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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 34  |  Issue : 1  |  Page : 53-59

T-Scan guided occlusal equilibration as an effective treatment in the management of symptomatic temporomandibular disorders: An open clinical trial


1 Masters in Dental Surgery (Department of Oral Medicine and Radiology), Consultant Oral Physician and Maxillofacial Radiology, Hyderabad, Telangana, India
2 Department of Oral Medicine and Radiology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Chaitanyapuri, Dilsukhnagar, Hyderabad, Telangana, India

Date of Submission11-Oct-2021
Date of Decision21-Dec-2021
Date of Acceptance16-Jan-2022
Date of Web Publication25-Mar-2022

Correspondence Address:
Dr. Komali Garlapati
Department of Oral Medicine and Radiology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Kamala Nagar, Road number-5, Chaitanyapuri, Dilsukhnagar, Hyderabad – 500 060, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.340761

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   Abstract 


Background: Temporomandibular disorders (TMDs) constitute clinical problems that involve the masticatory muscles, the temporomandibular joints, associated structures, or both. The etiology of TMDs is multifactorial. The association between occlusal interferences and TMD is controversial.. Objectives: This study is designed to evaluate the clinical outcome of T-Scan guided occlusal equilibration in patients suffering from TMD associated with occlusal discrepancies. Materials and Methods: A total of 15 patients clinically diagnosed with TMD based on the Diagnostic Criteria for Temporomandibular Disorders and with positive occlusal interferences were included in the study. The occlusal equilibration was achieved by performing T-Scan guided Immediate Complete Anterior Guidance Development. Results: The obtained data was subjected to statistical analysis using SPSS version 20.0 software. There was a statistically significant reduction in the occlusion time, i.e., from 0.77 ± 0.6 pre-treatment to 0.31 ± 0.2 post-treatment (P = 0.005), and also disclusion time, i.e., from 1.71 ± 1.09 pre-treatment to 0.11 ± 0.03 post-treatment (P = 0.000). There was a statistically significant reduction in the VAS score post-treatment (P = 0.000). Conclusion: T-Scan guided occlusal equilibration in TMD patients has resulted in significant improvement of symptoms. Hence, we emphasize the importance of the identification and correction of occlusal interferences in the management of symptomatic TMDs.

Keywords: Myofascial pain, occlusal interferences, temporomandibular disorders


How to cite this article:
Ignatius AV, Garlapati K, Chaitanya NC, Saba A, Kandi P, Reddy CS. T-Scan guided occlusal equilibration as an effective treatment in the management of symptomatic temporomandibular disorders: An open clinical trial. J Indian Acad Oral Med Radiol 2022;34:53-9

How to cite this URL:
Ignatius AV, Garlapati K, Chaitanya NC, Saba A, Kandi P, Reddy CS. T-Scan guided occlusal equilibration as an effective treatment in the management of symptomatic temporomandibular disorders: An open clinical trial. J Indian Acad Oral Med Radiol [serial online] 2022 [cited 2022 May 27];34:53-9. Available from: https://www.jiaomr.in/text.asp?2022/34/1/53/340761




   Introduction Top


The constituents of the masticatory system are the teeth, periodontal tissues, muscles of mastication, and temporomandibular joint (TMJ).[1] The disorders of the temporomandibular joint are associated with chronic pain, which can cause severe distress and disability to the patient. The temporomandibular disorder(s) (TMD) are characterized by facial pain in the region of the TMJs and muscles of mastication, limitation or deviation in mandibular movements, hyperalgesia of the musculoskeletal structures, and TMJ sounds during jaw movement and function.[2] Population-based studies show that TMD affects 10%–15% of adults, but only 5% seek treatment. The peak incidence of TMD ranges from 20–40 years of age[3], with a greater frequency and severity in females than in males.[4]

The causes of TMD are complex and multifactorial, which include occlusal abnormalities, orthodontic treatment, bruxism, orthopedic instability, macrotrauma and microtrauma, factors like poor health and nutrition, joint laxity, and exogenous estrogen. Psychosocial factors like stress, tension, anxiety, and depression may also lead to TMD. Occlusion is the first and probably the most debatable etiologic aspect of temporomandibular disorders.[5]Studies have shown that TMD arises due to occlusal instability, causing excessive load on the masticatory system.[6]

The most widely used diagnostic tool for marking the contact points between the maxillary and mandibular teeth is articulating paper. The intensity of the occlusal forces is interpreted based on the size of the marked area on the articulating paper.[7] However, studies have shown that the articulating paper mark size cannot be taken as an accurate indicator for occlusal corrections.[8] The invention of modern diagnostic tools like the T-Scan computerized occlusal analysis system has opened a new horizon for precise guidance in occlusal equilibration procedure, which is one of the treatment modalities for managing TMDs.

