Moscow, Moscow, Russian Federation
Moscow, Moscow, Russian Federation
employee
Moscow, Moscow, Russian Federation
Moscow, Moscow, Russian Federation
Moscow, Moscow, Russian Federation
UDC 616.31
Relevance. One clinically significant yet insufficiently studied provoking factor is prolonged forced maximum mouth opening during dental treatment. Conventional bite-opening devices do not provide individualized mandibular positioning and do not allow dynamic adjustment of interocclusal distance during treatment. Objective. To evaluate the clinical efficacy of an individual programmable bite block during prolonged therapeutic dental treatment in terms of pain intensity, functional limitations, and treatment tolerance. Materials and methods. A prospective controlled clinical study included 20 patients with clinically confirmed masticatory muscle myalgia. The study design involved sequential comparison of two methods of dental arch separation during 120-minute treatment visits: a standard serial bite block and an individual programmable bite block. Pain intensity was assessed using the visual analogue scale, along with the number of pain episodes per visit, time distribution of pain episodes, post-procedural muscle pain, maximal mouth opening, electromyographic activity of masticatory muscles, treatment tolerance, and the number of forced treatment interruptions. Results. The individual programmable bite block significantly reduced the within-visit increase in pain. EMG amplitude of masticatory muscles at the end of treatment was 64.7 ±10.9 μV with the standard bite block and 49.2 ±8.6 μV with the individual programmable device. Integral EMG activity at Tend was 211.6 ±31.4 and 158.7 ±26.9 μV•s, respectively. Conclusion. The individual programmable bite block reduces the functional load on masticatory muscles and temporomandibular joint structures, decreases pain intensity during and after treatment, lowers the number of pain episodes, and improves tolerance of prolonged dental procedures.
temporomandibular joint dysfunction, masticatory muscle myalgia, prolonged dental treatment, individual programmable bite block, visual analogue scale, electromyography, treatment tolerance
1. Dworkin S.F. Research diagnostic criteria for temporomandibular disorders: current status & future relevance. Journal of oral rehabilitation. 2010;37(10):734-743. https://doi.org/10.1111/j.1365-2842.2010.02090.x
2. Gauer R.L., Semidey M.J. Diagnosis and treatment of temporomandibular disorders. American Family Physician. 2015;91(6):378-386. https://www.aafp.org/afp/2015/0315/p378
3. Kapos F.P., Exposto F.G., Oyarzo J.F., Durham J. Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management. Oral surgery. 2020;13(4):321-334. https://doi.org/10.1111/ors.12473
4. Zieliński G., Pająk-Zielińska B., Ginszt M. A Meta-Analysis of the Global Prevalence of Temporomandibular Disorders. Journal of clinical medicine. 2024;13(5):1365. https://doi.org/10.3390/jcm13051365
5. Lebedenko I.Yu., Arutyunov S.D., Ryahovskiy A.N., red. Ortopedicheskaya stomatologiya: nacional'noe rukovodstvo. V 2 t. Tom 1. 2-e izd., pererab. i dop. Moskva: GEOTAR-Media; 2022. 520 s. [Lebedenko I.Yu., Arutyunov S.D., Ryakhovsky A.N., eds. Orthopedic dentistry: national guidelines. In 2 vol. Vol. 1. 2nd ed., revised and enlarged. Moscow: GEOTAR-Media; 2022. 520 p.].
6. Safour W., Hovey R. Advice for Dentists from Temporomandibular Disorder Patients: A Phenomenological Study. Journal of the Canadian Dental Association. 2022;88:m4. https://jcda.ca/m4
7. Yarygina E.N., Shkarin V.V., Makedonova Yu.A. Problemy vedeniya pacientov s sindromom bolevoy disfunkcii po dannym anketirovaniya vrachey-stomatologov. Volgogradskiy nauchno-medicinskiy zhurnal. 2024;21(2):37-44. [Yarygina E.N., Shkarin V.V., Makedonova Yu.A. Problems of managing patients with pain dysfunction syndrome according to a survey of dentists. Volgograd Journal of Medical Research. 2024;21(2):37–44. (In Russ.)]. https://hum-ecol.ru/2658-4514/article/view/635389
8. Chisnoiu A.M., Picos A.M., Popa S., Chisnoiu P.D., Lascu L., Picos A. et al. Factors involved in the etiology of temporomandibular disorders – a literature review. Clujul medical. 2015;88(4):473-478. https://doi.org/10.15386/cjmed-485
