Temporomandibular joint pain and associated magnetic resonance findings: a retrospective study with a control group

Background To better understand and evaluate clinical usefulness of magnetic resonance imaging (MRI) in diagnosis and treatment of temporomandibular disorders (TMD), parameters for the evaluation are useful. Purpose To assess a clinically suitable staging system for evaluation of MRI of the temporomandibular joint (TMJ) and correlate the findings with age and some clinical symptoms of the TMJ. Material and Methods Retrospective analysis of 79 consecutive patients with clinical temporomandibular disorder or diagnosed inflammatory arthritis. Twenty-six healthy volunteers were included as controls. Existing data included TMJ pain, limited mouth opening (<30 mm) and corresponding MRI evaluations of the TMJs. Results The patients with clinical TMD complaints had statistically significantly more anterior disc displacement (ADD), disc deformation, caput flattening, surface destructions, osteophytes, and caput edema diagnosed by MRI compared to the controls. Among the arthritis patients, ADD, effusion, caput flattening, surface destructions, osteophytes, and caput edema were significantly more prevalent compared to the healthy volunteers. In the control group, disc deformation and presence of osteophytes significantly increased with age, and a borderline significance was found for ADD and surface destructions on the condylar head. No statistically significant associations were found between investigated clinical and MRI parameters. Conclusion This study presents a clinically suitable staging system for comparable MRI findings in the TMJs. Our results indicate that some findings are due to age-related degenerative changes rather than pathological changes. Results also show that clinical findings such as pain and limited mouth opening may not be related to changes diagnosed by MRI.

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Non-invasive treatment modalities of limited mouth opening due to diseases and internal disorders of the temporomandibular joint

SUCHASNA STOMATOLOHIYA ◽

10.33295/1992-576x-2021-3-76 ◽

2021 ◽

Vol 107 (3) ◽

pp. 76-81

Author(s):

M. Drogomyretska ◽

◽

R. Mirza ◽

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Temporomandibular Joint ◽

Mouth Opening ◽

Resonance Imaging ◽

Invasive Treatment ◽

Limited Mouth Opening ◽

Open Mouth ◽

Non Invasive ◽

Patient Complaints

Abstract. Magnetic resonance imaging is widely used in the presence of such patient complaints as clicking, locking and pain in the temporomandibular joint. The different problems in the treatment of temporomandibular joint pathology, which is accompanied by limited mouth opening, requires certain recommendations for magnetic resonance imaging, supported by current classifications. The purpose of the study: to substantiate the need for the use of an individual mandibular fixator, made before magnetic resonance imaging in the open mouth position to systematization of the treatment outcomes. Materials and methods. On the basis of clinical examination and objectification of the temporomandibular joint status by magnetic resonance imaging the results of treatment of diseases and internal disorders of the temporomandibular joint, which can be obtained by a dentist-gnathologist using non-invasive methods, was analyzed. To obtain images after treatment of the temporomandibular joint an individual mandibular fixator was used, which provided the possibility of evidencebased determination of the articular head position in the open mouth state. To systematize the analysis results of magnetic resonance imaging of the temporomandibular joint, the most convenient classification was chosen. Results. From a clinical sight, the gnathological treatment of temporomandibular joint dislocation without reposition is considered effective if the distance between the incisors, at maximum mouth opening, is 41–50 mm, the articular head is located at the apex of articular tubercle, and in the questioning and isometric tests the patient complaints are absent. Conclusions. The most effective non-invasive treatment of limited mouth opening is possibly with early ambulation, i.e. from three to seven months after onset. Key words: temporomandibular joint, gnathologist, magnetic resonance imaging.

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Temporomandibular disorder in children at deciduous and mixed denture

Brazilian Dental Science ◽

10.14295/bds.2015.v18i4.1188 ◽

2015 ◽

Vol 18 (4) ◽

pp. 89 ◽

Cited By ~ 2

Author(s):

João Carlos Rocha ◽

Leticia Simino Carvalho ◽

Elisângela Da Silva Moreira Chetelat

Keyword(s):

