An investigation of the sleep quality status of adolescent patients with temporomandibular joint anterior disc displacement and its influencing factors / 口腔疾病防治

Objective @# To survey the current situation and analyze the relevant influencing factors of sleep quality in adolescent patients with temporomandibular joint anterior disc displacement. @*Methods@#This study has been reviewed and approved by the Ethics Committee, and informed consent has been obtained from patients. A convenience sampling method was used to investigate 120 adolescent patients with temporomandibular joint anterior disc displacement in the outpatient department of stomatology in a grade A tertiary hospital in Shanghai using the general data questionnaire, the Pittsburgh sleep quality index scale (PSQI), the Chinese middle school student mental health scale (MMHI-60) and the pain visual analog scale (VAS). Descriptive analysis, single factor analysis, correlation analysis and multiple regression analysis were used to explore the relevant influencing factors. @* Results@#The PSQI score of adolescent patients with temporomandibular joint anterior disc displacement in this study was 7.77 ± 4.63. There was a statistically significant difference in sleep quality among patients with different academic pressures and levels of sleep bruxism (P<0.05). The sleep quality score was positively correlated with the pain score (r = 0.45, P<0.001) and positively correlated with the psychological score (r = 0.74, P<0.001). The degree of pain can affect the patient's sleep quality, and those with good mental health have better sleep quality. The results of regression analysis showed that academic stress (OR = 2.511, 95% CI =1.307 ~ 4.828), bruxism (OR = 3.694, 95% CI = 1.394 ~ 9.791), pain score (OR = 2.104, 95% CI =1.095 ~ 4.041) and psychological score (OR = 1.039, 95% CI = 1.021 ~ 1.058) were statistically significant.@*Conclusion @#The sleep quality of adolescent patients with temporomandibular joint anterior disc displacement is generally poor. Academic pressure, sleep bruxism, pain and mental health are the influencing factors of sleep quality.

Effects of Different Stabilization Splint Thicknesses on Stress Distribution in Temporomandibular Joint for Patients with Anterior Disc Displacement with Reduction / 医用生物力学

Objective To compare the stress distributions in temporomandibular joint (TMJ) for patients with bilateral anterior disc displacement with reduction (ADDwR) after wearing stabilization splints with two different thicknesses during prolonged clenching by using three-dimensional (3D) finite element methods. Methods The 3D TMJ finite element models were constructed based on CT and MRI image data when the patient was biting in maximum intercuspation (working condition 1), on 3 mm thickness splint (working condition 2) and on 5 mm thickness splint (working condition 3), respectively. The von Mises stresses in the articular cartilages ,the TMJ disc and bilaminar zone under 3 working conditions were evaluated after the maximum jaw-closing forces were applied to the mandible for 60 s. Results The von Mises stress of left TMJ was bigger than that of right TMJ under each working condition. After wearing the 3 mm thickness splint, the disc was not recaptured, the stress was concentrated at the posterior band and bilaminar zone of the disc, and the stress on bilateral TMJ was significantly increased. After wearing the 5 mm thickness splint, the right disc was recaptured, the maximum stress was located at intermediate zone of the disc, and the von Mises stresses of articular cartilages and bilaminar zone were decreased by about 40%. However, the left disc was not recaptured, and the von Mises stresses of glenoid fossa cartilage and bilaminar zone were only slightly decreased by about 6%. Conclusions Different thicknesses of occlusal splints lead to different stresses and stress distribution patterns in TMJ of patients with ADDwR. The 5 mm thickness stabilization splint can reduce the stress of glenoid fossa cartilage and bilaminar zone in ADDwR patients. Disc recapture is helpful for ADDwR patients to relieve TMJ stress. When using stabilization splints for the treatment of ADDwR patients, on the premise of comfort wearing, a thicker splint can achieve more favorable stress distributions.