Hence, this study is designed to correlate the association of occlusal interferences with TMD and to evaluate the clinical signs and symptoms of T-Scan guided occlusal equilibration in patients suffering from TMD associated with occlusal discrepancies.


   Materials and Methods Top


Study setting

The patients attending the Department of Oral Medicine and Radiology in a private dental college in India were randomly screened, and those who were clinically diagnosed with temporomandibular disorders based on the Diagnostic Criteria for Temporomandibular Disorders (DC-TMD) Axis I were selected for the study and subjected to T-Scan guided occlusal equilibration to evaluate the clinical signs and symptoms of TMDs associated with occlusal discrepancies. Ethical clearance, which was approved on 28th November 2016, was obtained from the Institutional Ethical Committee (PMVIDS&RC/IEC/OMR/DN/0090-16) adherent to the guidelines provided by the World Medical Association Declaration of Helsinki on ethical principles for medical research involving humans for studies. The sample size is derived based on stepped rules of thumb for pilot trial size per treatment arm. The expected standardized effect size was medium (0.3≤ 𝛿 <0.7) with 90% powered main trial in a non-central t-distribution approach, thus the sample size is obtained as 15 hence a pilot study on 15 participants was conducted in the current study.

Selection of sample

This is a prospective pilot study done in a total of 15 patients either of gender and with age group ranging from 18 to 50 years. The patients who were clinically diagnosed with TMD based on the DC-TMD Axis I were randomly selected. The patients with TMJ arthralgia and with or without myalgia and with or without disc displacement with reduction were included in the study. Examination of the patients was performed and were assessed for occlusal interferences using articulating paper. The patients with positive occlusal interferences were included in the study, then informed written consent was obtained from the patients.

Inclusion criteria

  1. Patients with Arthralgia.
  2. Patients with Myalgia.
  3. Patients with/without disc displacement with reduction.
  4. Patients with myofascial pain and myofascial pain with referral
  5. Patients with full complement of teeth.
  6. Age: 18–50 years.


Exclusion criteria

  1. Patients with musculoskeletal and joint disorders.
  2. History of trauma or surgery in the TMJ region.
  3. Luxation and subluxation of TMJ.
  4. Trismus due to reasons other than myalgia.
  5. Neurological disorders.
  6. Diseases of ear.
  7. Completely edentulous patients.


The patients with positive occlusal interferences were selected for the study, counselled and at the 1st visit, pain was assessed using a visual analog ordinal scale; after that they were subjected to T-Scan guided Immediate Complete Anterior Guidance Development (ICAGD). These patients were recalled after 1 week and the signs and symptoms were re-assessed using a visual analog ordinal scale. The occlusal interferences were rechecked using T-Scan and corrected if required to attain occlusal equilibration. Patients were recalled for follow-up after 1 month and 3 months; if signs and symptoms persisted, they were given alternative treatment. Of 15 patients included in the study, 1 patient lost to follow-up after 1 month.

The obtained data were subjected to statistical analysis using SPSS version 20.0 software. The one-way analysis of variance (ANOVA) test was performed to compare the VAS score for pain in the TMJ region before treatment and after 1-week and 1-month post-treatment. The paired sample t-test was performed to compare the change in mean occlusion time and disclusion time, change in force distribution pattern on the right side and left side, respectively, and also to compare the mean asymmetry index of occlusal force (AOF) pre-treatment and post-treatment. The P value ≤ 0.05 was considered to be statistically significant.


   Results Top


Out of the total 15 patients, males were 5 (33.30%), and females were 10 (66.60%). The age distribution ranged from 18–35 years with a mean age of 24.6 years (SD = 6.334). Of the 15 patients, 4 (26.7%) patients reported pain in the right TMJ region, 9 (60%) patients in the left TMJ region, and 2 (13.3%) patients bilaterally. Almost 13 (86.7%) patients reported pain in any one of the associated facial and cervical muscles. The medial and lateral pterygoid muscle tenderness was present in 13 (86.7%) patients, followed by masseter muscle in 12 (80%) patients, sternocleidomastoid muscle in 5 (33.3%) patients, temporalis muscle in 3 (20%) patients, and finally trapezius muscles in only 2 (13.3%) patients [Graph 1]. In the present study, post-treatment, there was a reduction in pain in the associated facial and cervical muscles in almost 11 (73.3%) patients, except for 4 (26.7%) patients who had a mild reduction, but the pain persisted in both the medial and lateral pterygoid muscles [Graph 2].



