CATEGORY 82 AUSTRALASIAN DENTIST CLINICAL improvement reported was 90.9% (Table 3), with 51 patients (53% of the group) reporting a 100% improvement and 72 (75% of the group) reporting a 90%, or more, improvement. The 62 splint wearers at the follow-up reported a 90.5% improvement while the 34 splint non-wearers had an average reported improvement of 91.7%. Detailed data on three of the 96 Group B patients are presented in Table 2. Group C completed OST, OE and molar guidance/anterior guidance (MG/AG), and comprised 56 patients, or 28% of the sample (20% male, and 80% female). Average improvement reported was 95.6% (Table 3), with 40 patients (71% of the group) reporting a 100% improvement and 52 (93% of the group) reporting at least a 90% improvement. The 45 splint wearers at the follow-up reported a 97.4% improvement while the 11 splint non-wearers had an average reported improvement of 88.2%. Molar guidance was performed on three out of 200 patients, namely, numbers one, six and 161 and all reported a 100% improvement of symptoms (Darveniza 2024). Patient number six was treated in 1992 and the first to be treated with MG and some clinical notes are presented in Table 2. Detailed data on three of the 56 Group C patients are presented in Table 2. Occlusal splint therapy resulted in a mean improvement of 84% in Group A, 70% in Group B and 58% in Group C with a mean of 71% for all groups. The average level of self-reported overall improvement was higher for each additional stage of occlusal therapy completed (Table 3). Specifically, overall improvement increased from an average of 84.0% for patients completing only OST, to 90.9% if OST and OE were completed, and to 95.6% where patients completed all three stages of treatment. The statistical tests (Table 3) showed that the average improvement after completing only OST (Group A) was significantly lower than the improvement after completing all three treatment stages (Group C) (p < 0.05). However, the level of improvement after OST and OE (Group B) were completed was not significantly different from the groups A and C (p > 0.05). Patients who stopped treatment after OST (Group A) recorded an average improvement of 84.0%, while those who stopped after OST and OE (Group B), or who completed all three stages (Group C) had reported only 70.4% and 58.4% improvement at the end of OST, respectively. The statistical tests showed that these three percentage improvement figures were significantly different (p < 0.05) (Table 3). The level of reported improvement after OST and OE (90.9%) was significantly higher for Group B (who stopped treatment at that stage) than Group C patients who had reached the OST+OE stage (80.7%) prior to completing Stage 3. Finally, within Groups B and C each additional treatment completed resulted in a significant improvement in symptoms (Table 3). For patients who completed only OST and OE (Group B), the addition of the OE treatment stage increased the selfreported improvement by 20.5%. Group C patients who completed all three treatment stages recorded a 22.3% improvement from OE and OST. Group C patients recorded another 14.9% improvement from MG/AG after OST + OE. These results suggest that patients move through the treatment stages until they have achieved a satisfactory level of improvement. Inspection of the data suggests that for many patients, this is in the vicinity of an 80 to 85% improvement. The people who responded most strongly had achieved a ‘satisfactory’ level of improvement at the end of Stage 1, and so tended to stop at that point, while those who had not improved as much were prepared to go onto the next stage, or stages, of treatment. At each stage of treatment, the patients in Group C were significantly slower to respond than one, or both, of the other groups. This would Fig. 15 An occlusal view illustrates a bio-designed anterior guidance at the ground-in stage during an occlusal reconstruction. Note the lateral guidance path on 23 has an early path with a disto-lateral vector to accommodate the lax right TMJ associated with his bruxism. The mid-path has a vertical vector and final path an anterior vector to complete a fully protective left lateral path. The protrusive path illustrates bilateral protrusive ramps on 11 and 21 teeth which created a protective sagittal mandibular vector. Fig. 16 Lateral view of a right first molar rise occlusal reconstruction at an increased vertical dimension for a dolichofacial TMD patient, in 2013. The patient had disc displacement and underwent formal fully protective occlusal splint therapy prior to reconstruction. Bio-designing the porcelain/ zirconia crowns on all first molars for this patient with extreme lateral mandibular movements involved designing a long lateral path by: deleting the distal cusp, increasing the normal height of the lower distobuccal cusp by 0.5-0.75 mm and tilting this cusp more lingual, elongating the upper distobuccal cusp by 1.25 mm and positioning it more buccal with a flat landing pad. At edge-to-edge molar rise there was a vertico-lateral mandibular vector, disclusion of the second molars of 1.5-2 mm clearance and a generous lateral guidance path of about 3.5 mm for this extreme clencher/grinder. Treatment Treatment completed Amount of self-reported improvement (%) Overall improvement‡ group After OST only† After OST and OE† After OST, OE and MG/AG† A OST 84.0 cd – – 84.0 x B OST + OE 70.4 b 90.9 cd – 90.9 xy C OST + OE +AG/MG 58.4 a 80.7 bc 95.6 d 95.6 y † Within these three columns and across rows, means followed by the different letters (a – d) are significantly different (Tukey’s test, p = 0.05). ‡ Within this column, means followed by the different letters (x, y) are significantly different (Tukey’s test) Table 3. Results of statistical analysis of patient self-reported improvement in symptoms after treatment with occlusal splint therapy (OST) only, OST plus occlusal equilibration (OE), and OST, OE, and molar/anterior guidance (MG/AG).
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