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Bogdanov V, Ilova D, Yordanova G. Adolescent Patient's Perceptions During Treatment With Class II Elastics. Case Rep Dent 2024; 2024:1489397. [PMID: 39139475 PMCID: PMC11321889 DOI: 10.1155/2024/1489397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/26/2024] [Accepted: 06/05/2024] [Indexed: 08/15/2024] Open
Abstract
The article presents a case of a 13-year-old adolescent male patient who started orthodontic treatment at the age of 12. Before treatment, he was diagnosed with narrow maxilla, proclination of upper incisors, deep overbite, distal occlusion bilaterally with significant sagittal overjet in frontal area, skeletal Class II, and hypodivergent growth pattern. During treatment, the patient is in his pubertal growth spurt. About 2 months after intermaxillary Class II elastics (1/4 heavy, 6.5 Oz) were applied, he complained of pain during mastication, wide opening of the mouth, and sometimes during protrusive and lateral movements in the right TMJ. The TMJ X-ray examination did not reveal abnormal morphological changes. Occlusion was evaluated by an electromyographic device, Teethan. The result was typical for Class II malocclusion. During the bilateral palpation of the zones of TMJ and opening of the mouth and chewing, the patient reported pain on the right side. There was no clicking in the joint. The elastic wear was stopped, and soon afterwards, the pain disappeared. These complaints point to a possible relationship between orthodontic treatment and TMJ pain. However, the disappearance of complaints after the removal of the Class II elastics points that the temporomandibular joint disorder (TMD) symptoms are reversible and resolved.
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Affiliation(s)
- V. Bogdanov
- Department of OrthodonticsFaculty of Dental MedicineMedical University, Sofia, Bulgaria
| | - D. Ilova
- Department of OrthodonticsFaculty of Dental MedicineMedical University, Sofia, Bulgaria
| | - Gr. Yordanova
- Department of OrthodonticsFaculty of Dental MedicineMedical University, Sofia, Bulgaria
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Halapanavar B, Padmini MN, Deshmukh S, Tirupathi S, Waremani AS, Kasodekar A. Comparison of Skeletal Changes in the Temporomandibular Joint between the Twin Block Appliance and Fixed Functional Appliance: A Longitudinal Follow-up Study. Int J Clin Pediatr Dent 2024; 17:7-14. [PMID: 38559857 PMCID: PMC10978514 DOI: 10.5005/jp-journals-10005-2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Aim This current study evaluated and compared the skeletal changes in the head of the condyle, glenoid fossa, and articular space between the twin block appliance and PowerScope™ a fixed functional appliance. Materials and methods This study was a pilot, randomized, single-blinded, assessing the skeletal changes in the components of the temporomandibular joint (TMJ) using cone-beam computed tomography (CBCT). The study was conducted in 20 subjects in the age range of 11-14 years with class II division 1 malocclusion. These subjects were distributed randomly between two groups with an allocation ratio of 1:1 (group I-twin block and group I-PowerScope™). Follow-ups of both groups were done till desirable skeletal correction was attained (clinical edge-to-edge incisor relation). Results Condylar parameters such as position, height, and length were evaluated bilaterally in the CBCT scans. After using both devices, there was an increase in all condylar qualities; however, the twin block appliance showed a more noticeable difference, which has been determined to be statistically significant. In the twin block group, there was an average decrease of 0.56 mm in the anterior articular space and an increase of 1.2 and 2.64 mm in the middle and posterior articular spaces, respectively. In the PowerScope™ group, there was an average decrease of 0.23 mm in the anterior articular space and an increase of 2.55 and 1.85 mm in the middle and posterior articular spaces, respectively. In the case of the twin block device, the change in glenoid fossa angle was observed to be 6.1 mm on both sides and a mean difference of 1.25 mm on the right-side and 1.75 mm on the left-side was observed in the case of PowerScope™. The difference was established to be significant with a p < 0.05 in all cases. Conclusion Condylar attributes increased after the application of both devices but the difference was more pronounced in the case of twin block appliances. The difference in articular space (middle and posterior) between the twin block group and PowerScope™ group, was not significant statistically. In the present study, the remodeling in the glenoid fossa was greater in the twin block group compared to the PowerScope™ group. How to cite this article Halapanavar B, MN P, Deshmukh S, et al. Comparison of Skeletal Changes in the Temporomandibular Joint between the Twin Block Appliance and Fixed Functional Appliance: A Longitudinal Follow-up Study. Int J Clin Pediatr Dent 2024;17(1):7-14.
