP o o r V e r y p o o rE x c e l l e n t E x c e l l e n tG o o d F a i rF a i r E x c e l l e n t

Visit 4. (30 daysf rom sp l in t )E x c e l l e n tV e r y p o o rP o o rG o o dE x c e l l e n tE x c e l l e n t

In i t i a l l y , s u b j e c t s w e re s u rv e y e d r a d i o g ra p h i c a l l y , e l e c t ro , n y o g ra p h i c a l l y , a n dp a n t o g r a p h i c a l l y . E M G w a s u s e d t o h e l p i n d e t e r m i n i n g t h e p r e s en c e o r a b s en c eo f m u s c l e d y s f un c t io n . T h e p a n t o g r a p h w a s u s e d t o o bs e rv e m a n d i b u l a r b o r d e rm o v e m e n t s . D i a g n o s t i c c as ts w e r e m a d e a n d m o u n t e d o n a H a n a u s e m i a d j u s t a b lea r t i c u l a t o r .* O c c l u sa l b i te s p l in t s w e r e w a x e d a n d t h e n p r o c e s s e d i n c l e a r h e a t - c u r e dacryl ic res in 19 (Fig . 1) .

A t t h e s e c o n d v i s i t , EMG re c o rd s w e re o b t a i n e d b e fo re a n d a f t e r s p l i n t i n s e r t i o n .T h e n s t an d a r di z e d p a n t o g r a p h i c r e co r ds w e r e a t t e m p t e d .

O n e w e e k a f t e r s p li n t i n se r ti o n , E M G r e c o rd s w e r e o b t a i n e d w i t h t h e s p li n ti n t h e m o u t h a n d a f t e r r e m o v a l o f t h e s p l i n t . P a n t o g r a p h i c r e c o r d s w e r e a l s oo b t a i n e d . T h e s a m e p r o c e d u r e w a s r e p e a t e d o n e m o n t h a f t e r s p l i n t i n s e r t i o n .Cl in ica l symp tom s were as sessed o n e ach v i si t.

A s a c o n t r o l , p a n t o g r a p h i c r e c o r d s w e r e o b t a i n e d o n t h e " n o r m a l " s u b j e c t a tfo u r c o m p a ra b l e v i s i t s .

* H a n a u E n g i n e e r i n g C o m p a n y , I n c . , B u f f a l o , N . Y .


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444 Roura and Clayton J . P r o s t h e l . D e n t :Ap ril, 1975

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Fi g , 2 . A schemat ic d ia gra m of the border t r ac ings il lus t ra ting the po in t s where m easurementsw e r e m a d e . (A ) Enla rgement o f the t r ac ing f rom each t rac ing tab le showing the measurementto mark the points . (B ) Onc e the po in t is p laced , the num ber o f l ines i s de te rmined a t th a tp o i n t . T h e r u le r (D ) is p laced tange nt ia l to the point . A ma gnify ing glass scale ({2, in tenthsOf mi l l imete r s ) is p la ced perpend icu la r to the ru le r . A de te rmina t ion i s then m ade wh e therthere are mutiple l ines or a s ingle l ine a t that point .

- , , = - ~ . - , , ' 3 , , , I - ~ + _ ~ , - , > . , - ,

':: ~> ' ~ ~ ~ ~, . , ! > < ~ , .... ' ! l ,' " : ~ >-~ " ' / i: i ~ 7 ' , ~ : i . : , , : ' , ~ - ~ : < : ! . : : / ~ ' . , , , ' ? : i : : : ' ~ i ~ ; ~ 9 1 , ' , - ' ' ~ ! - % . ~ : i i i : " , . ' / ~ < : , ' / i ~ : : ~ : i ' : , ~ ~ t' , ~ . ; , X ' - ~ 7 - \ - ' . . ~ , " . : ;' ~ ' ,' ~ . " . - S . ~ < . . . '~ < ' . ' ? " ~ ; % t L . - . ' ~ " . - < ., ~ ~ e . y ' , " , ~ , ~ " ~ ' , . - : ~ . . , " ., ~ , . :. . " , ' " , ~ " ~ , ~ > , ' .

