Evaluation of the relationship between the attachment type of lateral pterygoid muscle and the position of temporomandibular joint disc in patients with temporomandibular joint disorders based on wireless amplified MRI detector high resolution imaging / 中华口腔医学杂志

Objective: To explore the correlation between the attachment type of lateral pterygoid muscle (LPM) and the position of temporomandibular joint (TMJ) disc in patients with temporomandibular disorders (TMD) by using wireless amplified magnetic resonance imaging detector (WAND) coupled with conventional head and neck joint coil for high resolution imaging of TMJ. Methods: Eighty-five patients with TMD diagnosed by oral and maxillofacial surgeons of Guizhou Provincial People's Hospital from October 2019 to January 2022 were collected. A total of 160 TMJ were included. There were 16 males and 69 females, aged (32.7±14.2) years. All patients were scanned with open, closed oblique sagittal and coronal WAND coupled head and neck coils with bilateral TMJ. Based on TMJ and LPM high resolution imaging, to explore the correlation between LPM attachment types and the position of TMJ disc in TMD patients, and to evaluate the potential clinical value of LPM attachment types in TMD patients. χ2 test and Pearson correlation analysis were used to evaluate the correlation between LPM attachment type and TMJ disc location. Results: There were three types of LPM attachment: type Ⅰ in 51 cases [31.9% (51/160)], type Ⅱ in 77 cases [48.1% (77/160)] and type Ⅲ in 32 cases [20.0% (32/160)]. There was a significant correlation between the type of LPM attachment and the position of articular disc (χ2=28.20, P=0.002, r=0.776). There was no statistical significance between the type of LPM attachment and the reversible displacement of articular disc (χ2=0.24, P=0.887, r=0.825). Conclusions: There is a correlation between the attachment type of LPM and the position of the disc in TMD patients. WNAD coupled with conventional head and neck joint coil TMJ high resolution scan can provide reliable imaging evidence for TMD patients in evaluating the type of LPM attachment and the location of disc.

Systemic scleroderma: imaging findings of diagnosis and clinical management of temporomandibular joint disorders / Esclerodermia sistêmica: diagnóstico por achados imaginológicos e manejo clínico das disfunções temporomandibulares

Scleroderma, an autoimmune disease, directly affects the production of collagen in the connective tissue. In its systemic form, the disease causes oral manifestations such as: limited mouth opening, xerostomia, periodontal disease, thickening of the periodontal ligament and bone resorption of the mandible. This case report aims to draw attention to the difficulties encountered in providing dental care to patients with scleroderma and also to highlight the imaging findings, with emphasis on the temporomandibular joints, which are of interest to dentists about the disease. In the present case, the patient presented bilateral condylar erosion, in addition to disc displacement without reduction. Due to the systemic condition of the patient, it was decided to make an individualized occlusal splint. The limitation of mouth opening is a limiting factor for the manufacture of prostheses and plates, which is why partial prostheses are indicated and are easily removed by the patient. The decisions taken have a great impact on the health and quality of life of patients in these conditions, so there is a need for multidisciplinary involvement in order to arrive at the best treatment plan. After five years of using the stabilizing plate overnight, the patient reports greater comfort and muscle relaxation upon waking up (AU)

Esclerodermia, uma doença autoimune, afeta diretamente a produção de colágeno do tecido conjuntivo. Na forma sistêmica, a doença causa manifestações bucais, como: limitação de abertura bucal, xerostomia, doença periodontal, espessamento do ligamento periodontal e reabsorção da mandíbula. Este relato de caso tem por objetivo chamar atenção para as dificuldades encontradas ao promover atendimento odontológico para pacientes com esclerodermia e também destacar os achados imaginológicos, com ênfase na articulação temporomandibular, que são da doença e de interessa ao cirurgião-dentista. No presente caso, a paciente apresentava erosão condilar bilateral, com deslocamento de disco sem redução. Devido à condição sistêmica da paciente, foi decidido confeccionar uma placa oclusal individualizada. A limitação de abertura bucal é um fator limitante para confecção de próteses e placas, por isso próteses parciais são indicadas, além de serem de fácil remoção pelo paciente. As decisões tomadas tem grande impacto na saúde e qualidade de vida de pacientes nessas condições, deste modo é necessário uma equipe multidisciplinar envolvidas para chegar no melhor plano de tratamento. Após cinco anos fazendo uso da placa estabilizadora durante a noite, a paciente relata maior conforto e relaxamento muscular ao acordar (AU)

