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Tervahauta E, Närhi L, Pirttiniemi P, Sipilä K, Näpänkangas R, Tolvanen M, Vuollo V, Silvola AS. Prevalence of sagittal molar and canine relationships, asymmetries and midline shift in relation to temporomandibular disorders (TMD) in a Finnish adult population. Acta Odontol Scand 2022; 80:470-480. [PMID: 35148484 DOI: 10.1080/00016357.2022.2036364] [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: 11/01/2022]
Abstract
OBJECTIVE To examine the prevalence of sagittal relationships, asymmetries and midline shift, and their associations with temporomandibular disorders (TMD) in the Northern Finland Birth Cohort 1966 (NFBC1966). MATERIALS AND METHODS 1845 subjects participated in a clinical examination at the age of 46. Occlusal measurements were performed using 3D models. Symptoms of TMD were screened using validated questions, and signs and diagnoses of TMD were assessed using a modified protocol of the Diagnostic Criteria for TMD (DC/TMD) and questionnaires. Associations between variables of occlusion and TMD were evaluated with χ2-test and Fisher's exact test and using logistic regression analyses, adjusted for self-reported general health, mental health, bruxism, and rheumatoid arthritis. RESULTS The most common sagittal relationships were Class I and normal canine relationship. Half-cusp Class II and post-normal canine relationship were more frequent in females, and Class III and pre-normal canine relationship in males. Deviations from normal cuspid or molar relationships showed a weak but statistically significant association with TMD, especially in females. Half-cusp Class II and Class II relationships were more frequent in relation to joint-related TMD signs and diagnoses while missing canines were associated with pain-related TMD diagnoses. CONCLUSIONS The present study findings gave some indications that canine relationships are associated with pain-related TMD, whereas Angle II sagittal occlusal relations may associate with joint-related TMD. Occlusal characteristics should therefore be taken into account as one possible associating factor in subjects with TMD.
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Affiliation(s)
- Elisa Tervahauta
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Linnea Närhi
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pertti Pirttiniemi
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ritva Näpänkangas
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mimmi Tolvanen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland
| | - Ville Vuollo
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anna-Sofia Silvola
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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Velásquez RL, Coro JC, Bustillo JM, Sato S. Evaluation of horizontal condylar angle in malocclusions with mandibular lateral displacement using cone-beam computed tomography. Angle Orthod 2021; 91:815-821. [PMID: 34096985 PMCID: PMC8549560 DOI: 10.2319/012621-76.1] [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: 01/01/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the horizontal condylar angle (HCA) in mandibular lateral displacement (MLD). MATERIALS AND METHODS HCA in MLD malocclusions were examined using cone-beam computed tomography data in subjects with MLD and control subjects. RESULTS HCA in joints of control patients and contralateral side joints of MLD patients were not significantly different. The mean HCA on the shifted side was larger than on the contralateral side (P < .001) in the different HCA groups. HCA was significantly larger on the shifted side than on the contralateral side in skeletal Class I, Class II, and Class III groups (P < .001). CONCLUSIONS (1) There was no statistically significant difference between HCA in control patients and on the contralateral side in MLD patients. (2) HCA was significantly larger on the shifted side than on the contralateral side. (3) HCA on the shifted side and the contralateral side in MLD Class I, Class II, and Class III are significantly different.