Temporomandibular Joint ◽

Clinical Symptoms ◽

Temporomandibular Disorder ◽

Mouth Opening ◽

Signs And Symptoms ◽

Open Bite ◽

Mixed Dentition ◽

Structural Factors ◽

Temporomandibular Joint Dysfunction Syndrome ◽

School Of Dentistry

The temporomandibular joint (TMJ) plays an important role in the function of stomatognathic system. The acronym TMD – Temporomandibular disorder – is a general term for a series of signs and symptoms involving the masticatory muscles, TMJ, and associated structures. TMDs have a multifactorial etiology despite that many controversies still exist on this subject. Structural factors as trauma, malocclusion, systemic hypermobility, oral parafunctions, and emotional conditions (stress, anxiety, and depression) may trigger TMDs appearance. Objective: This study aimed to evaluate the signs and clinical symptoms of TMDs in patients treated at the School of Dentistry of the Institute of Science and Technology of São José dos Campos – UNESP - SP. Material and Methods: Fifty patients, both genders, aged between five and thirteen years were examined through muscle palpation and auscultation. Intra and extraoral examinations were performed, observing occlusion interference, denture type, protrusion or retrusion of the mandible, open bite or crossbite, edge-to-edge bite relation, midline shifts, limitation of mouth opening, and mandible shift during mouth opening and closing. Anamnesis comprised questions on the child’s habits and symptoms noticeable by the parents or legal guardians, information on the child’s personality and mood. Results: The obtained data were analyzed through percentage and qualitative analysis. Conclusion: It can be concluded that children exhibited signs and symptoms of TMDs, but TMDs presence cannot be affirmed in the studied sample; stress or altered behavior influenced on the presence of the signs and symptoms in the TMJ area Keywords Temporomandibular joint; Mixed dentition; Primary dentition; Temporomandibular joint dysfunction syndrome.

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Temporomandibular joint injection with corticosteroid and local anesthetic for limited mouth opening

Journal of Oral Science ◽

10.2334/josnusd.53.321 ◽

2011 ◽

Vol 53 (3) ◽

pp. 321-325 ◽

Cited By ~ 11

Author(s):

Aveed Samiee ◽

Daniel Sabzerou ◽

Faraz Edalatpajouh ◽

Glenn T. Clark ◽

Saravanan Ram

Keyword(s):

Temporomandibular Joint ◽

Local Anesthetic ◽

Mouth Opening ◽

Joint Injection ◽

Limited Mouth Opening

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Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report

Brazilian Dental Journal ◽

10.1590/s0103-64402012000600025 ◽

2012 ◽

Vol 23 (6) ◽

pp. 779-782 ◽

Cited By ~ 5

Author(s):

Carolina Ortigosa Cunha ◽

Lívia Maria Sales Pinto ◽

Luana Menezes de Mendonça ◽

Aline Dantas Diógenes Saldanha ◽

Ana Cláudia de Castro Ferreira Conti ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Temporomandibular Joint ◽

Correct Diagnosis ◽

Mouth Opening ◽

Limited Range ◽

Contralateral Side ◽

Limited Mouth Opening ◽

Tmj Ankylosis ◽

Inflammatory Conditions ◽

Limited Range Of Motion

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

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Cervical and scapular instability in subjects with temporomandibular disorder

Manual Therapy Posturology & Rehabilitation Journal ◽

10.17784/mtprehabjournal.2018.16.616 ◽

2020 ◽

pp. 1-5

Author(s):

Maryllian de Albuquerque Vieira ◽

Maria das Graças Rodrigues de Araújo ◽

Gabriel Barreto Antonino ◽

Angélica da Silva Tenório ◽

Maria das Graças Paiva ◽

...

Keyword(s):

Temporomandibular Joint ◽

Temporomandibular Disorder ◽

Neck Disability Index ◽

Shoulder Girdle ◽

Masticatory Muscles ◽

Control Group ◽

Cervical Instability ◽

Mobility Data ◽

Significant Difference ◽

Neck Disability

Background: Temporomandibular disorder (TMD) is a set of disorders involving the masticatory muscles, the temporomandibular joint (TMJ) and/or the associated structures. Objectives: To evaluate the occurrence of cervical and scapular instability in subjects with TMD. Methods: A total of 22 patients participated in the study, being 11 of them with TMD, selected using the RDC/TMD criteria, and 11 in the control group. The stabilization capacity of the neck muscles was evaluated through StabilizerTM and the muscles of the shoulder girdle through specific tests. Cervical mobility data from both groups were provided using the accelerometer while for cervical disability was used the Neck Disability Index (NDI) questionnaire. Results: Cervical instability was higher in the TMD group (20.36 ± 3.2) than in the control group (28.54 ± 0.8), revealing significant difference (p= 0.03). The highest percentages of scapular stabilization tests were found in subjects with TMD, (n= 9; 81.81%) when compared with control subjects (n= 5; 45.45%). The NDI results showed that the TMD group presented mild cervical incapacity (11.18 ± 2) and the control presented no disability (2.27 ± 0.4; p= 0.001). Conclusion: Cervical disability, and cervical and scapular instability were more frequent in subjects with TMD.

