401
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Al-Baghdadi M, Durham J, Steele J. Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of 'locking duration'. J Oral Rehabil 2014; 41:24-58. [PMID: 24393132 DOI: 10.1111/joor.12126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 11/30/2022]
Abstract
Temporomandibular joint (TMJ) 'closed lock' (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be 'acute' or 'chronic' depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid-August 2013 were conducted for English-language studies of any design investigating the effects of non-surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor-quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high-quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by 'unlock' mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.
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Affiliation(s)
- M Al-Baghdadi
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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402
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Effects of massage therapy and occlusal splint therapy on mandibular range of motion in individuals with temporomandibular disorder: a randomized clinical trial. J Manipulative Physiol Ther 2014; 37:164-9. [PMID: 24387891 DOI: 10.1016/j.jmpt.2013.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/02/2013] [Accepted: 10/23/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of massage therapy compared with occlusal splint therapy on mandibular range of motion (ROM) in individuals with temporomandibular disorder (TMD) and compare the results with ROM obtained in a group of individuals without this disorder. METHODS A blinded randomized clinical trial was conducted. Twenty-eight volunteers with TMD were randomly distributed into either a massage therapy group or an occlusal splint group. Both treatments were provided for 4 weeks. Fourteen individuals without TMD were consecutively allocated to a comparison group. Fonseca anamnestic index was used to characterize TMD and allocate the volunteers to either of the intervention groups or asymptomatic comparison group. Mandibular ROM was evaluated before and after treatment using a digital caliper. Two-way repeated-measures analysis of variance with a post hoc Bonferroni testing was used for intergroup and intragroup comparisons (level of significance was set to 5%). Cohen d was used to calculate the effect size. RESULTS In the intragroup analysis, significant increases in ROM were found for all measures in both the massage and occlusal splint groups (P < .05). A small to moderate clinical effect of treatment with the occlusal splint was found regarding right and left lateral excursion in comparison with the massage therapy and asymptomatic comparison groups (0.2 <d < 0.5). CONCLUSION Massage therapy on the masticatory muscles and the use of an occlusal splint lead to an increase in mandibular ROM similar to that of the asymptomatic comparison group with regard to maximum active mouth opening and both right and left excursion in individuals with TMD.
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403
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Campos JADB, Carrascosa AC, Bonafé FSS, Maroco J. Severity of temporomandibular disorders in women: validity and reliability of the Fonseca Anamnestic Index. Braz Oral Res 2014; 28:16-21. [DOI: 10.1590/s1806-83242013005000026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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404
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Rodrigues-Bigaton D, Dibai-Filho AV, Packer AC, Costa ACDS, de Castro EM. Accuracy of two forms of infrared image analysis of the masticatory muscles in the diagnosis of myogenous temporomandibular disorder. J Bodyw Mov Ther 2014; 18:49-55. [DOI: 10.1016/j.jbmt.2013.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/14/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
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405
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Accuracy study of the main screening tools for temporomandibular disorder in children and adolescents. J Bodyw Mov Ther 2014; 18:87-91. [DOI: 10.1016/j.jbmt.2013.05.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 05/25/2013] [Accepted: 05/26/2013] [Indexed: 11/23/2022]
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406
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Two commentaries on interventions for the management of temporomandibular joint osteoarthritis. Evid Based Dent 2013; 14:5-7. [PMID: 23579296 DOI: 10.1038/sj.ebd.6400909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
DATA SOURCES The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and PEDro databases were searched with no language restrictions. Handsearching of a number of relevant dental journals and the reference lists of identified articles was also conducted. STUDY SELECTION Randomised controlled trials (RCTs) comparing any form of non-surgical or surgical therapy for TMJ OA in adults were included. Only studies with clinical and/or radiological diagnosis of TMJ OA according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guideline or compatible criteria were considered. Pain/tenderness/discomfort in the TMJs or jaw muscles, self assessed range of mandibular movement and TMJ sounds were the primary outcomes considered. Secondary outcomes included the measurement of quality of life or patient satisfaction, morphological changes of the TMJ and TMJ sounds DATA EXTRACTION AND SYNTHESIS Study selection, data abstraction and risk of bias assessment were carried out independently by two reviewers. Meta-analysis was not conducted owing to clinical heterogeneity. RESULTS Although three RCTs were included in this review, pooling of data in a meta-analysis was not possible due to wide clinical diversity between the studies. The reports indicate a not dissimilar degree of effectiveness with intra-articular injections consisting of either sodium hyaluronate or corticosteroid preparations, and an equivalent pain reduction with diclofenac sodium as compared with occlusal splints. Glucosamine appeared to be just as effective as ibuprofen for the management of TMJ OA. CONCLUSIONS In view of the paucity of high level evidence for the effectiveness of interventions for the management of TMJ OA, small parallel group RCTs which include participants with a clear diagnosis of TMJ OA should be encouraged and especially studies evaluating some of the possible surgical interventions.