~ , : , ' ~ . . ! : ' - ~ . " - ; .~ ' < ~ " , ' ~ f . " ; . m ~ , " ~ , ? . ~ . : : , ~" " L ~ ' , I - , - , , ~ " . ~ . ' ~ , , ' . . : , C ~ : , " : - , , , / ' j ~ ' : : , " " , : . ' : - " ~ , " , . - e ~

F i g , 3. T h e " n o r m a l " s u b je c t m a d e t h re e g u i d e d a t t e m p t s t o m o v e a l o n g t h e b o r d e r p o s i t i o n a t(a t t h e i n i t ia l a p p o i n t m e n t a n d ( b ) 3 0 d a y s a f t e r w e a r i n g a n o c c l u s a l s p l i n t . N o t i c e t h e r e -p r o d u c i b i l i t y of these movements as exhibi ted by s ingle l ines . The dots on the t racings in (a )represen t the pos i t ions where measurements were made . ( H , V , and .4 represent the hor izontal ,ver t ical , and anter ior t racing tables . The r ight s ide of the f igure is the subject ' s lef t . Thislegend is same for Figs . 4 to 8 . )


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4 4 6 R o u r a a n d C l a y t o n J . Pros the t . Den t .Ap ril, 1975

F i g .. 5 . S u b j e c t 2 m a d e t h r i~ e g u i d e d a t t e m p t s t o m o v e a l o n g t h e b o r d e r p o s it io n s a t (a ) th ei n i t i a l . a p p 0 i n t m e n t a n d " (b ) 3 0 d a y s _ a f t e r w e a r i n g a n o c c l u s a l s p l i n t . N o t e t h e m u l t i p l e c e n t r i cp o i n t s a n d m u l t i p l e l a t e r a l t r a c i n g s (a ) . " / 'h i s sub jec t appear s to have l es s r eproducib i l i ty a f t e r3 0 d a y s o f o c c l u s a l s p l i n t t h e r a p y ( b ) .

w i t h a sc a le i n - t e n t h s o f a m i l l i m e t e r ) a t 3 6 st a n d a r d i z e d p o i n t s o n t h e t r ac i n g s .W h e n e v e r m o r e - t h a n a si ng le li n e w a s re c o r d e d a t a p a r t i c u la r p o i n t o f m e a s u r e-m e n t , t h e w i d t h s o f t h e t w o . o r t h r e e l in e s p ! u s - t h e d i s ta n c e b e t w e e n t h e l in e s w e r ei n c l u d e d in _ t h e: -r rf e as u re m e ~n t ( F i g . 2 ) . T h e v a l u e s m e a s u r e d f o r t h e i n i t ia l a n df i n a l - v i s i t s f o r t h e f iv e s u b j e c t s w e r e i a n a l y z e d s t a t is t i c a ll y t o d e t e r m i n e i f - t h et r a c i n g s w e r e , r e p ro d u c i b le . ,, A p a i r w i s e - t s t a t i s ti c a l c o m p a r i s o n a n d a f o u r - p o i n tm u l t i v a r i a t e t e st w e r e m a d e .RESULTS

Borc le r m ov e m e n t . R e p r o d u c i b i l it y o f m a n d i b u l a r b o r d e r m o v e m e n t s w a s b a s edu p o n t h e a b i l i t y o f th e s u b j e c t t o r e t r a c e t h e s a m e l i n e a t t h e 3 6 p o i n ts o f m e a s u r e -m e n t s o n t h r e e r e p e a t e d g u i d e d l a t e r a l ex c u rs io n s . R e p r o d u c i b l e , p a n t o g r a p h i c ,b o r d e r - m o v e m e n t t r a c i n g s f o r c o m p a r a b l e v i si ts w e r e re c o r d e d f r o m th e " n o r m a l "s u b j e c t ( F i g . 3 ) . A f t e r b i t e - s p l i n t t h e r a p y , t h r e e o f t h e s u b j e c t s s h o w e d a n i m p r o v e -


6/12

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F i g . 6 . S u b j e c t 3 m a d e t h r e e g u i d e d a t t e m p t s t o m o v e a l o n g t h e b o r d e r p o s i t i o n s a t (a) thei n i t i a l a p p o i n t m e n t a n d (b ) 3 0 d a y s a f t e r w e a r i n g a n o c c l u s a l s p l i n t . N o t e t h e l a c k o f r e -p r o d u c i b i l i t y i n a l l l a te r a l m o v e m e n t (a) . T h e r e i s c o n s i d e r a b l e i m p r o v e m e n t a f t e r 3 0 d a y s o fs p l in t t h e r a p y , b u t t h e r e a r e s t il l m u l t i p l e - t r a c i n g s i n t h e r i g h t l a t e r a l m o v e m e n t (b ) .

m e n t i n r e p r o d u c i n g t h e t r a c i n g s , a n d t w o s u b j e c t s d i d n o t s h o w i m p r o v e m e n t( T a b l e I a n d F i g s . 4 t o 8 ) .

