Changes in The Temporomandibular Joint after Occlusal Deprogramming

2020 ◽  
pp. 1-21
Author(s):  
Rohit Kulshrestha ◽  
Keyword(s):  
Controlled Trial ◽  
Arthroscopic Surgery ◽  
Mandibular Condyle ◽  
Mouth Opening ◽  
Signs And Symptoms ◽  
Joint Space ◽  
Pharmacological Intervention ◽  
Occlusal Splints ◽  
Condylar Position ◽  
Surgery Education

Common signs and symptoms of TMD include masticatory muscle pain, TMJ sounds, limited mouth opening, and deviations in mandibular movements. Treatment generally involves some combination of occlusal splints, physiotherapy, relaxation therapy, pharmacological intervention, arthroscopic surgery, education, and behavioural counselling. One randomized controlled trial indicated that an occlusal deprogramming splint is more effective than other methods in treating TMD, although another study produced contradictory results. Measurements of the radiographic joint space a radiolucent area between the mandibular condyle and the temporal bone were introduced by Ricketts to describe condylar position. The clinical significance of condyle-fossa relationships in the TMJ is controversial, but several studies have suggested an association between eccentric condylar position and TMD. This chapter describes key changes in the condyle-fossa relationship after the use of an occlusal deprogramming splint in patients with TMD.

scholarly journals A Tomographic Study of the Mandibular Condyle Position in Partially Edentulous Population

2015 ◽  
Vol 16 (1) ◽  
pp. 68-73 ◽  
Author(s):  
Susan Ammanna ◽  
Anisha Rodrigues ◽  
N Sridhar Shetty ◽  
Karunakar Shetty
Keyword(s):  
Mandibular Condyle ◽  
Joint Space ◽  
Class I ◽  
Linear Measurements ◽  
Posterior Displacement ◽  
Stomatognathic System ◽  
Rest Position ◽  
Condyle Position ◽  
Condylar Position ◽  
Partially Dentate

ABSTRACT Background and objectives The influence of the loss of teeth on the condylar position and on temporomandibular joint (TMJ) dysfunction syndrome remains a controversial issue. This study analyses the condylar position by means of a tomogram in partially dentate subjects which serves as a guide to predict which of the partially dentate statuses is prone to develop TMJ dysfunction syndrome in personnel without symptoms of the same. Methodology Eighty personnel were enrolled in this study consisting of Kennedy's class I, II, III, IV and control to analyze the condylar position by means of a tomogram. In all the five groups TMJ sectional tomogram programmed in a panoramic radiographic machine (PLANMECA PM 2002 CC PROLINE) was taken with the subjects at maximal intercuspal position and rest position. Tomograms were evaluated using linear measurements of the anterior and posterior intra-articular joint spaces on the basis of drawings and tracings. Results The results of the study revealed a predominance of reduced posterior condylar space in Kennedy's class I and II. A disparity was seen between the maximum intercuspal position and rest position, where the posterior joint space was reduced in the rest position. Conclusion Within the limitations of this study, it has been revealed that in Kennedy's classes I and II, for partially dentate personnel, a posterior displacement of the condyles was seen. This predisposition would suggest towards the necessity of restoring the missing dentition in order to maintain the harmony of the stomatognathic system. How to cite this article Ammanna S, Rodrigues A, Shetty NS, Shetty K, Augustine D, Patil S. A Tomographic Study of the Mandibular Condyle Position in Partially Edentulous Population. J Contemp Dent Pract 2015;16(1):68-73.

scholarly journals An additional lysis procedure during arthrocentesis of the temporomandibular joint

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Keon-Mo Lee ◽  
Wan-Hee Jang ◽  
Myoung-Sang You ◽  
Bu-Kyu Lee
Keyword(s):  
Temporomandibular Joint ◽  
Arthroscopic Surgery ◽  
Mouth Opening ◽  
Invasive Procedure ◽  
Joint Space ◽  
Temporomandibular Joint Disorders ◽  
Invasive Procedures ◽  
The Mean ◽  
Mechanical Lysis ◽  
Over Time