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407
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Hoglund LT, Scott BW. Automobilization intervention and exercise for temporomandibular joint open lock. J Man Manip Ther 2013; 20:182-91. [PMID: 24179326 DOI: 10.1179/2042618612y.0000000008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Temporomandibular joint disorders (TMDs) are common and may cause temporomandibular joint (TMJ) locking, pain, and disability. Evidence supports use of manual therapy and exercise for treatment of TMDs including disk displacement limiting full mouth opening, TMJ 'closed lock'. Only limited case studies describe management of TMJ 'open lock', a condition due to posterior disk displacement (PDD) or TMJ anterior dislocation (TMJ-AD). Reported treatment for open lock includes splinting and intraoral joint manipulation. This case report describes a novel extraoral automobilization using the mandibular elevator muscles to treat TMJ open lock in a 22-year-old male after intraoral joint mobilization failed. The exercise program used to restore neuromuscular control for post-reduction management is described. Short term results of automobilization were excellent with restored ability to swallow, speak normally, and achieve occlusion. Long term results at 14 months were good: the patient was pain-free, could swallow and speak normally, had no recurrence of TMJ locking, and minimal disability. Limited right lateral excursion range and left mandibular deviation during mouth opening indicated possible persistence of PDD. This case suggests that mandibular elevator automobilization and masticatory muscle exercise may be useful to treat TMJ open lock and should be considered to treat PDD and TMJ-AD.
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408
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Abstract
Temporomandibular disorder (TMD) is a multifactorial disease process caused by muscle hyperfunction or parafunction, traumatic injuries, hormonal influences, and articular changes. Symptoms of TMD include decreased mandibular range of motion, muscle and joint pain, joint crepitus, and functional limitation or deviation of jaw opening. Only after failure of noninvasive options should more invasive and nonreversible treatments be initiated. Treatment can be divided into noninvasive, minimally invasive, and invasive options. Temporomandibular joint replacement is reserved for severely damaged joints with end-stage disease that has failed all other more conservative treatment modalities.
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Affiliation(s)
- Frederick Liu
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, USA.
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409
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Shaefer JR, Holland N, Whelan JS, Velly AM. Pain and temporomandibular disorders: a pharmaco-gender dilemma. Dent Clin North Am 2013; 57:233-62. [PMID: 23570804 DOI: 10.1016/j.cden.2013.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Gender is the biggest risk factor in the development of temporomandibular disorders (TMD) and orofacial pain. Gender differences in pain thresholds, temporal summation, pain expectations, and somatic awareness exist in patients with chronic TMD or orofacial pain. There are gender differences in pharmacokenetics and pharmacodynamics of medications used to treat pain. A better understanding of the mechanisms that contribute to the increased incidence and persistence of chronic pain in females is needed. Future research will elucidate the sex effects on factors that protect against developing pain or prevent debilitating pain. Gender-based treatments for TMD and orofacial pain treatment will evolve from the translational research stimulated by this knowledge.
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Affiliation(s)
- Jeffry R Shaefer
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA 02215, USA.