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Affiliation(s)
- Bhakti Halapanavar
- Department of Orthodontics & Dentofacial Orthopedics, Dr DY Patil Dental College and Hospital, Dr DY Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - MN Padmini
- Department of Orthodontics, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Sonali Deshmukh
- Department of Orthodontics & Dentofacial Orthopedics, Dr DY Patil Dental College and Hospital, Dr DY Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Sunnypriyatham Tirupathi
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India
| | - Afshan S Waremani
- Department of Orthodontics, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India
| | - Aniket Kasodekar
- Department of Orthodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences & Research Centre, Belagavi, Karnataka, India
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Al-Tayar B, Al-Somairi MAA, ALshoaibi LH, Wang X, Wang J, Liu J, Al-Tayar B, An X, Si Q. Impact of molar teeth distalization by clear aligners on temporomandibular joint: a three-dimensional study. Prog Orthod 2023; 24:25. [PMID: 37455279 DOI: 10.1186/s40510-023-00474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/15/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Maxillary molar distalization is a common technique used in the non-extraction treatment of Angle Class II malocclusion that can effectively correct the molar relationship and create spaces for anterior teeth alignment. However, this approach may also impact the temporomandibular joint (TMJ) due to predictable changes in the posterior vertical dimension. Despite its widespread use, Class II malocclusions correction by molar distalization with clear aligners has not been investigated for their effects on the TMJ. Therefore, this study aimed to analyze the impact of sequential molar distalization using clear aligners on the TMJ. METHODS Three-dimensional CBCT scans of 23 non-growing patients (7 males, 16 females; mean age 29.8 ± 4.6 years) with skeletal class I or II malocclusion and a bilateral molar class II relationship treated by sequential upper molars distalization with orthodontic clear aligners (Invisalign, Align Technology, San Josè, Ca, USA). A total of 46 joints were examined before and after molar distalization using Anatomage InvivoDental 6.0.3. Linear and angular measurements of the mandibular joint were measured, including joint parameters, inclination, position, and the dimension of the condyle and articular fossa. In addition, 3D volumetric spaces of the joint were analyzed. All data were statistically analyzed by paired T test to determine the differences between the pre-and post-orthodontic procedures. RESULTS No statistically significant differences were found in all primary effects resulting from maxillary molars distalization by clear aligners on TMJ components measurements and joint spaces between T0 and T1. Meanwhile, statistically significant differences were observed in the linear position of the upper molars and the molar relationship parameter with at least P ≤ 0.05. CONCLUSION Treatment by sequential upper molars distalization with clear aligners does not lead to significant TMJ parameters changes in condyle and fossa spaces, dimensions, and positions.
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Affiliation(s)
- Barakat Al-Tayar
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
- Orthodontics Division, Faculty of Medicine and Health Sciences, Taiz University, Taiz, Yemen
| | - Majedh A A Al-Somairi
- Orthodontics Department, School of Stomatology, China Medical University, Shenyang, 110000, China
| | - Lina H ALshoaibi
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Xiaoli Wang
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Junbin Wang
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Jiajie Liu
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Baher Al-Tayar
- Graduate Student of Dental Health Science, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Dentistry, Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen
| | - Xiaoli An
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China.
| | - Qingzong Si
- Department of Oral Medicine, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
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Wu Y, Yu Q, Xia Y, Wang B, Chen S, Gu K, Zhang B, Zhu M. Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances? BMC Oral Health 2023; 23:65. [PMID: 36732724 PMCID: PMC9896678 DOI: 10.1186/s12903-023-02709-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The study aimed to compare the dentoskeletal effects of Vanbeek Activator, Herbst, Twin-Block and Mandibular Advancement with clear aligners in children with skeletal Class II malocclusions. METHODS A sample with sixty-three patients (37 males, 26 females) was included and divided into untreated control group (C, n = 12), Vanbeek Activator group (V, n = 14), Herbst group (H, n = 11), Twin-Block group (TB, n = 12) and MA group (MA, n = 14). Cephalometric analysis and Johnston Pitchfork analysis were performed to quantify the skeletal and dentoalveolar components in molar relationship and overjet correction. Compare the differences of cephalometric data and Johnston-analysis data. RESULTS The treatment changes showed significant differences in SNB, FH-NP, NA-PA, Co-Go, Co-Pog, ANB, lower facial height ratio, U1-PP, U6-PP, L1-MP and U1-L1. All the appliances improved overjet relationships significantly (Vanbeek, Herbst, Twin-Block and MA were 2.77 mm, 5.53 mm, 4.73 mm and 3.66 mm respectively) with significant retraction of maxillary incisors. The lower incisor displacement of group V and MA was negative, while that of group H and TB was positive and there were significant differences. Molar relationships were also improved by 3.45 mm, 6.85 mm, 3.48 mm and 0.92 mm for Vanbeek, Herbst, Twin-Block and MA. Mandible displacement showed a trend of group H > TB > V > MA. The displacement of maxillary molars in group H was greater than that in group C, TB and MA, and that of mandibular ones was greater than that in group C, V and MA, significantly. Herbst, Twin-Block and MA have more significant dentoalveolar effect than Vanbeek, while Vanbeek has more skeletal effect than the others especially in restraining maxillary growth. CONCLUSIONS Four appliances are all effective in mandibular advancement, modification of class II molar relationship and deep overjet, with unavoidable increase in lower facial ratio. Vanbeek Activator has the most skeletal effects. Vanbeek and MA have a good control of mandibular incisors while more compensatory lower incisors proclination in Herbst and Twin-Block. Herbst has greater maxillary molar distalization. MA allows aligning and leveling meanwhile leading the mandible forward.
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Affiliation(s)
- Yanqi Wu
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Qian Yu
- Department of Pediatric Dentistry, Shanghai Xuhui District Dental Center, Shanghai, 200032 China
| | - Yunhui Xia
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Bo Wang
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Siyue Chen
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Kaijun Gu
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Bojun Zhang
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Min Zhu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China. .,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China. .,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
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Patel B, Kukreja MK, Gupta A, Rohilla S. Evaluation of Changes in Soft and Hard Tissues of TMJ among Class II Division 2 Patients after Prefunctional Orthodontics and Twin Block Functional Appliance Therapy: A Prospective MRI Study. Int J Clin Pediatr Dent 2022; 15:479-488. [PMID: 36865723 PMCID: PMC9973096 DOI: 10.5005/jp-journals-10005-2439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction No study has been conducted to explore soft and hard tissue changes brought by functional appliances within the temporomandibular joint (TMJ) after correction of class II division 2 (div 2) malocclusion. Hence, we planned this study to evaluate the mandibular condyle disk-fossa relationship before and after prefunctional and twin block therapy using a magnetic resonance imaging (MRI) scan. Methodology This prospective observational study was conducted among 14 males treated with prefunctional appliances for 3-6 months, followed by 6-9 months of fixed mechanotherapy. MRI scan was evaluated for changes in the TMJ at baseline after completion of prefunctional phase and after completion of functional appliance therapy. Results At pretreatment, there was a flat contour on the posterosuperior surface of the condyles and a notch-like projection on its anterior surface. After functional appliance therapy, slight convexity appeared on the posterosuperior surface of the condyle and the prominence of the notch was reduced. There was a statistically significant anterior shift of condyles both after prefunctional and twin block treatment. The meniscus on both sides had significantly shifted posteriorly over three stages with respect to the posterior condylar (PC) plane and Frankfort horizontal (FH) plane. The superior joint space had significantly increased with significant linear glenoid fossa displacement between pre and posttreatment stages. Conclusion Prefunctional orthodontics induced favorable changes in TMJ soft and hard tissues of patients, but they were not sufficient to place the soft and hard tissues in their normal positions. A functional appliance phase is needed to place the TMJ in their respective normal positions. How to cite this article Patel B, Kukreja MK, Gupta A, et al. Evaluation of Changes in Soft and Hard Tissues of TMJ among Class II Division 2 Patients after Prefunctional Orthodontics and Twin Block Functional Appliance Therapy: A Prospective MRI Study. Int J Clin Pediatr Dent 2022;15(5):479-488.