Almost 11 (73.3%) patients reported clicking sounds in the TMJ. However, post-treatment, there was no reduction in the clicking sounds in any of the patients. Out of the 15 patients, 7 (46.7%) patients had restricted mouth opening (<36 mm) due to myalgia before treatment. Post-treatment there was an improvement in the mouth opening in all 7 patients.

In the present study, T-Scan version 8 system (Tekscan Inc. South Boston, MA, USA) was used for the occlusal analysis of all 15 patients. All 15 patients were subjected to T-Scan guided occlusal equilibration and the T-Scan recordings like occlusion time, disclusion time, and force distribution pattern were recorded and analyzed. The comparison of the change in mean T-Scan occlusion time recording revealed a reduction in the occlusion time, i.e., from 0.77 ± 0.6 pre-treatment to 0.31 ± 0.2 post-treatment (P = 0.005*) [Table 1]. The comparison of the change in mean T-Scan disclusion time recording revealed a reduction in the disclusion time, i.e., from 1.71±1.09 pre-treatment to 0.11 ± 0.03 post-treatment (P = 0.000*) [Table 2]. The comparison of the change in mean T-Scan recording of force distribution pattern on the rig a reduction in the mean force distribution, i.e., from 54.7±13.29 pre-treatment to 48.0±3.74 post-treatment (P = 0.05*) [Table 3], and on left side, there was an improvement in the mean force distribution, i.e., from 45.2±13.29 pre-treatment to 51.9+3.7 post-treatment (P = 0.05*) [Table 4].
Table 1: Comparison of change in mean T-Scan occlusion time recording before and after treatment

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Table 2: Comparison of change in mean T-Scan disclusion time recording before and after treatment

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Table 3: Comparison of change in mean T-Scan force distribution pattern before and after treatment on right side

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Table 4: Comparison of change in mean T-Scan force distribution pattern before and after treatment on left side

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The comparison of the change in mean AOF revealed a significant reduction, i.e., from 34.06 ± 0.11 pre-treatment to 6.6 ± 0.05 post-treatment (P = 0.001*).

The ANOVA analysis done to compare the VAS score for pain in TMJ region revealed a significant reduction of 7.31 ± 1.63 pre-treatment to 1.58 ± 1.58 after 1-week post-treatment and to 0.34 ± 0.62 after 1-month post-treatment (P = 0.000*) [Table 5], [Table 6] and [Graph 3].
Table 5: Comparison of mean VAS score for pain in the TMJ region before treatment, after 1 week, and after 1 month of treatment

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Table 6: Comparison of mean VAS score for pain in the TMJ region before treatment, after 1 week, and after 1 month of treatment between and within the groups

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   Discussion Top


TMD is one of the major cause of nondental pain in the maxillofacial region affecting the quality of life of the patients There are various etiological factors contributing to the TMDs. The role of occlusion in the development of TMDs is considered to be 10-20% of the total spectrum of etiological factors in TMDs & is gaining importance.[5] Recently it has been considered a predisposing, initiating & perpetuating factor for TMDs.However, it has been considered to be controversial by some of the researchers. Hence this study is carried out to investigate the role and association of occlusal interferences in TMDs.

Out of the total 15 patients in the present study, males were 5 (33.30%) and females were 10 (66.60%), which is in accordance with the studies conducted by Cooper et al., and Muthukrishnan et al.[9],[10] Studies suggest that endogenous reproductive hormones may play a role in TMD pain conditions: the age of pain onset is almost always after puberty, prevalence rates are higher in women than in men, and prevalence is lower for women in the post-menopausal years than for those of reproductive age. LeResche et al. have hypothesized that the presence of estrogen receptors in the TMJ of women modulates the metabolic functions in relation to the laxity of the ligaments.[11]

In the present study, all the 15 patients were in the age range of 18–35 years and are nearly similar to the findings of Ozden AN et al.,[12] and Le Resche.[13]

Masticatory muscle activity leads to a contraction in the muscles during closed position and when the posterior teeth are in contact during excursive movement, it can cause release of lactic acid in the muscle resulting in muscle spasm, muscle fatigue, and pain.[14]