The effects of combining posture control training with exercise on the disc-condyle relationship after manipulative reduction of anterior disc displacement / 中华物理医学与康复杂志

Objective:To observe the curative effect of exercise training combined with posture control among patients with displacement of the anterior disc of the temporomandibular joint (TMJ) without reduction.Methods:Forty-four patients with anterior TMJ disc displacement without reduction who had successfully been treated with manual repositioning were randomly divided into a control group and a treatment group, each of 22. Both groups underwent routine exercise training, while the experimental group was additionally provided with posture training five times a week for 4 weeks. After the 4th week of training both groups were evaluated using a visual analogue scale (VAS) and their maximum active mouth opening was compared. Six months later, MRI was performed to observe the disc-condyle relationship of the temporomandibular joint and its position.Results:①After 4 weeks of training, the average VAS scores of both groups were significantly lower than those before the training. The improvement in the treatment group′s average was significantly greater than among the control group. ②After the 4 weeks of training the average maximum active mouth opening of both groups had increased, with the improvement in the treatment group significantly greater. ③Six months later, 19 persons in the treatment group had a normal disc-condyle relationship, significantly more than the 13 in the control group.Conclusions:Posture control training can improve the effectiveness of sports training in maintaining manual repositioning of the TMJ after anterior disc displacement without reduction.

Three-dimensional morphological changes in the temporomandibular joints of patients with anterior disc displacement with reduction / 华西口腔医学杂志

OBJECTIVES@#To investigate the differences in the temporomandibular joints (TMJs) between patients with anterior disc displacement with reduction (ADDwR) and asymptomatic subjects by using 3D morphometric measurements.@*METHODS@#A total of 15 patients with ADDwR and 10 asymptomatic subjects were enrolled. Then, 3D models of the maxilla and mandible were reconstructed using MIMICS 20.0. Nine morphologic parameters of TMJs on both sides were measured on the 3D solid model. The differences in the parameters were analyzed between the patients and the asymptomatic subjects and between the left and right sides of each group.@*RESULTS@#The horizontal and coronal condylar angles on the ipsilateral side of the patients were significantly greater than those of the asymptomatic subjects (@*CONCLUSIONS@#ADDwR will increase the condylar angles to be significantly greater than the normal level and decrease SRA and articular spaces to be significantly smaller than the normal level. The condyles will be displaced upward, closer to the fossa.

Management of internal derangement of temporomandibular joint disc displacement with reduction using two different lines of treatment / Manejo do desarranjo interno do deslocamento de disco temporomandibular com redução utilizando dois tipos diferentes de tratamento

Objetive: This study was to compare the effectiveness of arthrocentesis versus the insertion of anterior repositioning splint (ARS) in improving the mandibular range of motion (MRM) for patients with the temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Methods: 36 patients diagnosed as ADDwR were recruited and divided randomly into two groups. The first group (G1) was treated by arthrocentesis, and the second (G2) was treated using ARS. All patients were reexamined after six months. Results: Except that for protrusive movement, there were significant differences between the two groups for the percentage changes of the MRM as measured by the amount of pain free opening, unassisted opening, maximum assisted opening, right lateral and left lateral movements (p < 0.05). Conclusion: Within the context of the current study, the non-invasive, lower cost ARS, provided better results in improving the MRM when managing ADDwR cases. (AU)

Objetivo: O presente estudo comparou a eficácia da Artrocentese em relação à inserção da Placa Reposicionadora Anterior (PRA) na melhoria da Amplitude de Movimento Mandibular (AMM) para pacientes que apresentam Deslocamento de Disco Anterior com Redução (DDAcR) da Articulação Temporomandibular (ATM). Método: 36 pacientes diagnosticados como DDAcR foram recrutados e divididos aleatoriamente em dois grupos. O primeiro grupo (G1) foi tratado através da Artrocentese e o segundo (G2), tratado com a PRA. Todos os pacientes foram reexaminados após seis meses. Resultados: Com exceção do movimento protrusivo, houve diferenças significativas entre os dois grupos para as mudanças percentuais das medidas de AMM pela quantidade de abertura sem dor, abertura sem assistência, abertura máxima com assistência, movimentos laterais direitos e laterais esquerdos (p < 0,05). Conclusão: Dentro do contexto do estudo atual, a PRA, não invasiva e de menor custo, proporcionou melhores resultados na melhoria da AMM no gerenciamento de casos de DDAcR (AU)

Association between -1607 1g/2g polymorphism of mmp1 and temporomandibular joint anterior disc displacement with reduction