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410
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Gomes CAFDP, Dibai-Filho AV, Silva JRD, Oliveira PMD, Politti F, Biasotto-Gonzalez DA. Correlation between severity of temporomandibular disorder and mandibular range of motion. J Bodyw Mov Ther 2013; 18:306-10. [PMID: 24725801 DOI: 10.1016/j.jbmt.2013.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/25/2013] [Accepted: 08/29/2013] [Indexed: 11/17/2022]
Abstract
The aim of the present study was to determine the association between the severity of temporomandibular disorder (TMD) and mandibular range of motion (ROM). For such, a cross-sectional study was carried out with a sample of 92 women from the university community. The Fonseca's anamnestic index (FAI) was used to determine the severity of TMD, as follows: without TMD (n = 23), mild TMD (n = 23), moderate TMD (n = 23), and severe TMD (n = 23). Mouth opening, lateral excursion and protrusion of the mandible were measured. Spearman's correlation coefficients were calculated to determine the association between the FAI and mandibular ROM. Comparisons among groups were performed using the Kruskal-Wallis test with Dunn's post hoc test. No significant associations were found between TMD severity based on the classification of the FAI and ROM of functional mouth opening (rs = -0.001, p = 0.987), maximum active mouth opening (rs = -0.023, p = 0.822), passive mouth opening (rs = -0.026, p = 0.803), left lateral excursion (rs = 0.125, p = 0.231), right lateral excursion (rs = 0.087, p = 0.406) or protrusion (rs = -0.148, p = 0.157). Moreover, no statistically significant differences among severity groups were found (p > 0.05). Based on the findings of the present study, the severity of signs and symptoms of TMD was not associated with mandibular range of motion.
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Affiliation(s)
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Rehabilitation and Functional Performance, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Janaina Rodrigues da Silva
- Postgraduate Program in Rehabilitation and Functional Performance, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Fabiano Politti
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, SP, Brazil
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411
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Zhang Y, Che B, Ni Y, Zhang H, Pan Y, Wang L, Ma J. Three-dimensional condylar positions and forms associated with different anteroposterior skeletal patterns and facial asymmetry in Chinese adolescents. Acta Odontol Scand 2013; 71:1174-80. [PMID: 23294119 DOI: 10.3109/00016357.2012.757359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the association of condylar asymmetry and chin position with different anteroposterior skeletal patterns using three-dimensional models reconstructed from cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS CBCT scans of 123 Chinese adolescents (aged 11-15 years, 68 girls and 55 boys) with 64 skeletal Class I, 46 Class II and 13 Class III were selected from scans of patients attending the orthodontic clinic. The condyles of the subjects were reconstructed bilaterally and 25 linear, angular and volumetric measurements were performed to evaluate the asymmetry of the condyles and position of the chin. The proportions of condylar asymmetry in the different skeletal groups were calculated by the absolute difference value between the left and right sides to the smaller side value. One-way analysis of variance and Pearson's correlations were used to analyse the data. RESULTS The values for RV, RCL, LCH, RCH, LCGM, RCGM, LCo-Me and RCo-Me were significantly different among the three skeletal groups (p < 0.05). There were significant positive correlations between Pog-Ss and Co-Sh, Co-Me in the Class I and II groups (p < 0.05). Asymmetries for Co-Ss, Co-Sh, CP and SP between the left and right condyles exceeded a ratio of 20% for more than 30% of the subjects. CONCLUSION Condylar asymmetry varied significantly among the three skeletal groups, with the vertical position of the condyle (Co-Sh) and height of the mandibular ramus (Co-Me) being significantly and positively related to the chin position.
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Affiliation(s)
- Yang Zhang
- Institute of Stomatology, Nanjing Medical University, Nanjing, PR, China.
