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Santana-Penín U, Santana-Mora U, López-Solache A, Mora MJ, Collier T, Pocock SJ, Lorenzo-Franco F, Varela-Centelles P, López-Cedrún JL. Remodeling dental anatomy vs sham therapy for chronic temporomandibular disorders. A placebo-controlled randomized clinical trial. Ann Anat 2023; 250:152117. [PMID: 37302432 DOI: 10.1016/j.aanat.2023.152117] [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: 04/01/2023] [Revised: 05/08/2023] [Accepted: 05/20/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence regarding the etiology or effective treatments for chronic orofacial pain, the majority diagnosed as temporomandibular disorder (TMD), is limited. PURPOSE To investigate whether occlusal equilibration therapy (ET) and decreasing the (higher) angle of the lateral guidance on the nonworking-side leads to a reduction in chronic TMDs intensity. METHODS It was conducted a randomized, explanatory, single blind with blinded assessment, placebo-controlled trial with strong protection against bias involving patients with chronic TMDs. Participants were randomly assigned to receive equilibration therapy or sham therapy. ET in this study consisted of minimal invasive occlusal remodeling to obtain balanced occlusion with reduction of the steeper angle of lateral mandibular movement with respect to the Frankfort plane. The primary outcome was a change in the pain intensity score (on a 0-10 point scale, with 0 indicating no pain and 10 the worst possible pain) at month 6. Secondary outcomes include maximum unassisted mouth opening and psychological distress. RESULTS A total of 77 participants underwent randomization, 39 of whom received ET and 38 sham therapy. The trial was stopped early for efficacy, according to preestablished rules when 67 participants (n = 34, n = 33, respectively) had completed the analysis. At month 6, the mean unadjusted pain intensity score was 2.1 in the ET and 3.6 in the sham therapy group (adjusted mean difference, -1.54; 95% confidence interval [CI] -0.5 to -2.6; P = 0.004; ANCOVA model). The mean increase in maximum unassisted mouth opening (main secondary outcome) was significantly higher in the real therapy group (adjusted mean difference 3.1 mm, 95% CI 0.5-5.7, p = 0.02). CONCLUSION ET significantly reduced the intensity of facial pain associated with chronic TMDs and increased maximum unassisted mouth opening, as compared with sham therapy, over the course of 6 months. There were no serious adverse events. Funded by the Instituto de Salud Carlos III from the Ministry of Science and Innovation of the Government of Spain and European Regional Development Fund, Grant nº PI11/02507; "una manera de hacer Europa".
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Affiliation(s)
- Urbano Santana-Penín
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Urbano Santana-Mora
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Alicia López-Solache
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - María Jesús Mora
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Pablo Varela-Centelles
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José Luís López-Cedrún
- Oral and Maxillofacial Surgery Service, University Hospital of A Coruña, A Coruña, Spain
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Santana-Mora U, López-Cedrún J, Suárez-Quintanilla J, Varela-Centelles P, Mora MJ, Da Silva JL, Figueiredo-Costa F, Santana-Penín U. Asymmetry of dental or joint anatomy or impaired chewing function contribute to chronic temporomandibular joint disorders. Ann Anat 2021; 238:151793. [PMID: 34186201 DOI: 10.1016/j.aanat.2021.151793] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The etiologies of most chronic temporomandibular joint disorders are unknown. However, an association between habitual chewing on a particular side and chronic temporomandibular joint disorders has been reported. The aim of this study was to investigate the differences between sides (affected vs unaffected) of biodynamic factors (including lateral dental guidance determined by dental anatomy) or condylar path angles (determined by temporomandibular joint morphology) and chewing function (physiological alternate chewing vs single habitual chewing side). The study scope was to investigate possible etiological factors to improve the understanding of temporomandibular joint disorders. The null hypothesis was that no difference would be found between sides that are or are not affected by chronic temporomandibular joint disorders in chewing function or in levels of dental or temporomandibular joint remodeling. METHODS This cross-sectional, double-blind study involved 24 adults with substantial, chronic, unilateral symptoms diagnosed as temporomandibular joint disorders. Chewing function, temporomandibular joint remodeling (using axiography) and dental anatomy (lateral guidance angles using kinesiography) were assessed. RESULTS Habitual chewing on one particular side was observed in 17 of 24 participants; significantly more (n=15) chewed on the affected side than on the unaffected side (P=0.002 in a two-tailed Fisher's exact test; risk estimate=4.5; 95% CI 1.326-15.277). The condylar path (CP) angle was steeper on the affected side than on the unaffected side (mean (standard deviation)=50.52° (9.98°) versus 45.50° (7.98°); P=0.002 in a two-tailed t-test). The lateral guidance (LG) angles were flatter on the affected side in all 24 participants. CONCLUSION Our results suggest that habitual chewing on one side may be associated with increasing condylar path, with flattening lateral guidance angles, and also with chronic temporomandibular joint disorder on the habitual chewing side.