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Affiliation(s)
- Bhumika Patel
- Department of Orthodontics, Postgraduate Institute of Dental Sciences (Govt. Dental College and Hospital), Rohtak, Haryana, India
| | - Manisha Kamal Kukreja
- Department of Orthodontics and Dentofacial Orthopedics, Postgraduate Institute of Dental Sciences (Govt. Dental College and Hospital), Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Ambika Gupta
- Department of Oral Medicine and Radiology, Postgraduate Institute of Dental Sciences (Govt. Dental College and Hospital), Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Seema Rohilla
- Department of Radiology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
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Deshmukh S, Durkar S, Kharat A, Shiranjani S, Ajmera P. Evaluation of Changes in Condylar Cartilage Thickness Using MRI and Ultrasound Imaging in Patients Treated by Mandibular Advancement With Myofunctional Appliance: An In-Vivo Pilot Study. Cureus 2021; 13:e16338. [PMID: 34395121 PMCID: PMC8357081 DOI: 10.7759/cureus.16338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The changes occurring due to growth modulation of the condylar cartilage act as an important mechanism for mandibular advancement using myofunctional appliance therapy. So this study aims to evaluate the condylar cartilage thickness by using MRI and USG in patients undergoing myofunctional appliance therapy for mandibular advancement with the null hypothesis being that there are no changes seen in the thickness of condylar cartilage in growing children. Materials and methods A prospective evaluation of samples having skeletal Class-II malocclusion ranging between cervical vertebral maturation index (CVMI) stage II and III, requiring twin block functional therapy was performed. Ten patients were selected randomly who underwent MRI and USG in the open and close positions for the evaluation of condylar cartilage thickness and the dimensional changes in the width of the right and left condyle in mm at T0 and T1. Result There was no statistically significant difference between the values interpreted by MRI or USG imaging when compared at T0 and T1 and in the open and closed mouth on the left and right sides. At T0, the mean thickness noted was 0.49 mm and 0.48 mm during opening and closing on the left side and 0.52 mm in both positions on the right side. At T1, the mean thickness noted was 0.8 and 0.79mm during opening and closing on the left side, whereas it was 0.81 mm in both positions on the right side. Conclusion The condylar cartilage thickness increases significantly after twin block therapy suggestive of mandibular growth in skeletal class II malocclusion. It can be inferred that both MRI and USG carry equal diagnostic interpretation, as there was no statistically significant difference between the two imaging modalities.
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Affiliation(s)
- Sonali Deshmukh
- Orthodontics and Dentofacial Orthopaedics, Dr. D.Y. Patil Dental College, Dr. D.Y. Patil Vidyapeeth (DPU), Pune, IND
| | - Sachin Durkar
- Orthodontics, Dr. D.Y. Patil Dental College, Dr. D.Y. Patil Vidyapeeth (DPU), Pune, IND
| | - Amit Kharat
- Musculoskeletal Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth (DPU), Pune, IND
| | - Suramya Shiranjani
- Dentistry, Dr. D.Y. Patil Dental College, Dr. D.Y. Patil Vidyapeeth (DPU), Pune, IND
| | - Pranav Ajmera
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth (DPU), Pune, IND
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Torres D, Lopes J, Magno MB, Cople Maia L, Normando D, Leão PB. Effects of rapid maxillary expansion on temporomandibular joints. Angle Orthod 2020; 90:442-456. [PMID: 33378434 PMCID: PMC8032308 DOI: 10.2319/080619-517.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/01/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the impact of rapid maxillary expansion (RME) on the condylar position, disc joint, joint space, and interarticular relationship in growing patients. MATERIALS AND METHODS A systematic search was performed in nine databases. The clinical studies selected included those with pre- and post-magnetic resonance, conventional computed tomography or cone beam tomography in growing patients. Risk of bias assessment was performed using the Cochrane Collaboration tool for controlled clinical studies and National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment for Before-After Studies With No Control Group. RESULTS Initially, 4303 records were identified. Only eight studies fulfilled the criteria and were included in the qualitative analysis. Of those, two were controlled clinical studies with a risk of uncertain to high bias. The remaining papers had a low to moderate risk of bias. Results showed that RME in children and adolescents promoted the following: remodeling in the head and or condylar branch, changes in condylar position and joint space, maintenance of improved symmetry between the condyles, and no ability to modify the position or shape of the articular disc. CONCLUSIONS RME in growing patients is able, in the short term, to modify the condyle-fossa relationship but does not change the position or shape of the articular disc. The intercondylar symmetric relationship is maintained or improved. Although the NHLBI score shows low to moderate risk of bias, the clinical relevance of these review findings is limited by Cochrane and Grades of Recommendation, Assessment, Development and Evaluation scores.
