1
|
Wojtovicz EL, Alvarez OM, Lopez-Davis A, Armijo-Olivo S. Botulinum toxin type A injection into the masticatory muscles and its effects on mandibular bone resorption and density. A systematic review. Clin Oral Investig 2024; 28:477. [PMID: 39123075 DOI: 10.1007/s00784-024-05838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE This systematic review aims to summarize and synthesize the evidence that investigates the secondary effects of the application of botulinum toxin (BT) into the masticatory muscles and its effects on bone density. MATERIALS AND METHODS Database searches were conducted until March 19th, 2024. The quality of the studies was assessed by the Cochrane tool risk of bias for the randomized controlled trials and the ROBINS-I tool for non-randomized studies. The Cochrane Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the confidence in the overall evidence. RESULTS Five studies looking at the effects of botulinum toxin on bone density and resorption when applied to masticatory muscles were found. No significant changes were observed in most of the studies when looking at the effects of botulinum toxin on mandibular condyle volume, density, mandibular angle thickness, and coronoid process volume. The only finding that was statistically and clinically relevant was the difference between patients who received a double application of BT when compared with patients who received a single application (SMD: -0.99 [95%CI: -1.94,-0.05]) on the volume of the mandibular angle. CONCLUSIONS There is no clear pattern on whether the application of botulinum toxin is associated with bone resorption or not. Although some studies show statistical significance of the findings, the magnitude of the changes in bone density and their clinical significance are not completely clear. CLINICAL RELEVANCE To understand the effectiveness of the use of botulinum toxin into the masticatory muscles and its possible secondary adverse effects on the density of the mandible.
Collapse
Affiliation(s)
- Eduardo Luiz Wojtovicz
- Posgraduate in Craneomandibular Dysfunction and Orofacial Pain, San Pablo CEU University, Madrid, Spain.
| | - Olga Martinez Alvarez
- Posgraduate in Craneomandibular Dysfunction and Orofacial Pain, San Pablo CEU University, Madrid, Spain
| | - Antonio Lopez-Davis
- Master Program in Craneomandibular Dysfunction and Orofacial Pain, School of Medicine, San Pablo CEU University, Madrid, Spain
| | - Susan Armijo-Olivo
- University of Applied Sciences- Faculty of Business and Social Sciences, Caprivistr 30A, 49076, Osnabrück, Germany
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 3-48 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| |
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
|
Sitnikova V, Kämppi A, Kämppi L, Alvesalo E, Burakova M, Kemppainen P, Teronen O. Clinical benefit of botulinum toxin for treatment of persistent TMD-related myofascial pain: A randomized, placebo-controlled, cross-over trial. Pain Pract 2024. [PMID: 38963228 DOI: 10.1111/papr.13396] [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: 07/05/2024]
Abstract
BACKGROUND Injections of botulinum toxin type A (BoNT-A) have been proposed as an additional treatment modality for patients suffering chronic temporomandibular disorder (TMD)-related myofascial pain (MFP). BoNT-A impairs muscle function, along with its analgesic effect, and a minimal effective dose should be used. The objective of this randomized placebo-controlled crossover study was to evaluate the clinical benefit of a moderate dose (50 U) of BoNT-A. METHODS Sixty-six subjects were randomized into two groups, one which received BoNT-A first and a second which received a saline solution (SS) first. Follow-ups were performed 2, 11, and 16 weeks after the injections. Diagnostic criteria for temporomandibular disorders (DC/TMD) diagnostic algorithms were used to evaluate characteristic pain intensity (CPI) and pain-related disability based on the Graded Chronic Pain Scale (GCPS). Electromyographic and bite force were also evaluated. RESULTS The within-group analysis showed a significant improvement in pain intensity and pain-related disability after BoNT-A (p < 0.001, p = 0.005, p = 0.011) and SS (p = 0.003, p = 0.005, p = 0.046) injections up to week 16. The between-group analysis of pain-related variables revealed no differences between groups at any time. Nonetheless, BoNT-A, but not SS, caused a significant decline in muscle performance. The number needed to treat (NNT) regarding a clinically significant pain reduction (≥30%) was 6.3, 57.0, and 19.0 at 2, 11, and 16-week follow-ups favoring BoNT-A. CONCLUSIONS Injections of 50 U of BoNT-A might improve MFP symptoms, but the specific effect of the drug on pain compared to the placebo is not obvious.
