Frecuencia de Signos Óseos de Osteoartritis en la Articulación Temporomandibular en una Población Adulta Chilena Mediante CBCT, Durante 2021-2022

La osteoartritis (OA) de la articulación temporomandibular (ATM) es un desorden degenerativo de etiología multifactorial, que requiere un manejo interdisciplinario. Es considerada como la enfermedad degenerativa más frecuente de la articulación. Por esto es importante conocer lo más preciso posible las estructuras internas del área donde se requiere realizar la intervención o tratamiento, en este caso la ATM. Para esto existen distintos exámenes radiográficos complementarios como: tomografía computarizada, resonancia magnética y por último la tomografía computarizada de haz cónico (CBCT), debido a su capacidad de visualizar tridimensionalmente y con buena definición las estructuras óseas y distintas patologías o alteraciones presentes. A pesar de esto, no hay suficiente evidencia actual que demuestre la frecuencia de signos óseos de osteoartritis presentes en ATM según edad y sexo en la población Chilena. El objetivo este trabajo consistió en Determinar frecuencia de los signos óseos en osteoartritis de ATM mediante CBCT en una población adulta Chilena atendida en un centro radiológico durante los años 2021-2022. Se realizó un estudio observacional descriptivo, donde se observó informes radiológicos de CBCT en pacientes adultos atendidos en el centro radiológico privado de Valdivia durante el periodo del primer semestre del 2021 a primer semestre 2022. Se evaluó la presencia de los siguientes signos óseos imagenológicos: aplanamiento de superficie articular, erosión superficial, osteofitos condilares, esclerosis subcondral, quistes subcortical, esclerosis generalizada, cuerpos libres intraarticulares, reabsorción completa y parcial de la cabeza condilar y trabeculado heterogéneo. De un total de 101 exámenes, 70 exámenes fueron considerados válidos para este estudio según los criterios de selección. Los 31 exámenes restantes no calificaron según los criterios o no presentaban osteoartritis de ATM. De los 70 pacientes 58 pertenecían a mujeres y 12 a hombres. El promedio de edad fue de 37,2 años. Los signos imagenológicos más frecuentes fueron: Trabeculado heterogéneo, Aplanamiento de la superficie articular, Esclerosis subcondral condilar.

Osteoarthritis (OA) of the temporomandibular joint (TMJ) is a degenerative disorder of multifactorial etiology, requiring interdisciplinary management. It is considered the most common degenerative joint disease. For this reason, it is important to know asprecisely as possible the internal structures of the area where the intervention or treatment is required, in this case the TMJ. For this purpose, there are several additional radiographic examinations such as: computed tomography, magnetic resonance imaging and finally cone-beam computed tomography (CBCT), due to its ability to visualize three-dimensionally and with good definition the bone structures and different pathologies or present alterations. Despite this, there is not enough current evidence to demonstrate the frequency of osteoarthritis bone signs present in TMJ according to age and gender in the Chilean population. The aim of this study was to determine the frequency of bone signs of TMJ osteoarthritis through CBCT in a Chilean adult population attended in a radiological center during 2021-2022. A descriptive observational study was made, where CBCT radiological reports were observed in adult patients attended in a private radiological center in Valdivia during the first semester of 2021 to the first semester of 2022. The presence of the following imaging bone signs was evaluated: flattening of the articular surface, surface erosion, condylar osteophytes, subchondral sclerosis, subcortical cysts, generalized sclerosis, intraarticular free bodies, complete and partial reabsorption of the condylar head and heterogeneous trabeculate. Of a total of 101 examinations, 70 examinations were considered valid for this study according to the selection criteria. The remaining 31 examinations did not qualify according to the criteria or did not present TMJ osteoarthritis. Of the 70 patients, 58 were female and 12 were male. The average age was 37.2 years. The most frequent imaging signs were: heterogeneous trabeculation, flattening of the articular surface, subchondral condylar sclerosis.

