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Murray GM, Sessle BJ. Pain-sensorimotor interactions: New perspectives and a new model. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2024; 15:100150. [PMID: 38327725 PMCID: PMC10847382 DOI: 10.1016/j.ynpai.2024.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/25/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
How pain and sensorimotor behavior interact has been the subject of research and debate for many decades. This article reviews theories bearing on pain-sensorimotor interactions and considers their strengths and limitations in the light of findings from experimental and clinical studies of pain-sensorimotor interactions in the spinal and craniofacial sensorimotor systems. A strength of recent theories is that they have incorporated concepts and features missing from earlier theories to account for the role of the sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions of pain in pain-sensorimotor interactions. Findings acquired since the formulation of these recent theories indicate that additional features need to be considered to provide a more comprehensive conceptualization of pain-sensorimotor interactions. These features include biopsychosocial influences that range from biological factors such as genetics and epigenetics to psychological factors and social factors encompassing environmental and cultural influences. Also needing consideration is a mechanistic framework that includes other biological factors reflecting nociceptive processes and glioplastic and neuroplastic changes in sensorimotor and related brain and spinal cord circuits in acute or chronic pain conditions. The literature reviewed and the limitations of previous theories bearing on pain-sensorimotor interactions have led us to provide new perspectives on these interactions, and this has prompted our development of a new concept, the Theory of Pain-Sensorimotor Interactions (TOPSMI) that we suggest gives a more comprehensive framework to consider the interactions and their complexity. This theory states that pain is associated with plastic changes in the central nervous system (CNS) that lead to an activation pattern of motor units that contributes to the individual's adaptive sensorimotor behavior. This activation pattern takes account of the biological, psychological, and social influences on the musculoskeletal tissues involved in sensorimotor behavior and on the plastic changes and the experience of pain in that individual. The pattern is normally optimized in terms of biomechanical advantage and metabolic cost related to the features of the individual's musculoskeletal tissues and aims to minimize pain and any associated sensorimotor changes, and thereby maintain homeostasis. However, adverse biopsychosocial factors and their interactions may result in plastic CNS changes leading to less optimal, even maladaptive, sensorimotor changes producing motor unit activation patterns associated with the development of further pain. This more comprehensive theory points towards customized treatment strategies, in line with the management approaches to pain proposed in the biopsychosocial model of pain.
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Affiliation(s)
- Greg M. Murray
- Discipline of Restorative and Reconstructive Dentistry, Sydney School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Darcy Road, Westmead, NSW 2145, Australia
| | - Barry J. Sessle
- Faculty of Dentistry and Temerty Faculty of Medicine Department of Physiology, and Centre for the Study of Pain, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada
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Effat KG. Chronic craniomandibular pain after craniotomy: A long-term clinical study. Cranio 2022:1-8. [PMID: 36503374 DOI: 10.1080/08869634.2022.2154930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Chronic craniomandibular/cervical pain and temporomandibular disorders have not been studied in patients who had a craniotomy several years previously. The aim of the current clinical work was to address these issues. METHODS A total group of 150 ambulant patients who had a previous craniotomy was subclassified according to whether or not the temporalis muscle was manipulated. RESULTS The average incidence of multiple subsite regional head and neck pain was 69.3% a number of years after a craniotomy. Evidence of internal derangement of the temporomandibular joint was significantly higher in the group that required manipulation of the temporalis muscle during the procedure. CONCLUSION The pattern of chronic craniomandibular/cervical pain experienced years after a craniotomy supports the brain neuromatrix theory of pain.