Abstract Background Arthrocentesis of the temporomandibular joint (TMJ) is an easy, highly efficient, minimally invasive procedure for treating temporomandibular joint disorders (TMDs). However, in some cases of mouth opening limitation (MOL), routine arthrocentesis is ineffective due to severe fibrotic adhesion in the superior joint space of the TMJ. In this condition, mechanical lysis of the adhesions might be needed to resolve the MOL, as well as other symptoms, such as chronic pain. Currently, this can be achieved by arthroscopic surgery or open TMJ surgery. The objective of this study was to introduce and evaluate our trial of the adhesion lysis procedure during arthrocentesis of the TMJ using normal 18-gauge needles. Results In this study, 40 patients with MOL due to disc derangement underwent conventional arthrocentesis at first and then physical detachment was conducted using the same needle. The change in maximum mouth opening (MMO) and the pain at the TMJ were recorded before, during, and after treatment according to our protocol. The mean increase in MMO after conventional arthrocentesis was 6.6 ± 4.2mm. The mean increase in MMO after the detachment procedure with the same needle was 4.2 ± 2.0 mm. The MMO in ten patients was significantly increased after the detachment procedure than after arthrocentesis alone. In all cases, the pain intensity in the TMJ significantly decreased over time, whereas the MMO increased over time. No adverse effect was observed in all joints during our observation periods. Conclusion We confirmed that our simple lysis procedure with the same needle of the arthrocentesis of the TMJ could not only improve the MMO more than after a conventional arthrocentesis but also resolve severe adhesion of the joint space that was ineffective by conventional arthrocentesis. Although this additional lysis procedure is simple, it might reduce the number of cases of more invasive procedures such as arthroscopic surgery or open TMJ surgery.

scholarly journals Effect of Occlusal Splints on the Temporomandibular Disorders, Dental Wear and Anxiety of Bruxist Children

2011 ◽  
Vol 05 (04) ◽  
pp. 441-450 ◽  
Author(s):  
Claudia C Restrepo ◽  
Isabel Medina ◽  
Patiñob Isabel
Keyword(s):  
Temporomandibular Disorders ◽  
Mouth Opening ◽  
Signs And Symptoms ◽  
Mixed Dentition ◽  
Control Group ◽  
Parent Rating ◽  
Dental Wear ◽  
Occlusal Splints ◽  
Significant Difference ◽  
Experimental Group

ABSTRACTObjectives: To evaluate the effectiveness of occlusal splints to reduce the signs and symptoms of temporomandibular disorders (TMD), dental wear and anxiety in a group of bruxist children. Methods: All of the subjects were 3 to 6 years old, had complete primary dentition, class I occlusion and were classified as bruxist according to the minimal criteria of the ICSD for bruxism. For each child, anxiety was evaluated with the Conners’ Parent Rating Scales (CPRS). The TMD were evaluated using the RDC/TMD. The dental wear was processed in digital format with Mat Lab® and Lab view® software to determine its size and form. The children were randomized into an experimental (n=19) and a control (n=17) group. The children in the experimental group used rigid bite plates for a two-year period, until mixed dentition. Afterwards, the CPRS and the RDC/TMD were applied again and dental casts were taken. Comparisons of the variables regarding dental wear, signs and symptoms of TMD and anxiety before and after treatment among the groups were analyzed using the t-test, the Wilcoxon rank sum test and the Mann-Whitney test. Results: The subjects in the experimental group showed no statistically significant difference regarding anxiety levels and dental wear when compared with the control group. The signs and symptoms of TMD were not reduced except for the deviation in mouth opening. Conclusions: The use of rigid occlusal bite plates was not efficient in reducing the signs of bruxism as a whole but did reduce the deviation in mouth opening. (Eur J Dent 2011;5:441-450)

scholarly journals Occlusal splints in reversible occlusal therapy of craniomandibular dysfunction

2011 ◽  
Vol 58 (3) ◽  
pp. 156-162
Author(s):  
Vojkan Lazic ◽  
Igor Djordjevic ◽  
Ana Todorovic
Keyword(s):  
Mouth Opening ◽  
Medical Attention ◽  
Negative Effects ◽  
Posterior Teeth ◽  
Temporal Area ◽  
Craniomandibular Dysfunction ◽  
Occlusal Splints ◽  
Condylar Position ◽  
Surrounding Areas ◽  
Mandibular Movements

Craniomandibular dysfunction (CMD) is a set of structural and functional disorders of different etiology that affects temporomandibular joint (TMJ) and orofacial muscles. The most common etiologic factors are psychogenic, occlusal, trauma and congenital anomalies of craniofacial structures. About 75% of the examined population have mild symptoms of CMD while 3-4% have more severe symptoms which require medical attention. The main symptoms why people seek for medical attention are: facial pain which increases with chewing and irradiates in surrounding areas and pain in TMJ which irradiates in the ear canal, temporal area or neck. Painful restriction of mandible during mouth opening and eccentric movements is frequent as well as mandible deviation or deflection. Sound effects in TMJ such as popping or clicking during mouth opening are common. Initial and least invasive therapeutic procedure is reversible occlusal therapy using splints. There are two main types of occlusal splints: stabilization and relaxation. First type of splints works on condyle stabilization in orthopedically stable position; it is superoanterior condylar position in articular fossa with position of intercondylar discs between condyle and articular fossa when working cusps of the antagonists are in maximal contact with the splint. Another type of splint causes disocclussion of posterior teeth and eliminates negative effects of occlusal interference in the intercuspal position or during eccentric mandibular movements. During therapy, occlusal splint temporarily changes occlusal relationships as well as relations within TMJ, causing reduction of CMD symptoms. The best therapeutic effect for reduction of CMD symptoms is achieved by combination of physical therapy and medication.

