Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

Psychological Factors in Temporomandibular Disorders Patients during COVID-19 Pandemic: A Cross-Sectional Study

Abstract Objective: To assess the influence of the COVID-19 pandemic on levels of anxiety, stress, and orofacial pain in individuals with and without TMD. Material and Methods: In this cross-sectional study, the participants were divided into two groups (n=10, each) experimental group (EG) TMD patients and control group (CG), without TMD. The presence of TMD was confirmed using the RDC/TMD. The Beck Anxiety Scale (BAI), Perceived Stress Scale (PSS), and Oral Analog Scale were used for assessment. The Beck Anxiety Scale is composed of 21 multiple-choice questions describing symptoms of anxiety, while the PSS is a measure that evaluates life situations as stressful. An Oral Analogue Scale was applied to each individual to quantify orofacial pain, with 0 (zero) without pain and 10 (ten) being the worst pain ever felt. The comparison between groups was performed using the Mann-Whitney test. Logistic regression was used to verify TMD dependence in relation to BAI and PSS-10. Quantitative variables were correlated with each other by Pearson's correlation coefficient. The level of significance considered for all tests was 5%. Results: The association was statistically significant (p≤0.05) for BAI and PSS with a TMD. Conclusion: Although the COVID 19 pandemic has had a psychological impact on the general population, patients with TMD have higher levels of anxiety and stress than the control group.

Association between temporomandibular disorder and condylar position in a university population / Asociación entre nivel de trastorno temporomandibular y posición condilar en una población universitaria

Aim: To determine the association between the level of temporomandibular disorder (TMD) and the condylar position in a university population. Material and Methods: A cross-sectional study was carried out in 41 university students between 18 and 27 years old (21±2.28). The level of TMD was determined using the Helkimo index modified by Maglione, whereas the condylar position was found radiographically by lateral scan. The association was evaluated using the Chi-square statistical test. Results: Statistically significant association was found between the TMD level and the condylar position in the female gender (p=0.003). The central condylar position was the most frequent in females (70.00%), while in males the highest frequency of condylar positions was posterior and anterior, 40.48% and 35.71% respectively. In mild TMD, the most frequent condylar position was central (46.34%), whilst non-centric positions were prevalent in moderate TMD, with 2.44%. There was no statistically significant association between the TMD level and the condylar position of the participants, nor in males (p>0.05). Conclusion: The TMD was associated with the condylar position in females of the university population studied, analyzed in lateral temporomandibular joint scans. Non-centric condylar positions were more frequent in the moderate TMD level and centric positions in mild TMD.

Objetivo: Determinar la asociación entre el nivel de trastorno temporomandibular (TTM) y la posición condilar en una población universitaria. Material y Métodos: Se realizó un estudio transversal en 41 individuos universitarios entre 18 y 27 años (21±2.28). Se determinó el nivel de TTM mediante el índice de Helkimo modificado por Maglione, mientras que la posición condilar fue hallada radiográficamente mediante escanografía lateral. La asociación fue evaluada mediante la prueba estadística Chi-cuadrado. Resultados: Se halló asociación estadísticamente significativa entre el nivel de TTM y la posición condilar en el género femenino (p=0.003). La posición condilar central fue la más frecuente en las mujeres con un 70.00% de aparición, mientras que en los hombres la mayor frecuencia de posiciones condilares fue posterior y anterior con 40.48% y 35.71% respectivamente. En el TTM leve la posición condilar más frecuente fue la central con un 46.34% de aparición, mientras que las posiciones no-céntricas lo fueron en el TTM moderado con un 2.44%. No hubo asociación estadísticamente significativa entre el nivel de TTM y la posición condilar en el total de participantes, ni tampoco en el género masculino (p>0.05). Conclusión: Se encontró asociación entre el nivel de TTM y la posición condilar en escanografías laterales de articulación temporomanibular en el género femenino de la población universitaria estudiada, mientras que no se encontró en el total de muestra, ni en el género masculino. Las posiciones condilares no-céntricas fueron más frecuentes en el nivel de TTM moderado y las céntricas en el TTM leve.

