Evaluation of Biofeedback Usefulness in Masticatory Muscle Activity Management-A Systematic Review

Anxiety mediates association between sex and jaw function limitation in temporomandibular disorder patients from China

Aim

The objective of this study is to explore the relationship between sex and jaw function and to test whether anxiety mediates the causal relationship between sex and jaw function in temporomandibular disorders (TMDs) patients.

Methods

A total of 488 participants with TMD were included in the analysis. Demographic data were collected. Generalized anxiety symptoms and anxiety severity were initially assessed using the GAD-7 questionnaire. And jaw function limitation was measured using the JFLS-8 scale. A directed acyclic graph (DAG) was used in this study to evaluate the hypotheses. Mediation analysis was conducted to explore causality and to calculate the total effect, natural direct effect (NDE) and natural indirect effect (NIE).

Results

In TMD patients, there was a significant association between female and jaw function (r = 0.17, p < 0.001), female and anxiety (r = 0.15, p = 0.002), anxiety and jaw function (r = 0.35, p < 0.001). In addition, sex can directly lead to differences in impaired jaw function (NDE: 3.719, 95% CI: 1.619-5.828, p < 0.001), and can also be causally related to jaw function through anxiety (NIE: 1.146, 95% CI: 0.267-2.024, p = 0.011). And the total effect was 4.865 (95% CI, 2.709-7.029, p < 0.001).

Conclusion

A causal mechanism was found that anxiety acts as a mediator of sex effects on jaw function. Therefore, psychological factors need to be taken into account in the treatment of female TMD patients. Further clinical trials are needed to explore whether psychotherapy is more beneficial to improve jaw function in female TMD patients.

The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis

BACKGROUND

To evaluate the effectiveness of instrument-assisted soft tissue mobilization (IASTM) on range of motion (ROM).

METHODS

We performed a literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases from inception to December 23, 2023. Randomized controlled trials that compared treatment groups receiving IASTM to controls or IASTM plus another treatment(s) to other treatment(s) among healthy individuals with or without ROM deficits, or patients with musculoskeletal disorders were included. The Cochrane risk of bias tool was used to assess the risk of bias.

RESULTS

Nine trials including 450 participants were included in the quantitative analysis. The IASTM was effective in improving ROM in degree in healthy individuals with ROM deficits and patients with musculoskeletal disorders (n=4) (MD = 4.94, 95% CI: 3.29 to 6.60), and in healthy individuals without ROM deficits (n=4) (MD = 2.32, 95% CI: 1.30 to 3.34), but failed to improve ROM in centimeter in healthy individuals with ROM deficits (n=1) (MD = 0.39, 95% CI: -1.34 to 2.11, p=0.66, I2 = 88%).

CONCLUSIONS

IASTM can improve ROM in degree in healthy individuals with or without ROM deficits, or in patients with musculoskeletal disorders (with very low to low certainty).

TRIAL REGISTRATION

The PROSPERO registration ID is CRD42023425200.

Evaluating the Impact of Various Treatment Modalities on the Chewing Efficiency of Anterior Disc Displacements of Temporomandibular Joint Disorder Cases: A Comparative Study

Aim

Internal disc displacement of the temporomandibular joint (TMJ) is identified by an anomaly between the condylar-disc assembly, which, in many cases, may lead to discomfort and malfunction of the chewing function. The study's objective was to assess the effects of four distinct treatment approaches on temporomandibular disorder cases with anterior disc displacements focusing on their chewing efficiency.

Materials and Methods

One hundred participants suffering from reducible TMJ disc displacement were selected for enrollment in the study. Subjects were divided equally into four groups: group I patients were treated with behavioral therapy; group II patients were treated with low-level laser therapy (LLLT); group III patients were treated with anterior repositioning splints; and group IV patients were treated with flat plane splints. Chewing efficiency was assessed utilizing the fractional sieving method and a synthetic food substitute was created using silicon impression material. The statistical analysis encompassed comparisons of chewing efficiency between groups and between baseline and posttreatment within each group, employing analysis of variance (ANOVA) and paired t tests, respectively.

Results

Using the paired t test, a significant difference in chewing efficiency values as expressed by the median particle size was observed between the baseline and 6-month values in all groups (P < 0.05), except for group I where no significant change was noted over the 6 months (P > 0.05). The one-way ANOVA test revealed a statistically significant difference among groups following therapies (P ˂ 0.05). The post hoc Tukey test was employed for pairwise comparisons and revealed statistically significant variances in the main values of chewing efficiency among all groups at a 95% confidence level (P ˂ 0.05).

Conclusion

The study's results suggest that occlusal splints and LLLT are more effective in improving chewing efficiency than behavioral interventions.

