Temporomandibular Disorders and Orthodontics: how to conduct a screening examination? / Dysfonctionnements temporo-mandibulaires et orthodontie : comment conduire un examen de dépistage ?

Introduction: Common Temporomandibular Disorders (TMD) involve the masticatory muscles, temporomandibular joints, and/or their associated structures. Clinical manifestations can vary, including sounds (cracking, crepitus), pain, and/or dyskinesias, often corresponding to a limitation of mandibular movements. Signs or symptoms of muscular or joint disorders of the masticatory system may be present before the initiation of orthodontic treatment, emerge during treatment, or worsen to the point of stopping treatment. How do you screen for common TMD in orthodontic treatment? Materials and Methods: The main elements of the interview and clinical examination for screening common TMD in the context of orthodontic treatment are clarified and illustrated with photographs. Moreover, complementary examinations are also detailed. Results: A clinical screening form for common TMD is proposed. A synthetic decision tree helping in the screening of TMD is also presented. Conclusion: In the context of an orthodontic treatment, the screening examination for common TMD includes gathering information (interview), a clinical evaluation, and possibly complementary investigations. The orthodontist is supported in this approach through the development of a clinical form and a dedicated synthetic decision tree for the screening of TMDs. Systematically screening for common TMD before initiating orthodontic treatment allows the orthodontist to suggest additional diagnostic measures, implement appropriate therapeutic interventions, and/or refer to a specialist in the field if necessary.

Introduction: Les dysfonctionnements temporo-mandibulaires (DTM) concernent les muscles masticateurs, les articulations temporo- mandibulaires et/ou leurs structures associées. Les manifestations cliniques peuvent être diverses : bruits (craquements, crépitements), algies et/ou dyscinésies correspondant le plus souvent à une limitation des mouvements mandibulaires. Or, des signes ou symptômes de troubles musculaires ou articulaires de l'appareil manducateur peuvent être présents avant le début de la prise en charge orthodontique, voire apparaître en cours de traitement ou s'aggraver au point de remettre en question la poursuite du traitement engagé. Comment conduire un dépistage de DTM communs dans le cadre d'une prise en charge orthodontique ? Matériel et méthodes: Les éléments essentiels de l'entretien et de l'examen clinique d'un dépistage des DTM communs dans le cadre d'une consultation d'orthodontie sont clarifiés et illustrés à l'aide de photographies. Le recours aux examens complémentaires a également été détaillé. Résultats: Une fiche clinique de dépistage des DTM communs est proposée. Un arbre décisionnel synthétique aidant au dépistage des DTM est présenté. Conclusion: Dans le cadre d'une consultation d'orthopédie dento-faciale, l'examen de dépistage des DTM communs inclut un recueil d'informations (entretien), une évaluation clinique et éventuellement des examens complémentaires. L'orthodontiste est soutenu dans cette démarche par la création d'une fiche clinique et d'un arbre décisionnel synthétique dédiés au dépistage des DTM. Effectuer systématiquement un dépistage des DTM communs avant d'initier un traitement orthodontique permettra à l'orthodontiste de proposer des moyens diagnostiques supplémentaires si nécessaire, et de mettre en place la prise en charge adéquate et/ou de référer à un spécialiste du domaine pour démarrer le traitement orthodontique dans les meilleures conditions.

Impact of Orthodontic-Surgical Treatments on the Signs and Symptoms of Temporomandibular Disorders: A Systematic Review.

INTRODUCTION: Some patients exhibit temporomandibular joint or muscular disorders of the masticatory system before, during, or after orthognathic surgery (OS). These are collectively referred to as temporomandibular disorders (TMDs). This systematic literature review aimed to determine the relationship between orthodontic-surgical treatment and TMDs. METHODS: An electronic search of the PubMed database, supplemented by a manual search, was performed; the search included any studies published between 2021 (date of the last search in a systematic review of the literature on the subject) and June 2023 that evaluate the prevalence of TMDs during orthodontic-surgical treatment. The diagnosis of TMDs had to be established using the diagnostic algorithm "diagnostic criteria for temporomandibular disorders (DC/TMDs)", and the diagnosis of disc displacement had to be confirmed using magnetic resonance imaging (MRI). The data were extracted and statistically analyzed. RESULTS: Of the 100 results, seven eligible articles were included, representing a total of 529 cases undergoing orthodontic-surgical treatment. A reduction in joint noises (64.8%), arthralgia (57 to 77%), and myalgia (73 to 100%) was found after orthodontic-surgical treatment despite the fact that a minority of patients exhibited these signs and symptoms even though they were asymptomatic before treatment. The effects of OS on disc position were objectively unpredictable. After surgery, the presence of headaches decreased without significance and the risk of their occurrence was very low (1%). The studies converged toward a reduction in the amplitudes of mouth opening and lateral/protrusion movements. Finally, after the treatment, mandibular function was improved. CONCLUSION: Under the conditions of this study, OS seems to have a positive impact on the signs and symptoms of TMDs; however, it is not possible to predict the consequential effects on the position of the TMJ disc, whether it is initially in a normal position or displaced.