scholarly journals Protocol for a multicenter randomized controlled trial comparing a non-opioid prescription to the standard of care for pain control following arthroscopic knee and shoulder surgery

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Aaron Gazendam ◽  
◽  
Seper Ekhtiari ◽  
Nolan S. Horner ◽  
Nicole Simunovic ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Pain Control ◽  
Shoulder Arthroscopy ◽  
Controlled Trial ◽  
Arthroscopic Surgery ◽  
Standard Of Care ◽  
Opioid Prescription ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Arthroscopic Knee

Abstract Background Opioids continue to be the analgesic of choice for postoperative pain control following arthroscopic knee and shoulder surgery. Despite their widespread use, there are limited evidence-based clinical practice guidelines for postoperative opioid prescribing. The Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) Trial is a randomized controlled trial (RCT) designed to determine whether a non-opioid analgesia approach to postoperative pain, compared to usual care, reduces oral morphine equivalents (OME) consumed in patients undergoing outpatient knee and shoulder arthroscopy. Methods This is a multi-centre, RCT with a target sample size of 200 patients. Adult (18+ years of age) patients undergoing outpatient knee and shoulder arthroscopy will be randomized to a non-opioid postoperative protocol (intervention) or the current standard of care (control). The intervention will consist of a standardized non-opioid analgesic prescription, a limited rescue opioid prescription, and a patient education infographic. The control is defined as the treating surgeons’ pre-trial postoperative analgesic regimen. Exclusion criteria include chronic opioid use, concomitant open surgery, contraindications to the prescribed analgesics or ongoing workers compensation/litigation. The primary outcome is OMEs consumed at 6 weeks postoperatively. Secondary outcomes will include patient-reported pain and satisfaction, quantity of OMEs prescribed, number of opioid refills, and any adverse events up to 6 weeks postoperatively. Utilizing the intention to treat principle for all analyses, independent samples t-test and presented with a p-value as well as a mean difference (MD) with 95% confidence intervals (CIs) will be performed for primary and secondary outcomes. Discussion The ongoing opioid epidemic and overprescribing of opioids in orthopaedics serve as the rationale for this trial. There is a lack of evidence upon which to develop post-operative pain management guidelines for patients undergoing arthroscopic surgery. A prospective evaluation of this relatively inexpensive intervention will demonstrate whether an explicit effort to reduce the number of opioids prescribed results in a reduction in the amount of opioids consumed and help to inform future studies and guidelines. Trial registration The NO PAin trial has been prospectively registered with clinicaltrials.gov (NCT04566250).

scholarly journals Atorvastatin is unlikely to prevent rheumatoid arthritis in high risk individuals: results from the prematurely stopped STAtins to Prevent Rheumatoid Arthritis (STAPRA) trial

RMD Open ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e001591
Author(s):  
Laurette van Boheemen ◽  
Samina Turk ◽  
Marian van Beers-Tas ◽  
Wouter Bos ◽  
Diane Marsman ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
High Risk ◽  
Cox Regression ◽  
Controlled Trial ◽  
Pharmacological Intervention ◽  
Trial Participation ◽  
Double Blind ◽  
Cox Regression Analysis ◽  
Atorvastatin Group ◽  
Clinical Arthritis

ObjectivesPersons at high risk of rheumatoid arthritis (RA) might benefit from a low-risk pharmacological intervention aimed at primary prevention. Previous studies demonstrated disease-modifying effects of statins in patients with RA as well as an association between statin use and a decreased risk of RA development. A randomised, double-blind, placebo-controlled trial investigated whether atorvastatin could prevent arthritis development in high-risk individuals.MethodsArthralgia patients with anticitrullinated protein antibody (ACPA) >3 xULN or ACPA and rheumatoid factor, without (a history of) arthritis, were randomised to receive atorvastatin 40 mg daily or placebo for 3 years. The calculated sample size was 220 participants. The primary endpoint was clinical arthritis. Cox regression analysis was used to determine the effect of atorvastatin on arthritis development.ResultsDue to a low inclusion rate, mainly because of an unwillingness to participate, the trial was prematurely stopped. Data of the 62 randomised individuals were analysed. Median follow-up was 14 (inner quartiles 6–35) months. Fifteen individuals (24%) developed arthritis: 9/31 (29%) in the atorvastatin group; 6/31 (19%) in the placebo group: HR 1.40, 95% CI 0.50 to 3.95.ConclusionsIn this small set of randomised high-risk individuals, we did not demonstrate a protective effect of atorvastatin on arthritis development. The main reason for the low inclusion was unwillingness to participate; this may also impede other RA prevention trials. Further research to investigate and solve barriers for prevention trial participation is needed.