Maximum bilateral bite strength and RMS EMG for the diagnosis of myogenic TMD

Aim: The study aimed to evaluate the accuracy of the maximum bilateral molar bite force and the Root Mean Square (RMS) Electromyography (EMG) index of the masticatory muscles in the maximum bilateral molar bite (MMBMax) of women with myogenic Temporomandibular Disorder (TMD) and asymptomatic. Methods: This is a cross-sectional study, composed of 86 women allocated to the TMD Group (n=43) and Control Group (n=43) diagnosis through the Diagnostic Criteria for Temporomandibular Disorders. The maximum bilateral molar bite force was evaluated using a bite dynamometer and the RMS EMG index of the masticatory muscles (anterior temporalis, masseter) during 5 seconds of the MMBMax task. Student t-test was used for data comparison between accuracy of the bite force and RMS EMG of masticatory muscles during the MMBMax. Results: The maximum bilateral molar bite force showed high accuracy (AUC=0.99) for the diagnosis of women with myogenic TMD and asymptomatic women, and the RMS EMG index evaluated during the MMBMax showed a moderate level of accuracy for all masticatory muscles (AUC=0.70 to 0.75). Conclusion: The bilateral bite dynamometer with a surface EMG during bilateral bite can be used to diagnose TMD in young women

Imaging study on the relationship between anterior and posterior occlusal planes and temporomandibular osteoarthrosis / 华西口腔医学杂志

OBJECTIVES@#The aim of this study was to compare the anterior and posterior occlusal plane characteristics of patients with different temporomandibular joint osseous statuses.@*METHODS@#A total of 306 patients with initial cone beam CT (CBCT) and cephalograms were included. They were divided into three groups on the basis of their temporomandibular joint osseous status: bilateral normal (BN) group, indeterminate for osteoarthrosis (I) group, and osteoarthrosis (OA) group. The anterior and posterior occlusal planes (AOP and POP) of the different groups were compared. Then, the regression equation was established after adjusting for confounding factors, and a correlation analysis between the occlusion planes and other parameters was performed.@*RESULTS@#SNA, SNB, FMA, SN-MP, Ar-Go, and S-Go were correlated with the occlusal planes. Relative to the BN and I groups, the FH-OP of the OA group increased by 1.67° on the average, FH-POP increased by 1.42° on the average, and FH-AOP increased by 2.05° on the average.@*CONCLUSIONS@#The occlusal planes were steeper in the patients with temporomandibular osteoarthrosis than in the patients without it, and the mandible rotated downward and backward. The height of the mandibular ramus, the mandibular body length, and the posterior face height were small. In clinical practice, attention should be given to the potential risk of temporomandibular joint osteoarthrosis in such patients. In addition, SNB, FMA, SN-MP, Ar-Go, S-Go, and occlusal planes had moderate correlations.

Multimodal imaging analysis of the cyst like lesion of condyle in temporomandibular joint / 中华口腔医学杂志

Objective: To investigate the imaging features of condylar cystic degeneration of temporomandibular joint (TMJ) by cone-beam CT (CBCT), spiral CT, MRI and radionuclide bone imaging. Methods: From January 2018 to December 2020, thirty-two patients with cyst-like lesions of condylein temporomandibular joint were examined by CBCT, spiral CT, MRI and radionuclide bone imaging at the Department of Oral and Maxillofacial Surgery in General Hospital of Chinese PLA. There were 12 males and 20 females involved, aged from 16 to 65 years with an average age of (33.9±12.5) years. The characteristics of CBCT, spiral CT, MRI and radionuclide bone imaging were analyzed. Condylar cyst like lesions were classified as type A and type B based on the presence or absence of surface bone defects. Condylar cyst like lesions were classified as type Ⅰ(yes) and type Ⅱ(no) according to the accompanying bone marrow edema-like lesions of the condyles. The incidence of condylar bone marrow edema, disc displacement and abnormal bone metabolism were analyzed. Results: A total of 64 joint images of 32 patients were included, including 34 sides with TMJ cyst-like lesion and 6 sides with multiple cyst-like lesions,the total cyst-like lesions were 42. The largest diameter of cyst-like lesion ranged from 1.0 to 12.4 mm, with an average length of (3.7± 1.8) mm. There were 24 cases of type A TMJ cyst like lesion and 10 cases of type B cyst-like lesion. The detection rate of CBCT was 95.2% (40/42) and that of spiral CT was 100% (42/42), there was no significant difference (Calibration Chi-square=0.51, P=0.474). The detection rate of nuclear magnetic resonance was 80.1% (34/42), and the detection rate of cyst-like lesions less than 2 mm was 3/11. In the cyst like lesion side, there were 9 sides with anterior disc displacement with reduction, 20 sides with anterior disc displacement without reduction. In the non-cyst like lesion side, 10 sides with anterior disc displacement with reduction and 6 sides with anterior disc displacement without reduction. There was a significant difference in the displacement of the disc between cyst-like and non-cystic lesion side (χ²=7.80, P=0.005). MRI showed that 6 cases of cystic side[17.6% (6/34)] had bone marrow edema-like lesions (all type A), 1 case of non-cyst like lesions side [3.3% (1/30)] had bone marrow edema-like lesion, there was no significant difference between cystic and non-cystic lesions (Calibration Chi-square=2.04, P=0.153). There was a significant difference between type A and B cystic lesions (Fisher exact probability method, P=0.024). Radionuclide bone imaging showed abnormal bone metabolism in 26 patients in the cyst-like lesion side and 5 patients in the non-cyst like lesion side (χ²=22.82, P<0.001). Conclusions Multi-slice Spiral CT could detect the cyst-like lesion of TMJ condyle in the early stage, which is different from the large joint. And the formation mechanism may vary from the different classifications.

