Optimizing Occlusal Splint Therapy: ElMohandes Protocol for Minimizing Musculoskeletal Alterations With Reduced Wear Time.

AIM: The aim of this study is to evaluate the clinical efficacy and safety of the ElMohandes protocol, a combined regimen of intermittent occlusal splint therapy, musculoskeletal physiotherapy, and structured patient education, in reducing pain, enhancing jaw function, and minimizing occlusal side effects in adults with myogenic temporomandibular disorders (TMD) or internal derangement.

METHODS

Forty-two consecutive patients (age 18-55 years) diagnosed with myogenous TMD or temporomandibular joint (TMJ) internal derangement according to diagnostic criteria for temporomandibular disorders (DC/TMD) were enrolled in this single-arm case series. Exclusion criteria included prior TMJ surgery, condylar fracture, systemic disease, and recent minimally invasive TMJ interventions. Each participant received a maxillary stabilization splint to be worn 10-12 hours/day over six months, with gradual "weaning in" and "weaning out" phases. Adjunctive therapy comprised thrice‑weekly sessions of transcutaneous electrical nerve stimulation (20-30 min) and ultrasound (8 MHz, 0.73 W/cm²) for four weeks, delivered by an expert physical therapist. A multimodal educational program on TMD etiology, self-management, and stress reduction was provided through face-to-face and digital materials. Primary outcomes, i.e., pain intensity (visual analog scale), maximal interincisal opening (MIO), muscle pain/tenderness scores, and patient satisfaction, were assessed at baseline, one week, and one, three, and six months. Statistical analyses included repeated‑measures ANOVA, Friedman tests, and chi-square tests (α=0.05).

RESULTS

All 42 patients completed the protocol with no dropouts. Mean VAS pain scores declined from 7.57 ± 0.50 at baseline to 3.38 ± 0.49 at six months (p<0.001), and mean MIO increased from 31.87 ± 1.34 mm to 35.61 ± 1.70 mm (p<0.001). Significant muscle pain and tenderness improvements were observed at all post-baseline timepoints (p<0.0001). At six months, 76.2% of patients reported "highly satisfied" functional recovery, 19.0% reported "quiescent acceptance," and 4.8% remained "unsatisfied" (p<0.0001). No clinically relevant occlusal changes or adverse events were detected.

CONCLUSION

The ElMohandes protocol yielded rapid, substantial reductions in pain and functional gains while preserving occlusal stability and achieving high patient satisfaction. Its integration of part-time splint use, physiotherapeutic modalities, and patient education appears to optimize conservative TMD management. Randomized controlled trials with objective compliance monitoring and extended follow-up are warranted to confirm these findings and establish long-term benefits.