Use of Surface Electromyography to Evaluate Effects of Therapeutic Methods on Masticatory Muscle Activity in Patients with Temporomandibular Disorders: A Narrative Review

The presented narrative review aims to present the impact of therapeutic methods on the masticatory muscle activity measured using surface electromyography (sEMG) in patients with temporomandibular disorders (TMDs). Original interventional studies with baseline data for diagnosed TMD groups with full-text articles in English published in scientific journals in the last ten years were included in the evaluation process. The following narrative review considered only clinical, controlled, and randomized studies. Articles that included the following parameters were qualified for this review: adult participants, diagnosis of temporomandibular disorder, the presence of a musculoskeletal dysfunction, no other severe comorbidities, use of therapeutic interventions, and sEMG measurement before and after the intervention. Ten papers were accepted and analyzed for the final evaluation in the presented review. Several studies using surface electromyographic examination prove the effectiveness of various therapies to normalize the bioelectrical activity of the masticatory muscles, either reduction during rest or increase during a functional task in patients diagnosed with temporomandibular disorders. This narrative review shows the influence of manual and physical treatments on electromyographic masticatory muscle activity, including soft tissue mobilization, transcutaneous electrical nerve stimulation, low-level laser therapy, and moist heat therapy. Changes in masticatory muscle activity coincided with changes in TMD-associated pain and range of mandibular mobility.

Clinical aspects of mastication myalgia-an overview

Mastication myalgia is the most common cause of non-odontogenic pain in the orofacial region and is often associated with a reduced quality of life. The purpose of this review is to provide an overview of the clinical aspects of myalgia based on available research. The review includes epidemiological, diagnostic, and etiological aspects. In addition, the potential risk factors related to the transition from acute to chronic myalgia are explored and treatment strategies are presented for its management. As a result, this review may increase clinical knowledge about mastication myalgia and clarify strategies regarding prevention, diagnostics, and management to improve prognosis and reduce patient suffering.

Comparative analysis of different types of occlusal splints for the management of sleep bruxism: a systematic review

BACKGROUND

Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including occlusal splints, have been used to manage sleep bruxism and temporomandibular disorders, including occlusal splints. This study aimed to compare the effectiveness of different occlusal splints in managing sleep bruxism.

METHODS

The PICO framework encompasses the characterization of the population, intervention, comparison, and pertinent outcomes. A comprehensive and systematic literature review was conducted on PubMed, Scopus, and Google Scholar to identify grey literature. The search specifically targeted scientific studies published before September 20, 2023. The Cochrane Collaboration Risk of Bias Tool assessed the accuracy of the included Randomized Control Trials (RCTs). The modified Newcastle-Ottawa Scale assessed non-randomized studies. Data were systematically extracted, synthesized, and reported thematically.

RESULTS

Out of the total of 808 articles that were evaluated, only 15 articles were found to meet the specified inclusion criteria. Adjustable splints, such as full-occlusion biofeedback splints, were more effective in reducing sleep bruxism episodes, improving patient-reported symptoms, and enhancing overall well-being. The impact of different occlusal sprints on electromyographic activity varies, and potential adverse effects should be considered individually.

CONCLUSIONS

This review provides valuable insights into the effectiveness of occlusal splints in managing sleep bruxism. The results of this study indicate that occlusal splint therapy is a viable treatment approach for sleep bruxism.

Efficacy of the transcutaneous electrostimulation in treatment dysfunctions of the TMJ associated with occlusion distortions

BACKGROUND

The study evaluation of the effectiveness the method of electrostimulation in treatment TMJ associated with occlusion disorders with the use of a patches by the company "Aganyan''.

METHODS

The study included 54 patients with temporomandibular dysfunction syndrome who had previously undergone endodontic dental treatment. In patients temporomandibular disorders (TMD) determined on the basis of Diagnostic criteria for temporomandibular disorders(DC/TMD).All patients had occlusion disorders due to errors after dental filling restoration. To diagnose the TMJ, a CT scan was used. The complex therapy also included therapy and with the use of a patches by the company "Aganyan''. The wearable patch includes a flexible substrate, a binder an adhesive layer, with an electrode foil attached to it. Patients applied one patch behind each TMJ. The patches were applied for eight hours every third day for three months. All the patients were given full-fledged endodontic treatment and restoration of the crown part, taking into account anatomical features.

RESULTS

The dynamics of the complex treatment of patients diagnosed with TMJ dysfunction syndrome showed that after treatment, the clinical symptoms gradually decreased and disappeared at the end of treatment. CT scan a year after treatment showed a normal ratio of TMJ elements. Сomplex treatment was effective in 87% of patients, after 3-5 months gradually decreased pain, noise in the joints, restriction of opening and closing of the mouth disappeared. Patients recovered their chewing functions, psycho-emotional state.

CONCLUSION

The results of the studies revealed a positive effects for the complex treatment dysfunctions syndrome TMJ the using the patches by the company "Aganyan" through electrical stimulation with low intensity.

Dynamic Correlations and Disorder in the Masticatory Musculature Network

BACKGROUND

Temporomandibular joint (TMJ) disorders, which affect millions of people worldwide, have multiple etiological factors that make an accurate diagnosis and effective treatments difficult. As a consequence, the gold standard diagnostic criteria for TMJ disorders remain elusive and often depend on subjective decisions.