Posición condilar y espacio articular témporomandibular valorado con tomografía Cone beam / Condylar position and Temporomandibular Joint Space analysis with Cone-beam tomography

Resumen Objetivo. Comparar posición condilar y espacio articular en articulación témporo-mandibular, en pacientes con y sin disfunción témporo-mandibular mediante tomografía Cone Beam. Métodos. Criterios diagnósticos de investigación para trastornos témporo-mandibulares Eje II, n=50 pacientes ambos sexos, edad comprendida 18 - 27 años. Muestra aleatoria n= 50 pacientes equivalente a 100 articulaciones, se obtuvo: n=25 pacientes sin disfunción témporo-mandibular, considerados asintomáticos 25 con y sin disfunción témporo-mandibulares, considerados sintomáticos. Mediante tomografía Cone Beam de articulación témporo-mandibular boca abierta - boca cerrada se avaluó de forma manual los espacios interarticulares. Resultados. El espacio condilar anterior en pacientes con y sin disfunción témporo-mandibular no presentó diferencia significativa, p=0,30. La posición condilar tampoco mostró diferencia significativa p=0,58. En pacientes con y sin disfunción témporo-mandibular (sintomáticos) la posición central y posterior del cóndilo (35,2%), pacientes con y sin disfunción témporo-mandibular (asintomáticos) la posición anterior y central fue más significativa (37,0%); seguido de la posición posterior del cóndilo (26,1%). Conclusión. No existe diferencia significativa en la posición condilar y el espacio interarticular en pacientes sintomáticos y asintomáticos.

Abstract Aim. To compare the condylar position and joint space of the temporomandibular join in individuals with and without temporomandibular dysfunction, using cone beam computed tomography (CBCT). Methods. Research Diagnostic Criteria for Temporomandibular Disorders Axis II (n= 50) patients both sexes, age 18 - 27 years. Random sample (n=50) patients equivalent to 100 joints, obtaining: n-25 patients without temporomandibular dysfunction, considered asymptomatic and 25 patients with and without temporomandibular dysfunction, considered symptomatic. By tomography Cone Beam of open mouth temporomandibular joint - closed mouth was manually evaluated the interarticular spaces. Results. The anterior condylar position space and condylar position not significantly different in induvials with and without temporomandibular dysfunction temporomandibular disorders p=0,30 and p=0,58, respectively. Conclusions. There is no significant difference in the condylar position and intraarticular.

Artrocentesis en el tratamiento de artritis séptica en articulación temporomandibular: reporte de un caso / Arthrocentesis in the treatment of septic arthritis in the temporomandibular joint: a case report

Objetivo: El objetivo de este reporte de caso es presen- tar a la artrocentesis como una alternativa quirúrgica mínima- mente invasiva en el tratamiento de la artritis séptica tempo- romandibular. Caso clínico: Un paciente hombre de 26 años con an- tecedente de flegmón perimandibular derecho tratado, acude a la Unidad Hospitalaria de Cirugía Maxilofacial por dolor articular temporomandibular, impotencia funcional y trismus, a un mes de haber sido dado de alta de un primer cuadro infec- cioso. Luego de los exámenes clínicos y complementarios, se diagnostica artritis séptica de articulación temporomandibular derecha, la cual fue tratada quirúrgicamente mediante dos ar- trocentesis acompañadas de terapia farmacológica (AU)

Aim: The aim of this case report is to present arthrocen- tesis as a minimally invasive surgical alternative in the treat- ment of temporomandibular septic arthritis. Clinical case: A 26-year-old male patient, with a his- tory of treated right perimandibular phlegmon, came to the Maxillofacial Surgery Hospital Unit due to temporomandibu- lar joint pain, functional impairment and trismus, one month after having recovered from his first infectious process. After clinical and complementary examinations, septic arthritis of the right temporomandibular joint was diagnosed, which was treated surgically by means of two arthrocenteses and phar- macological therapy (AU)

Evaluation of Lateral Pterygoid Muscle Contraction in Patients with Temporomandibular Disorders Based on 3D-T2 Weighted Imaging / 中国医学科学院学报

