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Ângelo DF, Faria-Teixeira MC, Maffia F, Sanz D, Sarkis M, Marques R, Mota B, João RS, Cardoso HJ. Association of Malocclusion with Temporomandibular Disorders: A Cross-Sectional Study. J Clin Med 2024; 13:4909. [PMID: 39201051 PMCID: PMC11355311 DOI: 10.3390/jcm13164909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/12/2024] [Accepted: 08/17/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Temporomandibular disorders (TMD) encompass a range of musculoskeletal and neuromuscular conditions affecting the temporomandibular joint (TMJ) and associated structures. This cross-sectional study, conducted in a Portuguese TMD department, aimed to assess the relationship between malocclusion and TMD severity. Methods: Data on demographic variables, TMD clinical symptoms, and malocclusion classes were collected using the EUROTMJ database. The Chi-square test (χ2) identified associations, with their intensity measured by Cramér's V (φc). Results: The study included 1170 patients (932 females and 238 males), with a mean age of 41.73 ± 16.80 years. Most patients exhibited Angle Class I malocclusion (85.5%), followed by Angle Class II (13.5%) and Angle Class III (1.1%). Class II malocclusion was associated with increased TMD severity (p < 0.001), higher myalgia levels (p = 0.002), more frequent disc displacement without reduction (p = 0.002) and lower maximum mouth opening values (Class II: 38.13 ± 7.78 mm, Class I: 39.93 ± 8.67 mm). Significant associations were also found between malocclusion type and arthralgia (p = 0.021), mouth-opening limitation (p = 0.016), and TMJ crepitus (p = 0.017). In cases of malocclusion, the presence of oral signs of bruxism explained the degree of myalgia, disc displacement, and severity (p = 0.003; p = 0.048; p = 0.045). Conclusions: This study highlights that (1) the most common type of dental malocclusion in TMD patients was Class I; (2) Class II malocclusion was associated with increased TMD severity and oral signs of bruxism; and (3) Class III was rarely observed in TMD consultation. The findings suggest that bruxism behavior in cases of malocclusion may be significant in TMD.
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Affiliation(s)
- David Faustino Ângelo
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Marinha Grande, Portugal
- Faculty of Medicine, Lisboa University, 1649-028 Lisbon, Portugal
- Serviço de Estomatologia Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, 1349-019 Lisbon, Portugal
- Centro Hospitalar Universitário Lisboa Norte (CHUNL), Clinica Universitária de Estomatologia, 1648-028 Lisbon, Portugal
| | | | - Francesco Maffia
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy
| | - David Sanz
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
| | - Marcella Sarkis
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
| | - Rute Marques
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
| | - Beatriz Mota
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
- Centro Hospitalar Universitário Lisboa Norte (CHUNL), Clinica Universitária de Estomatologia, 1648-028 Lisbon, Portugal
| | - Ricardo São João
- Department of Computer Science and Quantitative Methods, School of Management and Technology, Polytechnic Institute of Santarém, 2001-904 Santarém, Portugal
- CEAUL—Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisbon, Portugal
- Center for Global Studies (CEG-UAb), Aberta University, 1250-100 Lisbon, Portugal
- Nursing Research, Innovation and Development Center of Lisbon (CIDNUR), 1600-190 Lisbon, Portugal
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Zhu Y, Zheng F, Gong Y, Zhu J, Yin D, Liu Y. Effect of occlusal contact on TMJ loading during occlusion: An in silico study. Comput Biol Med 2024; 178:108725. [PMID: 38878405 DOI: 10.1016/j.compbiomed.2024.108725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/08/2024] [Accepted: 06/07/2024] [Indexed: 07/24/2024]
Abstract
Alterations in occlusal features may have significant consequences, ranging from dental aesthetics to health issues. Temporomandibular joint disorders (TMDs) are often associated with joint overload, and the correlation between occlusal features and TMDs has been thoroughly discussed. In current work, we introduced a novel stomatognathic model that aligns well with in vivo experimental measurements, specifically designed to decouple the impact of occlusal contact and periodontal ligament (PDL) negative feedback on temporomandibular joint (TMJ) loading. Utilizing an in-silico approach, the simulation analysis included six symmetric occlusal contact scenarios. Furthermore, a biomechanical lever model was employed to clarify the mechanical mechanism and investigate the multi-factorial effects of TMJ overload. These findings indicate that anterior shifts in the occlusal centre lead to increased TMJ loading, particularly in occlusal contact cases with anteroposterior changes. Considering the symmetrical distribution of occlusal contact, mediolateral alterations had a more modest effect on TMJ loading. Additionally, potential negative feedback activated by principal strain of periodontal could not only alleviate joint load but also diminish occlusal force. These investigations enhance our understanding of the intricate interactions between masticatory muscles, occlusal forces, and joint contact forces, thereby providing motivation for future comprehensive studies on TMJ biomechanical overload.
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Affiliation(s)
- Yunfan Zhu
- College of Aerospace Engineering, Chongqing University, Chongqing, 400044, China
| | - Fangjie Zheng
- College of Aerospace Engineering, Chongqing University, Chongqing, 400044, China
| | - Yanji Gong
- State Key Laboratory of Oral Disease, National Center for Stomatology &National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Jinyi Zhu
- State Key Laboratory of Oral Disease, National Center for Stomatology &National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Deqiang Yin
- College of Aerospace Engineering, Chongqing University, Chongqing, 400044, China.
| | - Yang Liu
- State Key Laboratory of Oral Disease, National Center for Stomatology &National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Uzunçıbuk H, Marrapodi MM, Ronsivalle V, Cicciù M, Minervini G. Lessons to be learned when designing comprehensible patient-oriented online information about temporomandibular disorders. J Oral Rehabil 2024. [PMID: 39034447 DOI: 10.1111/joor.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Temporomandibular disorders (TMD) are a prevalent ailment with a global impact, affecting a substantial number of individuals. While some individuals are receiving treatment from orthodontists for TMD, a significant proportion of individuals obtain knowledge through websites. OBJECTIVES Our purpose had been to evaluate, from a patient-oriented perspective, the readability of home pages of websites scored in the 10 most prominent devoted to TMD. We also determined what level of education would have been needed to get an overview of the information on the websites under scrutiny. This approach ensures that our findings are centred on the patient experience, providing insights into how accessible and understandable websites about TMD. METHODS We determined the top 10 patient-focused English language websites by searching for 'temporomandibular disorders' in the 'no country redirect' plugin of the Google Chrome browser (www.google.com/ncr). The readability of the texts was assessed using the Gunning fog index (GFI), Coleman Liau index (CLI), Automated readability index (ARI) Simple Measure of Gobbledygook (SMOG), Flesch Kincald grade level (FKGL), Flesh reasing ease (FRE) (https://readabilityformulas.com). RESULTS The mean Flesch reading ease index score was determined to be 48.67, accompanied by a standard deviation of 15.04 and these websites require an average of 13.49 years of formal education (GFI), with a standard deviation of 2.62, for ease of understanding. CONCLUSION Our research indicates that a significant proportion of websites related to TMD can be defined as a level of complexity that exceeds the ability to read comprehension of the general population.
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Affiliation(s)
- Hande Uzunçıbuk
- Department of Orthodontics, Dentistry Faculty, Trakya University, Edirne, Turkey
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Oliveira DFLM, Fernandes EE, Lopes SLPDC, Rode SDM, Oliveira WD, Ertty E, Cardoso MDA, Tien-Li A, Meloti F. Prevalence of condylar morphological changes in individuals with class II malocclusion. Braz Oral Res 2024; 38:e060. [PMID: 39016367 DOI: 10.1590/1807-3107bor-2024.vol38.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/06/2024] [Indexed: 07/18/2024] Open
Abstract
This observational, cross-sectional study with retrospective collection was aimed to evaluate the prevalence of morphological changes in mandibular condyles in individuals with class II malocclusion, classified according to different vertical growth patterns (brachyfacial, mesofacial, and dolichofacial), through cone beam computed tomography (CBCT). Seventy CBCT images (140 mandibular condyles) were selected from individuals without orthodontic treatment, of both sexes, aged between 25 and 50 years. No statistically significant differences were found between facial patterns; however, there was a higher relative prevalence of bone changes in dolichofacial individuals with flattening (62%), sclerosis (44%), and subchondral bone cyst (20%). Erosion and osteophytes prevailed in mesofacial (39%), and brachyfacial individuals (32%), respectively. Thus, there was no statistically significant difference in the prevalence of degenerative changes between the vertical skeletal patterns. Flattening was the most prevalent change, whereas subchondral bone cyst was the least prevalent among the three groups studied. The observational design of this study makes it possible to analyze image banks to verify the correlation of morphological changes in the temporomandibular joint in different facial patterns in patients with class II malocclusion. A limitation of the study is that clinical characteristics were not evaluated.
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Affiliation(s)
| | - Ellen Eduarda Fernandes
- Institute of Science and Technology - UNESP, Department of Biosciences and Oral Diagnosis, São José dos Campos, SP, Brazil
| | | | - Sigmar de Mello Rode
- Institute of Science and Technology - UNESP, Department of Dental Materials and Prosthodontics, São José dos Campos, SP, Brazil
| | - Wagner de Oliveira
- Institute of Science and Technology - UNESP, Department of Dental Materials and Prosthodontics, São José dos Campos, SP, Brazil
| | - Ertty Ertty
- Faculdade São Leopoldo Mandic. Department of Orthodontics, Campinas, Brazil
| | | | - An Tien-Li
- University of Brasília - UNB, Department of Dentistry, Brasília, DF, Brazil
| | - Fernanda Meloti
- Faculdade São Leopoldo Mandic. Department of Orthodontics, Campinas, Brazil
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Paz-Cortés MM, Martín-Vacas A, Mendoza PA, Rozalén M, Alvaredo MÁ. Analysis of the Effect of Exams on Perceived Stress and Temporomandibular Joint Status in Physiotherapy Students: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:952. [PMID: 38929569 PMCID: PMC11206016 DOI: 10.3390/medicina60060952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Temporomandibular disorders or dysfunction (TMDs) encompass a range of complex conditions that impact the temporomandibular joint (TMJ), chewing muscles, teeth, and/or their supporting tissues. Stress is one of the most associated factors studied as a TMD predictor. The aim is to figure out the influence of stress on TMJ status and salivary cortisol in university students during and before exams. Materials and Methods: The study was non-experimental, employing a longitudinal, analytical, observational cohort design. The study population consisted of students enrolled in the physiotherapy degree program at the Alfonso X El Sabio University (Madrid, Spain). Data were collected during two distinct academic periods: the first period was characterized by low academic stress and no exams, and the second period coincided with the high academic stress of final course exams. The collected results included sociodemographic data, assessment of TMJ status (Fonseca Index), evaluation of muscle evaluation (masseter, upper trapezius, and sternocleidomastoid) using a MOXY Monitor (muscle oxygenation) and Neurotrac® (surface EMG, sEMG), assessment of perceived stress (PSS-14), and measurement of salivary cortisol (enzyme immunoassay with Elisa). The statistical analysis was conducted with a confidence level of 95% (p ≤ 0.05) and asymptotic or bilateral significance. Results: 70 students were analyzed during two different measurement periods. According to the Fonseca Index, initially, 37.14% of the analyzed students showed mild TMDs, 17.14% moderate TMDs, and 45.72% showed no TMDs. In general terms, stress increased with age and is related to female sex, maximum mouth opening decreased with age, oxygen saturation decreased with age and academic stress, and myoglobin concentration was related to age. Furthermore, muscle contraction decreased during higher academic stress and increased with age. For women, age was a risk factor for suffering from TMDs, and stress worsened the transition from having TMDs to having no TMDs in both sexes. Conclusions: Academic stress influences TMJ status and muscle outcomes such as oxygen saturation, myoglobin concentration, and muscle contraction, although more research is needed.