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Jain S, Sharma N, Patni P, Jain D. Association of midline discrepancy with tempromandibular joint disorder. A systematic review. ACTA ACUST UNITED AC 2018; 91:151-156. [PMID: 29785152 PMCID: PMC5958979 DOI: 10.15386/cjmed-832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 11/23/2022]
Abstract
Aim The aim is to evaluate the association between midline discrepancies and tempromandibular disorders (TMDs). Methods Literature search was performed by using various search engines to include human studies in English. TMDs include a wide variety of signs and symptoms such as pain in and around TMJ, jaw muscles, clicking and locking of jaws, pain during mandibular movement and restricted mandibular movements. The etiology is multifactorial, including one or several of the following factors like severe malocclusions (increased overjet, retroclination of incisors, cross bite, CR CO discrepancies etc), stress and psychological factors, structural abnormalities as possible etiology. There are controversies concerning the association between different traits of malocclusion and TMDs. The aim of the present study was to find out any association between signs and symptoms of TMDs with midline discrepancies, which represent an important trait of malocclusion. Result Of the seven studies evaluated in this systematic review for investigating the association between midline discrepancy and TMD, six had moderate grade (B) of evidence. Four studies of moderate grade evidence (B) showed a significant association between the presence of midline shift and TMDs, and the remaining studies (two) had non-significant association. Only one study had a strong grade of evidence (A) and interestingly it denies the presence of midline shift to be a causative factor for TMDs. So, it can be concluded that the results are inconclusive regarding the association of midline discrepancies with TMDs. Nonetheless, this requires concrete evidence which necessitates further long term research into this aspect.
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Affiliation(s)
- Sandhya Jain
- Department of Orthodontics and Dentofacial Orthopedics, Government Dental College, Indore, M.P., India
| | - Neetu Sharma
- Department of Orthodontics and Dentofacial Orthopedics, Government Dental College, Indore, M.P., India
| | - Pallav Patni
- Department of Endodontics and Conservative Dentistry, Sri Aurbindo College of Dentistry, Indore, M.P., India
| | - Deshraj Jain
- Department of Prosthodontics, Government Dental College, Indore, M.P., India
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Sójka A, Huber J, Hędzelek W, Wiertel-Krawczuk A, Szymankiewicz-Szukała A, Seraszek-Jaros A, Kulczyk A, Wincek A, Sobieska M. Relations between the results of complex clinical and neurophysiological examinations in patients with temporomandibular disorders symptoms. Cranio 2017; 36:44-52. [DOI: 10.1080/08869634.2017.1290907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Anna Sójka
- Department and Clinic of Prosthodontics, University of Medical Sciences, Poznań, Poland
| | - Juliusz Huber
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, Poznań, Poland
| | - Wiesław Hędzelek
- Department and Clinic of Prosthodontics, University of Medical Sciences, Poznań, Poland
| | | | | | - Agnieszka Seraszek-Jaros
- Department of Bioinformatics and Computational Biology, University of Medical Sciences, Poznań, Poland
| | - Aleksandra Kulczyk
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, Poznań, Poland
| | - Agnieszka Wincek
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, Poznań, Poland
| | - Magdalena Sobieska
- Department of Rheumatology and Rehabilitation, University of Medical Sciences, Poznań, Poland
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Manfredini D, Lombardo L, Siciliani G. Dental Angle class asymmetry and temporomandibular disorders. J Orofac Orthop 2017; 78:253-258. [PMID: 28084514 DOI: 10.1007/s00056-016-0079-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether there is an association between the presence of asymmetric molar or canine Angle classes on the two sides and the presence of temporomandibular joint dysfunction (TMD). MATERIALS AND METHODS Participants to the study were divided into two groups: TMD group (90 patients) or a control group (58 patients). In the TMD group, clinical assessment for TMD was performed according to the Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines by the same two trained examiners. In both groups, all subjects underwent an assessment of dental occlusion, focusing on the assessment of bilateral canine and molar Angle class relationship. The study protocol was reviewed and approved by the Institutional Review Board of the University of Padova, and each participant gave written consent to take part in the investigation. RESULTS TMJ pain was diagnosed in 58, disk displacement in 96, arthrosis in 17, and muscle pain in 46 individuals. Molar Angle class was symmetrical in 86 individuals and asymmetrical in 62 subjects. Molar Angle class was not correlated with any of the TMD diagnoses. Canine Angle class was correlated with TMJ arthrosis. Correlation values with the other TMD diagnoses were low and were not significant. CONCLUSIONS It can be suggested that an association between dental Angle class asymmetry and TMDs does not exist and that the role of dental asymmetries as a factor correlated with the presence of TMD signs and symptoms is minimal.