A p a i r w i s e t s t a t is t i ca l c o m p a r i s o n s h o w e d t h a t f o r o n l y tw o o f t h e 3 6 p a i r sc o m p a r e d w a s t h e d i f f e r e n c e o f m e a n s s i g n i f i c a n t a t a l e v e l o f 0 . 1 . T h e m u l t i v a r i a t ea n a ly s is s h o w e d t h a t t h e m e a n f o r t h e s e t o f v a l u e s o f t h e f i n a l v i s it w a s n o ts i g n i f i c a n t l y c l o s e r t o z e r o t h a n w a s t h a t o f t h e i n i t i a l v is i t.Electromyography. E l e c t r o m y o g r a p h i c a l l y , f o u r o f t h e f iv e s u b j e ct s s h o w e ds l ig h t m u s c l e i m p r o v e m e n t t h r o u g h b i t e -s p l i n t t h e r a p y . F o u r s u b je c t s s h o w e d ad e c r e a se i n m u s c l e a c t iv i t y a t r e st , t h r e e s h o w e d a s l i g h t i m p r o v e m e n t i n c h e w i n g ,a n d t w o s h o w e d a n i m p r o v e d m u s c l e s y n c h r o n y d u r i n g l a t e r a l s l id i n g . N o n e o f t h es u b j ec t s s h o w e d a n y n o t i c e a b l e c h a n g e i n s w a l l o w i n g p a t t e r n . T h e s u p r a h y o i dm u s c l e s s h o w e d a n i n c r e a s e i n r e s t i n g a c t i v i t y w h e n t h e o c c l u s a l s p l i n t w a s i n s e r t e d( F i g . 9 ) . A f t e r 3 0 d a y s o f o c e l u s a l s p l i n t t h e r a p y , h o w e v e r , t h e s u b j e c t s s h o w e d ad e c r e a s e i n r e s t in g a c t i v i t y a t t h e f i n a l v i s i t w i t h o u t t h e s p l i n t i n th e m o u t h ( F i g . 1 0 ) .


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F~.~--~7.. ~ j e c t . 4 ma[d _ e '- th ree a t t em p t s ' t o . r f i~g v e a lo n g , m e b o rd e r p o s i t i o n s a t ( a ) ' t l a e !n , t t a l-app _ o ~n fmen t 'f "an d ~f_b ') -3 0 d a y s "a f t e r w ea r in g an " o cc lu ssa l s p l i n t . In i t i a l l y , t h i s su b j ec t sh o ;weda l a c k " ' o ~ d u c i ~ l [ t y - b y _ _ ~ m u l t i p l e t r ac i n g m a , n l y , n d i e a ', gh t l a te r a l m o v e m e n t (a ) . A f t e r.30 . day s of occlS"sM ~l~l if i t- thera lSY,--t tie .2movem ents-were_consider6-d" rep ro du cib le (b ) .

Symptoms. F o u r o f . th e . .~ u b j ec ts wh o h ad p a i n i n it i a ll y sh o wed i m p ro v em en t o fc l in i ca l s y m p to m s . S u b j e c t ~ . . ~ i a l s y m p t o m s o f c li ck i ng a n d p o p p i n g o f t h ej o i n t o n l y , d i d n o t s h o w an i m p ro v em en " t ~ in -~ m p t o m s .D ISCUSS IONT h r o . u . g h 3 0 d a y s o f t r e a t m e n t w i t h o c c l u s a l b i t e s p l i n t s , o " ~ l ~ b j e c t -i m p ro ' eed t o t h e p o i n t o f m a k i n g r ep ro d u c i b l e b o rd e r m o v em en t s ( " ex c~ .l len t~ra t in g in T abie"~I) .z- ..Tl- id rd lSr6ducibi l i ty of these t racing s w as co m pa rab le to tha to f t h e t r ac i n g s f ro m t h '~ e n o r m a l " p a t i en t an d t o t h a t d e s c r ib ed b y C o h e n 1 an dClay ton and assoc ia tesY

T h e p a i rw i s e t s t at is t ic a l te s t s h o wed i h "a t; - - ~ o s t o f t h e p o in t s m e as u red fo rin i t i a l and f ina l v is it s, there w ere no s ta t i s t ica l ly s tgmfiean t changes in l i n e , w id th .T h e m u l t i v a r i a te a n al ys is d e m o n s t r a t e d t h a t th ere d i d n o t s ~ b e - a n ~ v s ta ti st ic a lt re nd as to ch an ge in re pro du cib i l i ty o f bo rde r t racin gs w ith the use of th is ----'m~e ure~m en t sys tem, b ia t the l ines t race d d i f fe red s ign i f ican t ly enou gh to jus t i fy an ana lys is .