Artroscopia diagnóstica en cirugía maxilofacial / Diagnostic arthroscopy in Maxillofacial Surgery

Introducción: los desarreglos internos de la articulación temporomandibular (ATM) son los más comunes. La artroscopia es de gran utilidad en cirugía maxilofacial como alternativa para el diagnóstico y el tratamiento de los desarreglos internos de la ATM. El objetivo de la presente revisión es describir la artroscopia diagnóstica de la ATM. Métodos: se realizó una revisión narrativa de la literatura y una búsqueda en las bases de datos PubMed, ProQuest, SciELO, Mendeley y Elsevier empleando los descriptores (artroscopia diagnóstica, articulación temporomandibular) en español e inglés. Se seleccionaron los artículos publicados en un período de 40 años (1980-2020), incluyendo en el estudio un total de 26 artículos y 6 libros de 702 documentos revisados. Discusión: en la artroscopia de la ATM se puede observar la posición, calidad y textura del cartílago articular, la vascularización y la redundancia de la membrana sinovial y se pueden realizar procedimientos como técnicas de artroscopia avanzada. Conclusiones: la artroscopia diagnóstica facilita el diagnóstico y manejo de las patologías intraarticulares, por lo que el conocimiento de esta técnica resulta imprescindible.

Introduction: Internal disorders of the TMJ are the most common. Arthroscopy is very useful in Maxillofacial Surgery as an alternative for the diagnosis and treatment of internal disorders of the Temporomandibular Joint. The aim of this review is to describe the diagnostic arthroscopy of the Temporomandibular Joint. Methods: A narrative literature review and search of PubMed, ProQuest, SciELO, Mendeley and Elsevier databases were performed in English and Spanish using the descriptors (Diagnostic arthroscopy, Temporomandibular Joint) in Spanish and English. Articles published over a period of 40 years (1980-2020) were selected, including a total of 26 articles and 6 books from 702 reviewed documents in the study. Discussion: In the arthroscopy of the Temporomandibular Joint the position, quality, texture of the articular cartilage, the vascularization, and the redundancy of the synovial membrane can be observed, and procedures such as advanced arthroscopic techniques can be performed. Conclusions: Diagnostic arthroscopy facilitates the diagnosis and management of intra-articular pathologies. Being necessary and essential knowledge of this technique.

Sociodemographic Profile of Elderly People with Temporomandibular Disorder and Depression in Combination with Parkinson's Disease

ABSTRACT Objective: To describe the sociodemographic profile of elderly people with temporomandibular disorder and depression in Parkinson's disease cases. Material and Methods: It is a cross-sectional cohort cut study, which used secondary data from 124 elderly people with Parkinson's disease (PD). To diagnose temporomandibular disorder (TMD), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire was used, and the variables studied were: age, sex, race, education, marital status, family income, stage of the disease, and depression. The statistical analysis performed was descriptive and used absolute numbers and a frequency count. Results: After the application of the eligibility criteria, the patient records of 81 elderly people with Parkinson's disease were selected; 15 presented associated TMD and depression. The average age was 69 years old; 66.67% were male; 46.67% had more than 9 years of schooling; 60% were married or had a partner; 53.33% received between 1 and 2 minimum wages; 33.33% stated they were brown; 80% were in the moderate stage of the disease; 46.66% were in group II according to the RDC/TMD, presenting disk displacement; and 53.33% presented severe depression. Conclusion: It was verified that the elderly people with Parkinson's and associated TMD and depression were male, married or with a partner, on a low income, with nine or more years of schooling, and were in the moderate stage of the disease.

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.