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Affiliation(s)
- Urbano Santana-Mora
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - José López-Cedrún
- Oral and Maxillofacial Surgery Service,University Hospital of La Coruña, La Coruña, Spain.
| | - Juán Suárez-Quintanilla
- Department of Morphological Sciences, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Pablo Varela-Centelles
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - María Jesús Mora
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - José Luís Da Silva
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - Fernanda Figueiredo-Costa
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - Urbano Santana-Penín
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
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Shen YF, Wei MC, Li HP, Pan YH, Hong HH, Chen CC, Kuo SB, Ho CY, Chang CT, Huang YF. Vertical dimension of occlusion related to mandibular movement during swallowing. Biomed J 2021; 44:217-222. [PMID: 33863681 PMCID: PMC8178566 DOI: 10.1016/j.bj.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/01/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background Increasing the vertical dimension of occlusion (VDO) is a common procedure in complicated prosthodontic treatment. The swallowing technique had been verified as a functional method to determine the VDO. The purpose of this study was to investigate the association between increasing VDO and mandibular movement during swallowing. Methods 26 females and 14 males were enrolled (age range: 21 to 30 year-old). Under different increased VDO (3, 5, and 8 mm), the mandibular trajectory during swallowing was measured by K7 Evaluation System (Myotronics®). When the subjects were instructed to salivary swallowing, the range of mandibular movement in vertical, anteroposterior and lateral directions were recorded. Results Increasing VDO significantly impacted the range of mandibular movement in lateral direction during swallowing (p < 0.0001, F value = 40.09). The average variance of the mandibular movement distance in lateral direction during swallowing raise 1.58 (p = 0.001); 3.59 (p = 0.0001) and 2.01 (p = 0.001) when th VDO was raised from 3 mm to 5 mm; from 3 mm to 8 mm and from 5 to 8 mm respectively. The range of mandibular movement was significantly correlated to the increasing VDO (p ≤ 0.05) under the analysis of the Post Hoc test. Conclusions VDO was closely correlated to the trajectory of mandibular motion during swallowing. The increase in VDO could change the extent of mandibular trajectory during swallowing if the increase was more than 3 mm. The range of mandibular motion when swallowing had positive correlative tendency as the VDO was increased.
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Affiliation(s)
- Yu-Fu Shen
- Department of General Dentistry, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Ming-Chia Wei
- Department of General Dentistry, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Hsin-Pin Li
- Department of General Dentistry, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Yu-Hwa Pan
- Department of General Dentistry, Chang Gung Memorial Hospital at Taipei, Taiwan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Hsi Hong
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan; Department of Periodontology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Cheng-Chang Chen
- Department of General Dentistry, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Song-Bor Kuo
- Department of General Dentistry, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Chun-Yeh Ho
- Department of General Dentistry, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Chung-Ta Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Fang Huang
- Department of General Dentistry, Chang Gung Memorial Hospital at Linkou, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
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Jaw biodynamic data for 24 patients with chronic unilateral temporomandibular disorder. Sci Data 2017; 4:170168. [PMID: 29112190 PMCID: PMC5674825 DOI: 10.1038/sdata.2017.168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/26/2017] [Indexed: 12/03/2022] Open
Abstract
This study assessed 24 adult patients, suffering from severe chronic unilateral pain diagnosed as temporomandibular joint (TMJ) disorder (TMD). The full dentate patients had normal occlusion and had never received an occlusal therapy, i.e., were with natural dental evolution/maturation. The following functional and dynamic factors were assessed: (1) chewing function; (2) TMJ remodeling or the condylar path (CP); and (3) lateral jaw motion or lateral guidance (LG). CPs were assessed using conventional axiography, and LG was assessed by K7 jaw tracking. Seventeen (71%) of the 24 (100%) patients consistently showed a habitual chewing side. The mean (standard deviation [SD]) of the CP angles was 47.90 (9.24) degrees. The mean (SD) of the LG angles was 42.95 (11.78) degrees. Data collection emerged from the conception of a new TMD paradigm where the affected side could be the habitual chewing side, the side with flatter lateral jaw motion or the side with an increased CP angle. These data may lead to improved diagnosis, therapy plans and evolution in TMD patients.
