1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
Guignardat JF, Raoul G, Ferri J, Sciote JJ, Nicot R. Systematic review of the histological and functional effects of botulinum toxin A on masticatory muscles: Consideration in dentofacial orthopedics and orthognathic surgery. Ann Anat 2024; 256:152302. [PMID: 39038690 DOI: 10.1016/j.aanat.2024.152302] [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: 10/27/2023] [Revised: 05/31/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Botulinum toxin type A causes muscle paralysis and is widely used in the masticatory muscle for stomatognathic diseases, such as temporomandibular disorder, bruxism, or masseteric hypertrophy. Nonetheless, its muscular effect remains unclear. Better understanding could aid improved use and perhaps new indications, particularly in dentofacial orthopaedics and orthognathic surgery. METHODS This systematic review explored the histologic and functional effects of botulinum toxin in animal and human masticatory muscles and was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The MEDLINE, Web of Science, and Cochrane Library electronic databases were searched for relevant articles. The inclusion criteria were human or animal masticatory muscle analysis after botulinum toxin injection(s) AND histological structural/ultrastructural analysis by optical or electronic microscopy OR functional effect analysis by bite force evaluation (occlusal force analyzer) and muscle activity (electromyography). RESULTS Of an initial 1578 articles, 44 studies were eventually included. Botulinum toxin injection in the masticatory muscle altered its histological structure and functional properties. The human and animal studies revealed ultrastructural change, atrophy, and fiber type modifications of the masticatory muscles after one injection. Botulinum toxin decreased bite force and muscle activity, but recovery was uncertain. CONCLUSIONS Muscle forces applied on the skeleton is a key feature of facial growth. Masticatory muscle paralysis changes mechanical stress on bones, which rebalances the force applied on facial bones. This new balance could benefit dental deformity or surgical relapse. Therefore, botulinum toxin could limit the orthognathic effect of the masticatory muscles in such patients. Given the uncertain recovery, multiple injections should be avoided, and usage should not deviate from established consensus.
Collapse
Affiliation(s)
| | - Gwénaël Raoul
- Univ. Lille, Inserm, CHU Lille, U1008 - Advanced Drug Delivery Systems, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France
| | - Joël Ferri
- Univ. Lille, Inserm, CHU Lille, U1008 - Advanced Drug Delivery Systems, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France
| | - James J Sciote
- Department of Orthodontics, Temple University, Philadelphia, Pennsylvania, USA
| | - Romain Nicot
- Univ. Lille, Inserm, CHU Lille, U1008 - Advanced Drug Delivery Systems, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France.
| |
Collapse
|
3
|
Grillo R, Balel Y, Reis BAQ, Stanbouly D, Samieirad S, Melhem-Elias F. The online attention analysis on orthognathic surgery research. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101826. [PMID: 38484842 DOI: 10.1016/j.jormas.2024.101826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Altmetrics is one of the fields of bibliometrics that seeks to assess the impact and interest of a given subject through Internet users. The aim of this study is to make an altmetric analysis of the orthognathic surgery literature. METHODS A literature search was conducted using Dimensions app up to December 2023. A list of the 100 most mentioned articles on the topic was compiled. A Google Trends search was performed with same strategy to visualize important data regarding internet search. Charts and tables were created using Microsoft Excel and VOSviewer software to allow bibliometric visualization. RESULTS There was a very poor correlation between the number of mentions and the number of citations (r = 0.0202). Most articles discussed on technical innovations associated to orthognathic surgery, majority related to virtual planning (n = 26). Other topics considered interesting to internet readers were complications (n = 18), surgical technique (n = 14), and psychological aspects/quality of life (n = 13). CONCLUSION Online interest in orthognathic surgery closely aligns with the level of academic interest but is also influenced by factors such as location and economic status. The internet is a powerful tool for disseminating scientific research to a broad audience, making it more accessible and engaging than traditional academic channels.
Collapse
Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, School of Dentistry of the University of São Paulo, São Paulo-SP, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília-DF, Brazil.
| | - Yunus Balel
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | | | - Dani Stanbouly
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Sahand Samieirad
- Department of Oral & Maxillofacial surgery, Mashhad dental school, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fernando Melhem-Elias
- Department of Oral & Maxillofacial Surgery, School of Dentistry of the University of São Paulo, São Paulo-SP, Brazil; Private Practice in Oral and Maxillofacial Surgery, São Paulo-SP, Brazil
| |
Collapse
|
4
|
Chen PRF, Chuang KT, Hsu SSP, Chen YR, Chen CT. Modification of Sagittal Split Osteotomy in Class II Asymmetry: Optimizing Bone Contact between Proximal and Distal Segments. Plast Reconstr Surg 2024; 153:1142e-1151e. [PMID: 37257138 DOI: 10.1097/prs.0000000000010784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Computer-assisted surgical simulation (CASS) allows more precise orthognathic surgery. However, few studies have evaluated associations between CASS-designed bilateral sagittal split osteotomy (SSO) and bone contact surface in class II mandibular asymmetry. This study aims to evaluate the effects of using computer-assisted simulation and design modification of SSO to improve bony contact in skeletal class II asymmetry. METHODS This retrospective analysis reviewed 28 patients with class II asymmetry who underwent orthognathic surgery, including 15 with modified SSO (group CS) and 13 with conventional SSO (group C). Modified SSO was designed under CASS. Operative characteristics, postoperative outcomes, and complications were collected and compared between the two groups. RESULTS Bony contact was found at the distal end of the proximal segment in all group CS patients, while bone gap was noted in all group C patients ( P < 0.05). Moreover, bone graft was used in four group C patients but was not used in all cases in group CS patients ( P < 0.05). A trend toward lower operative time or perioperative bleeding was noted in group CS, but without statistical significance. After 1-year follow-up, inferior alveolar nerve disturbances were noted in two group CS patients and one group C patient. Palpable bone gap with uneven jaw line was noted in two group C patients 1 year after surgery and one patient received fat graft treatment. CONCLUSION The simulation-based SSO modification provides appropriate contact surface and eliminates the bone gap between proximal and distal segments in class II asymmetry. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
| | - Kai-Ti Chuang
- Department of Plastic and Reconstructive Surgery, New Taipei Municipal TuCheng Hospital
| | | | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| | - Chien-Tzung Chen
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital at Linkou
- Craniofacial Research Center at Taoyuan, Chang Gung University, College of Medicine
| |
Collapse
|
5
|
Ehrmann E, Bernabeu M, Tillier Y, Camia J, Ecalle C, Savoldelli C, Charavet C. Impact of Orthodontic-Surgical Treatments on the Signs and Symptoms of Temporomandibular Disorders: A Systematic Review. Dent J (Basel) 2024; 12:132. [PMID: 38786530 PMCID: PMC11120548 DOI: 10.3390/dj12050132] [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: 02/21/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Some patients exhibit temporomandibular joint or muscular disorders of the masticatory system before, during, or after orthognathic surgery (OS). These are collectively referred to as temporomandibular disorders (TMDs). This systematic literature review aimed to determine the relationship between orthodontic-surgical treatment and TMDs. METHODS An electronic search of the PubMed database, supplemented by a manual search, was performed; the search included any studies published between 2021 (date of the last search in a systematic review of the literature on the subject) and June 2023 that evaluate the prevalence of TMDs during orthodontic-surgical treatment. The diagnosis of TMDs had to be established using the diagnostic algorithm "diagnostic criteria for temporomandibular disorders (DC/TMDs)", and the diagnosis of disc displacement had to be confirmed using magnetic resonance imaging (MRI). The data were extracted and statistically analyzed. RESULTS Of the 100 results, seven eligible articles were included, representing a total of 529 cases undergoing orthodontic-surgical treatment. A reduction in joint noises (64.8%), arthralgia (57 to 77%), and myalgia (73 to 100%) was found after orthodontic-surgical treatment despite the fact that a minority of patients exhibited these signs and symptoms even though they were asymptomatic before treatment. The effects of OS on disc position were objectively unpredictable. After surgery, the presence of headaches decreased without significance and the risk of their occurrence was very low (1%). The studies converged toward a reduction in the amplitudes of mouth opening and lateral/protrusion movements. Finally, after the treatment, mandibular function was improved. CONCLUSION Under the conditions of this study, OS seems to have a positive impact on the signs and symptoms of TMDs; however, it is not possible to predict the consequential effects on the position of the TMJ disc, whether it is initially in a normal position or displaced.
Collapse
Affiliation(s)
- Elodie Ehrmann
- Université Côte d’Azur, Faculté de Chirurgie Dentaire, Département de Réhabilitation Orale, 06300 Nice, France; (E.E.); (M.B.)
- Centre Hospitalier Universitaire de Nice, Institut de Médecine Bucco-Dentaire, Unité Douleur et Dysfonction Orofaciales, 06300 Nice, France
- Biomechanics/Department of Computational Mechanics & Physics, Mines Paris, PSL University, Centre for Material Forming (CEMEF), UMR7635 CNRS, 06904 Sophia Antipolis, France; (Y.T.); (C.S.)
| | - Marie Bernabeu
- Université Côte d’Azur, Faculté de Chirurgie Dentaire, Département de Réhabilitation Orale, 06300 Nice, France; (E.E.); (M.B.)
- Centre Hospitalier Universitaire de Nice, Institut de Médecine Bucco-Dentaire, Unité Douleur et Dysfonction Orofaciales, 06300 Nice, France
| | - Yannick Tillier
- Biomechanics/Department of Computational Mechanics & Physics, Mines Paris, PSL University, Centre for Material Forming (CEMEF), UMR7635 CNRS, 06904 Sophia Antipolis, France; (Y.T.); (C.S.)
| | - Julien Camia
- Université Côte d’Azur, Faculté de Chirurgie Dentaire, Département d’Orthodontie, 06300 Nice, France; (J.C.)
- Centre Hospitalier Universitaire de Nice, Institut de Médecine Bucco-Dentaire, Unité d’Orthodontie, 06300 Nice, France
| | - Corentin Ecalle
- Université Côte d’Azur, Faculté de Chirurgie Dentaire, Département d’Orthodontie, 06300 Nice, France; (J.C.)
- Centre Hospitalier Universitaire de Nice, Institut de Médecine Bucco-Dentaire, Unité d’Orthodontie, 06300 Nice, France
| | - Charles Savoldelli
- Biomechanics/Department of Computational Mechanics & Physics, Mines Paris, PSL University, Centre for Material Forming (CEMEF), UMR7635 CNRS, 06904 Sophia Antipolis, France; (Y.T.); (C.S.)
- Centre Hospitalier Universitaire de Nice, Institut Universitaire de la Face et du Cou, 06300 Nice, France
- Université Côte d’Azur, Faculté de Médecine, 06800 Nice, France
| | - Carole Charavet
- Université Côte d’Azur, Faculté de Chirurgie Dentaire, Département d’Orthodontie, 06300 Nice, France; (J.C.)