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Affiliation(s)
- Daniele Manfredini
- Department of Orthodontics, University of Ferrara, Ferrara, Italy.,, Via Montebello, 31, 44100, Ferrara, Italy
| | - Luca Lombardo
- Department of Orthodontics, University of Ferrara, Ferrara, Italy. .,, Contrada Nicolizia, 92100, Licata, AG, Italy.
| | - Giuseppe Siciliani
- Department of Orthodontics, University of Ferrara, Ferrara, Italy.,, Via Montebello, 31, 44100, Ferrara, Italy
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Moroi A, Ishihara Y, Sotobori M, Iguchi R, Kosaka A, Ikawa H, Yoshizawa K, Marukawa K, Ueki K. Changes in occlusal function after orthognathic surgery in mandibular prognathism with and without asymmetry. Int J Oral Maxillofac Surg 2015; 44:971-6. [PMID: 25864000 DOI: 10.1016/j.ijom.2015.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/18/2015] [Accepted: 03/24/2015] [Indexed: 11/27/2022]
Abstract
This study aimed to evaluate the postoperative changes in masticatory function in patients with jaw deformities with or without asymmetry treated by orthognathic surgery. Thirty female patients who underwent a Le Fort I osteotomy with sagittal split ramus osteotomy (SSRO) were enrolled. The patients were divided into symmetry and asymmetry groups. The bite force, occlusal contact area, and bite force balance were measured before and at 1, 3, and 6 months and 1 year after surgery; these measurements were compared statistically within and between the two groups. In the symmetry group, there was a significant difference in the preoperative bite force and the 1 month postoperative bite force (P=0.0033). In the asymmetry group, the bite force before surgery was significantly different from that at 1 month (P=0.0375) and at 1 year (P=0.0353) after surgery. Significant differences in the bite force were also observed between the following time points: 1 month and 1 year (P=0.0003), 3 months and 1 year (P=0.0034), and 1 month and 6 months (P=0.0486). The occlusal contact area, bite force, and occlusal balance tended to change after Le Fort I osteotomy with SSRO, with a significantly improved bite force in patients with asymmetry before surgery.
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Affiliation(s)
- A Moroi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.
| | - Y Ishihara
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - M Sotobori
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - R Iguchi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - A Kosaka
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - H Ikawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - K Yoshizawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - K Marukawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - K Ueki
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
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D’Ippolito S, Ursini R, Giuliante L, Deli R. Corrélations entre les asymétries mandibulaires et les troubles temporomandibulaires (TTM). Int Orthod 2014. [DOI: 10.1016/j.ortho.2014.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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D'Ippolito S, Ursini R, Giuliante L, Deli R. Correlations between mandibular asymmetries and temporomandibular disorders (TMD). Int Orthod 2014; 12:222-38. [PMID: 24820702 DOI: 10.1016/j.ortho.2014.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Mandibular asymmetries are the fulcrum of many debates among modern orthodontists and maxillofacial surgeons. The interest is even greater when facial asymmetries are correlated to the development of TMJ symptoms and temporomandibular disorders (TMD). OBJECTIVE The aim of this study is to investigate how mandibular asymmetries constitute etiological or predisposing factors for the development of temporomandibular disorders (TMD). We considered patients with mandibular asymmetries associated with TMD. Using orthodontic or surgical-orthodontic treatment, patients experienced correction of their TMJ symptoms. Thus, mandibular asymmetries represent a major risk factor for the development of TMD. MATERIAL AND METHODS We studied a sample of 16 subjects aged between 14 and 36-years-old (11 females and 5 males) with mandibular asymmetries (81% structural asymmetry, 19% functional asymmetry). These subjects presented skeletal and dental malocclusions combined with several temporomandibular disorders, mostly due to muscle tension. In 100% of cases, patients received orthodontic treatment. We compared pre- and post-treatment postero-anterior (PA) cephalometric analyses in order to evaluate asymmetry resolution. RESULTS Comparison of measurements from pre- and post-therapy PA cephalograms showed resolution of mandibular asymmetries after treatment. The treatment resolved mandibular asymmetries and completely eliminated temporomandibular symptoms. CONCLUSIONS Orthodontic treatment of patients presenting mandibular asymmetry enables correction of all TMJ symptoms and TMD. Mandibular symmetries can therefore be considered to constitute etiological or predisposing factors for the development of TMD.