Management of temporomandibular disorders with transcutaneous electrical nerve stimulation: A systematic review.

Objective: The objectives of this systematic review were to assess the efficacy of transcutaneous electrical nerve stimulation (TENS) for the management of temporomandibular disorders (TMD) and to determine the indications and most appropriate application modalities.Methods: Papers published in the Medline database, EMBASE, and the Cochrane Library before November 2018 were included.Results: Fourteen articles were retained, corresponding to a total of 532 patients, among which, 285 had a TMD. Immediately after a TENS session, significant relief of pain (19.2% to 77%), significant functional improvement (mouth opening amplitude increased by between 8.7% and 19.46%), and reduced electromyographic activity of the anterior temporalis and masseter muscles were observed. However, studies comparing TENS to other physical medicine modalities (ultrasound and laser) reported equivalent results.Conclusion: Further randomized comparative clinical trials will be necessary to optimize the use of TENS (program, duration of sessions, duration of treatment) for different types of TMD.

Modjaw® device: Analysis of mandibular kinematics recorded for a group of asymptomatic subjects.

OBJECTIVE: To assess the repeatability and kinematic data of Modjaw® recordings from a group of asymptomatic patients. METHODS: Modjaw® mandibular kinematic data were recorded for 22 asymptomatic volunteers (DC/TMD questionnaire). Sagittal (SCI at 3 and 5 mm) and transversal (TCI at 4 mm) condylar inclination values of the instantaneous center of rotation were measured over two recording sessions. The repeatability of recordings was determined from the intraclass correlation coefficient (ICC), which is based on a one-way random-effects ANOVA. RESULTS: The repeatability of recordings was found to be good to excellent. The mean TCI in mediotrusion was 7.1° ± 5.1, and the mean SCI in protrusion was 51.07° ± 9.43. CONCLUSION: The Modjaw® device reliably records the patient's real hinge axis kinematics during functional mandibular movements. Data can be transferred with the patient's personal reference plane and digital casts to the CAD/CAM software.

Update on the parameters influencing the adjustment of the sagittal and transversal condylar inclination of dental articulators.

OBJECTIVES: The literature review aimed to compile and summarize the results of research relating to the recordings of condylar displacements obtained with extraoral devices, to guide clinicians to set dental (virtual) articulator parameters. The meta-analysis was undertaken to assess the sagittal condylar inclination (SCI) and transversal condylar inclination (TCI, also known as Bennett angle) values according to horizontal reference planes, movement studied, and patient characteristics: dental status, interocclusal relationship, skeletal pattern, and signs and symptoms of temporomandibular disorders (TMD). DATA SOURCES: A bibliographic search was conducted in the three following electronic databases: MEDLINE, EMBASE, and Cochrane Library and Best Evidence. The review was restricted to trials involving participants meeting the following criteria: (1) adult, (2) no previous surgery in the temporomandibular region, and (3) no serious comorbidity conditions. Descriptive statistics were calculated for all study groups and were compared by applying a one-way ANOVA. CONCLUSION: All 20 articles selected corresponded to a total of 933 subjects evaluated. The recording devices and horizontal reference planes had a significant impact on the SCI values. Age, dental status, and the presence of symptoms and signs of TMD in subjects had no influence on SCI values, unlike Angle class II, division 2, the class II sagittal pattern, or the increased vertical skeletal pattern SCI parameters (P < .05). The mean TCI value was 8 degrees and was independent of individual patient characteristics and the extraoral recording device used. For accurate kinematic simulation, the patient's personal plane of reference must be transferred to the system.