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412
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Accuracy of infrared thermography of the masticatory muscles for the diagnosis of myogenous temporomandibular disorder. J Manipulative Physiol Ther 2013; 36:245-52. [PMID: 23706912 DOI: 10.1016/j.jmpt.2013.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 10/10/2012] [Accepted: 11/25/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the accuracy of infrared thermography of the central point of the masseter and anterior temporalis muscles for the diagnosis of myogenous temporomandibular disorder (TMD). METHODS This is an observational study of university women with and without TMD. Through the use of the Research Diagnostic Criteria for Temporomandibular Disorders, 104 women were divided into a TMD group (n = 52) and control group (n = 52). All volunteers had their masseter and anterior temporalis muscles evaluated by infrared thermography. The receiver operating characteristic (ROC) curve was used to determine the accuracy of diagnosis (area under the ROC curve), the best cut-off point, sensitivity, and specificity. RESULTS No significant differences were observed (P > .05) in the skin surface temperature of the masticatory muscles, when the groups were compared. With regard to the ROC curve, the area under the curve was lower than the recommended for all the muscles tested, ranging from 0.433 to 0.502. CONCLUSION The findings of this study suggest that infrared thermography of the masticatory muscles is not an accurate instrument for the myogenous TMD diagnosis.
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413
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Comparison of magnetic resonance imaging findings in temporomandibular joints of the two sides. Clin Oral Investig 2013; 18:499-506. [DOI: 10.1007/s00784-013-0984-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 04/08/2013] [Indexed: 01/18/2023]
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414
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Accuracy and Reliability of Infrared Thermography in the Diagnosis of Arthralgia in Women With Temporomandibular Disorder. J Manipulative Physiol Ther 2013; 36:253-8. [DOI: 10.1016/j.jmpt.2013.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/23/2013] [Accepted: 04/03/2013] [Indexed: 11/22/2022]
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415
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Jorge JH, Silva Junior GSD, Urban VM, Neppelenbroek KH, Bombarda NHC. Desordens temporomandibulares em usuários de prótese parcial removível: prevalência de acordo com a classificação de Kennedy. REVISTA DE ODONTOLOGIA DA UNESP 2013. [DOI: 10.1590/s1807-25772013000200001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: O objetivo deste estudo foi determinar a prevalência das desordens temporomandibulares em pacientes com prótese parcial removível, de acordo com a classificação de Kennedy. MÉTODO: A população estudada consistiu de pacientes que procuraram tratamento na Universidade Estadual de Ponta Grossa. Os pacientes selecionados eram usuários de prótese total superior e prótese parcial removível inferior, e esse uso, à época do estudo, fazia entre 1 e 5 anos. Os pacientes foram divididos em cinco grupos (n = 15): G1: usuários de prótese total superior e prótese parcial removível inferior Classe I (Kennedy); G2: usuários de prótese total superior e prótese parcial removível inferior Classe II (Kennedy); G3: usuários de prótese total superior e prótese parcial removível inferior Classe III (Kennedy); G4: usuários de prótese total superior e prótese parcial removível inferior Classe IV (Kennedy), e G5: pacientes totalmente dentados (grupo controle). O questionário de Fonseca foi aplicado para verificar o grau de DTM. O teste qui-quadrado (α = 0,05) foi usado para avaliar a associação entre as variáveis. RESULTADO: Nenhuma diferença estatística (P > 0,05) foi encontrada entre os grupos. Em todos os grupos, os pacientes apresentaram DTM leve ou moderada. CONCLUSÃO: Os resultados deste estudo clínico mostraram que a presença de DTM em pacientes usuários de prótese não pôde ser correlacionada ao uso de prótese, já que a presença de DTM para pacientes desdentados e dentados apresentou-se semelhante.
