1
|
Murakami K, Yamamoto K, Kawakami M, Horita S, Kirita T. Changes in strain energy density in the temporomandibular joint disk after sagittal split ramus osteotomy using a computed tomography-based finite element model. J Orofac Orthop 2024; 85:289-305. [PMID: 36629885 DOI: 10.1007/s00056-022-00441-3] [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: 02/04/2022] [Accepted: 11/13/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE We evaluated the changes in the strain energy density (SED) in the temporomandibular joint (TMJ) disk after sagittal split ramus osteotomy (SSRO) at three time points. A finite element model (FEM) based on real patient-based computed tomography (CT) data was used to examine the effect of SSRO on the TMJ. METHODS Measurements of the condylar position and angulation in CT images and FEM analyses were performed for 17 patients scheduled to undergo SSROs at the following time points: before surgery, immediately after surgery, and 1 year after surgery. SED on the entire disk was calculated at each of the three time points using FEM. Furthermore, the relationship between individual SED values and the corresponding condylar position was also evaluated. RESULTS No significant change was observed in the condylar position at the three time points. The FEM analysis showed that SED was the highest and lowest immediately after and 1 year after surgery, respectively. A possible SED distribution imbalance between the left and right joints was improved 1 year after SSRO. Concerning the effect of fossa morphometry and condylar position, wide and deep glenoid fossae and a more posterior condylar position tended to show lower SED. CONCLUSION SED in the articular disk temporarily increased after surgery and significantly decreased 1 year after surgery compared with that before surgery. SSRO generally improved the imbalance between the left and right joints. Thus, SSRO, which improves maxillofacial morphology, may also improve components of temporomandibular disorders.
Collapse
Affiliation(s)
- Kazuhiro Murakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan.
| | - Kazuhiko Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan
| | - Masayoshi Kawakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan
| | - Satoshi Horita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan
| |
Collapse
|
2
|
Benkhalifa M, Tobji S, Moatemri R, Ben Amor A, Dallel I, Ben Amor W. Surgical-orthodontic approach for correcting Vertical Maxillary Excess: Case report. SAGE Open Med Case Rep 2024; 12:2050313X241256805. [PMID: 38835425 PMCID: PMC11149436 DOI: 10.1177/2050313x241256805] [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: 12/30/2023] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
This report describes a patient with Vertical Maxillary Excess without open bite in whom surgical orthodontic treatment to reduce lower facial height remarkably improved function and facial esthetics. The patient was a 22-year-old male whose main concern was crowding and temporomandibular joint clicking sounds. The clinical and radiological findings led to the diagnosis of Vertical Maxillary Excess with a mild skeletal class II malocclusion. The proposed treatment plan comprised a bimaxillary surgery without premolar extractions. LeFort I osteotomy was planned to reposition the maxilla superiorly by 7-8 mm. This surgery was combined with a bilateral sagittal split osteotomy for mandibular anterior derotation to adjust the mandible to the occlusal and anteroposterior change. Postoperatively, the mandibular plane angle (GoGn-SN) was decreased by 4° and skeletal class I was achieved (ANB, 4°). In addition, lip incompetence was corrected and the excessive gingiva exposure upon smiling was significantly improved. The patient was satisfied with the treatment result and reported the temporomandibular joint clicking sounds disappearing after surgery.
Collapse
Affiliation(s)
- Mona Benkhalifa
- Department of Orthodontics, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Samir Tobji
- Department of Orthodontics, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Ramzi Moatemri
- Department of Maxillofacial, Plastic and Esthetic Surgery, Sahloul University Hospital of Sousse, Sousse, Tunisia
| | - Adel Ben Amor
- Department of Orthodontics, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Ines Dallel
- Department of Orthodontics, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
| | - Wiem Ben Amor
- Department of Orthodontics, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
| |
Collapse
|
3
|
Kämäräinen M, Savolainen J, Tynkkynen J, Kellokoski J, Pahkala R. Long-term patient satisfaction and the sense of coherence - a longitudinal study 10-15 years after orthognathic surgery. Acta Odontol Scand 2021; 79:377-382. [PMID: 33423587 DOI: 10.1080/00016357.2020.1869825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study focuses on evaluating the long-term treatment outcome (10-15 years) and patient satisfaction after orthognathic treatment with bisagittal split osteotomy (BSSO). Furthermore, the aim was to evaluate whether the psychosocial factor, sense of coherence (SOC) associates with long-term patient satisfaction. MATERIALS AND METHODS Study sample consisted of 57 patients who had orthognathic treatment with BSSO. Self-completion questionnaires were distributed approximately 1.8 years and 10-15 years after surgery to evaluate treatment outcome. SOC was evaluated with a 12-scale questionnaire 10-15 years after the surgery. RESULTS After 10-15 years following BSSO, 96% of patients were highly or moderately satisfied with the treatment outcome and none expressed dissatisfaction. Less educated patients were more satisfied with the treatment outcome than those with a higher educational level. Patients who felt clear improvement in their facial appearance expressed higher satisfaction than those experiencing only minor facial improvement. Furthermore, patients with improvement in orofacial pains and headaches more often expressed high satisfaction than those without improvement of these symptoms. Patients with strong SOC seemed to have somewhat higher scores for functional aspects of long-term treatment outcome. CONCLUSIONS Post-treatment satisfaction with orthognathic treatment appears to be long-lasting. Psychosocial factors may play a role in long-term post-treatment satisfaction. Our study strongly suggests that psychosocial factors should be taken into account in the treatment planning of orthognathic patients.