Desafíos de la Red Asistencial Pública de Chile en la Especialidad de Trastornos Temporomandibulares y Dolor Orofacial / Challenges of the Chilean Public Health Care System Network in the Temporomandibular Disorders and Orofacial Pain Specialty

RESUMEN: Los Trastornos Temporomandibulares (TTM) son un conjunto de patologías musculares y articulares que afectan al sistema masticatorio. Según estadísticas nacionales, la prevalencia de al menos un diagnóstico de TTM en la población adulta corresponde al 49,6 %, mientras que el 19,6 % padece de un dolor temporomandibular severo. La atención de pacientes afectados por estos trastornos corresponde al odontólogo especialista en trastornos temporomandibulares y dolor orofacial (TTM y DOF), especialidad reconocida legalmente desde el año 2013 por el decreto 8 del Ministerio de Salud. Estas patologías no están incorporadas a las prestaciones de salud oral de las Garantías Explícitas en Salud (GES) y recientemente se han comenzado a establecer protocolos de derivación a la especialidad desde la Atención Primaria Odontológica. En el presente estudio se realiza un análisis de la situación actual de la especialidad de TTM y DOF en la red pública de atención y se plantean posibles soluciones y mejoras a los problemas encontrados.

ABSTRACT: Temporomandibular Disorders (TMD) comprise a heterogenous group of muscle and joint disorders that affect the masticatory system. According to national statistics, the prevalence of at least one diagnosis of TMD in the adult population is 49.6 %, while 19.6 % suffers from severe temporomandibular pain. Care of patients affected by these disorders corresponds to the dentist specialized in temporomandibular disorders and orofacial pain (TMD and OFP); these particular disorders and the specialty were incorporated by the Ministry of Health in 2013.. The pathologies are not incorporated in the Explicit Health Care Guarantees (GES) and only recently protocols for a referral program were established for Primary Dental Care in this area. In this study, the present situation of the specialty of TMD and OFP in the public health care network is analyzed, as well as possible solutions and improvements to the difficulties encountered therein.

Condromatosis Sinovial Primaria de la Articulación Temporomandibular con Extensión a Hueso Temporal. Reporte de un Caso y Revisión de la Literatura / Primary Synovial Chondromatosis of the Temporomandibular Joint with Temporal Bone Extension. Case Report and Literature Review

RESUMEN: La condromatosis sinovial (CS), es una lesión benigna poco frecuente y de clínica bastante inespecífica. Suele afectar articulaciones de huesos largos como la rodilla, el codo y la cadera, presentándose generalmente de manera unilateral. Se cree que solo un 3 % de los casos de CS afecta la articulación temporomandibular. Esta condición se caracteriza por ser un trastorno metaplásico del tejido conectivo sinovial que suele manifestarse con la formación de pequeños y múltiples nódulos de cartílago que posteriormente pueden desprenderse, calcificarse y formar cuerpos libres dentro del espacio articular. Presentamos el caso de una mujer de 55 años con condromatosis sinovial de la articulación temporomandibular, tratada desde hace 3 años bajo el diagnóstico de desórdenes temporomandibulares. A pesar de ser considerada una lesión de tipo benigna, esta puede llegar a ser localmente agresiva, extendiéndose como en nuestro reporte hacia la fosa craneal media, adelgazando parte del hueso temporal.

ABSTRACT: Synovial chondromatosis (CS) is a benign lesion that is rare and clinically quite nonspecific. It usually affects the joints of long bones such as the knee, elbow and hip, usually occurring unilaterally. It is believed that in only 3 % of cases of CS the temporomandibular joint. This is a condition its characterized by being a metaplastic synovial connective tissue that manifests itself with the formation of small and multiple cartridges that detach, calcify and form free bodies within the joint space. We present the case of a 55-year-old woman with synovial chondromatosis of the temporomandibular joint, treated for 3 years under the diagnosis of temporomandibular disorders. Despite being considered a benign lesion, this can become locally aggressive, extending as in our report to the cranial fossa, thinning part of the temporal bone.

