Anterior Disc Dislocation Research Articles

High-Field Magnetic Resonance Imaging of the Temporomandibular Joint Low Agreement with Clinical Diagnosis in Asymptomatic Females.

(1) Background: The aim of this study was to investigate the agreement between a clinical diagnosis based on research diagnostic criteria/temporomandibular disorders (RDC/TMD) and high-field magnetic resonance imaging (MRI) findings of temporomandibular joints (TMJs) in asymptomatic females. (2) Methods: A prospective study on 100 females (200 TMJs) was performed, using clinical examinations (RDC/TMD) and same-day MRIs of TMJs on a 3T MR unit. The inclusion criteria were as follows: females, age > 18, the presence of upper and lower incisors, and an understanding of the Serbian language. Descriptive statistics (means and standard deviations) and ANOVA with a post hoc Tukey test for differences among the patient subgroups was performed. The agreement between the clinical and MRI findings was determined using Cohen's kappa coefficient (k < 0.21 slight, 0.21-0.4 fair, 0.41-0.6 moderate, 0.61-0.8 substantial, and 0.81-1 almost perfect). The statistical significance was set at p ≤ 0.05. (3) Results: Normal findings were observed in 86.7%, disc dislocation (DD) was observed in 9.2%, and arthralgia/osteoarthritis/osteoarthrosis was observed in 2.6% of TMJs using RDC/TMD. On the MRI, normal findings were observed in 50.5%, disc dislocation was observed in 16.3%, and arthralgia/osteoarthritis/osteoarthrosis was observed in 23.5% of TMJs. The anterior DD with reduction showed fair agreement of the clinical and MRI findings (k = 0.240, p < 0.001) compared with the DD without reduction (k = 0.355, p < 0.001). Both showed high specificity (94.9% and 99.4%) but low sensitivity (24.2% and 25.0%). The sensitivity in osteoarthritic changes was low (4.8%), but the specificity remained high (96.2%). (4) Conclusions: The sensitivity of the clinical examination remains low compared with 3T MRI, especially in osteoarthritic changes and anterior DD with reduction. However, the number of false positive diagnoses using RDC/TMD is low in asymptomatic patients. RDC/TMD remains a sensible method for establishing a clinical diagnosis and avoiding the overtreatment of asymptomatic patients.

Assessment of Injuries of Tempo ro-Mandibular Joint by MRI

Abstract Background: The use of magnetic resonance imaging (MRI) in the assessment of temporomandibular joint (TMJ) injuries has been a mainstay. Since it can non-invasively showing major regional anatomic structures and revealing the presence of joint effusion and bone marrow signal-intensity abnormalities. Aim of Study: To elucidate the role of MRI in the diagnosis of TMJ injuries and for which extent MRI is able to detect its abnormalities. Patients and Methods: A total of 43 patients with TMJ injuries were included in the study. A 1.5 tesla MRI machine is used to assess the TMJs. The position of the disc, its configuration, the presence or absence of joint effusion, osteoarthritis, and the morphology of the mandibular condyle were all evaluated. Results: The clinical symptoms of the patients there were higher of symptoms in sensation of pain (86%); followed by limited mouth opening (44.2%). The patients anterior disc dislocation with reduction was higher value was found in patients' injuries of temporomandibular joint 17 patients (39.5%) with p-value