Collapse
Affiliation(s)
- Minna Kämäräinen
- Faculty of Health Sciences, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral and Maxillofacial Department, Kuopio University Hospital, Kuopio, Finland
| | - Jarno Savolainen
- Faculty of Health Sciences, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Jenni Tynkkynen
- Faculty of Health Sciences, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Jari Kellokoski
- Faculty of Health Sciences, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral and Maxillofacial Department, Kuopio University Hospital, Kuopio, Finland
| | - Riitta Pahkala
- Oral and Maxillofacial Department, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
4
|
Ploder O, Sigron G, Adekunle A, Burger-Krebes L, Haller B, Kolk A. The Effect of Orthognathic Surgery on Temporomandibular Joint Function and Symptoms: What are the Risk Factors? A Longitudinal Analysis of 375 Patients. J Oral Maxillofac Surg 2020; 79:763-773. [PMID: 33285107 DOI: 10.1016/j.joms.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The effects of orthognathic surgery (OGS) on the temporomandibular joint (TMJ) are still controversial. Based on a high-volume uniform collective, the function and clinical symptoms of the TMJ and the dysfunction index (Di) by Helkimo were evaluated prior and up to 2 years after OGS. METHODS A longitudinal cohort study was performed between 2006 and 2016. A comprehensive examination focusing on TMJ function, temporomandibular disorder (TMD) symptoms, and the Di had been performed preopertaively (T0) and postoperatively at 6 weeks (T1), 6 months (T2), 1 year (T3), and 2 years (T4). The predictor variables used were sex, age, skeletal class, type of surgery, and amount of dysfunction or number of TMD complaints before treatment. The outcome of this study was TMD symptoms and the Di. Descriptive and bivariate statistics were computed, and the significance level was set at P < .05. RESULTS The sample consisted of 375 patients (247 women, 128 men, mean age 28.1 ± 9.4 years), 269 with skeletal Class II (71.7%) and 106 with skeletal Class III (28.3%) treated with sagittal split osteotomy bilateral sagittal split osteotomy (n = 173) or Le Fort I and bilateral sagittal split osteotomy (n = 202). Severe signs of dysfunction (Di 2/3) were seen in 5.9% of the patients before OGS and in 2.1% of the patients 2 years after OGS. The difference in Di (Di0/1 and Di2/3) between T0 and T1/T2 was statistically significant (P = .028; P = .011, respectively). TMD symptoms were significantly reduced 2 years after OGS (P = .028). Female gender (P = .013), skeletal Class II (P < .001), and counterclockwise rotation (P < .001) were the only risk factors significantly associated with the occurrence of TMD at T1. CONCLUSIONS The results of this study suggest that in most cases TMD symptoms can be significantly reduced and only a few can be induced with OGS. No risk factors were found for long-term effects on the TMJ.
Collapse
Affiliation(s)
- Oliver Ploder
- Head, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Guido Sigron
- Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Adeola Adekunle
- Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Laura Burger-Krebes
- Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria; and Postdoc student, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Andreas Kolk
- Head, Department of Oral and Maxillofacial Surgery, Medical University Innsbruck, Innsbruck, Austria.
| |
Collapse
|
5
|
Sefidroodi M, Lobekk OK, Løes S, Schilbred Eriksen E. Temporomandibular joint function 10-15 years after mandibular setback surgery and six weeks of intermaxillary fixation. J Appl Oral Sci 2019; 27:e20180510. [PMID: 31166550 PMCID: PMC6534369 DOI: 10.1590/1678-7757-2018-0510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/02/2018] [Indexed: 11/22/2022] Open
Abstract
Intermaxillary fixation (IMF) is a classic method for immobilization of the mandible after mandibular fractures and corrective surgery. However, it has been suggested that IMF may be a risk for developing temporomandibular joint (TMJ)-related symptoms, especially when applied for longer periods.
Collapse
Affiliation(s)
| | - Ole Kristian Lobekk
- University of Bergen, Faculty of Medicine, Department of Clinical Dentistry, Bergen, Norway
| | - Sigbjørn Løes
- University of Bergen, Faculty of Medicine, Department of Clinical Dentistry, Bergen, Norway.,Haukeland University Hospital, Department of Maxillofacial Surgery, Bergen, Norway
| | | |
Collapse
|
6
|
Prevalence of Temporomandibular Disorder Symptoms among Orthognathic Patients in Southern Germany: Retrospective Study. Int J Dent 2018; 2018:4706487. [PMID: 30420885 PMCID: PMC6211154 DOI: 10.1155/2018/4706487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/02/2018] [Accepted: 09/24/2018] [Indexed: 11/24/2022] Open
Abstract
This study investigated the prevalence of temporomandibular disorder (TMD) among patients before and after orthognathic surgery and assessed the effect of orthognathic surgery on each of the TMD symptoms (clicking, pain, crepitus, and MRI findings). A sample of 100 consecutive patients undergoing bimaxillary surgery for correction of craniofacial deformities (31 male and 69 female), with ages ranging between 17 and 58 years (mean age: 27.7 ± 9.3 years), were interviewed and examined regarding signs and symptoms of TMD. Clinical examination and X-ray and magnetic resonance imaging of the temporomandibular junction were performed at the time of surgery and 1 year thereafter. The prevalence of TMD preoperatively and postoperatively was 35% and 27%, respectively. A high frequency of relief was found in the patients with TMD symptoms (74.3%; 19 (70.3%) of patients had reduced clicking, 7 (87.5%) patients had reduced pain, 4 (100%) patients had reduced crepitus, and 4 (57.1%) patients showed changes in MRI findings), 12 patients who were asymptomatic before surgery developed clicking in TMJ after surgery, 3 developed pain, and 3 developed crepitus. TMD problems can occur in a variety of patients, including those who have facial deformities, and require orthognathic surgery. However, orthognathic surgery may not predictably treat or reduce the symptoms of TMD.
Collapse
|
7
|
Dolwick MF, Widmer CG. Orthognathic Surgery as a Treatment for Temporomandibular Disorders. Oral Maxillofac Surg Clin North Am 2018; 30:303-323. [PMID: 29866451 DOI: 10.1016/j.coms.2018.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Well-controlled clinical trials supporting orthognathic surgery as the primary management for temporomandibular disorders (TMDs) are lacking. Most published studies lack an adequate experimental design to minimize biases. Studies that did minimize some biases do support an overall reduction in the frequency of TMD signs and symptoms in some Class III and Class II patients who had orthognathic surgery. However, Class II correction with counter-clockwise rotation of the mandible increased TMD. Individual variability precludes the ability to predict TMD outcome after surgery. Irreversible therapies such as orthognathic surgery should not be primary treatments in the management or prevention of TMDs.