Abstract Anterior disc displacement with reduction (DDWR) is considered one of the most common disorders within the temporomandibular joint (TMJ), with a prevalence of 41% in adults. Matrix metalloproteinases play an important role in the degradation of the TMJ and the matrix metalloproteinase 1 (MMP1) 1607 1G/2G polymorphism increases the local expression of MMP1 thus leading to accelerated degradation of the extracellular matrix. The objective of this study was to evaluate the association between the 1607 1G/2G polymorphism of MMP1 gene and DDWR in a group of Mexican individuals from western Mexico. A total of 67 unrelated individuals, between the ages of 18 and 36 years, of both genders, were included in this study. Study participants with DDWR were required to meet the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), while a second control group of 90 individuals without DDWR were also included. Both groups were required to have paternal and maternal ancestry (grandparents) of the same geographic and ethnic region. Genotypes were determined using the nested PCR technique. The 1G/2G polymorphism was found in 68.7%, followed by 2G/2G in 25.4% and 1G/1G in 6.0% of the cases group. While the prevalence in the control group was 55.5% for the 1G/2G polymorphism, 26.6% for 1G/1G and 17.7% for 2G/2G. An association was found between the 2G allele of the 1607 1G/2G polymorphism of MMP1 gene and the presence of DDWR in the patients of western Mexico.

Resumo O deslocamento anterior do disco com redução (DADR) é considerado um dos distúrbios mais comuns na articulação temporomandibular (ATM), com prevalência de 41% em adultos. As metaloproteinases da matriz desempenham um papel importante na degradação da ATM e o polimorfismo 1607 1G/2G da metaloproteinase da matriz 1 (MMP1) aumenta a expressão local da MMP1, levando à degradação acelerada da matriz extracelular. O objetivo deste estudo foi avaliar a associação entre o polimorfismo 1607 1G/2G do gene MMP1 e a DADR em um grupo de indivíduos mexicanos do oeste do México. Um total de 67 indivíduos não relacionados, com idades entre 18 e 36 anos, de ambos os sexos, foram incluídos neste estudo. Os participantes do estudo com DADR foram obrigados a cumprir os Critérios de Diagnóstico de Pesquisa para Disfunções Temporomandibulares (CDP/DTM), enquanto um segundo grupo controle de 90 indivíduos sem DADR também foi incluído. Ambos os grupos tinham ascendência paterna e materna (avós) da mesma região geográfica e étnica. Os genótipos foram determinados pela técnica de nested PCR. o polimorfismo 1G/2G foi encontrado em 68,7%, seguido por 2G/2G em 25,4% e 1G/1G em 6,0% do grupo de casos. Enquanto a prevalência no grupo controle foi de 55,5% para o polimorfismo 1G/2G, 26,6% para 1G/1G e 17,7% para 2G/2G. Foi encontrada uma associação entre o alelo 2G do polimorfismo 1607 1G/2G do gene MMP1 e a presença de DADR nos pacientes do oeste do México.

Clinical value of MRI in treatment choice of anterior disc displacement with reduction / 中华放射学杂志