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Affiliation(s)
- Simona D'Ippolito
- Università Cattolica del Sacro Cuore, Istituto di Clinica Odontoiatrica, Largo F. Vito 1, 00168 Roma, Italy.
| | | | | | - Roberto Deli
- Università Cattolica del Sacro Cuore - Policlinico "A. Gemelli", 6° Piano, Scuola di Specializzazione in Ortognatodonzia, Largo F. Vito 1, 00168 Roma (RM), Italy
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Sakar O, Calişir F, Marşan G, Oztaş E. Evaluation of the effects of temporomandibular joint disc displacement and its progression on dentocraniofacial morphology in symptomatic patients using posteroanterior cephalometric analysis. Cranio 2013; 31:23-31. [PMID: 23461259 DOI: 10.1179/crn.2013.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of this study was to evaluate the effects of disc displacement (DD) and its progression on dentocraniofacial morphology in symptomatic patients, and to compare the results with asymptomatic volunteers. Female patients with DD, diagnosed with magnetic resonance imaging (MRI) and posteroanterior cephalometric analysis, were included in this study. Subjects were grouped as follows: control group with bilateral normal disc position (group 1, n=20), unilateral DD with reduction (group 2, n=17), bilateral DD with reduction (group 3, n=32), unilateral DD without reduction (group 4, n=16), and bilateral DD without reduction (group 5, n=19). Thirteen cephalometric variables were measured. A significant increase in the ANS (Anterior nasal spine)-Me (Menton)-MSP (Midsagittal plane) angle in unilateral DD groups and decreases in the Ag (Antegonial notch)-Me dimension on the affected side in all DD groups were observed. Also, the maximum values of the Me-MSP dimension and ANS-Me-MSP angle were observed in group 4. The results of this study showed that the deviation of the menton point toward the disc displacement side causes a mandibular asymmetry. It can be concluded from these results that the presence of DD in female patients affects facial morphology, and its progression makes the differences more significant and remarkable. These results emphasize the importance of early diagnosis and treatment in the management of DD.
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Affiliation(s)
- Olcay Sakar
- Istanbul University, Faculty of Dentistry, Dept. of Prosthodontics Capa 34093, Istanbul, Turkey.
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Yáñez-Vico RM, Iglesias-Linares A, Torres-Lagares D, Gutiérrez-Pérez JL, Solano-Reina E. Association between craniofacial asymmetry and unilateral temporomandibular joint sounds in adult patients using 3D-computed tomography. Oral Dis 2012; 19:406-14. [PMID: 23034131 DOI: 10.1111/odi.12020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 08/28/2012] [Accepted: 08/31/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the possible relationship between unilateral temporomandibular joint (TMJ) sounds and craniofacial asymmetry, using 3D-computed tomography (CT) measurements. SUBJECTS AND METHODS Forty-one reconstructed 3D-CT models of adult subjects were measured to analyze craniofacial asymmetry. Subjects were divided into two groups depending on the presence (n = 20) or absence (n = 21) of unilateral joint sounds, and the results compared using the Mann-Whitney U-test. To investigate the association between these parameters, the Pearson correlation coefficient was calculated. RESULTS Asymmetries in the maxillary and mandibular structures were statistically significant (P < 0.05) for subjects with unilateral TMJ sounds and for controls, except in the case of maxillary rotation and mandibular ramus height (P > 0.05). The highest deviations found were frontal and lateral ramal inclination, goniac angle and canting of occlusal plane. CONCLUSIONS Adult patients with unilateral joint sounds may have skeletal jaw asymmetry and a canted occlusal plane.
