Effects of wear time differences of removable functional appliances in class II patients: prospective MRI study of TMJ and masticatory muscle changes.

OBJECTIVES: The aim of this prospective study was to evaluate the short-term effects of full-time and night-time wear of functional appliances on the temporomandibular joint (TMJ) and masticatory muscles and to compare the differences in craniofacial structures, TMJ, and masticatory muscles with magnetic resonance imaging (MRI). METHODS: The study was carried out using cephalometric radiographs and MRI of 20 Class II patients who were treated with monoblock/twin-block appliances. The patients were divided into 2 groups: ten patients in Group 1 used their appliances all day, while ten patients in Group 2 were instructed to wear the appliances during sleep. After at least 6 months of uninterrupted treatment, post-treatment cephalograms and MRI were obtained for patients whose molar relationship improved by at least a half cusp width. Signal intensity ratios (SIR) of TMJ structures and morphological evaluations of masticatory muscles were done for all patients. RESULTS: It was found a significant increase in SIR values of the condylar process, articular disc, retrodiscal tissue, and masticatory muscles for all treatment groups. Length of the masseter and medial pterygoid muscles increased to varying degrees which left side of Group 2 was significantly increased (P < 0.05). The volume of all muscles also increased to varying degrees. CONCLUSIONS: The cephalometric and MRI findings of this study show that the treatment effects were similar for both wear schedules.

Evaluation of temporomandibular joint, masticatory muscle, and brain cortex activity in patients treated by removable functional appliances: a prospective fMRI study.

OBJECTIVES: The aim of this study is to evaluate the effects of functional orthodontic appliances on the masticatory muscles, temporomandibular joint (TMJ), and brain to determine whether using functional appliances full-time or only at night yields different results. METHODS: 16 patients with Class II malocclusion were included in this study. Eight patients were instructed to wear their appliances (monoblock/twinblock) full-time and the other eight patients were instructed to wear them at night while sleeping. An additional 10 patients with Class II malocclusion were later included as a pre-treatment control group. Signal intensity ratios (SIR) of TMJ structures and morphological evaluations of the masticatory muscles were done for all patients. Functional MRI (fMRI) data were also obtained from the patients while performing chewing and biting movements. RESULTS: ANB angle was reduced significantly in both the full-time and night wear groups, by values of 1.17° and 1.35°, respectively (p < 0.05). MRI showed that SIRs were significantly increased in both groups in the masticatory muscles, retrodiscal pad, condylar process, and articular disc (p < 0.05). Both resting and task-based fMRI evaluation revealed significant increases in blood oxygen level dependent signals in several regions of the brain in both groups (p < 0.05). CONCLUSIONS: The cephalometric and MRI findings of this study indicate that the treatment effects were similar for both wear schedules. Functional appliances should be regarded not as simple devices that treat Class II malocclusion through skeletal and dental correction alone, but as exercise devices that lead to neuromuscular changes by facilitating muscle adaptation and activating various brain regions.

TGFα/HinfI Polymorphisms Contribute to Nonsyndromic Cleft Lip and Palate in Turkish Patients.

BACKGROUND: Nonsyndromic cleft lip with/without cleft palate (nsCL ± P) is one of the most common birth defects of complex etiology, occurring in ∼1/700 live births worldwide. A series of epidemiological studies were conducted to investigate the association between a transforming growth factor alpha (TGFα) polymorphism and nsCL ± P risk. The aim of this study was to investigate the association between the TGFα/HinfI polymorphisms and nsCL ± P in Turkish patients. METHODS: One hundred fifty-five Turkish subjects were enrolled: 70 nsCL ± P patients and 85 unrelated control individuals. Genomic DNA was isolated from peripheral blood leukocytes, and molecular analysis of gene polymorphisms was carried out using polymerase chain reaction and restriction enzyme digestions. RESULTS: We found significant difference between the TGFα gene HinfI allele frequencies of the controls and: 1) the occurrence of nonsyndromic cleft lip (p = 0.029,); 2) the occurrence of nonsyndromic cleft lip and palate (nsCL + P) cases (p = 0.024; and 3) the occurrence of both nsCL ± nsCLP cases (p = 0.0365). The association between age of parents, gender, maternal exposures, socioeconomic status and clefts was assessed in each group separately. CONCLUSION: Our study indicates that the TGFα HinfI gene polymorphism might be associated with nsCL ± P susceptibility, thus contributing to the occurrence of nsCL ± P in Turkish patients. The relatively small sample size of our study is one limitation of our study, and future research with larger specimen sets from different ethnicities will be required to validate our findings.