Can orthodontic relapse be blamed on the temporomandibular joint?

Assessment of Condylar Changes in Patients with Degenerative Joint Disease of the TMJ After Stabilizing Splint Therapy: A Retrospective CBCT Study

BACKGROUND/OBJECTIVES

Degenerative joint disease (DJD) of the TMJ can impact patients' quality of life and complicate orthodontic treatment. Stabilizing splints are a common conservative treatment in managing TMDs symptoms, although their long-term effects on condylar morphology are poorly studied. This study aimed to assess the impact of stabilizing splints on condyle morphology using cone-beam computed tomography (CBCT) in patients with various stages of DJD. Forty-two condyles with pre- (T1) and post- (T2) splint therapy scans were analyzed.

METHODS

CBCT scans were sectioned into sagittal and coronal slices for condyle classification and measurement. T1 and T2 CBCTs were superimposed before linear and area measurements at different poles.

RESULTS

Our results indicate that condyles in the normal group remain unchanged after splint therapy. The majority of subjects in the degenerative groups remained in the same classification group: six out of fourteen degenerative-active patients became degenerative-repair, while three out of twenty-two degenerative-repair patients progressed to degenerative-active. There is no significant remodeling of condylar width pre- and post-splint therapy. On average, there is more bone deposition than reduction in condylar height after splint therapy, although individual variation exists.

CONCLUSIONS

Stabilizing splints offer a low-risk intervention for managing DJD and may contribute to favorable adaptive changes in the condyles.

Evaluating changes in the condylar head after orthognathic surgery with or without articular disc repositioning: a systematic review

Failures in orthognathic surgery are associated with different factors, including those related to untreated or undiagnosed preoperative temporomandibular joint (TMJ) disorders. This systematic review aimed to assess potential alterations in the condylar head following orthognathic surgery. A systematic search for randomised controlled trials and retrospective studies was performed. For inclusion in the review, studies had to meet the following eligibility criteria according to the PICO framework: Patients: patients with orthognathic deformity and temporomandibular dysfunction (or temporomandibular osteoarthritis); Intervention: patients submitted to orthognathic surgery concomitantly with TMJ disjunction; Control: patients undergoing only orthognathic surgery with or without presurgical data; and Outcome: changes in temporomandibular joint position and volume. Nine studies met all the inclusion criteria and were selected for qualitative analysis. The results of this review show that simultaneous articular disc repositioning and orthognathic surgery provide better results in patients with preoperatively diagnosed condylar osteoarthritic changes. In conclusion, condylar remodelling (resorption/deposition) and its extent are determined by the direction of condylar displacement during surgery. Other factors such as age are also associated with the development of condylar resorption.

Correlation between TMJ Space Alteration and Disc Displacement: A Retrospective CBCT and MRI Study

This study aims to determine if a large anterior and reduced posterior/superior joint space is highly predictable for disc displacement. From patients with temporomandibular disorders symptoms, fifty-two experimental joints and fourteen control joints were included. The cone beam computed tomography (CBCT) images were used to calculate posterior-to-anterior (P-A) and superior-to-anterior (S-A) joint space ratios, while disc position was determined using magnetic resonance imaging (MRI). One-way analysis of covariance test and receiver operating characteristics analysis were carried out. The results showed that among the 52 experimental joints, 45 were diagnosed as disc displacement and 7 as normal disc positions (N). All 14 control joints showed normal disc positions. The P-A ratio was 1.46 ± 0.21, 0.99 ± 0.23, and 0.86 ± 0.30 in the control, N, and DD groups, respectively (p < 0.001). The S-A ratio was 1.80 ± 0.27, 1.44 ± 0.33, and 1.08 ± 0.35 in the control, N, and DD groups, respectively (p < 0.001). When an altered P-A ratio and/or S-A ratio are observed on the CBCT, the diagnosis of disc displacement is quite predictable with high sensitivity and specificity.

Influence of local factors on the condylar growth after arthroscopic discopexy in adolescents with temporomandibular joint anterior disc displacement without reduction: a retrospective longitudinal study

The aim of this retrospective longitudinal study was to investigate the condylar growth after arthroscopic discopexy in adolescents with temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDwoR), and to determine whether local or systemic factors influence this growth. A total of 145 patients aged 10-20 years who were diagnosed with ADDwoR by magnetic resonance imaging were included. Patients who underwent arthroscopic discopexy were assigned to the arthroscopy group (n = 108) and others to the control group (n = 37). Demographic information, clinical assessments, body indicators, and bone density information were collected. Condylar height, disc length, and disc position were measured. The mean condylar height change in the arthroscopy group was 2.12 mm more than that in the control group (P < 0.001). Condylar growth after surgery was negatively correlated with age (P = 0.017) and disc length (P = 0.015), and positively correlated with follow-up duration (P = 0.002) and disc position (P < 0.001). Moreover, arthroscopic discopexy patients had better outcomes regarding improvements in pain (P = 0.024), maximum inter-incisal opening (P < 0.001), and quality of life (P < 0.001) than control patients. In conclusion, arthroscopic discopexy can restore condylar growth and relieve symptoms in ADDwoR patients, and the condylar growth is closely related to the local factors.