AIM

In this context, the lack of a non-invasive quantitative methodology capable of assessing the functional physiological state and, consequently, identifying risk indicators for the early diagnosis of TMJ disorders must be tackled and resolved.

METHODOLOGY

In this work, we have studied the biomechanics and viscoelastic properties of the functional masticatory system by a non-invasive approach involving 52 healthy subjects, analysed by statistical-physics analysis applied to myotonic measurements on specific points of the masticatory system designing a TMJ network composed of 17 nodes and 20 links.

RESULTS

We find that the muscle tone and viscoelasticity of a specific cycle linking frontal, temporal, and mandibular nodes of the network play a prominent role in the physiological functionality of the system. At the same time, the functional state is characterised by a landscape of nearly degenerated levels of elasticity in all links of the network, making this parameter critically distributed and deviating from normal behaviour.

CONCLUSIONS

Time evolution and dynamic correlations between biomechanics and viscoelastic parameters measured on the different cycles of the network provide a quantitative framework associated with the functional state of the masticatory system. Our results are expected to contribute to enriching the taxonomy of this system, primarily based on clinical observations, patient symptoms, and expert consensus.

Synchronous Muscle Synergy Evaluation of Jaw Muscle Activities during Chewing at Different Speeds, a Preliminary Study

Human mastication is a complex and rhythmic biomechanical process regulated by the central nervous system (CNS). Muscle synergies are a group of motor primitives that the CNS may combine to simplify motor control in human movement. This study aimed to apply the non-negative matrix factorization approach to examine the coordination of the masticatory muscles on both sides during chewing. Ten healthy individuals were asked to chew gum at different speeds while their muscle activity was measured using surface electromyography of the right and left masseter and temporalis muscles. Regardless of the chewing speed, two main muscle synergies explained most of the muscle activity variation, accounting for over 98% of the changes in muscle patterns (variance accounted for >98%). The first synergy contained the chewing side masseter muscle information, and the second synergy provided information on bilateral temporalis muscles during the jaw closing. Furthermore, there was robust consistency and high degrees of similarity among the sets of muscle synergy information across different rate conditions and participants. These novel findings in healthy participants supported the hypothesis that all participants in various chewing speed conditions apply the same motor control strategies for chewing. Furthermore, these outcomes can be utilized to design rehabilitation approaches such as biofeedback therapy for mastication disorders.

Wearables for personalized monitoring of masticatory muscle activity - opportunities, challenges, and the future

Wearable devices are worn on or remain in close proximity of the human body. The use of wearable devices specific to the orofacial region is steadily increasing. Orofacial applications of wearable devices include supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and understanding oral parafunctional behaviours. In this short communication, the role of wearable devices in advancing personalized dental medicine are highlighted with a specific focus on masticatory muscle activity monitoring in naturalistic settings. Additionally, challenges, opportunities, as well as future research areas for successful use of wearable devices for precise, personalized care of muscle disorders are discussed.

Myofunctional orofacial examination tests: a literature review

INTRODUCTION

Myofunctional orofacial examination (MOE) is an important tool for the assessment of the stomatognathic system and orofacial functions, and the early diagnosis of orofacial myofunctional disorders. Therefore, the purpose of the study is to scan the literature and determine the most preferred test for myofunctional orofacial examination.

MATERIALS AND METHODS

A literature review was conducted to collect information. Pubmed and ScienceDirect database was explored by using keywords gained by MeSH (Medical Subject Headings).

RESULTS

Fifty-six studies were retrived from the search and all of the studies were screened and evaluated regarding the subject, aim, conclusions and the orofacial myofunctional examination test they used. It has been observed that traditional evaluation and inspection methods have been replaced by newer and methodological approaches in recent years.

CONCLUSIONS

Although the few tests used differ, 'Orofacial Examination Test With Scores' (OMES) was found to be the most preferred myofunctional orofacial evaluation method from ENT to cardiology.

Pain inhibition-the unintended benefit of electrically elicited muscle strengthening contractions

BACKGROUND

Neuromuscular electrical stimulation (NMES) is effective in muscle strengthening after orthopedic injury particularly when muscle activation failure is present, but the associated pain can be a barrier. Pain itself can produce a pain inhibitory response called Conditioned Pain Modulation (CPM). CPM is often used in research studies to assess the state of the pain processing system. However, the inhibitory response of CPM could make NMES more tolerable to patients and could improve functional outcomes in people with pain. This study compares the pain-inhibitory effect of NMES compared to volitional contractions and noxious electrical stimulation (NxES).

METHODS

Healthy participants, 18-30 years of age experienced 3 conditions: 10 NMES contractions, 10 bursts of NxES on the patella, and 10 volitional contractions on the right knee. Pressure pain thresholds (PPT) were measured before and after each condition in both knees and the middle finger. Pain was reported on an 11-point VAS. Repeated measures ANOVAs with 2 factors: site and time were performed for each condition followed by post-hoc paired t-tests, with Bonferroni correction.