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Ferrario VF, Piancino MG, Dellavia C, Castroflorio T, Sforza C, Bracco P. Quantitative Analysis of the Variability of Unilateral Chewing Movements in Young Adults. Cranio 2014; 24:274-82. [PMID: 17086857 DOI: 10.1179/crn.2006.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Kinesiography can be used as a diagnostic tool in a dental clinic context. In the current study, a kinesiograph was used to detect and record the three-dimensional motion of the mandibular mid-incisor point during unilateral chewing as a function of time. The aim of the study was to quantify the within-subject short-term reproducibility of the kinesiographic recordings in normal, healthy subjects. Ten seconds of unilateral (right and left) gum chewing were recorded in 20 control subjects using computerized kinesiography. Each subject performed 18 chewing sequences (three repetitions x three sessions x two sides). Chewing cycle duration, volume, standardized depth and width, and the number of reversed cycles were calculated. Intraclass correlation coefficients (two-way random effects analysis of variance with interactions) and paired t-tests were used to compare sessions. For each subject and side, chewing variability was expressed as the coefficient of variation (percentage ratio of standard deviation to mean) of each variable. Mean left and right side mastications were computed over all sessions and subjects. For all the analyzed variables, larger variations between subjects (analysis of variance, p < 0.001) than between sessions were found, with intraclass correlation coefficients ranging between 0.432 (left side cycle duration) and 0.989 (right side standardized width). No systematic errors between the three measurement sessions were found for cycle volume and shape (paired t, p > 0.05). The highest between subjects/ between sessions variance ratios (up to 223.28) were found for cycle duration and shape. In all subjects, chewing cycle volume was very variable, with mean coefficients of variation up to 47% (left side in females). Cycle duration and standardized depth and width were more reproducible, with mean coefficients of variation up to 10% (duration), 14% (standardized width), and 18% (standardized depth). The spatial characteristics of gum chewing cycles had a large within-subject variability. The temporal and size-standardized (shape) characteristics were more consistent within subject. The results should allow selection of a set of relatively more consistent variables for the definition of normality and the comparison of patients.
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Temporomandibular disorders: the habitual chewing side syndrome. PLoS One 2013; 8:e59980. [PMID: 23593156 PMCID: PMC3620406 DOI: 10.1371/journal.pone.0059980] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 02/19/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Temporomandibular disorders are the most common cause of chronic orofacial pain, but, except where they occur subsequent to trauma, their cause remains unknown. This cross-sectional study assessed chewing function (habitual chewing side) and the differences of the chewing side and condylar path and lateral anterior guidance angles in participants with chronic unilateral temporomandibular disorder. This is the preliminary report of a randomized trial that aimed to test the effect of a new occlusal adjustment therapy. METHODS The masticatory function of 21 randomly selected completely dentate participants with chronic temporomandibular disorders (all but one with unilateral symptoms) was assessed by observing them eat almonds, inspecting the lateral horizontal movement of the jaw, with kinesiography, and by means of interview. The condylar path in the sagittal plane and the lateral anterior guidance angles with respect to the Frankfort horizontal plane in the frontal plane were measured on both sides in each individual. RESULTS Sixteen of 20 participants with unilateral symptoms chewed on the affected side; the concordance (Fisher's exact test, P = .003) and the concordance-symmetry level (Kappa coefficient κ = 0.689; 95% confidence interval [CI], 0.38 to 0.99; P = .002) were significant. The mean condylar path angle was steeper (53.47(10.88) degrees versus 46.16(7.25) degrees; P = .001), and the mean lateral anterior guidance angle was flatter (41.63(13.35) degrees versus 48.32(9.53) degrees P = .036) on the symptomatic side. DISCUSSION The results of this study support the use of a new term based on etiology, "habitual chewing side syndrome", instead of the nonspecific symptom-based "temporomandibular joint disorders"; this denomination is characterized in adults by a steeper condylar path, flatter lateral anterior guidance, and habitual chewing on the symptomatic side.