Objective To evaluate lateral pterygoid muscle(LPM)contraction in the patients with temporomandibular disorders(TMD)based on 3D-T2 weighted imaging(3D-T2WI).Multiplanar reconstruction(MPR)was employed to measure the length of LPM in the images taken in closed-and open-mouth positions. Methods Seventeen TMD patients [age of(29.82±10.70)years,males/females=8/9] and 13 normal volunteers [control,age of(23.54±3.31)years,males/females=6/7] received 3D-T2WI of the temporomandibular joints in closed-and open-mouth positions from November 2019 to April 2020 in Department of Radiology,Hainan Hospital of Chinese PLA General Hospital.According to the position of the discs,the subjects were classified into the following groups:TMD with disc displacement without reduction(TMD-DDwoR),TMD with disc displacement with reduction(TMD-DDwR),TMD without disc displacement(TMDwoDD),and normal control without disc displacement(NCwoDD).MPR was employed to measure the maximal length of the superior belly of LPM.One-way analysis of variance,receiver operating characteristic curve,and permutation test were employed for the statistical analyses. Results The contraction of LPM was significantly shorter in TMD-DDwoR group [(3.36±1.96)mm] than in TMDwoDD group [(7.90±3.95)mm],NCwoDD group [(8.77±3.13)mm](

Abnormal static and dynamic brain function in patients with temporomandibular disorders: a resting-state functional magnetic resonance imaging study / 华西口腔医学杂志

OBJECTIVES@#This study was conducted to investigate the brain function of patients with temporomandibular disorders (TMD) by combining the static and dynamic amplitudes of low-frequency fluctuation (ALFF).@*METHODS@#Thirty patients with TMD and 20 healthy controls were enrolled. All the participants completed their questionnaires, received clinical examinations, and underwent resting-state functional magnetic resonance imaging scanning. We compared the static and dynamic ALFF between the patients and healthy controls by conducting a two-sample @*RESULTS@#The patients with TMD showed increased static and dynamic ALFF in the posterior cingulate cortex compared with that of the controls (whole-brain level, uncorrected @*CONCLUSIONS@#Our findings revealed that the resting-state brain function of the posterior cingulate cortex and the medial orbitofrontal cortex of patient with TMD increased. These changes probably indicated the potential central mechanisms underlying the increased self-relevant thoughts, negative emotion, and abnormal emotion regulation in TMD.

Características de pacientes con diagnóstico de patologías de ATM: una serie de casos / Characteristics of patients with diagnosis of TMJ pathologies: case series

Los tejidos que conforman la articulación temporomandibular (ATM) pueden verse afectados como cualquier otra articulación del cuerpo. Entre los factores etiológicos, podemos nombrar los traumáticos, infecciosos, autoinmunes y oclusales. El diagnóstico de las patologías de la ATM debe incluir una completa historia clínica, estudios de laboratorios y de imágenes. El objetivo del siguiente trabajo es describir características de una serie de pacientes que concurrieron a la consulta con signos y síntomas de patologías de la ATM a un consultorio particular en el sur de la provincia de Buenos Aires. Se estudió a 30 pacientes que concurrieron a la consulta con signos y síntomas de patología de la ATM; se completaron historias clínicas, se solicitaron estudios de laboratorio para la detección de anticuerpos específicos contra bacterias y resonancia nuclear magnética. La edad promedio de la población fue de 35 años, 26 eran mujeres y 25 tuvieron resultados de estudios bacteriológicos positivos. Sobre un total de 60 articulaciones, 54 presentaron alteración en la forma y de la posición del disco articular. Se verificó la importancia en la solicitud y asociación de estudios para el diagnóstico diferencial(AU)

Occurrence of nonarticular incidental findings on panoramic radiographs in painful temporomandibular disorders / Ocurrencia de hallazgos incidentales no articulares en ortopantomografias en los trastornos temporomandibulares dolorosos

Facial pain is one of the symptoms of temporomandibular disorders (TMDs) but can be associated with other pathological conditions. The present study retrospectively evaluated the occurrence of nonarticular incidental findings in panoramic radiographs in a group of patients with painful TMDs. Outpatients with a diagnosis of TMD were included and distributed into three groups: arthralgia, myalgia or arthralgia and myalgia, according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Nonarticular incidental findings of their panoramic radiographs were classified in relation to pathological, dental and endodontic status. The dependency relationships among the variables were analyzed using the likelihood test. Sixty patients (38 women and 22 men; mean age: 36.9 years) were evaluated. There was a predominance of arthralgia plus disc displacement (43.4 %), followed by myopain plus arthralgia and disc displacement (38.3 %) and myopain (18.3 %). Pathologic radiographic changes such as bone loss, caries, maxillary sinus opacification and periapical lesions were frequent. Dental alterations such as the absence and altered position of teeth and impacted teeth were frequent. Endodontic changes such as periapical lesions with or without endodontic treatment were frequent. There was no significant difference between groups except for gyroversion. The incidental findings were compatible with caries, sinusitis, impacted tooth and periapical lesion, which may be associated with orofacial pain and could potentially be superimposed on the initial diagnosis, although this hypothesis was discarded. Findings such as the absence and altered position of teeth were also frequent, which may represent occlusal factors associated with TMDs.