Collapse
Affiliation(s)
- V Sitnikova
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - A Kämppi
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - L Kämppi
- Epilepsia Helsinki (Member of ERN EpiCARE), HUS Neurocenter, Helsinki, Finland
- Department of Neuroscience, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Central Hospital (HYKS), Helsinki, Finland
| | - E Alvesalo
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - M Burakova
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - P Kemppainen
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki University Central Hospital (HYKS), Helsinki, Finland
| | - O Teronen
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Private Practice Mehiläinen Oy, Helsinki, Finland
| |
Collapse
|
4
|
Sendra LA, Azeredo Alves Antunes L, Barboza EP. Use of botulinum neurotoxin Type A in the management of primary bruxism in adults: An updated systematic review. J Prosthet Dent 2024; 132:93-99. [PMID: 35779974 DOI: 10.1016/j.prosdent.2022.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/20/2022]
Abstract
STATEMENT OF PROBLEM The psycho-emotional effects caused by the coronavirus pandemic have increased the intensity and number of cases of bruxism, for which no treatment has been considered fully effective. Botulinum neurotoxin Type A (BoNT-A) has shown positive results as an adjunct treatment of primary bruxism; however, this off-label use does not have an established protocol, and further studies are required. PURPOSE The purpose of this updated systematic review was to analyze the clinical outcomes of BoNT-A in the management of primary bruxism in adults. MATERIAL AND METHODS The review was registered under the International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42021287653, without funding. PubMed, Web of Science, Scopus, LILACS, Cochrane Library, and Open Grey Literature databases were searched by using the Mendeley Desktop software program without language restrictions up to June 6, 2021. The risk of bias of the selected randomized clinical trials was assessed by using RoB2, and the level of evidence was measured by 2 independent researchers using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. RESULTS A total of 741 references were obtained from the 6 databases in this systematic review. The 11 randomized clinical trials selected achieved a reduction in bruxism symptoms by injecting BoNT-A into 211 participants with different protocols. The heterogeneity of the included studies did not permit a meta-analysis. CONCLUSIONS All the evaluated studies supported the effectiveness of BoNT-A injections in reducing bruxism symptoms. The reduction of symptoms can be obtained with doses lower than 25U applied exclusively in the masseter muscles.
Collapse
Affiliation(s)
- Luiza Abreu Sendra
- Brazilian Army Major Dentist, Central Dental Clinic (OCEx), Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lívia Azeredo Alves Antunes
- Professor, Department of Pediatric Dentistry, Fluminense Federal University School of Dentistry, Niterói, Rio de Janeiro, Brazil
| | - Eliane Porto Barboza
- Professor, Department of Dental Clinic, Fluminense Federal University School of Dentistry, Niterói, Rio de Janeiro, Brazil.
| |
Collapse
|
5
|
Dechaufour P, Libouban H, Chappard D, Kün-Darbois JD. Repeated unilateral injections of botulinum toxin in masticatory muscles in adult rats do not amplify condylar and alveolar bone loss nor modify the volume of the hypertrophic bone proliferation at enthesis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101955. [PMID: 38950733 DOI: 10.1016/j.jormas.2024.101955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES Botulinum toxin is used in human in repeatedly masticatory muscles injections. A single BTX injection in animal induces mandibular bone loss with a muscle enthesis hypertrophic metaplasia. Our aim was to evaluate mandibular bone changes after unilateral repeated injections of BTX in adult rats. STUDY DESIGN Mature male rats were randomized into 3 groups: one, two or three injections. Each rat received injections in right masseter and temporalis muscles. The left side was the control side. Microcomputed tomography was used to perform 2D and 3D analyses. RESULTS Bone loss was evidenced on the right sides of alveolar and condylar bone. Alveolar bone volume increased in both control left side and injected right side whereas condylar bone volume remained constant in all groups, for both sides. Enthesis bone hypertrophic metaplasias were evidenced on the BTX injected sides without any modification with the number of injections. CONCLUSION BTX repeated injections in masticatory muscles lead to major mandibular condylar and alveolar bone loss that does not worsen. They lead to the occurrence of an enthesis bone proliferation that is not dependent on the number of injections. These results are an argument for the safety of BTX injections in masticatory muscles in human.