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Affiliation(s)
- Marta Macarena Paz-Cortés
- Faculty of Dentistry, Alfonso X El Sabio University, 28691 Villanueva de la Cañada, Spain; (M.M.P.-C.)
| | - Andrea Martín-Vacas
- Faculty of Dentistry, Alfonso X El Sabio University, 28691 Villanueva de la Cañada, Spain; (M.M.P.-C.)
| | - Pedro Antonio Mendoza
- Physiotherapy Department, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Villanueva de la Cañada, Spain; (P.A.M.); (M.R.)
| | - Manuel Rozalén
- Physiotherapy Department, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Villanueva de la Cañada, Spain; (P.A.M.); (M.R.)
| | - Miguel Ángel Alvaredo
- Physiotherapy Department, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Villanueva de la Cañada, Spain; (P.A.M.); (M.R.)
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6
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Manfredini D, Ercoli C, Poggio CE, Carboncini F, Ferrari M. Centric relation-A biological perspective of a technical concept. J Oral Rehabil 2023; 50:1355-1361. [PMID: 37394665 DOI: 10.1111/joor.13553] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Few terms and concepts have been so extensively debated in dentistry as the words 'centric relation' (CR). Debates involve its biological, diagnostic and therapeutic usefulness. METHODS A review of the literature on the current concepts on CR as a diagnostic or therapeutic aid in dentistry was provided. Clinical trials assessing the superiority of one CR recording method over the others to identify patients with temporomandibular disorders (diagnostic use) or to manage patients with prosthodontic or orthodontic needs (therapeutic use) were tentatively included. RESULTS Due to the absence of literature addressing either of the above targets, a comprehensive overview was provided. The diagnostic use of CR as a reference position to identify the correct position of the temporomandibular joint condyle within the glenoid fossa is not supported and lacks anatomical support. From a therapeutic standpoint, the use of CR can be pragmatically useful in prosthodontics as a maxillo-mandibular reference position when occlusal re-organization is warranted and/or when the position of maximum intercuspation is no longer available. CONCLUSIONS The derived occlusal goals from a diagnostic misuse of CR are generally the result of circular reasoning, that is a technique is based on the recording of a certain condylar position that is believed to be 'ideal' and the treatment is considered successful when such position is shown by the specific instrument that was manufactured for that purpose. The term 'Centric Relation' might be replaced with the term 'Maxillo-Mandibular Utility Position'.
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Affiliation(s)
- Daniele Manfredini
- School of Dentistry, Department of Biomedical Technologies, University of Siena, Siena, Italy
| | - Carlo Ercoli
- Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
| | - Carlo E Poggio
- Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
| | - Fabio Carboncini
- School of Dentistry, Department of Biomedical Technologies, University of Siena, Siena, Italy
| | - Marco Ferrari
- School of Dentistry, Department of Biomedical Technologies, University of Siena, Siena, Italy
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Ravelo V, Olate G, de Moraes M, Huentequeo C, Sacco R, Olate S. Condylar Positional Changes in Skeletal Class II and Class III Malocclusions after Bimaxillary Orthognathic Surgery. J Pers Med 2023; 13:1544. [PMID: 38003858 PMCID: PMC10672009 DOI: 10.3390/jpm13111544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023] Open
Abstract
Orthognathic surgery is indicated to modify the position of the maxillomandibular structure; changes in the mandibular position after osteotomy can be related to changes in the position of the mandibular condyle in the articular fossa. The aim of this study was to determine changes produced in the mandibular condyle 6 months after orthognathic surgery. A cross-sectional study was conducted that included subjects who had undergone bimaxillary orthognathic surgery to treat dentofacial deformity of Angle class II (group CII) or Angle class III (group CIII). Standardized images were taken using cone-beam computed tomography 21 days before surgery and 6 months after surgery; measurement scales were used to identify the condylar position and its relations with the anterior, superior, and posterior joint spaces. The results were analyzed using the Shapiro-Wilk and Student's t-tests, while considering a value of p < 0.05 as indicating a significant difference. Fifty-two joints from 26 patients, with an average age of 27.9 years (±10.81), were analyzed. All subjects in both group CII and group CIII showed a significant change in the anterior, superior, and posterior joint spaces. However, postoperative changes in the position of the condyle in the articular fossa were not significant in the anteroposterior analysis. We conclude that orthognathic surgery causes changes in the sagittal position of the mandibular condyle in subjects with mandibular retrognathism and prognathism.
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Affiliation(s)
- Víctor Ravelo
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
- PhD Program in Morphological Sciences, Facultad de Medicina, Universidad de La Frontera, Temuco 4780000, Chile
| | - Gabriela Olate
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
| | - Marcio de Moraes
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba 13414-903, SP, Brazil
| | - Claudio Huentequeo
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
| | - Roberto Sacco
- Division of Dentistry, Oral Surgery Department, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
- Oral Surgery Department, King's College Hospital NHS Trust, London SE5 9RW, UK
| | - Sergio Olate
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
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Aldayel AM, AlGahnem ZJ, Alrashidi IS, Nunu DY, Alzahrani AM, Alburaidi WS, Alanazi F, Alamari AS, Alotaibi RM. Orthodontics and Temporomandibular Disorders: An Overview. Cureus 2023; 15:e47049. [PMID: 38021494 PMCID: PMC10644174 DOI: 10.7759/cureus.47049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
The relationship between orthodontics and temporomandibular disorders (TMDs) constitutes a subject of paramount significance in dental and craniofacial health. This abstract embarks upon an in-depth examination of the intricate connection between orthodontic practices and TMD, primarily focusing on evaluating the impact of orthodontic treatment modalities on the health and functionality of the temporomandibular joint (TMJ). This exploration elucidates the multifaceted interplay between orthodontic interventions and TMD by traversing a landscape of scholarly research and empirical investigations. The review draws from a broad spectrum of studies to analyze the potential influence of orthodontic treatments, which encompass occlusal adjustments and alterations in jaw positioning, on the development and management of TMD symptoms. The inquiry delves into the diverse range of TMD conditions, considering the implications of orthodontic techniques on occlusal stability, condylar alignment, and overall TMJ function. Through a comprehensive synthesis of the available body of knowledge, this abstract aspires to equip dental practitioners, orthodontists, and researchers with a nuanced understanding of the complex dynamics that govern the relationship between orthodontics and TMD. This knowledge, in turn, offers a foundation for informed clinical decision-making and the formulation of effective treatment strategies for patients presenting with TMD symptoms. By shedding light on the intricate interactions between orthodontic procedures and TMJ health, this abstract contributes to the advancement of clinical practices, promoting improved patient outcomes and well-being in the context of both orthodontics and TMDs.
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Affiliation(s)
- Abdullah M Aldayel
- Dental Clinic at King Khalid University Hospital, King Saud University, Riyadh, SAU
| | | | | | - Duaa Y Nunu
- General Dentistry, Ministry of Health, Najran, SAU
| | | | | | - Fahad Alanazi
- General Dentistry, King Abdulaziz Medical City, Jeddah, SAU
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Miotto AV, Bonotto DV, Silva JSC, De Souza JF, Sebastiani AM, Scariot R. Temporomandibular Disorders at the Preoperative Time of Orthognathic Surgery. Diagnostics (Basel) 2023; 13:2922. [PMID: 37761289 PMCID: PMC10528885 DOI: 10.3390/diagnostics13182922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Individuals seeking orthodontic treatment combined with orthognathic surgery (OS) have a high prevalence of temporomandibular disorders (TMDs), but the relationship between TMD diagnoses and dentofacial deformities (DFDs) is still controversial. Therefore, this cross-sectional study with a comparison group aimed to analyze the association between dentofacial deformities and TMDs. METHODOLOGY Eighty patients undergoing OS were consecutively selected from the stomatology department of the Federal University of Paraná between July 2021 and July 2022. Forty patients who would undergo OS composed the group of participants with DFD, and forty who received other types of attention and did not present changes in the dental bone bases formed the group without DFDs (DFDs and no DFDs groups). The groups were matched for sex, age, and self-reported ethnicity. The diagnostic criteria for TMDs (DC/TMDs) were used to diagnose TMD based on the Axis I criteria. The psychosocial aspects, oral behaviors in wakefulness, and sleep bruxism were evaluated through the Axis II criteria. The data were analyzed with a 5% significance level. RESULTS The presence of DFDs was significantly associated with arthralgia (p = 0.01). The other types of TMDs were not associated with DFDs. Comorbidities, habits, and psychosocial variables were not associated with DFDs at a level of 0.05. (p > 0.05). In analyzing the participants with arthralgia, the ones with this condition presented higher frequencies of sleep bruxism (p = 0.046). CONCLUSIONS Participants with DFDs presented a significantly higher frequency of arthralgia when compared to no DFDs ones. Sleep bruxism was associated with the occurrence of joint TMDs in these participants.
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Affiliation(s)
| | | | | | | | - Aline Monise Sebastiani
- Department of Stomatology, School of Dentistry, Federal University of Paraná, 623 Prefeito Lothário Meissner Avenue, Curitiba 80210-170, PR, Brazil; (A.V.M.); (J.S.C.S.); (J.F.D.S.); (R.S.)