Of 15 patients included in the study, the medial and lateral pterygoid muscle tenderness was present in 13 patients, followed by masseter muscle in 12 patients, sternocleidomastoid muscle in 5 patients, then by temporalis muscle in 3 patients, and trapezius muscles in only 2 patients. Except for the medial and lateral pterygoid muscles which were tender in 4 (26.7%) patients' post-treatment after 2 visits of T-Scan guided occlusal corrections, all the other patients had pain reduction in all the associated facial and cervical muscles. These findings are in accordance with studies conducted by Kerstein RB and Radke J[15] and Thumati P and Thumati RP,[16] where there was a reduction in the myofascial pain symptoms after T-Scan guided occlusal equilibration.

In the present study, all 15 patients reported pain in the TMJ region. Among them, 4 patients reported pain in the right TMJ region, 9 patients reported pain in the left TMJ region, and 2 patients reported pain bilaterally. In view of Thumati P, Manuuani R, Mahant Shetty M the ICAGD coronoplasty procedure allows the new occlusal design to operate with lessened muscle activity and lower lactic acid production, which increases the availability of oxygen for improved muscular function, muscular tissue healing, and reduced muscular symptoms.[17]

TMJ sounds, such as clicking or crepitation, are one of the most common symptoms in TMDs.[4] In the present study, out of 15 patients included in the study, clicking sounds were present in 11 patients and absent in 4 patients. However, post-treatment no reduction in the clicking sounds was observed during the 1-month follow-up period.

The mean maximal mouth opening for Indian males is 51.3 mm ± 8.3 (range: 39–70 mm) and for females is 44.3 mm ± 6.7 (range: 36–56 mm).[18] Therefore, in the present study, <36 mm was taken as restricted mouth opening and the results showed that out of the total 15 patients included in the study, 7 patients had <36 mm of mouth opening. All 7 patients had muscle induced restriction (soft-end feel on mouth opening), which was due to muscle pain. After the 1st visit of T-Scan guided occlusal equilibration, there was an improvement in the mouth opening in all 7 patients. There was further improvement in the mouth opening after the 2nd visit. Therefore, post-treatment all the patients had >36 mm of mouth opening.

According to Kerstein et al., T-Scan occlusal force and timing data eliminates subjective interpretation of contacts using articulating paper marks and precisely pinpoints the excessively forceful contact locations, and displays them for analysis in a 3-Dimensional view.[19] The T-Scan system allows obtaining additional information about occlusion and disclusion time, the Centre of Occlusal Force (COF), and the distribution of forces on both sides of the mandible.[20]

The studies carried out by Agbaje JO et al, Bozhkova TP, Garcia CA et al., Koos B et al., and few other authors have proved the T-Scan system to be a reliable method for the analysis and evaluation of occlusal contact distribution.[1],[7],[21],[22] Therefore, the new T-Scan 8 system was used in the present study in all the 15 patients in the first visit and also during the second visit 1 week apart for the precise evaluation of the occlusal contact distribution required for occlusal corrections.

The studies conducted by Dzingutė et al.[20]., Haralur SB,[23] revealed a longer occlusion time in TMD patients when compared to healthy subjects. In the present study, the comparison of change in mean T-Scan occlusion time recording revealed a reduction in the occlusion time, i.e., from 0.77 ± 0.6 pre-treatment to 0.31 ± 0.2 post-treatment (P = 0.005*)[Figure 1] and [Figure 2]. According to Kerstein RB & Grundset K[24], the reduction of the occlusion time causes a decrease in the contractility of the muscles, thereby reducing the symptoms that is achieved in the present study.
Figure 1: T-Scan occlusal analysis revealing occlusal interferences and occlusal forces distribution before treatment

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Figure 2: T-Scan occlusal analysis revealing occlusal interferences and occlusal forces distribution after treatment

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the present study there was a reduction in the disclusion time, i.e., from 1.71 ± 1.09 pre-treatment to 0.11 ± 0.03 post-treatment (P = 0.000*) [Figure 1] and [Figure 2]. This is in accordance with the studies conducted by Kerstein RB and Radke J[15]and Thumati et al[14],[15],[16],[[17],[18],[19],[20],[21],[22],[23],[24],[25] where the disclusion time after immediate complete anterior guidance development was <0.4/0.5s.

The present study shows an improvement in mean T-Scan recording of force distribution pattern on right and left side of jaws. Hence, equilibrium was achieved regarding the force distribution pattern between right and left sides of jaws.