El dolor orofacial es uno de los síntomas de los trastornos temporomandibulares (TTM), pero puede estar asociado con otras afecciones patológicas. El presente estudio evaluó retrospectivamente la aparición de hallazgos incidentales no articulares a través de ortopantomografías en un grupo de pacientes con TTM dolorosas. Se incluyeron pacientes con diagnóstico de TTM y se distribuyeron en tres grupos: artralgia, mialgia o artralgia y mialgia, de acuerdo con los criterios de diagnóstico para los trastornos temporomandibulares (DC/TMD). Los hallazgos incidentales no articulares de las ortopantomografias se clasificaron en relación al estado patológico, dental y endodóncico. Las relaciones de dependencia entre las variables se analizaron mediante la prueba de probabilidad. Fueron evaluados 60 pacientes (38 mujeres y 22 hombres; edad media: 36,9 años). Hubo predominio de artralgia más desplazamiento de disco (43,4 %), seguido de mialgia más artralgia y desplazamiento de disco (38,3 %) y mialgia (18,3 %). Las alteraciones radiográficas patológicas como pérdida ósea, carie dentaria, opacificación del seno maxilar y lesiones periapicales fueron frecuentes. Entre las alteraciones dentales, las impactaciones, malposiciones o ausencias dentarias fueron frecuentes. Entre las alteraciones endodóncicas, las lesiones periapicales frecuentes. No hubo diferencias significativas entre los grupos, excepto para la girosversión dentaria. Los hallazgos incidentales fueron compatibles con carie dentaria, sinusitis, diente impactado y lesión periapical, lo que podría estar asociado con el dolor orofacial y así estar sobrepuesto en el diagnóstico inicial, aunque esta hipótesis fue descartada. Hallazgos como la ausencia y la posición alterada de los dientes también fueron frecuentes, lo que puede representar factores oclusales asociados con TTM.

Mandibular condyle depth analysis in magnetic resonance of patients with temporomandibular disorders / Análisis de la profundidad del cóndilo mandibular a través resonancia magnética de pacientes con trastornos temporomandibulares

The study of the temporomandibular joint (TMJ) through imaging, is useful for the analysis of intra-articular procedures in view of its complex anatomy. Precise knowledge of the depth at which the TMJ is located is required to achieve an ideal puncture technique. The aim of this study was to measure the depth of the TMJ through magnetic resonance imaging (MRI) in patients with temporomandibular disorders (TMD). A cross-sectional study was conducted, selecting 150 MRI of patients who attended the Polyclinic for TMD and Orofacial Pain. The variables analyzed were: 1) Depth of the right and left TMJ; 2) Age of the patients; and 3) Sex of the patients. Of the total MR, 114 corresponded to women with a median age of 23 years. The median depth of the right TMJ was 17.16 mm and median on the left side was 16.98 mm, there was no statistically significant difference (p> 0.05) but there was a strong correlation (r = 0.842). There were no differences between the depths and the sex of the patients in both the right and left TMJ. There was no correlation between age and depth of TMJ. In conclusion the depth of the right and left condyle are highly correlated, being approximately 17 mm according to the population studied. There is no association between patient age and condylar depth, and there are no differences in average according to sex.

El estudio por imágenes de la articulación temporomandibular (ATM) es útil para el análisis de procedimientos intra-articulares debido a la compleja anatomía que presenta. Se requiere un conocimiento preciso de la profundidad a la cual se encuentra la ATM para una adecuada técnica de punción. El objetivo de este estudio fue medir la profundidad de laATM en relación a la piel a través de resonancia magnética (RM) en pacientes con trastornos temporomandiblaes (TTM). Se realizó un estudio transversal, seleccionando 150 RM de pacientes que asistieron al Policlínico de TTM y Dolor Orofacial. La variables analizadas fueron: 1) Profundidad de la ATM derecha e izquierda; 2) Edad de los pacientes; y 3) Sexo de los pacientes. Del total de RM, 114 correspondían a mujeres con una mediana de edad de 23 años. La mediana de la profundidad de la ATM derecha fue de 17,16 mm y la mediana del lado izquierdo fue de 16,98 mm, no hubo una diferencia estadísticamente significativa (p>0,05) pero si una fuerte correlación (r=0,842). No hubo diferencias entre las profundidades y el sexo de los pacientes tanto en la ATM derecha como en la izquierda. No hubo correlación entre la edad y la profundidad de la ATM. La profundidad de los cóndilos derecho e izquierdo están altamente correlacionados, siendo 17 mm aproximadamente en la población estudiada. No existe asociación entre la edad de los pacientes y la profundidad condilar, y no hay diferencias en promedios por sexo.