Collapse
Affiliation(s)
- Pierre Dechaufour
- Univ Angers, Nantes Université, Oniris, Inserm, RMeS, REGOS, SFR ICAT, F-49000 Angers, France; CHU Angers, Service de Chirurgie Maxillo-faciale, F-49933 Angers, France
| | - Hélène Libouban
- Univ Angers, Nantes Université, Oniris, Inserm, RMeS, REGOS, SFR ICAT, F-49000 Angers, France
| | - Daniel Chappard
- Univ Angers, Nantes Université, Oniris, Inserm, RMeS, REGOS, SFR ICAT, F-49000 Angers, France
| | - Jean-Daniel Kün-Darbois
- Univ Angers, Nantes Université, Oniris, Inserm, RMeS, REGOS, SFR ICAT, F-49000 Angers, France; CHU Angers, Service de Chirurgie Maxillo-faciale, F-49933 Angers, France.
| |
Collapse
|
6
|
Moussa MS, Bachour D, Komarova SV. Adverse effect of botulinum toxin-A injections on mandibular bone: A systematic review and meta-analysis. J Oral Rehabil 2024; 51:404-415. [PMID: 37668276 DOI: 10.1111/joor.13590] [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: 05/30/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Botulinum toxin-A (BTX) is a potent neurotoxin that is emerging in the scope of dental practice for its ability to temporarily paralyse musculature and reduce hyperfunction. This may be desirable in diseases/disorders associated with hyperactive muscles such as the muscles of mastication, most implicated in painful temporomandibular disorders (TMDs). The use of BTX extends beyond its indications with off-label use in TMD's and other conditions, while potential adverse effects remain understudied. BTX is well-established hindlimb paralysis model in animals leading to significant bone loss with underlying mechanisms remaining unclear. The objective of this study is to systematically review the literature for articles investigating changes in mandibular bone following BTX injections and meta-analyse available data on reported bone outcomes. METHODS Comprehensive search of Medline, Embase and Web of Science retrieved 934 articles. Following the screening process, 36 articles in animals and humans were included for quantitative synthesis. Articles in human individuals (6) and three different animal species (14) presented mandibular bone outcomes that were included in the meta-analysis. RESULTS The masseter and temporalis muscles were frequently injected across all species. In humans, we observe a decrease of about 6% in cortical thickness of mandibular regions following BTX injection with no evident changes in either volume or density of bone structures. In animals, bone loss in the condylar region is significantly high in both cortical and trabecular compartments. DISCUSSION Our analysis supports the concept of BTX-induced bone-loss model in animal mandibles. Further, bone loss might be confined to the cortical compartments in humans. Most studies did not address the reality of repeated injections and excessive dosing, which occur due to the reversible action of BTX. More rigorous trials are needed to draw a full picture of potential long-term adverse effects on bone.
Collapse
Affiliation(s)
- Mahmoud S Moussa
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
- Shriners Hospital for Children - Canada, Montreal, Quebec, Canada
| | - Dona Bachour
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Svetlana V Komarova
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
- Shriners Hospital for Children - Canada, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Bakke M. Botulinum Toxin, a Drug with Potential Interest for Dentists—An Introduction. Toxins (Basel) 2022; 14:toxins14100667. [PMID: 36287936 PMCID: PMC9607019 DOI: 10.3390/toxins14100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
The review is an introduction to medical, non-cosmetic treatments with botulinum neurotoxin (BoNT) in the orofacial region. It focuses on the current most common, best-documented and safest indications of interest for dentists in terms of dystonia and sialorrhea. These conditions are recommended to start with and suitable to gain better skill and experience with BoNT. The introduction also stresses the importance of correct diagnostics based on interdisciplinary cooperation, precise targeting of the injections, measurements of treatment effect, and control of the oral health with regard to side effects.