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Zúñiga-Herrera ID, Aguilar-Pérez FJ, Escoffié-Ramírez M, Herrera-Atoche JR. Malocclusion Complexity in Patients with Disc Displacement Disorders: A Case-Control Study. Healthcare (Basel) 2023; 11:2202. [PMID: 37570442 PMCID: PMC10418584 DOI: 10.3390/healthcare11152202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed to determine the possible association between disc displacement (DD) disorders and malocclusion complexity. This cross-sectional study was carried out using a case-control design. The Research Diagnosis Criteria for Temporomandibular Disorders were used to identify cases and controls. The Index of Complexity, Outcome, and Need (ICON) was used to quantify malocclusion complexity as easy, mild, moderate, difficult, or very difficult. A total of 310 subjects were included: 130 cases and 180 controls. A binary logistic regression (p < 0.05) was used to identify associations. The odds ratio (OR) was also calculated. DD was associated with sex, age, and malocclusion complexity (p < 0.05). The malocclusion complexity comparison showed that 89.3% of the controls fell within the easy-moderate levels of the ICON, whereas 85.4% of the cases were in the moderate-very difficult levels (p ≤ 0.001). Difficult and very difficult malocclusions had high ORs (9.801 and 9.689, respectively) compared to the easy cases. In conclusion, patients with malocclusion complexity levels classified as difficult or very difficult have greater odds of presenting DD.
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Affiliation(s)
| | | | | | - José Rubén Herrera-Atoche
- Department of Orthodontics, School of Dentistry, Autonomous University of Yucatan, Mérida 97000, Mexico; (I.D.Z.-H.); (F.J.A.-P.); (M.E.-R.)
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11
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Hysa E, Lercara A, Cere A, Gotelli E, Gerli V, Paolino S, Pizzorni C, Sulli A, Smith V, Cutolo M. Temporomandibular disorders in immune-mediated rheumatic diseases of the adult: A systematic review. Semin Arthritis Rheum 2023; 61:152215. [PMID: 37167773 DOI: 10.1016/j.semarthrit.2023.152215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/24/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To systematically review the literature concerning temporomandibular disorders (TMDs) in immune-mediated rheumatic diseases (IMRDs) of the adult. The temporomandibular joint (TMJ) outcomes used in clinical studies, the prevalence of TMDs in IMRDs and the risk factors for their development were qualitatively synthetized. METHODS A literature search on PubMed Central, Embase and Cochrane Library databases was performed for studies including TMJ outcomes in IMRDs patients compared with healthy controls, other rheumatic diseases or in the assessed IMRDs patients after follow-up and treatment. Among the IMRDs of the adult, original articles investigating TMJ involvement in inflammatory polyarthritides and/or autoimmune connective tissue diseases were considered. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). RESULTS Of the 3259 screened abstracts, 56 papers were included in the systematic review. Most of the papers (77%) investigated TMDs in rheumatoid arthritis (RA) with a prevalence of signs and symptoms varying from 8% to 70%. The risk factors for TMDs development in RA were female sex, younger age, anti-citrulline peptide autoantibodies (ACPA) positivity, higher disease activity, cervical spine involvement, cardiovascular and neuropsychiatric comorbidities. Ten papers (18%) evaluated TMDs in spondylarthritides (SpA) reporting a prevalence of symptoms and signs in 12%-80% of patients with higher TMDs prevalence in patients with radiographic spine involvement, skin psoriasis and HLADRB1×01 positivity. Among autoimmune connective tissue diseases (CTDs), systemic sclerosis (SSc) displayed the highest evidence of TMDs patient-reported outcomes (PROs) and clinical findings (20-93%), followed by systemic lupus erythematosus (SLE) in 18-85%, primary Sjogren's syndrome (24-54%) and idiopathic inflammatory myopathies (4-26%). In SSc and SLE, TMDs were more frequent in patients with higher disease activity and duration, correlating with the extent of skin fibrosis in SSc and with renal involvement in SLE. CONCLUSION TMDs in IMRDs display a significant relevance in the rheumatological clinical practice even if often misdiagnosed. This burden is epidemiologically important in terms of PROs and clinical findings which correlate with disease activity in RA, SpA, SSc and SLE. The early recognition and multidisciplinary management of TMDs is warranted and should be aimed at hindering the TMJ structural damage maximizing the quality of life of patients.
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Affiliation(s)
- Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Adriano Lercara
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Andrea Cere
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Veronica Gerli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Department of Rheumatology, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy.
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12
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Huang ZW, Yang R, Gong C, Zhang CX, Wen J, Li H. Treatment of severe open bite and mandibular condyle anterior displacement by mini-screws and four second molars extraction: A case report. World J Clin Cases 2023; 11:3599-3611. [PMID: 37383903 PMCID: PMC10294191 DOI: 10.12998/wjcc.v11.i15.3599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) disorders are closely related to high-angle and skeletal Class II malocclusion. Sometimes pathological changes in the mandibular condyle can cause open bite to occur after growth is complete.
CASE SUMMARY This article is about the treatment of an adult male patient with a severe hyperdivergent skeletal Class II base, an unusual and gradually occurring open bite and an abnormal mandibular condyle anterior displacement. Because the patient refused surgery, four second molars with cavities and root canal therapy were extracted, and four mini-screws were used for intrusion of the posterior teeth. The treatment duration was 22 mo, and after the treatment, the open bite was corrected and the displaced mandibular condyles were seated back to the articular fossa as shown by cone-beam computed tomography (CBCT). Based on the patient’s open bite history, the result of clinical examinations and CBCT comparisons, we believe it is possible that the occlusion interference was eliminated after the four second molars were extracted and the posterior teeth were intruded, and the patient's condyle spontaneously returned to its physiologic position. Finally, a normal overbite was established, and stable occlusion was achieved.
CONCLUSION This case report suggested that identifying the cause of open bite is essential, and the TMJ factors for hyperdivergent skeletal Class II cases should be particularly examined. For these cases, intruding posterior teeth may place the condyle in a more appropriate position and provide an environment suitable for TMJ recovery.
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Affiliation(s)
- Zi-Wei Huang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Ren Yang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Cheng Gong
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Cai-Xia Zhang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Juan Wen
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Huang Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
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Lassmann Ł, Nowak Z, Orthlieb JD, Żółtowska A. Complicated Relationships between Anterior and Condylar Guidance and Their Clinical Implications-Comparison by Cone Beam Computed Tomography and Electronic Axiography-An Observational Cohort Cross-Sectional Study. Life (Basel) 2023; 13:life13020335. [PMID: 36836692 PMCID: PMC9959043 DOI: 10.3390/life13020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
A complex prosthodontic treatment is believed to be more successful when the condylar path is replicated using the articulator. However, there is an ongoing major disagreement between the researchers as the exact relationship between the posterior and anterior determinants has not been clear. The purpose of this study was to investigate whether the protrusive movement of the mandible does correlate with the temporomandibular joint (TMJ) anatomy or with incised features. Subjects (15 males and 15 females) were qualified for this study based on an initial interview including the following criteria: age 21-23 (+/-1), no history of trauma, orthodontic treatment, or temporomandibular disorders (TMD). For each patient, the angle of the condylar path, incisal guidance angle (IGA), interincisal angle, as well as overbite and overjet were measured on cone beam computed tomography (CBCT). This was followed by the examination with the Modjaw® electronic axiograph recording and calculating the functional sagittal condylar guidance angle (SCGA) for the right and left TMJ during the protrusion. The results show that the mean functional axiographic measurement of SCGA in protrusion significantly correlates with the TMJ anatomy presented on CBCT. Moreover, a significant correlation was found between the values of SCGA in the functional and anatomical measurements in all its variants. It turned out that, statistically, the AB measurement was the most accurate. Finally, results showed that incisal relationships of permanent teeth such as overbite, overjet, incisal guidance angle and interincisal angle do not correlate with TMJ anatomy, and therefore, regarding an analyzed study group, do not affect the TMJ formation in young adults.
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Affiliation(s)
- Łukasz Lassmann
- Dental Sense Medicover, ul. Myśliwska 33a, 80-283 Gdańsk, Poland
- Correspondence:
| | - Zuzanna Nowak
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland
| | - Jean-Daniel Orthlieb
- Faculty of Odontology, Aix-Marseille University, 58 Boulevard Charles Livon, 13007 Marseille, France
| | - Agata Żółtowska
- Department of Conservative Dentistry, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Radej I, Dargiewicz E, Sawczuk-Siemieniuk M, Ferrando Cascales R, Ferrando Cascales Á, Agustín-Panadero R, Szarmach I. The Role of Maxillofacial Structure and Malocclusion on Condylar Displacement in Maximum Intercuspation and Centric Relation in Patients Seeking Orthodontic Treatment-A Scoping Review. J Clin Med 2023; 12:jcm12020689. [PMID: 36675620 PMCID: PMC9863588 DOI: 10.3390/jcm12020689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Available knowledge about malocclusion and cephalometric variables and their connection with an increased risk of condylar displacement (CD) is scarce. This article aims to present current information on the relationship between centric relation-maximum intercuspal position discrepancies and maxillofacial morphology and malocclusion in patients seeking orthodontic treatment as well as to identify those who require expanded diagnostic evaluation for this disorder. METHODS This review analyzed the PubMed, Cochrane Library, Web of Science, and Scopus electronic databases up to February 2022. Keywords and additional manual searches were performed. Literature selection was based the PRISMA-ScR checklist. The JBI Critical Appraisal Tool assessed the methodological quality of included studies. RESULTS The databases search provided 2321 studies. A total of 10 studies were included in this review after eligibility criteria and JBI assessment. This review was separated into five parts that evaluated CD correlations depending on the following: maxillofacial structure in different vertical and sagittal skeletal patterns, vertical, horizontal, and transverse malocclusions. CONCLUSIONS A hyperdivergent facial skeletal structure is a risk factor for increased CD, particularly in the vertical dimension. The condylar processes are usually displaced in a posteroinferior direction. Further studies are warranted to elucidate the relationship among remaining skeletal and dental malocclusions and the occurrence of CD.