9. Emodi-Perlman A., Eli I., Smardz J., Uziel N., Wieckiewicz G., Gilon E. et al. Temporomandibular Disorders and Bruxism Outbreak as a Possible Factor of Orofacial Pain Worsening during the COVID-19 Pandemic—Concomitant Research in Two Countries. Journal of Clinical Medicine. 2020;9(10):3250. https://doi.org/10.3390/jcm9103250
10. Scelza G., Amato A., Rongo R., Nucci L., D'Ambrosio F., Martina S. Changes in COVID-19 Perception and in TMD Prevalence after 1 Year of Pandemic in Italy. European journal of dentistry. 2023;17(3):771-776. https://doi.org/10.1055/s-0042-1755192
11. Trezubov V.N., Bulycheva E.A., Trezubov V.V., Bulycheva D.S. Lechenie pacientov s rasstroystvami visochno-nizhnechelyustnogo sustava i zhevatel'nyh myshc. Moskva: GEOTAR-Media; 2021. 96 s. [Trezubov V.N., Bulycheva E.A., Trezubov V.V., Bulycheva D.S. Treatment of Patients with Temporomandibular Joint and Masticatory Muscle Disorders. Moscow: GEOTAR-Media; 2021. 96 p. (In Russ.)]. https://doi.org/10.33029/9704-6151-8-STO-2021-1-96
12. Zhang J., Yu W., Wang J., Wang S., Li Y., Jing H. et al. A Comparative Study of Temporomandibular Joints in Adults with Definite Sleep Bruxism on Magnetic Resonance Imaging and Cone-Beam Computer Tomography Images. Journal of clinical medicine. 2023;12(7):2570. https://doi.org/10.3390/jcm12072570
13. Li C., Chen B., Zhang R., Zhang Q. Comparative study of clinical and MRI features of TMD patients with or without joint effusion: a retrospective study. BMC Oral Health. 2024;24(1):314. https://doi.org/10.1186/s12903-024-04065-4
14. Sargisyan A.E. Mediko-psihologicheskie podhody k lecheniyu bol'nyh s bolevoy disfunkciey visochno-nizhnechelyustnogo sustava: dissertaciya na soiskanie uchenoy stepeni kandidata medicinskih nauk. Moskva; 2014. 98 s. [Sargsiyan A.E. Medico-Psychological Approaches to the Treatment of Patients with Painful Temporomandibular Joint Dysfunction: dissertation for the degree of candidate of medical sciences. Moscow; 2014. 98 p. (In Russ.)]. https://rusneb.ru/catalog/000199_000009_005101853/
15. Bekreev V.V. Diagnostika i kompleksnoe lechenie zabolevaniy visochno-nizhnechelyustnogo sustava: dissertaciya na soiskanie uchenoy stepeni doktora medicinskih nauk. Moskva; 2019. 333 s. [Bekreev V.V. Diagnosis and Complex Treatment of Temporomandibular Joint Diseases: dissertation for the degree of Doctor of Medical Sciences. Moscow; 2019. 333 p. (In Russ.)]. https://www.sechenov.ru/upload/medialibrary/c4a/DISSERTATSIYA-Bekreev.pdf
16. Garamyan B.G. Sravnitel'nyy analiz metodov repozicii sustavnogo diska pri vnutrennih narusheniyah visochno-nizhnechelyustnogo sustava: dissertaciya na soiskanie uchenoy stepeni kandidata medicinskih nauk. Moskva; 2022. 137 s. [Garamyan B.G. Comparative Analysis of Methods for Repositioning the Articular Disc in Internal Temporomandibular Joint Disorders: dissertation for the degree of candidate of medical sciences. Moscow; 2022. 137 p. (In Russ.)]. https://rusneb.ru/catalog/000199_000009_011299312/?ysclid=mpdz9eq6ib411440914
17. Solaberrieta E., Otegi J.R., Goicoechea N., Brizuela A., Pradies G. Comparison of a conventional and virtual occlusal record. The Journal of prosthetic dentistry. 2015;114(1):92-97. https://doi.org/10.1016/j.prosdent.2015.01.009
18. Revilla-León M., Alonso Pérez-Barquero J., Zubizarreta-Macho Á., Barmak A.B., Att W., Kois J.C. Influence of the number of teeth and location of the virtual occlusal record on the accuracy of the maxillomandibular relationship obtained by using an intraoral scanner. Journal of prosthodontics. 2023;32(3):253-258. https://doi.org/10.1111/jopr.13526
19. Blasi A., Henarejos-Domingo V., Palacios-Bañuelos R., Vidal-Ponsoda C., Aparicio C., Roig M. CAD-CAM and analog occlusal splints comparison based on the amount of occlusal adjustments. 3D analysis of the volumetric changes: a pilot study. The Journal of Esthetic and Restorative Dentistry. 2023;35(8):1271-1278. https://doi.org/10.1111/jerd.13080
20. Rabel K., Lüchtenborg J., Linke M., Burkhardt F., Roesner A.J., Nold J. et al. 3D printed versus milled stabilization splints for the management of bruxism and temporomandibular disorders: study protocol for a randomized prospective single-blinded crossover trial. Trials. 2024;25(1):589. https://doi.org/10.1186/s13063-024-08437-7
