Correlation of MRI and arthroscopic findings with clinical outcome in temporomandibular joint disorders: a retrospective cohort study

Background Arthroscopy is a minimally invasive diagnostic tool and treatment strategy in patients suffering from temporomandibular disorders (TMD) when conservative treatment fails. This study aimed to find specific variables on pre-operative MRI or during arthroscopy that could predict success of arthroscopic lysis and lavage. Methods This retrospective analysis compared pre-operative maximum interincisal opening (MIO), pain and main complaint (pain, limited MIO or joint sounds) with results at short-term and medium-term follow-up (ST and MT respectively). Different variables scored on MRI or arthroscopy were used to make a stepwise regression model, subsequently a combined analysis was conducted using variables from both MRI and arthroscopy. Results A total of 47 patients (50 joints) met the inclusion criteria. The main complaint improved by 62 and 53% at ST and MT respectively. The absolute or probable absence of a crumpled disc scored on MRI predicted success at ST and MT (p = 0.0112 and p = 0.0054), and remained significant at MT in the combined analysis (p = 0.0078). Arthroscopic findings of degenerative joint disease predicted success at ST (p = 0.0178), absolute or probable absence of discal reduction scored during arthroscopy significantly predicted success in the combined analysis at ST (p = 0.0474). Conclusion To improve selection criteria for patients undergoing an arthroscopic lysis and lavage of the TMJ, future research might focus on variables visualized on MRI. Although more research is needed, disc shape and in particular the absolute or probable absence of a crumpled disc might be used as predictive variable for success.

A new atraumatic temporomandibular joint dislocation reduction technique. Note preview

In light of the new coronavirus pandemic, emotional temporomandibular joint disorders have become more common. As a result, abnormal wear of the bones and cartilages in this joint may favor the triggering of temporomandibular dislocations. This technical note describes a new atraumatic method for reducing temporomandibular dislocation, with advantages over the traditional Nelaton maneuver. The corresponding author states that he has been using this technique for over 20 years in Brazilian public hospitals with absolute success. The note is original and has never been submitted, in full or in part, to any journal. This work aims to present an innovative technique, easy to perform and free of cost, in order to facilitate the reduction of temporomandibular dislocations.

Radiographical Measurements of Overeruption in Unopposed Posterior Teeth Among Selected Population of Saudi Arabia

The suspended replacement of extracted teeth may disrupt the structural integrity of the whole dental arch, particularly in posterior maxillary or mandibular tooth/teeth. This phenomenon often has consequences of masticatory deficiency and temporomandibular joint disorders. This work aims to assess and measure the overeruption of posterior teeth from panoramic radiographs (OPGs) and its relation to gender, age, tooth type, arch, sides, and cause of tooth loss. A total of 100 OPGs were included in this in vitro study. The level of posterior overeruption was measured in mm using the panoramic digital radiograph machine and its software systems. Other variables such as gender, tooth/teeth involved, arches, and side were considered. All parameter values were inputted to a software program and assessed. P value < 0.05 was considered as statistically significant. Males accounted for 63% of the OPGs. Age groups 18–30 and 31–45 years had the highest frequency and percentage (34%). Approximately 74% of the patients got their tooth/teeth extracted 4–6 years ago. The 0.7–1.2 mm overeruption subgroup had the highest proportion of 41%. The rate of overeruption in mandibular molars was 36%, which was the highest among the subgroups. Males had higher percentage than females in ≥60 and 31–45 age groups (84.65% and 76.5%, respectively), 4–6 years post-extraction time (85.7%), with significant differences, also, mandibular molars (85.0%) and mandibular arches (74.3%) were the higher among males. The highest level of overeruption was 0.7–1.2 mm, and mandibular molars were the most affected type. Significant differences between genders were detected in age groups, years after tooth loss, and arch side but not in cause of tooth loss, supra-erupted tooth type, and arch type parameters.