RESULTS

Pain ratings were higher in the NxES condition compared to NMES (p = .000). No differences in PPTs prior to each condition were observed but PPTs were significantly higher in the right and left knees after the NMES contractions (p = .000, p = .013, respectively) and after the NxES (p = .006, P-.006, respectively). Pain during NMES and NxES did not correlate with pain inhibition (p > .05). Self-reported pain sensitivity correlated with pain during NxES.

CONCLUSION

NxES and NMES produced higher PPTs in both knees but not in the finger, suggesting that the mechanisms responsible for the reduction in pain are located in the spinal cord and local tissues. Pain reduction was elicited during the NxES and NMES conditions regardless of the self-reported pain ratings. When NMES is used for muscle strengthening significant pain reduction can also occur, which is an unintended benefit of the intervention that could improve functional outcomes in patients.

Short-term effects of Kinesio taping combined with cervical muscles multi-angle isometric training in patients with cervical spondylosis

OBJECTIVE

The purpose of this study was to investigate the efficacy of Kinesio taping (KT) combined with multi-angle isometric resistance training for cervical spondylosis.

METHODS

Sixty-one patients were divided into two groups by random number table method. Both groups were given multi-angle isometric training, the patients in the observation group were supplemented with Kinesio taping. Before and after treatment, the symptoms of cervical spine function were evaluated in two groups by visual analogue scale (VAS), cervical dysfunction index (NDI), cervical range of motion and muscle stiffness.

RESULTS

After 3 weeks of treatment, VAS, NDI scores and the cervical range of motion were significantly better than before (P < 0.05). The range of anterior flexion and extension was significantly larger than the control group (P < 0.05), but the range of other motions were not certain. The muscle stiffness in KT group were significantly lower than the control group.

CONCLUSION

Kinesio taping combined with multi-angle isometric resistance training can further alleviate the clinical symptoms and correct the neck abnormal posture. But its effects on the range of cervical motion remain uncertain.

Effects of Physiotherapy on Pain and Mouth Opening in Temporomandibular Disorders: An Umbrella and Mapping Systematic Review with Meta-Meta-Analysis

The aim of this meta-meta-analysis was to assess the current evidence regarding the effect of physical therapy (PT) interventions on pain and functional variables in temporomandibular disorders (TMD). We conducted an umbrella systematic review (SR) and four meta-meta-analyses (MMA) and created an evidence map to determine the effectiveness of PT on pain intensity and maximum mouth opening in patients with TMD. The quality of the included SR was assessed with the AMSTAR 2, and the risk of bias with ROBIS. Of the 31 SR included in the umbrella SR, only 10 were included in the MMA. The MMA showed moderate effects for manual therapy and therapeutic exercise, and large effects for low-level laser therapy on improving pain intensity and maximum mouth opening in patients with TMD, with a limited to moderate quality of evidence. The overlapping analyses showed only a slight overlap for all the MMA according to the corrected covered area (range from 0.07 to 0.2), 23.1% to 41.6%. This umbrella SR showed that manual therapy and exercise interventions, as well as low-level laser therapy interventions, are effective in the reduction in pain intensity and improvement of maximum mouth opening in TMD. This article presents a synthesis of the available evidence related to the various physical therapy interventions used in patients presenting with temporomandibular disorders. These results could help clinicians to select the optimal intervention for their patients and to reject those that are less useful.

Modified minimally invasive surgery in reconstructing the temporomandibular joint disk by transplantation of the temporalis myofascial flap

OBJECTIVE

The transplantation of temporalis myofascial flap (TMF) is an indispensable method to treat severe temporomandibular joint disorders with disk failure. How to select the indication and the ways of transplantation is still a challenging topic for achieving the ideal effect. We reported the new methods and follow-up results of the patients treated with pedicled TMF transplantation.

METHODS

Retrospective case series was performed at Temporomandibular Joint Specialist Clinic, the First Affiliated Hospital of Xinjiang Medical University, from December 2014 to August 2022. 39 patients (50 sides) included anterior disk displacement without reduction and disk perforation who underwent discectomy and immediate reconstruction with pedicled TMF. The initial and postoperative maximum mouth opening (MMO), and pain visual analogue scale (VAS) were compared via paired t-test and Wilcoxon signed-rank sum test, respectively.

RESULTS

The average of follow-up time was 30.07 months. The reconstructed temporomandibular joints basically achieved stable occlusion, good function, and satisfactory effect. The patients displayed a remarkable reduction of VAS score of pain, and improvement of the MMO compared with that before operation (P <  0.001). MR scanning revealed the grafts in joint space showed band-shaped soft tissue density of medium signal and had the clear edges, without interruption and fragment.

CONCLUSION

Reconstruction of the temporomandibular joint disk by transplantation of the TMF applying modified minimally invasive surgery was a feasible method, which could improve the function of joints and prevent adhesion, without obvious complications in donor region.