DYNAMIC FUNCTIONAL MAGNETIC RESONANCE IMAGING OF TEMPOROMANDIBALAR JOINT

The aim of the study was to compare the potential of fast pulse sequences and traditional static images for evaluation of temporomandibular joint (TMJ) biomechanics and to optimize the magnetic resonance imaging (MRI) protocol of TMJ by inclusion of dynamic scanning to improve the diagnosis of internal derangements. Material and methods. Dynamic MRI with HASTE and true-FISP pulse sequences was integrated into conventional MRI examination of TMJ in 16 symptomatic patients with pain, restricted motion and clicking in the joint. MRI was performed on superconductive 1.5 T scanner Magnetom Espree (Siemens, Germany). The presence of motion and susceptibility artifacts, range of mandible head motion and intrarticular disc location in different jaw positions were analyzed when comparing static and dynamic series. Results and discussion. HASTE was chosen for dynamic functional MRI of TMJ because it was less prone to susceptibility artifacts and provided better tissue contrast compared to true-FISP. Our initial experience has demonstrated dynamic scanning to be a time-efficient supplementary technique providing detailed information about TMJ biomechanics during active jaw movements at a high temporal resolution compared to traditional MRI examination. However, minimal anterior disc dislocation could be missed on dynamic series due to poor visualization of the posterior disc band on full closing. The further optimization of dynamic scanning technique on a large patients group using principles of the evidence-based medicine is needed. This would allow improving the diagnosis and assisting clinicians to optimize treatment strategy in a wide range of TMJ disorders.

Evaluation of occlusion types, pain severity, and onset of complaints in 127 patients with temporomandibular disorders: A retrospective study

ABSTRACTObjective: The aims of this study are to evaluate if occlusal types affect the type of temporomandibular disorders and if the onset of complaints are related to the type of internal derangements.Methods: One hundred thirty-four patients were evaluated. Occlusion types were grouped as Angle Class I, II, and III. The temporomandibular disorders were classified as masticatory muscle disorders, anterior disc dislocation with reduction, and anterior disc dislocation without reduction.Results: No significant relationships were found between the occlusion types, pain severity, the onset of the complaints, and the temporomandibular disorders. Premature contacts were found to be significantly higher in Class II and Class III patients, but no significant relations were found between premature contacts and temporomandibular disorders.Discussion: Occlusal features are not discriminant factors in the occurrence of temporomandibular disorders. Also, it cannot be concluded that the longer the patients have temporomandibular disorders, the higher their pain scores will be.

Temporomandibular joint disc perforation: a retrospective study

The aim of this study was to evaluate disc perforation diagnosed in patients undergoing arthroscopy of the temporomandibular joint (TMJ). A retrospective analysis of 33 patients with disc perforation (35 joints) was performed. Patients and joints were divided into two groups: those with distal perforation (DP; perforation of the retrodiscal tissue, or the distal area of the disc at the site of ligament insertion into the retrodiscal tissue) and those with central perforation (CP; central and anterior part of the disc). The retrospective evaluation included aetiological factors, clinical symptoms, arthroscopic findings, and the effects of arthroscopic lavage. The most frequent aetiological factors in patients with disc perforation were stress and related parafunctional activities. The most frequent arthroscopic finding in both groups was hyperaemia of the bilaminar zone and synovial tissue. Other predominant arthroscopic findings were the presence of adhesions and anterior disc dislocation in the DP group and synovial hyperplasia in the CP group. Better outcomes of arthroscopic lysis and lavage were found in the CP group than in the DP group. At 12 months after arthroscopic lavage, the results showed that the therapy was satisfactory for 72% of the joints. The most common cause of distal perforation is anterior disc dislocation, whilst chronic inflammatory changes account for central perforation.

Intraoperative arthroscopy of the TMJ during surgical management of condylar head fractures: A preliminary report

PurposeThe purpose of this preliminary study was to evaluate intraarticular soft tissues of the temporomandibular joint (TMJ) using intraoperative arthroscopy during open reduction and internal fixation (ORIF) of condylar head fractures (CHF). Materials and methods26 patients (29 joints) were diagnosed in period of 5 years (2011–2015) with CHF, 5 patients had concomitant mandibular fracture. Fractures were diagnosed on basis of conventional orthopantomogram (OPG) and computed tomography (CT). ResultsIntraoperative arthroscopy revealed hyperemia and hypervascularity in all 29 joints, anterior disc dislocation in 26 joints, cartilage erosion in 21 joints and hemorrhagic clots were present in 10 joints. Major hemarthrosis or tear of the posterior band, as often described in MRI, could not be shown in our patients. Data from the study further the understanding of intraarticular pathology of the TMJ after acute trauma in a group with CHF. ConclusionIntraoperative arthroscopy is useful for direct evaluation and accurate diagnosis of the extent of soft tissue damage to TMJ in CHF. Larger and more long-term studies including comparison to MRI findings should be helpful to refine the treatment and postoperative management of patients after CHF.

