Short-term postoperative changes in temporomandibular joints and masticatory muscles of Angle class II patients after mandibular advancement surgery: Clinical findings.

BACKGROUND AND OBJECTIVE: The aim of the study was to detect postoperative changes in the temporomandibular joints (TMJs) and masticatory muscles of Angle class II malocclusion patients who underwent mandibular advancement surgery. MATERIAL AND METHODS: Twenty-three patients were selected for mandibular advancement by bilateral sagittal split ramus osteotomy (BSSO). Cephalograms and clinical evaluation were performed before the surgery as well as fourteen days and six months after surgery. Clinical examination included measurement of overjet, overbite and of the amplitude of mandibular movements, registration of deviation on mouth opening, of TMJ pain and pathological sounds and of tenderness of masticatory muscles on palpation. Mandibular position was determined by cephalometric analysis. Statistical analyses were performed using a mixed-level longitudinal random intercept model with a confidence level of 95% and a P-value of 0.05 to reveal significant differences. RESULTS: Statistical results showed a mean mandibular advancement of 4 mm (3.1-5.0). Cephalometric measurements, overjet and overbite remained stable six months after surgery. Postoperative amplitude of mandibular movements was limited and did not completely recover 6 months later. Mouth opening was the most affected, showing an average reduction of 7.5 mm six months after surgery. Deviation on mouth opening, pathological TMJ sounds, TMJ pain and masticatory muscle tenderness did not show significant changes. CONCLUSIONS: Moderate mandibular advancement surgery offers stable results, yet the amplitudes of mandibular movements, were significant smaller after surgery and did not completely recovered 6 months following surgery. TMJ and masticatory muscles symptoms did not change after the surgery, suggesting that mandibular advancement surgery does not change the course of TMD.

Association analysis of juvenile idiopathic arthritis genetic susceptibility factors in Estonian patients.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic condition of childhood. Genetic association studies have revealed several JIA susceptibility loci with the strongest effect size observed in the human leukocyte antigen (HLA) region. Genome-wide association studies have augmented the number of JIA-associated loci, particularly for non-HLA genes. The aim of this study was to identify new associations at non-HLA loci predisposing to the risk of JIA development in Estonian patients. METHODS: We performed genome-wide association analyses in an entire JIA case-control sample (All-JIA) and in a case-control sample for oligoarticular JIA, the most prevalent JIA subtype. The entire cohort was genotyped using the Illumina HumanOmniExpress BeadChip arrays. After imputation, 16,583,468 variants were analyzed in 263 cases and 6956 controls. RESULTS: We demonstrated nominal evidence of association for 12 novel non-HLA loci not previously implicated in JIA predisposition. We replicated known JIA associations in CLEC16A and VCTN1 regions in the oligoarticular JIA sample. The strongest associations in the All-JIA analysis were identified at PRKG1 (P = 2,54 × 10-6), LTBP1 (P = 9,45 × 10-6), and ELMO1 (P = 1,05 × 10-5). In the oligoarticular JIA analysis, the strongest associations were identified at NFIA (P = 5,05 × 10-6), LTBP1 (P = 9,95 × 10-6), MX1 (P = 1,65 × 10-5), and CD200R1 (P = 2,59 × 10-5). CONCLUSION: This study increases the number of known JIA risk loci and provides additional evidence for the existence of overlapping genetic risk loci between JIA and other autoimmune diseases, particularly rheumatoid arthritis. The reported loci are involved in molecular pathways of immunological relevance and likely represent genomic regions that confer susceptibility to JIA in Estonian patients. Key Points • Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease with heterogeneous presentation and genetic predisposition. • Present genome-wide association study for Estonian JIA patients is first of its kind in Northern and Northeastern Europe. • The results of the present study increase the knowledge about JIA risk loci replicating some previously described associations, so adding weight to their relevance and describing novel loci. • The study provides additional evidence for the existence of overlapping genetic risk loci between JIA and other autoimmune diseases, particularly rheumatoid arthritis.

Arthrocentesis techniques used in the treatment of temporomandibular disorders: Literature review.