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Relationship between Clinical Symptoms and Magnetic Resonance Imaging in Temporomandibular Disorder (TMD) Patients Utilizing the Piper MRI Diagnostic System

Journal of Clinical Medicine ◽

10.3390/jcm10204698 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4698

Author(s):

Tor Tegnander ◽

Grzegorz Chladek ◽

Anders Hovland ◽

Jarosław Żmudzki ◽

Piotr Wojtek

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Muscle Pain ◽

Joint Pain ◽

Clinical Symptoms ◽

Temporomandibular Disorder ◽

Diagnostic System ◽

Resonance Imaging ◽

Tmj Pain ◽

Clinical Problems

Clinical problems of the temporomandibular joint (TMJ) and the masticatory musculature are both included in the term temporomandibular disorder (TMD). The purpose of the present study was to examine the pathology of the joints of patients diagnosed with TMD utilizing the dedicated Piper MRI-based classification, and to link these pathologies with various symptoms while considering their severity. In total, 64 patients with clinical TMD were examined. Symptoms were recorded using a questionnaire. The clinical examination included diagnosing the occlusion in centric relation, which was followed by a standardized MRI. It was confirmed that, although they occurred in a high percentage in all classes, muscle pain and occlusal interference are not indicators of TMJ damage. The results indicate that the progressive degradation of the TMJ, represented by qualification to the higher Piper classes, is associated with an increase in TMJ pain only up to a certain stage. For the highest Piper classes, the joint pain occurs in a smaller percentage of patients, but sounds are more frequent.

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Automated segmentation of articular disc of the temporomandibular joint on magnetic resonance images using deep learning

Scientific Reports ◽

10.1038/s41598-021-04354-w ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Shota Ito ◽

Yuichi Mine ◽

Yuki Yoshimi ◽

Saori Takeda ◽

Akari Tanaka ◽

...

Keyword(s):

Neural Network ◽

Deep Learning ◽

Magnetic Resonance ◽

Convolutional Neural Network ◽

Temporomandibular Joint ◽

Temporomandibular Disorders ◽

Temporomandibular Disorder ◽

Semantic Segmentation ◽

Magnetic Resonance Images ◽

Articular Disc

AbstractTemporomandibular disorders are typically accompanied by a number of clinical manifestations that involve pain and dysfunction of the masticatory muscles and temporomandibular joint. The most important subgroup of articular abnormalities in patients with temporomandibular disorders includes patients with different forms of articular disc displacement and deformation. Here, we propose a fully automated articular disc detection and segmentation system to support the diagnosis of temporomandibular disorder on magnetic resonance imaging. This system uses deep learning-based semantic segmentation approaches. The study included a total of 217 magnetic resonance images from 10 patients with anterior displacement of the articular disc and 10 healthy control subjects with normal articular discs. These images were used to evaluate three deep learning-based semantic segmentation approaches: our proposed convolutional neural network encoder-decoder named 3DiscNet (Detection for Displaced articular DISC using convolutional neural NETwork), U-Net, and SegNet-Basic. Of the three algorithms, 3DiscNet and SegNet-Basic showed comparably good metrics (Dice coefficient, sensitivity, and positive predictive value). This study provides a proof-of-concept for a fully automated deep learning-based segmentation methodology for articular discs on magnetic resonance images, and obtained promising initial results, indicating that the method could potentially be used in clinical practice for the assessment of temporomandibular disorders.

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COMPARISON OF ARTHROCENTESIS PLUS PLATELET RICH PLASMA WITH ARTHROCENTESIS ALONE IN THE TREATMENT OF TEMPOROMANDIBULAR JOINT DYSFUNCTION

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i4.5361 ◽

2021 ◽

Vol 71 (4) ◽

pp. 1377-81

Author(s):

Humaira Sarwar ◽

Irfan Shah ◽

Ali Akhtar Khan ◽

Muhammad Afzal ◽

Adnan Babar ◽

...

Keyword(s):

Combination Therapy ◽

Temporomandibular Joint ◽

Platelet Rich Plasma ◽

Maxillofacial Surgery ◽

Mouth Opening ◽

Military Hospital ◽

Control Group ◽

Group I ◽

Significant Difference ◽

Group Ii

Objective: To evaluate the role of combination therapy of platelet rich plasma (PRP) with arthrocentesis and to compare it with arthrocentesis alone in the temporomandibular dysfuction (TMD) patients.Study Design: Quasi experimental study.Place and Duration of Study: Oral and Maxillofacial Surgery department, Armed Forces Institute of Dentistry, Combined Military Hospital Rawalpindi, from Jan 2017 to Jun 2019.Methodology: Forty-two patients diagnosed with refractory unilateral temporomandibular dysfuction, were included in the study. Patients were divided in two groups with 21 temporomandibular joints in each. Arthrocentesis alone was the control group (group I) and arthrocentesis with intra-articular injection of platelet rich plasma (group II) was the study group. Treatment outcomes were assessed and compared for all patients based on clinical parameters of pre and post treatment; for pain, maximal mouth opening and temporomandibular joint clicking sounds. Results: Out of 42 patients, 33 (79%) were females and 9 (21%) were males with mean age of 34.3 ± 8.4 years. There was statistically significant difference in both groups for all variables. The p-value of maximum mouth opening of both groups before and after treatment was 0.746 and 0.01, joint clicking sounds were present in 69% of our patients before the treament and it reduced to 14% after the treatment. There was marked gradual decrease in pain of both groups, group I (6.48 ± 1.470 to 1.81 ± 0.602) and group II (7.29 ± 1.007 to 1.19 ± 0.402). Conclusion: Combination therapy of platelet rich plasma with arthrocentesis is more effective treatment method than.......