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Jiang YY, Sun L, Wang H, Zhao CY, Zhang WB. Three-dimensional cone beam computed tomography analysis of temporomandibular joint response to the Twin-block functional appliance. Korean J Orthod 2020; 50:86-97. [PMID: 32257934 PMCID: PMC7093662 DOI: 10.4041/kjod.2020.50.2.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To propose a three-dimensional (3D) method for evaluating temporomandibular joint (TMJ) changes during Twin-block treatment. Methods Seventeen patients with Class II division 1 malocclusion treated using Twin-block and nine untreated patients with a similar malocclusion were included in this research. We collected their cone beam computed tomography (CBCT) data from before and 8 months after treatment. Segmentations were constructed using ITK-SNAP. Condylar volume and superficial area were measured using 3D Slicer. The 3D landmarks were identified on CBCT images by using Dolphin software to assess the condylar positional relationship. 3D models of the mandible and glenoid fossa of the patients were constructed and registered via voxel-based superimposition using 3D Slicer. Thereafter, skeletal changes could be visualized using 3DMeshMetric in any direction of the superimposition on a color-coded map. All the superimpositions were measured using the same scale on the distance color-coded map, in which red color represents overgrowth and blue color represents resorption. Results Significant differences were observed in condylar volume, superficial area, and condylar position in both groups after 8 months. Compared with the control group (CG), the Twin-block group exhibited more obvious condyle-fossa modifications and joint positional changes. Moreover, on the color-coded map, more obvious condyle-fossa modifications could be observed in the posterior and superior directions in the Twin-block group than in the CG. Conclusions We successfully established a 3D method for measuring and evaluating TMJ changes caused by Twin-block treatment. The treatment produced a larger condylar size and caused condylar positional changes.
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Affiliation(s)
- Yuan-Yuan Jiang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Lian Sun
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Hua Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Chun-Yang Zhao
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Wei-Bing Zhang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
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Ozdiler O, Orhan K, Cesur E, Köklü A, Algın O. Evaluation of temporomandibular joint, masticatory muscle, and brain cortex activity in patients treated by removable functional appliances: a prospective fMRI study. Dentomaxillofac Radiol 2019; 48:20190216. [PMID: 31322927 DOI: 10.1259/dmfr.20190216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the effects of functional orthodontic appliances on the masticatory muscles, temporomandibular joint (TMJ), and brain to determine whether using functional appliances full-time or only at night yields different results. METHODS 16 patients with Class II malocclusion were included in this study. Eight patients were instructed to wear their appliances (monoblock/twinblock) full-time and the other eight patients were instructed to wear them at night while sleeping. An additional 10 patients with Class II malocclusion were later included as a pre-treatment control group. Signal intensity ratios (SIR) of TMJ structures and morphological evaluations of the masticatory muscles were done for all patients. Functional MRI (fMRI) data were also obtained from the patients while performing chewing and biting movements. RESULTS ANB angle was reduced significantly in both the full-time and night wear groups, by values of 1.17° and 1.35°, respectively (p < 0.05). MRI showed that SIRs were significantly increased in both groups in the masticatory muscles, retrodiscal pad, condylar process, and articular disc (p < 0.05). Both resting and task-based fMRI evaluation revealed significant increases in blood oxygen level dependent signals in several regions of the brain in both groups (p < 0.05). CONCLUSIONS The cephalometric and MRI findings of this study indicate that the treatment effects were similar for both wear schedules. Functional appliances should be regarded not as simple devices that treat Class II malocclusion through skeletal and dental correction alone, but as exercise devices that lead to neuromuscular changes by facilitating muscle adaptation and activating various brain regions.
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Affiliation(s)
- Orhan Ozdiler
- Department of Orthodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Kaan Orhan
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral &Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Emre Cesur
- Department of Orthodontics, Medipol Mega University Hospital, İstanbul, Turkey
| | - Ayşegül Köklü
- Department of Orthodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Oktay Algın
- Department of Radiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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10
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Maurya RK, Jayan B, Singh H, Nakra O, Sharma P. Effects of Low-Intensity Pulsed Ultrasound Therapy on the Temporomandibular Joint Complex in Conjunction With a Fixed Functional Appliance: A Prospective 3-Dimensional Cone Beam Computed Tomographic Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1661-1676. [PMID: 30393868 DOI: 10.1002/jum.14850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/07/2018] [Accepted: 09/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This prospective study aimed to analyze 3-dimensional changes in the temporomandibular joint (TMJ) complex with a synergistic effect of functional jaw orthopedics using a fixed functional appliance and low-intensity pulsed ultrasound (LIPUS) therapy. METHODS Forty patients with skeletal class II malocclusion were randomly assigned to 4 groups (2 control groups and 2 test groups) of 10 patients each. After insertion of the fixed functional appliance, the test group was stimulated with LIPUS therapy in the TMJ region bilaterally for 20 minutes daily for first 10 days and thereafter at least 3 times per week until complete mandibular advancement was achieved. Three-dimensional images obtained with a cone beam computed tomographic scanner were used to analyze the changes in the TMJ complex at the prefunctional stage and after completion of functional appliance therapy. Direct intragroup and intergroup comparisons for different morphometric variables were conducted with the Student t test. RESULTS The 40 patients included 20 male and 20 female patients between the ages of 12 and 16 years (mean age ± SD, 13.2 ± 1.8 years). Both the test groups and the control groups showed statistically significant variable changes in condylar head position and morphometric changes in relation to the joint space analysis (mean differences, -1.000 and -1.080 mm; P < .05). However, no significant differences were found during the intergroup comparisons at the prefunctional and postfunctional stages for the variables examined, except for the measurements of the linear distance of the condyle to the external auditory meatus on both the right and left sides at the prefunctional phase. CONCLUSIONS Low-intensity pulsed ultrasound therapy positively affects the quantum of the joint space, thus proving to be a promising adjunct in enhancing treatment outcomes of functional jaw orthopedics in growing patients with skeletal class II malocclusions.
