Development of Core Outcome Sets for Clinical Trials in Temporomandibular Disorders

Background Temporomandibular Disorder (TMD) is a generic term applied to describe musculoskeletal disorders that affect the temporomandibular joint (TMJ), the masticatory muscles and the related structures. TMD comprises two groups of disorders, namely intra-articular TMD and masticatory muscle disorders. There is still difficulty in establishing the effectiveness of different therapeutic modalities for TMD with robust evidence, despite the large volume of publications in the area. The lack of outcomes standardization may represent a limiting factor in the search for scientific evidence. Objective This study aims to develop a core outcome sets (COS) for clinical trials in intra-articular TMD and masticatory muscle disorders. Methods The protocol for determining the COS-TMD will consist of three phases: 1. Synthesis of TMD Management Intervention Outcomes. The identification of outcomes will be carried out through a systematic review, which will include randomized clinical trials that evaluated the effectiveness of interventions used in TMD management. 2. Through a two-round international Delphi survey, the list of outcomes will be scored by three panels of stakeholders. 3. A representative sample of key stakeholders will be invited to participate in a face-to-face meeting where they can discuss the results of the Delphi survey and determine the final core set. Conclusions The implementation of this protocol will determine the COS-TMD, which will be made available for use in all TMD clinical studies. The use of COS when planning and reporting TMD clinical trials will reduce the risk of publication bias and enable proper comparison of results found by different studies.

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

Temporomandibular 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.

Comparison of T2 Weighted, Fat-Suppressed T2 Weighted, and Three-Dimensional (3D) Fast Imaging Employing Steady-State Acquisition (FIESTA-C) Sequences in the Temporomandibular Joint (TMJ) Evaluation

Aim. Osteonecrosis can affect the mandibular condyle, and bone marrow edema may be a precursor in osteonecrosis development in temporomandibular disorder (TMD) patients. Early detection of bone marrow changes is crucial for occurring osteonecrosis. The purpose of this study was to compare the diagnostic value of fast spin-echo T2 weighted (FSE-T2W), fat-suppressed T2W (FS-T2W), and three-dimensional (3D) fast imaging employing steady-state acquisition (FIESTA-C) MR sequences for early detection of bone marrow changes as well as TMJ soft tissue alterations. Methods. A total of 60 joints with TMD were included in this study using a 1.5T MR machine (Signa HDxt, GE, Milwaukee, USA) using a dual surface TMJ coil. Qualitatively, the images were interpreted by two observers for disk configuration, disk position, joint fluid, and bone marrow changes. Quantitatively, signal intensity ratios (SIR) in the TMJ condyle, retrodiscal tissue, disk, and muscle were also measured using all tested sequences. Kappa coefficients were calculated to assess both intra- and interobserver agreements for each image set. The SIR of each sequence was compared using a one-way ANOVA Bonferroni-Dunn test. Results. Overall intraobserver kappa coefficients ranged between 0.35 and 0.88 for joint fluid and between 0.22 and 0.82 for bone marrow changes diagnosis, suggesting high intraobserver agreement for FS-T2W and 3D FIESTA-C sequences than FSE T2W sequence ( p < 0.05 ). 3D FIESTA-C showed higher agreement values for disk configuration and position detection than other sequences. Conclusions. 3D FIESTA-C sequences can be used and incorporated into routine MRI protocols for obtaining high-resolution TMJ MR images due to the short acquisition time and 3D nature of the sequence. Additional studies should be done for dynamic TMJ imaging with this sequence.

MANDIBULAR DEVIATION IN UNILATERAL CHEWING HABITS

ntroduction: The mandibular movement pattern was used to evaluate the presence of a dysfunction. Impaired TMJ function is called temporomandibular disorder (TMD). One of the causes that are often associated with TMD is a bad habit of chewing one side. This habit is often done without realizing it, causing an imbalance in the distribution of the chewing load and can result in deviation or displacement. The occurrence of TMD can be characterized by limited mouth opening of less than 40 mm. Objective: This study aims to determine the presence of abnormalities in the pattern of mandibular movement in the bad habit of chewing on one side. Methods: The research method used is descriptive observational research with saturated sampling technique with a sample of 25 students of the Faculty of Dentistry, Mahasaraswati University Denpasar, class of 2017. Data collection was carried out by observing through videos of mandibular movement patterns. Results and conclusions: The results showed the pattern of mandibular movement with the habit of chewing on one side, in men who deviated 28%, in women 32%, while in men who did not deviate 12% and in women as much as 28%

Pediatric Chronic Orofacial Pain: A Narrative Review of Biopsychosocial Associations and Treatment Approaches

Pediatric chronic orofacial pain (OFP) is an umbrella term which refers to pain associated with the hard and soft tissues of the head, face, and neck lasting &gt;3 months in patients younger than 18 years of age. Common chronic pediatric OFP diagnoses include temporomandibular disorder, headaches, and neuropathic pain. Chronic OFP can adversely affect youth's daily functioning and development in many areas of well-being, and may be associated with emotional stress, depression, functional avoidance, and poor sleep, among other negative outcomes. In this mini-review, we will discuss common psychological comorbidities and familial factors that often accompany chronic pediatric OFP conditions. We will also discuss traditional management approaches for pediatric orofacial pain including education, occlusal appliances, and psychological treatments such as relaxation, mindfulness-based interventions, and cognitive-behavioral treatments. Finally, we highlight avenues for future research, as a better understanding of chronic OFP comorbidities in childhood has the potential to prevent long-term pain-related disability in adulthood.