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Affiliation(s)
- R-M Yáñez-Vico
- Division of Orthodontics and Dentofacial Orthopaedics, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain
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Onodera K, Celar A. Midline correction by asymmetric reciprocal torque: a pilot study. J Orofac Orthop 2012; 73:317-25. [PMID: 22777167 DOI: 10.1007/s00056-012-0089-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/30/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Can we correct dental midline discrepancies by systematic torque bends on all canines and premolars without extraction and mesiodistal tooth movement? PATIENTS AND METHODS Eight orthodontic patients (4 males, 4 emales, mean age 31 years) presented a dental midline discrepancy of 2-4 mm, moderate deviation of the chin, no skeletal asymmetry, and a horizontal orientation of the occlusal plane in the frontal aspect. On the side where the mandible was shifted medially, asymmetric torque bends moved the antagonist canine and both premolar crowns buccally, while palatal crown torque was used on the maxillary canine and premolars on the other side. Lingual crown torque corrected the medially shifted canine and premolars in the mandibular dental arch, and buccal crown torque the laterally shifted lower canine and premolars. RESULTS On average, torque effects altered the canine guidance by 6.5 ± 4.7°, the first premolar guidance by 7 ± 4.1°, and the second premolar guidance by 6.3 ± 3.7°. Correction of the dental midline shift averaged 1.6 ± 0.8 mm after the torque, and eliminated the midline discrepancy completely (n = 2) or partly (n = 6). CONCLUSION In this pilot study, asymmetric reciprocal torque represented a treatment option for midline corrections of approximately 2-4 mm and improvement in the chin position without mesiodistal tooth movement or extraction.
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Affiliation(s)
- Kanji Onodera
- Department of Craniofacial Growth and Developmental Dentistry, Research Institute of Occlusion Medicine, Research Center of Brain and Oral Science, Division of Orthodontics, Kanagawa Dental College, Yokosuka, Japan
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Cooper BC. Temporomandibular disorders: A position paper of the International College of Cranio-Mandibular Orthopedics (ICCMO). Cranio 2012; 29:237-44. [PMID: 22586834 DOI: 10.1179/crn.2011.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
PURPOSE Two principal schools of thought regarding the etiology and optimal treatment of temporomandibular disorders exist; one physical/functional, the other biopsychosocial. This position paper establishes the scientific basis for the physical/functional. THE ICCMO POSITION: Temporomandibular disorders (TMD) comprise a group of musculoskeletal disorders, affecting alterations in the structure and/or function of the temporomandibular joints (TMJ), masticatory muscles, dentition and supporting structures. The initial TMD diagnosis is based on history, clinical examination and imaging, if indicated. Diagnosis is greatly enhanced with physiologic measurement devices, providing objective measurements of the functional status of the masticatory system: TMJs, muscles and dental occlusion. The American Alliance of TMD organizations represent thousands of clinicians involved in the treatment of TMD. The ten basic principles of the Alliance include the following statement: Dental occlusion may have a significant role in TMD; as a cause, precipitant and/or perpetuating factor. Therefore, it can be stated that the overwhelming majority of dentists treating TMD believe dental occlusion plays a major role in predisposition, precipitation and perpetuation. While our membership believes that occlusal treatments most frequently resolve TMD, it is recognized that TMD can be multi faceted and may exist with co-morbid physical or emotional factors that may require therapy by appropriate providers. The International College of Cranio-Mandibular Orthopedics (ICCMO), composed of academic and clinical dentists, believes that TMD has a primary physical/functional basis. Initial conservative and reversible TMD treatment employing a therapeutic neuromuscular orthosis that incorporates relaxed, healthy masticatory muscle function and a stable occlusion is most often successful. This is accomplished using objective measurement technologies and ultra low frequency transcutaneous electrical neural stimulation (TENS). CONCLUSION Extensive literature substantiates the scientific validity of the physical/functional basis of TMD, efficacy of measurement devices and TENS and their use as aids in diagnosis and in establishing a therapeutic neuromuscular dental occlusion. CLINICAL IMPLICATIONS A scientifically valid basis for TMD diagnosis and treatment is presented aiding in therapy.