Differences in Pain Threshold Values of Masseter and Temporalis Muscles Before and After Mastication

Abstract Objective: To analyze the differences in the pain thresholds of the masseter and temporalis muscles before and after chewing at the 5th and 10th minutes. Material and Methods: In this cross-sectional study, the pain thresholds of the muscles in both sides of 43 non-TMD subjects were measured using a digital algometer before and after chewing the bubble gum Xylitol for 5 and 10 min. The values of the muscles before and after mastication at the 5th and 10th were analyzed using Repeated ANOVA. A difference in the values between the left and right sides of the muscles were analyzed using independent t-test, and among the age groups using one-way ANOVA. Results: Average pain threshold values were 1.76 and 1.93 KgF/cm2 for the masseter and temporalis muscles. ANOVA tests indicated significant differences in the values of the muscles before and after mastication at the 5th and 10th min (p=0.000 vs. p<0.001). The differences in the values between the left and right sides of the muscles (p>0.05) and among the age groups (p>0.05) showed no significant difference. However, the values between temporalis and masseter and the values between men and women for each session revealed a significant difference (p<0.05) Conclusion: The masseter and temporalis pain threshold values were reduced 10 min after chewing. The values in both sides of the masseter and temporalis muscles and in different age groups were the same. The temporal muscle and men showed a higher pain threshold than the masseter muscle and women, respectively.

Desajustes intraarticulares en el paciente geriátrico / The intraarticulars disorders in the geriatric patient

RESUMEN Fundamento: Conocer el proceso de envejecimiento fisiológico y patológico de la articulación temporomandibular es importante debido al incremento en la frecuencia de los trastornos temporomandibulares en la población geriátrica. Son pocos los artículos que reflejan las alteraciones de esta articulación y sus repercusiones para la buena armonía de las funciones del sistema estomatognático en el adulto mayor. Objetivo: Describir las manifestaciones del envejecimiento en la articulación temporomandibular y los desajustes intraarticulares en el adulto mayor. Metodología: Se hizo una revisión documental en revistas, libros, tesis y otros documentos en formato electrónico; para la búsqueda de la información se usaron los descriptores relacionados con el tema. Resultados: De manera general en la literatura analizada se observó que, con el envejecimiento, la articulación temporomandibular se vuelve más susceptible a los cambios degenerativos, presentando aplanamiento de la superficie articular que se acompaña de una reducción del tamaño del cóndilo mandibular, con la producción de mayor laxitud en los movimientos articulares. Conclusiones: Las principales características de la articulación temporomandibular durante el envejecimiento se expresan en cambios degenerativos, sin que esto apunte a manifestaciones clínicas, lo que muestra una disminución notoria de los síntomas a medida que se envejece y en algunos casos ausencia total de sintomatología.

ABSTRACT Background: knowing the process of physiologic and pathological aging of the temporomandibular joint is important due to the increase of the frequency of the temporomandibular disorders in the geriatric population. There are few articles that reflect the alterations of this articulation in the aged and its repercussions for the good harmony of the functions of the stomatognathic system. Objective: To describe the manifestations of aging in the temporomandibular joint and the intra-articular maladjustment in the aged. Method: It was carried out a documental revision in magazines, books, thesis and other documents in electronic format; for the searching of information the descriptors related to the subject were used. Results: In general, in the analyzed literature it was observed that with aging, the temporomandibular joint becomes more susceptible to degenerative changes; presenting flattening of the join surface together with a reduction in the size of the mandibular condyle, with the production of greater laxity in join movements. Conclusions: The main characteristics of the temporomandibular joint during aging are expressed in degenerative changes without pointing at clinical manifestations, showing a significant decrease in symptoms as people get older, and in some cases total absence of symptoms.