- Centre Hospitalier Universitaire de Nice, Institut de Médecine Bucco-Dentaire, Unité d’Orthodontie, 06300 Nice, France
- Université Côte d’Azur, Laboratoire MICORALIS, UPR 7554, 06800 Nice, France
| |
Collapse
|
6
|
Eduardo Charles Pagotto L, Freitas de Morais E, de Santana Santos T, Pires Pastore G. Evaluating changes in the condylar head after orthognathic surgery with or without articular disc repositioning: a systematic review. Br J Oral Maxillofac Surg 2024; 62:340-348. [PMID: 38521741 DOI: 10.1016/j.bjoms.2024.01.004] [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: 06/27/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 03/25/2024]
Abstract
Failures in orthognathic surgery are associated with different factors, including those related to untreated or undiagnosed preoperative temporomandibular joint (TMJ) disorders. This systematic review aimed to assess potential alterations in the condylar head following orthognathic surgery. A systematic search for randomised controlled trials and retrospective studies was performed. For inclusion in the review, studies had to meet the following eligibility criteria according to the PICO framework: Patients: patients with orthognathic deformity and temporomandibular dysfunction (or temporomandibular osteoarthritis); Intervention: patients submitted to orthognathic surgery concomitantly with TMJ disjunction; Control: patients undergoing only orthognathic surgery with or without presurgical data; and Outcome: changes in temporomandibular joint position and volume. Nine studies met all the inclusion criteria and were selected for qualitative analysis. The results of this review show that simultaneous articular disc repositioning and orthognathic surgery provide better results in patients with preoperatively diagnosed condylar osteoarthritic changes. In conclusion, condylar remodelling (resorption/deposition) and its extent are determined by the direction of condylar displacement during surgery. Other factors such as age are also associated with the development of condylar resorption.
Collapse
Affiliation(s)
| | | | | | - Gabriel Pires Pastore
- Instituto de Ensino e Pesquisa do Hospital Sírio-Libanês (IEP), São Paulo (SP), Brazil.
| |
Collapse
|
7
|
Bevini M, Gulotta C, Lunari O, Cercenelli L, Marcelli E, Felice P, Tarsitano A, Badiali G. Morpho-functional analysis of the temporomandibular joint following mandible-first bimaxillary surgery with mandible-only patient-specific implants. J Craniomaxillofac Surg 2024; 52:570-577. [PMID: 38485626 DOI: 10.1016/j.jcms.2024.02.009] [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: 04/27/2023] [Revised: 10/25/2023] [Accepted: 02/02/2024] [Indexed: 05/18/2024] Open
Abstract
The aim of this study was to evaluate condylar and glenoid fossa remodeling after bimaxillary orthognathic surgery guided by patient-specific mandibular implants. In total, 18 patients suffering from dentofacial dysmorphism underwent a virtually planned bimaxillary mandibular PSI-guided orthognathic procedure. One month prior to surgery, patients underwent a CBCT scan and optical scans of the dental arches; these datasets were re-acquired 1 month and at least 9 months postsurgery. Three-dimensional models of the condyles, glenoid fossae, and interarticular surface space (IASS) were obtained and compared to evaluate the roto-translational positional discrepancy and surface variation of each condyle and glenoid fossa, and the IASS variation. The condylar position varied by an average of 4.31° and 2.18 mm, mainly due to surgically unavoidable ramus position correction. Condylar resorption remodeling was minimal (average ≤ 0.1 mm), and affected skeletal class III patients the most. Later condylar remodeling was positively correlated with patient age. No significant glenoid fossa remodeling was observed. No postoperative orofacial pain was recorded at clinical follow-up. The procedure was accurate in minimizing the shift in relationship between the bony components of the TMJ and their remodeling, and was effective in avoiding postoperative onset of orofacial pain. An increase in sample size, however, would be useful to confirm our findings.
Collapse
Affiliation(s)
- Mirko Bevini
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
| | - Chiara Gulotta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy.
| | - Ottavia Lunari
- School of Medecine, Alma Mater Studiorum, University of Bologna, Italy.
| | - Laura Cercenelli
- Laboratory of Bioengineering-eDIMES Lab, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
| | - Emanuela Marcelli
- Laboratory of Bioengineering-eDIMES Lab, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.
| | - Pietro Felice
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy.
| | - Achille Tarsitano
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy.
| | - Giovanni Badiali
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Italy.
| |
Collapse
|
8
|
Grillo R, Borba AM, da Silva YS, Brozoski MA, Miloro M, Naclério-Homem MDG. Exploring the relationship between the number of systematic reviews and quality of evidence: an orthognathic surgery-based study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:101-112. [PMID: 38155010 DOI: 10.1016/j.oooo.2023.07.018] [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: 05/02/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We analyzed the quality and quantity of systematic reviews (SRs) of orthognathic surgery, the most frequently published topic in maxillofacial surgery. STUDY DESIGN We searched the PubMed database for SRs of orthognathic surgery with no restriction on the language of publication date. We assessed the certainty of evidence presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and the Leiden Manifesto using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed the data using descriptive statistics, Pearson´s correlation test, and linear regression. RESULTS Of the 171 SRs evaluated, approximately one fifth presented evidence with a high level of certainty. The number of orthognathic surgery SRs has been increasing, and many SRs were published after very similar topics had already been published. There is no relationship between the impact factor and the certainty of evidence. CONCLUSIONS An excessive number of SRs of orthognathic surgery are published, and many SRs are superfluous, simply reporting previous findings. Clinicians should not base treatment decisions solely on the evidence presented in SRs, and journal editors and reviewers should evaluate these SRs more critically, particularly when they address topics that have already been covered in the literature.
Collapse
Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Alexandre Meireles Borba
- Research Program in Integrated Dental Sciences Department, Faculty of Dentistry of the University of Cuiabá, Cuiabá-MT, Brazil
| | | | - Mariana Aparecida Brozoski
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria da Graça Naclério-Homem
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis-Faculty of Dentistry of the University of São Paulo, Brazil
| |
Collapse
|
9
|
Thamwatharsaree N, Panyarak W, Wantanajittikul K, Yarach U, Tachasuttirut K. Does Articular Disc Position Change Following Mandibular Setback Surgery? J Oral Maxillofac Surg 2024; 82:144-151. [PMID: 37992759 DOI: 10.1016/j.joms.2023.11.003] [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: 02/15/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Maintaining condyle position following bilateral sagittal split ramus osteotomy (BSSO) is crucial to minimizing postoperative relapse. However, the impact of BSSO on the articular disc position remains inconclusive. PURPOSE This study aimed to investigate the changes in articular disc position following setback BSSO surgery. STUDY DESIGN, SETTING, AND SAMPLING In this prospective cohort study, subjects with mandibular prognathism requiring setback BSSO were enrolled between August 2021 and June 2022 at the Oral and Maxillofacial Surgery Clinic, Faculty of Dentistry, Chiang Mai University, Thailand. Patients with surgical complications, loss of follow-up, or significant artifacts in their MR images were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES The predictor variable was time. The articular disc position was assessed at 3 time points, preoperatively (T0), 3 months postsurgery (T1), and 6 months postsurgery (T2). MAIN OUTCOME The primary and secondary outcome variables were the changes in articular disc position between T0-T2 and T0-T1, respectively. Articular disc position was coded as normal, anterior disc displacement with reduction (ADDwR), anterior disc displacement without reduction (ADDwoR), and anterior disc displacement without reduction and degenerative joint disease (ADDwoR + DJD). COVARIATES Covariate variables collected included age (years), sex (male or female), asymmetry (present or absent), surgical procedure (single jaw (BSSO) or bimaxillary surgery), and setback distance (millimeters). ANALYSES Friedman's test with 80% power and a significance level of 0.05 was employed. Pairwise comparisons were performed using the Dunn-Bonferroni posthoc test to identify statistically significant differences. RESULTS The study included 16 subjects, 6 females and 10 males, with a total of 32 TMJs. Subjects had a mean age of 23.75 (4.57) years. The proportion of TMJs with normal disc position postoperatively increased from 3 (9.4%) to 19 (59.4%). Statistically significant differences were found in the changes in disc position over time (P < .001). CONCLUSIONS Following setback BSSO, the articular discs underwent changes, with a majority of ADDwR cases transitioning to a normal position. Cases with ADDwoR also demonstrated disc reduction capability after surgery. The combined orthodontic treatment and setback BSSO appear to have an effect on articular disc position in skeleton class III patients.
Collapse
Affiliation(s)
- Nathakarn Thamwatharsaree
- Graduate Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Wannakamon Panyarak
- Assistant Professor, Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Kittichai Wantanajittikul
- Assistant Professor, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Uten Yarach
- Lecturer, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kathawut Tachasuttirut
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
| |
Collapse
|
10
|
Kazimierczak N, Kazimierczak W, Serafin Z, Nowicki P, Jankowski T, Jankowska A, Janiszewska-Olszowska J. Skeletal facial asymmetry: reliability of manual and artificial intelligence-driven analysis. Dentomaxillofac Radiol 2024; 53:52-59. [PMID: 38214946 PMCID: PMC11003660 DOI: 10.1093/dmfr/twad006] [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: 06/20/2023] [Revised: 08/29/2023] [Accepted: 11/11/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES To compare artificial intelligence (AI)-driven web-based platform and manual measurements for analysing facial asymmetry in craniofacial CT examinations. METHODS The study included 95 craniofacial CT scans from patients aged 18-30 years. The degree of asymmetry was measured based on AI platform-predefined anatomical landmarks: sella (S), condylion (Co), anterior nasal spine (ANS), and menton (Me). The concordance between the results of automatic asymmetry reports and manual linear 3D measurements was calculated. The asymmetry rate (AR) indicator was determined for both automatic and manual measurements, and the concordance between them was calculated. The repeatability of manual measurements in 20 randomly selected subjects was assessed. The concordance of measurements of quantitative variables was assessed with interclass correlation coefficient (ICC) according to the Shrout and Fleiss classification. RESULTS Erroneous AI tracings were found in 16.8% of cases, reducing the analysed cases to 79. The agreement between automatic and manual asymmetry measurements was very low (ICC < 0.3). A lack of agreement between AI and manual AR analysis (ICC type 3 = 0) was found. The repeatability of manual measurements and AR calculations showed excellent correlation (ICC type 2 > 0.947). CONCLUSIONS The results indicate that the rate of tracing errors and lack of agreement with manual AR analysis make it impossible to use the tested AI platform to assess the degree of facial asymmetry.