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Affiliation(s)
- Raj Kumar Maurya
- Department of Orthodontics and Dentofacial Orthopedics, Army Dental Center (Research and Referral), Delhi, India
| | - Balakrishna Jayan
- Department of Orthodontics and Dentofacial Orthopedics, Army Dental Center (Research and Referral), Delhi, India
| | - Harpreet Singh
- Department of Orthodontics and Dentofacial Orthopedics, Employees' State Insurance Corporation Dental College and Hospital, Delhi, India
| | - Oonit Nakra
- Department of Orthodontics and Dentofacial Orthopedics, Army Dental Center (Research and Referral), Delhi, India
| | - Poonam Sharma
- Department of Orthodontics and Dentofacial Orthopedics, Employees' State Insurance Corporation Dental College and Hospital, Delhi, India
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Effects of wear time differences of removable functional appliances in class II patients: prospective MRI study of TMJ and masticatory muscle changes. Oral Radiol 2019; 36:47-59. [DOI: 10.1007/s11282-019-00379-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/03/2019] [Indexed: 12/20/2022]
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Can anterior repositioning splint effectively treat temporomandibular joint disc displacement? Sci Rep 2019; 9:534. [PMID: 30679602 PMCID: PMC6346049 DOI: 10.1038/s41598-018-36988-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 11/28/2018] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to determine whether anterior repositioning splint (ARS) can effectively treat temporomandibular joint (TMJ) anterior disc displacement with reduction (DDwR) in juvenile Class II patients. This study investigated disc repositioning clinically and through use of MRI with 12-month follow up. Patients with skeletal Class II malocclusions and DDwR diagnosed by magnetic resonance imaging (MRI) were treated with ARS. The efficacy of ARS was assessed clinically and by means of MRI before treatment (T0), immediately after bite registration (T1), at the end of treatment (T2), and at 12 months after functional appliance treatment (T3). Improvement in TMJ pain, TMJ noises, and range of mandibular movement were assessed. MRI evaluation was based on disc-condylar relationship in parasagittal images. Seventy-two juvenile patients with 91 joints were included in this study. The average age was 15.7 years old (range, 10–20 years) at first visit. There were statistically significant reductions in TMJ pain, disability in daily life and TMJ clicking (P < 0.01). MRI at T2 indicated that the success rate was 92.31% (84/91), but decreased to 72.53% (66/91) at T3. The unsuccessful splint disc capture was mainly observed in late adolescence, especially over 18 years old. Using MRI results as the gold standard, we found that clinical assessment had an accuracy rate of 75.82% at 12-month follow-up. In conclusion, although success rate for ARS treatment decreased over time, both clinical findings and MRI examination indicate that the ARS is relatively effective in repositioning the DDwR, especially for patients in early puberty. However, further and larger studies are needed to evaluate the outcome with ARS.
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Kinzinger GSM, Lisson JA, Booth D, Hourfar J. Are morphologic and topographic alterations of the mandibular fossa after fixed functional treatment detectable on tomograms? Visual classification and morphometric analysis. J Orofac Orthop 2018; 79:427-439. [PMID: 30203326 DOI: 10.1007/s00056-018-0156-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/08/2018] [Indexed: 11/25/2022]
Abstract
AIM The goal was to evaluate if changes in morphology and topography of the mandibular fossa after Functional Mandibular Advancer (FMA) treatment are detectable on tomograms. Furthermore, the suitability of digital tomograms (DT) over magnetic resonance imaging (MRI) for this particular question was investigated. MATERIALS AND METHODS In all, 25 patients (14 female, 11 male) with a skeletal class II malocclusion received treatment with a FMA. DTs were available prior to (T1) and after (T2) FMA treatment. A total of 50 temporomandibular joints were investigated. The mandibular fossae were evaluated metrically and visually regarding treatment-induced alterations. A p < 0.05 was set as the level for statistical significance for all tests. Results were compared to the results of a recent MRI study. RESULTS Visual inspection of all 50 joints in the DT at T1 and T2 revealed no alterations of the fossa shape in the sagittal plane; 24 patients showed identical morphology of right and left joints. The metrical analysis revealed no significant changes regarding width, depth and ratio thereof between T1 and T2. There also were no bilateral differences. Another 18 different distance measurements between porion, mandibular fossa, articular eminence and pterygoid fossa showed no significant changes. There was no detectable proof of a fossa shift. CONCLUSIONS No changes in the sagittal plane, mandibular fossa, the articular tubercle, or a possible fossa shift were found in the DT of class II patients after FMA treatment. DT and MRI measurements and the visual inspection revealed identical findings; thus, DT appears to be a valuable research tool for sagittal analysis of mandibular fossa changes.