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Affiliation(s)
- Kamal G Effat
- Department of Otolaryngology, El- Sahel Teaching Hospital, Cairo, Egypt
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Scolaro A, Khijmatgar S, Rai PM, Falsarone F, Alicchio F, Mosca A, Greco C, Del Fabbro M, Tartaglia GM. Efficacy of Kinematic Parameters for Assessment of Temporomandibular Joint Function and Disfunction: A Systematic Review and Meta-Analysis. Bioengineering (Basel) 2022; 9:bioengineering9070269. [PMID: 35877320 PMCID: PMC9311583 DOI: 10.3390/bioengineering9070269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this review was to answer the following PICO question: “Do TMJ kinematic parameters (intervention and comparison) show efficacy for assessment of mandibular function (Outcome) both in asymptomatic and TMD subjects? (Population)”. PubMed, Scopus, Web of Science, Embase, Central databases were searched. The inclusion criteria were (1) performed on human, (2) English only, (3) on healthy, symptomatic or surgically altered TMJ, (4) measured dynamic kinematics of mandible or TMJ (5) with six degrees of freedom. To assess the Risk of Bias, the Joanna Briggs Institute tool for non-randomised clinical studies was employed. A pairwise meta-analysis was carried out using STATA v.17.0 (Stata). The heterogeneity was estimated using the Q value and the inconsistency index. Ninety-two articles were included in qualitative synthesis, nine studies in quantitative synthesis. The condylar inclination was significantly increased in female (effect size 0.03°, 95% CI: −0.06, 0.12, p = 0.00). Maximum mouth opening (MMO) was increased significantly in female population in comparison with males (effect size 0.65 millimetres (0.36, 1.66). Incisor displacement at MMO showed higher values for control groups compared with TMD subjects (overall effect size 0.16 millimetres (−0.37, 0.69). Evidence is still needed, considering the great variety of devices and parameters used for arthrokinematics. The present study suggests standardising outcomes, design, and population of the future studies in order to obtain more reliable and repeatable values.
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Affiliation(s)
- Alessandra Scolaro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Pooja Mali Rai
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Francesca Falsarone
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Francesca Alicchio
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Arianna Mosca
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Christian Greco
- Azienda Sanitaria dell’Alto Adige, Merano Hospital, 39100 Bolzano, Italy;
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- IRCC Orthopaedic Institute Galeazzi, 20161 Milan, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
- Correspondence:
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Effat KG. A clinical study on the incidence of internal derangement of the temporomandibular joint following harvesting of temporalis fascia. Cranio 2022:1-8. [PMID: 35514168 DOI: 10.1080/08869634.2022.2072452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of the current clinical study was to reveal whether harvesting of a temporalis fascia graft would be associated with a higher incidence of temporomandibular joint (TMJ) internal derangement. METHODS The study group involved 104 patients who had middle-ear operations, 67 of which involved harvesting of temporalis fascia and 37 that did not. The TMJs were clinically examined in each group. RESULTS The total incidence of internal derangement of the TMJ was significantly higher in the group that had temporalis fascia harvesting (79.1%), compared to the group that did not have temporalis fascia harvesting (29.7%), (p= 0.001). CONCLUSION Harvesting of temporalis fascia probably alters mandibular kinematics and predisposes to internal derangement of the TMJs.
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Affiliation(s)
- Kamal G Effat
- Department of Otolaryngology, El- Sahel Teaching Hospital, Cairo, Egypt
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Wang WE, Ho RLM, Ribeiro-Dasilva MC, Fillingim RB, Coombes SA. Chronic jaw pain attenuates neural oscillations during motor-evoked pain. Brain Res 2020; 1748:147085. [PMID: 32898506 DOI: 10.1016/j.brainres.2020.147085] [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: 11/05/2019] [Revised: 08/04/2020] [Accepted: 08/25/2020] [Indexed: 11/15/2022]
Abstract
Motor- and pain-related processes separately induce a reduction in alpha and beta power. When movement and pain occur simultaneously but are independent of each other, the effects on alpha and beta power are additive. It is not clear whether this additive effect is evident during motor-evoked pain in individuals with chronic pain. We combined highdensity electroencephalography (EEG) with a paradigm in which motor-evoked pain was induced during a jaw force task. Participants with chronic jaw pain and pain-free controls produced jaw force at 2% and 15% of their maximum voluntary contraction. The chronic jaw pain group showed exacerbated motor-evoked pain as force amplitude increased and showed increased motor variability and motor error irrespective of force amplitude. The chronic jaw pain group had an attenuated decrease in power in alpha and lower-beta frequencies in the occipital cortex during the anticipation and experience of motor-evoked pain. Rather than being additive, motor-evoked pain attenuated the modulation of alpha and beta power, and this was most evident in occipital cortex. Our findings provide the first evidence of changes in neural oscillations in the cortex during motor-evoked jaw pain.
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Affiliation(s)
- Wei-En Wang
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Rachel L M Ho
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | | | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.