According to Wang C & Yin X, and Dzingute et al., AOF has been considered as a parameter to reflect occlusal balance. AOF indicates the difference of occlusal force between right and left sides. In their study, AOF in the TMD group was 16.66% ± 0.47% and significantly larger than in control subjects.[20],[26] That was observed even in the present study and significant equilibration of occlusal forces was achieved post-treatment.

In the present study, there was a significant reduction in the VAS score for pain in the TMJ region from 7.31 ± 1.63 pre-treatment to 1.58 ± 1.58 after 1-week post-treatment and to 0.34 ± 0.62 after 1-month post-treatment (P = 0.05*). Out of the total 15 patients, 6 patients reported complete remission of the pain (VAS = 0 cm) after the 1st visit of T-Scan guided occlusal equilibration subsequently by the end of 2nd visit, 11 patients reported complete remission of the pain (VAS = 0 cm). All the 15 patients were recalled after 1-month for the follow-up and the remaining 4 patients reported a further reduction in pain. This is in accordance with study by Thumati et al. where occlusal equilibration led to remission in the myofascial pain symptoms using ICAGD given by Kerstien RB and Farrell.[14]

However, a systematic review by Koh and Robinson[27] and a study by Tsukiyama et al.,[28] did not support occlusal adjustment as a TMD therapy. In contrary to the above studies, the present study has shown that T-Scan guided occlusal equilibration has resulted in significant alleviation of symptoms in TMD. Furthermore, the case selection in the present study was with explicit criteria to prevent bias. The patients included in the study showed good compliance with the treatment procedure and did not report any adverse effects during as well as post-treatment. Hence, based on the present study, we infer that identification of occlusal discrepancies can play a significant role in the management of symptomatic TMD.


   Limitations and Future Prospects Top


The present study is a non-randomized, uncontrolled trial in a small sample size. Therefore, more extensive studies with bigger sample size and longer duration of follow-up can further solidify the role of T-Scan guided equilibration in the treatment of TMD. This study found that T-Scan guided occlusal equilibration and ICAGD is effective in reducing the symptoms associated with temporomandibular disorders. Hence, early recognition and correction of occlusal interferences may prevent the incidence of symptomatic TMD.


   Conclusion Top


T-Scan guided occlusal equilibration procedure showed a statistically significant reduction in the VAS scores for pain in TMJ along with the associated muscles of mastication and cervical muscles after a significant reduction in the occlusion time and disclusion time post-treatment, suggesting that T-Scan guided occlusal equilibration procedure can be adopted as a treatment modality for symptomatic temporomandibular disorders with occlusal interferences.

Acknowledgements

We would like to acknowledge the cooperation and participation of patients in conducting this study, 3G MAX for providing the T-Scan to carry out the research, and also the Management and Principal of the institution for permitting us to conduct the research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Agbaje JO, Casteele EV, Salem AS, Anumendem D, Shaheen E, Sun Y, et al. Assessment of occlusion with the T-Scan system in patients undergoing orthognathic surgery. Sci Rep 2017;7:5356.  Back to cited text no. 1
    
2.
Michael Glick. Burket's Oral Medicine. 12th ed. Shelton, CT: People's Medical Publishing House; 2015.  Back to cited text no. 2
    
3.
Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician 2015;91:378-86.  Back to cited text no. 3
    
4.
Bagis B, Ayaz EA, Turgut S, Durkan R, Özcan M. Gender difference in prevalence of signs and symptoms of temporomandibular joint disorders: A retrospective study on 243 consecutive patients. Int J Med Sci 2012;9:539-44.  Back to cited text no. 4
    
5.
Chisnoiu AM, Picos AM, Popa S, Chisnoiu PD, Lascu L, Picos A, et al. Factors involved in the etiology of temporomandibular disorders - A literature review. Clujul Med 2015;88:473-8. (was 5) change 5 to 6  Back to cited text no. 5
    
6.
Komali G, Ignatius AV, Srivani GS, Anuja K. T-scan system in the management of temporomandibular joint disorders – A review. J Indian Acad Oral Med Radiol 2019;31:252-56.  Back to cited text no. 6
  [Full text]  
7.
Bozhkova TP. The T-SCAN System in evaluating occlusal contacts. Folia Med (Plovdiv) 2016;58:122-30.  Back to cited text no. 7
    
8.
Qadeer, Sarah et al. Relationship between articulation paper mark size and percentage of force measured with computerized occlusal analysis. The Journal of Advanced Prosthodontics. 2012;4(1):7-12.  Back to cited text no. 8
    
