Correlations between the Helkimo indices and the maximal mandibular excursion capacities of patients with temporomandibular joint disorders

Does anxiety have an impact on temporomandibular disorders? A study in a Turkish sample by using specific questionnaires

OBJECTIVE

The aim of the study is to verify the impact of anxiety on temporomandibular disorders (TMD) by using specific questionnaires in a Turkish sample.

METHODS

This survey was conducted on 292 patients with a mean age of 38.59 ± 10.38 using Helkimo index, Oral Health Impact Profile (OHIP-14), and State Trait Anxiety Inventory (STAI). Spearman Correlation and Fisher Freeman Halton analyses were used for the statistical analysis.

RESULTS

There was no statistically significant difference between the Helkimo anamnestic dysfunction (HAD) levels in terms of OHIP-14 total scores or STAI state scores. There was, however, a statistically positive correlation between STAI state and OHIP-14 total values at 18.4%, a positive correlation between the STAI trait and OHIP-14 total values at 29.8%.

CONCLUSION

No significant correlation was observed between OHIP-14 total scores, STAI state scores, and HAD levels. Therefore, this study did not find a significant relationship between TMDs and anxiety.

Intra-Articular Injections into the Inferior versus Superior Compartment of the Temporomandibular Joint: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to validate the hypothesis that intra-articular injections into the inferior temporomandibular joint compartment are more efficient than analogous superior compartment interventions. Publications reporting differences between the above-mentioned techniques in the domains of revealing articular pain, decreasing the Helkimo index, and abolishing mandibular mobility limitation were included. Medical databases covered by the Bielefeld Academic Search Engine, Google Scholar, PubMed, ResearchGate, and Scopus engines were searched. The risk of bias was assessed using dedicated Cochrane tools (RoB2, ROBINS-I). The results were visualized with tables, charts, and a funnel plot. Six reports describing five studies with a total of 342 patients were identified. Of these, four trials on a total of 337 patients were qualified for quantitative synthesis. Each eligible report was at moderate risk of bias. From 19% to 51% improvement in articular pain, 12-20% lower Helkimo index, and 5-17% higher maximum mouth opening were observed. The evidence was limited by the small number of eligible studies, discrepancies regarding the substances used, possible biases, and the differences in observation times and scheduled follow-up visits. Despite the above, the advantage of inferior over superior compartment temporomandibular joint intra-articular injections is unequivocal and encourages further research in this direction.

Degenerative Disorder of the Temporomandibular Joint Treated With Autologous Bone Marrow-Derived Stem Cells Using the Regentime Technique: A Case Report

Temporomandibular joint (TMJ) disease is a type of degenerative musculoskeletal disorder that leads to morphological and functional abnormalities. It has a poorly understood progression with numerous independent and interrelated factors, which makes it difficult for the available treatment options to meet long-term demands.  We present the case of a 37-year-old woman who suffered from excruciating pain in the right temporomandibular joint, associated with limited mandibular movement. She was found to have imaging features of TMJ disorder. She underwent the Regentime procedure which uses autologous bone marrow-derived stem cells that are partially differentiated and redirected to the targeted tissue. Clinical follow-up showed total clinical recovery.

Is the retromandibular approach a suitable approach to anatomical reduction of unilateral subcondylar fracture? A non-randomized clinical trial

The aim of this study was to evaluate the efficacy of the retromandibular approach (RMA) to produce three-dimensional (3-D) reduction of the unilateral subcondylar fracture and Temporomandibular Joint (TMJ) functional implication.

METHODS

 A prospective cohort study was designed. Twenty-nine patients with unilateral subcondylar fracture underwent consecutively Open Reduction, and Internal Fixation. The cohorts were divided into two groups; RMA group (n = 16, 55.17%) and submandibular approach SMA group (n = 13, 44.82%). The primary outcome was the anatomical 3-D reduction of the condyle. The secondary outcome was to compare the condyle position and inclination finding with TMJ outcomes. Helkimo Index score was used to evaluate the TMJ outcome at six months postoperatively.

RESULT

 There was a significant difference between the mediolateral condylar inclination, condylar medial and vertical positions when RMA compared with SMA groups (P < 0.05). The medial joint space was correlated with the medial condylar position in both groups (P < 0.05). The Helkimo Ai and Di was associated with mediolateral condylar inclination in SMG; however, Helkimo Ai was found to be correlated with the RMA group.

CONCLUSION

 The current study demonstrates that the RMA could re-establish the anatomical position of the unilateral subcondylar fracture in patients undergoing ORIF. The clinical outcome of the TMJ with RMA was better than SMA.

Is scoliosis related to mastication muscle asymmetry and temporomandibular disorders? A cross-sectional study

OBJECTIVE

Patients with adolescent idiopathic scoliosis (AIS) may face motor control problems and health disability barriers during mandibular movements and chewing. However, studies investigating the extent of these disadvantages, and possible associated factors are quite limited in patients with AIS. This study was conducted to gain a deeper perspective on the effect of AIS on temporomandibular disorders (TMD) and to contribute to the small amount of data on this subject.

METHODS

Twenty-nine patients with AIS and 29 age- and sex-matched asymptomatic controls participated in this cross-sectional study. Cobb's method was used to measure scoliosis curves. In both groups, the volume of the masseter muscle was determined on magnetic resonance imaging, and Helkimo and Fonseca anamnestic indexes were used to evaluate temporomandibular joint (TMJ).