Objective To investigate the clinical value of MRI in treatment choice of anterior disc displacement with reduction. Methods 1.5 T superconducting MR was used to scan bilateral temporomandibular joints in 72 consecutive patients who were diagnosed by MRI as unilateral(66 patients)/bilateral(6 patients) anterior disc displacement with reduction at closed and open mouth. MRI sequences included oblique sagittal T2 weighted image and proton density weighted image, and 78 joints' images were acquired. According to the severity of clinical symptoms, all joints were divided into severe symptom group (45 joints) and mild symptom group (33 joints). Treatment was performed in severe symptom group , while follow up was conducted in mild symptom group. Disk position(angle between posterior margin of the disc and the condyle vertical line), disk morphology(biconcave, biplanar, biconvex, rounded, folded, thick posterior band), and joint effusion (none effusion, mild effusion, moderate effusion, marked effusion) were evaluated by two radiologists. The observer agreement for image evaluation was calculated using Kappa statistics. Group difference in disk position was compared using t-test and Chi-square test was used to compare group difference in disk morphology and joint effusion. Results The Kappa value between two radiologists were 0.816 and 0.832 (P<0.01) on evaluation of disk morphology and joint effusion. Statistical results indicated that the angles between posterior margin of the disc and the condyle vertical line in severe symptom group (54.2 ± 10.9)° were larger than those in mild symptom group (46.4 ± 9.0)° (t=3.37, P<0.05). There was no significant difference in disc deformation incidence between the two groups (χ2=1.18,P=0.277). The common deformation in sever symptom group was thick posterior band (χ2=5.65, P<0.05), and in mild symptom group was biplanar (χ2=5.67, P<0.05). No statistical difference in joint effusion incidence was observed(χ2=1.02,P=0.312). Moderate and marked effusion were more common in sever symptom group than that in mild symptom group (χ2=6.55,P<0.05). Conclusions MRI is a useful tool for making treatment choice in anterior disc displacement with reduction. Treatment should be given when the following occurred on MRI:moderate anterior disc displacement, disc deformation (excepting for biplanar), moderate or marked joint effusion.

MRI analysis of the effect on mandibular retrusion with anterior disc displacement treated by using Herbst appliance / 中华口腔医学杂志

Objective@#To investgate the effect of Herbst appliance on the growth and remodeling of the temporomandibular joint (TMJ) in class Ⅱ patients with mandibular retrusion by using MRI.@*Methods@#Between December 2010 and October 2014, 12 class Ⅱ patients (11-16 years old) with mandibular retrusion were chosen. The patients were divided into two groups. The control group included 7 patients (14 joints) with normal disc condyle relationship and the anterior disc displacement (ADD) group included 5 patients (10 joints) with anterior disc displacement. The MRI images of TMJ were measured, including condylar height, joint space index and disc position ratio, before and after the treatment.@*Results@#The condylar height of the patients in the control group was significantly increased (P<0.001) after treatment, and no significant difference in joint space index (P=0.821) and disc position ratio (P=0.146) was found. The joint space index of the patients ([-14.70±8.82]% and [4.90±11.35]%) in ADD group changed significantly (P<0.001) after treatment, and no significant difference in condylar height (P=0.294) and disc position ratio (P=0.120) was found.@*Conclusions@#The normal disc condyle relationship was beneficial to the reconstruction of the condylar process, and the increase of the condylar height. The condyle moved forward in patients with anterior disc displacement after treatment.

Physical therapy for temporomandibular joint anterior disc displacement without reduction / 中华口腔医学杂志

Temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDwoR) is a common type of temporomandibular joint disorders. Most patients experience limited mouth opening and joint pain at the same time. The standpoint of physical therapy is the function of the joint instead of the displaced disc. The treatment aims to make symptoms disappeared and joint function regained through 3M techniques, including modality, manual and movement. For ADDwoR patients with limited mouth opening within 2 month, manual therapy may reposition disc and the following splint and movement therapy can maintain disc-condyle relationship. Even so, restoring anatomical relationship is not the end of physical therapy. Enhanced health education and multidisciplinary cooperation are important for successful management of the ADDwoR patients.

Intra-articular injections of hyaluronic acid for anterior disc displacement of temporomandibular joint / 中华口腔医学杂志

Anterior disc displacement (ADD) of temporomandibular joint (TMJ) is regarded as one of the major findings in temporomandibular disorders (TMD). It is related to joint noise, pain, mandibular dysfunction, degenerative change and osteoarthritis. In the mean time, the pathological changes were found in synovial membrane and synovial fluid. Hyaluronic acid is a principal component of the synovial fluid which plays an important role in nutrition, lubrication, anti-inflammation and cartilage repair. The synthesis, molecule weight, and concentration of hyaluronic acid are decreased during TMD and cause TMJ degenerative changes. The clinical conditions, pathological changes, the mechanism of action for hyaluronic acid and the treatment of anterior disc displacement of TMJ are discussed in this article.