Evaluation of Symptoms of Temporomandibular Disorders in Orthodontic Appliance Users / Evaluación de los Síntomas de Trastornos Temporomandibulares en los Usuarios de Aparatos Ortodónicos

ABSTRACT: Temporomandibular joint disorders (TMD) are multifactorial pathological conditions that can generate significant impacts on quality of life of individuals. Orthodontics treatments have been discussed in the current literature due to its possible association with the development of TMD. The aim of this study was to evaluate the relationship between the use of fixed orthodontic appliances and the symptoms of TMD. This cross-sectional study was performed with a sample of 336 undergraduate dental students that answered a structured questionnaire about symptoms of TMD. The sample was paired for sex and use of fixed orthodontic appliances. The results highlighted that the most prevalent symptoms of TMD were headaches (21.4 %, n=72), temporomandibular joint noises (21.4 %, n=72) and head and/or neck pain (20.0 %, n=67). The most of sample, 60.4 % (n=203), showed mild TMD symptomatology. No statistical association was observed between the use of orthodontic appliances and TMD symptoms (p=0.121). It can be suggested that the use of fixed orthodontic appliances is not a factor associated with the symptoms of TMD. Still, it is possible to conclude that the prevalence of light TMD symptoms in dentistry students is high.

RESUMEN: Los trastornos de la articulación temporomandibular (TTM) son un grupo de patologías multifactoriales que pueden generar impactos significativos en la calidad de vida de las personas. Los tratamientos de ortodoncia se han discutido en la literatura actual debido a su posible asociación con el desarrollo de TTM. Evaluar la relación entre el uso de aparatos de ortodoncia fijos y los síntomas de TTM. Material y métodos: este estudio transversal se realizó con una muestra de 336 estudiantes de odontología que respondieron un cuestionario estructurado sobre los síntomas de TTM. La muestra fue emparejada por género y uso de aparatos de ortodoncia fijos. Los resultados destacaron que los síntomas más prevalentes de TTM fueron cefaleas (21,4 %, n=72), ruidos de la articulación temporomandibular (21,4 %, n=72) y dolor de cabeza y/o cuello (20,0 %, n=67). La mayor parte de la muestra, 60,4 % (n=203), presentó síntomas leves de TTM. No se observó asociación estadística entre el uso de aparatos de ortodoncia y los síntomas de TTM (p=0,121). Se puede sugerir que el uso de aparatos de ortodoncia fijos no es un factor asociado con los síntomas de TTM. Aun así, es posible concluir que la prevalencia de síntomas leves de TTM en estudiantes de odontología es alta.

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.

Short term histopathological effects of GaAlAs laser on experimentally induced TMJ osteoarthritis in rabbits

Abstract The aim of this study was to evaluate the biostimulation (BS) effect of the gallium-aluminum-arsenide (GaAlAs) diode laser by histopathology with an experimental osteoarthritis (OA) model in the temporomandibular joints (TMJ) of rabbits, in the early period. GaAlAs diode laser is used for pain reduction in TMJ disorders. Twenty-four adult male New Zealand white rabbits were randomly divided into three equal groups: Control Group (CG), Study Group 1 (SG-1), and Study Group 2 (SG-2). Mono-iodoacetate (MIA) was administered to the right TMJs of all rabbits. The rabbits did not undergo any treatment for four weeks to allow the development of osteoarthritis. In SG-1, laser BS was applied to the rabbits at 940 nm, 5 W, and 15 J/cm2 in continuous wave mode at 48-hour intervals for 14 sessions; and in SG-2, laser BS was applied with the same parameters at 24-hour intervals for 28 sessions. Laser BS was not applied to the rabbits in CG. All rabbits were sacrificed simultaneously. The TMJ cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification were evaluated histopathologically. There was no statistically significant difference between the groups in terms of cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification values (p > 0.05). The laser BS protocol used in the study had no positive histopathological effects on TMJ OA in the early period.