Collapse
Affiliation(s)
- Merete Bakke
- Clinical Oral Physiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| |
Collapse
|
8
|
Sitnikova V, Kämppi A, Teronen O, Kemppainen P. Effect of Botulinum Toxin Injection on EMG Activity and Bite Force in Masticatory Muscle Disorder: A Randomized Clinical Trial. Toxins (Basel) 2022; 14:toxins14080545. [PMID: 36006207 PMCID: PMC9416064 DOI: 10.3390/toxins14080545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Botulinum toxin type A (BoNT-A) is increasingly used in treating masticatory muscle pain disorder; however, safe doses and reinjection intervals still need to be established. The purpose of this randomized clinical trial was to evaluate the degree and duration of the impairment of masticatory muscle performance. Fifty-seven subjects were randomly divided into two groups: one of which received BoNT-A first (n = 28) while the other received saline first (n = 29), with the cross-over being in week 16, and a total follow-up period of 32 weeks. A total dose of 50 U of BoNT-A was injected in the masseter and temporal muscles bilaterally. Electromyographic (EMG) activity and bite forces were assessed. A significant reduction in EMG activity was observed up to week 18 (p ≤ 001), with total recovery at week 33. A significant reduction in maximum bite force was observed up to week 11 (p ≤ 005), with total recovery at week 25. In conclusion, when treating masticatory muscle pain disorder with 50 U of BoNT-A, a reinjection interval of 33 weeks can be considered safe since the recovery of muscle function occurs by that time.
Collapse
Affiliation(s)
- Victoria Sitnikova
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, 00280 Helsinki, Finland
| | - Antti Kämppi
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, 00280 Helsinki, Finland
- Correspondence: ; Tel.: +358-2941911
| | - Olli Teronen
- Dental Clinic, Private Practice Mehiläinen, 00100 Helsinki, Finland
| | - Pentti Kemppainen
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, 00280 Helsinki, Finland
- Oral and Dental Centre, Helsinki University Central Hospital (HUCH), 00290 Helsinki, Finland
| |
Collapse
|
9
|
Herring SW, Liu ZJ, Rafferty KL, Baldwin MC, Salamati A, Cunningham C, Owart B, Tamasas B. Repeated botulinum treatment of rabbit masseter causes cumulative tissue damage. Arch Oral Biol 2022; 141:105480. [PMID: 35724521 DOI: 10.1016/j.archoralbio.2022.105480] [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: 01/24/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Botulinum neurotoxins (BoNT) are used in masticatory muscles for pain relief, unloading of the mandible, and cosmetic facial contouring. Treatment is often repeated every few months as function returns. This study assessed masticatory function and musculoskeletal structure after multiple BoNT treatment of the rabbit masseter. DESIGN Female rabbits received 3 injections of BoNT (n = 13) or saline (n = 5) into one masseter muscle at intervals of 12 weeks. The contralateral side served as control. Periodic measurements of masticatory electromyography (EMG) and stimulated anterior bite force were made. After the final 12-week recovery interval, neuromuscular connection was investigated by stimulating the masseteric nerve to elicit an evoked EMG response. Mandibular specimens were collected for microCT analysis, and masseters were collected for histomorphometry and counts of replicating cells. RESULTS Control and saline-injected muscles maintained consistent masticatory EMG and anterior bite force throughout the study. BoNT-injected masseters showed strong declines after each injection; during the 12-week recovery period, masticatory EMG and anterior bite force improved, although only electrical activity reached normal levels. Multiple injection resulted in persistently atrophied muscle fibers with fibrosis, and notable loss of bone from the mandibular body and condyle. The uninjected masseters of the BoNT group also showed evidence of mild toxin-related changes. CONCLUSIONS Although muscle function is mostly regained after each injection, masseters receiving multiple doses of BoNT show extensive damage. In addition, mandibular bone density is decreased on the injected side.
