Prosthetic rehabilitation in patients with temporomandibular disorders

Influence of edentulism on the structure and function of temporomandibular joint

Background

With the acceleration of the aging process of the population, the number of edentulous patients continuously increased. Edentulism induces the loss of occlusal relationship and cause adverse effects on the stomatognathic system. Temporomandibular joint (TMJ), as a significant component of this system, may also be affected by edentulism in the process of supporting mandibular movement.

Purpose

Provide a comprehensive review of the structure and function of TMJ in the edentulous population, as well as the prevalence of temporomandibular joint disorder (TMD) in edentulous group.

Study selection

An electronic search was conducted on articles prior to December 2022 to filter all papers relevant to the structure and function of TMJ in edentulous population. The internet databases (PubMed, Cochrane Library, Embase) were searched using various combinations of keywords for "edentulism" or "edentulous" and "TMJ" or "TMD".

Results

Firstly, 522 articles were selected from the internet database, and finally, a total of 44 articles met the inclusion and exclusion criteria. The research content of these articles mainly focuses on the structure and function of TMJ in edentulous patients, as well as the clinical signs and symptoms of TMD.

Conclusions

Edentulous arch induces the loss of occlusal relationship, which may lead to degenerative changes of TMJ components consisting of changes in morphology and bone mass density of condyle, articular fossa, and articular eminence. In addition, the condyle could be shifted backward and upward, and displacement of the articular disc may occur after dentition loss. And the condyle and the articular disc may be guided back to the normal position after effective prosthodontic treatment. But the conclusions of the study on the function of TMJ and the prevalence of TMD in edentulous people are inconsistent. The condition of TMJ, especially the position of condyle-fossa and the symptoms and signs of TMD should not be ignored. If necessary, radiographic examinations should be performed.

Prosthodontic Treatment in Patients with Temporomandibular Disorders and Orofacial Pain and/or Bruxism: A Review of the Literature

Temporomandibular disorders are a group of conditions affecting the temporomandibular joints, the jaw muscles, and related structures. Patients with temporomandibular signs and/or symptoms frequently present with indications for prosthetic treatment. The management of these patients aims to achieve patient comfort, occlusal stability, and the complex restoration of the teeth. The goal of this review is to provide an overview of the relationship between prosthodontics and temporomandibular disorders and/or bruxism with a focus on the cause-and-effect implications and the strategies for planning prosthetic treatments in patients with temporomandibular disorders and/or bruxism.

Oral rehabilitation following successful TMD treatment with condylar position changes: A case report

BACKGROUND

A 31-year-old woman with crowns, fixed partial prostheses, and dental restorations complained of recurrent pain in the left and right temporomandibular joints during the last 2 years.

CLINICAL PRESENTATION

The symptoms of temporomandibular disorder (TMD) resolved successfully after a 3-month-long treatment with a repositioning splint. Pre- and post-operative cone-beam computed tomography revealed slight changes in the condylar position after splint use. Minimally invasive oral rehabilitation guided by digital design was performed to maintain the acquired stable position. The status of the restorations was good, and the TMD symptoms did not relapse during the 3-year follow-up.

CONCLUSION

This case report demonstrates the importance of a stable adapted condylar position after extensive prosthodontic treatment.

Prevalence and Clinical Effects of Certain Therapy Concepts among Partially Edentulous Serbian Elderly

PURPOSE

This study was conducted to identify the prevalence of partially edentulous individuals in Serbia and to identify prosthodontic treatment used for their rehabilitation as well as to compare prosthodontic treatment concepts among Serbian elderly participants who answered closed-format questionnaires.

MATERIALS AND METHODS

The study was conducted at the Clinic for Dental Prosthetics, University of Belgrade, Military Medical Academy and the Department of Prosthodontics of Home Centre Belgrade; the study consisted of 120 participants. A questionnaire with closed-format questions regarding the influence of applied therapy concepts for participants with Kennedy Class I partial edentulism was created. Statistical software SPSS 11.5 was used for data analysis. Chi-square tests were performed, and p-values were calculated for each parameter.

RESULTS

A total of 1081 people were examined; 730 participants were partially edentulous in at least one jaw. Five hundred forty-one participants wore Kennedy Class I maxillary or mandibular removable partial dentures (RPDs). Ninety percent of the patients were restored with RPDs; 60% of participants were unrestored, had shortened dental arches, and requested alternative therapeutic solutions. Significantly lower needs for new treatments were identified in participants with fixed dental prostheses (7.5%).

CONCLUSIONS

Kennedy Class I was the most common type of partial edentulism among Serbian elderly, usually treated with RPDs. Elderly participants with the applied shortened dental arch and RPD therapy concepts requested alternative therapeutic solutions more often than those rehabilitated with fixed partial dentures.