Agulhamento seco no tratamento da dor miofascial associada a disfunção temporomandibular: uma revisão sistemática

Dor miofascial é um distúrbio muscular que esta frequentemente associada às desordens temporomandibulares, afeta os músculos da mastigação e pode levar a limitações funcionais. Esta revisão sistemática tem como objetivo identificar a literatura científica sobre os efeitos do agulhamento seco superficial e profundo para o tratamento da dor em pacientes com disfunção temporomandibular (DTM) miofascial. Trata-se de uma revisão sistemática buscando estudos primários nas bases de dados PubMed e Biblioteca Virtual em Saúde - BVS (que reúne bases de dados como LILACS - Literatura Latino-americana e do Caribe em Ciências da Saúde, MEDLINE - Medical Literature Analysis and Retrieval System Online, SciELO - Scientific Electronic Library Online, dentre outras) com os descritores “temporomandibular joint disorders dry needling”, or “myofascial temporomandibular dysfunction dry needling”, or “temporomandibular dysfunction dry needling”, assim artigos inglês, português ou espanhol que respondem à questão norteadora de utilização do agulhamento seco no tratamento de DTM miofascial foram incluídos; teses, monografias, associações de tratamentos, artigos que estavam em outras línguas que não as citadas acima e revisões sistemáticas foram excluídas. Nove estudos foram considerados elegíveis. Um estudo comparou o agulhamento seco superficial e profundo. Quatro estudos utilizaram apenas agulhamento seco profundo e outros 4 estudos não especificaram o tipo de agulhamento utilizado. Diante disso, os resultados encontrados sugerem que não há dados suficientes para tirar conclusões sólidas sobre qual tipo de agulhamento seco é melhor para o tratamento da dor miofascial associada à DTM. Ensaios clínicos randomizados de baixo risco de viés são fortemente necessários.

Influence of the type of anesthesia on 111 arthrocentesis in temporomandibular joint disorders: results of a prospective study

Aims: Temporomandibular dysfunction is a generic term that covers a large number of clinical problems affecting not only TMJ (Temporomandibular Joint), but also the masticatory musculature and related structures. Arthrocentesis is the most commonly used technique in patients with pain or limitation of the oral opening due to joint causes in which conservative treatment has failed. It is generally performed under local anesthesia and sedation, although depending on the type of patient and the preferences of the surgeon it can also be performed under general anesthesia. Material and method: A prospective, observational, analytical cohort study has been carried out to evaluate if the type of anesthesia, the drugs used for sedation and whether or not anesthetic induction is performed during arthrocentesis influence the results of 111 arthrocentesis performed in patients with TMJ pathology. Results: In patients who arthrocentesis was performed with propofol without midazolam the improvement in pain at one week and one month postarthrocentesis was greater than propofol with midazolam was used. Conclusion: The type of anesthesia could influence the results of arthrocentesis.

Loeys-Dietz and Shprintzen-Goldberg syndromes: analysis of TGF-β-opathies with craniofacial manifestations using an innovative multimodality method

BackgroundElevated transforming growth factor-beta (TGF-β) signalling has been implicated in the pathogenesis of Loeys-Dietz syndrome (LDS) and Shprintzen-Goldberg syndrome (SGS). In this study, we provide a qualitative and quantitative analysis of the craniofacial and functional features among the LDS subtypes and SGS.MethodsWe explore the variability within and across a cohort of 44 patients through deep clinical phenotyping, three-dimensional (3D) facial photo surface analysis, cephalometric and geometric morphometric analyses of cone-beam CT scans.ResultsThe most common craniofacial features detected in this cohort include mandibular retrognathism (84%), flat midface projection (84%), abnormal eye shape (73%), low-set ears (73%), abnormal nose (66%) and lip shape (64%), hypertelorism (41%) and a relatively high prevalence of nystagmus/strabismus (43%), temporomandibular joint disorders (38%) and obstructive sleep apnoea (23%). 3D cephalometric analysis demonstrated an increased cranial base angle with shortened anterior cranial base and underdevelopment of the maxilla and mandible, with evidence of a reduced pharyngeal airway in 55% of those analysed. Geometric morphometric analysis confirmed that the greatest craniofacial shape variation was among patients with LDS type 2, with distinct clustering of patients with SGS.ConclusionsThis comprehensive phenotypic approach identifies developmental abnormalities that segregate to mutation variants along the TGF-β signalling pathway, with a particularly severe phenotype associated with TGFBR2 and SKI mutations. Multimodality assessment of craniofacial anomalies objectively reveals the impact of mutations of the TGF-β pathway with perturbations associated with the cranium and cranial base with severe downstream effects on the orbit, maxilla and mandible with the resultant clinical phenotypes.