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Affiliation(s)
- Gero Stefan Michael Kinzinger
- Department of Orthodontics, Saarland University, Universitätskliniken 56, 66421, Homburg/Saar, Germany
- Private Orthodontic Practice, Toenisvorst, Germany
| | - Jörg Alexander Lisson
- Department of Orthodontics, Saarland University, Universitätskliniken 56, 66421, Homburg/Saar, Germany.
| | - Dania Booth
- Department of Orthodontics, Saarland University, Universitätskliniken 56, 66421, Homburg/Saar, Germany
- Private Orthodontic Practice, Rheinberg, Germany
| | - Jan Hourfar
- Department of Orthodontics, Saarland University, Universitätskliniken 56, 66421, Homburg/Saar, Germany
- Private Orthodontic Practice, Michelstadt, Germany
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Jiménez-Silva A, Carnevali-Arellano R, Venegas-Aguilera M, Tobar-Reyes J, Palomino-Montenegro H. Temporomandibular disorders in growing patients after treatment of class II and III malocclusion with orthopaedic appliances: a systematic review. Acta Odontol Scand 2018; 76:262-273. [PMID: 29252064 DOI: 10.1080/00016357.2017.1416165] [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 determine if the use of orthopaedic appliances in growing patients applied to correct Class II and III malocclusion is related to the development of temporomandibular disorders (TMD). MATERIAL AND METHODS A systematic review was conducted between 1960 and July 2017, based on electronic databases: PubMed, Cochrane Library, Embase, Medline, Scopus, EBSCOhost, Scielo, Lilacs and Bireme. Controlled clinical trials (CCTs) and randomized controlled trials (RCTs) were identified. The articles were selected and analyzed by two authors independently. The quality of the evidence was determined according to the guidelines of the Cochrane Risk Bias Assessment Tool and the Cochrane Quality Study Guide. RESULTS Seven articles were included, four CCTs and three RCTs. The studies were grouped according to malocclusion treatment in (a) class II appliances (n = 4) and (b) class III appliances (n = 3). The quality of evidence was low due to the high risk of bias, independent of the association reported. All studies concluded that the use of orthopaedic appliances would not contribute to the development of TMD. CONCLUSIONS The quality of evidence available is insufficient to establish definitive conclusions, since the studies were very heterogeneous and presented a high risk of bias. However, it is suggested that the use of orthopaedic appliances to correct class II and III malocclusion in growing patients would not be considered as a risk factor for the development of TMD. High-quality RCTs are required to draw any definitive conclusions.
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Affiliation(s)
- Antonio Jiménez-Silva
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
- Ortodoncia y Ortopedia Dentomaxilofacial, Facultad de Odontología, Universidad Andrés Bello, Santiago, Chile
| | - Romano Carnevali-Arellano
- Ortodoncia y Ortopedia Dentomaxilofacial, Facultad de Odontología, Universidad Andrés Bello, Santiago, Chile
| | | | | | - Hernán Palomino-Montenegro
- Ortodoncia y Ortopedia Dentomaxilofacial, Facultad de Odontología, Universidad Andrés Bello, Santiago, Chile
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Nucera R, Lo Giudice A, Rustico L, Matarese G, Papadopoulos MA, Cordasco G. Effectiveness of orthodontic treatment with functional appliances on maxillary growth in the short term: A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2017; 149:600-611.e3. [PMID: 27131242 DOI: 10.1016/j.ajodo.2015.09.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of this systematic review was to evaluate the treatment effects on maxillary growth of removable functional appliances that advance the mandible to a more forward position in patients with Class II malocclusion. METHODS Sixteen electronic databases and reference lists of studies were searched up to April 2015. Only randomized clinical trials and prospective controlled clinical trials investigating Class II growing patients treated with removable functional appliances were included. Two authors independently accomplished study selection, data extraction, and risk of bias assessment. All pooled analyses of data were based on random-effects models. Statistical heterogeneity was evaluated. RESULTS In total, 14 studies were included (5 randomized clinical trials, 9 prospective controlled clinical trials) that collected data from 765 patients (405 treated, 360 untreated controls). The mean differences in treatment effect of functional appliances, relative to the untreated controls, were -0.61° per year (95% CI, -0.69° to -0.25°) for SNA angle, -0.61 mm per year (95% CI, -0.90 to -0.32 mm) for anterior maxillary displacement, and +0.07° per year (95% CI, -0.17° to +0.32°) for maxillary plane rotation. CONCLUSIONS Removable functional appliances in Class II growing patients have a slight inhibitory effect on the sagittal growth of the maxilla in the short term, but they do not seem to affect rotation of the maxillary plane.
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Affiliation(s)
- Riccardo Nucera
- Assistant professor, Department of Orthodontics, School of Dentistry, University of Messina, Messina, Italy.
| | - Antonino Lo Giudice
- Research associate, Department of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
| | - Lorenzo Rustico
- Research fellow, Department of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
| | - Giovanni Matarese
- Associate professor, Department of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
| | - Moschos A Papadopoulos
- Professor, chairman, and program director, Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giancarlo Cordasco
- Professor and chairman, Department of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
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Knappe SW, Bakke M, Svanholt P, Petersson A, Sonnesen L. Long-term side effects on the temporomandibular joints and oro-facial function in patients with obstructive sleep apnoea treated with a mandibular advancement device. J Oral Rehabil 2017; 44:354-362. [PMID: 28094865 DOI: 10.1111/joor.12485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/27/2022]
Abstract
Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim was to investigate the influence of long-term MAD treatment on the TMJs, oro-facial function and occlusion. This prospective study included 30 men and 13 women (median age 54) with OSA [Apnoea-Hypopnoea Index (AHI): 7-57]. They were examined with the Nordic Orofacial Test Screening (NOT-S), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and cone beam computed tomography (CBCT) of the TMJs. The examination was performed before MAD treatment (T0), and 3-6 months (T1, no CBCT), 1 year (T2) and 3 years (T3) after treatment start. The results were analysed as long term (T0-T3, n = 14) and short term (T0-T2, n = 24) by t-test, Fisher's exact test and anova. Both long- and short-term analyses revealed a reduction in AHI (P < 0·002). Significant long term were increased scores in the NOT-S Interview (P < 0·045), reduced vertical overbite (P < 0·031) and increased jaw protrusive movement (P < 0·027). TMJ changes were found as joint sounds in terms of reciprocal clicking and crepitus, short term as a decrease and subsequent recurrence (P < 0·053; P < 0·037). No significant radiological changes were found. In conclusion, MAD treatment is beneficial to some OSA patients, but might induce changes in the TMJs, the oro-facial function and the occlusion. However, these changes seemed to be less harmful than previously reported with careful adaptation, control and follow-ups.