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416
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Manfredini D, Favero L, Del Giudice A, Masiero S, Stellini E, Guarda-Nardini L. Axis II psychosocial findings predict effectiveness of TMJ hyaluronic acid injections. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2012.10.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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417
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Deregibus A, Castroflorio T, De Giorgi I, Burzio C, Debernardi C. Diagnostic concordance between MRI and electrovibratography of the temporomandibular joint of subjects with disc displacement disorders. Dentomaxillofac Radiol 2013; 42:20120155. [PMID: 23420863 DOI: 10.1259/dmfr.20120155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the diagnostic concordance of MRI and electrovibratography (EVG) of the temporomandibular joint (TMJ) in the diagnosis of articular disc displacement with reduction (ADDwR) and articular disc displacement without reduction (ADDw/oR). METHODS 50 patients (12 males, 38 females; mean age 37.46 ± 15.64 years) with a hypothesis of disc displacement were selected. For each patient an MRI of the TMJ was performed. MRIs were evaluated sorting the 100 TMJs by kind of pathology (no pathology, ADDwR, ADDw/oR, and joint hypermobility). Afterwards, the patients had an EVG exam. The EVG exams were performed with vibration transducers over each TMJ, enabling simultaneous, bilateral recording of vibrations emanating from joint sounds during the opening and closing movements. The presence of a sound peak was compared with the MRI diagnosis of ADDwR, while a multipeak aspect was compared with ADDw/oR diagnosis using Cohen's kappa test. RESULTS The presence of a peak-shaped track has high specificity for ADDwR (90.27%). The Cohen's kappa calculated for the ADDwR was 0.5615 (good-moderate). The presence of a multipeak-shaped track has low specificity (65.22%) and sensitivity (70.42%). The Cohen's kappa calculated for the ADDw/oR was 0.2992 (poor). CONCLUSIONS The present study recommends the use of EVG to support the clinical diagnosis of a disc displacement with reduction when MRI is not available or when subjects cannot be investigated by MRI.
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Affiliation(s)
- A Deregibus
- University of Turin, Dental School, Turin, Italy.
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418
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Manfredini D. I fondamenti della pratica etica nei disordini temporomandibolari in era di evidence-based medicine. DENTAL CADMOS 2013. [DOI: 10.1016/s0011-8524(13)70020-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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419
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Ficnar T, Middelberg C, Rademacher B, Hessling S, Koch R, Figgener L. Evaluation of the effectiveness of a semi-finished occlusal appliance--a randomized, controlled clinical trial. Head Face Med 2013; 9:5. [PMID: 23351923 PMCID: PMC3562212 DOI: 10.1186/1746-160x-9-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/16/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Painful temporomandibular disorders (TMDs) are usually treated with physiotherapy, self-exercises, medication-based therapy and splint therapy. For splint therapy different types of splints are available. Therefore this randomized controlled study compared the effectiveness of a semi-finished occlusal appliance (SB) with a laboratory-made occlusal appliance (SS) in myofascial pain patients. Method The trial subjects allocated to the experimental groups with the (SB) occlusal appliance and those provided with a laboratory-made occlusal appliance (SS) did, in addition, receive conservative treatment (self-exercises, drug-based and manual therapy). The control group was given conservative therapy (CO) only. Overall, a total of 63 patients participated in the study with each group consisting of 21 subjects. Results When the first follow-up examination took place (14 days after splint insertion) mouth opening within the SB group was significantly enlarged. When the second examination was conducted (2.5 months after splint insertion) mouth opening was significantly enlarged in both splint groups when compared with the initial value. In the control group, no significant enlargement of mouth opening was detected. At no point there was a significant reduction in the number of pressure-sensitive areas of the TMJ. On palpation of the masticatory muscles however, a significant reduction in the number of pressure-sensitive areas could be observed within the CO group and the SS group after 2.5 months. When comparing pain reduction (muscle/joint pain) and mouth opening, no significant differences could be detected between the treatments. Conclusion The results suggest that TMD should be treated conservatively. In cases of restricted mouth opening, the additional use of occlusal appliances can eliminate the patient’s discomfort more quickly. In this context, the tested, semi-finished occlusal appliance appears to offer an immediately available, temporary alternative to laboratory-made splints.
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Affiliation(s)
- Tobias Ficnar
- Department of Prosthetic Dentistry and Biomaterials, University Hospital Münster, Alber-Schweitzer-Campus 1, Building W 30, 48149, Münster, Germany.