The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders

Temporomandibular disorders (TMD) are primarily characterized by pain as well as disorders concerning the proper functioning of individual elements of the stomatognathic system (SS). The aim of the study was to compare the degree of relaxation of the anterior part of the temporal muscles and the masseter muscles, achieved through the use of post-isometric relaxation and myofascial release methods in patients requiring prosthetic treatment due to temporomandibular joint disorders with a dominant muscular component. Sixty patients who met the inclusion criteria were alternately assigned to one of the two study groups, either group I—patients received post-isometric relaxation treatment (PIR), or group II—patients received myofascial release treatment (MR). The series of ten treatments were performed in both groups. The comparative assessment was based on physiotherapeutic examination, a surface electromyography (sEMG) of the anterior temporal and masseter muscles and the intensity of spontaneous masticatory muscle pain, assessed using the Visual Analogue Scale (VAS). We observed a significant decrease in the electrical activity of examined muscles and a significant drop in the intensity of spontaneous pain in the masticatory muscles both in group I and II. There were no significant differences between groups. Both therapeutic methods may be used as successful forms of adjunctive therapy in the prosthetic treatment of TMD. The trial was registered with an international clinical trials register.

The Effect of Functional Mandibular Advancement for Adolecent Patients with Skeletal Class Ⅱ Malocclusion on the TMJ——a Systematic Review and Meta-Analysis

Objectives: This study aimed to assess whether functional mandibular advancement will induce or aggravate temporomandibular joint disorders.Methods: All searched databases, including PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trails were searched. Gray literature and unpublished literature was also searched. Randomized controlled trails directly observe the condition of patients’ TMJ after finishing treatment will be considered to include in our study. Cochrane Collaboration risk of bias tool was used to assess the quality of included studies according to the established inclusion criteria.Result:Finally 13 researches were statistically pooled in meta-analysis. The number of samples under investigated among primary studies was 285 individuals ,there were 142 patients who developed temporomandibular symptoms during or after treatment. But all the subjective symptoms disappeared during follow-up time. The statistical outcomes proved that patients recieved FMA didn’t show more tendency to develop temporomandibular symptoms[I²=25%, OR=0.39, 95%CI (0.22 ,0.68), p=0.001].Conclusion: (1) TMJ symptoms may occur during the functional oral appliance wearing, but the symptoms will release or disappear during follow-up period. (2) Less convinced evidence indicate that slightly previous TMD will be improved after treatment. (3) There is TMJ disc anterior displacement observed during treatment, but most of them will return to the normal position later. (4) Moderate evidence support that FMA will not induce or aggravate TMD.

Nano Drug Delivery Platforms for Dental Application: Infection Control and TMJ Management—A Review

The oral cavity is an intricate environment subjected to various chemical, physical, and thermal injuries. The effectiveness of the local and systemically administered drugs is limited mainly due to their toxicities and poor oral bioavailability that leads to the limited effectiveness of the drugs in the target tissues. To address these issues, nanoparticle drug delivery systems based on metals, liposomes, polymeric particles, and core shells have been developed in recent years. Nano drug delivery systems have applications in the treatment of patients suffering from temporomandibular joint disorders such as preventing degeneration of cartilage in patients suffering from rheumatoid arthritis and osteoarthritis and alleviating the pain along with it. The antibacterial dental applications of nano-drug delivery systems such as silver and copper-based nanoparticles include these agents used to arrest dental caries, multiple steps in root canal treatment, and patients suffering from periodontitis. Nanoparticles have been used in adjunct with antifungals to treat oral fungal infections such as candida albicans in denture wearers. Acyclovir being the most commonly used antiviral has been used in combination with nanoparticles against an array of viral infections such as the herpes simplex virus. Nanoparticles based combination agents offer more favorable drug release in a controlled manner along with efficient delivery at the site of action. This review presents an updated overview of the recently developed nanoparticles delivery systems for the management of temporomandibular joint disorders along with the treatment of different oral infections.