OBJECTIVE: The article presents a systematic overview of single- and double-puncture techniques of arthrocentesis methods published in the Scopus database during 2016-2020, highlighting the advantages and shortcomings of different methods. MATERIALS AND METHODS: A search was conducted in the Scopus database using the terms "TMJ OR temporomandibular OR mandibular OR jaw AND arthrocentesis". Arthrocentesis techniques were described and categorized mostly as single- or double-needle ones. RESULTS: The literature reviewed in the article represents studies of arthrocentesis treatment in 2675 patients involving 2740 joints. Arthrocentesis techniques can mainly be divided into single- and double-needle techniques. Single-needle techniques are subcategorized into type 1 and type 2, of which the first is a single-needle cannula technique where inflow and outflow pass through the same lumen, while the second uses a Y-shaped device, which has two ports and two lumens. Double needle techniques use two needles - one for the inflow and the other for the outflow. The literature found in the Scopus database during the period investigated presents 28% of single-puncture (type 1 - 10%, type 2 - 15%, single puncture with distention of the upper joint compartment - 3%), 69% of double-puncture, 1% of ancillary second-puncture methods and 1% employing a CBCT-based tragus-supported guide with 3 needles. CONCLUSION: All of the arthrocentesis techniques described in the literature are effective as treatment modalities, none appears to be superior to others. The selection of the method to be used depends on the surgeon´s choice and experience.

Temporomandibular Disorder Signs, Occlusal Support, and Craniofacial Structure Changes Among the Elderly Vietnamese.

OBJECTIVE: The aim of study was to determine the association between signs of temporomandibular disorders (TMD), occlusal support, and alterations in the craniofacial structure of elderly Vietnamese by using cephalometric analysis. METHODS: The cross-sectional study consisted of 244 participants aged 65-74 years. Participants were examined for signs of TMD, including limited mouth opening, temporomandibular joint (TMJ) crepitus, TMJ tenderness, and muscle tenderness. Dentition was divided into four occlusal support zones based on occluding pairs of posterior teeth by using Eichner's classification: Class A = 4 support zones; Class B = 1-3 support zones or only contact in anterior teeth; Class C = 0 support zones. Fifteen angular and seven linear parameters were used for sagittal craniofacial skeleton analysis. RESULTS: 10.3% of participants had limited mouth opening, 49.6% TMJ crepitus, 16.3% TMJ tenderness, and 24.2% muscle tenderness; 45.5% had Class A occlusal support, 38.5% Class B, and 16.0% Class C. Those with Class C had significantly smaller ramus inclination, articular angle, and angles formed by the mandibular plane and shorter facial height compared to Class A and Class B (P < .001). TMD signs were significantly associated with: angles formed by mandibular plane, gonial angle, cranial base angle, effective mandibular length, and anterior facial height (P < .05). CONCLUSIONS: The alteration of craniofacial structures was significantly associated with TMD signs among elderly Vietnamese. The higher number of lost occlusal support zones, the more significant the changes to craniofacial structures.

Oral Health Behaviour and Oral Health Status of Elderly Vietnamese.

PURPOSE: To describe oral health behaviours and problems among elderly Vietnamese as well as determine their prevalence of caries and periodontal disease. MATERIALS AND METHODS: This cross-sectional study examined 258 elderly persons aged 65-74 years living in Danang, Vietnam. All subjects self-reported oral health behaviour and problems. Dental caries was assessed using the DMFT index. Periodontal status was evaluated with the modified Community Periodontal Index, whereby all teeth were examined for gingival bleeding and periodontal pocket depth (PPD), and the index teeth were assessed for clinical attachment loss (CAL). RESULTS: 48.4% of the elderly brushed their teeth at least twice a day; 34% had never visited a dentist; 27.8% often had difficulty chewing foods. Of the sample, mean DMFT was 14.3 ± 8.7 (DT = 6.4 ± 5.5, MT = 7.7 ± 7.1, and FT = 0.2 ± 0.9), 88.8% had untreated caries, 21.0% had at least one tooth with a PPD ≥ 6 mm, and 49.8% had at least one sextant with CAL ≥ 6 mm. The mean number of teeth per person was 22.0, of which 19.5 teeth (88.6%) had gingival bleeding, 7.7 teeth (37.1%) with a PPD 4-5 mm, and 0.8 teeth (5.0%) with a PPD ≥ 6 mm. The mean number of sextants with CAL 4-5 mm and CAL ≥ 6 mm were 2.5 ± 2.0 and 1.3 ± 1.7, respectively. Rural residence was found to be negatively associated with MT, FT, and healthy periodontal status (p < 0.05). CONCLUSIONS: Dental diseases are prevalent among elderly Vietnamese owing to a lack of awareness of oral health self-care behaviours, especially among those living in rural areas. This suggests that an oral health care programme is required to improve the oral health status of elderly Vietnamese.