Collapse
Affiliation(s)
| | - Wojciech Kazimierczak
- Kazimierczak Private Dental Practice, 85-009 Bydgoszcz, Poland
- Department of Radiology and Diagnostic Imaging, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-067 Bydgoszcz, Poland
| | - Zbigniew Serafin
- Department of Radiology and Diagnostic Imaging, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-067 Bydgoszcz, Poland
| | - Paweł Nowicki
- Kazimierczak Private Dental Practice, 85-009 Bydgoszcz, Poland
| | | | | | | |
Collapse
|
11
|
Meral SE, Koç O, Tosun E, Tüz HH. Effects of sagittal split Ramus osteotomy on condylar position and Ramal orientation in patients with mandibular asymmetry. Clin Oral Investig 2023; 28:65. [PMID: 38158456 DOI: 10.1007/s00784-023-05400-9] [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: 09/22/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The purpose of this study is to assess the impact of Sagittal Split Ramus Osteotomy (SSRO) on the alignment of the condyle and orientation of the Ramal segment following surgery in patients operated for the correction of mandibular asymmetry. METHODS A total of 27 patients who underwent SSRO were enrolled in this study, and study groups were defined as asymmetric (study group) and symmetric (control group) using linear measurements from the dental midline based on a three-dimensional coordinate system. Differences on preoperative and postoperative values of anterior (AJS), posterior (PJS) and superior joint spaces (SJS), condylar axial angle (CAA), Sagittal Ramal Angle (SRA), and Coronal Ramal Angles (CRA) of study and control groups were measured and compared. The data was analyzed using the "Wilcoxon signed-ranks test" to identify differences between groups. RESULTS Differences between preoperative and postoperative values of CRA and SRA of the contralateral group showed statistically significant results with p-values of 0.007 and 0.005, respectively. A statistically significant change in CAA angle was found in the control and deviation groups (p = 0.018 and p = 0.010, respectively). CONCLUSIONS SSRO has inevitable effects on the condylar and ramal orientation. Individuals with asymmetry require particular attention throughout the planning process and beyond. Conjunctive modalities and modifications should be considered and utilized when necessary. Future studies with larger sample sizes, homogenous follow-up periods, and more comprehensive clinical data are needed to substantiate understanding of the response of the condylar segment. CLINICAL RELEVANCE Orthognathic surgeries inevitably alter the alignment and harmony of temporomandibular structures and may result in change of AJS, PJS, SJS, CAA, SRA, and LRA, which may change the biomechanics of joint and lead to several complications like temporomandibular disorders. Especially in cases with midline asymmetry needs special consideration from planning till the end of the treatment to achieve best results. In severe cases, conjunctive modalities and modifications and other alternatives such as inverted-L osteotomies should be considered.
Collapse
Affiliation(s)
- Salih Eren Meral
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey.
| | - Onur Koç
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
| | - Emre Tosun
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
| | - Hakan H Tüz
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Grillo R, Brozoski MA, Samieirad S, Al-Moraissi EA, Cavalcante RCL, Naclério-Homem MDG. Global network mapping research findings on orthognathic surgery and temporomandibular disorder. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101531. [PMID: 37290748 DOI: 10.1016/j.jormas.2023.101531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The objective of this work is to assess the relationship between orthognathic surgery and temporomandibular disorders literature through a bibliometric analysis. METHODS A bibliographic search in line with the STROBE guidelines and the concepts of the Leiden Manifesto was performed on the Web of Science using the terms orthognathic surgery AND temporomandibular. A citation analysis and establishment of the more cited articles were performed. A graphical representation of the keywords was created with VOSviewer. RESULTS A total of 810 articles were analyzed in this study. The research revealed a significant increase in publications on this topic, particularly in English language articles and a high H-index. The publications represented 55 nations, with the highest number of articles coming from the USA. The discussion of highly cited articles covered various aspects such as the relationship between orthognathic surgery and TMD, including condylar resorption or displacement, predisposing factors, dentoskeletal and occlusion patterns, anatomical factors, osteotomy techniques, condylar positioning techniques, and emerging technologies for improved TMJ stability. CONCLUSION The analysis reveals an increasing research interest in this field, with a significant number of publications in English and a high citation rate per article, indicating the impact of the research. Various factors associated with TMD in orthognathic surgery are explored, including condylar alterations, predisposing factors, occlusion patterns, and surgical techniques. The study underscores the importance of thorough assessment, treatment, and monitoring of TMD in orthognathic surgery patients, while acknowledging the need for further research and consensus in management strategies.
Collapse
Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Mariana Aparecida Brozoski
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil
| | - Sahand Samieirad
- Department of Oral & Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil
| |
Collapse
|
14
|
Ren R, Li Y, Telha W, Zhu S, Jiang N. Effect of the magnitude of condylar head displacement on the TMJ function in skeletal class II patients undergoing different degrees of mandibular advancement: A retrospective comparative study. J Plast Reconstr Aesthet Surg 2023; 84:241-249. [PMID: 37352620 DOI: 10.1016/j.bjps.2023.06.001] [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: 12/14/2022] [Accepted: 06/05/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE This study aimed to compare the condylar head displacement (CHD) after bilateral sagittal split ramus osteotomy (BSSO) between different degrees of mandibular advancement in skeletal class II patients and to evaluate whether the temporomandibular joint (TMJ) function would be affected. PATIENTS AND METHODS Fifty-nine patients (118 condyles) were included in this retrospective study and were divided into three groups based on the distance of mandibular advancement. The CHD in three directions, x (sagittal direction), y (coronal direction), and z (axial direction), was measured before operation (T0), immediately after operation (T1), and at least 6 months after operation (T2), and the TMJ function of patients was followed up and scored using the Helkimo index system. All the abovementioned data were statistically analyzed, and p < 0.05 was considered the statistical difference standard. RESULT During the BSSO surgery, the condyle was predominantly displaced in a lateral, posterior, and superior direction whenever in T1 and T2, even though the degree of CHD was different. Regarding the amount of CHD, the large advancement group was higher than the other two groups in T1 and T2 (p<0.01). The Helkimo index scores of the three groups were evaluated, and there was no significant statistical difference between the Ai and Di index of the three groups. CONCLUSION In our center, CHD occurred in lateral, posterior, and superior directions following mandibular advancement in skeletal class II patients, with a positive correlation between the CHD and the mandibular advancement; however, the TMJ function of the three groups did not show significant differences.
Collapse
Affiliation(s)
- Rong Ren
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China
| | - Yibo Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China
| | - Wael Telha
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China.
| | - Nan Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China.
| |
Collapse
|
15
|
Telha W, Bi R, Abotaleb B, Al-Watary M, Sakran K, Zhu S, Jiang N. Condylar positional changes and remodeling following bimaxillary anterior segment osteotomy with and without Le Fort I osteotomy: a three-dimensional comparative analysis. Clin Oral Investig 2023; 27:5121-5130. [PMID: 37474831 DOI: 10.1007/s00784-023-05132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To evaluate 3D condylar displacement and long-term remodeling following the correction of bimaxillary protrusion by anterior segment osteotomy (ASO) with and without Le Fort I surgery. MATERIALS AND METHOD This retrospective study included 32 adults with bimaxillary protrusion who underwent ASO alone (group 1) or with concomitant Le Fort I osteotomy (group 2). Subject's computed tomography scans at basic (T0), immediate postoperatively (T1), and at 1 year or more follow-up (T2) were collected. The condyle displacement was measured at superior-inferior, lateromedially, and anteroposterior surfaces, while condyle remodeling was measured at the superior, lateral, anterior, medial, and posterior surfaces. All 3D analyses were performed using 3D Slicer software (4.11.2). RESULTS At T1, 52.7%, 86.7%, and 94.4% of condyles in group 1 were displaced inferiorly, laterally, and posteriorly, respectively, as well as 75%, 89.2%, and 53.5% of condyles in group 2, which had not fully returned to the original preoperative positions at T2. Condylar remodeling was observed in both groups at T2, and no significant difference was found in the overall condylar volume between T1 and T2 in both groups. Patients in group 2 exhibited significant bone resorption at both lateral and anterior surfaces compared to group 1 (P = 0.000 and 0.01, respectively). CONCLUSION This study's results demonstrated that ASO is associated with a degree of condylar changes even if the posterior mandible is not osteomized. The positional changes vary between bimaxillary ASO alone and those with simultaneous Le Fort I osteotomy. However, both groups' condyle volume remained stable at the long-term follow-up.
Collapse
Affiliation(s)
- Wael Telha
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Rui Bi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Bassam Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Mohammed Al-Watary
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Karim Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China.
| | - Nan Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
16
|
Kimoto A, Yamashita J, Ohori H, Negi N, Sekitani T, Komori H, Shioyasono A, Tateishi C, Hasegawa T, Akashi M. A Novel Imaging Technique for Analyzing Condylar Movement During Mastication in Patients With Jaw Deformities: Four-Dimensional Computed Tomography. J Craniofac Surg 2023; 34:1880-1883. [PMID: 37428979 DOI: 10.1097/scs.0000000000009509] [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: 10/26/2022] [Accepted: 05/17/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE This study aimed to reveal characteristic condylar movements in patients with jaw deformities. STUDY DESIGN Thirty patients with jaw deformities before surgery were enrolled and instructed to chew a cookie during 4-dimensional computed tomography (4DCT). The distance between the most anterior and posterior positions of the bilateral condyles on 4DCT images was measured and compared among patients with different skeletal classes. Correlations between the condylar protrusion and cephalometric values were also determined. RESULTS The distances of condylar protrusion during mastication were significantly greater in the skeletal class II group than in the skeletal class III group ( P =0.0002). Significant correlations were found between the distances of condylar protrusion during mastication and the sella-nasion-B point angle ( r =-0.442, P =0.015), A point-nasion-B point angle ( r =0.516, P =0.004), sella-nasion plane to ramus plane angle ( r =0.464, P =0.01), sella-nasion plane to occlusal plane angle ( r =0.367, P =0.047), and condylion-gonion length ( r =-0.366, P =0.048). CONCLUSION Motion analysis with 4DCT images revealed that condylar movement in patients with retrognathism was larger than in patients with mandibular prognathism. Skeletal structure was therefore correlated with condylar movement during mastication.