A d ec rea s e i n m u s c l e ac t i v i ty a t r e s t an d s l ig h t i m p ro v em en t in ch ew i n g ' " ' ' ' an di n m u s c l e s y n ch ro n y ~ s u g g est im p ro v e m en t i n t h e m u s c l e d y s fu n c ti o n . O n t h e b a si so f t h e se f ac ts a lo n e , h o w ev e r , an d s in ce a ty p i ca l s wa l l o wi n g p a t t e rn s d i d n o t i m p ro v e ,


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F i g . 9 . P h o t o g r a p h s o f th e E M G r e c o r d i n g s o f S u b j e c t 5: ( A ) t h e m u s c l e r e s ti n g a c t i v i t y a tv i s i t 3 w i t h t h e o c c l u s a l s p l i n t i n t h e m o u t h ; (B ) t h e r e s t i n g a c t i v i t y a t v i s i t 3 w i t h o u t t h eo e c l u s a l s p l in t i n t h e m o u t h . T h e r e w a s a d e c r e a se i n m u s c l e r e s ti n g a c t i v i ty (B ) r i g h t a f t e r t h er e m o v a l o f t h e o c c l u s a l s p l i n t .


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4 5 2 l~oura and Clayton j . l ' r o s t h e t . Den t .Apri l , 1975m ov em en ts. Th e resul ts , of this ,, s tudy sug ges t- that the. abi l i ty of ,a : subject to t racer e p ro d u c ib l e . m a n d i b u l a r b o r d e r ' m o v e m e n ts ' o n , ~ / p a n t o g r a p h m i g h t b e a v a l u a b l ea id i n de t e rmin ing i '. no rma l" Or, abno r ma l~m andibu la r movement s l T he va lue o fthe pan to gr ap h a s a d i agnos t ic a id sho u ldb e s tud ied f u r the r .CONCLUS IONS

W ithin the g roup of s ix pa t ients s tudied the fol lowing conc lus ions were m ad e:1 . A subjec t wi th no app are nt c l in ica l s igns and symp toms of T M J dysfunc t ion

c a n make r epr oduc ib le m andib u la r bor de r mov emen t t r ac in gs a s r ecorded by ap a n t o g r a p h .

2 . Subjec ts wi th T M J dysfunc t ion may not be able to m ake reproduc iblemandibu la r bor de r movement t r ac ings .

3 . On e m on th o f occ lusal spl in t therap y re lieved most of the s igns and symp tomsof T M J dysfun c t ion, wh en s tudied c l in ica lly and e lec tromyo graphica l ly . Co m ple terel ief of muscle dysfunction was not evident .

4 . In a subjec t wi th T M J dysfunc t ion, one m on th of occ lusal b i te - spl in t therapya lone m ay n o t insure re l ie f of symp toms to the po int w here the Subjec t can t racer epr oduc ib l e mandibu la r bor de r movement s .S UMMA R Y

Five subjec ts wi th T M J dysfunc t ion showed di ff icul ty in m aking reprod uc ib lemandibu la r bor de r movement s a s r ecor ded by a pan togr aph . These sub jec t s we r etreated with occlusal bi te spl ints , and muscle act ivi ty was studied by electromyog-raphy. Af te r one month of t r ea tment , most subjec ts showed re l ie f of c l in ica ls y m p to m s a n d i m p r o v e d E M G m u s c u l a r a c ti vi ty .

M os t o f t he sub jec t s ' mand ibu la r movement s d id no t impr ove to the po in t o fmak ing r epr o du c ib l e bor de r movem ent s on a pan togr aph . Th e l eng th o f time andthe type of t r ea tm en t m ay have had a s igni f icant e f fec t on the result s. This shouldbe invest igated fur ther .References

1. C o h e n , R . : T h e R e l a t i o n s h i p o f A n t e ri o r G u i d a n c e t o C o n d y l a r G u i d a n c e i n M a n d i b u l a rM ove me nt , J . PRosTHET. DEN T. 6: 758-767, 1956.2 . C lay ton , J . A . , Kotowicz, W . E . , and Myers , G . E . : G raph ic R ecord ings o f Mand ibu la rM ove me nts : Research Cri ter ia , J . PROSTHET. Dv.Nr. 25: 287-298, 1971.3 . Mc Col lum , B . B . , and S tuar t , G . E . : A Research Repor t , Sou th Pasadena , Ca l if . , 195 5 ,Scientific Press.4 . S tua r t , C . E . : Accuracy in Measur ing Func t iona l Dimens ions and Re la t ions in Ora lProsthesis , J . PRosTrtET. DEN T. 9: 220-236 , 1960.5. Posselt , U . : Sag i t ta l Co ndy lar Guid ance. Odo ntol . Revy 11: 32-36, 1960.6 . Guiche t , N . F . : Occ lus ion : A Tea ch ing M anua l , Anahe im, Ca li f ., 1970, De nar Corp .7 . C lay ton , J . A . : Border Pos it ions and Res to r ing Occ lus ion , Den t . C l in . No r th A m. 15 :5 2 5 - 5 4 2 , 1 9 7 1 .

