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Temporomandibular disorders. Part 6: related irreversible restorative interventions

From Volume 49, Issue 9, October 2022 | Pages 705-710

Authors

Martin James

Specialty Registrar in Restorative Dentistry, University Dental Hospital of Manchester

Articles by Martin James

Charles Crawford

Lead Clinician TMD Clinic, University Dental Hospital of Manchester

Articles by Charles Crawford

Peter Clarke

DCT in Restorative Dentistry, Liverpool University School of Dentistry, Pembroke Place, Liverpool L3 5PS, UK (pete.t.clarke@gmail.com)

Articles by Peter Clarke

Funmi Oluwajana

Specialty Registrar in Restorative Dentistry, University Dental Hospital of Manchester; Clinical Fellow, Health Education England Northwest

Articles by Funmi Oluwajana

Email Funmi Oluwajana

Emma Foster-Thomas

Academic Clinical Fellow in Restorative Dentistry, University Dental Hospital of Manchester

Articles by Emma Foster-Thomas

Julian Satterthwaite

BDS, MSc, PhD, PGDip, PGCertHE, FDS, MFDS RCS, FDS(Rest Dent), FHEA, FADM, Professor and Honorary Consultant in Restorative Dentistry, University of Manchester

Articles by Julian Satterthwaite

Abstract

Considering the complex biopsychosocial nature of temporomandibular disorders (TMD), irreversible interventions of any kind should be used with extreme caution. Frequently they are reserved for those patients who have not achieved adequate control with reversible measures and in whom a significant improvement is anticipated. Irreversible restorative interventions range from the simple adjustment of a single restoration or tooth up to an occlusal equilibration, and may use a subtractive, additive or combined approach. This article, the last in a series of six, reviews the available evidence in the use of irreversible restorative interventions in the management of TMD, demonstrates some of the commonly used techniques and provides some guidance for the general dental practitioner (GDP) considering this approach.

CPD/Clinical Relevance: The GDP needs to be aware of when to, and more importantly when not to, consider making irreversible changes to a patient's dentition with the aim of managing their TMD.

Article

Until relatively recently, static and dynamic occlusal contacts were considered to be a major aetiological factor in temporomandibular disorders (TMD) and, therefore, predicated logic dictated that making changes to these could prevent and/or manage the condition. Even with the mounting evidence minimizing the role of occlusion in the biopsychosocial model of TMD, there are still many proponents for extensive irreversible therapies in its management.

There may be situations when it is appropriate to make additive and/or subtractive changes to the dentition as part of a management strategy for TMD. It is essential, however, that as these procedures are irreversible, the treating practitioner ensures that all reasonable conservative management strategies have been exhausted. There should also be a significant benefit expected from the intervention that outweighs the risks associated with many of these techniques.

This article reviews the evidence base for irreversible restorative interventions in relation to the management of TMD. This ranges from simple single-tooth adjustments to full-mouth rehabilitations, and examples are provided to demonstrate several techniques.

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