Effects of centric mandibular splint therapy on orofacial pain and cerebral activation patterns

  • Marius Ernst
  • A. Elisa Schenkenberger
  • Martin Domin
  • Bernd Kordass
  • Martin LotzeEmail author
Original Article



To investigate the effects on pain, movement kinematics, and cerebral representation by a 3-month mandibular splint therapy.

Material and methods

Thirteen patients with temporo-mandibular joint disease (TMD) and moderate pain intensity were investigated before (PRE), within (after 2 weeks, POST1) and after a period of 12 weeks (POST2) using functional magnetic resonance imaging (fMRI) of representation of occlusal movements on natural teeth and on an individually fitted mandibular splint. In addition, kinematic investigations of jaw movements, muscle electromyography and pain ratings using a pain diary (VAS-scale 0–100) were measured.


Although the patient’s pain ratings decreased about 60%, kinematic and electromyographic characteristics over therapy were not significantly altered. Over therapy, we observed a decrease of fMRI activation magnitude in the primary somatosensory cortex (S1) and secondary somatosensory cortex (S2) and insular cortex during occlusion. Left hemispheric anterior insula and the cerebellar fMRI activation decrease were associated with decrease in pain over time.


Within the limitations of this pilot study, a reduction in both discriminative (primary and secondary somatosensory cortex) and affective (anterior insula) areas for pain processing suggest that altered pain anticipation is critical for the therapeutic effects of mandibular splint therapy after TMD.

Clinical relevance

A 3-month mandibular splint therapy moderately decreases pain and anticipatory anterior insular activation.


Temporo-mandibular joint disease Functional splint therapy fMRI EMG Kinematography 



We would like to thank “Fundamental” for preparing the individual adjusted splints. L.M. and K.B. were supported by the “Deutsche Forschungsgemeinschaft” (LO 795/25-1; KO 1598/6-1).

Funding information

Fundamental prepared the individual adjusted splints. L.M. and K.B. were supported by the “Deutsche Forschungsgemeinschaft” (LO 795/25-1; KO 1598/6-1).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Functional Imaging Unit, Center of Diagnostic Radiology and NeuroradiologyUniversity Medicine GreifswaldGreifswaldGermany
  2. 2.Department of Dental Radiology, Centre of Dentistry and Oral HealthUniversity Medicine GreifswaldGreifswaldGermany
  3. 3.Department of Clinical Dental CAD/CAM and CMD-Treatment, Centre of Dentistry and Oral HealthUniversity Medicine GreifswaldGreifswaldGermany

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