Effects of occlusal splint and exercise therapy, respectively, for the painful temporomandibular disorder in patients seeking for orthodontic treatment: a retrospective study

OBJECTIVE

To evaluate the effect of hard stabilization splints (HSS), counselling and exercise therapies, respectively, for the painful temporomandibular disorder (TMD) in patients seeking for orthodontic treatment through magnetic resonance imaging (MRI) and clinical examination.

MATERIALS AND METHODS

Eighty-seven TMD patients were divided into two groups according to their therapies: the HSS group (n = 43) comprising of patients treated with HSS, counselling and masticatory muscle exercises; the control group (n = 44) comprising of patients treated with counselling and masticatory muscle exercises alone. All patients had orthodontic therapies after the first treatment phase. The joint pain and clicking of all patients were recorded via clinical examination. MRIs of HSS groups were taken before (T₀), after the first phase (T₁), and after the orthodontic treatment (T₂). Parameters indicating the condyles and articular discs were evaluated. Clinical symptom (pain and clicking) changes among T₀, T₁ and T₂ time point were detected in the two groups respectively. The significant differences between HSS and control groups, as well as between male and female were tested at T₁ and T₂. Position changes of condyles and discs in HSS group among T₀, T₁ and T₂ were detected in male and female respectively.

RESULTS

After the first treatment phase, there was no difference in the decrease of facial pain between the two group, as well as between male and female in the two groups (P > 0.05). Clicking decreasing was not statistically significant. After the whole orthodontic periods, the TMJ pain relapsed in female of the control group, and the number of female's pain joints was more than male's (P < 0.05). In the HSS group, the posterosuperior movements of discs and the anteroposterior movements of condyles were recorded in closing position (P < 0.05). After the whole orthodontic periods, female's disc-condyle angles increased, the discs to HRP distance decreased and condyles to VRP distance increased when compared with the data of T₁ (P < 0.05).

CONCLUSIONS

For the orthodontic patients with painful TMD, HSS combined with counselling and exercise therapies before orthodontic treatment could provide pain relief. HSS is helpful to improve the position and relation of discs and condyles. In addition, male's prognosis is better than female's in terms of stability.

Effectiveness of conservative therapeutic modalities for temporomandibular disorders-related pain: a systematic review

PURPOSE

The aim of this systematic review was to evaluate the effectiveness of conservative different therapeutic modalities for temporomandibular disorders (TMD) pain.

MATERIALS AND METHODS

An electronic systematic search was conducted in the MEDLINE (PubMed) database to identify the randomized clinical trials (RCTs) published between 2001 and 2021. The following, simple or multiple conjunctions, search keywords were selected: TMD pain, TMD management or conservative treatment or treatment strategies and TMD pain, therapeutic modalities or interventions and TMD. Studies included must have patients older than 18 years, with painful TMD, which diagnosis was performed by Research Diagnostic Criteria for TMD or Diagnostic Criteria for TMD. Outcome variables were pain relief and post treatment pain intensity reduction. Data were analysed with non-parametric tests and the level of significance was set at p<.05.

RESULTS

Out of 1599 articles obtained, 28 RCTs fulfilled all selection criteria and were included. The results of this study show that there was a significant decrease in short-term post-treatment TMD pain with the use of occlusal splint alone or in combination with other therapeutic modalities when compared with the control group. Statistically significant differences were also detected between laser and photobiomodulation group and the control, in short-term treatment TMD-related pain.

CONCLUSIONS

The primary findings of the present systematic review showed that the occlusal splint alone or combined with other therapeutic intervention presented positive effect on short-term TMD pain reduction. Secondary outcome suggests that laser and photobiomodulation therapy had, also, a significant role in short term pain relief.

Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review

Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen–ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.

Oral-Health-Related Quality of Life and Anxiety in Orthodontic Patients with Conventional Brackets

The aim of this study was to evaluate the oral-health-related quality of life (OHRQoL) and anxiety levels of adult patients undergoing orthodontic treatment with fixed multibracket appliances.

MATERIALS AND METHODS

The study was carried out at the Dental Clinic of the University of Salamanca in 2021. It included 120 adult patients between 19 and 45 years of age undergoing orthodontic treatment with conventional metal brackets. The data collection instruments chosen were the state-trait anxiety inventory (STAI) to assess anxiety levels and the OHIP-14 questionnaire to measure the OHRQoL. Anxiety levels and OHRQoL were analyzed one month after starting treatment.

RESULTS

The mean age was 31.7 years ± 6.5 years; 68 patients were women (56.7%) and 52 were men (43.3%). Psychological disability was the dimension of the OHIP-14 questionnaire that was found to have the greatest impact (3.20 ± 1.08) on patients, as compared to the dimension of disability, which had the lowest impact on the oral-health quality of life (0.37 ± 0.56). The mean total score of the OHIP-14 questionnaire was 11.93 (±2.19). There was no statistically significant influence from either sex or age on the anxiety and oral-health quality of life of the participants; however, there was a significant relationship between the dimensions of physical disability and anxiety traits.