Collapse
Affiliation(s)
- M Franklin Dolwick
- Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, PO Box 100416, Gainesville, FL 32610-0416, USA.
| | - Charles G Widmer
- Division of Facial Pain, Department of Orthodontics, University of Florida College of Dentistry, PO Box 100444, Gainesville, FL 32610-0444, USA
| |
Collapse
|
8
|
Jussila P, Krooks L, Näpänkangas R, Päkkilä J, Lähdesmäki R, Pirttiniemi P, Raustia A. The role of occlusion in temporomandibular disorders (TMD) in the Northern Finland Birth Cohort (NFBC) 1966. Cranio 2018; 37:231-237. [PMID: 29308993 DOI: 10.1080/08869634.2017.1414347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the role of occlusion in temporomandibular disorders (TMDs) in the Northern Finland Birth Cohort 1966 (NFBC 1966). METHODS Subjects (n = 1962) participated in clinical medical and dental examinations. The association between TMD signs and diagnoses with occlusal disturbances, i.e. malocclusions and occlusal interferences, was examined. Pearson's chi-square test, as expressed by odds ratios (OR) and 95% confidence intervals (CI) and logistic regression models, were used in the analysis. RESULTS A statistically significant association was found between myalgia and lateral scissor bite and also between arthralgia and lateral deviation in the retruded contact position and intercuspal contact position (RCP-ICP) slide. Pain in the masticatory muscles was associated with negative overjet and the amount of RCP-ICP slide. DISCUSSION Occlusal factors showed a statistically significant association with TMD. The TMD signs were associated with unstable occlusion, especially the amount and lateral deviation in RCP-ICP slide, as well as negative overjet.
Collapse
Affiliation(s)
- Päivi Jussila
- a Research Unit of Oral Health Sciences, Faculty of Medicine , University of Oulu , Oulu , Finland.,b Medical Research Center , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Laura Krooks
- a Research Unit of Oral Health Sciences, Faculty of Medicine , University of Oulu , Oulu , Finland.,b Medical Research Center , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Ritva Näpänkangas
- a Research Unit of Oral Health Sciences, Faculty of Medicine , University of Oulu , Oulu , Finland.,b Medical Research Center , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Jari Päkkilä
- c Department of Mathematical Sciences , University of Oulu , Oulu , Finland
| | - Raija Lähdesmäki
- a Research Unit of Oral Health Sciences, Faculty of Medicine , University of Oulu , Oulu , Finland.,b Medical Research Center , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Pertti Pirttiniemi
- a Research Unit of Oral Health Sciences, Faculty of Medicine , University of Oulu , Oulu , Finland.,b Medical Research Center , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Aune Raustia
- a Research Unit of Oral Health Sciences, Faculty of Medicine , University of Oulu , Oulu , Finland.,b Medical Research Center , Oulu University Hospital and University of Oulu , Oulu , Finland
| |
Collapse
|
9
|
Al-Moraissi EA, Wolford LM, Perez D, Laskin DM, Ellis E. Does Orthognathic Surgery Cause or Cure Temporomandibular Disorders? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2017; 75:1835-1847. [DOI: 10.1016/j.joms.2017.03.029] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 01/30/2023]
|
10
|
di Paolo C, Pompa G, Arangio P, di Nunno A, Di Carlo S, Rosella D, Papi P, Cascone P. Evaluation of Temporomandibular Disorders before and after Orthognathic Surgery: Therapeutic Considerations on a Sample of 76 Patients. J Int Soc Prev Community Dent 2017; 7:125-129. [PMID: 28462182 PMCID: PMC5390577 DOI: 10.4103/jispcd.jispcd_443_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/01/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives: Temporomandibular disorders may be associated with dental and facial malformations. The aim of this study is to record the prevalence of TMDs in patients scheduled for orthognathic surgery, reporting the development of TMDs and symptoms during the entire period of the treatment, and demonstrating the benefits of a team effort on this population. Materials and Methods: Assessment of temporomandibular status was performed using the RDC/TMD criteria at T0 (prior to orthodontic therapy), T1 (3 months after the surgery), and T2 post-therapeutic cycle (6 to 12 months postoperatively). A total of 76 participants were included in the study; all the patients underwent surgical treatment: 12 had bilateral sagittal split osteotomy, 6 with condylar position devices; 64 had Le Fort I + bilateral sagittal split osteotomy, and 15 with condylar position devices. Results were evaluated with a paired-sample t-test and segmentation analysis. Results: Forty-seven patients were affected by TMDs. At T0, 25 patients experienced TMJ pain, 27 had muscular pain, 31 suffered headaches, 42 had disc dislocation with reduction, and 5 were affected by disc dislocation without reduction. Thirty-five patients had occlusal signs of parafunctions, 8 reported tinnitus, and 7 dizziness. At T1, TMJ pain changed from 33.3% to 4.44%, muscular pain changed from 35.5% to 11.1%, headaches improved from 40% to 6.67%, and disc dislocation from 55.2% to 17.7%. Segmentation analysis highlighted improvement after therapy; 57 patients were considered recovered, 14 improved, none were considered stable, whereas 5 patients demonstrated some worsening, 3 of whom had not presented disc dislocation before surgery. At T2, 71 patients were considered completely recovered or improved. Conclusions: Our data indicates beyond any doubt that both functional status and pain levels related to TMDs can be significantly improved with a multi-disciplinary approach. We concluded that surgeon's intervention need to be modified in the presence of presurgical TMDs.