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Rilo B, Fernandez J, Da Silva L, Martinez Insua A, Santana U. Frontal-plane lateral border movements and chewing cycle characteristics. J Oral Rehabil 2008. [DOI: 10.1111/j.1365-2842.2001.00723.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ogawa T, Ogawa M, Koyano K. Different responses of masticatory movements after alteration of occlusal guidance related to individual movement pattern. J Oral Rehabil 2008. [DOI: 10.1111/j.1365-2842.2001.00672.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Midline shift and lateral guidance angle in adults with unilateral posterior crossbite. Am J Orthod Dentofacial Orthop 2008; 133:804-8. [DOI: 10.1016/j.ajodo.2006.05.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 05/01/2006] [Accepted: 05/01/2006] [Indexed: 11/21/2022]
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Ferrario VF, Sforza C, Schmitz JH, Serrao G. Comparison of unilateral chewing movements vs. dental guidance through the dental guidance ratio. J Prosthet Dent 2001; 86:586-91. [PMID: 11753308 DOI: 10.1067/mpr.2001.120654] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM Limited knowledge exists about the interaction between dental morphology and mandibular excursive movements. PURPOSE This study evaluated dental guidance in lateral excursive movement and its relationship to jaw motion in unilateral chewing. MATERIAL AND METHODS Three-dimensional mandibular movement paths (in lateral guiding movements and in the final part of a monolateral chewing stroke) were collected with automated infrared motion analysis in 22 subjects with complete, permanent dentitions. On 2 traces selected from the recorded movements, the angular values projected in all planes of space obtained from 2 lines tangent to a point at a distance of 2.5 mm from maximum intercuspation were used to calculate a canine and a molar dental guidance ratio (DGR). Descriptive statistics were computed for the DGRs in the 3 spatial planes. RESULTS Assuming masticatory movements of any given subject are restricted or guided by dental anatomy, a value below 100% of the DGR was expected. This was true for the frontal plane only, with mean values of approximately 80% (working-side movements, canines, and molars) and approximately 60% (nonworking-side movements for both molars and canines). In the horizontal and sagittal planes, mean values between 102% and 137% were found. CONCLUSION Within the limitations of this study, masticatory movement was within the physical borders dictated by dental anatomy in the frontal plane only.
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Affiliation(s)
- V F Ferrario
- Department of Human Anatomy, Faculty of Medicine, University of Milan, Milan, Italy.
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Ogawa T, Ogimoto T, Koyano K. Pattern of occlusal contacts in lateral positions: canine protection and group function validity in classifying guidance patterns. J Prosthet Dent 1998; 80:67-74. [PMID: 9656180 DOI: 10.1016/s0022-3913(98)70093-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STATEMENT OF PROBLEM The concept of canine protection and group function lack consistency in the definitions and examining methods, and a valid system for evaluating and classifying occlusal contact patterns has not been established. PURPOSE This study assessed the use of canine protection and group function in classifying occlusal guidance in the natural dentition. MATERIAL AND METHODS Occlusal contacts of 86 young adults were examined with shim stock in regulated lateral positions, 0.5,1,2 and 3 mm from the maximum intercuspation. The patterns of occlusal contacts varying with the lateral position were described. RESULTS Focusing on the working-side contact only, most contact patterns belonged to group function, and a few to canine protection. Focusing on both the working and nonworking side contacts, nearly half the contact patterns were those other than canine protection and group function and were classified into balanced occlusion. CONCLUSION The validity of the classification system using canine protection and group function is questionable. A new classification system of occlusal guidance is desirable.
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Affiliation(s)
- T Ogawa
- Department of Removable Prosthodontics, Kyushu University, Faculty of Dentistry, Fukuoka, Japan
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Jendresen MD, Allen EP, Bayne SC, Donovan TE, Hansson TL, Klooster J, Kois JC. Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 1997; 78:54-92. [PMID: 9237147 DOI: 10.1016/s0022-3913(97)70088-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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