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Affiliation(s)
- Barry C Cooper
- Division of Translational Oral Biology, State University of New York (SUNY) Stony Brook School of Dental Medicine, USA.
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Changes in temporomandibular joint and ramus after sagittal split ramus osteotomy in mandibular prognathism patients with and without asymmetry. J Craniomaxillofac Surg 2012; 40:821-7. [PMID: 22507292 DOI: 10.1016/j.jcms.2012.03.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to examine the changes in the temporomandibular joint (TMJ) and ramus after sagittal split ramus osteotomy (SSRO) with and without Le Fort I osteotomy. The subjects consisted of 87 Japanese patients diagnosed with mandibular prognathism with and without asymmetry. They were divided into 2 groups (42 symmetric patients and 45 asymmetric patients). The TMJ disc tissue was assessed by magnetic resonance imaging (MRI) and the TMJ space, condylar and ramus angle were assessed by computed tomography (CT) preoperatively and postoperatively. Medial joint space on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0043), and coronal ramus angle on the non-deviation side in the asymmetry group was significantly larger than that in the symmetry group preoperatively (P = 0.0240). The horizontal condylar angle on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0302), posterior joint space on the non-deviation side in the symmetry group was significantly larger than that in the asymmetry group postoperatively (P = 0.00391). The postoperative anterior joint space was significantly larger than the preoperative value on both sides in both groups (the deviation side in the symmetry group: P = 0.0016, the non-deviation side in the symmetry group: P < 0.0001, the deviation side in the asymmetry group: P = 0.0040, the non-deviation side in the asymmetry group: P = 0.0024). The preoperative disc position could was not changed in either group. These results suggest that significant expansion of anterior joint space could occur on the deviation side and non-deviation side in the asymmetry group as well as on both sides in the symmetry group, although disc position did not change in either group.
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Abstract
Human jaw dysmorphologies are frequent and often affect young patients, resulting in malocclusion of teeth and inappropriate jaw relationships. Treatment is performed by means of orthodontics with orthognathic surgery as required. Mandibular asymmetry is one of the most frequent dysmorphologies, but in many cases, the specific cause is unknown.In healthy patients who were undergoing orthognathic surgery for correction of malocclusion, we tested the hypothesis that masseter muscle phenotype composition, which determines contractile properties, was different between sides in patients with mandibular asymmetry but not in those without mandibular asymmetry. After cephalometric analysis, 50 patients from whom we obtained samples of both right and left masseter muscles were separated into 2 groups: with or without mandibular lateral deviation. Samples were immunostained with myosin-isoform-specific antibodies to identify 4 skeletal muscle fiber types, and their fiber areas and proportions were measured. Two-tailed Wilcoxon test for paired samples was used to compare the 4 fiber-type compositions by means of percent occupancy and mean fiber area on both sides. Patients with mandibular asymmetry were associated with a significant increase of type II fiber occupancy (P = 0.0035) on the same side as the deviation. This finding that masseter muscle phenotype is significantly linked to mandibular asymmetry is of relevance to physiotherapeutic and surgical managements of jaw discrepancies and merits further investigation in the light of its possible role in the etiology of this condition.