8 . H u f f m a n , R . W . , R e g c n o s , J . W . , a n d T a y l o r , R . R . : P r i nc i p le s f O c c l u s i o n : L a b o r a t o r ya n d C l i n ic a l e a c h i n g M a n u a l , e d. 3 , C o l u m b u s , O h i o , 1 9 6 9 , H & R P re ss .9 . Mol le r , E . : C l in ica l E lec t rom yograph y in Den t i s try , In t . D en t . J . 19 : 250-266, 1 . 9 7 ~ 9 .I0 . Gr i ff in , G . J . , and M unro , R , R . : E lec t romyog raphy o f the Masse te r and An te r io r Te m -pora l i s Musc les in Pa t ien t s Wi th Temporomandibu la r Jo in t Dysfunc t ion , Arch . Ora l B io l .16: 929-949, 1971.


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Volume 33Numher 4 T M ] dys/unction treated w ith occtusal splints 4 5 311. M unro, R . R . : Elec tromyography of the Masse ter and A nter ior Tem pora l i s Muscles inSubjec ts W i th Te m po rom and ibu lar Jo in t Dysfunction , Aus t . De nt . J . 17 : 209-218, 1972.12. Ra mfjo rd , S. P . : Dysfunct ional Tem porom andibu lar Jo in t and Muscle Pain , J . PROSTHET.DENT. 11: 353-374, 1961.13. L ous, I , A' , Sheik-Ol 'E~!am, A. , and M oller , E . : Postural Act ivi ty in Subjects W ithFun ct ional Disorders of the :CheWing Apparatus~ S eand. J . 'Dent . Res. 78: 404-410, i970.14. Jarabak, J. "R.:~ Elec t romyographie Analysi s of MUscular a nd Te mp orom and ibular Jo in t-Dis turbances D ue to Imbalance s of Occlus ion, Angle O r th od . 26: 170-190, 1956.15. Yemm , R ." Com par i son of the Act iv i ty of Lef t and R ig h t Masse ter M uscles of NormalIndividuals and Pat ients W i th M and ibular Dysfunct ion Du r ing Ex per imenta l St ress , J .Dent . Res. 50: 1320-1323, I97I .16. Yemm, R . : Tem porom andibu lar Dysfunction and Masse ter Muscle Response to Exper i-me ntal Stress, Br . Dent . J . 127 : 508-510 , 1969.17~ Per ry , H . T. : M uscular Changes Associa ted Wi th Temp orom andibu lar Jo in t Dysfunct ion ,J. Am . Dent. A ssoc. 54: 644-653, 1957.18. Possel t, U . , and Wolff, I . B . : T rea tm en t of Bruxism by Bite Guards and Bite Plates , J .Can . De nt . Assoc, 29: 773-778, 1963;I9. Ram fjord, S. P. , and Ash, M. M .: Occlusion, ed. 2, Phi lade lphia, 1971, W. B. Sau ndersCompany.20. H uppa uf , L. , and W ei tkamp, J . : Ergebnisse der Behandlung yon hunktionsbed~ngtenErkramkungen des Kausystems mit Aufbifsplat ten, Dtsch. Zahnaerzt l . Z. 24: 347-352, 1969.21. Fuchs , P . , Boos , W. , and L aub, M . : Eper imente l le Un tersueh ung en zur Behand lung yonjunkt ionel len Kiefergelenksbesehwerden mit Aufbifsplat ten, Dtsch. Zahnaerzt l . Z. 27:383-393, 1972.

D R . R O U R AC O N D O M I N I O L o s R O B LE S , 3 - DRio PIEDRAS, PUERT O RICO 00927

DR. CLAYTONCROWN & BRIDGE DEPARTMENTSCHOOL OF DENTISTRYTH E UNIVERSITY OF MICHIGANANN ARBOR, MICH. 48104

roura & clayton. pan to graphic records on tmj dysfunction subjects treated with occlusal splints -...

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