21. Moxley B., Stevens W., Sneed J., Pearl C. Novel Diagnostic and Therapeutic Approaches to Temporomandibular Dysfunction: A Narrative Review. Life (Basel). 2023;13(9):1808. https://doi.org/10.3390/life13091808
22. Warzocha J., Gadomska-Krasny J., Mrowiec J. Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) from 2018 to 2022. Healthcare (Basel). 2024;12(5):575. https://doi.org/10.3390/healthcare12050575
23. Nickel J.C., Iwasaki L.R., Gonzalez Y.M., Gallo L.M., Yao H. Mechanobehavior and Ontogenesis of the Temporomandibular Joint. Journal of dental research. 2018;97(11):1185–1192. https://doi.org/10.1177/0022034518786469
24. Ovcharenko E.S., Lapina N.V., Voychenko A.A., Skorikova L.A., Nadtochiy A.V., Triandafilov S.A. Sovremennye aspekty mezhdisciplinarnogo podhoda k diagnostike i kompleksnoy vosstanovitel'noy terapii zhevatel'no-rechevogo apparata bol'nyh s neyromuskulyarnym disfunkcional'nym sindromom visochno-nizhnechelyustnogo sustava sistematicheskiy obzor. Mediko-farmacevticheskiy zhurnal "Pul's". 2023;25(6):74–83. [Ovcharenko E.S., Lapina N.V., Voychenko A.A., Skorikova L.A., Nadtochiy A.V., Triandafilov S.A. Modern aspects of an interdisciplinary approach to diagnostics and complex rehabilitation therapy of the mustering and speech apparatus in patients with neuromuscular dysfunctional syndrome of the temporomantomandibular joint systematic review. Medical & Pharmaceutical Journal «Pulse». 2023;25(6):74–83. (In Russ.)]. https://doi.org/10.26787/nydha-2686-6838-2023-25-6-74-83
25. Angst L., Koolstra J.H., Wiedemeier D., Van Sluijs R.M., Pulfer A.M., Gallo L.M. et al. Masticatory Muscles Activation and TMJ Space During Asymmetrically Loaded Jaw Closing. Annals of biomedical engineering. 2024;52(4):877-887. https://doi.org/10.1007/s10439-023-03424-6
26. Nachar'yan D.G., Apresyan S.V., Stepanov A.G., Moskovec O.O., Butkov D.S. Cifrovye protokoly kompleksnoy ortopedicheskoy reabilitacii pacientov s sindromom bolevoy disfunkcii visochno-nizhnechelyustnogo sustava (obzor literatury). Problemy stomatologii. 2025;21(2):37–42. [Nacharyan E.G., Apresyan S.S., Stepanov A.G., Moskovets O.O., Butkov D.S. Digital protocols for comprehensive orthopedic rehabilitation of patients with temporomandibular joint pain dysfunction syndrome. Actual problems in dentistry. 2025;21(2):37–42. (In Russ.)]. https://doi.org/10.18481/2077-7566-2025-21-2-37-42
27. Apresyan S.V., Stepanov A.G., Nacharyan D.G., Moskovec O.O., Kopylov M.V., avtory; Federal'noe gosudarstvennoe avtonomnoe obrazovatel'noe uchrezhdenie vysshego obrazovaniya "Rossiyskiy universitet druzhby narodov imeni Patrisa Lumumby", patentoobladatel'. Prikusnoy blok dlya fiksacii chelyustey. Rossiyskaya Federaciya patent RU 2844632. Opubl. 04.08.2025, Byul. № 2. [Apresyan S.V., Stepanov A.G., Nacharyan D.G., Moskovets O.O., Kopylov M.V. inventors; Federalnoe gosudarstvennoe avtonomnoe obrazovatelnoe uchrezhdenie vysshego obrazovaniya "Rossijskij universitet druzhby narodov imeni Patrisa Lumumby"(RUDN), assignee. Bite block for fixation of jaws. Russian Federation patent RU 2844632. Date of publication: 04.08.2025, Bulletin No. 2]. https://elibrary.ru/item.asp?id=82764489
28. Apresyan S.V., Stepanov A.G., Nacharyan D.G., Moskovec O.O., Kopylov M.V. avtory; Federal'noe gosudarstvennoe avtonomnoe obrazovatel'noe uchrezhdenie vysshego obrazovaniya "Rossiyskiy universitet druzhby narodov imeni Patrisa Lumumby", patentoobladatel'. Sposob profilaktiki patologii visochno-nizhnechelyustnogo sustava vo vremya stomatologicheskogo lecheniya. Rossiyskaya Federaciya patent RU 2843790. Opubl. 18.07.2025, Byul. № 20. [Apresian S.V., Stepanov A.G., Nacharian D.G., Moskovets O.O., Kopylov M.V. inventors; Federalnoe gosudarstvennoe avtonomnoe obrazovatelnoe uchrezhdenie vysshego obrazovaniya "Rossijskij universitet druzhby narodov imeni Patrisa Lumumby"(RUDN), assignee. Method for prevention of temporomandibular joint pathology during dental treatment. Russian Federation patent RU 2843790. Date of publication: 18.07.2025, Bulletin No. 2]. https://elibrary.ru/item.asp?id=82661790