scholarly journals Mandibular movements in children with and without signs and symptoms of temporomandibular disorders

2004 ◽  
Vol 12 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Leonardo Rigoldi Bonjardim ◽  
Maria Beatriz Duarte Gavião ◽  
Luciano José Pereira ◽  
Paula Midori Castelo
Keyword(s):  
Clinical Signs ◽  
Mouth Opening ◽  
Signs And Symptoms ◽  
Lateral Movement ◽  
Mandibular Movement ◽  
Group I ◽  
Group Ii ◽  
The Right ◽  
Mandibular Movements ◽  
Digital Caliper

This research aimed to evaluate mandibular movements in children with and without signs and symptoms of temporomandibular dysfunction. The sample taken consisted of 99 children aged 3 to 5 years distributed in two groups: I - Absence of signs and/or symptoms of TMD (25 girls/40 boys); II - Presence of signs and symptoms of TMD (16 girls/18 boys). The symptoms were evaluated through an anamnesis questionnaire answered by the child's parents/caretakers. The clinical signs were evaluated through intra- and extraoral examination. Maximum mouth opening and left/right lateral movements were measured using a digital caliper. The maximum protrusive movement was measured using a millimeter ruler. The means and standard deviations for maximum mouth opening in Group I and Group II were 40.82mm±4.18 and 40.46mm±6.66, respectively. The values found for the left lateral movement were 6.96mm±1.66 for Group I and 6.74mm±1.55 for Group II, while for the right lateral movement they were 6.46mm±1.53 and 6.74mm±1.77. The maximum protrusion movements were 5.67mm±1.76 and 6.12mm±1.92, in Groups I and II, respectively. The mandibular movement ranges neither differed statistically between groups nor between genders. FAPESP Process 96/0714-6.

scholarly journals Study protocol for a randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017436 ◽  
Author(s):  
Søren Thorgaard Skou ◽  
Martin Lind ◽  
Per Hölmich ◽  
Hans Peter Jensen ◽  
Carsten Jensen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Knee Injury ◽  
Controlled Trial ◽  
Meniscal Tear ◽  
Arthroscopic Surgery ◽  
Meniscal Tears ◽  
Younger Adults ◽  
Meniscal Surgery ◽  
Randomised Controlled

IntroductionArthroscopic surgery is a very common orthopaedic procedure. While several trials have investigated the effect of knee arthroscopy for middle-aged and older patients with meniscal tears, there is a paucity of trials comparing meniscal surgery with non-surgical treatment for younger adults. The aim of this randomised controlled trial (RCT) is to investigate if early arthroscopic surgery is superior to exercise therapy and education, with the option of later surgery if needed, in improving pain, function and quality of life in younger adults with meniscal tears.Methods and analysisThis is a protocol for a multicentre, parallel-group RCT conducted at six hospitals across all five healthcare regions in Denmark. 140 patients aged 18–40 years with a clinical history and symptoms consistent with a meniscal tear, verified on MRI, found eligible for meniscal surgery by an orthopaedic surgeon will be randomly allocated to one of two groups (1:1 ratio). Participants randomised to surgery will undergo either arthroscopic partial meniscectomy or meniscal repair followed by standard postsurgical care, while participants allocated to exercise and education will undergo a 12-week individualised, supervised neuromuscular and strengthening exercise programme and patient education. The primary outcome will be difference in change from baseline to 12 months in the mean score on four Knee Injury and Osteoarthritis Outcome Score subscales, covering pain, symptoms, function in sports and recreation and quality of life (Knee Injury and Osteoarthritis Outcome Score (KOOS4)) supported by the individual subscale scores allowing clinical interpretation. Alongside, the RCT an observational cohort will follow patients aged 18–40 years with clinical suspicion of a meniscal tear, but not fully eligible or declining to participate in the trial.Ethics and disseminationResults will be presented in peer-reviewed journals and at international conferences. This study is approved by the Regional Committees on Health Research Ethics for Southern Denmark.Registration detailsClinicalTrials.gov (NCT02995551).