Chirurgie discale de l’articulation temporo-mandibulaire

Temporomandibular joint (TMJ) disorders are a common disease and may be responsible for major functional and painful repercussions. Treatment is not consensual. The literature highlights the role of conservative treatments (physiotherapy, analgesics, splints) in a first attempt. Minimally invasive surgical techniques (arthroscopy, arthrocentesis) have developed rapidly in recent decades. They have proven effective and reliable, especially in patients suffering from irreducible or reducible anterior disc dislocation or presenting with arthopathies. The goal of our work was to make an update about disk surgery.

Magnetic resonance imaging of temporomandibular joint with anterior disk dislocation without reposition - long-term results

ObjectivesAnterior disk dislocation (ADD) without reposition in the temporomandibular joint (TMJ) may be associated with morphological changes in the retrodiscal region of the bilaminar zone presenting as pseudo-disk (PD). The present study was initiated to investigate the development of retrodiscal fibrosis in a period of 4–8 years and to assess if patients with a PD show differences in the clinical and radiologic findings versus patients without a PD.Materials and MethodsIn a retrospective follow-up study of 33 consecutive patients with ADD without reposition in one or both TMJs, a clinical and MRI-supported evaluation was conducted 4 to 8 years after baseline diagnosis.ResultsIn 45 % of the TMJs with ADD without reposition, a PD could be identified. Twenty-one of 31 patients who showed pain at the baseline examination (VAS mean 56 ± 38) were pain free. The mouth opening capacity (MO) of the mandible could be increased in 80 %. There were no statistical significant differences between patients with or without PD in these clinical features. The MRI parameters effusion and translation showed a statistical tendency for more improvement in the group with PD (p = 0.061, 0.064).ConclusionIn about half of the patients, a structure corresponding to a pseudo-disk developed during follow-up. Pain and the mouth opening capacity improved in all patients independent of the development of a PD.Clinical RelevanceDetection of a PD during follow-up of patients with ADD without spontaneous reposition does neither predict favorable nor worse therapy response and clinical course.

Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis

BackgroundTemporomandibular joint (TMJ) internal derangements are progressive painful conditions and cause joint dysfunction, joint sound, malocclusion, and locking of the mouth. Conservative and invasive techniques can be used for the treatment of TMJ internal derangements. The objective of the present study was to examine the benefit of an intra-articular platelet-rich plasma (PRP) injection and to compare this with arthrocentesis. MethodsTwenty patients (female: male; 15:5; age 26, 3 ± 9.3 years) for a total of 32 joints with reducible anterior disc dislocation, as confirmed by Magnetic Resonance Imaging (MRI), were divided into two groups. PRP was used for the study group, and arthrocentesis was used for the control group. Pain intensity, maximal interincisal opening, and TMJ sounds were assessed and compared for evaluation of treatment success. ResultsThere was a statistically significant reduction in pain intensity and joint sound and an increase in mouth opening in the study group when compared with the control group. ConclusionsThis study shows that intra-articular PRP injection for the treatment of reducible disc displacement of the TMJ is a more effective method than arthrocentesis.

The worth of sound recording as evaluation criteria of response to surgery in non-reduced anterior disc dislocation.