Occlusal changes secondary to temporomandibular joint conditions: a critical review and implications for clinical practice

ABSTRACT The relationship between Temporomandibular Disorders (TMD) and malocclusion is an extremely critical issue in dentistry. Contrary to the old concept that malocclusion causes TMD, occlusal changes, especially those observed as sudden, may be secondary and reflect joint or muscle disorders due to the obvious connection between these structures and the dental occlusion. Objectives The aim of this article is to present the most commonly occlusal changes secondary to TMD. Methods The clinical presentation of these conditions is discussed. Details regarding diagnosis, treatment, and follow-up of patients presenting TMD prior or during treatment are also presented. Conclusions All plans for irreversible therapy should be preceded by a meticulous analysis of TMD signs and symptoms in such a way that patients are not submitted to irreversible treatment, based on an untrue occlusal relationship, secondary to articular and/or muscular disorders. When present, TMD symptoms must always be controlled to reestablish a “normal” occlusion and allow proper treatment strategy.

Correlation between facial types and muscle TMD in women: an anthropometric approach

Temporomandibular disorders (TMD) affecting the articular disc and/or the facial muscles are common among the population, recording a higher incidence in women age 20-40 years. The aim of this study was to investigate the correlation between facial types and muscle TMD in women. This study comprised 56 women age 18 to 49 years, seeking treatment for TMD at the School of Medicine, Federal University of São Paulo. All of the study individuals were diagnosed with muscle TMD, based on the Research Diagnostic Criteria (RDC). Facial type was determined using the Facial Brugsch Index and classified as euryprosopic (short and/or broad), mesoprosopic (average width) and leptoprosopic (long and/or narrow). The data were submitted to the Chi-square test and ANOVA-Tukey’s test to conduct the statistical analysis. The faces of 27 individuals were classified as euryprosopic (48%), 18 as mesoprosopic (32%), and 11 as leptoprosopic (20%). A statistically significant difference (Chi-square, p = 0.032) was found among the facial types, in that leptoprosopic facial types showed the lowest values for muscle TMD. A greater number (p = 0.0007) of cases of muscle TMD were observed in the 20 to 39 year-old subjects than in the subjects of other age segments. In conclusion, women with euryprosopic facial types could be more susceptible to muscle TMD. Further studies are needed to investigate this hypothesis.

Manejo de la anquilosis temporomandibular postraumática / Management of postraumatic temporomandibular joint ankylosis

La anquilosis de la articulación temporomandibular (ATM) es una patología cada vez menos común y generalmente se presenta como la secuela de un trauma. Es una enfermedad extremadamente invalidante que causa problemas en la masticación, la digestión, el habla, la apariencia y la higiene, que limita la capacidad de atención, especialmente en los pacientes en crecimiento, donde también se asocia a deformidades de la mandíbula y maxila, causando asimetría facial. El enfoque terapéutico de la anquilosis postraumática depende fundamentalmente de la edad del paciente, la localización y la magnitud de la fusión. El tratamiento de estos pacientes es controvertido por el alto índice de recidiva y el inconveniente de predecir el crecimiento de la mandíbula y en consecuenica, del maxilar. El objetivo es marcar la necesidad de protocolizar el tratamiento según la edad del paciente, enfatizando la intervención temprana y un acompañamiento integral del individuo. Se debe prestar especial consideración a los niños para garantizar el seguimiento durante el proceso de crecimiento y desarrollo, con la intención de disminuir las secuelas de la patología en el desarrollo del macizo craneofacial

Evaluación de la posición condilary del espacio articular en atm de individuos chilenos con trastornos temporomandibulares / Assessment of tmj condylar position and joint space in chilean individuals with temporomandibular disorders