Collapse
Affiliation(s)
- Carlo di Paolo
- Gnathology Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Pompa
- Implant Prosthetic Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Arangio
- Cranio Maxillofacial Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy
| | - Anna di Nunno
- Gnathology Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy
| | - Stefano Di Carlo
- Implant Prosthetic Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Rosella
- Implant Prosthetic Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy
| | - Piero Papi
- Implant Prosthetic Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy
| | - Piero Cascone
- Cranio Maxillofacial Unit, Department of Oral and Maxillo Facial Science, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
11
|
Antonarakis GS, Kalberer N, Courvoisier DS, Scolozzi P. Clinical predictive factors for temporomandibular disorders following combined orthodontic and orthognathic surgical treatment in patients with Class III malocclusion. Cranio 2017; 35:397-404. [PMID: 28129722 DOI: 10.1080/08869634.2017.1283764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to identify clinical factors predisposing to the development or worsening of temporomandibular disorders (TMDs) following orthodontic surgical treatment for Class III malocclusion. METHODS A retrospective cohort study was performed on 88 patients with Class III malocclusion having undergone a combined orthodontic and orthognathic surgical treatment. Temporomandibular joint and masticatory muscle examinations were available prior to treatment and one year post-operatively. Multivariate logistic regression was used to predict the development of post-operative TMDs, and linear regression was used to predict the worsening of TMDs using Helkimo indices. RESULTS Patients with Class III malocclusion presenting with pre-treatment anamnestic TMJ clicking (OR = 5.8; p = 0.03) and undergoing bimaxillary osteotomy procedures (OR = 18.6; p = 0.04) were more at risk for the development of TMDs. DISCUSSION TMDs must be evaluated, monitored, and managed with caution in patients with Class III malocclusion presenting with pre-treatment joint clicking and who are planned for bimaxillary osteotomies.
Collapse
Affiliation(s)
| | - Nicole Kalberer
- b Division of Fixed and Removable Prosthodontics , University of Geneva , Geneva , Switzerland
| | - Delphine S Courvoisier
- c Division of Oral and Maxillofacial Surgery , University Hospitals of Geneva , Geneva , Switzerland
| | - Paolo Scolozzi
- c Division of Oral and Maxillofacial Surgery , University Hospitals of Geneva , Geneva , Switzerland
| |
Collapse
|
12
|
Raberin M. [Orthognathic surgery: the incisor decompensation and its effect on articulation]. Orthod Fr 2016; 87:411-425. [PMID: 27938654 DOI: 10.1051/orthodfr/2016044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The surgical protocols are based on arches preparation before or immediately after the surgical phase. Incisor guides normalization is achieved by incisor decompensation in three dimensions. Place and extend of surgical movements depend on the incisor position obtained at the end of orthodontic preparation. Extraction versus non extraction depends on incisor position planning. Orthognathic surgery induces muscular and temporo-mandibular joint stress which can cause temporo mandibular dysfunction (TMD). OBJECTIVES This article studies relations between incisor decompensation amplitude, orthognathic surgical procedures and risk to create or to increase TMD. CONCLUSIONS Sagittal, vertical and transversal incisor decompensation impact to place and amplitude of surgical movements. Incisor decompensation does not seem to induce TMD during orthodontic preparation even if occlusal guide controls are lost. Temporo mandibular dysfunction degrees define surgical movements area, moderate specially mandibular surgical movements and incisor decompensation objectives.
Collapse
|
13
|
Takahara N, Kabasawa Y, Sato M, Tetsumura A, Kurabayashi T, Omura K. MRI changes in the temporomandibular joint following mandibular setback surgery using sagittal split ramus osteotomy with rigid fixation. Cranio 2016; 35:38-45. [PMID: 27077250 DOI: 10.1080/08869634.2016.1143167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study examined the changes in temporomandibular joint dysfunction (TMD) symptoms and investigated the variations in the disc position, disc and condylar morphology following sagittal split ramus osteotomy (SSRO) with rigid fixation in patients with mandibular prognathism. Furthermore, the authors examined the correlation between mandibular setback and TMD symptoms. METHODS The study included 24 Japanese patients with jaw deformities who were treated using bilateral SSRO and Le Fort I osteotomy. The clinical and magnetic resonance imaging findings in the temporomandibular joint were evaluated preoperatively and at three and six months postoperatively. RESULTS The preoperative TMD symptoms were significantly associated with the prevalence of TMD symptoms at six months postoperatively. Anterior disc displacement improved in four joints with slight displacement and with no morphological change. There were no postoperative changes in condylar morphology. There was no significant correlation between mandibular setback and the postoperative TMD symptoms. CONCLUSION Postoperative TMD symptoms may be influenced mainly by preoperative TMD symptoms rather than mandibular setback using SSRO with rigid fixation. Therefore, patients with TMD symptoms require physical examination and MRI for appropriate diagnosis preoperatively.
Collapse
Affiliation(s)
- Namiaki Takahara
- a Department of Oral and Maxillofacial Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Yuji Kabasawa
- a Department of Oral and Maxillofacial Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Masaru Sato
- b Department of Dentistry and Oral Surgery , Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - Akemi Tetsumura
- c Department of Oral and Maxillofacial Radiology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Tohru Kurabayashi
- c Department of Oral and Maxillofacial Radiology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Ken Omura
- d Department of Dentistry and Oral Surgery , Tokyo General Hospital , Tokyo , Japan
| |
Collapse
|
14
|
Kuhlefelt M, Laine P, Thorén H. Bilateral sagittal split surgery is not a predictable treatment for temporomandibular dysfunction in patients with retrognathia. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:595-601. [PMID: 26948019 DOI: 10.1016/j.oooo.2015.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/11/2015] [Accepted: 12/25/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A prospective study to clarify the impact of forward bilateral sagittal split osteotomy (BSSO) on temporomandibular dysfunction (TMD). STUDY DESIGN We examined and interviewed patients with BSSO before and at 1 year after surgery to evaluate the changes in TMD symptoms. A well-known TMD index, which incorporated two complementary subindices-the objective functional Helkimo dysfunction index (Di) and the subjective symptomatic anamnestic index (Ai)-was used. Patients with a forward movement of the mandible and osteosynthesis with titanic miniplates were included. RESULTS Forty patients (26 females and 14 males, mean age of study population 36.9 years) retrognathia completed the study. There was no change in TMD symptoms in 24 patients (60%), as measured by the Di, and 26 (65%), as measured by the Ai. Twelve patients improved (30%), according to the Di scores and 10 (25%) according to the Ai scores. Four patients had more TMD symptoms at follow-up (10%), as measured by both Di and Ai. CONCLUSIONS Surgery for orthognathia is a predictable treatment for improving aesthetics and occlusion but less predictable for alleviating TMD symptoms in patients with retrognathia. TMD symptoms should therefore be treated independently.