The Role of Magnetic Resonance Imaging of the Temporomandibular Joint to Investigate Tinnitus in Adults with Temporomandibular Joint Disorder: A Comparative Study

Abstract Introduction The prevalence of tinnitus is higher in individuals with temporoman- dibular joint disorder (TMD) than in the general population. Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) is the method of choice for investigation, and it has been hypothesized that specific MRI findings might be observed in TMD with comorbid tinnitus. Objective To comparatively describe MRI findings in patients with TMD with and without tinnitus, identifying the most common TMJ alterations and determining whether a correlation exists between severity of TMD and tinnitus. Methods A cross-sectional study of 53 adult patients with bilateral or unilateral TMD (30 with and 23 without tinnitus). The association between tinnitus and morphological aspects of TMD (changes in condylar morphology, articular eminence morphology, and disc morphology), disc displacement (with/without reduction), condylar translation, and intra-articular effusion was analyzed on MRI images. Results The mean patient age was 46.12 ± 16.1 years. Disc displacement was the most common finding in both groups (24 patients with tinnitus versus 15 without; p = 0.043). Only the frequency of disc displacement with reduction was significantly different between groups. Conclusion Additional imaging techniques should be explored to detect specific aspects of the relationship between tinnitus and TMD.

Evaluating the Effectiveness of Orthognathic Surgery on the Pre-existing Temporomandibular Disorders in Patients with Malocclusion: A Systematic Review and Meta-analysis

Abstract Objective: To evaluate the prevalence of temporomandibular disorders (TMDs) for those patients with dentofacial deformities, who underwent orthognathic surgery, and the control group. It also identified whether orthognathic surgery had a positive or negative impact on TMD symptoms by comparing TMD patients, who underwent orthognathic surgery, and people did not experience this surgery. Finally, this systematic review and meta-analysis aimed to evaluate the effectiveness of orthognathic surgery on the pre-existing TMDs in malocclusion patients. Material and Methods: MEDLINE, PubMed, Cochrane Library, Embase, ISI, google scholar have been utilized as the electronic databases for systematically reviewing the literature between 2001 and February 2019. Inclusion criteria were undergoing orthognathic surgery, patients with/without pre-existing TMDs, and physical disabilities. Results: A total of 669 abstracts and titles with potential relevance have been identified in the course of the manual and electronic searches. It has been found that five studies met our inclusion criteria for a systematic review. Temporomandibular disorders (TMDs) before orthognathic surgery in comparison to the controls (RR=0.02; 95% CI -0.08-0.13) and heterogeneity among the papers has been I2 = 42.86% (p=0.64). Conclusion: Malocclusion by orthognathic and orthodontics surgeries had a considerable rate of TMD compared to the controls.

Disc stability after condylar discopexy with open surgery technique: a case report

Of the temporomandibular joint (TMJ) pathologies, temporomandibular disorders (TMD) of discdisplacement present several clinical signs and symptoms, the main ones being joint pain me-asured with the visual analogue scale (VAS) reporting on average VAS>6, and functional inca-pacity measured in mm of mouth opening, reporting on average <30mm in cases of TMD. The present case corresponds to a patient with limitation of mouth opening <15mm, joint pain VAS= 8, and functional limitation. The subject's condition was diagnosed clinically and by magnetic resonance imaging (MRI). The patient presented a Wilkes VI lateral dislocation of the left cond-yle disc without reduction, treated with open surgery discopexy, with disc fixation by monocryl suture and retrodiscal thermocoagulation. The patient showed a significant improvement in the removal of pain and in joint function. In clinical checkups at 1 month, 3 months, 6 months and 1 year, the patient showed decrease of pain levels, from VAS= 8 to VAS= 0, and mouth opening of <15mm to 36mm in the last checkup. Clinical and imaging evaluation at 4 years shows disc stability, with maximum mouth opening of 36 mm, with no disc displacement and clinically asymptomatic VAS = 0. In this case, discopexy with open surgery achieved improvements in functional capacity and removal of pain at short term. Long-term stability was associated with anatomical functions without alteration and without relapse of the symptomatology.

Consideraciones clínicas e imagenológicas de la osteoartrosis en la articulación temporomandibular / Clinical and imaging remarks on temporomandibular joint osteoarthrosis

La osteoartrosis es una enfermedad degenerativa que, instalada en la articulación temporomandibular, genera efectos deletéreos en los tejidos blandos y óseos que la constituyen. En los tejidos duros se destaca la aparición de procesos osteolíticos a nivel condilar y de la cavidad glenoidea con cambios morfológicos importantes. Estas modificaciones están íntimamente relacionadas con el debilitamiento y/o destrucción de los tejidos blandos que ocurren previamente. Los síntomas que se presentan con mayor frecuencia en esta afección son la alteración del rango de movimiento, el dolor y, el más característico, la crepitación durante el examen con estetoscopio. La frecuencia de aparición alcanza entre un 8% y un 18%. Las causas para su documentación son variables y están vinculadas al desplazamiento discal, el trauma, hormonales y la inestabilidad oclusal, siendo el aumento de carga (bruxismo) la de mayor significación. El examen imagenológico puede documentar aplanamiento de los componentes óseos, disminución del espacio articular, discontinuidad de las corticales, esclerosis subcondral, osteofitos, quistes subcondrales y cuerpos libres periarticulares. En ocasiones la radiografía panorámica puede ser poco demostrativa para la documentación de esas particularidades; por el contrario, la tomografía computada es un excelente procedimiento diagnóstico. El aporte de la IRM es relevante en la ubicación del disco articular; asimismo, posibilita la observación de colección de fluido en los espacios articulares, generando una señal hiperintensa. Tratamiento: actuar principalmente para disminuir la carga sobre la ATM y,`por lo tanto, concientizar al paciente de la presencia del bruxismo, instalar un dispositivo oclusal miorrelajante (DOM) y suplementar con analgésicos, antiinflamatorios y antiartrósicos. Cuando la OA está asociada al desplazamiento discal, debe indicarse un dispositivo oclusal de desplazamiento anterior mandibular (DODAM) (AU)