Collapse
Affiliation(s)
- Akira Kimoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Yamashita
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Ohori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Negi
- Department of Radiology, Kobe University Hospital, Kobe, Japan
| | - Toshinori Sekitani
- Department of Radiological Technologist, Osaka College of High Technology, Osaka, Japan
| | - Hiroki Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Shioyasono
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Chizu Tateishi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
17
|
Crescente BB, Bisatto NV, Rübensam G, Fritscher GG, Campos MM. Assessment of temporomandibular disorders and their relationship with life quality and salivary biomarkers in patients with dentofacial deformities: A clinical observational study. PLoS One 2023; 18:e0288914. [PMID: 37471347 PMCID: PMC10358945 DOI: 10.1371/journal.pone.0288914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
A close relationship between dentofacial deformities (DFD) and temporomandibular disorders (TMD) has been suggested, which might impact the quality of life (QoL) and psychological aspects. We evaluated the presence of TMD in DFD patients, correlating these findings with QoL and salivary levels of biochemical markers of pain and psychological disorders. The study enrolled 51 patients, which were distributed into three groups: (i) orthodontic, (ii) TMD, and (iii) DFD. TMD diagnosis was conducted according to Axis I and II of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). QoL was evaluated by the Oral Health Impact Profile (OHIP-14). The salivary levels of interleukin-1β (IL-1β) were determined by ELISA, while glutamate and serotonin amounts were evaluated by mass spectroscopy. DFD individuals had a positive diagnosis for TMD, as indicated by the Axis I (DC/TMD). They exhibited poorer outcomes regarding pain, functional, and psychological dimensions, according to the Axis II DC-TMD. The QoL evaluation demonstrated poorer outcomes for DFD individuals, accompanied by greater IL-1β salivary contents. Notably, glutamate levels had a positive correlation with behavioral parameters in Axis II DC-TMD, with a mild relevance for serotonin. DFD patients display chronic myofascial pain featuring TMD, with altered psychological symptoms and poor QoL, encompassing changes in pain mediators. Data bring new evidence about the relevance of TMD in DFD patients, which likely impacts the QoL and the salivary levels of biochemical markers of functional, painful, and psychological disorders.
Collapse
Affiliation(s)
- Betina B Crescente
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Natalia V Bisatto
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriel Rübensam
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Guilherme G Fritscher
- Ambulatório de Cirurgia Oral, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria M Campos
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| |
Collapse
|
18
|
Marlière DAA, Vicentin Calori MJA, Medeiros YDL, Santiago RC, Strujak G, Asprino L. Clinical outcomes of the discopexy using suture anchors for repositioning disc displacement in temporomandibular joints: Systematic review and meta-analysis. J Craniomaxillofac Surg 2023; 51:475-484. [PMID: 37517977 DOI: 10.1016/j.jcms.2023.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 04/05/2023] [Accepted: 06/25/2023] [Indexed: 08/01/2023] Open
Abstract
The present study evaluated the literature regarding the clinical outcomes after discopexy using suture bone anchors for repositioning disc displacement. A systematic review was conducted according to the PRISMA statement and applied for the PROSPERO platform. The database searches were performed in the PubMed, Scopus, Web of Science, EMBASE, The Cochrane Library, and LILACS for full articles published from no restrictions of the initial period time to April 2022. Selection criteria included clinical studies in humans comparing maximal inter-incisal opening (MIO), pain by visual analogue scale (VAS), and protrusive and lateral excursions before and after discopexy. The screening process was performed by two independent reviewers, and if they did not agree with each other, a third reviewer was consulted before proceeding. The meta-analysis was carried out by Comprehensive Meta-Analysis software. Eleven studies met the inclusion criteria. A total of 327 patients were diagnosed with disc displacement, and 142 patients were refractory to conservative and minimally surgical therapies. Preauricular and endaural approaches were performed to place suture bone anchors on the posterior area of the condyle. A significant difference was found in MIO, which ranged from 15.5 mm pre-opeatively to 41.6 mm post-operatively (p = 0.001). Pain scores using the VAS ranged from 7.42 to 0.28 indicating improvement post-operatively (p = 0.001). Mandibular excursions were underestimated. The available results have shown that discopexy using suture anchors seemed to decrease pain and improve mouth opening. Clinical studies are required in a larger sample and lower variability of follow-up time to predict actual benefits.
Collapse
Affiliation(s)
- Daniel Amaral Alves Marlière
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil; Division of Oral and Maxillofacial Surgery, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.
| | | | | | - Rodrigo César Santiago
- Division of Oral and Maxillofacial Surgery, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - Luciana Asprino
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| |
Collapse
|
19
|
Uetanabaro LC, Gerber JT, Dos Santos KM, Meger MN, da Costa DJ, Küchler EC, Sebastiani AM, Scariot R. Prevalence and associated factors of myofascial pain in orthognathic patients with skeletal class II malocclusion. Oral Maxillofac Surg 2023; 27:25-31. [PMID: 35262814 DOI: 10.1007/s10006-022-01046-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
UNLABELLED Orthognathic patients with skeletal class II malocclusion frequently suffer from myofascial pain (MP). PURPOSE This study aimed to evaluate the prevalence and associated factors of MP in these patients. METHODS This cross-sectional study was performed in adult patients with skeletal Class II malocclusion requiring orthognathic surgery. They were divided according to the presence or absence of MP. The predictor variables were craniofacial morphology, sex, temporomandibular disorders, chronic pain, depression, and polymorphisms of dopamine receptors DRD2 (rs6275 and rs6276) and ANKK1 (rs1800497) genes. Data were submitted to statistical analyses using the linear regression model and Poisson regression with a significance level of 0.05. RESULTS Sixty-five individuals were selected, of which 50 (76.92%) were females. A total of 21 (32.3%) patients had MP. Individuals with MP showed a decrease in the mandible gonial angle (p = 0.042) and an increased risk of having temporomandibular joint (TMJ) disc displacement (p = 0.003), TMJ pain (p = 0.030), chronic pain (p = 0.001), and severe depression (p = 0.015). Additionally, individuals carrying AA and AG genotypes in rs6275, and CC genotype in rs6276, were more likely to have MP (p < 0.05). CONCLUSION In this study, 32.3% of skeletal class II orthognathic patients had MP, which was associated with a decreased gonial angle, TMJ disc displacement, TMJ pain, chronic pain, depression, and polymorphisms in the DRD2 gene.
Collapse
Affiliation(s)
| | | | | | | | - Delson João da Costa
- Department of Stomatology, Federal University of Parana, 632 Prefeito Lothário Meissner Avenue, Curitiba, PR, 80210-170, Brazil
| | - Erika Calvano Küchler
- Department of Pediatric Dentistry, Ribeirão Preto Dental School, University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Aline Monise Sebastiani
- Department of Stomatology, Federal University of Parana, 632 Prefeito Lothário Meissner Avenue, Curitiba, PR, 80210-170, Brazil.
| | - Rafaela Scariot
- Department of Stomatology, Federal University of Parana, 632 Prefeito Lothário Meissner Avenue, Curitiba, PR, 80210-170, Brazil
| |
Collapse
|
20
|
Sjöström M, Lund B, Sunzel B, Bengtsson M, Magnusson M, Rasmusson L. Starting a Swedish national quality registry for orthognathic surgery: a tool for auditing fundamentals of care. BMC Oral Health 2022; 22:588. [PMID: 36494655 PMCID: PMC9732981 DOI: 10.1186/s12903-022-02568-6] [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: 06/25/2022] [Accepted: 11/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND National quality registries (NQRs) provide open data for user-directed acquisition. National Quality Registry (NQR) data are often used to analyze the rates of treatment success and adverse events for studies that aim to improve treatment quality and patient satisfaction. Thus, NQRs promote the goal of achieving evidence-based therapies. However, the scientific literature seldom focuses on the complex process of initiating, designing, and implementing an NQR. Starting an NQR may be particularly challenging in a setting where specialized care is decentralized, such as orthognathic surgery in Sweden. The present study describes the initiation and early phases of a new NQR for orthognathic surgery in Sweden. METHODS The initial inventory phase included gaining knowledge on regulations, creating economic plans, and identifying pitfalls in existing NQRs. Next, a crude framework for the registry was achieved. Outcome measures were selected with a nation-wide questionnaire, followed by a Delphi-like process for selecting parameters to include in the NQR. Our inclusive process comprised a stepwise introduction, feedback-based modifications, and preparatory educational efforts. Descriptive data were collected, based on the first 2 years (2018-2019) of registry operation. RESULTS Two years after implementation, 862 patients that underwent 1320 procedures were registered. This number corresponded to a 91% coverage rate. Bimaxillary treatments predominated, and the most common were a Le Fort I osteotomy combined with a bilateral sagittal split osteotomy (n = 275). Reoperations were conducted in 32 patients (3.6%), and the rate of patient satisfaction was 95%. CONCLUSIONS A National Quality Registry should preferentially be started and maintained by an appointed task force of active clinicians. A collaborative, transparent, inclusive process may be an important factor for achieving credibility and high coverage, particularly in a decentralized setting.
Collapse
Affiliation(s)
- Mats Sjöström
- grid.412215.10000 0004 0623 991XOral and Maxillofacial Surgery, Umeå University Hospital, Umeå, Sweden ,grid.12650.300000 0001 1034 3451Department of Odontology, Umeå University, Umeå, Sweden
| | - Bodil Lund
- grid.4714.60000 0004 1937 0626Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Department for Oral and Maxillofacial Surgery and Jaw Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Bo Sunzel
- grid.32995.340000 0000 9961 9487Dep Oral and Maxillofacial surgery Public Dental health Växjö, Malmö University, Malmö, Sweden
| | - Martin Bengtsson
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Oral & Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden
| | - Mikael Magnusson
- Department of Specialist Dentistry, Oral and Maxillofacial Surgery, Colloseum and Smile AB, Stockholm, Sweden
| | - Lars Rasmusson
- grid.8761.80000 0000 9919 9582Department of Oral and Maxillofacial Surgery, The Sahlgrenska Academy and hospital, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
21
|
Kim HS, Han SS, Lee C. Unintentional temporomandibular joint disc reduction after orthognathic surgery: A case report with long-term imaging follow-up. Imaging Sci Dent 2022; 52:409-413. [PMID: 36605856 PMCID: PMC9807793 DOI: 10.5624/isd.20220048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 01/09/2023] Open
Abstract
This report presents a rare case where a displaced temporomandibular joint (TMJ) disc was reduced to its normal position after orthognathic surgery, and long-term magnetic resonance imaging (MRI) follow-up visualized these postoperative changes. A 22-year-old male patient presented for facial asymmetry. He also complained of pain in the right TMJ area, and MRI showed disc displacements in both TMJs. After orthognathic surgery for facial asymmetry correction, the TMJ was re-evaluated. The symptom had resolved and the disc was positioned within the normal range during mouth opening. However, 6 and a half years after surgery, he complained of recurrent pain in the right joint, and MRI revealed medial disc displacement in the right TMJ. In conclusion, the influence of orthognathic surgery on the disc position might continue for a long time until the TMJ adapts to the new position. Careful and long-term follow-up is suggested to assess the TMJ complex.