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Woodford SC, Robinson DL, Mehl A, Lee PVS, Ackland DC. Measurement of normal and pathological mandibular and temporomandibular joint kinematics: A systematic review. J Biomech 2020; 111:109994. [PMID: 32971491 DOI: 10.1016/j.jbiomech.2020.109994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/27/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023]
Abstract
Motion of the mandible and temporomandibular joint (TMJ) plays a pivotal role in the function of the dentition and associated hard and soft tissue structures, and facilitates mastication, oral communication and access to respiratory and digestive systems. Quantification of TMJ kinematics is clinically relevant in cases of prosthetic rehabilitations, TMJ disorders, osteoarthritis, trauma, tumour resection and congenital abnormalities, which are known to directly influence mandibular motion and loading. The objective of this systematic review was to critically investigate published literature on historic and contemporary measurement modalities used to quantify in vivo mandibular and TMJ kinematics in six degrees of freedom. The electronic databases of Scopus, Web of Science, Medline, Embase and Central were searched and 109 relevant articles identified. Publication quality was documented using a modified Downs and Black checklist. Axiography and ultrasonic tracking are commonly employed in the clinical setting due to their simplicity and capacity to rapidly acquire low-fidelity mandibular motion data. Magnetic and optoelectronic tracking have been used in combination with dental splints to produce higher accuracy measurements while minimising skin motion artefact, but at the expense of setup time and cost. Four-dimensional computed tomography provides direct 3D measurement of mandibular and TMJ motion while circumventing skin motion artefact entirely, but employs ionising radiation, is restricted to low sampling frequencies, and requires time-consuming image processing. Recent advances in magnetic tracking using miniature sensors adhered to the teeth in combination with intraoral scanning may facilitate rapid and high precision mandibular kinematics measurement in the clinical setting. The findings of this review will guide selection and application of mandibular and TMJ kinematic measurement for both clinical and research applications.
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Affiliation(s)
- Sarah C Woodford
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Dale L Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Albert Mehl
- Centre of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Peter V S Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.
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Malik B, Whittle T, Ogawa T, Murray GM. Reorganization of motor unit activity at different sites within the human masseter muscle during experimental masseter pain. Eur J Oral Sci 2018; 126:400-410. [PMID: 30059170 DOI: 10.1111/eos.12561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Abstract
The aims were to test the hypotheses that experimental masseter muscle pain leads to recruitment and/or derecruitment of motor units at different sites within the masseter and that the patterns of change in motor unit activity differ between sites. Single motor unit (SMU) activity was recorded at two sites within the right masseter [superior/anterior, inferior/posterior (IP)] during isometric biting tasks (ramp, step level) on an intraoral force transducer in 17 participants during three experimental blocks comprising no infusion (baseline), 5% hypertonic saline infusion (pain), or isotonic saline infusion (control). A visual analog scale (VAS) was used to score pain intensity. The VAS scores were statistically significantly greater during infusion of hypertonic saline than during infusion of isotonic saline. No significant differences in force levels and rates of force change were found between experimental blocks. In comparison with isotonic saline infusion, SMUs could be recruited and derecruited at both sites during hypertonic saline infusion. The frequency of recruitment or derecruitment, in comparison with no change, was statistically significantly greater at the IP site than at the superior/anterior site. Experimental noxious masseter stimulation results in a reorganization of motor unit activity throughout the muscle, and the pattern of reorganization may be different in different regions of the muscle.
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Affiliation(s)
- Bushra Malik
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, Westmead Hospital Centre for Oral Health, University of Sydney, Westmead, Australia
| | - Terry Whittle
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, Westmead Hospital Centre for Oral Health, University of Sydney, Westmead, Australia
| | - Toru Ogawa
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Greg M Murray
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, Westmead Hospital Centre for Oral Health, University of Sydney, Westmead, Australia
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8
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Wang WE, Roy A, Misra G, Archer DB, Ribeiro-Dasilva MC, Fillingim RB, Coombes SA. Motor-Evoked Pain Increases Force Variability in Chronic Jaw Pain. THE JOURNAL OF PAIN 2018; 19:636-648. [DOI: 10.1016/j.jpain.2018.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/26/2022]
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9
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An index for the evaluation of 3D masticatory cycles stability. Arch Oral Biol 2017; 83:124-129. [DOI: 10.1016/j.archoralbio.2017.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 11/18/2022]
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10
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Amhamed M, Whittle T, Maulina T, Gal J, Akhter R, Murray GM. Effect of experimental anterior temporalis muscle pain on jaw movements. J Oral Rehabil 2016; 43:889-899. [PMID: 27739087 DOI: 10.1111/joor.12449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2016] [Indexed: 11/28/2022]
Abstract
To test the hypotheses that experimental noxious stimulation of the anterior temporalis muscle results in significant decreases in jaw movement amplitude and velocity, and there are significant correlations between scores of mood or pain-related cognitions and amplitude and velocity. The jaw movements of 14 asymptomatic participants were recorded during standardised open/close jaw movements and free and standardised chewing tasks. Tonic infusion of hypertonic saline into the right anterior temporalis muscle maintained pain intensity between 40 and 60 mm on a 100-mm visual analogue scale. Tasks were performed in a single session in the following sequence: baseline condition, test 1 condition (during hypertonic or isotonic saline infusion), test 2 condition (during saline infusion) (10-min rest between conditions). Participants completed the Depression, Anxiety and Stress Scale (DASS-21) and the Pain Catastrophizing Scale (PCS). Amplitude and velocity of opening and closing were compared between conditions with a repeated-measures analysis of variance (anova), and Spearman's rank correlation coefficient explored correlations; statistical significance: P < 0·05. For any of the three tasks, there were no significant differences in kinematic variables between any condition and no significant correlations between DASS-21 or PCS scores and kinematic variables during hypertonic saline infusion. The absence of a significant reduction in velocity or amplitude of open/close or chewing jaw movements during experimental temporalis muscle pain is not consistent with the Pain Adaptation Model proposing decreases in kinematic measures in pain. The lack of significant correlations between psychological variables and measures of jaw movement may reflect the low scores reported by our study sample.