The objective of the present study was to examine whether joint sounds are objective criteria for evaluating the success of surgery for non-reduced anterior disc dislocation. Twenty-seven patients (age, 35.6 ± 10.6 years; female/male, 22:5) with non-reduced disc dislocation, as confirmed by MRI, were included in the study. Temporomandibular joint (TMJ) sounds were assessed and digitized by custom-made device. As a surgical treatment, all patients underwent "disc plication technique". The success of surgery was evaluated with maximal interincisial opening (MIO), pain, patient satisfaction scores, MRI examination, and TMJ sound intensity. Recording of sounds of TMJ and pain and satisfaction scores were repeated again at postoperative 12 months and compared to preoperative results. Mean preoperative sound intensities with jaw opening and closing and left-right movement were 79.37 ± 3.52 dB and 81.0 ± 4.99 dB, respectively. Mean postoperative sound intensity with jaw opening and closing was 64.81 ± 4.54 dB whereas that with left-right movement was 65.6 ± 5.38 dB. Examination of preoperative and postoperative sounds showed that decreased volume level related with clinical improvement and postoperative replaced disc image in MRI. MIO values increased from 25.89 ± 1.76 mm to 34.26 ± 1.403 mm. Postoperative pain scores were lower than preoperative period and patient satisfaction improved markedly. The results of this study showed that patients who underwent plication for non-reduced disc dislocation had clinical improvement, which was related with the decreasing volume level of the click sound, reducing the pain, improving satisfaction, and replacing the disc to normal position in MRI.

청소년 측두하악장애 환자의 임상적 연구

본 연구는 부산 청소년의 측두하악장애의 양태, 증상과 진단명에 대한 변화를 알아보기 위해 다음과 같은 조사를 시행하였다. 2000년과 2008년에 내원한 12-19세 청소년의 측두하악장애 분석검사를 조사하여 성별, 나이, 악관절환자를 위한 조사 설문지, 원인, 진단명, 장치치료여부, 치료종결시 Pain NAS 항목에 대한 자료를 정리, 분석하였다. 1. 2000년도에 비해 2008년도의 청소년 내원 환자수가 증가했다. 이 중 남자 청소년의 비중이 현저히 증가했다. 2. 2000년도에 비해 2008년도의 청소년이 개구제한보다는 소리를 주소로 내원하는 경우가 많아졌으며 악습관 중 이갈이, 이악물기, 턱괴기, 수면의 질 저하 비율이 유의하게 증가하였다. 3. 골관절염은 유의하게 증가하였고 과운동은 유의하게 감소하였다. 4. 골관절염 환자에서2000년도에 비해 2008년도 10대 청소년의 남자비율이 현저히 증가하였다. 턱괴기, 이갈이, 이악물기 악습관을 가진 환자 중 지난 10년간 공통적으로 골관절염이 유의하게 증가한 것으로 미루어 턱괴기, 이갈이, 이악물기가 골관절염 발병 증가와 유의한 관계가 있을 것으로 추측할 수 있다. A retrospective study was conducted to determine the patterns of Temporomandibular Disorder(TMD) among adolescents (12-19 years) over last ten years. 174 patients who had visited the Oral medicine of Pusan National University Dental Hospital in 2000 and 491 patients in 2008 were found on chart review. The results obtained were as follows : 1. The number of adolescent patients was significantly increased in 2008 than in 2000, especially in male. 2. Bruxing, clenching, holding habits and bad sleep hygiene were highly increased more in 2008 than in 2000. 3. Osteoarthritis was significantly increased in 2008 than in 2000 and anterior disc dislocation without reduction was slightly increased. 4. The ratio of male to female adolescent patients with osteoarthritis was remarkably increased. Among the patients who had holding, bruxing, clenching habits, significantly increased osteoarthritis found to be common. This could imply holding, bruxing, clenching habits are prominently associated with increasing risk of developing osteoarthritis.

Occlusal Change as a Sequela of Anterior Disc Displacement without Reduction of Temporomandibular Joint: Case Reports

We report 4 patients who developed change of occlusion which seemed to be related to anterior disc dislocation without reduction, but there was no distinct evidence of condylar destruction or collapse. They experienced sudden occurrence of occlusal change, anterior open bite in 2 patients, lateral CR-CO discrepancy in 1 patient, and anteroposterior CR-CO discrepancy in 1 patient. Also, this report is to find out if there is a relation between sudden occurrence of occlusal change and anterior disc dislocation without reduction.