Collapse
Affiliation(s)
- Susan W Herring
- Department of Orthodontics, University of Washington, Seattle, WA 98195, USA.
| | - Zi-Jun Liu
- Department of Orthodontics, University of Washington, Seattle, WA 98195, USA.
| | | | - Michael C Baldwin
- Department of Oral Health Sciences, University of Washington, Seattle, WA 98195, USA.
| | - Atriya Salamati
- Department of Oral Health Sciences, University of Washington, Seattle, WA 98195, USA.
| | - Cambria Cunningham
- Department of Orthodontics, University of Washington, Seattle, WA 98195, USA.
| | - Birkin Owart
- Department of Orthodontics, University of Washington, Seattle, WA 98195, USA.
| | - Basma Tamasas
- Department of Oral Health Sciences, University of Washington, Seattle, WA 98195, USA.
| |
Collapse
|
10
|
Owen M, Gray B, Hack N, Perez L, Allard RJ, Hawkins JM. The Impact of Botulinum Toxin Injection into the Masticatory Muscles on Mandibular Bone: A Systematic Review. J Oral Rehabil 2022; 49:644-653. [DOI: 10.1111/joor.13326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Owen
- Orofacial Pain Resident Naval Postgraduate Dental School Uniformed Services University of the Health Sciences Postgraduate Dental College Naval Medal Leader and Professional Development Command
| | - Benjamin Gray
- Oral Diagnosis Department Staff Oral and Maxillofacial Radiologist Naval Medical Leader and Professional Development Command
| | - Nawaz Hack
- Department of Neurology Uniformed Services University of the Health Sciences School of Medicine Walter Reed National Military Medical Center
| | - Leonel Perez
- Oral Maxillofacial Surgery Program Director Assistant Professor of Surgery Uniformed Services University of the Health Sciences School of Medicine Walter Reed National Military Medical Center
| | - Rhonda J. Allard
- James A. Zimble Learning Resource Center Uniformed Services University of the Health Sciences
| | - James M. Hawkins
- Orofacial Pain Program Director Associate Professor of Orofacial Pain Uniformed Services University of the Health Sciences Postgraduate Dental College Naval Medal Leader and Professional Development Command
| |
Collapse
|
11
|
Sitnikova V, Kämppi A, Teronen O, Kemppainen P. Comprehensive evaluation of botulinum toxin treatment outcomes of a patient with persistent myofascial orofacial pain. Clin Case Rep 2021; 9:e04731. [PMID: 34484765 PMCID: PMC8405429 DOI: 10.1002/ccr3.4731] [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: 01/29/2021] [Revised: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 01/09/2023] Open
Abstract
The outcome evaluation method presented in this case study, including Axes I and II findings combined with the results of quantitative bite force and EMG measurements, provides a good tool for proper evaluation of the effect of BoNT-A on patients with myofascial orofacial pain and changes in jaw muscle function.
Collapse
Affiliation(s)
- Victoria Sitnikova
- Department of Oral and Maxillofacial DiseasesFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Antti Kämppi
- Department of Oral and Maxillofacial DiseasesFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Olli Teronen
- Department of Oral and Maxillofacial DiseasesFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Private Practice MehiläinenHelsinkiFinland
| | - Pentti Kemppainen
- Department of Oral and Maxillofacial DiseasesFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Helsinki University Central Hospital (HUCH)HelsinkiFinland
| |
Collapse
|
12
|
Raphael KG, Janal MN, Tadinada A, Santiago V, Sirois DA, Lurie AG. Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex. J Oral Rehabil 2020; 47:1319-1329. [PMID: 32885475 PMCID: PMC7693250 DOI: 10.1111/joor.13087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 01/02/2023]
Abstract
Background Adverse effects of masticatory muscle injections of Botulinum Toxin (Btx) have been noted in animal and, less dramatically, human studies. Objective Among women treated in multiple community‐based private practices, to compare TMJ bone density and mandibular condylar volume between patients with myofascial TMJD receiving multiple masticatory muscle Btx treatments and similarly diagnosed women not receiving such treatment. Methods Cohorts consisted of women whose treatment charts indicated a diagnosis of myofascial TMJD: 35 received at least 2 Btx treatment cycles; 44 received none. Bone density at pre‐specified regions of interest (ROI) was defined by grey scale values from Cone Beam CT, adjusting for a fixed density phantom included in each scan. Mean bone density and mandibular condyle volume were compared between groups. Dose‐response effects were tested within the Btx‐exposed group. Results The mean density of primary and secondary ROIs was similar between exposure groups, as was condylar volume. Among Btx‐exposed women, increasing dose of Btx to the temporalis muscle was inversely proportional to the density of the trabecular area of the mandible body. Many Btx‐exposed women received smaller doses of Btx to the masseter muscles than in most TMJD Btx clinical trials. Conclusion Masticatory muscle injections of Btx failed to produce clinically significant TMJ bone‐related changes. Should Btx receive regulatory approval for treatment of myofascial TMJD, a phase IV study is recommended to evaluate potential adverse effects of Btx on bone and muscle when administered at higher doses and/or for more treatment cycles.