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Ueki K, Nakagawa K, Marukawa K, Yamamoto E, Takeuchi N. Stress change on the temporomandibular joint in mandibular prognathism subjects with asymmetry after orthognathic surgery. Eur J Orthod 2010; 32:522-9. [DOI: 10.1093/ejo/cjp143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ueki K, Takeuchi N, Nakagawa K, Yamamoto E. Simplified stress analysis on the temporomandibular joint in Class III patients with and without mandibular asymmetry using a rigid body spring model. Orthod Craniofac Res 2009; 12:312-8. [DOI: 10.1111/j.1601-6343.2009.01467.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nakamura T, Okamoto K, Maruyama T. Facial asymmetry in patients with cervicobrachial pain and headache. J Oral Rehabil 2008. [DOI: 10.1111/j.1365-2842.2001.00766.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Buranastidporn B, Hisano M, Soma K. Temporomandibular joint internal derangement in mandibular asymmetry. What is the relationship? Eur J Orthod 2005; 28:83-8. [PMID: 16257990 DOI: 10.1093/ejo/cji073] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The purpose of this study was to clarify the contributing factors and their influences on temporomandibular joint internal derangement (TMJ ID) symptoms in subjects with mandibular asymmetry. Postero-anterior (PA) cephalograms of 187 pre-orthodontic treatment subjects (aged 18-45 years, mean 23.9 years) were used to investigate the inclination of the frontal occlusal (FOP) and frontal mandibular (FMP) planes to determine vertical asymmetry. Mandibular dental midline shift (DMS) and mandibular midline shift (MMS) were studied to determine transverse asymmetry. The degree of asymmetry was analysed in conjunction with the results from self-administered TMJ ID history forms. A prevalence of TMJ ID was most related to the inclination of the FMP (P < 0.01), with the symptoms being notably higher when the cant was greater than 3 degrees. The symptomatic side was related only to the inclination of the FOP and FMP. Symptoms confined to the ipsilateral side were primarily found in subjects with mild asymmetry, whereas symptoms on both sides and those on the contralateral side were greater in those with moderate and severe asymmetry, respectively. No significant correlation was found for DMS and MMS. The results suggest that the degree of asymmetry in the vertical dimension is significantly correlated with TMJ ID symptoms.
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Affiliation(s)
- B Buranastidporn
- Department of Orthodontics, Faculty of Dentistry, Chiang Mai University, Thailand.
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Ciancaglini R, Gherlone EF, Radaelli G. Unilateral temporomandibular disorder and asymmetry of occlusal contacts. J Prosthet Dent 2003; 89:180-5. [PMID: 12616239 DOI: 10.1067/mpr.2003.9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM The relationship between temporomandibular disorders and occlusal tooth contacts is unclear and controversial. PURPOSE This study assessed whether unilateral temporomandibular disorders were associated with the absence of bilateral symmetry in the number of occlusal contacts. MATERIAL AND METHODS Fifteen university dental students who had complete natural dentition and normal occlusion and exhibited unilateral signs and symptoms of temporomandibular disorders were compared to 15 age- and sex-matched healthy control subjects. All participants met specific inclusion and exclusion criteria. Occlusal contacts were recorded in the intercuspal position with wax registrations. Dental impressions were made and poured in type I stone. Contacts were classified according to location and intensity. Four experienced dentists using an established protocol made all measurements. Assessment of the reliability of the occlusal registration procedure showed a small (<4%) within-subject variability. Statistical analysis was based on the binomial distribution and nonparametric tests (P < .05). RESULTS Subjects with unilateral temporomandibular disorders had greater bilateral difference in the number of contacts than controls. The median (95% confidence interval) difference was 3 (2 to 4) and 2 (1 to 2), respectively. In unilateral temporomandibular disorder subjects, the number of occlusal contacts was greater on the side with, rather than without, disorder (median number 20 vs. 16). The median (95% confidence interval) difference between sides with and without unilateral temporomandibular disorders was 3 (2 to 4) for all contacts and 2 (1 to 3) for contacts on the posterior teeth. CONCLUSION Within the population of this study, a weak association was found between unilateral temporomandibular disorders and asymmetry in the number of occlusal contacts.
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Affiliation(s)
- Riccardo Ciancaglini
- Department of Biomedical Sciences and Technologies, LITA, San Paolo Hospital, University of Milan, and San Raffaele Hospital, Milan, Italy
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