Occlusal Support and Temporomandibular Disorders Among Elderly Vietnamese.

PURPOSE: The aim of this study was to analyze the associations between missing teeth, occlusal support, and temporomandibular disorders (TMD) among elderly Vietnamese. MATERIALS AND METHODS: The study consisted of 145 TMD and 112 non-TMD (control group) participants aged 65 to 74 years. TMD was evaluated using Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I. An occlusal unit (OU) was defined as the cusp of a tooth coupled with the fossa of its antagonist tooth. A premolar pair was counted as one OU and a molar pair as two OUs. Dentition was divided into four occlusal support zones (OSZs) based on occluding pairs of posterior teeth by using Eichner classification: Class A had 4 OSZs, Class B had 1 to 3 OSZs or only anterior teeth, and Class C had no OSZ. RESULTS: The TMD group lost significantly more posterior teeth (mean ± SD 5.1 ± 4.7) than the control group (4.0 ± 3.9, P = .033). The mean ± SD OUs of the TMD and control groups were 5.1 ± 4.6 and 6.0 ± 4.3, respectively, which was nonsignificant (NS). The distribution of Class A (40.7%), Class B (40.0%), and Class C (19.3%) among the TMD group was not significantly different from the control group (50.0%, 38.4%, and 11.6%, respectively, NS). The odds of having TMD were positively associated with total unilateral loss of OUs (OR = 3.4, 95% CI = 1.2-9.4, P = .020) and total bilateral loss of OUs (OR = 2.7, 95% CI = 1.2-6.6, P = .027). CONCLUSION: Total loss of OSZs on one or both sides of the mouth were found to be predictors of TMD among elderly Vietnamese.

Intramuscular botulinum toxin injection additional to arthrocentesis in the management of temporomandibular joint pain.

OBJECTIVE: The aim of this study was to compare the effect of intramuscular injection of botulinum toxin (BTX-A) as an adjunct to arthrocentesis with the effect of BTX-A injections alone in the treatment of temporomandibular joint disorders (TMDs) with masticatory muscles tension. STUDY DESIGN: The clinical study included 20 TMD patients divided into 2 groups. The influence of daily activities on pain in the temporomandibular joint (TMJ) area was evaluated in both groups using the rating scale by List and Helkimo. Range of maximal interincisial opening (MIO) and joint pain as measured by the visual analogue scale (VAS) were examined to determine the clinical efficiency of the procedures before and after treatment. Group A consisted of 12 patients; they were treated with arthrocentesis and BTX-A injections in the temporal and masseter muscles. Group B consisted of 8 patients; they had only BTX-A injections in the same muscles as mentioned. RESULTS: In group A, VAS decreased significantly (P = .005), and MIO improved significantly (P < .005). CONCLUSIONS: Arthrocentesis with BTX-A seems to affect the clinical outcomes with regard to MIO and VAS compared with the results when BTX-A only was used. BTX-A in combination with arthrocentesis improved the TMJ area symptoms.

Contemporary management of TMJ involvement in JIA patients and its orofacial consequences.