RESULTS

It was observed that the TMD symptoms were higher in the AIS group (22.6- Helkimo and 1.2 - Fonseca) than the asymptomatic group (13.6 - Helkimo and 0.7 - Fonseca). There was no significant asymmetry in masseter volume in patients with AIS, however the volume of the masseter muscles was smaller in the AIS group (R = 14.6/L = 13.6) compared to the control group (R = 16.1/L = 16.2).

CONCLUSIONS

The study results indicate that spinal curvatures affect the anatomical, biomechanical, and kinesiological features of the masticatory system, and individuals with AIS may experience more chewing problems than asymptomatic individuals. Examining musculoskeletal properties of masticatory system can provide information about the limitation of the TMJ in patients with AIS.

Painful and non-painful symptoms evoked by experimental bracing and thrusting of the mandible in healthy individuals

BACKGROUND

Bruxism may involve bracing and thrusting of the mandible, in addition to clenching or grinding of the teeth. It is unclear how bracing and thrusting may contribute to potential musculoskeletal symptoms associated with bruxism.

OBJECTIVE

To examine the effect of experimental bracing and thrusting of the mandible on the development of musculoskeletal symptoms in healthy volunteers.

METHODS

Thirty healthy volunteers performed six trials of 5 min of repeated bracing and thrusting of the mandible. Bracing involved forcefully maintaining maximum protruded position (5 s with 1 s rest in between), whereas thrusting involved forcefully moving the mandible in a forward direction and back (1 Hz). The participants rated pain, unpleasantness, soreness, fatigue, tension, stiffness, stress and headache on 10-cm visual analogue scales (VAS) before, immediately and 24 h after the tasks. Pain drawings were obtained and maximum voluntary protrusive force (MVPF) was determined before and after the tasks. The outcome parameters for each task were compared between the time points.

RESULTS

There was a significant increase in the VAS scores (2-4/10) of pain, unpleasantness, soreness, fatigue, tension, stiffness and stress immediately following the tasks compared to baseline and 24 h after the tasks (p < .008). Pain was frequently reported in masseter muscles. MVPF values were significantly higher immediately (p < .001) and 24 h after thrusting (p < .001) and bracing (p = .012) tasks compared to the baseline.

CONCLUSIONS

Experimental bracing and thrusting of the mandible evoked transient, mild-to-moderate levels of muscle pain, fatigue, tension and stiffness and increased unpleasantness and stress scores in healthy volunteers.

Three-dimensional assessment of accuracy for open reduction and internal fixation of the subcondylar fracture and its implications on the TMJ function

This study used three-dimensional cone beam computed tomography (CBCT) to assist the accuracy of open reduction and internal fixation (ORIF) for the unilateral subcondylar fracture and the long-term temporomandibular joint (TMJ) function impairment. Bilateral TMJs were analyzed postoperatively on CBCT images, involving the following three-dimensional (3D) parameters: condylar position and inclination; circumferential joint space, ramus, and mandible length; and the volumetric joint space. The inclusion criteria for adult patients included having a displaced fracture >5°, a shortening in ramus length >2 mm, and mouth opening limitation. The non-fracture side was used as the comparison group. The Helkimo index was employed for the clinical assessment of the outcomes, while the paired student t-test and Pearson coefficient test were used to compare both sides. The study included 60 joints in 30 consecutive patients. The condylar inclination to the horizontal plane on the fracture and non-fracture sides was 9.29 ± 3.9°, 12.46 ± 4.2°, (p < 0.001) and was positively related to the subjective (Helkimo Hi) and objective (Helkimo Di) clinical outcomes. In contrast, the condylar position to the midsagittal plane in the fracture and non-fracture sides was 51.95 ± 3.5 mm, 50.17 ± 3.6 mm (P = 0.038), and was positively related to the objective outcomes. Additionally, the objective outcome was negatively related to the change of the posterior joint space. CONCLUSION: The three-dimensional assessments seem to demonstrate that the ORIF is an accurate approach for obtaining a three-dimensional reduction to the displaced subcondylar fracture.

Comparison of two needles arthrocentesis versus double needle cannula arthrocentesis in the treatment of temporomandibular disc displacement

OBJECTIVE

To compare clinical and imaging results of two needles arthrocentesis (TNA) versus double-needle cannula arthrocentesis (DNCA) in the treatment of temporomandibular joint disc displacement (DD).

METHODS

Twenty patients with DD were randomly divided into two groups: TNA and DNCA. Clinical data (pain scores; maximal interincisal distance [MID], and protrusion and laterality movements) were evaluated before and 24 months after the arthrocentesis. Disc and condyle position and joint effusion (JE) were evaluated by magnetic resonance exams.

RESULTS

Both groups presented improvement in the MID, including pain reduction, modifications in disc and condyle positions, and reduction of the presence of JE, without difference between groups (p > 0.05). The DNCA was performed significantly faster (p = 0.0001).

CONCLUSION

Both TNA and DNCA are efficient in promoting improvement in the MID: reduction in pain, modifications in disc and condyle positions, and, in part, may account for less JE, without difference between techniques.