Collapse
Affiliation(s)
- Hak-Sun Kim
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| |
Collapse
|
22
|
Kaur A, Rattan V, Rai S, Singh SP, Kalra P, Sharma S. Changes in condylar position after orthognathic surgery and its correlation with temporomandibular symptoms (TMD)- a prospective study. J Craniomaxillofac Surg 2022; 50:915-922. [PMID: 36621385 DOI: 10.1016/j.jcms.2022.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/16/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
The aim of the study was to assess the changes in the condylar position after orthognathic surgery (OGS) and its effect on temporomandibular disorders (TMD). A total of 37 dentofacial deformity patients included in the study who had undergone OGS were divided into three groups: Group I, Le Fort I maxillary advancement; Group II, bilateral sagittal split osteotomy (BSSO) mandibular advancement ± Le Fort I; and Group III, BSSO mandibular setback ± Le Fort I. Patients were evaluated clinically using Diagnostic Criteria for TMD and by radiography preoperatively and 6 months postoperatively. The positional changes in condyle were correlated with signs and symptoms of TMD. A total of 37 patients in three groups (Group I, 8 patients; Group II, 10 patients; and Group III, 19 patients) were evaluated. Overall, condyles had anterio-medio-inferior movement with 7 of 8 patients in Group I, 6 of 10 patients in Group II and 13 of 19 patients in Group III having ≤2 mm displacement. In angular changes, inward-anterio-medial movement was observed with 6 of 8 patients in Group I; about 5 of 10 patients, and 10 of 19 patients in Group II and III respectively had ≤5° change. Intragroup and intergroup comparisons showed insignificant changes in TMD and linear/angular movement (p ≥ 0.05). Pearson correlation coefficient was found to be nonsignificant on the radiographic and clinical comparison (p ≥ 0.05). Intrarater reliability (Kappa value) was found to be 0.83, confirming the results. Within the limitations of the study it seems that there are minimal linear and angular changes in condyle after orthognathic surgery that were not responsible for the development of temporomandibular disorders in the postoperative course.
Collapse
Affiliation(s)
- Amanjot Kaur
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Vidya Rattan
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Sachin Rai
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Satinder Pal Singh
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Parveen Kalra
- Centre of Excellence in Industrial and Product Design, Punjab Engineering College, Chandigarh, India.
| | - Shagun Sharma
- Centre of Excellence in Industrial and Product Design, Punjab Engineering College, Chandigarh, India.
| |
Collapse
|
23
|
Chen CM, Chen PJ, Hsu HJ. Changes in Preexisting Temporomandibular Joint Clicking after Orthognathic Surgery in Patients with Mandibular Prognathism. Bioengineering (Basel) 2022; 9:bioengineering9120725. [PMID: 36550931 PMCID: PMC9774496 DOI: 10.3390/bioengineering9120725] [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: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the changes in preexisting temporomandibular joint (TMJ) clicking and the new incidence of TMJ clicking after orthognathic surgery. A total of 60 patients (30 men and 30 women) with mandibular prognathism underwent intraoral vertical ramus osteotomy (IVRO) for a mandibular setback. The setback amount and TMJ clicking symptoms (preoperative and one year postoperative) were recorded. To assess the risk of new incidence of TMJ clicking in asymptomatic patients, the cutoff value for postoperative mandibular setback was set at 8 mm. The left and right mandibular setbacks were 11.1 and 10.9 mm in men, respectively, and 10.7 and 10.0 mm in women, respectively. Thus, no difference in setback amount on either side was observed between the sexes. The improvement rate in patients with preexisting TMJ clicking was 69.2% (18 of 26 sides); the postoperative improvement rates were 71.4% (setback amount > 8 mm) and 60% (setback amount ≤ 8 mm). IVRO may reduce the severity of preexisting TMJ clicking. A high setback amount (>8 mm) may not be associated with a considerable increase in the risk of postoperative TMJ clicking.
Collapse
Affiliation(s)
- Chun-Ming Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Pei-Jung Chen
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Han-Jen Hsu
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- School of Oral Hygiene, College of Dental Science, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101
| |
Collapse
|
24
|
"Proportional Condylectomy" for Vertical Condylar Hyperplasia Without Intermaxillary Elastics: Clinical Results and Patient Satisfaction. J Craniofac Surg 2022; 34:1004-1009. [PMID: 36217227 DOI: 10.1097/scs.0000000000009053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES First, to investigate the clinical outcome of 'proportional condylectomy' for patients with active unilateral condylar hyperplasia without complementary treatment by intermaxillary elastics and, second, to examine their level of satisfaction regarding function and esthetics. STUDY DESIGN A retrospective observational descriptive study was conducted. All patients included in the study suffered from active unilateral condylar hyperplasia with a vertical component. The length of the condylar-ramus unit was measured on both sides by an multidetector computed tomography scan. The difference was calculated and resected from the hyperplastic condyle during the operation. Facial, occlusal, and skeletal changes were evaluated using photographic and radiologic records, and a satisfaction questionnaire regarding function and esthetics was completed. P<0.05 was considered significant. RESULTS Fifteen patients were included in the study. The mean participants' age was 27.93±13.06 years, and the mean follow-up duration was 12.40±6.55 months. The mean chin deviation improved by 58.47% (P=0.001). Mean lip commissure plane tilt was improved by 61.31% (P=0.001). Six months postoperatively, all patients exhibited centered dental midlines (P=0.001). Occlusal plane tilt was significantly improved by 70.02% (P=0.001), and high patient satisfaction was recorded. Twenty-six percent (4/15) of patients did not require the complementary orthodontic treatment, and none of them required complementary orthognathic surgery. CONCLUSIONS 'Proportional condylectomy' for patients with active unilateral vertical condylar hyperplasia without complementary treatment by intermaxillary elastics is a predictable procedure in terms of function and esthetics.
Collapse
|
25
|
Muacevic A, Adler JR. The Impact of Orthodontic Treatment on Masticatory Performance: A Literature Review. Cureus 2022; 14:e30453. [PMID: 36415350 PMCID: PMC9674042 DOI: 10.7759/cureus.30453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 01/20/2023] Open
Abstract
The aim of this narrative review was to evaluate the possible association between orthodontic therapy and improved masticatory function. A search strategy was conducted using the PubMed database for up to January 2020 using the keywords "mastication" and "orthodontics". Only human studies investigating mastication in orthodontics settings were selected. The search strategy resulted in 1,011 articles, out of which 57 were included in the final analysis. Investigations have generally agreed that masticatory and chewing functions improved post-orthodontic and orthognathic treatments. Studies also showed improvement in the quality of life of patients' post-orthodontic treatment. The articles examined reinforced that besides esthetic reasons, orthodontic therapy does improve the masticatory and chewing functions of individuals, ultimately enhancing their health-related quality of life.
Collapse
|
26
|
Endo S, Niimi K, Kato Y, Nohno K, Hasebe D, Hayashi T, Saito I, Kobayashi T. Examination of factors affecting condylar bone changes following surgical-orthodontic treatment. Cranio 2022:1-11. [PMID: 36101940 DOI: 10.1080/08869634.2022.2118263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To identify factors affecting condylar bone changes following surgical-orthodontic treatment. METHODS A total of 200 patients with dentofacial deformities were classified into skeletal Classes I, II, and skeletal Class III groups consisting of 61 and 139 subjects, respectively. Temporomandibular joints (TMJs) were evaluated using clinical findings and computed tomography images before treatment, immediately before surgery, and 6 months after surgery. RESULTS Condylar bone changes occurred at a significantly higher rate after surgery in both groups. Factors related to condylar bone changes following surgical-orthodontic treatment included skeletal Class I or II, disc displacement, and condylar bone changes before treatment. There were three cases with condylar bone changes after surgery that were diagnosed with condylar resorption and skeletal Class II and anterior disc displacement before surgery. CONCLUSION Condylar resorption could occur when the load on the condyle increases after orthognathic surgery and exceeds the permissible limit.
Collapse
Affiliation(s)
- Satoshi Endo
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| | - Kanae Niimi
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
- Oral Management Unit for Medical Cooperation, Niigata University Medical and Dental Hospital, Niigata City, Japan
| | - Yusuke Kato
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
- Department of Oral and Maxillofacial Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma City, Japan
| | - Kaname Nohno
- Division of Preventive Dentistry, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| | - Daichi Hasebe
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| | - Takafumi Hayashi
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| | - Isao Saito
- Division of Orthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| | - Tadaharu Kobayashi
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| |
Collapse
|
27
|
Long-term three-dimensional condylar remodeling during presurgical orthodontics and after orthognathic surgery of mandibular retrognathia with high mandibular plane angle. Clin Oral Investig 2022; 26:7253-7263. [PMID: 35978222 DOI: 10.1007/s00784-022-04686-5] [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: 01/07/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patients with high mandibular plane facial morphology are the most dominant facial type who experience TMJ abnormalities with resultant condylar resorption, affecting the orthodontic and orthognathic treatment outcomes. The study aimed to quantitatively assess the three-dimensional condylar remodeling during the presurgical orthodontics and after orthognathic surgery of the retrognathic mandible with a high mandibular plane angle. The study also investigated the correlation between the resultant remodeling based on the hypothesis that condylar resorption following orthognathic surgery is a part of a progressive presurgical resorption process. MATERIALS AND METHODS The study included adults with mandibular retrognathism and high mandibular plane angle who have computed tomography scans (CT) obtained before any treatment (T0), after completion of presurgical treatment before surgery (T1), and at long-term follow-up after surgery (T2). DICOM of CT scan was gathered and processed using ITK-SNAP and 3D Slicer software. The interval between T0 and T1 was represented as a presurgical phase, while between T1 and T2 was defined as a postsurgical phase (T1-T2). RESULTS Twenty-five patients (50 condyles) were included with a mean age of 23 ± 3.2 years. The mean of the follow-up during the presurgical phase was 19.8 ± 7.1 months and 15.5 ± 5.5 months during the postsurgical phase. The condylar volume during the presurgical phase (T0-T1) was relatively stable (- 3.3 ± 37.2mm3). However, during the postsurgical phase (T1-T2), the volume was significantly reduced - 113.8 ± 98.3mm3 (P < 0.001). Localized condylar surface resorption during the postsurgical phase was significantly higher than during the presurgical phase (P < 0.05). No correlation was found between the localized condylar surface remodeling during the presurgical and postsurgical phases. However, a negative statistically significant correlation existed between the overall condylar volume changes during the presurgical and postsurgical phases (r = 0.502, P < 0.001). CONCLUSION Significant condylar resorption following orthognathic surgery of the retrognathic mandible with a high mandibular plane angle might occur regardless of the presurgical status of the condyle. CLINICAL RELEVANCE The study provided an evidence to be discussed with the patients and considered throughout the treatment of mandibular retrognathia with high mandibular plane angle.
Collapse
|
28
|
Ohba S, Tominaga J, Shido R, Koga T, Yamamoto H, Zaiima H, Yoshida N, Asahina I. Influence of different treatment procedures on the temporomandibular joint after mandibular setback in skeletal class III - A retrospective study. J Craniomaxillofac Surg 2022; 50:712-718. [DOI: 10.1016/j.jcms.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
|
29
|
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.