La importancia de la relación cóndilo-fosa en la articulación temporomandibular (ATM) aún no es clara, sin embargo algunos autores asocian la posición no céntrica del cóndilo de la mandíbula en la fosa mandibular con trastorno temporomandibular (TTM). Además, otros autores sugieren que la evaluación del espacio articular es una herramienta diagnóstica para la evaluación de las alteraciones de ATM. El objetivo de este estudio fue evaluar la posición condilar y el espacio articular de ATM en individuos chilenos con TTM utilizando tomografía computarizada cone-beam. Fueron seleccionados 19 pacientes de la Unidad de Trastornos Cráneo Cervico Mandibulares-Universidad de Talca, con diagnóstico de TTM según el Research Diagnostic Criteria for Temporomandibular Disorders. Para la evaluación de la posición condilar se utilizó la técnica de Pullinger & Hollender y para la evaluación de los espacios articulares anterior (EAA), superior (EAS) y posterior (EAP) se utilizó la técnica de Ikeda & Kawamura. Un 39,47% de los cóndilos se presentaron en posición posterior, 34,21% en posición central y un 26,31% en posición anterior. Para cóndilos en posición central encontramos: EAA=1,57 mm; EAS=2,20 mm; EAP= 1,54 mm. Para cóndilos en posición posterior encontramos: EAA= 2,18 mm; EAS= 2,02 mm; EAP= 0,98 mm. Para cóndilos en posición anterior encontramos: EAA= 1,00 mm; EAS= 1,89 mm y EAP= 2,07 mm. Concluimos que individuos con diagnóstico de TTM presentan las regiones anatómicas predisponientes a las alteraciones articulares con espacios articulares disminuidos cuando comparados con sujetos asintomáticos. La posición posterior fue la más común en individuos con TTM, sin embargo hubo gran variabilidad en la posición condilar, por ello sugerimos que una posición no centralizada del cóndilo no está necesariamente asociada con la presencia de TTM. Concluimos además que en individuos con TTM los cóndilos ubicados en posición central y posterior presentan EAP disminuido en comparación con individuos sanos.

The importance of the condyle-fossa relationship in the temporomandibular joint (TMJ) is not yet fully clear, however, some authors associate the non-central position of the head of the mandible in the mandibular fossa with temporomandibular disorder (TMD). Furthermore, other authors suggest that assessment of joint space is a diagnostic tool for assessing the TMJ alterations. The aim of this study was to evaluate the TMJ condylar position and joint space in Chilean individuals with TMD using cone-beam computed tomography. We selected 19 patients of "Unidad de Trastornos Cráneo Cervico Mandibulares (UCRACEM) - Universidad de Talca, Chile", who had a diagnosis of TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders. The assessment of condylar position was performed using Pullinger & Hollender technique and to evaluate the anterior joint space (AJS), superior joint space (SJS) and posterior joint space (PJS) was used Ikeda & Kawamura technique. Posterior condylar position was found in 39.47% of condyles, central condylar position in 34.21% and anterior condylar position in 26.31%. To condyles in central position we found: AJS = 1.57 mm; SJS = 2.20 mm; PJS = 1.54 mm. To condyles in posterior position we found: AJS = 2.18 mm; SJS = 2.02 mm; PJS = 0.98 mm. To condyles in anterior position we found: AJS = 1.00 mm; SJS = 1.89 mm and PJS = 2.07 mm. We conclude that individuals diagnosed with TMD present anatomical regions predisposing to joint disorders with joint spaces diminished when compared with asymptomatic subjects. Furthermore, the posterior condylar position was the most common in individuals with TMD, however there was great variability in condylar position, therefore we suggest that a non-centralized position of the condyle is not necessarily associated with the presence of TMD. We further conclude that in individuals with TMD the condyles located in central and posterior position present EAP decreased compared with healthy individuals.