[Conservative and simple rehabilitation to compensate posterior open bite: partial bonded restauration]. / Des solutions simples et conservatrices pour la compensation des infraclusions postérieures : les restaurations partielles collées.

Posterior open bite is a malocclusion characterized by the absence of vertical contacts between the occlusal surfaces of the posterior teeth of the opposing arches. It can be uni- or bilateral and involve one tooth or more. Several aetiologies of these posterior open bite have been described, including pathological eruptions, dento-maxillary dysmorphosis and temporo-mandibular dysfunctions. When considering a correction or compensation, there are several therapeutic options (orthodontic and/or surgical and/or prosthetic). Recent developments in adhesive dentistry (bonding biomaterials, ceramics and composites) have made possible the development of more conservative approach for restorative and prosthetic treatments. In order to understand the possible use of these restorations and the help it can provide in our treatment plan, we have selected three original clinical situations. Each one illustrated a posterior open bite aetiology and explained the rehabilitation strategies chosen (process of decision making and realization). Partial bonded restorations (direct composites, overlays, tabletops, veenerlays) can be considered to compensate open bite, in case of impossibility, failure or as a complement of orthodontic treatments. Additive equilibration is not described in the literature for the compensation of posterior open bite, despite the many functional advantages along a simple and conservative technique.

Biomechanical assessment of different fixation methods in mandibular high sagittal oblique osteotomy using a three-dimensional finite element analysis model.

With modern-day technical advances, high sagittal oblique osteotomy (HSOO) of the mandible was recently described as an alternative to bilateral sagittal split osteotomy for the correction of mandibular skeletal deformities. However, neither in vitro nor numerical biomechanical assessments have evaluated the performance of fixation methods in HSOO. The aim of this study was to compare the biomechanical characteristics and stress distribution in bone and osteosynthesis fixations when using different designs and placing configurations, in order to determine a favourable plating method. We established two finite element models of HSOO with advancement (T1) and set-back (T2) movements of the mandible. Six different configurations of fixation of the ramus, progressively loaded by a constant force, were assessed for each model. The von Mises stress distribution in fixations and in bone, and bony segment displacement, were analysed. The lowest mechanical stresses and minimal gradient of displacement between the proximal and distal bony segments were detected in the combined one-third anterior- and posterior-positioned double mini-plate T1 and T2 models. This suggests that the appropriate method to correct mandibular deformities in HSOO surgery is with use of double mini-plates positioned in the anterior one-third and posterior one-third between the bony segments of the ramus.

Diagnosis and management of bruxism: Evaluation of clinical practices in France.

Objective: The Evaluation of Clinical Practice (ECP) conducted with a sample of French general dental practitioners aimed to measure the methods used to diagnose and manage bruxism.Methods: The ECP was performed using a declarative online questionnaire-based anonymous survey (SurveyMonkey) of 1388 practitioners. Twenty-two questions were grouped in 5 categories: (1) Sociodemographic characteristics (Q1-6); (2) Knowledge of the prevalence and definition of bruxism (Q7-9); (3) Diagnostic approach (Q10-11) and management (Q12-Q13); (4) The use of occlusal splints (Q14-21); (5) Oral rehabilitation (Q22).Results: The answers obtained (233; 16.8%) revealed a wide disparity and insufficient diagnosis (e.g. only 41% looked for sleep disorders, 22.3% for consumption of stimulants, 3% for upper airway obstruction) and management of bruxism (e.g. only 21.9% of participants proposed cognitive-behavioral therapy).Discussion: The discrepancies detected, such as the use of inappropriate splints (30 to 70%), emphasize the need for more prompt research-to-practice transfer of new knowledge.

Finishing and polishing effects of multiblade burs on the surface texture of 5 resin composites: microhardness and roughness testing.

