Studies of occlusal adjustment therapy in patients with craniomandibular disorders

Sammanfattning: In the first part of this thesis, measurement and registration procedures of occlusal interferences and their inter and intraobserver variability were evaluated. In the second part of this thesis, the short and long-term effect of occlusal adjustment therapy was prospectively assessed in a controlled clinical trial in a selected group of 50 patients with myogeneous craniomandibular disorders (CMD). The treatment outcome of occlusal adjustment and combined treatment modes was investigated up to 7 years. The selcted patients were compared with a group of consecutive CMD patients. Observer variability was the same for the different methods of registration and was acceptable for most of the occlusal variables investigated. As the intraobserver constancy was greater than that between observers repeated registrations in longitudinal studies should be done by the same observer. Occlusal adjustment had in a short-term perspective of 1 to 3 months a positive effect on symptoms and clinical signs of CMD but had little or no effect in the long-term perspective in this group of muscular CMD patients. The usefulness of occlusal adjustment as the only form of treatment for this subgroup of CMD has limitations as the majority of patients had demanded several treatment modes in a 7-year perspective. The long-term effect of a combined treatment approach was good. The strongest associations in relation to treatment outcome were found for the variables stress and demand of treatment. The selected group was comparable to a consecutive CMD group with respect to background factors of socioeconomical character and the result from this selected group can therefore be applied to a broader group of CMD patients.