Occlusal Splint Therapy Followed by Orthodontic Molar Intrusion as an Effective Treatment Method to Treat Patients with Temporomandibular Disorder: A Retrospective Study
Round 1
Reviewer 1 Report
The aim of the present study is to present the results of a series of 18 consecutive cases with orthopaedic instability treated with occlusal splint therapy followed by skeletally anchored molar intrusion, and studied by pre and posttreatment articulator mounting, lateral cephs and CBCT.
The results highlighted that occlusal splint therapy followed by skeletally anchored molar intrusion is an effective treatment method for patients with TMD as it provides CR-MI harmony, therefore orthopaedic stability and favourable bony changes of the TMJ.
I have several suggestions:
1. Abstract:
- please expand the abbreviations in the summary, eg TMD, CR, ANB.
- Line 21: "mandibular plane–palatal plane" - not clear to understand, please correct
2. Introduction
- Line 37: "Orthodontic treatment of patients Temporomandibular Disorder(TMD)" - please correct the grammar throughout the work
- Line 47: "The contraction of the muscle distracts the condyle out of CR position resulting in hyperactivation of the elevator muscles. Imbalance between the elevator and depressor muscles can lead to consequent masticatory muscle spasm and pain" - please provide a citation
- Line 54 - please expand the TMJ abbreviation
- Line 57: "Due to its design, it can reposition the mandible to CR and switch off the neuromuscular adaptation to MI by relaxing the muscles and achieve orthopaedic stability. Therefore, in orthodontic patients reporting TMD due toorthopaedic instability these stabilization splints are recommended 60prior to orthodontic therapy. During the splint wear, condyle is passively seated in the fossa, resulting in altered dental occlusion; contact on the most posterior teeth and anterior open bite (AOB) will develop" - please provide citations
3. Material and Methods
- Please provide, if the study was carried out according to the Helsinki Declaration’s recommendations and with the consent of the Bioethics Committee.
- Please provide exclusion/inclusion criteria for presented research
- Line 85: "...47 orthodontic patients with TMD, reversible disc dislocation and muscle pain (18 men, 29 women, mean age: 35.3 years)" - please provide the age range of the respondents. Was the average age of men and women similar? Moreover, a summary table with demographic data of the participants would be useful.
- Line 86: "patients with TMD, reversible disc dislocation and muscle pain" - which muscles were painful? How many participatns have muscular (masticatory muscles?) pain and how many have problems with disk dislocation?
- Line 87: "All subjects were diagnosed with TMD with orthopaedic instability and therefore,were treated with full-coverage hard acrylic occlusal splints" - please provide the TMD diagnostic criteria used in the paper
4. Results:
- Line 189: "From the original 47 patients, only 18 patients were included in the study. 29 had to be excluded due to missing final CBCT scans,no use of skeletal anchors,lack of proper compliance in full-time splint wear and because of moving to another location" - please provide the gender and age of participants who were finally qualified for the presented study. I suggest including this information in the Material and Methods section for better readability of the work.
Overall:
Improve the style of the paper, standardize the style (e.g.: line 262 : ...of TMD, nevertheless, completely rejecting the role of it may be inappropriate [1,30] It has ...) - no full stop at the end of the sentence.
In general, the work is interesting and can make a contribution to literature. I hope my suggestions will help improve this work.
Author Response
Dear Reviewer,
Please see the attachment.
Author Response File: 
Author Response.docx
Reviewer 2 Report
I’d like to ask the authors the following points.
1) At first, I’d like to ask the original condition of the patients. Did the patients in this study already have orthopaedic surgey?
2) In “Materials and methods”, the authors mentioned the patients who were treated successfully. In fact, how many patients were treated in a similar way?
3) Could you suggest the reason of TMD? What caused TMD?
4) I’m concerning the molar condition including periodontal tissue. Please mention.
5) Can you describe the prognosis of these patients? In addition, I’d like the authors to mention about the treatment period.
Author Response
Dear Reviewer,
Please see the attachment.
Author Response File: Author Response.docx
Reviewer 3 Report
Dear Author,
The article is very interesting.
I invite you to increase the introduction by adding recent articles the timing and method of using bite, and
describe the precautions to avoid side effects, these articles can improve your manuscript:
-
Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials.
PMID: 31982236
-
Polyphenols as potential agents in the management of temporomandibular disorders
Applied Sciences (Switzerland),2020, 10(15), 5305
it is also useful to describe the relationship between the disc and the condyle using the MRI (the gold standard for the visualization of these tissues) in addition these papers about intra-articular anatomy of TMJ visualized by MRI will improve the topic.
-
Mandibular Coronoid Proc Mandibular Coronoid Process Hypertrophy: Diagnosis and 20-Year Follow-Up with CBCT, MRI and EMG Evaluations
DOI: 10.3390/app11104504
In the future i suggest to continue your research by evaluating intra-articular status with the use of MRI in patients with MI-CR discrepancy.
Good luck
Author Response
Dear Reviewer,
Please see the attachment.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
Dear Authors,
Thank you for your responses and revision of the presented manuscript. The paper has been corrected according to my suggestions.
Reviewer 2 Report
My concerns were resolved. I hope this article will be valuable for the readers.