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Affiliation(s)
- Ilona Radej
- Department of Orthodontics, Medical University of Białystok, ul. Waszyngtona 15A, 15-274 Białystok, Poland
- Correspondence:
| | - Ewelina Dargiewicz
- Department of Orthodontics, Medical University of Białystok, ul. Waszyngtona 15A, 15-274 Białystok, Poland
| | | | - Raúl Ferrando Cascales
- Faculty of Health Sciences, San Antonio de Murcia Catholic University (UCAM), 30107 Murcia, Spain
| | - Álvaro Ferrando Cascales
- Faculty of Health Sciences, San Antonio de Murcia Catholic University (UCAM), 30107 Murcia, Spain
| | - Rubén Agustín-Panadero
- Prosthodontic and Occlusion Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Izabela Szarmach
- Department of Orthodontics, Medical University of Białystok, ul. Waszyngtona 15A, 15-274 Białystok, Poland
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15
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Diwakar R, Bucci R, Kaushik A, Bansal A, Bucci P, Kochhar AS, Spagnuolo G. Three-Dimensional Assessment of Temporomandibular Joint Morphology and Facial Asymmetry in Individuals with Different Vertical Skeletal Growth Patterns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1437. [PMID: 36674193 PMCID: PMC9859447 DOI: 10.3390/ijerph20021437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
The aim of the current study was to investigate, by means of Cone-Beam Computed Tomography (CBCT), condyle−fossa relationship, temporomandibular joint (TMJ) morphology and facial asymmetry in subjects with different vertical skeletal growth patterns. CBCT of 56 patients (112 TMJs) were categorized into three groups according to the mandibular plane angle (MP): Hypodivergent (MP ≤ 23°), Normodivergent (23° < MP < 30°), and Hyperdivergent (MP ≥ 30°). TMJ spaces, width and depth of the condyle and thickness of the fossa were measured. Horizontal and vertical measurements were used to assess facial asymmetry. One-way Analysis of Variance (ANOVA) and post-hoc Turkey tests were computed for the between-groups comparison. Statistical significance was set at p < 0.05. Larger anterior joint space and smaller condylar dimensions (medio-lateral diameter and medio-lateral thickness) were observed in the hyperdivergent group compared to the normodivergent and hypodivergent groups. Right condylar distances to midsagittal plane were significantly larger than left distances in all the three groups. A vertical pattern of growth in healthy individuals seems to be associated with condylar position and dimension, while facial asymmetry values do not differ among different vertical groups.
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Affiliation(s)
- Rohan Diwakar
- Department of Orthodontics, PDM Dental College, Bahadurgarh 124507, India
| | - Rosaria Bucci
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Ankur Kaushik
- Department of Orthodontics, PDM Dental College, Bahadurgarh 124507, India
| | - Anubhav Bansal
- Department of Orthodontics, PDM Dental College, Bahadurgarh 124507, India
| | - Paolo Bucci
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | | | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, 80131 Naples, Italy
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, 119991 Moscow, Russia
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16
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Zhang Q, Gong Y, Liu F, Wang J, Xiong X, Liu Y. Association of temporomandibular joint osteoarthrosis with dentoskeletal morphology in males: A cone-beam computed tomography and cephalometric analysis. Orthod Craniofac Res 2022. [PMID: 36577692 DOI: 10.1111/ocr.12630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/08/2022] [Accepted: 12/17/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of the study was to assess the differences in dentoskeletal morphology in males with and without temporomandibular joint osteoarthrosis (TMJOA). METHODS Three hundred seventy-one male participants seeking orthodontic treatment were enrolled in this cross-sectional study. Each participant's osseous status was evaluated using cone-beam computed tomography (CBCT) and classified into normal (N = 104), indeterminate for TMJOA (N = 110) and TMJOA (N = 157) groups. The dentoskeletal characteristics were evaluated using cephalograms. Stratified analysis was performed based on age and skeletal pattern. Descriptive statistics and one-way analysis of variance were performed to investigate dentoskeletal differences among groups. P < .05 was considered statistically significant. RESULTS The differences in posterior cranial base length, FMA, MP-OP, anterior facial height, articular angle, ramus height and L1-MP were statistically significant. After stratification by age, the differences in FMA, maxillomandibular angle, posterior facial height, facial height ratio, gonial angle and mandibular body length were statistically significant in adults. No statistical difference except for articular angle was observed in adolescents. After stratification by skeletal pattern, statistical differences were mainly apparent in skeletal Class II adults. CONCLUSION Males with TMJOA showed a posteriorly positioned and backward-rotated mandible, especially in skeletal Class II adults. Compared with women, the craniofacial morphology of men is less affected by TMJOA. The association between TMJOA and craniofacial morphology also varied across different age groups and skeletal patterns. Prospective studies are required to clarify the cause-effect relationship between TMJOA and craniofacial morphology in males.
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Affiliation(s)
- Qinlanhui Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yanji Gong
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fang Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jun Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xiong
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yang Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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17
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Palone M, Brucculeri L, Cremonini F, Albertini P, Lombardo L. Treatment of severe Class II skeletal malocclusion in a hyperdivergent adult patient via hybrid clear aligner approach: A case report of successful camouflage therapy. J Orthod 2022; 50:205-214. [DOI: 10.1177/14653125221138588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This case report describes the camouflage treatment of an adult patient with hyperdivergent facial pattern presenting with severe Class II skeletal malocclusion, through the use of a hybrid clear aligner approach, that relies on both a partial lingual fixed appliance and the continuous use of Class II elastics throughout therapy. After 11 months of treatment, the goals had been achieved, highlighting that the correct diagnostic framework, proper patient selection and careful digital planning of a compromise treatment can provide satisfactory aesthetic and functional outcomes.
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Affiliation(s)
- Mario Palone
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - L Brucculeri
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - F Cremonini
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - P Albertini
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - L Lombardo
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
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18
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Zhu R, Zheng YH, Zhang ZH, Fan PD, Wang J, Xiong X. Development of a new category system for the profile morphology of temporomandibular disorders patients based on cephalograms using cluster analysis. Front Public Health 2022; 10:1045815. [PMID: 36466455 PMCID: PMC9713943 DOI: 10.3389/fpubh.2022.1045815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This study aims to develop a new category scheme for the profile morphology of temporomandibular disorders (TMDs) based on lateral cephalometric morphology. Methods Five hundred and one adult patients (91 males and 410 females) with TMD were enrolled in this study. Cluster tendency analysis, principal component analysis and cluster analysis were performed using 36 lateral cephalometric measurements. Classification and regression tree (CART) algorithm was used to construct a binary decision tree based on the clustering results. Results Twelve principal components were discovered in the TMD patients and were responsible for 91.2% of the variability. Cluster tendency of cephalometric data from TMD patients were confirmed and three subgroups were revealed by cluster analysis: (a) cluster 1: skeletal class I malocclusion; (b) cluster 2: skeletal class I malocclusion with increased facial height; (c) cluster 3: skeletal class II malocclusion with clockwise rotation of the mandible. Besides, CART model was built and the eight key morphological indicators from the decision tree model were convenient for clinical application, with the prediction accuracy up to 85.4%. Conclusion Our study proposed a novel category system for the profile morphology of TMDs with three subgroups according to the cephalometric morphology, which may supplement the morphological understanding of TMD and benefit the management of the categorical treatment of TMD.
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Affiliation(s)
- Rui Zhu
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Yun-Hao Zheng
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Zi-Han Zhang
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Pei-Di Fan
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Jun Wang
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Xin Xiong
- The State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China,Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Sichuan, China,*Correspondence: Xin Xiong
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19
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Wang P, Chen J, Wang X, Bai D, Guo Y. Orthodontic correction of a skeletal Class II malocclusion with severe gummy smile by total intrusion of the maxillary dentition. Am J Orthod Dentofacial Orthop 2022; 162:777-792. [PMID: 35985965 DOI: 10.1016/j.ajodo.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/01/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022]
Abstract
A 22-year-old woman visited the hospital complaining of lip protrusion, crowded teeth, and a gummy smile. The clinical examination showed a convex profile with a hyperdivergent mandible and a severe gummy smile in both anterior and posterior regions. The unstable mandible position was considered during treatment planning, and a targeted mechanic system was carefully designed. Temporary skeletal anchorage devices in the posterior dental region and a transpalatal arch were introduced as anchorage for the intrusion of the entire maxillary dentition and controlled retraction of the anterior teeth. Based on effective and simple mechanisms, we successfully eliminated the severe gummy smile and improved the facial aesthetics with the aid of conventional appliances. This approach provided an alternative option to orthognathic surgery or bulky invasive miniscrews for treatment of skeletal Class II malocclusion with severe gummy smile.
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Affiliation(s)
- Peiqi Wang
- State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiajun Chen
- State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xinghai Wang
- State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ding Bai
- State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yongwen Guo
- State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Dibello V, Panza F, Mori G, Ballini A, Di Cosola M, Lozupone M, Dibello A, Santarcangelo F, Vertucci V, Dioguardi M, Cantore S. Temporomandibular Disorders as a Risk Factor for Suicidal Behavior: A Systematic Review. J Pers Med 2022; 12:jpm12111782. [PMID: 36579500 PMCID: PMC9692338 DOI: 10.3390/jpm12111782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Temporomandibular disorders (TMD) are a group of common musculoskeletal dysfunctions that affect the temporomandibular joint or masticatory muscles and related structures or are expressed as a clinical combination of these two factors. The etiology of TMD is multifactorial and features related to anxiety, depression and mental disorders can contribute to the predisposition, onset and progression of TMD. The ability to adapt and develop coping attitudes was reduced in patients presenting with chronic pain, while suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) was increased. The objective of this review was therefore to investigate suicidal behavior in relation to TMD. METHODS The review was performed according to the PRISMA 2020 guidelines. Six databases (PubMed, MEDLINE, EMBASE, Scopus, Ovid, and Google Scholar) were consulted through the use of keywords related to the review topic. The study is registered on PROSPERO (CRD42022320828). RESULTS The preliminary systematic search of the literature yielded 267 records. Excluding duplicates, 15 were considered potentially relevant and kept for title and abstract analysis. Only six articles were considered admissible reporting a single exposure factor, TMD and a single outcome, suicidal behavior, although these were evaluated through different assessment tools. We found a low association of TMD with suicidal behavior in observational studies, with estimates partly provided [prevalence ratio (PR) from 1.26 to 1.35, 95% confidence intervals (CI) from 1.15 to 1.19 (lower) and from 1.37 to 1.54 (higher); and odds ratios (OR) from 1.54 to 2.56, 95% CI from 1.014 to 1.157 (lower) and 2.051 to 6.484 (higher)], a relevant sample size (n = 44,645), but a few studies included (n = 6). CONCLUSIONS The results of the included studies showed that the prevalence data of suicidal behavior were more present in young adults with TMD, with a controversial association with gender. Suicidal behavior was also correlated and aggravated by the intensity of pain.