Collapse
|
30
|
Leck R, Paul N, Rolland S, Birnie D. The consequences of living with a severe malocclusion: A review of the literature. J Orthod 2022; 49:228-239. [PMID: 34488471 PMCID: PMC9160782 DOI: 10.1177/14653125211042891] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
AIM To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living with a severe malocclusion. METHODS A comprehensive narrative literature review was conducted to explore the potential complications of severe malocclusion. A systematic electronic literature search of four databases combined with supplementary hand searching identified 1024 articles of interest. A total of 799 articles were included in the narrative literature review, which was divided into 10 themes: Oral Health Related Quality Of Life; Temporomandibular Joint Dysfunction; Masticatory Limitation; Sleep Apnoea; Traumatic Dental Injury; Tooth Surface Loss; Change Over Time; Periodontal Injury; Restorative Difficulty; and Functional Shift and Dual Bite. A deductive approach was used to draw conclusions from the evidence available within each theme. RESULTS The narrative literature review established 27 conclusions, indicating that those living with a severe malocclusion may be predisposed to a range of potential consequences. With the exception of Oral Health Related Quality Of Life, which is poorer in adults with severe malocclusion than those with normal occlusions, and the risk of Traumatic Dental Injury, which increases when the overjet is >5 mm in the permanent and 3 mm in the primary dentition, the evidence supporting the remaining conclusions was found to be of low to moderate quality and at high risk of bias. CONCLUSION This article summarises the findings of a comprehensive narrative literature review in which all of the relevant research evidence within a substantive investigative area is established and evaluated. Notwithstanding limitations regarding the quality of the available evidence; when combined with clinical expertise and an awareness of individual patient preferences, the conclusions presented may facilitate the orthognathic shared decision-making process and furthermore, may guide the development of the high-quality longitudinal research required to validate them.
Collapse
Affiliation(s)
- Richard Leck
- School of Dental Sciences, Newcastle University,
Newcastle upon Tyne, UK
| | - Ninu Paul
- School of Dental Sciences, Newcastle University,
Newcastle upon Tyne, UK
| | - Sarah Rolland
- School of Dental Sciences, Newcastle University,
Newcastle upon Tyne, UK
| | - David Birnie
- School of Dental Sciences, Newcastle University,
Newcastle upon Tyne, UK
| |
Collapse
|
31
|
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.
Collapse
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.
| |
Collapse
|
32
|
Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines. Int J Oral Maxillofac Surg 2022; 51:1211-1225. [PMID: 35339331 DOI: 10.1016/j.ijom.2021.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/10/2021] [Accepted: 11/16/2021] [Indexed: 01/08/2023]
Abstract
Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.
Collapse
|
33
|
Sahu GR, Kaur A, Rattan V, Singh SP, Rai S. Effect of Orthognathic Surgery on Temporomandibular Disorders: A Prospective Study. J Maxillofac Oral Surg 2022; 21:277-282. [PMID: 35400935 PMCID: PMC8934891 DOI: 10.1007/s12663-021-01644-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose The relationship of orthognathic surgery and temporomandibular disorders (TMD) has always been a topic of debate. The results have varied from mild/moderate improvement to actual worsening in some cases. The purpose of this study was to evaluate the effects of orthognathic surgery on TMD in patients with dentofacial deformities. Method An observational study was conducted on 56 patients (112 condyles) of patients with dentofacial deformities with age range of 19-35 years who underwent orthognathic surgery. TMD was evaluated using seven types of disorders in diagnostic criteria for TMD (DC/TMD, 2010) pre-operatively and after 6-month follow-up. Results There was minimal decrease in unassisted mouth opening without pain, maximum unassisted mouth opening and maximum assisted mouth opening after surgery. There was significant improvement in joint sounds and headache in 18 patients. Overall, there was improvement in 29 cases (33.93%), worsening in 8 cases (14.29%) and no change in 19 cases (33.93%). Conclusion There was high prevalence of TMDs in dentofacial deformity patients. Most of the patients with pre-operative TMD improved with orthognathic surgery, whereas a small percentage of patients who were asymptomatic pre-operatively developed TMD after surgery and in some patients TMD worsened. The risk of developing TMD and worsening of severity conditions is low.
Collapse
Affiliation(s)
- Gyana Ranjan Sahu
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjot Kaur
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidya Rattan
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satinder Pal Singh
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Rai
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
34
|
The Frequency of Temporomandibular Disorders, Surgical Complications, and Self-Reported Mental Health Problems in Orthognathic Patients. J Craniofac Surg 2022; 33:2076-2081. [PMID: 35240673 DOI: 10.1097/scs.0000000000008579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/29/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the frequency of signs and symptoms of temporomandibular disorders (TMD), surgical complications, and patient's self-reported mental health problems during orthognathic treatment. MATERIAL AND METHODS The clinical records of 145 patients treated with orthognathic treatment were retrospectively studied. Variables regarding occlusal parameters, treatment duration, TMD symptoms, complications, and self-reported mental health status at time points of T0 (beginning of the treatment), T1 (before surgery), and T2 (final examination) were evaluated. The variables were statistically compared with significance level of P < 0.05. RESULTS A total of 51% (n = 74) of the patients had TMD symptoms at 1 or several time points, women having significantly more TMD signs and symptoms (P = 0.002). Temporomandibular disorder signs and symptoms decreased significantly after orthognathic treatment (P=0.001). At least 1 self-reported mental health-related factor during 1 or several time points (T0-T2) was recorded in 17.2% (n = 25) of the patients. There was no significant difference in frequency of self-reported mental health problems in patients with TMD signs and symptoms compared with patients without TMD signs and symptoms (P > 0.05). The frequency of postoperative complications was 39.3%, being significantly higher after Bilateral Sagittal Split Osteothomy (BSSO, 48.7%). There was no difference in treatment duration of patients with self-reported mental health problems compared with patients without (P > 0.05). CONCLUSIONS In this study population, TMD signs and symptoms seem to be typical both in patients with or without self-reported mental health problems. Women had significantly more TMD symptoms. Orthognathic surgery treatment seems to have a positive effect on TMD signs and symptoms.
Collapse
|
35
|
Toh AQJ, Leung YY. The effect of orthognathic surgery on temporomandibular disorder. J Craniomaxillofac Surg 2021; 50:218-224. [PMID: 34887170 DOI: 10.1016/j.jcms.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/17/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022] Open
Abstract
This study aimed to evaluate the difference in prevalence of temporomandibular disorder (TMD) before and after orthognathic surgery (OGS), particularly in patients with mandibular asymmetry. A prospective cohort study of patients undergoing corrective orthognathic surgery was conducted. Pre-operative and post-operative (3 months, 6 months and 1 year) TMD assessment were performed according to the Diagnostic Criteria for TMD (DC/TMD) protocol. 64 patients were included in the study. Overall, there was a significant reduction of 26.5% in TMD prevalence from 60.9% pre-operatively to 34.4% 1-year post-operatively (p = 0.003). In all, 37.5% of patients had their TMD condition treated, 50% had no change in their symptoms while 12.5% experienced a worsening of their symptoms. No significant difference in terms of change in TMJ status was observed among the different ramus procedures, the type and magnitude of mandibular movement, skeletal class, and presence of mandibular asymmetry. In conclusion, it appears that corrective orthognathic surgery for dentofacial deformities might provide a secondary benefit of treating TMD. However, surgeons have to be aware that a small percentage of patients might experience a deterioration of their TMD condition, and that those who were previously asymptomatic may develop TMD symptoms after surgery.
Collapse
Affiliation(s)
- Aileen Qiu Jin Toh
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong.
| |
Collapse
|
36
|
Park J, Hong KE, Yun JE, Shin ES, Kim CH, Kim BJ, Kim JH. Positional changes of the mandibular condyle in unilateral sagittal split ramus osteotomy combined with intraoral vertical ramus osteotomy for asymmetric class III malocclusion. J Korean Assoc Oral Maxillofac Surg 2021; 47:373-381. [PMID: 34713812 PMCID: PMC8564090 DOI: 10.5125/jkaoms.2021.47.5.373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 10/06/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES In the present study, the effects of sagittal split ramus osteotomy (SSRO) combined with intraoral vertical ramus osteotomy (IVRO) for the treatment of asymmetric mandible in class Ⅲ malocclusion patients were assessed and the postoperative stability of the mandibular condyle and the symptoms of temporomandibular joint disorder (TMD) evaluated. MATERIALS AND METHODS A total of 82 patients who underwent orthognathic surgery for the treatment of facial asymmetry or mandibular asymmetry at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital, from 2016 to 2021 were selected. The patients that underwent SSRO with IVRO were assigned to Group I (n=8) and patients that received bilateral SSRO (BSSRO) to Group II (n=10, simple random sampling). Preoperative and postoperative three-dimensional computed tomography (CT) axial images obtained for each group were superimposed. The condylar position changes and degree of rotation on the superimposed images were measured, and the changes in condyle based on the amount of chin movement for each surgical method were statistically analyzed. RESULTS Group I showed a greater amount of postoperative chin movement. For the amount of mediolateral condylar displacement on the deviated side, Groups I and II showed an average lateral displacement of 0.07 mm and 1.62 mm, respectively, and statistically significantly correlated with the amount of chin movement (P=0.004). Most of the TMD symptoms in Group I patients who underwent SSRO with IVRO showed improvement. CONCLUSION When a large amount of mandibular rotation is required to match the menton to the midline of the face, IVRO on the deviated side is considered a technique to prevent condylar torque. In the present study, worsening of TMD symptoms did not occur after orthognathic surgery in any of the 18 patients.
Collapse
Affiliation(s)
- Jun Park
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Ki-Eun Hong
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Ji-Eon Yun
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Eun-Sup Shin
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Chul-Hoon Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Bok-Joo Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Jung-Han Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| |
Collapse
|
37
|
Bilateral Sagittal Split Mandibular Ramus Osteotomy Alters the Temporomandibular Joint. J Craniofac Surg 2021; 32:e598-e600. [PMID: 34387266 DOI: 10.1097/scs.0000000000007898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In this retrospective analysis, we examined temporomandibular joint space volume and condyle position in 10 patients undergoing bilateral sagittal split mandibular ramus osteotomy plus Le Fort I osteotomy to correct mandibular asymmetry. Cone beam computed tomography was used to map temporomandibular joint prior to (T0), immediately after (T1), and at 1 year after surgery (T2). In the deviated side, we detected significant lateral shift of the condyle in 5 patients at T1, and the shift disappeared at T2. In the non-deviated side, we detected significant medial shift of the condyle in all 10 patients at T1; the shift continued in 9 patients at T2. Temporomandibular joint space volume increased significantly at T1 and returned to presurgical volume at T2. In conclusion, there is significant shift in position of condyle in majority of the patients after bilateral sagittal split mandibular ramus osteotomy. The most consistent and persisting change was medial shift on the nondeviated side.