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Efficacy of Manual Therapy in Temporomandibular Joint Disorders and Its Medium-and Long-Term Effects on Pain and Maximum Mouth Opening: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9113404 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3404

Author(s):

Andres Herrera-Valencia ◽

Maria Ruiz-Muñoz ◽

Jaime Martin-Martin ◽

Antonio Cuesta-Vargas ◽

Manuel González-Sánchez

Keyword(s):

Systematic Review ◽

Temporomandibular Joint ◽

Manual Therapy ◽

Temporomandibular Disorder ◽

Mouth Opening ◽

Temporomandibular Joint Disorders ◽

Treatment Manual ◽

Therapeutic Exercise ◽

Long Term Treatment

The aim of this study was to conduct a systematic review of the medium- and long-term efficacy of manual therapy for temporomandibular joint disorders, alone or in combination with therapeutic exercise. Information was compiled from the PubMed, SCOPUS, Cochrane, SciELO and PEDro databases. The inclusion criteria were established: randomized controlled trials only; participants must present any kind of temporomandibular disorder; the treatments must include manual therapy in at least one of the experimental groups; a minimum of 3 months of follow-up; pain must be one of the primary or secondary outcomes; and the article must be available in English, Spanish, Italian, Portuguese or French. Six documents that fulfilled all the criteria were obtained for analysis, two of them considered low quality and four considered high quality. A significant improvement in pain and mouth opening compared to baseline was observed after manual therapy treatment. Manual therapy seems to be an effective treatment for temporomandibular disorders in the medium term, although the effect appears to decrease over time. However, when complemented with therapeutic exercise, these effects can be maintained in the long term. This review underlines the importance of manual therapy and therapeutic exercise for the medium- and long-term treatment of temporomandibular joint disorders in daily practice.

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Reliability of Clinical Symptoms in Diagnosing Temporomandibular Joint Arthritis in Juvenile Idiopathic Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.131337 ◽

2014 ◽

Vol 41 (9) ◽

pp. 1871-1877 ◽

Cited By ~ 37

Author(s):

Bernd Koos ◽

Marinka Twilt ◽

Ullrike Kyank ◽

Helge Fischer-Brandies ◽

Volker Gassling ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Temporomandibular Joint ◽

Power Analysis ◽

Statistical Power ◽

Clinical Symptoms ◽

Correct Diagnosis ◽

False Negative ◽

Mouth Opening ◽

High Rate ◽

Healthy Controls

Objective.Temporomandibular joint (TMJ) arthritis, commonly considered oligoarthritic/asymptomatic, occurs frequently in children with juvenile idiopathic arthritis (JIA), and gadolinium-enhanced magnetic resonance imaging (Gd-MRI) has proved to be a sensitive diagnostic tool in this context. We compared the reliability of clinical examinations to Gd-MRI results in diagnosing the condition.Methods.Patients with JIA (134 consecutive) underwent routine clinical and Gd-MRI examinations. The clinical items examined were clicking, tenderness (TMJ/adjacent muscles), and mouth-opening capacity. Blinded MRI reading focused on inflammation (synovitis/hypertrophy). After statistical power analysis, the clinical findings for 134 healthy controls were included. Contingency analysis was used to determine the sensitivity, specificity, and frequency of clinical symptoms (JIA/healthy controls); Cohen’s κ was used to establish the interrater reliability.Results.Statistically significant differences were observed between JIA and healthy control groups with regard to the concise screening items (power analysis > 0.95), whereas no differences in mouth-opening capacity were noted. In 80% of the patients with JIA, Gd-MRI revealed signs of TMJ arthritis, with positive correlations between concise screening items and Gd-MRI results. The average specificity was 0.81, but the sensitivity was low, at 0.42. Combining items led to a marked increase in the sensitivity (0.73). There was a high rate of both false-negative and false-positive results (corresponding to clinical underdiagnosis or overdiagnosis of TMJ arthritis).Conclusion.Despite a relatively high specificity, clinical examination alone does not seem sufficiently sensitive to adequately detect TMJ arthritis. Thus, a relatively high number of cases will be missed or overdiagnosed, potentially leading to undertreatment or overtreatment. Gd-MRI may support correct diagnosis, thereby helping to prevent undertreatment or overtreatment.

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