OBJECTIVES: The aim of this in vitro study was to test the effect of 2 finishing-polishing sequences (QB, combining a 12/15-fluted finishing bur and an EVO-Light polisher; QWB, adding a 30-fluted polishing bur after the 12/15-fluted finishing bur used in the QB sequence) on 5 nanotech-based resin composites (Filtek Z500, Ceram X Mono, Ceram X Duo, Tetric Evoceram, and Tetric Evoceram Bulk Fill) by comparing their final surface roughness and hardness values to those of a Mylar strip control group (MS). MATERIALS AND METHODS: Twelve specimens of each nanocomposite were prepared in Teflon moulds. The surface of each resin composite was finished with QB (5 samples), QWB (5 samples), or MS (2 samples), and then evaluated (60 samples). Roughness was analysed with an optical profilometer, microhardness was tested with a Vickers indenter, and the surfaces were examined by optical and scanning electron microscopy. Data were analysed using the Kruskal-Wallis test (p < 0.05) followed by the Dunn test. RESULTS: For the hardness and roughness of nanocomposite resin, the QWB sequence was significantly more effective than QB (p < 0.05). The Filtek Z500 showed significantly harder surfaces regardless of the finishing-polishing sequence (p < 0.05). CONCLUSIONS: QWB yielded the best values of surface roughness and hardness. The hardness and roughness of the 5 nanocomposites presented less significant differences when QWB was used.

Role of DNA gyrase and topoisomerase IV mutations in fluoroquinolone resistance of Capnocytophaga spp. clinical isolates and laboratory mutants.

Objectives: Capnocytophaga spp. are often reported to cause bacteraemia and extra-oral infections and are characterized by their significant contribution to resistance to ß-lactam and macrolide-lincosamide-streptogramin antibiotics in the human oral microbiota. The implication of mutations in the quinolone resistance-determining region (QRDR) of DNA gyrase A and B ( gyrA and gyrB ) and topoisomerase IV ( parC and parE ) of fluoroquinolone (FQ)-resistant Capnocytophaga spp., hitherto unknown, was explored in this study. Methods: Two reference strains ( Capnocytophaga gingivalis ATCC 33624 and Capnocytophaga sputigena ATCC 33612) and four Capnocytophaga spp. isolated from clinical samples were studied. Nine in vitro FQ-resistant mutants, derived from two reference strains and one FQ-susceptible clinical isolate, were selected by successive inoculations onto medium containing levofloxacin. MICs of ofloxacin, norfloxacin, ciprofloxacin, levofloxacin and moxifloxacin were determined. The presumed QRDRs of GyrA, GyrB, ParC and ParE from Capnocytophaga spp. were determined by sequence homology to Bacteroides fragilis and Escherichia coli . PCR primers were designed to amplify the presumed QRDR genetic region of Capnocytophaga spp. and sequence analyses were performed using the BLAST program at the National Center for Biotechnology Information. Results and conclusions: gyrA mutations leading to a substitution from amino acid position 80 to 86 were systematically detected in Capnocytophaga spp. with ciprofloxacin MIC >1 mg/L and considered as the primary target of FQs. No mutational alteration in the QRDR of gyrB was detected. Other mutations in parC and parE led to spontaneous amino acid substitutions of DNA topoisomerase IV subunit B with no alteration in FQ susceptibility.

Disc displacement without reduction: a retrospective study of a clinical diagnostic sign.

OBJECTIVE: The purpose of this retrospective study is to evaluate a clinical diagnostic sign for disc displacement without reduction (DDWR), the absence of additional condylar translation during opening compared with protrusion. METHOD: Thirty-eight electronic axiographic and magnetic resonance imaging (MRI) examinations of the TMJ were analyzed in order to compare the opening/protrusion ratio of condylar translation between non-painful DDWR and non-DDWR. RESULT: According to the Mann-Whitney U test, the opening/protrusion ratio in non-painful DDWR differs significantly from non-DDWR (p < 0.0001). DISCUSSION: Among non-painful DDWR, there is no additional condylar translation during opening in comparison with protrusion, and this is probably also the case for DDWR without limited opening, which is a subtype that has not been validated by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Comparative condylar palpation can analyze this sign, and therefore, further comparative investigations between MRI and clinical examination are needed to validate the corresponding clinical test.

Multidrug-resistant oral Capnocytophaga gingivalis responsible for an acute exacerbation of chronic obstructive pulmonary disease: Case report and literature review.