scholarly journals Temporomandibular joint dysfunction in Parkinson's Disease: an integrative literature review

Revista CEFAC ◽  
2017 ◽  
Vol 19 (5) ◽  
pp. 702-711 ◽  
Author(s):  
Taysa Vannoska de Almeida Silva ◽  
Maria das Graças Wanderley de Sales Coriolano ◽  
Carla Cabral dos Santos Accioly Lins
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Temporomandibular Joint ◽  
Myofascial Pain ◽  
Mouth Opening ◽  
Signs And Symptoms ◽  
Masticatory Muscles ◽  
Therapeutic Interventions ◽  
Temporomandibular Joint Dysfunction ◽  
Language Restriction

ABSTRACT Temporomandibular joint dysfunction is a set of disorders involving the masticatory muscles, temporomandibular joint and associated structures. It is known that the progression of motor symptoms in Parkinson's disease is an indication that these people are more prone to the development of this dysfunction. Thus, this study aims to investigate the signs and symptoms of temporomandibular dysfunction in people with Parkinson's disease. The search was performed in the databases: MEDLINE/ PubMed, LILACs, CINAHL, SCOPUS, Web of Science and PEDro, without timing or language restriction. Specific descriptors were used for each database and keywords, evaluated by the instruments: Critical Appraisal Skill Program and Agency for Health care and Research and Quality. A total of 4,209 articles were found but only 5 were included. After critical analysis of the methodology of the articles, one did not reach the minimum score required by the evaluation instruments, thus, it was excluded. The selected articles addressed, as signs and symptoms of temporomandibular joint dysfunction, the following: myofascial pain, bruxism, limitation of mouth opening, dislocation of the articular disc and asymmetry in the distribution of occlusal contacts. Further studies are needed in order to determine the relationship between cause and effect of the analyzed variables, so as to contribute to more specific and effective therapeutic interventions.

scholarly journals Clinical Trial of Efficacy and Toxicity of Disoproxil Tenofovir Fumarate and Emtricitabine for Mild to Moderate SARS-CoV-2 Infections

2021 ◽  
Author(s):  
Aldo A M Lima ◽  
Erico A G Arruda ◽  
Roberto J Pires-Neto ◽  
Melissa S Medeiros ◽  
J Quirino-Filho ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Vitamin C ◽  
Respiratory Infection ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clinical Suspicion ◽  
Pharmacological Intervention ◽  
Controlled Clinical Trial ◽  
Double Blind

This study aimed to evaluate the efficacy and toxicity of tenofovir (TDF) and TDF combined with emtricitabine (TDF/FTC) in patients with mild to moderate COVID-19 infections. We conducted a randomized, double-blind, placebo-controlled clinical trial in patients with clinical suspicion of mild to moderate respiratory infection caused by SARS-CoV-2 who were treated at an outpatient clinic. Patients were randomly recruited to take 10 days of TDF (300 mg/day), TDF (300 mg/day) combined with FTC (200 mg/day) or placebo Vitamin C (500 mg/day). The primary parameter was the score of symptoms and predictive signs of COVID-19, assessed on the seventh day of patient follow-up. From a total of 309 patients with clinical suspicion of SARS-CoV-2, 227 met the inclusion criteria and were randomly distributed into the following groups: (a) 75 (one did not initiate treatment) in the TDF group; (b) 74 in the TDF combined with FTC group; and (c) 77 in the Vitamin C group (placebo). Of the 226 patients, 139 (62%) were positive for SARS-CoV-2. Fever (37.8oC), ageusia or dysgeusia, anosmia or dysosmia, and two or more clinical symptoms or signs were significantly associated with SARS-CoV-2 infection. There was no significant change in clinical score based on clinical symptoms and signs between treatment groups. Patients with mild to moderate infection by SARS-CoV-2 had higher concentrations of G-CSF, IL-1β, IL-6 and TNF-α compared to patients without infection. Patients with mild to moderate respiratory infection, with fever (37.8oC), loss of smell, loss of taste and two or more symptoms, have a better prediction for the diagnosis of COVID-19. Patients with SARS-CoV-2 showed higher and more persistent proinflammatory cytokines profile compared to patients not infected with SARS-CoV-2. Pharmacological intervention with TDF or TDF combined with FTC did not change the clinical signs and symptoms score in mild to moderate respiratory infection in patients with SARS-CoV-2 compared to the Vitamin C group (placebo).

Sign in / Sign up

Export Citation Format

Share Document