Collapse
Affiliation(s)
- Marina Kuhlefelt
- Consultant (Oral and Maxillofacial Surgery), Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
| | - Pekka Laine
- Professor, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Thorén
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
15
|
Silvola AS, Tolvanen M, Rusanen J, Sipilä K, Lahti S, Pirttiniemi P. Do changes in oral health-related quality-of-life, facial pain and temporomandibular disorders correlate after treatment of severe malocclusion? Acta Odontol Scand 2015; 74:44-50. [PMID: 25936383 DOI: 10.3109/00016357.2015.1040063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The aim was to evaluate the relationships of changes in facial pain, temporomandibular disorders (TMDs) and oral health-related quality-of-life (OHRQoL) in adults who underwent orthodontic or orthodontic/surgical treatment. METHODS Sixty-four patients (46 women, 18 men, range 18-64 years) with severe malocclusion and functional problems were treated in Oulu University Hospital. Of these, 44 underwent orthodontic-surgical and 20 orthodontic treatment. Data were collected with questionnaires and clinical stomatognathic examinations before and on average 3 years after treatment. The OHRQoL was measured with OHIP-14 (The Oral Health Impact Profile), the intensity of facial pain with the Visual Analogue Scale (VAS) and the severity of TMD with the Helkimo's anamnestic (Ai) and clinical (Di) dysfunction indices. RESULTS A significant improvement was found in facial pain, signs and symptoms of TMD and OHRQoL after the treatment (p < 0.05). The decrease in VAS was associated with improvement in OHIP-14 severity (r = 0.296, p = 0.019). The correlations between changes in OHIP-14 severity and Ai and Di were not statistically significant. CONCLUSION Treatment of severe malocclusion seemed to improve OHRQoL via decreased facial pain. Decreased facial pain was associated especially with improved OHRQoL dimensions of physical pain, physical disability and social disability.
Collapse
Affiliation(s)
- Anna-Sofia Silvola
- a 1 Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, MRC, Oulu University Hospital , Oulu, Finland
| | - Mimmi Tolvanen
- b 2 Department of Community Dentistry, Institute of Dentistry, University of Turku , Turku, Finland
| | - Jaana Rusanen
- a 1 Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, MRC, Oulu University Hospital , Oulu, Finland
| | - Kirsi Sipilä
- c 3 Institute of Dentistry, University of Eastern Finland , Kuopio, Finland
- d 4 Kuopio University Hospital , Kuopio, Finland
| | - Satu Lahti
- b 2 Department of Community Dentistry, Institute of Dentistry, University of Turku , Turku, Finland
| | - Pertti Pirttiniemi
- a 1 Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, MRC, Oulu University Hospital , Oulu, Finland
| |
Collapse
|
16
|
Valladares-Neto J, Cevidanes LH, Rocha WC, Almeida GDA, Paiva JBD, Rino-Neto J. TMJ response to mandibular advancement surgery: an overview of risk factors. J Appl Oral Sci 2014; 22:2-14. [PMID: 24626243 PMCID: PMC3908759 DOI: 10.1590/1678-775720130056] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 08/23/2013] [Indexed: 11/22/2022] Open
Abstract
Objective In order to understand the conflicting information on temporomandibular joint
(TMJ) pathophysiologic responses after mandibular advancement surgery, an overview
of the literature was proposed with a focus on certain risk factors. Methods A literature search was carried out in the Cochrane, PubMed, Scopus and Web of
Science databases in the period from January 1980 through March 2013. Various
combinations of keywords related to TMJ changes [disc displacement, arthralgia,
condylar resorption (CR)] and aspects of surgical intervention (fixation
technique, amount of advancement) were used. A hand search of these papers was
also carried out to identify additional articles. Results A total of 148 articles were considered for this overview and, although
methodological troubles were common, this review identified relevant findings
which the practitioner can take into consideration during treatment planning: 1-
Surgery was unable to influence TMJ with preexisting displaced disc and crepitus;
2- Clicking and arthralgia were not predictable after surgery, although there was
greater likelihood of improvement rather than deterioration; 3- The amount of
mandibular advancement and counterclockwise rotation, and the rigidity of the
fixation technique seemed to influence TMJ position and health; 4- The risk of CR
increased, especially in identified high-risk cases. Conclusions Young adult females with mandibular retrognathism and increased mandibular plane
angle are susceptible to painful TMJ, and are subject to less improvement after
surgery and prone to CR. Furthermore, thorough evidenced-based studies are
required to understand the response of the TMJ after mandibular advancement
surgery.
Collapse
Affiliation(s)
- José Valladares-Neto
- Federal University of Goiás, School of Dentistry, Department of Orthodontics, GoiâniaGO, Brazil, Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Lucia Helena Cevidanes
- University of Michigan, School of Dentistry, Department of Orthodontics, Ann Arbor, USA, Department of Orthodontics, School of Dentistry, University of Michigan, Ann Arbor, USA
| | - Wesley Cabral Rocha
- General Hospital of Goiânia, Department of Oral and Maxillofacial Surgery, GoiâniaGO, Brazil, Department of Oral and Maxillofacial Surgery, General Hospital of Goiânia, Goiânia, GO, Brazil
| | - Guilherme de Araújo Almeida
- Federal University of Uberlândia, School of Dentistry, Department of Orthodontics, UberlândiaMG, Brazil, Department of Orthodontics, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - João Batista de Paiva
- University of São Paulo, School of Dentistry, Department of Orthodontics, São PauloSP, Brazil, Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - José Rino-Neto
- University of São Paulo, School of Dentistry, Department of Orthodontics, São PauloSP, Brazil, Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
17
|
Rusanen J, Pirttiniemi P, Tervonen O, Raustia A. MRI of TMJ in Patients with Severe Skeletal Malocclusion Following Surgical/Orthodontic Treatment. Cranio 2014; 26:182-90. [DOI: 10.1179/crn.2008.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
18
|
Chauvel-Lebret D, Leroux A, Sorel O. [Relations between orthognathic surgery and temporomandibular disorders: a systematic review]. Orthod Fr 2013; 84:169-83. [PMID: 23719245 DOI: 10.1051/orthodfr/2013049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 02/14/2013] [Indexed: 11/14/2022]
Abstract
A painful and dysfunctional temporomandibular joint can be associated with a musculoskeletal anomaly. The multifactorial character of the etiology is now recognized. Among the etiologies, the role of orthognathic surgery is still debated. The analysis of the literature from 2000 to 2011 reveals for most authors a decrease in the frequency and intensity of signs and symptoms after surgery, especially pain and clicking. Risk factors may influence post-surgical results. Studies on patient risk factors such as age, sex, type of dysmorphia are inconclusive. Surgical techniques and the procedure used may have an influence on the development of post-surgical clinical signs and symptoms of temporomandibular disorders.