Osteoarthrosis is a degenerative disease. When is located in the TMJ produces deleterious effects in its soft and hard tissues, osteolytic processes on condyle and glenoid cavity in the latter, with significant morphological changes, closely related to weakening and destruction of the tissues that had happened previously. Symptoms most frequent are alteration of the range of movement, pain and,the most characterystic, cracking while examination through stethoscope. Its frequency is between 8 and 18%.Causes for its documentation are variable and related to disc displacement, trauma, hormones and occlusal unsteadiness, being de increase of charge (clenching) the most relevant. Imaging can show flattening on osseusparts,, the articular space, discontinuation of cortexes, subchondral sclerosis, osteophytes, subchondral cysts,and loose particular bodies. Sometimes orthopantomograph may be barely demonstrative to document these phenomena, conversely CT is an excellent diagnostic procedure. The contribution of MRI is relevant to locate articular disc, and facilitate visualize fluid collection within the articular spaces, producing a hiperintense signal. Treatment: to act mainly for diminishing charge on the TMJ, so to raise patients conscience of the presence of clenching, install a myorelaxant occlusal device (DOM) and additionally analgesics, antiinflamatories and antiarthrosis When osteoarthrosis is associated with disc displacement and occlusal device for anterior mandibular displacement (DODAM) is suitable(AU)

Prevalencia y distribución de signos degenerativos en cóndilo de la ATM presentes en radiografías panorámicas en población chilena / Prevalence and distribution of degenerative signs in ATM condyle in panoramic radiographs in a Chilean population

La articulación temporomandibular (ATM), como todas las articulaciones, es afectada por enfermedades inflamatorias o degenerativas, traumatismos, malformaciones, infecciones, quistes y tumores. La artrosis u osteoartrosis (OA) es la enfermedad degenerativa más frecuente de las articulaciones del cuerpo humano, incluyendo la ATM. El propósito de este estudio fue determinar la prevalencia de signos imagenológicos de trastornos degenerativos en el proceso condilar de la ATM, presentes en radiografías panorámicas digitales (RPD) de población chilena. Para ello se realizó un estudio de corte transversal que utilizó 651 radiografías de individuos adultos, en las que se buscó la presencia de los siguientes signos imagenológicos de osteoartrosis: esclerosis, pérdida de la cortical, erosión, osteofitos y quistes endocondrales. La prevalencia de signos radiográficos de OA fue de un 35 % (n=230); donde el 50 % de los individuos con signos de OA fueron mayores de 50 años, mientras la diferencia se distribuyó de forma homogénea en los distintos rangos etáreos. El signo más prevalente fue el osteofito (25 %) y la pérdida de cortical fue la menos observada (3 %). Además, la esclerosis presentó una prevalencia del 6 %, la erosión del 4 % y los quistes endocondrales del 6 %. Por su parte la frecuencia de signos observada en hombres fue mayor, detectándose un aumento en relación directa con la edad independiente del sexo. La radiografía panorámica por su accesibilidad, baja dosis de radiación y constituir un examen de rutina, constituye un medio apropiado para pesquizar hallazgos de signos degenerativos de la ATM.

The temporomandibular joint (TMJ), like all joints, is affected by inflammatory or degenerative diseases, traumatisms, malformations, infections, cysts and tumors. Osteoarthrosis (OA) is the most common degenerative disease of the joints of the human body, including the temporomandibular joint. The purpose of this study was to estimate the prevalence of imaging signs of degenerative disorders in the TMJ condyle, present in digital panoramic radiographs in Chilean population. A cross-sectional study was conducted using 651 radiographs of adult individuals. The presence of the following imaging signs of osteoarthrosis was recorded: sclerosis, cortical loss, erosion, osteophytes and endochondral cysts. The prevalence of radiographic signs of OA was 35 % (n = 230); where 50 % of the individuals with signs of OA were older than 50 years, while the difference was distributed homogeneously in the different age ranges. The most prevalent sign was osteophyte (25 %) and cortical loss was the least observed (3 %). In addition, sclerosis presented a prevalence of 6 %, erosion of 4 % and endochondral cysts of 6 %. On the other hand, the frequency of signs observed in men was greater, detecting an increase in direct relation with age independent of sex. The data of this study allows us to conclude that the prevalence of OA in the studied population was 35 % with a higher representation in men and older people. Both the value of the prevalence of OA and that corresponding to each sign are affected by the modality of radiographic analysis and methodological considerations.