The relationship between temporomandibular joint disc displacement and condylar resorption and the comprehensive treatment protocol / 中华口腔医学杂志

Temporomandibular joint (TMJ) anterior disc displacement (ADD) is one of the most common TMJ disease. However, the treatment of ADD have been far from reaching a consensus. In this article, we focused on the following three aspects: ①The relationship between ADD and condylar resorption. ②Whether disc reposition can stop condylar resorption or even make condylar regeneration. ③Proposing a more reasonable treatment pattern, that is TMJ-jaw-occlusion comprehensive treatment protocol.

Adaptive remodeling of temporomandibular joint following anterior disc displacement and treatment decision making / 中华口腔医学杂志

Anterior disc displacement (ADD) of temporomandibular joint (TMJ) is one of the common oral diseases. The TMJ can be remodeled after disc displacement. The author's recent studies show that remodeled bilaminar zone is similar to the disc in composition and functions. The remodeled condyle can match the disc-like bilaminar zone. The new disc-condylar relationship can, to a certain extent, restore the function of the TMJ. Based on these studies, the author believes that the adaptive remodeling in TMJ has important guiding significance for clinical treatment and discusses the views of the treatment decision for various stages of temporomandibular disorders.

Displacement and tissue remodeling of temporomandibular joint disc / 中华口腔医学杂志

Sounding takes the highest prevalence of the signs of temporomandibular disorders (TMD). The well accepted theory of the mechanism for temporomandibular joint (TMJ) sounding is the internal derangement typically characterized by disc displacement. However, according to literature, there are approximately one third of asymptomatic joints in population had disc displacement, and, on the other hand, there are one fourth of TMJ sounding patients had not signs or very limited signs of disc displacement. Replacing the displaced disc to the normal position via methods like surgical operation did not achieve satisfactory long-term outcomes. In this review, we discuss and analyze the possible remodeling of the joint disc displacement diagnosed with imaging based on the anatomy and pathophysiology.

Disc displacement with reduction treated by modified Twin-block / 口腔疾病防治

Objective@# To investigate the morphology and position changes of displaced disk with reduction after treatment by modified Twin-block. @*Methods @#19 patients were diagnosed as displaced disk with reduction and they were treated with modified Twin-block from July 2015 to June 2016. 28 temporomandibular joints (TMJ) of these patients were included in the analysis. The disk length, disk-condylar distance, and disk-condylar angle were measured with MRI before and after treatment. Paired t-test was used. Disk morphology before and after treatment was also documented and analyzed by Wilcoxon signed rank test. The statistical significance was set at P<0.01.@*Results @# 28 TMJ disks were anteriorly displaced with reduction. 24 of them were repositioned while the other 4 were still anteriorly positioned after treatment. The disk length was increased significantly (P<0.01) while the disk-condylar distance and disk-condylar angle were decreased significantly after treatment (P<0.01). The disk morphology as hemiconvex (16) and bi planar (9) were the majority before treatment, while biconcave (16) and biplanar (10) were changed to the larger part after treatment. There was improvement on the disk deformation with a statistical significance (P<0.01). Larger disk-condylar distance, disk-condylar angle and severer deformation of disks were observed in the 4 disks without reposition.@*Conclusion @# Modified twin-block is an effective appliance for disk displacement with reduction by repositioning the disk and modifying the disk deformation. However the effect is not good for disks with severer deformation and displacement. Further studies with larger sample and stratified group are still needed.

Sodium hyaluronate injection for the treatment of anterior disc displacement without reduction in the temporomandibular joint: A CBCT evaluation / 实用口腔医学杂志

Objective:To provide imaging evidence for the treatment of anterior disc displacement without reduction by the injection of sodium hyaluronate into temporomandibular joint (TMJ).Methods:40 patients with anterior disc displacement without reduction were injected 3 times with sodium hyaluronate into the TMJ.Patient's TMJ and clinical symptoms were examined 3,9 and 12 months after treatment.The clinical parameters of Fricton's Craniomandibular Index(Fricton index),maximal mouth opening(MMO),pain intensity of a visual analog scale(VAS) and CBCT radiographic data of 48 TMJs from 40 patients were analysed.Results:The CBCT images showed that at 9 and 12 months follow-up the surface of the condylus became smooth,the density of the cortical bone and the adjacent subcortical bone increased and osteophyte in condylar head decreased(P =0.026,P =0.001).As for disc displacement without osteoarthritts,9 months after treatment condylus were moved forward(P =0.038).VAS and Fricton index were reduced(P ＜0.05),MMO was increased (P ＜ 0.05).3-12 months after treatment,there was no statistical difference of Fricton index (P ＞ 0.05).Conclusion:Injection of sodium hyaluronate into TMJ can remodel the condylar bone surface but cant make condyle back to the middle of acetabulum.