Collapse
|
38
|
Quality of Life After Class III Repair Orthognathic Surgery: Five-Year Retrospective Study. J Craniofac Surg 2021; 32:2588-2591. [PMID: 34172683 DOI: 10.1097/scs.0000000000007716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the effect of orthognathic surgery on the long-term quality of life of patients with presurgical skeletal Class III and to identify its strongest effect-whether esthetic, social, or functional. MATERIALS AND METHODS In this retrospective cohort study, the subjects were patients after orthognathic surgery for repairing skeletal Class III. Fifty-five patients who had undergone orthognathic surgery from 2013 to 2018 in the oral and maxillofacial surgery department participated in this study. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery. RESULTS The rate of esthetic improvement in orthognathic surgery patients was 88%. More than four-fifths (81.8%) of the patients reported improvement in their personal and social self-esteem and confidence. Finally, 40.7% of the patients reported functional improvement. No significant differences between male and female patients were found. All but one of the patients recommended orthognathic surgery for patients with similar problems. One in six (17.3%) patients was dissatisfied with the nasal appearance after the surgical procedure, while almost a quarter (21.8%) reported worsening of their mouth opening, and 25.4% reported worsening of TMJ (Temporo-Mandibular Joint) symptoms. Analysis of the results revealed no statistically significant pattern connecting preoperative overjet or overbite measures with satisfaction rates. CONCLUSIONS In this study, patient satisfaction with the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance, mouth opening, and TMJ complaints.
Collapse
|
39
|
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
| |
Collapse
|
40
|
Vieira AR, Prinz MCO. Patient Centeredness in Orthognathic Surgery. Clin Pract 2021; 11:92-100. [PMID: 33562459 PMCID: PMC7930993 DOI: 10.3390/clinpract11010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022] Open
Abstract
Patient centeredness in planning treatment and research has become paramount. The goal of this report was to describe a complex case in which untreated chronic pain was not properly addressed to reflect on the need to establish alternative protocols for controlling chronic orofacial pain. When a female underwent orthognathic surgery to correct her occlusion, she not only ended up with a worse occlusion, she developed chronic orofacial pain that could not be treated by opioids and only improved after the use of neuropathic medication, and finally disappeared after the use of low-level laser therapy. There is a need to incorporate alternative nonpharmacological approaches to manage chronic pain. Further, what the patient’s goals are for their treatments should be given priority in case of elective procedures.
Collapse
|
41
|
Bergamaschi IP, Cavalcante RC, Fanderuff M, Gerber JT, Petinati MFP, Sebastiani AM, da Costa DJ, Scariot R. Orthognathic surgery in class II patients: a longitudinal study on quality of life, TMD, and psychological aspects. Clin Oral Investig 2021; 25:3801-3808. [PMID: 33415380 DOI: 10.1007/s00784-020-03709-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate, longitudinally, the impacts of orthognathic surgery in patients with skeletal class II malocclusion on oral health-related quality of life (OHRQoL), temporomandibular disorders (TMD) and psychological symptoms. MATERIALS AND METHODS Forty-three patients with skeletal class II malocclusion who were submitted to orthognathic surgery were evaluated during their preoperative and postoperative periods. They answered the short version of the Oral Health Impact Profile (OHIP-14) and were also diagnosed according to Axes I and II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The evolution of OHRQoL and TMD before and after surgery was verified, and the relationships among these variables were found through statistical analysis using Wilcoxon, McNemar, chi-square, and Mann-Whitney tests, with a 5% significance level. RESULTS The median of the overall OHIP-14 score and five domains decreased after orthognathic surgery (p < 0.05), the functional limitation domain increased (p = 0.014), and the physical disability domain did not show an association (p = 0.133). There were improvements in articular pain (p = 0.016), chronic pain (p = 0.019), and nonspecific physical symptoms excluding pain (p = 0.013). In addition, an association was found between poorer OHRQoL (overall scale and domains) and the Axis II variables of the RDC/TMD (p < 0.05). CONCLUSION Orthognathic surgery improved perceived OHRQoL, articular pain, and chronic pain. The conditions of Axis II of the RDC/TMD interfered with OHRQoL postoperatively. CLINICAL RELEVANCE Although orthognathic surgery improves QoL and some TMD conditions in skeletal class II patients, poorer postoperative outcomes are observed when psychological conditions are present.
Collapse
Affiliation(s)
- Isabela Polesi Bergamaschi
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil
| | - Rafael Correia Cavalcante
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil
| | - Marina Fanderuff
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil
| | - Jennifer Tsi Gerber
- School of Health Sciences, Universidade Positivo, 5300 Prof. Pedro Viriato Parigot de Souza Street, Curitiba, Paraná, 81280-330, Brazil
| | - Maria Fernanda Pivetta Petinati
- School of Health Sciences, Universidade Positivo, 5300 Prof. Pedro Viriato Parigot de Souza Street, Curitiba, Paraná, 81280-330, Brazil
| | - Aline Monise Sebastiani
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil. .,School of Health Sciences, Universidade Positivo, 5300 Prof. Pedro Viriato Parigot de Souza Street, Curitiba, Paraná, 81280-330, Brazil.
| | - Delson João da Costa
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil
| | - Rafaela Scariot
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil.,School of Health Sciences, Universidade Positivo, 5300 Prof. Pedro Viriato Parigot de Souza Street, Curitiba, Paraná, 81280-330, Brazil
| |
Collapse
|
42
|
Goodacre CJ, Roberts WE, Goldstein G, Wiens JP. Does the Stomatognathic System Adapt to Changes in Occlusion? Best Evidence Consensus Statement. J Prosthodont 2020; 30:5-11. [PMID: 33350537 DOI: 10.1111/jopr.13310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The purpose of this Best Evidence Consensus Statement was to evaluate the existing literature on the stomatognathic system's ability to adapt to occlusal changes. MATERIALS AND METHODS The search term stomatognathic system was not useful as it resulted in over 400,000 results nor was the search term temporomandibular joint adaptation with 738 results due to the large number of references not related to the topic. The terms stomatognathic system adaptation to occlusal changes (186 results), teeth flexion (139 results), muscle adaptation to dental occlusion (278 results), and occlusal changes and neuroplasticity (11 results) provided the best selection of articles related to the topic. Limiting the above searches to systematic reviews and randomized controlled clinical trials resulted in multiple publications that were related to the question.9-13 Other literature reviews, data-based publications, and expert opinion resources have been included due to their relationship to the question. RESULTS From the extensive list of search results, 242 articles were determined to be potentially related to the focus question and were evaluated with 56 being included in this paper. It was determined that the stomatognathic system adapts to occlusal changes through the temporomandibular joint, muscles, teeth and bone. The dynamically modified periosteum on the articulator surfaces of the condyle and fossa has a unique load-bearing morphology with 3 subarticular layers of fibrocartilage that absorb and dissipate both peak (impact) and sustained loads. Adaptability of the TMJs and muscles can be documented through studies where artificially produced occlusal interferences were placed in patients and those study participants with normal temporomandibular joints (TMJs) adapted fairly well whereas those with a previous history of temporomandibular disorders (TMD) did not adapt as well. CONCLUSIONS Available evidence indicates patients generally adapt to the occlusal change inherent in orthodontic treatment, mandibular advancement surgery, and the use of mandibular advancement devices. The head and neck muscles also adapt to occlusal changes in patients without a history of TMD. The dentition adapts to changes through the bone and periodontal ligaments as well as the ability of teeth to undergo slight flexion under masticatory loading. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Charles J Goodacre
- Distinguished Professor, Advanced Education Program in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA
| | - W Eugene Roberts
- Professor Emeritus of Orthodontics, Adjunct Professor, Mechanical Engineering, Indiana University & Purdue University, Indianapolis, IN
| | | | - Jonathan P Wiens
- Adjunct Clinical Professor, Department of Restorative Dentistry, University of Detroit Mercy School of Dentistry, Detroit, Michigan
| |
Collapse
|
43
|
Ploder O, Sigron G, Adekunle A, Burger-Krebes L, Haller B, Kolk A. The Effect of Orthognathic Surgery on Temporomandibular Joint Function and Symptoms: What are the Risk Factors? A Longitudinal Analysis of 375 Patients. J Oral Maxillofac Surg 2020; 79:763-773. [PMID: 33285107 DOI: 10.1016/j.joms.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The effects of orthognathic surgery (OGS) on the temporomandibular joint (TMJ) are still controversial. Based on a high-volume uniform collective, the function and clinical symptoms of the TMJ and the dysfunction index (Di) by Helkimo were evaluated prior and up to 2 years after OGS. METHODS A longitudinal cohort study was performed between 2006 and 2016. A comprehensive examination focusing on TMJ function, temporomandibular disorder (TMD) symptoms, and the Di had been performed preopertaively (T0) and postoperatively at 6 weeks (T1), 6 months (T2), 1 year (T3), and 2 years (T4). The predictor variables used were sex, age, skeletal class, type of surgery, and amount of dysfunction or number of TMD complaints before treatment. The outcome of this study was TMD symptoms and the Di. Descriptive and bivariate statistics were computed, and the significance level was set at P < .05. RESULTS The sample consisted of 375 patients (247 women, 128 men, mean age 28.1 ± 9.4 years), 269 with skeletal Class II (71.7%) and 106 with skeletal Class III (28.3%) treated with sagittal split osteotomy bilateral sagittal split osteotomy (n = 173) or Le Fort I and bilateral sagittal split osteotomy (n = 202). Severe signs of dysfunction (Di 2/3) were seen in 5.9% of the patients before OGS and in 2.1% of the patients 2 years after OGS. The difference in Di (Di0/1 and Di2/3) between T0 and T1/T2 was statistically significant (P = .028; P = .011, respectively). TMD symptoms were significantly reduced 2 years after OGS (P = .028). Female gender (P = .013), skeletal Class II (P < .001), and counterclockwise rotation (P < .001) were the only risk factors significantly associated with the occurrence of TMD at T1. CONCLUSIONS The results of this study suggest that in most cases TMD symptoms can be significantly reduced and only a few can be induced with OGS. No risk factors were found for long-term effects on the TMJ.