Frequency, causes and effects of temporomandibular pain dysfunction syndrome among patients seen at Nishtar institute of dentistry, Multan

Temporomandibular joint pain dysfunction syndrome is the second most frequent cause of facial pain. The objective of this study was to find out most common etiological factor of TMD, its clinical symptoms, and distribution among gender. Etiology was multifactorial. All patients [100%] with TMD were having malocclusion and stress [100%]. Third most common factor was increased pain threshold [37%]. Out of 160 patients 82 [51%] were females and 78[48%] were males. Most patients were between 20-30 years of age group 51/160 [31.8%]. Most common presenting symptom was pain followed by clicking sounds in joint and then limited mouth opening. All these symptoms were more common in females

Morphological characteristics of the temporomandibular joint articular surfaces in patients with temporomandibular deisorders / Características morfológicas de las superficies articulares de la articulación temporomandibular de pacientes con trastornos temporomandibulares

The knowledge of the anatomical characteristics of the temporomandibular joint (TMJ) articular surfaces is essentital to enable physicians and dentists to recognize the morphological changes that occur in this articulation in patients with temporomandibular disorders (TMD). Several researchers associate the TMD with changes of TMJ articular surfaces. The careful identification of bone changes related to TMJ is critical, since these abnormalities are associated with signs and symptoms of TMD and the knowledge of TMD signs and symptoms is fundamental for correctly diagnosing and for adequate treatment planning. The aim of this study was to evaluate the morphological characteristics of the TMJ articular surfaces in patients with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). In addition, therelationship between increasing age-osteoarthrosis was evaluated. For the sample we selected 19 patients, 17 female and 2 male, referred to the "Unidad de Trastornos Cráneo Cérvico Mandibulares (UCRACEM) - Universidad de Talca, Chile". The imaging assessment was carried out by Cone-Beam Computed Tomography (CBCT). In the imaging analysis of the articular surfaces 11 joints (28.94 percent) showed normal morphology. The bone changes found were: sclerosis, flattening, erosion, osteoarthrosis, osteophytes, subcondral cysts. We found statistically significant difference between increasing age-osteoarthrosis (p=0.00). Considering our results we concluded that bone changes of the TMJ articular surfaces in patients with TMD are very common, with sclerosis as the most frequent finding. It was also possible to conclude that there was a significant association between increasing age-osteoarthrosis.

El conocimiento de las características anatómicas de las superficies articulares de la articulación temporomandibular (ATM) es fundamental para que clínicos y odontólogos reconozcan las alteraciones morfológicas que ocurren en la articulación de pacientes con trastornos temporomandibulares (TTM). Diversos investigadores asocian los TTMs con alteraciones en las superficies articulares de la ATM. La identificación de los cambios óseos relacionados con la ATM es crítica, ya que estos se asocian a signos y síntomas de TTM, y el conocimiento de estos es fundamental para el correcto diagnóstico y adecuada planificación de tratamiento. El objetivo fue analizar las características morfológicas de las superficies articulares de la ATM en pacientes con diagnóstico de TTM, diagnosticado de acuerdo a los Criterios Diagnósticos para Investigación de los Trastornos Temporomandibulares (CDI/TTM), junto con analizar la relación existente entre incremento de edad-osteoartrosis. Fueron seleccionados 19 pacientes, 17 mujeres y 2 hombres, de la Unidad de Trastornos Cráneo Cérvico Mandibulares (UCRACEM) - Universidad de Talca, Chile. La evaluación imagenológica se realizó mediante el examen de Tomografía Computarizada Cone-Beam (TCCB). En el análisis de las superficies articulares, 11 (28,94 por ciento) presentaron morfología normal. Los cambios óseos encontrados fueron: esclerosis, aplanamiento de la cabeza de la mandíbula, erosión, osteoartrosis, osteofitos y quiste subcondral. Hubo relación estadística significativa entre incremento de edad-osteoartrosis (p=0,00). Nuestros hallazgos nos permiten concluir que los cambios óseos en las caras articulares de la ATM en pacientes con TTM son frecuentes, y la esclerosis el hallazgo más común. También se encontró asociación entre incremento de edad y osteoartrosis.