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Affiliation(s)
- Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands
| | - Francesco Panza
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology and Research Hospital IRCCS “S. De Bellis”, Castellana Grotte, 70013 Bari, Italy
- Correspondence: (F.P.); (A.B.); (M.D.)
| | - Giorgio Mori
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
| | - Andrea Ballini
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Correspondence: (F.P.); (A.B.); (M.D.)
| | - Michele Di Cosola
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Antonio Dibello
- Accident and Emergency Department (AED), Fabio Perinei Hospital, Altamura, 70022 Bari, Italy
| | | | | | - Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
- Correspondence: (F.P.); (A.B.); (M.D.)
| | - Stefania Cantore
- Independent Researcher, Regional Dental Community Service “Sorriso & Benessere-Ricerca e Clinica”, 70129 Bari, Italy
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TMJ Position in Symmetric Dentofacial Deformity. J Clin Med 2022; 11:jcm11133631. [PMID: 35806915 PMCID: PMC9267339 DOI: 10.3390/jcm11133631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 12/10/2022] Open
Abstract
The aim of this research was to analyze the facial class, presence of malocclusion, and the mandibular plane and to relate this to the mandibular condyle position. A cross-sectional study in subjects under analysis for orthognathic surgery was done. The mandibular plane, the gonial angle, and the molar class were included to compare the coronal and sagittal position of the condyle and the joint space observed in the CBCT. The measurements were obtained by the same observer at an interval of two weeks. In addition, the Spearman test was performed to determine the correlation using a p value < 0.05 to observe any significant differences. Eighty-nine male and female subjects (18 to 58 years old, 24.6 ± 10.5) were included. In the coronal section, subjects with CIII had a greater mediolateral distance (MLD, p = 0.0001) and greater vertical distance (SID, p = 0.0001) than subjects with CII. In terms of the skeletal class and the mandibular plane, it was observed that subjects in the CII group had a greater mandibular angle (open angle) (p = 0.04) than the CII group and was related to the anterior position of the condyle. The most anterior condylar position was observed in the CII group (p = 0.03), whereas a posterior condylar position was significant in CIII subjects (p = 0.03). We can conclude that the sagittal position of the TMJ was related to the mandibular plane and the skeletal class showing a higher mandibular angle and most anterior position of the condyle in CII subjects and a lower mandibular angle and most posterior position of the condyle in CIII subjects. The implications for surgical treatment have to be considered.
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Cohen A, Rushinek H, Cohen Sela M, Sharafan D, Talisman S, Casap N. Are There Cephalometric Measurements Associated with Recurrent Temporomandibular Joint Dislocation? J Oral Maxillofac Surg 2022; 80:1587-1592. [DOI: 10.1016/j.joms.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/11/2022] [Accepted: 06/11/2022] [Indexed: 11/28/2022]
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Lei J, Chen S, Jing J, Guo T, Feng J, Ho T, Chai Y. Inhibiting Hh Signaling in Gli1 + Osteogenic Progenitors Alleviates TMJOA. J Dent Res 2022; 101:664-674. [PMID: 35045740 PMCID: PMC9124909 DOI: 10.1177/00220345211059079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
The increased prevalence of temporomandibular joint osteoarthritis (TMJOA) in children and adolescents has drawn considerable attention as it may interfere with mandibular condyle growth, resulting in dento-maxillofacial deformities. However, treatments for osteoarthritis have been ineffective at restoring the damaged bone and cartilage structures due to poor understanding of the underlying degenerative mechanism. In this study, we demonstrate that Gli1+ cells residing in the subchondral bone contribute to bone formation and homeostasis in the mandibular condyle, identifying them as osteogenic progenitors in vivo. Furthermore, we show that, in a TMJOA mouse model, derivatives of Gli1+ cells undergo excessive expansion along with increased but uneven distribution of osteogenic differentiation in the subchondral bone, which leads to abnormal subchondral bone remodeling via Hedgehog (Hh) signaling activation and to the development of TMJOA. The selective pharmacological inhibition and specific genetic inhibition of Hh signaling in Gli1+ osteogenic progenitors result in improved subchondral bone microstructure, attenuated local immune inflammatory response in the subchondral bone, and reduced degeneration of the articular cartilage, providing in vivo functional evidence that targeting Hh signaling in Gli1+ osteogenic progenitors can modulate bone homeostasis in osteoarthritis and provide a potential approach for treating TMJOA.
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Affiliation(s)
- J. Lei
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
- Center for TMD & Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China
| | - S. Chen
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - J. Jing
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - T. Guo
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - J. Feng
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - T.V. Ho
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - Y. Chai
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
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Hua J, Lu C, Zhao J, Yang Z, He D. Disc repositioning by open suturing vs. mini-screw anchor: stability analysis when combined with orthognathic surgery for hypoplastic condyles. BMC Musculoskelet Disord 2022; 23:387. [PMID: 35473596 PMCID: PMC9039607 DOI: 10.1186/s12891-022-05337-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Disc repositioning by Mitek anchors for anterior disc displacement (ADD) combined with orthognathic surgery gained more stable results than when disc repositioning was not performed. But for hypoplastic condyles, the implantation of Mitek anchors may cause condylar resorption. A new disc repositioning technique that sutures the disc to the posterior articular capsule through open incision avoids the implantation of the metal equipment, but the stability when combined with orthognathic surgery is unknown. The purpose of this study was to evaluate the stability of temporomandibular joint (TMJ) disc repositioning by open suturing in patients with hypoplastic condyles when combined with orthographic surgery. Methods Patients with ADD and jaw deformity from 2017 to 2021 were included. Disc repositioning by either open suturing or mini-screw anchor were performed simultaneously with orthognathic surgery. MRI and CT images before and after operation and at least 6 months follow-ups were taken to evaluate and compare the TMJ disc and jaw stability. ProPlan CMF 1.4 software was used to measure the position of the jaw, condyle and its surface bone changes. Results Seventeen patients with 20 hypoplastic condyles were included in the study. Among them, 12 joints had disc repositioning by open suturing and 8 by mini-screw anchor. After an average follow-up of 18.1 months, both the TMJ disc and jaw position were stable in the 2 groups except 2 discs moved anteriorly in each group. The overall condylar bone resorption was 8.3% in the open suturing group and 12.5% in the mini-screw anchor group. Conclusions Disc repositioning by open suturing can achieve both TMJ and jaw stability for hypoplastic condyles when combined with orthognathic surgery.
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Affiliation(s)
- Jiangshan Hua
- Department of Oral SurgeryShanghai Key Laboratory of Stomatology &National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chuan Lu
- Department of Oral SurgeryShanghai Key Laboratory of Stomatology &National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jieyun Zhao
- Department of Oral SurgeryShanghai Key Laboratory of Stomatology &National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Research Institute of Stomatology, Shanghai, China.
| | - Zhi Yang
- Department of Oral and Cranio-Maxillofacial SurgeryShanghai Key Laboratory of Stomatology &National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Research Institute of Stomatology, Shanghai, China.
| | - Dongmei He
- Department of Oral SurgeryShanghai Key Laboratory of Stomatology &National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Research Institute of Stomatology, Shanghai, China.
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Craniofacial Morphology of Orthodontic Patients with and without Temporomandibular Disorders: A Cross-Sectional Study. Pain Res Manag 2022; 2022:9344028. [PMID: 35360414 PMCID: PMC8964235 DOI: 10.1155/2022/9344028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/06/2022] [Accepted: 02/17/2022] [Indexed: 02/05/2023]
Abstract
Purpose We aimed to explore the relationship between temporomandibular disorders (TMDs) and craniofacial morphology in orthodontic patients. Methods Altogether, 262 orthodontic patients were included and divided into two groups according to their Fonseca Anamnestic Index (FAI) scores: a no-TMD group (control group, FAI < 20) and a TMD group (FAI ≥ 20). Cephalometric parameters including cranial, maxillary, mandibular, and dental parameters were traced on cephalograms. Craniofacial morphology was compared between TMD and control groups, followed by subgroup analyses based on TMD severity, gender, age, and temporomandibular joint (TMJ) symptoms. Results The prevalence of TMDs was 52.7% among included patients (138/262). The mean age of TMD patients was higher than that of the control group. No significant difference in gender distribution between the groups was observed. The most commonly reported FAI items were misaligned teeth, neck pain, and emotional tension. The Frankfort-mandibular plane angle (FMA) was larger in the TMD patients than in the control group, whereas no significant differences in other parameters were observed. Subgroup analysis based on TMD severity revealed that FMA and anterior facial height of moderate/severe TMD patients were significantly larger than those of mild or no-TMD patients. Among male patients, the anterior cranial base length was smaller, and the anterior facial height was larger in the TMD group. Among female patients, no significant differences in craniofacial morphology between the groups were observed. In juvenile patients, overjet and overbite were smaller in the TMD group. In adult patients, SNA, ANB, FMA, and gonial angle were larger in the TMD group. Within the TMD group, patients with TMJ pain or noises exhibited characteristic craniofacial features compared to patients without these symptoms. Conclusions Orthodontic patients with TMDs have specific craniofacial morphology, suggesting a relationship between TMDs and particular craniofacial features in orthodontic patients.
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Yeşiltepe S, Alkış HT, Kurtuldu E, Kılcı G. Articular eminence pneumatization in patients with different sagittal skeletal patterns: Cone-beam computed tomography study. APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_140_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
This study objectives to evaluate the type and degree of articular eminence pneumatization in individuals with different sagittal skeletal patterns.
Material and Methods:
Cone-beam computed tomography images of 139 patients were included in the study. The population was divided into groups according to their sagittal skeletal anomalies by A point-nasion-B point angle measurement. The laterality, grade, and type of pneumatization were recorded. Pearson Chi-square test and Fisher’s exact test were performed to evaluate gender, sagittal skeletal anomalies, pneumatization type, and grade.
Results:
A pneumatized articular eminence (PAT) was found in 74.8% of the population. Grade 1 pneumatization and the multilocular type where the most common pneumatization. There were no correlations between sagittal skeletal anomalies and pneumatization grades.
Conclusion:
The prevalence of PAT was high concerning the previous studies. However, there were no correlations between the sagittal skeletal anomalies, pneumatization type, and grade. Clinicians must always be aware of the potential for pneumatizations as they may cause untoward complications.