CONCLUSIONS

The physical disability dimension of the OHIP-14 questionnaire increased the anxiety level of adult patients treated with conventional brackets. The impact of orthodontic treatment on adult patients may negatively influence their levels of anxiety.

Effects of neuromuscular training on postural control of children with intellectual disability and developmental coordination disorders : Neuromuscular training and postural control

Background

Children with Intellectual disabilities who suffer from developmental coordination disorder represent insignificant physical fitness, strength, and balance. The prime objective of this research is to explore the impact of eight weeks of neuromuscular (combined physio-hemsball) training on postural control and balance of students with intellectual disabilities suffering from developmental coordination disorder.

Methods

The present study was a prospective randomized clinical trial with a pretest–posttest design. The statistical population consisted of boys with intellectual disabilities, suffering from developmental coordination disorder randomly divided into two groups: the experimental group (n = 15) and the control group (n = 15). informed consent was obtained from all participants’ parents. Parents completed developmental coordination disorder questionnaires. Tests (Balance Error Scoring System, Y-Balance, timed Get Up & Go) were used to determine postural control, dynamic balance, and functional balance of subjects. The experimental group performed a combined physio-hemsball training for 8 weeks. Ethical considerations were observed according to the Helsinki Declaration and the CONSORT guidelines and regulations were followed to report this study.

Results

Results showed that combined physio-hemsball training for 8 weeks can greatly improve postural control and dynamic and postural balance among students with intellectual disabilities suffering from developmental coordination disorder.

Conclusions

According to the results, instructors can use this type of training to improve postural control and balance in boys with intellectual disabilities enduring developmental coordination disorders.

Trial registration

This research was registered by the clinical trial centers of Iran (code IRCT20200125046254N1, Date of registration: 24/04/2020).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05569-2.

Efficacy of Electromyographic Biofeedback in Muscle Recovery after Meniscectomy in Soccer Players

Electromyographic biofeedback (EMG-BF) is a therapeutic technique that has been used successfully in the rehabilitation of injuries. Although it has been applied to athletes, its use in this field is not very widespread. The objective of this study is to analyze its effectiveness in the recovery of electromyographic activity of the quadriceps after meniscectomy, evaluated through isometric contraction of the vastus lateralis. The sample comprised ten professional footballers in the Spanish League (2nd Division A) who had previously suffered a meniscus injury in their knee and had undergone a meniscectomy. The intervention consisted of EMG-BF treatment lasting between 6 and 10 sessions. The electromyographic signal was recorded using a Thought Technology ProComp Infiniti 8-channel biofeedback unit with a sampling rate of 2048 samples/second. For each session, a within-subject ABA design of 6 or 10 trials per session was used, with three pre- and three post-measures, which determined the gain for each session. The results indicated (1) improvements in all cases, (2) EMG-BF was effective, (3) the working model was statistically significant with an explained variance of between 67% and 75%, and (4) the generalizability analysis showed that the results are reliable and generalizable. The results indicate that EMG-BF is effective in neuromuscular rehabilitation after this type of intervention.

Evaluation of the efficacy of platelet rich fibrin (I-PRF) intra-articular injections in the management of internal derangements of temporomandibular joints - a controlled preliminary prospective clinical study

Background

The temporomandibular joint (TMJ) is one of the most complex joints in the body. Temporomandibular disorders (TMD) are among the most troublesome disorders for patients, as they can cause pain, affect oral functions and disturb dentists on the level of diagnosis and treatment. The most common symptoms of temporomandibular joint disorders are articulated sounds (such as clicking or TMJ crepitation), joint pain in comfort and function situations (jaw movements), pain or strain in masseter and jaw muscles and or restricted mandibular movements. One of the most modern biocompatible substances used to treat joint disorders, including the TMJ, is platelet-rich plasma (PRP) and injectable platelet-rich fibrin (I-PRF). This study aims to evaluate the efficacy of platelet-rich fibrin (I-PRF) intra-articular injections in managing internal derangements of temporomandibular.

Methods

Twenty patients suffering from a unilateral click due to temporomandibular disorders were individually injected with 1 mL of (I-PRF) twice 1 week apart into the superior joint space of the TMJ with the internal disorder. Data were recorded and evaluated by the Helkimo index. This evaluation was conducted three times; 1 week after the first injection, 1 week after the second injection, and 6 months after the first injection.

Results

The clicking disappeared entirely in 14 out of 20 patients after 1 week of getting the first injection, and in all patients after 1 week of getting the second injection, and returned to two of them after a six-month since the first injection.

Conclusion

Preliminary results showed the efficacy of the Injectable Platelet-Rich Fibrin (I-PRF) in managing articular clicking in patients with internal disorders of the temporomandibular joint. Injectable Platelet Rich Fibrin has significant clinical efficacy in treating the articular clicking resulting from internal temporomandibular joint disorders.