Juvenile idiopathic arthritis is the most common chronic rheumatic condition during childhood. Temporomandibular joint arthritis is frequently asymptomatic. When it takes place during childhood, it may affect condylar growth; therefore, these children are at risk of unfavorable long-term outcomes from the associated joint damage. The etiology is not completely understood, but it is considered as multifactorial with both genetic and environmental factors involved. The standardized examination and imaging protocols serve important purpose to diagnose temporomandibular joint (TMJ) arthritis not only to establish an early interventional strategy but also to assess craniofacial growth and the progression of signs and symptoms in those patients. Although the treatment of juvenile idiopathic arthritis (JIA) has changed dramatically over the last decades due to new therapeutic options, TMJ arthritis still can develop during the course of the disease. In clinical experience, TMJs appear to respond less well to the standard of care used to treat other joints. More individualized approach to the patient's treatment serves as the main goal of personalized medicine. It could be achieved by adopting new methods of medical imaging such as conebeam computer tomography as well as developing reliable biomarkers which may assist with predicting disease type, course, or severity and predicting response to medication. This article provides an overview of current information on orofacial complications in JIA and its management. Based on information provided in this review, more precise diagnosis, proper tools for recognizing people at risk, and more efficient treatment approaches could be implemented. This may lead to more personalized treatment management strategies of TMJ complications of JIA patients.

Temporomandibular joint arthrocentesis for the treatment of osteoarthritis.

UNLABELLED: The aim of the study was to estimate the effect of arthrocentesis in the treatment of osteoarthritis of the temporomandibular joint (TMJ), evaluate and compare cytological and biochemical findings in the synovial fluid (SF) as well in venous blood samples and to determine the effectiveness of arthrocentesis with regard to TMJ pain intensity and mandibular movement. PATIENTS AND METHODS: Twenty three consecutive patients with a diagnosis of TMJ osteoarthritis (Wilkes´ stages III, IV) after noneffective conservative treatment were treated with arthrocentesis using push and pull technique (Alstergren et al. 1995). Preoperative radiographs and the scores pre- and posttreatment (after 6 months), maximal interincisal opening (MIO) and visual analogue scale (VAS) for pain estimation were performed. Blocking the auriculotemporal nerve with a 2 mL of 2% lidocaine solution, the needle was inserted into the upper joint compartment and connected with the three-way stopcock for infusion therapy (Discofix® Braun) and 2-3 mL of saline solution was pushed slowly to the upper compartment and then aspirated back. The first SF aspirate was allocated for the following analysis: SF viscosity, presence of crystals, SF rheumatoid factor (RF) compared to blood plasma RF. The washing was repeated 3-4 times until the aspirate was clear. RESULTS: After 6 months MIO improved significantly (p<0.05) and pain according to VAS had substantially decreased (p<0.01). Viscosity of the aspirate was 0.78 (medium), crystals were found in 5 patients (21.7%). There was not statistical significant difference between SF RF and plasma RF values (p>0.05).The effectiveness of arthrocentesis may be explained by the joint space expansion achieved with the introduction fluid, washing out inflammatory mediators, the particles of adhesions, fibrillations, crystals etc. CONCLUSIONS: Arthrocentesis with this technique for the treatment of TMJ osteoarthritis offer favourable results with regard to increasing MIO, reducing pain and dysfunction. The presence of crystals or chondromatosis granules in the synovial fluid and increased viscosity of the synovial fluid indicates a pathological condition of an inflammatory nature.

Synovial chondromatosis in the temporomandibular joint: case report with review of the literature.

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare benign condition characterized by the formation of metaplastic cartilage in the synovium resulting in numerous attached and unattached osteocartilagenous (calcified) loose bodies within the joint. The purpose of this article is to present a case of SC of the TMJ and to discuss current diagnostic approaches, treatment options and relevant follow-up data. We present a case of SC in the TMJ that was confirmed by histopathological analysis and treated via arthrotomy, and present the typical imaging findings, including Computed Tomography (CT) and orthopantomography (OPTG) findings.

Use of the suture anchor in interpositional arthroplasty of temporomandibular joint ankylosis.

