Incisal and condylar paths during habitual mouth opening movement of children with anterior reverse bite in the primary dentition

Reliability of landmark identification for analysis of the temporomandibular joint in real-time MRI

BACKGROUND

Real-time magnetic resonance imaging (rtMRI) is essential for diagnosing and comprehending temporomandibular joint (TMJ) movements. Current methods for tracking and analysis require manual landmark placement on each acquisition frame. Therefore, our study aimed to assess the inter- and intra-rater reliability of placing cephalometric landmarks in frames from a dynamic real-time TMJ MRI.

MATERIAL AND METHODS

Four real-time MRIs of the right TMJ were taken during mandibular movement at ten frames per second. Seven dentists identified ten landmarks on two frames (intercuspal position-ICP-and maximum mouth opening-MMO) twice at a two-week interval, yielding 112 tracings. Six typical cephalometric measurements (angles and distances) were derived from these landmarks. The reliabilities of landmarks and measurements were evaluated using distance-based (dbICC), linear mixed effect model intraclass correlation (lmeICC), and standard ICC.

RESULTS

The average inter-rater reliability for the landmarks stood at 0.92 (dbICC) and 0.93 (lmeICC). The intra-rater reliability scores were 0.97 and 0.98. Over 80% of the landmarks showed an ICC greater than 0.98 (inter-rater) and over 0.99 (intra-rater). The lowest landmark ICC was observed for the orbitale and the oblique ridge of the mandibular ramus. However, the cephalometric angle and distance measurements derived from these landmarks showed only moderate to good reliability, whereas the reliability in the frames with ICP was better than those with MMO. Measurements performed in the ICP frame were more reliable than measurements in the MMO frame.

CONCLUSION

While dentists reliably localize isolated landmarks in real-time MRIs, the cephalometric measurements derived from them remain inconsistent. The better results in ICP than MMO are probably due to a more familiar jaw position. The higher error rate of the TMJ measurements in MMO could be associated with a lack of training in real-time MRI analysis in dentistry.

Effect of malocclusion on jaw motor function and chewing in children: a systematic review

Objective

To investigate the effects of dental/skeletal malocclusion and orthodontic treatment on four main objective parameters of chewing and jaw function (maximum occlusal bite force [MOBF], masticatory muscle electromyography [EMG], jaw kinematics, and chewing efficiency/performance) in healthy children.

Materials and methods

Systematic searches were conducted in MEDLINE (OVID), Embase, and the Web of Science Core Collection. Studies that examined the four parameters in healthy children with malocclusions were included. The quality of studies and overall evidence were assessed using the Joanna Briggs Institute and GRADE tools, respectively.

Results

The searches identified 8192 studies; 57 were finally included. The quality of included studies was high in nine studies, moderate in twenty-three studies, and low in twenty-five studies. During the primary dentition, children with malocclusions showed similar MOBF and lower chewing efficiency compared to control subjects. During mixed/permanent dentition, children with malocclusion showed lower MOBF and EMG activity and chewing efficiency compared to control subjects. The jaw kinematics of children with unilateral posterior crossbite showed a larger jaw opening angle and a higher frequency of reverse chewing cycles compared to crossbite-free children. There was a low to moderate level of evidence on the effects of orthodontic treatment in restoring normal jaw function.

Conclusions

Based on the limitations of the studies included, it is not entirely possible to either support or deny the influence of dental/skeletal malocclusion traits on MOBF, EMG, jaw kinematics, and masticatory performance in healthy children. Furthermore, well-designed longitudinal studies may be needed to determine whether orthodontic treatments can improve chewing function in general.

Clinical relevance

Comprehensive orthodontic treatment, which includes evaluation and restoration of function, may or may not mitigate the effects of malocclusion and restore normal chewing function.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04356-y.

Development of a novel statistical model for mandibular kinematics

The purpose of this study was to establish a new statistical method for the analysis of masticatory function. The subjects were patients with anterior crossbite who had received orthognathic surgery. Chewing movement was measured by means of an opto-electronic motion-analysis system. This movement was compared with similar movement in control patients. We sought to develop a statistical model to predict the population average curves of the chewing cycles. In this study, the mandibular incisor point was used as a target point of jaw movement. The combination of a spline function with random coefficients and self-modeling regression (SEMOR) extended to three dimensions was used to predict population average curves for each group. Unquestionably, significant differences were present in some areas. The present modeling method that uses the combination of a spline function and SEMOR is one of the best ways to eliminate subjective estimation with regard to predicting representative chewing cycles.

Mandibular open-close motion in children with anterior crossbite occlusion

Anterior crossbite (ACB) malocclusions are frequent; however, its characteristic functional features have not been fully described. The purpose of this study was to determine the characteristics of habitual mandibular open-close motion in children with ACB of their primary dentition. Two groups of children were selected for study; 17 with ACB (eight boys and nine girls; four years one month to seven years one month) and 19 with normal occlusion (eight boys and 11 girls; four years six months to six years seven months). The motion was recorded using an optoelectronic analysis system with six degrees-of-freedom. Mandibular incisor and condylar motion were analyzed by measuring their three-dimensional ranges and trajectories. Also estimated incisor and condylar pathways of the two groups were compared. Patients with ACB opened wider with more anterior-posterior condylar translation and more mandibular rotation. Although between-subject (inter-individual) variance of all variables in children with ACB was larger, they had less within-subject variance at the condyles. These results indicate that open-close mandibular motion in children with ACB is completely different from that of children with normal occlusion. The different motions might be related to morphological differences between the two groups.

Incisal paths during habitual mouth opening and closing movements of children with anterior reverse bite in the early mixed dentition

The purpose of this study was to investigate whether the pathways of habitual mouth opening and closing in children with anterior reverse bite in the early mixed dentition differed from those of children with normal occlusion. The two subject groups for this study were composed of ten children with anterior reverse bite (reverse bite group) and twelve children with normal occlusion (normal occlusion group), respectively. These movements were measured by an optoelectronic analyzing system with six degrees of freedom. Movements of the incisal point were projected on the sagittal plane to characterize the paths, and sagittal angles between the incisal path and the horizontal plane were calculated and compared. Opening and closing sagittal angles in the reverse bite group were almost equal over the entire pathway, indicating that the pathways of habitual mouth opening and closing were similar. In contrast, all opening and closing sagittal angles in the normal occlusion group were different, especially close to maximum intercuspation, indicating that their pathway of habitual mouth opening differed from their mouth closing pathway. In conclusion, children with anterior reverse bite in the early mixed dentition have different patterns of habitual mouth opening and closing movements than children with normal occlusion.