Collapse
Affiliation(s)
| | - Malvin N Janal
- New York University College of Dentistry, New York, NY, USA
| | - Aditya Tadinada
- University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | | | - David A Sirois
- New York University College of Dentistry, New York, NY, USA
| | - Alan G Lurie
- University of Connecticut School of Dental Medicine, Farmington, CT, USA
| |
Collapse
|
13
|
Terhune CE, Sylvester AD, Scott JE, Ravosa MJ. Internal architecture of the mandibular condyle of rabbits is related to dietary resistance during growth. J Exp Biol 2020; 223:jeb220988. [PMID: 32127379 DOI: 10.1242/jeb.220988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022]
Abstract
Although there is considerable evidence that bone responds to the loading environment in which it develops, few analyses have examined phenotypic plasticity or bone functional adaptation in the masticatory apparatus. Prior work suggests that masticatory morphology is sensitive to differences in food mechanical properties during development; however, the importance of the timing/duration of loading and variation in naturalistic diets is less clear. Here, we examined microstructural and macrostructural differences in the mandibular condyle in four groups of white rabbits (Oryctolagus cuniculus) raised for a year on diets that varied in mechanical properties and timing of the introduction of mechanically challenging foods, simulating seasonal variation in diet. We employed sliding semilandmarks to locate multiple volumes of interest deep to the mandibular condyle articular surface, and compared bone volume fraction, trabecular thickness and spacing, and condylar size/shape among experimental groups. The results reveal a shared pattern of bony architecture across the articular surface of all treatment groups, while also demonstrating significant among-group differences. Rabbits raised on mechanically challenging diets have significantly increased bone volume fraction relative to controls fed a less challenging diet. The post-weaning timing of the introduction of mechanically challenging foods also influences architectural properties, suggesting that bone plasticity can extend well into adulthood and that bony responses to changes in loading may be rapid. These findings demonstrate that bony architecture of the mandibular condyle in rabbits responds to variation in mechanical loading during an organism's lifetime and has the potential to track dietary variation within and among species.