BACKGROUND: The purpose of this article is to demonstrate the use of a mini suture anchor to attach the temporal myofascial flap to the head of the mandibular condyle in interpositional arthroplasty for the treatment of temporomandibular joint (TMJ) ankylosis. CASE REPORT: A 29-year-old patient, with unilateral posttraumatic temporomandibular joint osseous ankylosis and pre-operative maximal interincisal distance of 9 mm, was treated by the interpositional gap arthroplasty using the temporal myofascial flap. After rotation, the flap and the TMJ capsule were attached to the lateral pole of the condyle by a non-absorbable mini suture anchor. The surgery was uneventful. On the first post-operative day, the range of motion was considerably improved, with a maximal interincisal distance of 26 mm, a mandibular protrusion of 1 mm and a lateral mandibular excursion of 4 mm to the left and 7 mm to the right. On the 20th post-operative day, the maximal interincisal distance was 30 mm, protrusion 4 mm, the lateral excursion to the right 7 mm and to the left 5 mm. On the third post-operative month, the maximal interincisal distance reached 40 mm. DISCUSSION: The mini suture anchor demonstrated to be a good tool for the fixation of the temporalis myofascial flap to the condyle, also allowing with the same suture to attach the capsular tissue to the lateral surface of the condyle. The bone-anchored suture permits the restoration of a more physiologic TMJ anatomy. The treatment of TMJ ankylosis should be comprehensive; physiotherapy plays an important role in the rehabilitation period to restore the normal function.

Relationship between radiographic changes in the temporomandibular joint and bone mineral density: a population based study.

OBJECTIVE. The aim of this population based study was to compare radiographic changes in the temporomandibular joint (TMJ) with the lumbar spine and femoral neck BMD. To find whether there is any relationship between TMJ radiographic changes, vitamin D (25(OH)D) and bone markers levels and the number of missing teeth. MATERIAL AND METHODS. The study included 95 randomly selected participants. Bilateral TMJ images were obtained using an orthopantomograph (OPTG) and were evaluated for presence of radiographic signs. BMD was measured by dual energy X-ray absorptiometry (DXA). BMD of the lumbar spine (LT score) and femur (FT score) was detected by DXA. The level of type I collagen telopeptide fragments (P1NP), of C-telopeptide crosslaps of type I collagen (CTX-1) and of 25(OH)D were also measured. RESULTS. Subjects with a lower LT score had significantly fewer occluding pairs of teeth (p=0.018) and were more frequent users of removable prostheses (p=0.008). Radiographic changes were negatively correlated with P1NP (p=0.041). CTX-1 correlated positively with P1NP (p<0.001) and negatively with 25(OH)D (p=0.042). Occluding pairs of teeth were positively correlated with the LT score (p=0.012) and FT score (p<0.001). Radiography showed changes in the TMJ of 57% of participants. Out of 95 participants, 60% demonstrated an abnormally low LT value. CONCLUSIONS. This population based study indicates that TMJ radiographic changes and teeth loss seems to be related to the low level of BMD and 25(OH)D level.

Long-term evaluation of arthroscopic surgery with lysis and lavage of temporomandibular joint disorders.

AIM: To estimate and analyse the long-term outcome of arthroscopy for the treatment of the temporomandibular joint (TMJ) internal derangements. PATIENTS AND METHODS: Twenty-nine patients (35 joints) who underwent TMJ arthroscopy under general anaesthesia due to osteoarthritis between years 2000 and 2007 (Wilkes stages IV and V) were included in this study. The age range at the time of surgery was from 18 to 69 years. The scores for preoperative maximal interincisal opening (MIO), and visual analogue scale (VAS) score for pain before arthroscopy, 6 months and 5 years after arthroscopy were compared. RESULTS: Fibrous adherences were found in all cases, fibrillations in 76% of cases. The most frequent radiographic sign was erosion (69%). There was a significant increase in the MIO postoperatively after 6 months (r(s)=0.56; n=29, p>0.01) that held during the longer-term follow-up (5 years) period (r(s)=0.58; p<0.001). VAS after 6 months was positively correlated to VAS after 5 years (r(s)=0.38; p=0.040). There were no significant differences between the results of follow-up when comparing the shorter (6 months) and longer (5 years) results. CONCLUSION: Arthroscopic lysis and lavage for the treatment of TMJ disorders offers favourable long-term stable results with regard to increasing MIO and reduced pain and dysfunction.