Ultra-thin Rigid diagnostic and therapeutic arthroscopy during arthrocentesis: Development and preliminary clinical findings / 대한악안면성형재건외과학회지

Arthroscopy is useful to detect early changes in the temporomandibular joint (TMJ). Despite great advances in arthroscopy, many arthroscopic surgeries have now been replaced by arthrocentesis. We propose a simple diagnostic and therapeutic method having operative rigid ultra-thin arthroscopy with 16 gauge needle size combined with arthrocentesis.

Anterior disc displacement and the superior head of lateral pterygoid muscle: a case-control study / Desplazamiento discal anterior y la cabeza superior del músculo pterigoideo lateral: un estudio caso-control

The objective of this study was to assess the association between an increase in the proportion of the superior head of the lateral pterygoid muscle (SHLP) inserted into the temporomandibular joint (TMJ) disc and the presence of anterior disc displacement diagnosed by using MRI. We analyzed 75 images of patients with anterior displacement and 75 controls with normal relationship between the mandibular head and the articular tubercle also diagnosed by MRI. Levels of insertion were measured. Descriptive and analytic statistics were calculated. Analyses of differences were made by Fischer's exact test and also were calculated clinical significance (OR, CI = 95 percent). The average insertion of SHLP was 71.14 percent (SD 14.13) in controls and 67.80 percent (SD.16.23) in cases group. The only relationship that presented a significant association (OR 5.61) was found when comparing subjects with a percentage of inserting the disc into the SHLP at 50 percent with those who had higher levels of insertion (50 percent). Our results suggest that the highest percentage of insertion serves as a protective factor for anterior disc displacement, probably due to greater control of neuromuscular activity.

El objetivo de este estudio fue evaluar la asociación entre el aumento de la proporción de la cabeza superior del músculo pterigoideo lateral (CSPT) insertado en la articulación temporomandibular (ATM) y la presencia de desplazamiento discal anterior diagnosticado mediante resonancia magnética. Se analizaron 75 imágenes de pacientes con desplazamiento discal anterior y 75 controles con una relación normal entre la cabeza de la mandíbula y el tubérculo articular, también diagnosticada por resonancia magnética. Los niveles de inserción fueron medidos. La estadística descriptiva y analítica fueron calculadas. Los análisis de las diferencias se hicieron por la prueba exacta de Fischer, y también se calculó la significancia clínica (OR, IC=95 por ciento). La inserción media de la CSPT fue 71,14 por ciento (DS 14,13) en los controles y 67,80 por ciento (SD 16,23) en los casos de grupo. La única relación que presentó una asociación significativa (OR 5,61) se encontró al comparar los sujetos con un porcentaje de inserción en la CSPT 50 por ciento con aquellos que tenían niveles más altos de inserción (50 por ciento). Nuestros resultados sugieren que el mayor porcentaje de inserción sirve como un factor de protección para el desplazamiento discal anterior, probablemente debido a un mayor control de la actividad neuromuscular.

Superior head of the lateral pterygoid muscle inserting in asymptomatictemporomandibular joints / Inserción de la cabeza superior del músculo pterigoideo lateral enarticulaciones temporomandibulares asintomáticas

The constitution and shape of superior head of the lateral pterygoid muscle (SHLP) inserts remains a topic of interest in the literature. The purpose of this study was to analyze by magnetic resonance imaging (MRI) the temporomandibular joint (TMJ) of individuals without signs of temporomandibular dysfunction. One hundred seventy-eight MRI images of one hundred and three patients were utilized, and the surface and percentage of the SHLP insert into the articular disc and condilar process was determined. In women, the average insertion into the disc was found to be between 5.7–5.5mm (SD 1.5–1.3), corresponding to 69.8–70.7 percent of the SHLP. In men, the average insertion into the disc was between 6.2–6.12mm (SD 1.8–1.9), or 68.9–74.2 percent. There were no differences in terms of the sex of the patients or the side of the joint. We found a significant percentage of SHLP fibers embedded in the disc of asymptomatic TMJs, and its role in theanterior disc displacement and the development of the temporomandibular dysfunction should be revised.