Disc repositioning by open suturing vs. mini-screw anchor: stability analysis when combined with orthognathic surgery for hypoplastic condyles

Background

Disc repositioning by Mitek anchors for anterior disc displacement (ADD) combined with orthognathic surgery gained more stable results than when disc repositioning was not performed. But for hypoplastic condyles, the implantation of Mitek anchors may cause condylar resorption. A new disc repositioning technique that sutures the disc to the posterior articular capsule through open incision avoids the implantation of the metal equipment, but the stability when combined with orthognathic surgery is unknown. The purpose of this study was to evaluate the stability of temporomandibular joint (TMJ) disc repositioning by open suturing in patients with hypoplastic condyles when combined with orthographic surgery.

Methods

Patients with ADD and jaw deformity from 2017 to 2021 were included. Disc repositioning by either open suturing or mini-screw anchor were performed simultaneously with orthognathic surgery. MRI and CT images before and after operation and at least 6 months follow-ups were taken to evaluate and compare the TMJ disc and jaw stability. ProPlan CMF 1.4 software was used to measure the position of the jaw, condyle and its surface bone changes.

Results

Seventeen patients with 20 hypoplastic condyles were included in the study. Among them, 12 joints had disc repositioning by open suturing and 8 by mini-screw anchor. After an average follow-up of 18.1 months, both the TMJ disc and jaw position were stable in the 2 groups except 2 discs moved anteriorly in each group. The overall condylar bone resorption was 8.3% in the open suturing group and 12.5% in the mini-screw anchor group.

Conclusions

Disc repositioning by open suturing can achieve both TMJ and jaw stability for hypoplastic condyles when combined with orthognathic surgery.

Temporomandibular Myofascial Pain Syndrome-Aetiology and Biopsychosocial Modulation. A Narrative Review

This review elaborates on the aetiology, diagnosis, and treatment of temporomandibular (TMD) myofascial pain syndrome (MPS) regulated by psychosocial factors. MPS impairs functioning in society due to the accompanying pain. Directed and self-directed biopsychosocial profile modulation may be beneficial in the treatment of MPS. Moreover, nutrition is also a considerable part of musculoskeletal system health. A fruit and vegetable diet contributes to a reduction in chronic pain intensity because of its anti-inflammatory influence. Cannabidiol (CBD) oils may also be used in the treatment as they reduce stress and anxiety. A promising alternative treatment may be craniosacral therapy which uses gentle fascia palpation techniques to decrease sympathetic arousal by regulating body rhythms and release fascial restrictions between the cranium and sacrum. MPS is affected by the combined action of the limbic, autonomic, endocrine, somatic, nociceptive, and immune systems. Therefore, the treatment of MPS should be deliberated holistically as it is a complex disorder.

[Dental disorders with a psychosocial background]

While the mouth and teeth play a lifelong central role in a person's development and wellbeing, psychosocial aspects of disease and health are still only reluctantly included in dental explanatory models. Only dental anxiety with its disease quality of a specific phobia is generally recognized as a mental disorder requiring intervention. It is interpreted as an emotional reaction to aspects of dental treatment, which results in distress for the affected person and appears to be unreasonably intense given the actual dangers involved. Apart from that, the tendency to provide a somatic explanation for symptoms in the dental context persists. This bears implications for the expectations of those affected as well as for interdisciplinary cooperation. In order to improve interdisciplinary support and mutual understanding, the following article introduces the clinical pictures of craniomandibular dysfunction, bruxism, occlusal dysaesthesia, and somatoform prosthesis intolerance alongside dental anxiety. Psychosocial factors can profoundly influence the development, course, and management of these conditions.

Comparative Evaluation of Occlusion before and after Soft Tissue Mobilization in Patients with Temporomandibular Disorder-Myofascial Pain with Referral

The aim of the study was to evaluate occlusal parameters in patients with myofascial pain with referral before and after soft tissue mobilization. The study group consisted of 50 people (37 females and 13 males, average age 23.36 ± 2.14 years) diagnosed with myofascial pain with referral. All patients underwent triplicate soft tissue mobilization. Occlusal parameters were evaluated six times, before and after each treatment, using T-scan III. A decreasing tendency of the occlusion time was observed after the first, second, and third therapy. After the third treatment, the mean occlusion time in the entire study group was 0.119 s. The 1st soft tissue mobilization shortened both right and left disclusion times to 0.181 s and 0.185 s, respectively. After the third treatment, these parameters amounted to 0.159 s and 0.165 s, respectively. The Friedman test for the entire study group indicated that soft tissue mobilization altered the occlusion time and both disclusion times (p < 0.05). In conclusion, soft tissue mobilization affects biotensegrity of the masticatory system, thus modifying occlusal parameters. The occlusion time and both disclusion times cannot be considered as cofactors of the existing temporomandibular disorders-myofascial pain with referral.