Collapse
Affiliation(s)
- Claire E Terhune
- Department of Anthropology, University of Arkansas, Fayetteville, AR 72701, USA
| | - Adam D Sylvester
- Center for Functional Anatomy and Evolution, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jeremiah E Scott
- Department of Medical Anatomical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Matthew J Ravosa
- Departments of Biological Sciences, Aerospace & Mechanical Engineering, and Anthropology, University of Notre Dame, Notre Dame, IN 46556, USA
| |
Collapse
|
14
|
Hong SW, Kang JH. Decreased mandibular cortical bone quality after botulinum toxin injections in masticatory muscles in female adults. Sci Rep 2020; 10:3623. [PMID: 32107437 PMCID: PMC7046747 DOI: 10.1038/s41598-020-60554-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
This study aimed to clarify how masticatory muscle atrophy induced by botulinum toxin (BTX) injection affects cortical bone quality of the mandible using 3D modeling technology. A total of 39 young (26.9 ± 6.0 years) and 38 post-menopausal (55.3 ± 6.3 years) females were included. Computed tomography (CT) images were obtained before and after 12 months of treatment. Predictor variables were application of a stabilization splint, and/or two times of BTX injection in the bilateral temporalis and masseter muscles within a six-month interval. Outcome variables were changes in average Hounsfield units (HU) and cortical thickness of region of interest (ROI). 3D mandibular models were reconstructed using CT images, and models were used to calculate average HU and cortical thickness of ROIs, including inferior half of the lateral surface of ascending ramus, coronoid process, and temporomandibular joint condyle. Cortical bone quality at muscle insertion site was influenced by decreased muscle thickness but seemed not to be affected by decreased functional loading. Reduced functional loading seemed to influence cortical bone quality of the condyles. These effects were more remarkable in post-menopausal females. Hence, decreased masticatory muscle thickness may lead to alterations of the mandibular cortical structures, especially in post-menopausal females.
Collapse
Affiliation(s)
- Seok Woo Hong
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181, Korea
| | - Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea.
| |
Collapse
|
15
|
Buvinic S, Balanta-Melo J, Kupczik K, Vásquez W, Beato C, Toro-Ibacache V. Muscle-Bone Crosstalk in the Masticatory System: From Biomechanical to Molecular Interactions. Front Endocrinol (Lausanne) 2020; 11:606947. [PMID: 33732211 PMCID: PMC7959242 DOI: 10.3389/fendo.2020.606947] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022] Open
Abstract
The masticatory system is a complex and highly organized group of structures, including craniofacial bones (maxillae and mandible), muscles, teeth, joints, and neurovascular elements. While the musculoskeletal structures of the head and neck are known to have a different embryonic origin, morphology, biomechanical demands, and biochemical characteristics than the trunk and limbs, their particular molecular basis and cell biology have been much less explored. In the last decade, the concept of muscle-bone crosstalk has emerged, comprising both the loads generated during muscle contraction and a biochemical component through soluble molecules. Bone cells embedded in the mineralized tissue respond to the biomechanical input by releasing molecular factors that impact the homeostasis of the attaching skeletal muscle. In the same way, muscle-derived factors act as soluble signals that modulate the remodeling process of the underlying bones. This concept of muscle-bone crosstalk at a molecular level is particularly interesting in the mandible, due to its tight anatomical relationship with one of the biggest and strongest masticatory muscles, the masseter. However, despite the close physical and physiological interaction of both tissues for proper functioning, this topic has been poorly addressed. Here we present one of the most detailed reviews of the literature to date regarding the biomechanical and biochemical interaction between muscles and bones of the masticatory system, both during development and in physiological or pathological remodeling processes. Evidence related to how masticatory function shapes the craniofacial bones is discussed, and a proposal presented that the masticatory muscles and craniofacial bones serve as secretory tissues. We furthermore discuss our current findings of myokines-release from masseter muscle in physiological conditions, during functional adaptation or pathology, and their putative role as bone-modulators in the craniofacial system. Finally, we address the physiological implications of the crosstalk between muscles and bones in the masticatory system, analyzing pathologies or clinical procedures in which the alteration of one of them affects the homeostasis of the other. Unveiling the mechanisms of muscle-bone crosstalk in the masticatory system opens broad possibilities for understanding and treating temporomandibular disorders, which severely impair the quality of life, with a high cost for diagnosis and management.
Collapse
Affiliation(s)
- Sonja Buvinic
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
- Center for Exercise, Metabolism and Cancer Studies CEMC2016, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- *Correspondence: Sonja Buvinic,
| | - Julián Balanta-Melo
- School of Dentistry, Faculty of Health, Universidad del Valle, Cali, Colombia
- Evidence-Based Practice Unit Univalle, Hospital Universitario del Valle, Cali, Colombia
- Max Planck Weizmann Center for Integrative Archaeology and Anthropology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Kornelius Kupczik
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Walter Vásquez
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Carolina Beato
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Viviana Toro-Ibacache
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| |
Collapse
|