Collapse
Affiliation(s)
- Oliver Ploder
- Head, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Guido Sigron
- Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Adeola Adekunle
- Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Laura Burger-Krebes
- Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria; and Postdoc student, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Andreas Kolk
- Head, Department of Oral and Maxillofacial Surgery, Medical University Innsbruck, Innsbruck, Austria.
| |
Collapse
|
44
|
Leung YY, Wang R, Wong NSM, Li DTS, Au SW, Choi WS, Su YX. Surgical morbidities of sagittal split ramus osteotomy versus intraoral vertical ramus osteotomy for the correction of mandibular prognathism: a randomized clinical trial. Int J Oral Maxillofac Surg 2020; 50:933-939. [PMID: 33168369 DOI: 10.1016/j.ijom.2020.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/14/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
The sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) are two common orthognathic procedures for the treatment of mandibular prognathism. This randomized clinical trial compared the surgical morbidities between SSRO and IVRO for patients with mandibular prognathism over the first 2 years postoperative. Ninety-eight patients (40 male, 58 female) with a mean age of 24.4±3.5 years underwent bilateral SSRO (98 sides) or IVRO (98 sides) as part or all of their orthognathic surgery. IVRO presented less short-term and long-term surgical morbidity in general. The SSRO group had a greater incidence of inferior alveolar nerve deficit at all follow-up time points (P< 0.01). There was more TMJ pain at 6 weeks (P= 0.047) and 3 months (P= 0.001) postoperative in the SSRO group. The SSRO group also presented more minor complications, which were related to titanium plate exposure and infection. There were no major complications for either technique in this study. Despite the need for intermaxillary fixation, IVRO appears to be associated with less surgical morbidity than SSRO when performed as a mandibular setback procedure to treat mandibular prognathism.
Collapse
Affiliation(s)
- Y Y Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong.
| | - R Wang
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - N S M Wong
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - D T S Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - S W Au
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - W S Choi
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Y-X Su
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| |
Collapse
|
45
|
Gaballah K, Alkubaisy A, Baker AA, Bawzeer A, Awad R. Revisiting the Risk Factors for Multiple Symptoms of Temporomandibular Disorders: A structured Cross-sectional Study. Open Dent J 2020. [DOI: 10.2174/1874210602014010503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The risk factors for Temporomandibular Disorders (TMD) are extensively studied, but the results showed no consistency. Only a small proportion of patients with TMD are likely to seek help and require treatment. Those individuals tend to present with multiple symptoms. This cohort of patients was not well investigated.
Objective:
The study aimed to examine the association between possible risk factors for presentation with multiple TMD symptoms.
Methods:
A population-based, cross-sectional study was conducted across 2101 individuals with an age range of 19-60 years. The condition was assessed via a detailed questionnaire comprising symptoms, habits, dental history, general health, sleep patterns, along with the completion of the Hospital Anxiety and Depression (HAD) scale, followed by an examination of the hypothesized clinical signs. The obtained data were tabulated and characterized the study population in a descriptive analysis in forms of percentages and frequencies. The significance level was set at P-value less than or equal to 0.005. The chi-squared test was implemented to assess the relationship between the multiple TMD symptoms reported and the potential risk factors.
Results:
Most participants reported a variable amount of stress. Moreover, 1528 (72.7 percent) mentioned abnormalities in sleep. About 80 percent had at least one TMD-related symptom. The multiple symptoms of TMD were identified among the 741 individuals. The following risk factors demonstrated association with a robust statistical significance (P=0.00), 1) occupation, 2) sleeping problems, 3) health concerns, 4) traumatic dental treatment, 5) various somatic symptoms, and 6) elevated HAD scale. When the outcomes of the clinical examination were analyzed, the statistical assessment could link soft tissue changes, namely; the cheek ridging and tongue indentations (P 0.00), with multiple symptoms of the condition.
Conclusion:
Multiple TMD symptoms were prevalent among individuals with elevated stress, abnormal sleep pattern, traumatic dental treatment, elevated HAD scale. The results highlighted the importance of psychological factors in the pathogenesis of TMD.
Collapse
|
46
|
Puthukkudiyil JS, Bhutia O, Roychoudhury A, Bhatt K, Yadav R, Bhalla AS. Does Repositioning of Temporomandibular Joint Disc With Bone Anchors Provide Better Clinical Outcomes Than Conventional Disc Plication Procedures for Anterior Disc Displacements Without Reduction in Patients Refractory to Nonsurgical Treatments? J Oral Maxillofac Surg 2020; 78:2160-2168. [PMID: 32777247 DOI: 10.1016/j.joms.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Although open temporomandibular joint arthroplasty with discopexy is a common treatment for patients with anterior disc displacements without reduction (ADDWo) unresponsive to medical management, there are no studies comparing disc repositioning with bone anchors and conventional discopexy procedure. The purpose of the study was to compare the efficacy between disc repositioning with bone anchors and the conventional discopexy procedure for ADDWo of temporomandibular joint refractory to medical management. PATIENTS AND METHODS A randomized controlled trial was conducted in patients with ADDWo. The primary objective was to compare the improvement in mouth opening (primary outcome variable) between the 2 treatment (primary predictor variable) groups-disc repositioning with bone anchors versus conventional disc plication. Secondary outcome variables were pain measured by visual analog scale, lateral excursions, and position of the disc evaluated by magnetic resonance imaging (MRI). Other variables of interest were age, gender, and duration of symptoms. The parameters were evaluated at preoperative, postoperative day 1, and 1-, 6-, and 12-month postoperative period. Categorical variables were compared with χ2 test and continuous variables with analysis of variance and adjusted for multiple comparisons with Bonferroni test. RESULTS The study sample comprised 14 patients (7 in each group) with MRI-proven ADDWo. Statistically significant differences were found in the improvement of mouth opening between the 2 groups, showing better improvement with bone anchors (14.42 ± 5.96 vs 7.57 ± 7.25 mm; P < .05). The reduction in visual analog scale also showed statistically significant difference with better pain reduction achieved with bone anchor (4.57 ± 1.61 vs 3.28 ± 0.75; P < .05). There was no statistically significant difference in lateral excursions and postoperative position of the disc evaluated by MRI between the groups at the 12-month follow-up period. CONCLUSIONS Disc repositioning with bone anchors provides better clinical outcomes in terms of maximal mouth opening and pain scores compared with conventional disc plication.
Collapse
Affiliation(s)
- Jithin Sasikumar Puthukkudiyil
- Senior Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ongkila Bhutia
- Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Ajoy Roychoudhury
- Professor and Head, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Krushna Bhatt
- Assistant Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rahul Yadav
- Associate Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ashu Seith Bhalla
- Professor, Department of Radio Diagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| |
Collapse
|
47
|
Nicot R, Chung K, Vieira AR, Raoul G, Ferri J, Sciote JJ. Condyle modeling stability, craniofacial asymmetry and ACTN3 genotypes: Contribution to TMD prevalence in a cohort of dentofacial deformities. PLoS One 2020; 15:e0236425. [PMID: 32726330 PMCID: PMC7390436 DOI: 10.1371/journal.pone.0236425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/06/2020] [Indexed: 01/01/2023] Open
Abstract
Craniofacial asymmetry, mandibular condylar modeling and temporomandibular joint disorders are common comorbidities of skeletally disproportionate malocclusions, but etiology of occurrence together is poorly understood. We compared asymmetry, condyle modeling stability and temporomandibular health in a cohort of 128 patients having orthodontics and orthognathic surgery to correct dentofacial deformity malocclusions. We also compared ACTN3 and ENPP1 genotypes for association to clinical conditions. Pre-surgical posterior-anterior cephalometric and panometric radiographic analyses; jaw pain and function questionnaire and clinical examination of TMD; and SNP-genotype analysis from saliva samples were compared to assess interrelationships. Almost half had asymmetries in need of surgical correction, which could be subdivided into four distinct morphological patterns. Asymmetric condyle modeling between sides was significantly greater in craniofacial asymmetry, but most commonly had an unanticipated pattern. Often, longer or larger condyles occurred on the shorter mandibular ramus side. Subjects with longer ramus but dimensionally smaller condyles were more likely to have self-reported TMD symptoms (p = 0.023) and significantly greater clinical diagnosis of TMD (p = 0 .000001), with masticatory myalgia most prominent. Genotyping found two significant genotype associations for ACTN3 rs1671064 (Q523R missense) p = 0.02; rs678397 (intronic SNP) p = 0.04 and one significant allele association rs1815739 (R577X nonsense) p = 0.00. Skeletal asymmetry, unusual condyle modeling and TMD are common and interrelated components of many dentofacial deformities. Imbalanced musculoskeletal functional adaptations and genetic or epigenetic influences contribute to the etiology, and require further investigation.
Collapse
Affiliation(s)
- Romain Nicot
- Department of Oral and Maxillofacial Surgery, Univ. Lille, Inserm, CHU Lille, U1008—Controlled Drug Delivery Systems and Biomaterials, Lille, France
- * E-mail:
| | - Kay Chung
- Department of Orthodontics, Temple University, Philadelphia, PA, United States of America
| | - Alexandre R. Vieira
- Department of Oral Biology, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, United States of America
| | - Gwénaël Raoul
- Department of Oral and Maxillofacial Surgery, Univ. Lille, Inserm, CHU Lille, U1008—Controlled Drug Delivery Systems and Biomaterials, Lille, France
| | - Joël Ferri
- Department of Oral and Maxillofacial Surgery, Univ. Lille, Inserm, CHU Lille, U1008—Controlled Drug Delivery Systems and Biomaterials, Lille, France
| | - James J. Sciote
- Department of Orthodontics, Temple University, Philadelphia, PA, United States of America
| |
Collapse
|
48
|
Abstract
Objectives To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism). Data sources Four databases including MEDLINE and EMBASE were searched from inception until 1 October 2018. Data selection and extraction Randomised controlled trials comparing all types of splints versus no/minimal treatment for patients with TMD or bruxism were eligible. Standard Cochrane review methods were used. Standardised mean differences (SMD) were pooled for the primary outcome of pain, using random effects models in TMD patients. Data synthesis Thirty-seven trials were included and the evidence identified was of very low certainty using GRADE assessments. When all subtypes of TMD were pooled into one global TMD group, there was no evidence that splints reduced pain: SMD (up to 3 months) -0.18 (95% CI -0.42 to 0.06); 13 trials, 1,076 participants. There was no evidence that any other outcomes improved when using splints. There was no evidence of adverse events associated with splints, but reporting was poor regarding this outcome. No trials measured tooth wear in patients with bruxism. There was a large variation in diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these factors did not indicate a reduction in pain. Conclusions The very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions. There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism.
Collapse
|
49
|
Mehraban SH, Jamali S, Azizi A, Nasrabadi N. Evaluating the Effectiveness of Orthognathic Surgery on the Pre-existing Temporomandibular Disorders in Patients with Malocclusion: A Systematic Review and Meta-analysis. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Affiliation(s)
| | | | - Amir Azizi
- Alborz University of Medical Sciences, Iran
| | | |
Collapse
|
50
|
Discussion: Clockwise Rotation of the Occlusal Plane for Aesthetic Purposes by Double Jaw Surgery without Orthodontic Treatment. Plast Reconstr Surg 2019; 144:1014e-1015e. [PMID: 31764643 DOI: 10.1097/prs.0000000000006249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|