Esfuerzos generados en la ATM en maloclusión clase II, tratada con exodoncias de premolares y ortodoncia: análisis mediante el método de elementos finitos / Strain generated in the TMJ with class II malocclusions, treated with extraction of premolars and orthodontics: analysis with the finite element method

RESUMEN Introducción: la exodoncia de premolares es una alternativa para el tratamiento de la maloclusión clase II. Un cambio en la biomecánica puede generar alteraciones en la Articulación Temporomandibular (ATM) lo que produce mayor desgaste dental y aparición de patologías articulares. El objetivo fue analizar mediante el método de elementos finitos la concentración de esfuerzos en la ATM, en maloclusión clase II, tratados con exodoncia de premolares y Ortodoncia. Métodos: dos modelos de simulación en 3D cada uno con estructuras óseas de los 2 maxilares, dentición completa y disco en la ATM. Uno corresponde al paciente sin recidiva (SR) tratado con exodoncia de primeros premolares y ortodoncia, donde se mantiene la estabilidad dental clase I. El otro modelo con recidiva (CR) tratada con exodoncia de primeros premolares y ortodoncia, aumento de overjet y overbite y clase II canina; la carga se aplicó sobre la rama mandibular. Resultados: con una carga de 900N los esfuerzos se triplicaron en todas las estructuras de los dos modelos al ser comparados con una carga de 300N; sin embargo, se dieron diferencias considerables en el modelo CR entre las cavidades glenoideas, a 300N de 19.9 MPa y a 900N de 59.3 MPa. La mayor concentración del disco se da en la parte lateral. Conclusiones: dada la asimetría en las estructuras de la ATM, los esfuerzos y la concentración de tensiones difieren entre el lado derecho e izquierdo en los dos modelos.

Abstract Introduction: premolar extraction is an alternative for the treatment of class II malocclusion. A change in biomechanics can generate alterations in the Temporomandibular Joint (TMJ), which produces greater dental wear and the appearance of joint dysfunctions. The objective was to assess the effort concentration in the TMJ by means of finite element analysis in class II malocclusions treated with premolar extraction and orthodontics. Method: two 3D simulation models each with bone structures of the 2 jaws, complete dentition and disc in the TMJ. One corresponds to the patient without recurrence (WR) treated with extraction of first premolars and orthodontics, where class I dental stability is maintained. The other model with recurrence (R) treated with extraction of first premolars and orthodontics, increased overjet and overbite and canine class II; the load was applied to the mandibular ramus. Results: loads of 900N triplicated on all structures compared to 300N in both models. However, there were considerable differences between the left and right glenoid cavities in the WR model, at 300N of 19.9 MPa and 900N at 59.3 MPa. Most tensions of the disc occur in the lateral part. Conclusions: due to the asymmetry in the TMJ structures, the stresses and stress concentration differ between the right and left sides in the two models.

Three-dimensional assessment of the temporo-mandibular joint in skeletal class II malocclusion females with high vertical pattern / 实用口腔医学杂志

Objective:To study the morphological characteristics of temporo-mandibular joint with high angle vertical skeletal pattern in adult females with class II skeletal type.Methods:41 CBCT films of adult females (20 normal controls;21 skeletal class II high angle subjects)were collected.The position of and form of condyle,form of fossa and joint spaces were measured by Mimics 17.0 soft-ware.Results:Compared with the control group the condyles in high angle patients located more posterior.The joint fossae were lower. The angles of posterior joint node bevels were smaller.The condyles were shorter,thinner and tipped more anteriorly.The position of the conyles were more anteriorly.Conclusion:Class II skeletal type adult females with high vertical skeletal patterns have different forms of fossae,different positions and forms of condyle compared with the normal controls.

Efficacy of temporalis myofascial flap as an interpositional graft material in the management of tmj ankylosis:.

Temporo-mandibular joint (TMJ) ankylosis is an extremely disabling affliction that causes problems in mastication, digestion, speech, appearance and hygiene. Surgery of TMJ ankylosis needs careful evaluation and planning to yield predictable results. Ankylosis may be corrected surgically by an array of procedures like gap arthroplasty, joint reconstruction and interpositional arthroplasty. Though many types of autogenous grafts and alloplastic materials are available for the interpositioning, the temporalis muscle graft offers significant advantages like ease of harvesting, minimal donor site morbidity and effective coverage of the arthroplasty site. The efficacy of the same is highlighted in this article by its application in four cases of TMJ ankylosis.

Intubation Difficulty in Patient with Pseudoankylosis of Temporo-mandibular Joint after Pterional Craniotomy

The authors report on a severe case of pseudoankylosis of the temporo-mandibular(TM) joint following a pterional craniotomy and the intubation difficulty encountered in the second surgery. Preventive and therapeutic aspects in addition to the clinical pitfalls of the case are discussed.