Collapse
Affiliation(s)
- Dominique Chauvel-Lebret
- Laboratoire de Biomatériaux en Site Osseux, UMR CNRS 6226, UFR d'Odontologie, Université de Rennes 1, Université Européenne de Bretagne, 2 avenue du Pr Léon Bernard, bâtiment 15, 35043 Rennes Cedex, France
| | | | | |
Collapse
|
19
|
Dujoncquoy JP, Ferri J, Raoul G, Kleinheinz J. Temporomandibular joint dysfunction and orthognathic surgery: a retrospective study. Head Face Med 2010; 6:27. [PMID: 21083902 PMCID: PMC2998459 DOI: 10.1186/1746-160x-6-27] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 11/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relations between maxillo-mandibular deformities and TMJ disorders have been the object of different studies in medical literature and there are various opinions concerning the alteration of TMJ dysfunction after orthognathic surgery. The purpose of the present study was to evaluate TMJ disorders changes before and after orthognathic surgery, and to assess the risk of creating new TMJ symptoms on asymptomatic patients. METHODS A questionnaire was sent to 176 patients operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri) from 01.01.2006 to 01.01.2008. 57 patients (35 females and 22 males), age range from 16 to 65 years old, filled the questionnaire. The prevalence and the results on pain, sounds, clicking, joint locking, limited mouth opening, and tenseness were evaluated comparing different subgroups of patients. RESULTS TMJ symptoms were significantly reduced after treatment for patients with pre-operative symptoms. The overall subjective treatment outcome was: improvement for 80.0% of patients, no change for 16.4% of patients, and an increase of symptoms for 3.6% of them. Thus, most patients were very satisfied with the results. However the appearance of new onset of TMJ symptoms is common. There was no statistical difference in the prevalence of preoperative TMJ symptoms and on postoperative results in class II compared to class III patients. CONCLUSIONS These observations demonstrate that: there is a high prevalence of TMJ disorders in dysgnathic patients; most of patients with preoperative TMJ signs and symptoms can improve TMJ dysfunction and pain levels can be reduced by orthognathic treatment; a percentage of dysgnathic patients who were preoperatively asymptomatic can develop TMJ disorders after surgery but this risk is low.
Collapse
|
20
|
Lindenmeyer A, Sutcliffe P, Eghtessad M, Goulden R, Speculand B, Harris M. Oral and maxillofacial surgery and chronic painful temporomandibular disorders--a systematic review. J Oral Maxillofac Surg 2010; 68:2755-64. [PMID: 20822845 DOI: 10.1016/j.joms.2010.05.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 05/12/2010] [Accepted: 05/21/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE To provide a systematic review of the best available research literature investigating the relation of oral and maxillofacial surgical procedures to the onset or relief of chronic painful temporomandibular disorder (TMD). MATERIALS AND METHODS A comprehensive review of the databases CINAHL, Cochrane Library, Embase, Medline, NHS Evidence--Oral Health, PsycINFO, Web of Knowledge, and MetaLib was undertaken by 2 authors (P.S., M.H.) up to June 2009 using search terms appropriate to establishing a relation between orofacial surgical procedures and TMD. The search was restricted to English-language publications. RESULTS Of the 1,777 titles reviewed, 35 articles were critically appraised but only 32 articles were considered eligible. These were observational studies that fell into 2 groups; 9 were seeking to establish a surgical cause for TMD. Of these, only 2 of a series of 3 claimed that there was a significant link, but this claim was based on weak data (health insurance records) and was abandoned in a subsequent report. Twenty-three studies were seeking to achieve relief by orthognathic surgical intervention. These were also negative overall, with 7 articles showing varying degrees of mostly nonsignificant improvement, whereas 16 showed no change or a worse outcome. No published report on the putative effect of implant insertion was found. CONCLUSION These apparently contradictory approaches underline a belief that oral surgical trauma or gross malocclusion has a causative role in the onset of TMD. However, there was no overall evidence of a surgical causal etiology or orthognathic therapeutic value. This review emphasizes that it is in the patients' best interest to carry out prospective appropriately controlled randomized trials to clarify the situation.
Collapse
Affiliation(s)
- Antje Lindenmeyer
- Postgraduate Dental Education Unit, Warwick Medical School, Coventry, UK
| | | | | | | | | | | |
Collapse
|
21
|
Øland J, Jensen J, Melsen B. Factors of importance for the functional outcome in orthognathic surgery patients: a prospective study of 118 patients. J Oral Maxillofac Surg 2010; 68:2221-31. [PMID: 20619525 DOI: 10.1016/j.joms.2010.01.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Accepted: 01/13/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to assess the influence of orthognathic surgery on patients' stomatognathic function and, further, to evaluate how post-treatment function relates to satisfaction. PATIENTS AND METHODS A total of 118 adult patients (51 men and 67 women) who were treated with orthognathic surgery were examined before and a minimum of 12 months after the surgical intervention. The stomatognathic function was evaluated with Helkimo's Anamnestic and Clinical Dysfunction index. The former was also used to assess a control group of 47 individuals with the same age and gender distribution and with no history of or present need for orthodontic treatment. RESULTS A total of 76 patients (64.4%) reported severe dysfunction at the beginning of the treatment, and 24 patients (20.3%) reported severe dysfunction at the end of the treatment. Clinical assessment showed that 36 patients (30.5%) had severe dysfunction symptoms upon inclusion versus only 5 (4.2%) at the final examination. However, 3 patients (2.5%) without clinical dysfunction at the time of inclusion developed mild dysfunction during treatment, and 8 patients (6.8%) developed increased dysfunction during treatment. The patients' functional status after treatment and their degree of satisfaction with the treatment were positively correlated. Although a general improvement was verified, the functional status of those who were treated never reached that of the control group. CONCLUSION This study indicates that orthognathic surgery improves patients' stomatognathic function in most cases, and that patients' satisfaction correlated with perceived, reported, and measured function at the end of the treatment.