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Affiliation(s)
- M Amhamed
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia.,Level 2, Westmead Hospital Centre for Oral Health, Westmead, NSW, Australia
| | - T Whittle
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia.,Level 2, Westmead Hospital Centre for Oral Health, Westmead, NSW, Australia
| | - T Maulina
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia.,Level 2, Westmead Hospital Centre for Oral Health, Westmead, NSW, Australia
| | - J Gal
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia.,Level 2, Westmead Hospital Centre for Oral Health, Westmead, NSW, Australia
| | - R Akhter
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia.,Level 2, Westmead Hospital Centre for Oral Health, Westmead, NSW, Australia
| | - G M Murray
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia.,Level 2, Westmead Hospital Centre for Oral Health, Westmead, NSW, Australia
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Mapelli A, Machado BCZ, Garcia DM, Rodrigues Da Silva MAM, Sforza C, de Felício CM. Three-dimensional analysis of jaw kinematic alterations in patients with chronic TMD - disc displacement with reduction. J Oral Rehabil 2016; 43:824-832. [PMID: 27545052 DOI: 10.1111/joor.12424] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2016] [Indexed: 11/28/2022]
Abstract
The study investigated whether chronic TMD patients with disc displacement with reduction (DDR), performing non-assisted maximum jaw movements, presented any changes in their mandibular kinematics with respect to an age-matched control group. Moreover, it was examined whether jaw kinematics and a valid clinic measure of oro-facial functional status have significant associations. Maximum mouth opening, mandible protrusion and bilateral laterotrusions were performed by 20 patients (18 women, 2 men; age, 18-34 years) and 20 healthy controls (17 women, 3 men; age, 20-31 years). The three-dimensional coordinates of their mandibular interincisor and condylar reference points were recorded by means of an optoelectronic motion analyser and were used to quantitatively assess their range of motion, velocity, symmetry and synchrony. Three functional indices (opening-closing, mandibular rototranslation, laterotrusion - right and left - and protrusion) were devised to summarise subject's overall performance, and their correlation with the outcome of a clinical protocol, the oro-facial myofunctional evaluation with scores (OMES), was investigated. TMD patients were able to reach maximum excursions of jaw movements comparable to healthy subjects' performances. However, their opening and closing mandibular movements were characterised by remarkable asynchrony of condylar translation. They had also reduced jaw closing velocity and asymmetric laterotrusions. The functional indices proved to well summarise the global condition of jaw kinematics, highlighting the presence of alterations in TMD-DDR patients, and were linearly correlated with the oro-facial functional status. The jaw kinematic alterations seem to reflect both oro-facial motor behaviour adaptation and a DDR-related articular impairment.
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Affiliation(s)
- A Mapelli
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.,Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - B C Z Machado
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.,Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - D M Garcia
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.,Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - M A M Rodrigues Da Silva
- Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil.,Department of Restorative Dentistry, School of Dentistry, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - C Sforza
- Functional Anatomy Research Center (FARC), Laboratory of Functional Anatomy of the Stomatognathic Apparatus, Dipartimento di Scienze Biomediche per la Salute, Faculty of Medicine, Università degli Studi di Milano, Milano, Italy
| | - C M de Felício
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil. .,Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil.
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