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Affiliation(s)
- Selin Yeşiltepe
- Department of Oral and Maxillofacial Radiology, Aydın Adnan Menderes University, Aydın, Turkey,
| | | | - Elif Kurtuldu
- Sakarya Oral and Dental Health Hospital, Health Ministry of Turkey Republic, Sakarya, Turkey,
| | - Gülçin Kılcı
- Department of Oral and Maxillofacial Radiology, Aydın Adnan Menderes University, Aydın, Turkey,
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Zuhour M, Ismayilzade M, Dadacı M, Ince B. The Impact of Wearing a Face Mask during the COVID-19 Pandemic on Temporomandibular Joint: A Radiological and Questionnaire Assessment. Indian J Plast Surg 2022; 55:58-65. [PMID: 35444759 PMCID: PMC9015843 DOI: 10.1055/s-0042-1743131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim Several health problems have been reported to be triggered or facilitated by prolonged mask usage during the coronavirus disease 2019 (COVID-19) pandemic. While wearing a face mask, people tend to push their jaws forward and downward in a repetitive manner to hold their masks in the right position; these jaw motions may induce temporomandibular joint disorder (TMD). In this study, we aimed to investigate these repetitive jaw movements while wearing face masks and their effects on TMD. Patients and Methods Patients who applied with TMD signs between June 2020 and May 2021 were evaluated prospectively. A survey using a questionnaire was conducted to define patients with TMD that caused only by mask-related repetitive jaw movements. Demographic data (age and gender), mean duration of daily mask usage, mask type, and magnetic resonance imaging results were recorded. Results Prolonged daily mask usage (≥8 hours/day) was significantly higher in patients with mask-related habits (group a) with a rate of 40.4% ( p ≈ 0.001). Also, in this group, the disc displacement with reduction rate (54.6%) was higher compared with other groups ( p ≈ 0.010). On the contrary, patients with no underlying risk factor (group c) showed an unexpected high osteoarthritis rate ( p ≈ 0.029). Conclusions In this study, we demonstrate that correcting the position of a face mask by repetitive jaw movements can increase the occurrence of TMD. Informing individuals wearing face masks about the risk of TMD and the importance of choosing the appropriate mask size according to the face shape are important issues to be addressed in the near future.
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Affiliation(s)
- Moath Zuhour
- Department of Plastic Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Majid Ismayilzade
- Department of Plastic Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Dadacı
- Department of Plastic Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Bilsev Ince
- Department of Plastic Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Hyoid Bone Position in Patients with and without Temporomandibular Joint Osteoarthrosis: A Cone-Beam Computed Tomography and Cephalometric Analysis. Pain Res Manag 2021; 2021:4852683. [PMID: 34931131 PMCID: PMC8684513 DOI: 10.1155/2021/4852683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/30/2021] [Indexed: 02/05/2023]
Abstract
Objective To assess the differences in hyoid bone position in patients with and without temporomandibular joint osteoarthrosis (TMJOA). Methods The present cross-sectional study was conducted in 427 participants whose osseous status was evaluated using cone-beam computed tomography and classified into normal, indeterminate osteoarthrosis (OA), and OA. The hyoid bone position and craniofacial characteristics were evaluated using cephalograms. Patients were divided into the normal group (N = 89), indeterminate OA group (N = 182), and OA group (N = 156). Descriptive statistics, one-way analysis of variance, and age- and sex-based stratified analyses were performed. P < 0.05 was considered statistically significant. Results The differences in Hy to MP, Hy-RGn, Hy to C3-RGn, C3-RGn, and Go-Hy-Me among the three groups were statistically significant. The differences in the Frankfort-mandibular plane angle, saddle angle, articular angle, gonial angle, ramus height, and posterior facial height were statistically significant. After adjusting age and sex, the Hy-RGn and C3-RGn in the normal group were significantly greater than the OA group. No statistical differences were observed in the hyoid measurements in the stratified analyses in males or subjects less than 18 years old. The differences in Hy to MP, Hy to C3-RGn, and Go-Hy-Me in female patients among the three groups were statistically significant. The differences in Hy to SN, Hy to FH, Hy to PP, Hy to MP, Hy-RGn, Hy-C3, Hy to C3-RGn, Go-Hy-Me, Hy-S, and C3-Hy-S in adults were statistically significant. Conclusion The differences in the hyoid bone position, mainly relative to the mandible, were statistically significant in patients with or without TMJOA. The difference pattern varied among different age and sex groups. Clinical evaluation of the hyoid position must consider the age and sex of patients. Longitudinal studies are required to clarify the causal relationship between TMJOA and hyoid bone position.
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Skeletal Divergence and Condylar Asymmetry in Patients with Temporomandibular Disorders (TMD): A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8042910. [PMID: 34608439 PMCID: PMC8487372 DOI: 10.1155/2021/8042910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023]
Abstract
Introduction This study was aimed at evaluating the association between vertical skeletal patterns, condylar height symmetry, and temporomandibular disorders in adults. Methods The study sample consisted of 200 patients (ages 18-30 years old) retrospectively recruited: 100 with temporomandibular disorders (TMD) and 100 without TMD (control), diagnosed by Diagnostic Criteria for the Temporomandibular Disorders (DC/TMD). For each subject, skeletal divergence was assessed on lateral cephalograms, and condylar height symmetry was evaluated by orthopantomography (Habets' method). Results Subjects with temporomandibular disorders showed a strong association with condylar asymmetry (p < 0.0001) and, for the skeletal pattern variables, hyperdivergence (p < 0.001). A correlation with the female sex was also found (p < 0.04), while there was no difference in terms of age in the 2 groups (p > 0.29). Conclusions Although it does not imply a direct cause-and-effect relationship, the present study suggests condylar asymmetry and hyperdivergent skeletal pattern are more likely to be associated with a higher risk of temporomandibular disorder joint diseases in adult patients.
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Osteoarthritis of the temporomandibular joint: A review of aetiology and pathogenesis. Br J Oral Maxillofac Surg 2021; 60:387-396. [PMID: 35307273 DOI: 10.1016/j.bjoms.2021.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/11/2021] [Indexed: 11/21/2022]
Abstract
The aim of this review was to assess the level of evidence for genetic, biological, and functional predictive and predisposing factors for end-stage temporomandibular joint arthritis within the published literature. A comprehensive review based upon PRISMA guidelines was performed from all literature relevant to the topic. Case series and animal studies were included given the rare nature of the disease and goal of finding root-cause predictive factors. Clinical and radiographic measures were used specifically to identify factors which may have contributed to disease onset and progression. A total of 249 abstracts were identified based on search terms of major databases. After application of exclusion and inclusion criteria, 63 full-text articles were included in the analysis of this paper. There were few factors that could be reliably used to predict end-stage temporomandibular joint disease. Limited evidence is available to adequately predict end-stage temporomandibular joint osteoarthritis. No descriptive process exists that explains how and why this process can occur in younger adults. A better understanding of the aetiology and pathogenesis of TMJ-OA may lead to prevention and more effective management strategies that may reduce the need for drastic surgical intervention, particularly in young adults.
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Greene CS, Manfredini D. Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis. J Oral Rehabil 2021; 48:1077-1088. [PMID: 33966303 PMCID: PMC8453911 DOI: 10.1111/joor.13180] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/31/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
Background Based on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been elucidated. Methods This paper describes known vulnerability factors that make individuals susceptible to developing temporomandibular disorders (TMDs), as well as those that contribute to the perpetuation of such problems. In addition, the topic of iatrogenesis is discussed as a major contributor to the negative outcomes that can be seen in this field. Results At the patient level, anatomical, psychosocial and genetic factors may contribute to individual vulnerability. The anatomy and pathophysiology of muscles, joints, disc and nerves may all be involved in predisposing to TMD symptoms, especially when the patients have pain elsewhere in the body. Among the psychosocial factors, some features may be elucidated by the DC/TMD axis II, while others (eg illness behaviour, Munchausen syndrome, lack of acceptance of non‐mechanical approaches) require careful evaluation by trained clinicians. Genetic predisposition to first onset TMDs and to chronification of symptoms has been identified for individuals with certain psychological traits, presence of comorbid conditions and certain abnormal clinical manifestations. Regarding iatrogenesis, sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment. Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification of TMDs. The patients who present with massive occlusal and jaw repositioning changes combined with persistent severe orofacial pain are not a rarity within TMD and orofacial pain canters; these patients are the most difficult ones to manage because of this horrific combination of negative factors. Conclusions The information presented in this paper will help clinicians to understand better why some individuals develop temporomandibular disorders, why some of them will progress to becoming chronic patients, and what the appropriate responses may be.
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Affiliation(s)
- Charles S Greene
- Department of Orthodontics, University of Illinois at Chicago College of Dentistry, Chicago, IL, USA
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
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Huh JK. Orthognathic surgery of temporomandibular disorders. J Korean Assoc Oral Maxillofac Surg 2021; 47:63-64. [PMID: 33911037 PMCID: PMC8084739 DOI: 10.5125/jkaoms.2021.47.2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
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Zhao X, Xiong X, Sun W, Shu C, Gu J, Liu Y. Symptoms, disc position, occluding pairs, and facial skeletal characteristics of older patients with temporomandibular disorders. J Int Med Res 2021; 49:300060521990530. [PMID: 33583228 PMCID: PMC7890733 DOI: 10.1177/0300060521990530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective To describe the proportions of different osseous diagnoses in older patients with temporomandibular disorders (TMD) and to analyze the symptoms, disc position, occluding pairs, and facial skeletal characteristics of patients with bilateral osteoarthrosis (BOA) and bilateral normal joints (BNJ). Methods This retrospective cross-sectional study constituted 88 older patients (age ≥60 years). The osseous diagnosis, symptoms, disc position, occluding pairs, and facial skeletal characteristics were evaluated. Variables in BOA patients and BNJ patients were compared using the t-test and chi-square test. Results Forty-eight patients had BOA, 7 had unilateral osteoarthrosis, 11 had intermediate osteoarthrosis, and 22 had BNJ. The prevalence of disc displacement without reduction (DDw/oR) in BOA patients was significantly higher than in BNJ patients. BOA patients exhibited greater ANB angle, PP-MP, U1-NPo, L1-NPo, and facial convexity angle; shorter posterior cranial base; and decreased ramus height. Conclusion BOA patients with associated DDw/oR had more complaints of orofacial pain and exhibited a shorter posterior cranial base, and greater mandibular retrusion, anterior tooth protrusion, and protruded profile than BNJ patients.
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Affiliation(s)
- Xiaokai Zhao
- Department of Dental Research, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xin Xiong
- Department of Orthodontics, State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wei Sun
- Department of Orthodontics, State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chang Shu
- Department of Orthodontics, State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jinning Gu
- Department of Orthodontics, State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yang Liu
- Department of Temporomandibular Joint, State Key Laboratory of Oral Disease, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Protocols for orthodontic treatment of patients with temporomandibular joint disorders. Am J Orthod Dentofacial Orthop 2021; 159:373-388. [PMID: 33485717 DOI: 10.1016/j.ajodo.2020.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022]
Abstract
Orthodontists often have trouble treating patients who have temporomandibular joint disorders because occlusion changes depend on the position of unstable condyles. This characteristic means the patients do not have definite criteria with which to make an accurate orthodontic diagnosis, so clinicians are unable to establish a reliable treatment plan. This article reports on the treatment of a patient with skeletal Class II relationship and condylar resorption. A stabilization splint was used before any active orthodontic tooth movement to stabilize her condylar position. Although the patient exhibited dramatically increased open bite and a retruded mandibular position after splint therapy, her occlusion and facial esthetics were resolved by orthodontic camouflage treatment with appropriate orthodontic mechanics after extraction of 4 premolars.