9.
Cooper BC, Kleinberg I. Examination of a large patient population for the presence of symptoms and signs of temporomandibular disorders. Cranio 2007;25:114-26.  Back to cited text no. 9
    
10.
Muthukrishnan A, Sekar GS. Prevalence of temporomandibular disorders in Chennai population. J Indian Acad Oral Med Radiol 2015;27:508-15.  Back to cited text no. 10
  [Full text]  
11.
LeResche L, Saunders K, Von Korff MR, Barlow W, Dworkin SF. Use of exogenous hormones and risk of temporomandibular disorder pain. Pain. 1997;69:153–60.  Back to cited text no. 11
    
12.
Ozden AN, Ersoy AE, Kisnisci RS. Clinical aspects of temporomandibular disorders. Turk J Med Sci 2000;30:77-81.  Back to cited text no. 12
    
13.
LeResche L. Epidemiology of temporomandibular disorders: Implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997;8:291-305.  Back to cited text no. 13
    
14.
Thumati P. The influence of immediate complete anterior guidance development technique on subjective symptoms in Myofascial pain patients: Verified using digital analysis of occlusion (Tek-scan) for analysing occlusion: A 3 years clinical observation. J Indian Prosthodont Soc 2015;15:218-23.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Kerstein RB, Radke J. Masseter and temporalis excursive hyperactivity decreased by measured anterior guidance development. Cranio 2012;30:243-54.  Back to cited text no. 15
    
16.
Thumati P, Thumati RP. The effect of disocclusion time-reduction therapy to treat chronic myofascial pain: A single group interventional study with 3-year follow-up of 100 cases. J Indian Prosthodont Soc 2016;16:234-41.  Back to cited text no. 16
    
17.
Thumati P, Manwani R, Mahantshetty M. The effect of reduced disclusion time in the treatment of myofascial pain dysfunction syndrome using immediate complete anterior guidance development protocol monitored by digital analysis of occlusion. Cranio 2014;32:289-99.  Back to cited text no. 17
    
18.
Khare N, Patil SB, Kale SM, Sumeet J, Sonali I, Sumeet B. Normal mouth opening in an adult Indian population. J Maxillofac Oral Surg 2012;11:309-13.  Back to cited text no. 18
    
19.
Kerstein RB. Handbook of Research on Computerized Occlusal analysis Technology Applications in Dental Medicine. Hershey PA: IGI Global Publishers; 2015.  Back to cited text no. 19
    
20.
Dzingutė A, Pileičikienė G, Baltrušaitytė A, Skirbutis G. Evaluation of the relationship between the occlusion parameters and symptoms of the temporomandibular joint disorder. Acta Med Litu 2017;24:167-75.  Back to cited text no. 20
    
21.
Garcia Cartagena A, Gonzalez Sequeros O, Garrido Garcia VC. Analysis of two methods for occlusal contact registration with the T-Scan system. J Oral Rehabil 1997;24:426-32.  Back to cited text no. 21
    
22.
Koos B, Godt A, Schille C, Göz G. Precision of an instrumentation-based method of analyzing occlusion and its resulting distribution of forces in the dental arch. J Orofac Orthop 2010;71:403-10.  Back to cited text no. 22
    
23.
Haralur SB. Digital evaluation of functional occlusion parameters and their association with temporomandibular disorders. J Clin Diagn Res 2013;7:1772-5.  Back to cited text no. 23
    
24.
Kerstein RB, Grundset K. Obtaining bilateral simultaneous occlusal contacts with computer analyzed and guided occlusal adjustments. Quintessence Int 2001;32:7-18.  Back to cited text no. 24
    
25.
Thumati P, Poovani S, Ayinala M. A retrospective five-year survey on the treatment outcome of disclusion time reduction (DTR) therapy in treating temporomandibular dysfunction patients. Cranio 2021;1-7.  Back to cited text no. 25
    
26.
Wang C, Yin X.Occlusal risk factors associated with temporomandibular disorders in young adults with normal occlusions. Oral Surg Oral Med Oral Pathol Radiol 2012;114:419-23.  Back to cited text no. 26
    
27.
Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev 2003;CD003812.  Back to cited text no. 27
    
28.
Tsukiyama Y, Baba K, Clark GT. An evidence-based assessment of occlusal adjustment as a treatment for temporomandibular disorders. J Prosthet Dent 2001;86:57-66.  Back to cited text no. 28
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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