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420
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Almăşan OC, Băciuţ M, Hedeşiu M, Bran S, Almăşan H, Băciuţ G. Posteroanterior cephalometric changes in subjects with temporomandibular joint disorders. Dentomaxillofac Radiol 2012; 42:20120039. [PMID: 23253565 DOI: 10.1259/dmfr.20120039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of the study was to establish the changes in posteroanterior cephalometric variables in subjects with temporomandibular joint disorders (TMDs). METHODS Posteroanterior cephalograms of 61 subjects (age range 16-36.6 years, standard deviation 4.88 years) were used to determine cephalometric differences. Subjects were classified according to the Research Diagnostic Criteria for Temporomandibular Joint Disorders into three groups: unilateral TMD, bilateral TMD and no TMD. 14 linear and angular measurements were assessed on the posteroanterior cephalogram. For assessing facial asymmetry, the asymmetry index for bilateral measurements was calculated between the right and the left side. In cases with unilateral TMD, the asymmetry index was calculated using the difference between the unaffected and affected side. The differences among multiple groups were analysed using the one-way analysis of variance test and Scheffé post hoc test. RESULTS 47 subjects were females (77%) and 14 were males (23%). 19 subjects had unilateral TMDs and 16 subjects had bilateral TMDs. The asymmetry index of the distance from the horizontal plane to the antegonion was higher in subjects with unilateral TMD than in patients with bilateral or no TMD (p < 0.05). Also, the asymmetry index of the distances from the vertical plane to the condyle (p = 0.05), gonion (Go) (p = 0.0004), antegonion (p = 0.002) and chin (Ch) (p = 0.02) was higher in subjects with unilateral TMDs. The asymmetry index of the O point-Go-Go' and O point-Ch-Ch' angles differed significantly in subjects with unilateral TMDs (p < 0.05). CONCLUSIONS Unilateral TMDs are associated with changes in posteroanterior cephalometric measurements. The assessment of posteroanterior cephalometric variables could be used as a key factor for evaluating the presence of TMDs.
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Affiliation(s)
- O C Almăşan
- Department of Prosthetic Dentistry, Faculty of Dentistry, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
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421
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Manfredini D, Arveda N, Guarda-Nardini L, Segù M, Collesano V. Distribution of diagnoses in a population of patients with temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e35-41. [PMID: 22921443 DOI: 10.1016/j.oooo.2012.03.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/23/2012] [Accepted: 03/30/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objective of this study was to describe the frequency of TMD diagnoses in a patient population for comparison with the available literature. METHODS Five hundred twenty consecutive patients seeking TMD treatment underwent a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) assessment. The prevalence and age distribution of the different RDC/TMD axis I and II diagnoses were described. RESULTS Muscle disorders, disk displacements, and other joint disorders were diagnosed respectively in 56.4%, 42.0%, and 57.5% of patients. Sixty percent of patients had depression symptoms, 76.6% had somatization, and 21.8% presented high levels of pain-related impairment. Disk displacements were more frequently diagnosed in the younger-aged, other joint disorders in the older-aged, and muscle disorders in the middle-aged subjects (ANOVA for mean age comparison, F = 3.355; P = .002). CONCLUSIONS These distribution frequencies of TMD diagnoses provide insight into the epidemiology of this disease.
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422
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Guarda-Nardini L, Stecco A, Stecco C, Masiero S, Manfredini D. Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. Cranio 2012; 30:95-102. [PMID: 22606852 DOI: 10.1179/crn.2012.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A randomized controlled trial was performed to compare the short-term effectiveness of botulinum toxin injections and physiatric treatment provided by means of Fascial Manipulation techniques in the management of myofascial pain of jaw muscles. Thirty patients with a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnosis of myofascial pain were randomized to receive either single-session botulinum toxin injections (Group A) or multiple-session Fascial Manipulation (Group B). Maximum pain levels (VAS ratings) and jaw range of motion in millimeters (maximum mouth opening, protrusion, right and left laterotrusion) were assessed at baseline, at the end of treatment, and at a three-month follow-up. Both treatment protocols provided significant improvement over time for pain symptoms. The two treatments seem to be almost equally effective, Fascial Manipulation being slightly superior to reduce subjective pain perception, and botulinum toxin injections being slightly superior to increase jaw range of motion. Differences between the two treatment protocols as to changes in the outcome parameters at the three-months follow-up were not relevant clinically. Findings from the present investigation are in line with literature data supporting the effectiveness of a wide spectrum of conservative treatment approaches to myofascial pain of the jaw muscles. Future studies on larger samples over a longer follow-up span are needed on the way to identify tailored treatment strategies.