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Affiliation(s)
- S W Knappe
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Bakke
- Section of Oral Medicine (Clinical Oral Physiology), Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Svanholt
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A Petersson
- Section of Radiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Xinqi H, Xiao C, Jun L. [Meta-analysis of the condylar position changes produced by functional appliances in class Ⅱ malocclusion]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2016; 34:589-593. [PMID: 28318159 DOI: 10.7518/hxkq.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to analyze the condylar position changes produced by functional appliances in class Ⅱ malocclusion by systematic review. METHODS Electronic search was conducted using Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Medline, Embase, Pubmed, and Cochrane Central Register of Controlled Trials. Studies on condylar position changes produced by functional appliances in class Ⅱ malocclusion were included. Risk of bias assessment and data extraction of included studies were conducted by two reviewers independently. The meta-analysis was carried out using Revman 5.1. RESULTS Six studies were included (five high quality and one low quality). The condylar position showed no changes after Herbst treatment. The condylar posterior space after Twin-block treatment averagely increased by 0.31 mm (P<0.000 01), whereas the condylar anterior space averagely reduced by 0.32 mm (P<0.000 01). CONCLUSIONS Twin-block appliance enables forward movement of the condylar position. This result contributes to the correction of class Ⅱ malocclusion.
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Affiliation(s)
- Huang Xinqi
- State Key Laboratory of Oral Diseases, Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Cen Xiao
- State Key Laboratory of Oral Diseases, Dept. of Oral and Maxillo-facial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Liu Jun
- State Key Laboratory of Oral Diseases, Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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18
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Ivorra-Carbonell L, Montiel-Company JM, Almerich-Silla JM, Paredes-Gallardo V, Bellot-Arcís C. Impact of functional mandibular advancement appliances on the temporomandibular joint - a systematic review. Med Oral Patol Oral Cir Bucal 2016; 21:e565-72. [PMID: 27475694 PMCID: PMC5005093 DOI: 10.4317/medoral.21180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/02/2016] [Indexed: 12/26/2022] Open
Abstract
Background Although many orthodontists have no doubts about the effectiveness of functional appliances for mandibular advancement, the impact on the temporomandibular joint (TMJ) is still in dispute. The objective of this systematic review is to examine the main effects on the TMJ of using functional appliances, both in healthy patients and in patients with a pre-existing disorder. Material and Methods A systematic review of the literature was conducted in accordance with the PRISMA guidelines. Only systematic reviews, meta-analyses, randomized clinical trials (RCTs), case-control studies and cohort studies were included. A detailed language-independent electronic search was conducted in the Pubmed, Scopus, Cochrane Library and Embase databases. All studies published between 2000 and 2015 were included. Results A total of 401 articles were identified. Of these, 159 were duplicates and were excluded. On reading the title and abstract, 213 articles were excluded because they did not answer the research question, leaving a total of 29 articles. These articles were read and assessed. Following critical reading of the full text, eight articles were excluded: seven because they were considered of low quality and one because it published redundant data. As a result, 21 articles were included. Conclusions After treatment with functional appliances, the condyle was found to be in a more advanced position, with remodelling of the condyle and adaptation of the morphology of the glenoid fossa. No significant adverse effects on the TMJ were observed in healthy patients and the appliances could improve joints that initially presented forward dislocation of the disk. Key words:Temporomandibular joint, TMJ, orthodontic appliances, functional, mandibular advancement, herbst appliance, bionator.
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Affiliation(s)
- L Ivorra-Carbonell
- Departamento de Estomatología, Unidad Docente de Ortodoncia, Clínica Odontológica, C/ Gascó Oliag n 1, 46010, Valencia, Spain,
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Cacho A, Ono T, Kuboki T, Martin C. Changes in joint space dimension after the correction of Class II division 1 malocclusion. Eur J Orthod 2015; 37:467-73. [DOI: 10.1093/ejo/cju091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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20
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Yildirim E, Karacay S, Erkan M. Condylar response to functional therapy with Twin-Block as shown by cone-beam computed tomography. Angle Orthod 2014; 84:1018-25. [PMID: 24713070 DOI: 10.2319/112713-869.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the condylar changes through cone-beam computed tomography (CBCT) images in patients treated with Twin-Block functional appliance. MATERIALS AND METHODS In this retrospective study, CBCT images of 30 patients who were treated with the Twin-Block appliance were used. Mandible was segmented and pretreatment and posttreatment (T0 and T1) condylar volume was compared. The angle between sella-nasion-Point A (SNA), angle between sella-nasion-Point B (SNB), angle between Point A-nasion-Point B (ANB), midfacial length (Co-A), mandibular length (Co-Gn), and the distances from right condylion to left condylion (CoR-CoL) were also measured on three-dimensional images. Differences were analyzed with Wilcoxon signed rank tests, and Mann-Whitney U-tests were used to compare the scores of male and female participants. Significance was set at P < .05. RESULTS In this study, a decrease in SNA and ANB (P < .05 and P < .01, respectively) and an increase in SNB (P < .01) were found. Additionally, CoR-CoL, Co-Gn, and condylar volume increased at both the left and right sides (P < .01). However, increase at Co-A was not statistically significant (P > .05). Comparison of differences by sex was not statistically significant for all measurements (P > .05). CONCLUSION Twin-Block appliance increases condylar volume, mandibular length, and intercondylar distance by stimulating growth of condyle in an upward and backward direction.