Prosthodontic management of temporomandibular disorders

Temporomandibular disorders (TMD) are examined from a biopsychosocial or illness perspective. It is considered that TMD share features with many common chronic pain conditions. Functional disturbances of the masticatory system can be as complicated as the system itself. Although numerous treatments have been advocated, the complex nature of TMD requires a multidisciplinary team. Effective treatment selection begins with a thorough understanding of the disorder & its etiology. However, the multifactorial nature of this malady places some aspects of the disease beyond the traditional education of a Prosthodontist. The management goals for the Prosthodontist as a member of a TMD team are patient comfort, occlusal stability & the complex restoration of the teeth.

Dental occlusion: a critical reflection on past, present and future concepts

For nearly a century, the diversity of concepts about 'normal' and 'ideal' dental occlusal relationships has led to confusion in trying to describe the occlusion of any individual patient. In addition, a similar controversy arises when trying to formulate treatment plans for patients who need extensive dental restorations or orthodontic treatment. And finally, the application of occlusal concepts to patients with temporomandibular pain and dysfunction has created a third area of debate. Over the past few decades, however, an appreciable part of the tenacious dogmatic heritage of this topic has been challenged. As a result, the acceptance of morphological and functional variability of the stomatognathic system has gained increasing support, and this change has important consequences for modern dental practice. In this article, the past, present and future of the subject of occlusion will be considered.

Position of mandibular joint surface in cenrric relation

The position of mandible in centric relation is the initial position in prosthodontic rehabilitation. This fact is especially significant today when, due to development of implantology, the use of osseointegrated prostheses is increasingly discussed. The aim of the study is to define if the peak of the articulating surface of mandible in centric relation position is directed towards the zenith of madibular fossa, or is in the retroposition. The research was conducted on macerated human sculls in anthropometric system, based on objective measuring techniques and methods. The results showed that if the zenith of mandibular fossa is determined according to the vertical line of the Frankfurt horizontal, the peak of the mandibular caput articulating surface is in retroposition. The relation of the lower joint surface to the mandibular fossa zenith is the same on both right and left side. The correlation coefficient demonstrates a high correlation between the sides, highly significant with probability level of p<0,01. If the peak of mandibular fossa is determined according to the vertical line of the Frankfurt horizontal, the peak of the articulating surface of mandibular caput is in retroposition in relation to the peak of the upper jaw surface. This original scientific work will help better understanding of x-ray analysis and understanding of relationship of TMJ surfaces, what is necessary for treatment of TMD and occlusal imbalances.

Alternative therapies: abuses of scientific method and challenges to dental research

STATEMENT OF PROBLEM

Alternative health practitioners compete with established dentistry and medicine for the treatment of many conditions. Their popularity accrues because of deficiencies of current treatments, increased acceptance of self-treatment, and a highly individualized approach. Ineffective alternative therapies can appear effective because of the placebo effect, symptom variability, short-term observations, combination with established treatments, and reporting bias. Alternative therapies often lack a rational basis. A sound theory underlying a treatment enables the approach to be integrated with other areas of science and leads to progressive research.

PURPOSE

This article argues that alternative therapies can best be considered bad science that commonly violates normal scientific norms or criteria for acceptance including comprehensiveness, falsifiability, openness, and objectivity.

CONCLUSIONS

The claims of alternative therapists are useful in identifying perceived deficiencies in conventional treatments. Suggestions for countering alternative practitioners' claims include targeted research and improved access to and evaluation of the dental research literature.

A new fully adjustable articulator system and procedure

This article presents a simple and efficient articulator to help with the registration of maxillomandibular relationships, mounting casts, and subsequent perfection of the occlusal scheme for various types of prosthodontic restorations. The system (Individual Anatomo-Physiological system), which is composed of the articulator and recommended procedures, allows for registration of positions and trajectories of the mandible at the level of the patient's occlusal plane. It is used to accurately transfer the records to the articulator. A luminous signal shows the correct centric occlusal relationship and vertical dimension, in both clinical and laboratory procedures. Interocclusal records are used for semiadjustment of the articulator for provisional restorations and stereographic records are used for full adjustment of the articulator for definitive treatment.

The effect of musculoskeletal facial pain on registration of maxillomandibular relationships and treatment planning: a synthesis of the literature

STATEMENT OF PROBLEM

A significant number of patients exist who are in need of prosthodontic rehabilitation and who at the same time report musculoskeletal pain in the facial area.

PURPOSE

This article, which is based on an assessment of both the past and the most recent basic science and clinical literature, evaluates the effect of musculoskeletal facial pain on two static (physiologic rest position and centric relation) and two dynamic (protrusive border and lateral border movements) maxillomandibular relationships.

MATERIAL AND METHODS

To find the relevant studies addressing the association between musculoskeletal facial pain and maxillomandibular relationships, a MEDLINE search was conducted, which was complemented by a hand search in selected journals.

RESULTS AND CONCLUSIONS

Musculoskeletal facial pain seems to variably affect the aforementioned positions and movements. Hence, the validity of maxillomandibular registrations in patients with existing facial pain is questioned. In those patients with facial pain who simultaneously are in need of a prosthodontic rehabilitation, clinicians should be cautious with regard to the timing of the restorative procedures.