MRI of TMJ in Patients with Severe Skeletal Malocclusion Following Surgical/Orthodontic Treatment

The aim of this study was to evaluate temporomandibular joints (TMJ) by magnetic resonance imaging (MRI) in patients who had undergone surgical/orthodontic or orthodontic treatment in a three-year follow-up study. Subjects consisted of 20 patients (40 TMJ), 16 females and four males (mean age 33.7 years, range 19-53 years), with severe temporomandibular disorders (TMD) referred to the Oral and Maxillofacial Department at Oulu University Hospital due to skeletal jaw discrepancy. All patients underwent extensive surgical/orthodontic or orthodontic treatment between 1996 and 2003. Clinical stomatognathic examination and MRI examinations were performed before the surgical/orthodontic or orthodontic treatment and one year after the completion of the treatment. The average treatment time was 23 months (range 12-34 months). MRI revealed a marked decrease, especially in the number of TMJ with joint effusion after the treatment. There were only a few changes in the number of diagnosed disk dislocations before and after the treatment. In five joints with anterior disk dislocation with reduction (r-ADD), a change to anterior disk dislocation without reduction (nr-ADD) was found. In 25 of the 40 condyles, the condylar configuration was normal on MRI before the treatment and in 19 condyles one year after the treatment. TMD signs and symptoms according to the Helkimo dysfunction index showed a statistically significant decrease after the treatment.

Poster 252: Preliminary Study of Temporomandibular Joint MRI and CT View After Intraoral Modified Condylotomy for the Treatment of an Anterior Disc Dislocation of the TMJ

The aim of this study was to evaluate the changes in the disc and condyle shape through a review of MRI and CT findings after an intraoral modified condylotomy (no formation of a butt joint, none or less stripping of the medial pterygoid muscle under 3mm) for treating a painful disc dislocation of the TMJ (Wiles Stage II and III). Thirteen sides in 7 consecutive patients with a painful anterior disc dislocation, who were operated on by a single surgeon at the Armed forces Capital Hospital in South Korea, were examined. Preoperatively, 6 patients complained of severe popping bilaterally or unilaterally. All the patients suffered from frequent pain, joint tenderness, intermittent locking, and masticatory muscle pain. A decision was made to perform this procedure after at least 6 months of conservative treatment (behavior, medication, splint therapy, and arthrocentesis). The positions of disc and condyle were inspected 3 times (pre op, post 1 week to 1 month, post 3 month to 6 month) with MRI. From the magnetic resonance imaging view, 11 sides had ADD with a reduction before surgery. In addition, the changes of condylar position and remodeling of the condylar surface were examined. n/a The symptoms of the TMJ showed significant improvement (by VAS) with the disappearance of the popping and intermittent locking. The MRI view showed that all discs had been reduced by the reciprocal movement of the condyle and disc. On the 3D CT view, the deposition of new bone at condylar surface was confirmed in 5 patients. However, one patient with ADD without a reduction (clinically no sounds with mouth opening limitation under 20mm) underwent surgery twice. He showed the relief of his TMJ symptoms but complained of an anterior open bite. The anterior open bite still remained even after the second operation. IVRO is useful of the treatment of TMJ disorder in selective case with severe popping refractory to conservative treatment.

A Michigan-type occlusal splint with spring-loaded mandibular protrusion functionality for treatment of anterior disk dislocation with reduction

For treatment of temporomandibular disorders Michigan-type splints are frequently used, as are mandibular advancement appliances for patients diagnosed with anterior disk dislocation. As both types show good results, the combination of these two mechanisms into one bimaxillary appliance was tested on eight patients where splint therapy had brought reduction but not complete elimination of the symptoms. An existing maxillary Michigan splint was modified so that advancement springs could be fitted and the generated forces were transmitted to a mandibular retainer, which did not interfere with the function of the splint. Treatment progress was monitored with computerized axiography and in all cases the axiographic tracings after the bimaxillary treatment showed no pattern indicative of disk dislocation under normal jaw movements. Myofascial pain symptoms, already improved by the pre-treatment with the Michigan splint, were found to be reduced further or eliminated completely. The approach of retrofitting a Michigan splint with the springs allowed for a versatile appliance, which required no occlusal alteration to the finely adapted splint but could as easily be brought back to the simple splint-functionality either for daytime use or for a period of stabilization of the result after successful treatment. Compliance was found to be very good and the short treatment period, together with the small force levels did not produce any detectable dental side effects.