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Chaurand J, Godínez-Victoria M, Tellez-Girón A, Facio-Umaña JA, Jimenez-Ponce F. Incobotulinum toxin type A for treatment of chronic myofascial pain. J Oral Sci 2020; 63:37-40. [PMID: 33298638 DOI: 10.2334/josnusd.20-0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE This study assessed the effectiveness of incobotulinum toxin type A (IBTx) for chronic myofascial pain affecting the masseter and temporal muscles. METHODS Twenty two patients who received a diagnosis of chronic masseter and temporalis myofascial pain were evaluated by using a visual analog pain scale (VAS), digital pressure algometry, and the SF-36 Health Survey at baseline (T0), before IBTx injection. Patients were again evaluated at 2 months (T1) and 7 months (T2) after IBTx injection. RESULTS VAS scores for pain significantly differed (P = 0.029, Friedman test). Post-hoc tests showed a significant reduction in pain at 2 months (T0-T1) and 7 months (T0-T2) (P = 0.011 and P = 0.028, respectively; Wilcoxon test) but not between 2 and 7 months (P = 0.676; Wilcoxon test). There was no significant difference in pressure algometry values (P = 0.385, Friedman test). Quality of life (QOL) assessment showed a significant difference (P = 0.002, Friedman test). Post-hoc tests showed a significant improvement in QOLat 2 months, but no significant difference at 7 months (P = 0.004 and P = 0.260, Wilcoxon test). CONCLUSION IBTx injection resulted in safe, effective short-term pain relief for patients with chronic facial pain affecting the masseter and temporalis muscles.
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Affiliation(s)
- Jorge Chaurand
- Maxillofacial Surgery Department, National Medical Center "20 de Noviembre" Institute for Social Security and Services for State Workers
| | | | - Aldo Tellez-Girón
- Maxillofacial Surgery Department, National Medical Center "20 de Noviembre" Institute for Social Security and Services for State Workers
| | | | - Fiacro Jimenez-Ponce
- Regulatory and Attention to Hospitals Department, Institute for Social Security and Services for State Workers
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Michelotti A, Rongo R, D'Antò V, Bucci R. Occlusion, orthodontics, and temporomandibular disorders: Cutting edge of the current evidence. J World Fed Orthod 2020; 9:S15-S18. [DOI: 10.1016/j.ejwf.2020.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
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Marques FBC, Lima LS, Oliveira PLE, Magno MB, Ferreira DMTP, Castro ACR, Maciel JVB, Ruellas ACDO, Maia LC. Are temporomandibular disorders associated with facial asymmetry? A systematic review and meta‐analysis. Orthod Craniofac Res 2020; 24:1-16. [DOI: 10.1111/ocr.12404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Lílian Siqueira Lima
- Department of Orthodontics and Pediatric Dentistry Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | | | - Marcela Baraúna Magno
- Department of Orthodontics and Pediatric Dentistry Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | | | - Amanda Cunha Regal Castro
- Department of Orthodontics and Pediatric Dentistry Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | | | | | - Lucianne Copple Maia
- Department of Orthodontics and Pediatric Dentistry Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
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Olliver S, Broadbent J, Thomson W, Farella M. Occlusal Features and TMJ Clicking: A 30-Year Evaluation from a Cohort Study. J Dent Res 2020; 99:1245-1251. [DOI: 10.1177/0022034520936235] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Occlusal features that deviate from normative values have been historically considered risk factors for temporomandibular joint (TMJ) disorders. Nowadays, a putative association between dental occlusion and TMJ disorders remains controversial, with research findings on associations being inconsistent and inconclusive. We hypothesized that putative occlusal features identified during adolescence are associated with TMJ clicking later in life. The Dunedin Multidisciplinary Health and Development Study is a longitudinal birth cohort study investigation of 1,037 children (48.4% female) born in Dunedin, New Zealand, between April 1, 1972, and March 31, 1973, and assessed repeatedly since then. Associations between posterior crossbite, overbite, and overjet at age 15, as well as both self-reported and clinically assessed TMJ clicking sounds at age 45, were studied. Data were analyzed using multivariate logistic regression, after controlling for sex, emotional style, self-reports of tooth clenching and sleep bruxism, and history of orthodontic treatment. Self-reported and examiner-reported TMJ clicking at age 45 affected 18.3% and 23.8% of the study sample, respectively, and were not associated with the presence of a posterior crossbite or abnormal overjet/overbite values during adolescence. Self-reported history of tooth clenching and emotional style were associated with self-reported TMJ clicking later in life. In addition, there is a suggestion that high overbite during adolescence is negatively associated with TMJ clicking later in life. A history of orthodontic treatment was not associated with TMJ clicking. Abnormal occlusal features, such as posterior crossbite and high and low overjet/overbite in adolescence, are not associated with higher prevalence of TMJ clicking later in life. Personality also appears to influence self-reports of TMJ clicking later in life.
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Affiliation(s)
- S.J. Olliver
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - J.M. Broadbent
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W.M. Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - M. Farella
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Herreira-Ferreira M, Tolentino EDS, da Silva MC, Walewski LÂ, Iwaki LCV. Cone-beam computed tomographic study of the persistent foramen tympanicum according to age, sex, and skeletal patterns. Br J Oral Maxillofac Surg 2020; 58:e57-e61. [PMID: 32561131 DOI: 10.1016/j.bjoms.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/03/2020] [Indexed: 11/19/2022]
Abstract
This cross-sectional study evaluated the influence of prevalence, laterality and diameter of persistent foramen tympanicum (PFT) in cone beam computed tomographic (CBCT) scans of adult patients with different sagittal skeletal patterns, sex and age. CBCT of 510 patients were assessed for the presence of PFT. Skeletal pattern, age and sex of the affected patients were recorded, as well as laterality and diameter of PFT. Differences were tested using the one-way ANOVA, chi squared and paired-t tests, at α=5%. A total of 49 (9.7%) patients presented with PFT; 36 (73.5%) were women (p<0.01) aging from 31-50 years (p>0.05), with Class III skeletal pattern (p>0.05). The unilateral/bilateral ratio was 3.9:1 (p<0.01). No correlation was found between the PFT diameters with sex and age, but differences were found between the classes, with the largest diameters in Class II individuals (p=0.046). The prevalence of PFT in CBCT scans was 9.7%, with women being more affected, with unilateral defects in most cases. Skeletal patterns did not have significant effects on PFT prevalence, although PFT diameter varied among classes, with higher measures in Class II individuals.
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Song J, Cheng M, Qian Y, Chu F. Cone-beam CT evaluation of temporomandibular joint in permanent dentition according to Angle's classification. Oral Radiol 2019; 36:261-266. [PMID: 31385140 DOI: 10.1007/s11282-019-00403-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/20/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare characteristics of temporomandibular joint (TMJ) and related structures according to Angle class I, II1, II2, and III. METHODS 123 Chinese patients (13-36 years old, 60 males, and 63 females) were classified in four groups according to Angle's classification: skeletal class I (31 patients), skeletal class II division 1 (30 patients), skeletal class II division 2 (30 patients), and skeletal class III (32 patients). Left and right TMJs of each subject were evaluated independently with cone-beam computed tomography (CBCT). The position of condyle in the joint fossa was analyzed according to Pullinger. RESULTS There were significant differences between class III subjects and class I, II1, II2 in the superior joint space (p < 0.05). Compared with class II1, II2, and III subjects, the height and diameter of condyle in class I was significantly larger (p < 0.05). The width of joint fossa was significantly larger in Angle class III than in Angle class I, II1, and II2, while the depth was significantly smaller. The condyle position in class III subjects was more anteriorly displaced compared with that in class I subjects. In class II2 patients, the condyle position was mainly concentric and posterior. CONCLUSIONS There are significant differences in condylar morphology, joint space, joint fossa morphology, and condylar position between different Angle classifications.
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Affiliation(s)
- Jungyul Song
- Department of Orthodontics, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China
| | - Mingjia Cheng
- Department of Orthodontics, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China
- Department of Stomatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yufen Qian
- Department of Orthodontics, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China.
| | - Fengting Chu
- Department of Orthodontics, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China.
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Temporal bone pneumatization in patients with dentofacial deformities: cone beam computed tomography study. Int J Oral Maxillofac Surg 2019; 48:1564-1569. [PMID: 31262681 DOI: 10.1016/j.ijom.2019.03.964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/15/2019] [Accepted: 03/23/2019] [Indexed: 11/20/2022]
Abstract
Pneumatization in the osseous components of the temporomandibular joint (TMJ) may represent a complicating factor in TMJ surgery. This study determined the prevalence and characteristics of pneumatized articular eminence (PAE) and pneumatized glenoid fossa (PGF) using cone beam computed tomography (CBCT) scans of patients with and without dentofacial deformities. The CBCT of 587 asymptomatic patients (216 class I, 179 class II, 192 class III) were assessed to determine PAE and PGF. Age, sex, laterality, and type (uni/multilocular) of pneumatization were recorded. Differences were tested using the χ2 test and binary logistic regression models (P<0.05). Overall, 63.7% of patients presented some pneumatization: 15.5% presented both PAE and PGF, 0.9% presented only PAE, and 47.4% presented only PGF. The multilocular type was more frequent in both PAE and PGF (P<0.001). There was a significant difference regarding dentofacial deformity for PAE (P=0.021), with a higher frequency in class I. There were no differences according to sex, age, or laterality. The absence or lower frequency of pneumatization in class II and III patients may indicate continuous remodelling of the joint, which is submitted to abnormal occlusion forces. This knowledge is helpful for TMJ surgery planning, particularly as patients with dentofacial abnormalities may more often be candidates for TMJ surgery.