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Affiliation(s)
- Ersin Yildirim
- a Assistant Professor, Gülhane Military Medical Academy Haydarpasha Education Hospital, Dental Service, Section of Orthodontics, Istanbul, Turkey
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21
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Temporomandibular joint changes after activator appliance therapy: a prospective magnetic resonance imaging study. J Craniofac Surg 2013; 24:1184-9. [PMID: 23851766 DOI: 10.1097/scs.0b013e31829972c0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this prospective clinical and magnetic resonance imaging study was to analyze the effect of 1-year Activator (Yi-fan Dental Co., Shanghai, China) treatment in internal anatomical relationships of the temporomandibular joint (TMJ) complex, including the condyle-disc relationship, condyle-fossa relationship, condylar height change, disc length change, and morphologic change of the glenoid fossa. The study was composed of patients with class II division 1 malocclusion (11 girls and 13 boys) who underwent 1-year Activator treatment. All the patients were in the acceleration or peak phase of the pubertal growth spurt. Magnetic resonance imaging in closed-mouth position and lateral cephalometric radiographs before and after 1 year of Activator treatment were analyzed metrically. Overall, condylar height showed a significant increase (P < 0.001), and the eminence angle decreased (P = 0.037). TMJ disc length has no statistically significant change before and after treatment. A slight advancement (P = 0.041) was found in the sagittal condylar position. A significant backward movement (P = 0.04) was shown in the sagittal disc position. Our results showed that the disc is not impaired by Activator therapy; it seems possible that adaptive remodeling, including a shallower glenoid fossa and increased condylar height, was seen after treatment.
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22
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Martina R, Cioffi I, Galeotti A, Tagliaferri R, Cimino R, Michelotti A, Valletta R, Farella M, Paduano S. Efficacy of the Sander bite-jumping appliance in growing patients with mandibular retrusion: a randomized controlled trial. Orthod Craniofac Res 2013; 16:116-26. [DOI: 10.1111/ocr.12013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/27/2022]
Affiliation(s)
- R. Martina
- Department of Oral Sciences; Section of Orthodontics; University of Naples Federico II; Naples; Italy
| | - I. Cioffi
- Department of Oral Sciences; Section of Orthodontics; University of Naples Federico II; Naples; Italy
| | - A. Galeotti
- Division of Dentistry; Bambino Gesù Hospital; Rome; Italy
| | - R. Tagliaferri
- Department of Oral Sciences; Section of Orthodontics; University of Naples Federico II; Naples; Italy
| | - R. Cimino
- Department of Oral Sciences; Section of Orthodontics; University of Naples Federico II; Naples; Italy
| | - A. Michelotti
- Department of Oral Sciences; Section of Orthodontics; University of Naples Federico II; Naples; Italy
| | - R. Valletta
- Department of Oral Sciences; Section of Orthodontics; University of Naples Federico II; Naples; Italy
| | | | - S. Paduano
- Department of Oral Sciences; Section of Orthodontics; University of Catanzaro Magna Graecia; Catanzaro; Italy
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Shaefer JR, Riley CJ, Caruso P, Keith D. Analysis of Criteria for MRI Diagnosis of TMJ Disc Displacement and Arthralgia. Int J Dent 2012; 2012:283163. [PMID: 23304143 PMCID: PMC3523517 DOI: 10.1155/2012/283163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 10/29/2012] [Accepted: 11/01/2012] [Indexed: 01/23/2023] Open
Abstract
Aims. To improve diagnostic criteria for TMJ disc displacement (DD). Methods. The standard protocol for MRI diagnosis of DD, using a 12 o'clock reference position, was compared to an alternative protocol. The alternative protocol involves the functional relationship between the condyle and articular eminence, using a line perpendicular to the posterior slope of the eminence as a reference for disc position. The disc location was examined using both protocols, and disc diagnoses were compared in their relationship with joint pain. Statistical analyses included P value, sensitivity, specificity, odds ratio, and kappa statistic. Results. 58 MRIs were interpreted. 36 subjects reported arthralgia; 22 did not. Both protocols demonstrated significance (standard P = 0.004, alternative P < 0.001) for the ability to predict arthralgia. The odds of arthralgia increased in DD patients diagnosed by standard methods 9.71 times and in DD diagnosed by alternative means 37.15 times. The diagnostic sensitivity decreased 30% using the alternative versus the standard protocol (0.6389 versus 0.9444), while specificity increased 60% (0.9545 versus 0.3636). Conclusions. A stronger relationship occurs between DD and arthralgia when using a function-based protocol. The alternative protocol correctly identifies subjects without arthralgia, who by standard methods would be diagnosed with DD, as having nondisplaced discs, providing a more clinically relevant assessment of TMJ disc displacement.
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Affiliation(s)
- Jeffry R. Shaefer
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 4 Monument Circle, Hingham, MA 02043, USA
| | - Cara Joy Riley
- Children's Hospital Colorado, 13123 E 16th Avenue B090, Aurora, CO 80045, USA
| | - Paul Caruso
- Department of Radiology, Massachusetts General Hospital, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | - David Keith
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Warren Building Suite 1201, 55 Fruit Street, Boston, MA 02114, USA
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Basili C, Costa HN, Sasaguri K, Akimoto S, Slavicek R, Sato S. Comparison of the position of the mandibular fossa using 3D CBCT in different skeletal frames in human caucasic skulls. INTERNATIONAL JOURNAL OF STOMATOLOGY & OCCLUSION MEDICINE 2010. [DOI: 10.1007/s12548-009-0031-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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