Collapse
Affiliation(s)
- Jesper Øland
- Department of Oral and Maxillofacial Surgery, University Hospital of Copenhagen, Copenhagen, Denmark.
| | | | | |
Collapse
|
22
|
|
23
|
Al-Riyami S, Cunningham SJ, Moles DR. Orthognathic treatment and temporomandibular disorders: a systematic review. Part 2. Signs and symptoms and meta-analyses. Am J Orthod Dentofacial Orthop 2009; 136:626.e1-16, discussion 626-7. [PMID: 19892270 DOI: 10.1016/j.ajodo.2009.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 02/01/2009] [Accepted: 02/01/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There have been conflicting viewpoints in the literature regarding the effects of orthognathic treatment on temporomandibular disorders (TMD). A systematic review was conducted to determine the percentage of orthognathic patients with TMD, establish the range of signs and symptoms, and follow patients longitudinally through treatment for any changes in signs and symptoms. METHODS Part 1 of this 2-part article described the methodology of this review, with a narrative analysis of the study characteristics and the TMD classification methods. Part 2 describes the percentage of patients suffering from TMD and the signs and symptoms reported. Meta-analyses were conducted on data from clinically similar studies. RESULTS Pain decreased after surgery for both self-reported symptoms and clinically diagnosed pain on palpation. However, postsurgical results were more varied for joint sounds. The percentage of patients with clicking had a tendency to decrease postsurgery, but improvements in crepitus were questionable. The results from all meta-analyses in this review were subject to considerable statistical heterogeneity, and it was not possible to draw strong inferences relating to the percentage of orthognathic surgery patients with TMD with any degree of certainty. CONCLUSIONS Although orthognathic surgery should not be advocated solely for treating TMD, patients having orthognathic treatment for correction of their dentofacial deformities and who are also suffering from TMD appear more likely to see improvement in their signs and symptoms than deterioration.
Collapse
Affiliation(s)
- Salma Al-Riyami
- Orthodontic Unit, UCL Eastman Dental Institute, London, United Kingdom.
| | | | | |
Collapse
|
24
|
Kim YK, Yun PY, Ahn JY, Kim JW, Kim SG. Changes in the temporomandibular joint disc position after orthognathic surgery. ACTA ACUST UNITED AC 2009; 108:15-21. [DOI: 10.1016/j.tripleo.2009.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 01/10/2009] [Accepted: 02/05/2009] [Indexed: 11/27/2022]
|
25
|
Chaves TC, Oliveira ASD, Grossi DB. Principais instrumentos para avaliação da disfunção temporomandibular, parte I: índices e questionários; uma contribuição para a prática clínica e de pesquisa. FISIOTERAPIA E PESQUISA 2008. [DOI: 10.1590/s1809-29502008000100015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Na literatura especializada, encontram-se variados instrumentos para avaliação da disfunção temporomandibular (DTM), sob a forma de índices, questionários, protocolos, escalas de avaliação e critérios de diagnóstico. Este estudo, dividido em duas partes, visou caracterizar os principais instrumentos de avaliação da DTM disponíveis na literatura, para auxiliar o clínico e o pesquisador na correta escolha da ferramenta apropriada para contemplar seus objetivos clínicos ou científicos. Nesta parte I são apresentados dois índices clínicos e três questionários (anamnésicos e funcionais); na parte II, um questionário funcional e dois conjuntos de critérios diagnósticos. Os índices são ferramentas que organizam a avaliação de sinais e sintomas, pela obtenção de pontuações. Os questionários são melhor aplicados para traçar perfis populacionais em estudos epidemiológicos. Para avaliação dos eventuais impactos da DTM nas atividades de vida diária, os questionários funcionais são mais adequados. Finalmente, há poucos conjuntos de critérios sistematizados para obter o diagnóstico da disfunção. A utilização de uma ou outra ferramenta depende de sua aplicabilidade e dos objetivos do profissional que a irá utilizar.
Collapse
|
26
|
Articular disc position in association with mandibular setback surgery. ACTA ACUST UNITED AC 2008; 105:e19-21. [DOI: 10.1016/j.tripleo.2007.07.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 07/10/2007] [Accepted: 07/23/2007] [Indexed: 11/19/2022]
|
27
|
Mendes Miguel JA, Cal-Neto JPE, da Silveira HM. Surgical correction of a Class II skeletal malocclusion associated with anterior open bite and temporomandibular joint pain. Am J Orthod Dentofacial Orthop 2007; 132:400-7. [PMID: 17826611 DOI: 10.1016/j.ajodo.2006.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2005] [Revised: 01/03/2006] [Accepted: 01/03/2006] [Indexed: 11/30/2022]
Abstract
This case report describes the treatment of a 25-year-old woman with anterior open bite, Class II skeletal malocclusion, and a history of temporomandibular joint pain and sounds. She also had significant anteroposterior and vertical discrepancies and a convex profile with protrusive lips. Intraorally, she had an anterior open bite of 3 mm and an overjet of 5 mm. Mandibular surgical rotation, associated with mandibular incisor extraction, was performed to reduce the protrusion, close the open bite, and minimize the temporomandibular joint disorder.