INTRODUCTION: Capnocytophaga genus was recently known to highly contribute to the beta-lactam (BL) and macrolide-lincosamide-streptogramin (MLS) resistance gene reservoir in the oral microbiota (BL: blaCSP-1 and blaCfxA; MLS: erm(F) and erm(C)). But fluoroquinolone (FQ) resistance remains uncommon in literature, without available data on resistance mechanisms. CASE REPORT: For the first time, a case of acute exacerbation of chronic obstructive pulmonary disease (COPD) was described in a 78-year-old immunocompetent patient due to a multidrug-resistant Capnocytophaga gingivalis isolate with significant microbiological finding. C.gingivalis acquired resistance to third generation cephalosporins (blaCfxA3 gene), MLS (erm(F) gene), and fluoroquinolones. Genetics of the resistance, unknown as regards fluoroquinolone, was investigated and a substitution in QRDR of GyrA was described (Gly80Asn substitution) for the first time in the Capnocytophaga genus. LITERATURE REVIEW: A comprehensive literature review of Capnocytophaga spp. extra-oral infection was conducted. Including the present report, on 43 cases, 7 isolates were BL-resistant (17%), 4 isolates were MLS-resistant (9.5%) and 4 isolates were FQ-resistant (9.5%). The studied clinical isolate of C.gingivalis was the only one to combine resistance to the three groups of antibiotics BL, MLS and FQ. Four cases of Capnocytophaga lung infection were reported, including three infections involving C. gingivalis (two FQ resistant) and one involving C. sputigena. CONCLUSION: This multidrug-resistant C. gingivalis isolate illustrated the role of oral flora as a reservoir of antibiotic resistance and its contribution to the limitation of effective antibiotics in severe respiratory infections.

Oral Gram-negative anaerobic bacilli as a reservoir of ß-lactam resistance genes facilitating infections with multiresistant bacteria.

Many ß-lactamases have been described in various Gram-negative bacilli (Capnocytophaga, Prevotella, Fusobacterium, etc.) of the oral cavity, belonging to class A of the Ambler classification (CepA, CblA, CfxA, CSP-1 and TEM), class B (CfiA) or class D in Fusobacterium nucleatum (FUS-1). The minimum inhibitory concentrations of ß-lactams are variable and this variation is often related to the presence of plasmids or other mobile genetic elements (MGEs) that modulate the expression of resistance genes. DNA persistence and bacterial promiscuity in oral biofilms also contribute to genetic transformation and conjugation in this particular microcosm. Overexpression of efflux pumps is facilitated because the encoding genes are located on MGEs, in some multidrug-resistant clinical isolates, similar to conjugative transposons harbouring genes encoding ß-lactamases. All these facts lead us to consider the oral cavity as an important reservoir of ß-lactam resistance genes and a privileged place for genetic exchange, especially in commensal strictly anaerobic Gram-negative bacilli.

High prevalence of ß-lactam and macrolide resistance genes in human oral Capnocytophaga species.

OBJECTIVES: To determine macrolide-lincosamide-streptogramin (MLS) resistance determinants in the Capnocytophaga genus and to describe the prevalence of ß-lactam resistance genes in human oral Capnocytophaga species. METHODS: Forty-eight Capnocytophaga isolates identified by analysis of 16S rRNA sequences were isolated from subgingival samples from 14 haematology patients (HPs), 11 periodontitis patients (PPs) and 17 healthy volunteers (HVs). MICs of ß-lactam and MLS antibiotics were obtained for all isolates. blaCfxA, blaCSP-1 (encoding a new class A ß-lactamase) and MLS resistance genes [erm(F), erm(B), erm(Q), erm(D), erm(C) and erm(A)] were evaluated using specific PCR and sequencing. RESULTS: In HVs, which had the lowest prevalence of ß-lactamase-producing isolates in comparison with the other groups (16%; P < 0.001), Capnocytophaga ochracea was the prominent species (68%; P < 0.03). In PPs, which had a high prevalence of ß-lactamase-positive isolates (82%; P < 0.001), Capnocytophaga sputigena was more frequently identified (64%; P < 0.03). In HPs, 50% of isolates were ß-lactamase-positive. The more rarely identified species (15%) Capnocytophaga gingivalis, Capnocytophaga granulosa and Capnocytophaga leadbetteri were isolated only from PPs and/or HPs. All ß-lactam-resistant isolates (44%) were PCR-positive for blaCfxA (31%) or blaCSP-1 (12.5%). Interestingly, blaCSP-1 was identified only in a subgroup of the C. sputigena species. Twenty-nine percent of isolates were MLS resistant independently of species identification, ß-lactamase production or patient group. The MLS-resistant isolates carried the erm(F) or erm(C) gene (93% and 7%, respectively), previously unknown in the Capnocytophaga genus. CONCLUSIONS: Our findings illustrate that Capnocytophaga species are important contributors to the ß-lactam and MLS resistance gene reservoir in the oral microbiome.