Termografia infravermelha na odontologia / Infrared thermography in dentistry

A termografia infravermelha consiste em um exame de imagem complementar aplicada na avaliação da temperatura corporal com base na emissão de radiação infravermelha através da pele, podendo auxiliar no diagnóstico ou monitoramento das intervenções terapêuticas. Trata-se de uma técnica não ionizante e não invasiva que capta e registra a distribuição térmica da superfície cutânea avaliada por meio das alterações na microcirculação dos pacientes frente a diferentes condições patológicas. Dentre as aplicações na Odontologia, a termografia pode complementar o exame físico anatômico, visto que apresenta em tempo real condições fisiológicas, de acordo com a temperatura. Esta técnica pode auxiliar no diagnóstico e planejamento do tratamento de alterações orofaciais, como processos inflamatórios e infecciosos na região orofacial, acompanhamento pós-cirúrgico e na avaliação de pacientes com desordens temporomandibulares (DTM). A termografia ainda é pouco utilizada na Odontologia, e protocolos para avaliação de alterações na região de cabeça e pescoço ainda devem ser testados e estabelecidos. Porém, já mostra ser um exame complementar de boa performance na detecção de pontos gatilho da dor, acompanhamento de pacientes de forma não invasiva e como documentação médico-legal.

Infrared thermography consists of a complementary imaging test applied to the assessment of body temperature based on the emission of infrared radiation through the skin, which may aid in the diagnosis or monitoring of therapeutic interventions. It is a non-ionizing and non-invasive technique that captures and records the thermal distribution of the cutaneous surface evaluated by means of the changes in the patients' microcirculation in face of different pathological conditions. Among the applications in Dentistry, thermography can complement the anatomical physical examination, since it presents in real time physiological conditions according to temperature. This technique can help in the diagnosis and planning of the treatment of orofacial alterations, such as inflammatory and infectious processes in the orofacial region, post-surgical follow-up and in the routine evaluation of patients with temporomandibular disorders (TMD). Thermography is still poorly used in Dentistry and protocols for the evaluation of head and neck disorders have yet to be tested and established. However, it already shows up as a good complementary examination for the detection of pain trigger points, follow-up of patients in a non-invasive way, and as medical-legal documentation.

Temporomandibular joint disorders as the only manifestation of juvenile idiopathic arthritis: a case report / Comprometimento da articulação temporomandibular como única manifestação da artrite idiopática juvenil: um relato de caso

ABSTRACT Juvenile idiopathic arthritis is a term used to include all chronic childhood arthritis of unknown etiology. It is characterized by chronic inflammation persisting for at least 6 weeks, beginning before 16 years of age. The characteristics present are chronic synovitis, arthralgia, impaired joint mobility in at least one joint, and erosion with destruction of cartilage and subchondral bone, that could be associated or not with systemic involvement, according to each subtype of the disease. During the pathologic process, the temporomandibular joint can be involved by the juvenile idiopathic arthritis, resulting in severe mandibular dysfunction, with higher frequency in female patients. Initially, these lesions can show minor alterations like flattening of the condyle, erosions, and evolve to severe lesions, like destruction of the head of the condyle. We report a case of male patient who had destruction of both condyles, as a result from juvenile idiopathic arthritis. Proposed mechanisms to explain the juvenile idiopathic arthritis was reviewed. In this report the patient did not have pain or inflammatory process, and the temporomandibular diseases was the only manifestation.

RESUMO Artrite idiopática juvenil é um termo usado para incluir toda artrite infantil crônica de etiologia desconhecida. É caracterizada por uma inflamação crônica, que persiste por pelo menos 6 semanas, com início antes dos 16 anos de idade. As características presentes são sinovite crônica, artralgia, mobilidade articular diminuída em pelo menos uma articulação, e erosão com destruição da cartilagem e do osso subcondral, podendo ser associada ou não com o envolvimento sistêmico, de acordo com cada subtipo da doença. Durante o processo patológico, a articulação temporomandibular pode ser envolvida pela artrite idiopática juvenil, resultando em disfunção mandibular severa, com maior frequência em pacientes do sexo feminino. Inicialmente, estas lesões podem mostrar pequenas alterações, como achatamento do côndilo e erosões, e evoluir para lesões graves, como a destruição da cabeça do côndilo. Relatou-se o caso de um paciente do sexo masculino, que apresentou destruição de ambos os côndilos, como resultado da artrite idiopática juvenil. Os mecanismos para explicar a artrite idiopática juvenil foram revisados na literatura. Neste relato de caso, o paciente não apresentou dor e nem processo inflamatório, sendo o comprometimento da articulação temporomandibular a única manifestação.