Collapse
|
28
|
Pahkala RH, Kellokoski JK. Surgical-orthodontic treatment and patients’ functional and psychosocial well-being. Am J Orthod Dentofacial Orthop 2007; 132:158-64. [PMID: 17693364 DOI: 10.1016/j.ajodo.2005.09.033] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 09/06/2005] [Accepted: 09/16/2005] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Surgical-orthodontic treatment is a common treatment approach for adult patients with skeletal maxillomandibular discrepancy. Some patients report improvement in signs and symptoms of temporomandibular disorder (TMD) after surgery. Whether the correction of malocclusion is responsible for the improvement of TMD symptoms after orthognathic surgery is still controversial. The objectives of this prospective study were to evaluate subjective treatment outcomes in patients with bilateral sagittal split osteotomy (BSSO) and to find out whether signs and symptoms of TMD and changes in occlusion are related to patient satisfaction. METHODS Eighty-two patients (53 female, 29 male) with a mean age of 32 years (range, 16-53 years) treated with BSSO in the Oral and Maxillofacial Department at Kuopio University Hospital in Finland were examined; 64 had mandibular advancement, and 18 had mandibular setback. Occlusion and signs and symptoms of TMD were registered pre- and postoperatively. At the postoperative examination (mean, 1.8 years after BSSO), the patients were asked to fill out a questionnaire about the influence of treatment on their masticatory function and symptoms of TMD, as well as their satisfaction with the treatment outcome. RESULTS TMD symptoms were significantly reduced after treatment. Improvements were also reported in facial appearance (82%) and chewing ability (61%); also, facial (56%) and temporomandibular joint (40%) pain disappeared. However, in 12% of the patients, temporomandibular joint problems were worse after treatment. Most patients (73%) were very satisfied with the outcomes; no one expressed dissatisfaction. Multiple logistic regression analysis showed that subjects with improved mastication and self-confidence, and those without long-term neurosensory deficits, expressed high satisfaction with the treatment outcome. Patients with mandibular setback were more pleased with the outcome than those with mandibular advancement. CONCLUSIONS Orthognathic patients generally experience functional and psychosocial benefits after surgical-orthodontic treatment. In addition to functional and morphological reasons, the psychosocial factors should be more emphasized when making the treatment decision and comparing the alternative treatment approaches.
Collapse
Affiliation(s)
- Riitta H Pahkala
- Oral and Maxillofacial Department, Kuopio University Hospital, Kuopio, Finland.
| | | |
Collapse
|
29
|
Farella M, Michelotti A, Bocchino T, Cimino R, Laino A, Steenks MH. Effects of orthognathic surgery for class III malocclusion on signs and symptoms of temporomandibular disorders and on pressure pain thresholds of the jaw muscles. Int J Oral Maxillofac Surg 2007; 36:583-7. [PMID: 17368852 DOI: 10.1016/j.ijom.2007.02.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 12/16/2006] [Accepted: 02/02/2007] [Indexed: 11/25/2022]
Abstract
The aim of this longitudinal study was to determine the effects of orthognathic surgery on signs and symptoms of temporomandibular disorders (TMD) and on pressure pain thresholds (PPTs) of the jaw muscles. Fourteen consecutive class III patients undergoing pre-surgical orthodontic treatment were treated by combined Le Fort I osteotomy and bilateral sagittal ramus osteotomy. The clinical examination included the assessment of signs and symptoms of TMD and the assessment of PPTs of the masseter and temporalis muscles. Anamnestic, clinical and algometric data were collected during five sessions over a 1-year period. Seven out of 14 patients presented with disc displacement with reduction at baseline, whereas four patients (two of them were new cases) did so at the end of follow up (p>0.05). None of the patients were diagnosed with myofascial pain of the jaw muscles at the beginning or end of follow up. PPTs of the masseter and temporalis muscles did not change significantly from baseline values throughout the whole study period. The occurrence of signs and symptoms of TMD fluctuates with an unpredictable pattern after orthognathic surgery for class III malocclusions.
Collapse
Affiliation(s)
- M Farella
- Department of Orthodontics, University of Naples Federico II, Italy.
| | | | | | | | | | | |
Collapse
|
30
|
Kohaut JC. Disorders of the manducatory apparatus: scientific uncertainties and clinical observations. Int Orthod 2007. [DOI: 10.1016/s1761-7227(07)89988-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
31
|
Ueki K, Marukawa K, Shimada M, Yoshida K, Hashiba Y, Shimizu C, Nakgawa K, Alam S, Yamamoto E. Condylar and disc positions after intraoral vertical ramus osteotomy with and without a Le Fort I osteotomy. Int J Oral Maxillofac Surg 2007; 36:207-13. [PMID: 17239565 DOI: 10.1016/j.ijom.2006.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 06/01/2006] [Accepted: 09/24/2006] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine the changes in temporomandibular joint (TMJ) morphology and clinical symptoms after intraoral vertical ramus osteotomy (IVRO) with and without a Le Fort I osteotomy. Of 50 Japanese patients with mandibular prognathism with mandibular and bimaxillary asymmetry, 25 underwent IVRO and 25 underwent IVRO in combination with a Le Fort I osteotomy. The TMJ symptoms and joint morphology, including disc tissue, were assessed preoperatively and postoperatively by magnetic resonance imaging and axial cephalogram. Improvement was seen in just 50% of joints with anterior disc displacement (ADD) that received IVRO and 52% of those that received IVRO with Le Fort I osteotomy. Fewer or no TMJ symptoms were reported postoperatively in 97% of the joints that received IVRO and 90% that received IVRO with Le Fort I osteotomy. Postoperatively, there were significant condylar position changes and horizontal changes in the condylar long axis on both sides in the two groups. There were no significant differences between improved ADD and unimproved ADD in condylar position change and the angle of the condylar long axis, although distinctive postoperative condylar sag was seen. These results suggest that IVRO with or without Le Fort I osteotomy can improve ADD and TMJ symptoms along with condylar position and angle, but it is difficult to predict the amount of improvement in ADD.
Collapse
Affiliation(s)
- K Ueki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|