Functional Magnetic Resonance Connectivity in Patients With Temporomadibular Joint Disorders

Myofascial pain in the masticatory region, generally referred to as headache, is a common temporomandibular disorder (TMD) characterized by the hypersensitive regions of the contracted skeletal muscle fibers. A correct clinical treatment of myofascial pain has the potential to modify the functional activation of cerebral networks associated with pain and unconscious teeth clenching, specifically the pain network (PN) and default mode network (DMN). In this study, research is presented as a case series of five patients with myofascial pain: three were diagnosed with intra- and extra-articular disorders, and two were diagnosed with only extra-articular disorders. All five patients received gnathological therapy consisting of passive splints and biofeedback exercises for tongue–palatal vault coordination. Before and after treatment, patients underwent pain assessments (through measures of visual analog scales and muscular palpation tests), nuclear magnetic resonance of the temporomandibular joint, and functional nuclear magnetic resonance of the brain. In each patient, temporomandibular joint nuclear magnetic resonance results were similar before and after the gnathological treatment. However, the treatment resulted in a considerable reduction in pain for all patients, according to the visual analog scales and the palpation test. Furthermore, functional nuclear magnetic resonance of the brain clearly showed a homogeneous modification in cerebral networks associated with pain (i.e., PN and DMN), in all patients. In conclusion, gnathological therapy consisting of passive aligners and biofeedback exercises improved myofascial pain in all five patients. Most importantly, this study showed that all five patients had a homogeneous functional modification of pain and default mode networks. Using passive splints in combination with jaw exercises may be an effective treatment option for patients with TMD. This research could be a starting point for future investigations and for clinicians who want to approach similar situations.

Is Biofeedback through an Intra-Aural Device an Effective Method to Treat Bruxism? Case Series and Initial Experience

Biofeedback was reported as an effective concept for bruxism treatment, through increasing patient’s awareness of the habit. During bruxing both ear canals become tighter, therefore, an in-ear device can provide biofeedback. The in-ear device is fitted to the ear canal in physiological status, during bruxing the ear-canal tightens resulting in stress on the canal walls and unpleasant feeling. Subsequently, patients stop their bruxing habit. The aim of this study is to provide first clinical evidence that in-ear devices have a positive impact on relieving bruxism in patients. Despite the low number of patients, this early study was designed as a controlled prospective study. The trial included seven female patients with a median age of 47.3 years (23–64 years). Only two patients implemented their devices for eight and seven months, respectively. One patient reported a relief in her symptoms, like headaches and pain intensity during the night, by 50% after three month and 80% after six months. Despite the limited number of participants, the study reflects a potential of Intra-aural devices as effective biofeedback devices in treating bruxism.

Interprofessional Collaboration in Dentistry: Role of physiotherapists to improve care and outcomes for chronic pain conditions and sleep disorders

Physiotherapists can manage chronic pain patients by using technical interventions such as mobility, strengthening, manual therapy, or flexibility in a specific and functional manner, being a key component of a multidisciplinary team. Dentists are involved in the management of different chronic pain conditions such as temporomandibular disorders and sleep disorders such as obstructive sleep apnea. However, they are frequently unaware of the benefits of collaborating with physical therapists. In this review, the collaboration of physical therapists and dentists will be explored when managing orofacial pain, headaches, and sleep disorders. The physical therapist is important in the management of these disorders and also in the screening of risk factors.

Low-Intensity Pulsed Ultrasound Alleviates Hypoxia-Induced Chondrocyte Damage in Temporomandibular Disorders by Modulating the Hypoxia-Inducible Factor Pathway

Temporomandibular disorders are a common cause of chronic pain in the orofacial region and have a complex and multi-factorial pathophysiology. Mechanical loading or inflammatory conditions have been shown to decrease oxygen tension within the joint cartilage and activate the hypoxia-inducible factor (HIF) pathway, which in turn aggravates the pathological processes underlying temporomandibular joint (TMJ) disorders. We previously showed that low-intensity pulsed ultrasound (LIPUS) treatment effectively repairs TMJ injury induced by chronic sleep deprivation (CSD). Here, we explored the effects of LIPUS treatment on hypoxia-induced chondrocyte injury. We found that it effectively restored the proliferation capacity of mandibular chondrocytes under hypoxic conditions and lowered their rate of apoptosis. Chondrogenic capacity, as assessed by type II collagen levels, and mucin-positive areas were also significantly increased after LIPUS treatment. Levels of matrix metalloprotein-3 and interleukin-6 decreased in mandibular chondrocytes following this treatment, whereas the expression of tissue inhibitor of metalloproteinase-1 increased. We also found that HIF-1α expression was upregulated in mandibular chondrocytes under hypoxic conditions and was further enhanced by LIPUS treatment. Similarly, HIF-2α levels increased in mandibular chondrocytes under hypoxic conditions but decreased following LIPUS treatment. Subsequently, we established a CSD-induced TMJ injury model and found that LIPUS increased mucin-positive areas as well as HIF-1α expression and decreased HIF-2 level in the chondrocyte layer. Together, our results indicate that the protective effect of LIPUS on chondrocyte is partly associated with the HIF pathway.