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423
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Fallah HM, Currimbhoy S. Use of botulinum toxin A for treatment of myofascial pain and dysfunction. J Oral Maxillofac Surg 2012; 70:1243-5. [PMID: 22538024 DOI: 10.1016/j.joms.2012.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/12/2012] [Accepted: 01/15/2012] [Indexed: 01/19/2023]
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424
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Sachse T, Schwestka-Polly R, Flieger S, Wiechmann D. A concept to transfer a therapeutic splint position into permanent occlusion with a customized lingual appliance. Head Face Med 2012; 8:16. [PMID: 22613064 PMCID: PMC3495773 DOI: 10.1186/1746-160x-8-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/02/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The role of occlusion concerning temporomandibular disorder is still unclear but seems to be the only component of the stomathognathic system dentists are able to change morphologically. The aim of the paper is to describe the orthodontist's approach for transferring and maintaining a therapeutic splint position into permanent occlusion using a fully customized lingual appliance. METHODS Fixed acrylic bite planes on lower molars were used to maintain a symptom-free condyle position prior to orthodontic treatment. Silicone impressions of the arches including the fixed bite planes were used for the Incognito laboratory procedure. Two digital setups were made. One setup represents the target occlusion. A second setup including the bite planes was used to fabricate an additional set of lower molar brackets. In the leveling stage all teeth except the lower molars were settled to maintain the therapeutic condyle position. Finally, the fixed bite planes were stepwise removed and molar brackets were replaced to establish the permanent occlusion planned with the first setup. RESULTS AND DISCUSSION The advantage of an individual lingual appliance consists in the high level of congruence between the fabricated setups and the final clinical result. Both the individual scope for design and the precision of the appliance were vitally important in the treatment of a patient with a functional disorder of the masticatory system.
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Affiliation(s)
- Tina Sachse
- Department of Orthodontics, Hannover Medical School, Hannover, Germany
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425
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New Proposals for the International Classification of Diseases-11 Revision of Pain Diagnoses. THE JOURNAL OF PAIN 2012; 13:305-16. [DOI: 10.1016/j.jpain.2012.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 01/13/2012] [Accepted: 01/16/2012] [Indexed: 11/23/2022]
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426
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Manfredini D, Winocur E, Guarda-Nardini L, Lobbezoo F. Self-reported bruxism and temporomandibular disorders: findings from two specialised centres. J Oral Rehabil 2012; 39:319-25. [PMID: 22251149 DOI: 10.1111/j.1365-2842.2011.02281.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aims of this investigation were to report the frequency of temporomandibular disorders (TMD) diagnoses and the prevalence of self-reported awake and sleep bruxism as well as to describe the possible differences between findings of two specialised centres as a basis to suggest recommendations for future improvements in diagnostic homogeneity and accuracy. A standardised Research Diagnostic Criteria for TMD (RDC/TMD) assessment was performed on patients attending both TMD Clinics, viz., at the University of Padova, Italy (n=219; 74% women) and at the University of Tel Aviv, Israel (n=397; 79% women), to assign axis I physical diagnoses and to record data on self-reported awake and sleep bruxism. Significant differences were shown between the two clinic samples as for the frequency of TMD diagnoses (chi-square, P<0·001) and the prevalence of at least one positive response to bruxism items (chi-square, P<0·001). The more widespread use of TMJ imaging techniques in one clinic sample led to a higher prevalence of multiple diagnoses, and the higher prevalence of self-reported bruxism in patients with myofascial pain alone described in the other clinic sample was not replicated, suggesting that the different adoption of clinical and imaging criteria to diagnose TMD may influence also reports on their association with bruxism. From this investigation, it emerged that the features of the study samples as well as the different interpretation of the same diagnostic guidelines may have strong influence on epidemiological reports on bruxism and TMD prevalence and on the association between the two disorders.
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Affiliation(s)
- D Manfredini
- Department of Maxillofacial Surgery, University of Padova, Padova, Italy.
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