La constitución y la forma de inserción de la cabeza superior del músculo pterigoideo lateral (CSMPL) sigue siendo un tema de interés en la literatura. El objetivo de este estudio fue analizar mediante resonancia nuclear magnética (RNM) la articulación temporomandibular (ATM) de individuos sin signos de disfunción temporomandibular. Fueron utilizadas 178 imágenes de RNM pertenecientes a 103 pacientes. Se determinó la superficie y porcentaje de la inserción de la CSMPL en el disco y proceso condilar. En mujeres, la media de inserción en el disco estuvo entre 5,7-5,5 mm (SD 1,5- 1,3) correspondiente al 69,8-70,7 por ciento de la CSMPL. En hombres, la media de inserción en el disco estuvo entre 6,2-6,12mm (SD 1,8-1,9) correspondiente al 68,9-74,2 por ciento de la CSMPL. No hubo diferencias en cuanto al sexo de los pacientes o lado de la articulación. Hemos encontrado un porcentaje significativo de las fibras de la CSMPL insertadas en el disco de ATMs asintomáticas, y su papel en el desplazamiento anterior del disco y el desarrollo de disfunción temporomandibular debe ser revisado.

Template therapy for mouth opening limitation by temporomandibular joint disorders

INTRODUCTION: Limited mouth opening is a representative clinical symptom of temporomandibular disorders (TMD) with anterior disc displacement without reduction (ADDWOR). Various treatment methods have been proposed for patients with ADDWOR. This study examined the clinical effectiveness of template therapy for patients with mouth opening difficulty due to the ADDWOR. MATERIALS AND METHODS: A total of 14 patients (female 12, male 2, average age: 29.1+/-14.4), who had been treated in the template clinic, Sooncheonhyang University Bucheon Hospital, from January of 2006 to December of 2008, were enrolled in this study. The subjects were selected according to the following criteria: more than 2 weeks after the onset of locking, mouth opening range < 35 mm, and confirmed ADDWOR without a synovial pathology by magnetic resonance imaging (MRI). All patients were treated with the template appliance, instructed to wear it while sleeping and exercise for at least 10 hours per day. The maximum mouth opening (MMO) range and pain recognition scores before and after template therapy were recorded and compared. A paired t-test and Wilcoxon's signed rank test were used for statistical analysis. RESULTS: After the periodical follow up, significant improvement in the opening range was observed in the template treatment group. The average MMO range before treatment was 30.2+/-3.5 mm and the average MMO after treatment and follow up was 47.1+/-4.7 mm. The mean amount of mouth opening increment was 16.9+/-5.4 mm (P<0.01) and the pain recognition scores before and after treatment was also improved.(P=0.001) CONCLUSION: The template appliance proved to be efficient for the treatment of TMD with a closed lock and painful joint due to ADDWOR.

Anterior disc displacement of temporomandibular joint induced by persistent traction through orbit / 实用口腔医学杂志

Objective:To establishing model of anterior disc displacement(ADD) of temporomandibular joint(TMJ) by persistent inducement of traction through orbit. Methods:The inferior and posterior walls of orbit of right side in 8 rabbits were exposed. The anterior part of disc was vertically passed through using a suture needle with an elastic rubber. The double strands of the elastic rubber was stretched forward from 7 mm to 16 mm and fixed in the hole drilled in the zygomatic arch bellow inferior orbit. The rabbits were killed 1,2,4 and 8 weeks after operation respectively, then both TMJs of each were resected. The paraffin sections were made and stained with hematoxylin & eosin. Results:The mandible of the rabbits deviated to the left side with inclined attribution of incisors. The disc was displaced forward and the degree of ADD in the rabbits was similar. Conclusions:The disc anterior displacement of temporomandibular joint can be induced by persitent anterior traction of the disc.