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Manfredini D, Ahlberg J, Wetselaar P, Svensson P, Lobbezoo F. The bruxism construct: From cut‐off points to a continuum spectrum. J Oral Rehabil 2019; 46:991-997. [DOI: 10.1111/joor.12833] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 04/29/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry University of Siena Siena Italy
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases University of Helsinki Helsinki Finland
| | - Peter Wetselaar
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
- Department of Dental Medicine Karolinska Institutet Huddinge Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
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Nojima K, Nagata M, Ootake T, Nishii Y, Yakushiji T, Narita M, Takano N, Sueishi K. Surgical Orthodontic Treatment Involving Mandibular Premolar Extraction in Patient with Mandibular Retrusion Associated with Temporomandibular Joint Osteoarthritis. THE BULLETIN OF TOKYO DENTAL COLLEGE 2019; 60:139-149. [PMID: 30971679 DOI: 10.2209/tdcpublication.2018-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Here, we report retention following surgical orthodontic treatment in a patient with vertical maxillary excess associated with temporomandibular joint osteoarthritis (TMJOA) and marked mandibular retrusion. The patient was a man aged 20 years 10 months who presented with the chief complaint of maxillary protrusion. The facial profile was of the convex type due to marked mandibular retrusion. In addition, the patient had a gummy smile. Intraoral findings revealed a Class II molar relation, +11 mm overjet, and 0 mm overbite. Mandibular dentition arch length discrepancy showed crowding of -2 mm, and the maxillary dentition showed a spaced arch of +5 mm. Panoramic radiographs confirmed flattening of the condylar head and proliferation of the bone margin. Cephalometric analysis of the skeletal pattern revealed that, horizontally, the maxilla was anterior and the mandible posterior; vertically, a dolichofacial pattern was noted. The anterior maxillary tooth axis was standard, but the anterior mandibular tooth axis showed labial inclination. Based on these findings, skeletal maxillary protrusion associated with TMJOA was diagnosed. Surgical orthodontic treatment comprised bilateral mandibular first premolar extraction with two-jaw surgery and genioplasty. Orthodontic treatment was performed with a multibracket system using a 0.22-slot pre-adjusted edgewise appliance. At 2 years and 11 months after initiation of treatment, the maxilla was transposed 6 mm upwards by orthognathic surgery and the mandible 17 mm anteriorly and 5 mm upwards by counterclockwise rotation. At 3 years and 10 months, the Pogonion was moved 6 mm anteriorly by genioplasty. At 4 years, orthodontic treatment was concluded on confirming satisfactory occlusion and improvement in facial features. At 2 years after completion of treatment, occlusion and the maxillofacial morphology remain stable, with almost no relapse. In addition, no temporomandibular joint disorder symptoms have occurred. Careful comprehensive follow-up observation will be continued.
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Affiliation(s)
| | | | | | | | - Takashi Yakushiji
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College.,Oral and Maxillofacial Surgery, National Hospital Organization, Takasaki General Medical Center
| | - Masato Narita
- Oral and Maxillofacial Surgery, National Hospital Organization, Takasaki General Medical Center
| | - Nobuo Takano
- Oral and Maxillofacial Surgery, National Hospital Organization, Takasaki General Medical Center.,Oral Cancer Center, Ichikawa General Hospital, Tokyo Dental College
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Liu YS, Yap AUJ, Lei J, Fu KY. Is Temporomandibular Joint Disc Displacement without Reduction a Plausible Cause of Condylar Hypoplasia? A Case Report. ACTA ACUST UNITED AC 2019. [DOI: 10.2174/2542579x01666180919121059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The causes of mandibular condylar hypoplasia can be congenital or acquired
in nature. Cited local causes of acquired hypoplasia include trauma, infection and irradiation.
We report a case of hypoplastic condyle that was attributed to temporomandibular joint (TMJ) disc
displacement without reduction (DDwoR).
Clinical Presentation:
A 16-year-old male presented with restricted mouth opening and right TMJ
pain for 6 months. He was subsequently diagnosed with DDwoR. Conservative treatment comprising
self-care and moist-heat therapy was administered and he was followed for 27 months without
any further interventions. During this period, transitions from “normal” morphology to condylar
flattening / erosion, and eventually a re-modeled smaller “normal” right TMJ were observed.
Conclusion:
The present case provided initial support that DDwoR could be a plausible cause of
condylar hypoplasia in adolescents / young adults.
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Affiliation(s)
- Yi-Shu Liu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
| | - Adrian U-Jin Yap
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
| | - Jie Lei
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
| | - Kai-Yuan Fu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China
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Walewski LÂ, Tolentino EDS, Yamashita FC, Iwaki LCV, da Silva MC. Cone beam computed tomography study of osteoarthritic alterations in the osseous components of temporomandibular joints in asymptomatic patients according to skeletal pattern, gender, and age. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:70-77. [PMID: 30876841 DOI: 10.1016/j.oooo.2019.01.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/01/2019] [Accepted: 01/18/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of osteoarthritic alterations in the osseous components of the temporomandibular joint (TMJ) in asymptomatic patients with different skeletal patterns, gender, and age groups with cone beam computed tomography (CBCT) images. STUDY DESIGN CBCT images of 213 asymptomatic patients were assessed for the presence of any degenerative changes in the condyle and fossa/eminence complex. Each TMJ was evaluated separately and was classified as normal, indeterminate for osteoarthritis, or affected by osteoarthritis. Differences were tested by using the χ2 and Fisher's exact tests (P < .05). RESULTS In total, 52.3% of the joints presented some visible alteration in the osseous components. Abnormalities were detected in 32.6% of the condyles and 31.5% of the articular fossae/eminences, and flattening was the most prevalent alteration in all classes. There was no statistically significant difference in the prevalence of alterations in either the condyle or the articular fossa/eminence among the skeletal groups for the entire sample or for the gender and age subsets. CONCLUSIONS There are no differences in degenerative TMJ changes in patients with or without skeletal jaw discrepancies. No differences were found when gender and age were considered.
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Affiliation(s)
- Letícia Ângelo Walewski
- Postgraduate Program in Integrated Dentistry, Department of Dentistry, State University of Maringá, Paraná, Brazil.
| | - Elen de Souza Tolentino
- Professor of Dental Radiology and Stomatology, Department of Dentistry, State University of Maringá, Paraná, Brazil
| | - Fernanda Chiguti Yamashita
- Postgraduate Program in Integrated Dentistry, Department of Dentistry, State University of Maringá, Paraná, Brazil
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Relationship between Cervical Spine and Skeletal Class II in Subjects with and without Temporomandibular Disorders. Pain Res Manag 2018; 2018:4286796. [PMID: 30410638 PMCID: PMC6206553 DOI: 10.1155/2018/4286796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 09/20/2018] [Indexed: 11/25/2022]
Abstract
Aim To assess changes in the craniocervical structure and in hyoid bone position in skeletal Class II subjects with and without temporomandibular disorders (TMD). Materials and Methods The cephalometric analysis of 59 subjects with skeletal Class II was evaluated and compared. The measurements considered were ANB as a parameter of Class II and C0-C1 distance, C1-C2 distance, craniocervical angle, and hyoid bone position for the cervical spine analysis. Patients were divided into patients with TMD (group A) and patients without TMD (group B). TMD were evaluated with Diagnostic Criteria for TMD (DC/TMD). Descriptive statistics and Pearson's and Spearman's correlation analysis, with p value <0,005, were performed. Results C0-C1 and C1-C2 distance values and hyoid bone position resulted within the normal range in the majority of patients examined. Craniocervical angle was altered in 33 patients. The reduction of this angle with the increase of the ANB value resulted to be statistically significant in group A, according to Pearson's correlation index. No other data were statistically significant. Conclusions The significant relationship between skeletal Class II and cervical spine cannot be highlighted. The alteration of craniocervical angle seems to be mildly present, with backward counterclockwise rotation of the head upon the neck in the sample (groups A and B). The presence of TMD as a key factor of changes in neck posture could explain the different result between the two groups about the relationship between ANB and craniocervical angle. This result should be further analyzed in order to better understand if cervical spine changes could be related to mandibular postural ones in the craniocervical space or to temporomandibular joint retropositioning, more recognizable in Class II with TMD, which could determine functional changes in other structures of this unit; neck posture could be the result of a compensatory/antalgic mechanism in response to TMD.
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Piancino MG, Tepedino M, Cavarra F, Bramanti E, Laganà G, Chimenti C, Cirillo S. Condylar long axis and articular eminence in MRI in patients with temporomandibular disorders. Cranio 2018; 38:342-350. [PMID: 30332921 DOI: 10.1080/08869634.2018.1532647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare morphologic findings in MRI and skeletal divergence of a group of patients with temporomandibular joint disorders (TMD) subdivided into condylar symmetric and asymmetric. METHODS Fifty-nine adults (26.7 years old) with TMD were retrospectively recruited. Condylar height symmetry was evaluated by orthopantomography (Habets's method) and used to divide patients into Symmetric and Asymmetric groups; skeletal divergence was assessed on lateral cephalograms. MRI was used to evaluate the condylar long axis' angle, the glenoid fossa morphology, and the degree of disc displacement. RESULTS Asymmetric subjects showed a hyperdivergent skeletal pattern (p = 0.036), asymmetric condylar long axis (p = 0.018), and deeper (p = 0.025) and asymmetric (p = 0.001) glenoid fossa compared to symmetric subjects. CONCLUSION Patients with TMD and condylar asymmetry diagnosed with orthopantomography are more likely to show hyperdivergent skull in cephalometry, condylar asymmetry of both height and major axis, and a steeper glenoid fossa in MRI.
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Affiliation(s)
- Maria Grazia Piancino
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin , Turin, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila, Italy
| | | | - Ennio Bramanti
- Department of Biomedical Sciences, University of Messina , Messina, Italy
| | - Giuseppina Laganà
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata , Rome, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila, Italy
| | - Stefano Cirillo
- S.C. Diagnostic Radiology, A.O. Ordine Mauriziano Hospital "Umberto I" , Turin, Italy
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48
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Mitteilungen DGKFO. J Orofac Orthop 2018. [DOI: 10.1007/s00056-018-0152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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Colonna A, Manfredini D, Lombardo L, Muscatello L, Marchese-Ragona R, Arveda N, Siciliani G. Comparative analysis of jaw morphology and temporomandibular disorders: A three-dimension imaging study. Cranio 2018; 38:158-167. [DOI: 10.1080/08869634.2018.1507094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Colonna
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Daniele Manfredini
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Luca Lombardo
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Luca Muscatello
- Section of ENT Pathology, NOA Hospital, Massa-Carrara, Italy
| | | | - Niki Arveda
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Giuseppe Siciliani
- Postgraduate School of Orthodontics, University of Ferrara, Ferrara, Italy
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50
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Manfredini D. Occlusal Equilibration for the Management of Temporomandibular Disorders. Oral Maxillofac Surg Clin North Am 2018; 30:257-264. [DOI: 10.1016/j.coms.2018.04.002] [Citation(s) in RCA: 15] [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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