Characteristics of patients with temporomandibular joint idiopathic condylar resorption

OBJECTIVE

To investigate characteristics of temporomandibular joint (TMJ) idiopathic condylar resorption (ICR) and analyze the related factors.

METHODS

A total of 755 consecutive patients (150 with ICR and 605 with anterior disc displacement [ADD]) from July 2015 to December 2018 were recruited. A comprehensive questionnaire characterizing the multidimensional impact of the TMJ was designed. Clinical examination and radiological evaluation were also performed. The odds ratio for each variable in the ICR group versus the ADD group was computed using logistic regression analysis.

RESULTS

Multivariate logistic regression analysis showed significant correlations between mouth opening restriction, disease course, mandibular retrusion, mandibular retrusion progression, skeletal Class II profile, and overjet in ICR patients.

CONCLUSION

These results suggest that a longer ADD disease course might have a strong relationship with ICR.

Adult orthodontic retreatment: A survey of patient profiles and original treatment failings

INTRODUCTION

A growing number of adult patients are seeking orthodontic treatment. This research aimed to analyze the particulars of patients seeking retreatment and identify the causes of their original treatment failure.

METHODS

An online questionnaire survey of adults seeking first-time orthodontic treatment (control) and retreatment (study) was conducted. Index of complexity, outcome, and need (ICON) scores were determined. Appraisal of treatment records was carried out to identify the causes of original treatment failure.

RESULTS

No significant differences were found between retreatment adult patients and first-timers regarding reasons for seeking orthodontic treatment, malocclusion type, self-perception of malocclusion, level of self-motivation, willingness for surgery, expectations of treatment improvement and duration. The predominant reason for seeking treatment in both groups was for aesthetic concerns. Retreatment patients presented with lower ICON scores (39.4; standard error, 0.26) than the first-time patients (54.3; standard error, 0.23), P ≤0.001. The predominant reasons for original treatment failings were poor treatment, maturational changes, inadequate retention, shortcomings in diagnosis and treatment planning, and unfavorable growth. Other causes were related to transverse deficiency, secondary malocclusion (after periodontal breakdown), poor retention compliance, and temporomandibular joint degeneration.

CONCLUSIONS

Adult orthodontic retreatment and first-time seekers' profiles are remarkably similar. Aesthetic concerns were the leading reasons patients sought treatment. ICON was not a useful proxy of patient profiles. Poor treatment was the chief reason for the failure of the original treatment. In terms of clinical significance, clinicians should be mindful of the patient profiles of retreatment seekers and vigilant about the possible causes of failings of orthodontic treatment to avoid suboptimal outcomes.

Immunohistochemical analysis of IL-1 Receptor 1 in the discs of patients with temporomandibular joint dysfunction

Objective Temporomandibular joint dysfunction (TMD) may affect a patient's quality of life, and one of the etiologies can be anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDWoR). Interleukin 1 Receptor 1 (IL-1R1) is a membrane receptor that plays an important role on initiating immune and inflammatory response by binding the agonists ligands of IL-1 alpha and IL-1 beta. Therefore, the aim of this study was to evaluate, through immunohistochemical analysis, the association of IL-1R1 with TMD. Methods Thirty-nine human disc samples were collected and composed three different groups: ADDwR (n = 19), ADDwoR (n = 12), and control group (n = 8). The samples were immunostained with IL-1R1 antibody and evaluated on both quantity and intensity of staining. Results There was a statistically significant difference (p < 0.05) between the control and test groups for both quantity and intensity of staining. Conclusion IL1-R1 was associated with ADDwR and ADDwoR in TMD discs of humans.

Effect of temporomandibular joint articular disc repositioning on anterior open-bite malocclusion: An orthodontic-surgical approach

An anterior open bite is a challenge to orthodontic treatment; it has a multifactorial etiology and a wide range of intervention options. Temporomandibular joint (TMJ) disorders are a risk factor for the development of malocclusions such as the anterior open bite, especially in patients who have TMJ osteoarthritis with disc displacement. Articular disc repositioning surgery is an available option for treating this pathology, and it contributes to maintaining the condyles in a more stable position. The aim of this article was to report the case of a 20-year-old woman diagnosed with anterior open bite and TMJ osteoarthritis with bilateral disc displacement. The patient received both orthodontic treatment and TMJ disc repositioning surgery. Cone-beam computed tomography was used to create 3-dimensional models of the condyles with regional superposition, and assessment of bone remodeling was performed at different time intervals. Complete orthodontic and surgical treatment time was approximately 12 months. The results provided a stable correction of the patient's anterior open bite with a 2-year follow-up and favorable bone remodeling of the condyles due to functional improvement of the TMJ.