Influence of Discoplasty and Discectomy of the Temporomandibular Joint on Elimination of Pain and Restricted Mouth Opening

The retrospective study was based on 36 open joint surgeries done in 33 consecutive patients with anterior disc dislocation without reduction with severe signs and symptoms and unsuccessful nonsurgical treatment lasting at least 6 months. The patients underwent either discoplasty or discectomy followed by auricular cartilage graft implantation and were evaluated for amount of interincisal mouth opening, severity of pain on VAS scores preoperatively and as well as 12 months postsurgically. The minimum pain levels were preoperatively 50 on VAS for the discoplasty group and 60 on VAS for the discectomy group. After the surgery, the VAS values lower than 20 were reported on 69.4% of 25 sides (72.7% in the discoplasty group, 68.0% in the discectomy group). Using the cutoff point for maximal interincisal opening of more than 35 mm, only 6 patients (16.6%) fulfilled the criterion at the baseline. Interincisal distance measured vertically 12 months after the operation increased in all but five patients. In three of the five subjects, the opening was at the same level as before the surgery. Almost ninety-one percent of the patients (90.9%) in discoplasty group and 81.8% in discectomy group, respectively reached 35 mm or more of vertical opening after the operation. Applying the 1984 Criteria for classification of postoperative results (AAOMS), 12 months after surgery, 24 patients (72.7%) displayed good results, 6 patients (18.2%) were evaluated with acceptable results, and in 3 cases (9.1%) we observed bad results. Although only short-term evaluation is presented, our findings show that both discoplasty and discectomy are effective methods for surgical treatment of patients suffering from severe temporomandibular pain and limited mouth opening. Discoplasty should be reserved only for patients without severe changes of the disc.

Comparative study of sagittal and coronal MRI of histological disk and temporomandibular joint specimen for examining an identity of anterior disk dislocation and anterior capsular connective tissue

Anterior dislocation of the articular disk of the temporomandibular joint (TMJ) found by MRI tomography often presents a problem. It may persist in MRI despite improvement of articular symptoms and even be found in healthy persons free of any symptoms. Can this be explained by the similarity in structure of the anterior connective tissue of the disk and capsule and their pathological changes? Is a second coronal plane required for MRI investigation? The preauricular regions of 72 patients of the TMJ clinic were examined by oblique-sagittal and oblique-coronal MRI. A Siemens-Vision MRI was used. It was also possible to prepare 10 articular disks of the TMJ with anterior capsular tissue as well as 20 complete TMJs of adults from autopsy material. Sagittal, transversal, and horizontal serial sections were examined histologically. In 49 of the 72 cases examined, an anterior dislocation without reduction found in the sagittal MRI was not confirmed in the oblique-coronal MRI. In the sagittal MRI it was possible to differentiate three, in the coronal MRI six typical forms of magnetic resonance signals, which are represented in figures. They are compared with anatomical and histological connective tissue findings adjacent to the TMJ. The structural similarity of the disk and anterior capsular tissue of the TMJ is demonstrated. The close connection of the disk and connective tissue surrounding the TMJ makes differentiation of MRI findings difficult especially following regressive and adaptive reactions. In MRI, anterior capsular tissue is able to simulate dislocation of the disk. Pathological tissue reactions may alter the MRI signal and lead to the wrong diagnosis of dislocation of the disk. Diagnosis of an anterior disk dislocation cannot be established solely on the basis of oblique-sagittal MRI findings.

Anterior disc displacement without reduction in the temporomandibular joint: MRI and associated clinical findings.

To determine the value of MRI in temporomandibular joint (TMJ) disorders, the data of MRI-proven anterior disc dislocation without reduction (ADWOR) were correlated with clinical history and clinical data. MRI demonstrated degenerative bony changes and a reduced sagittal diameter of the condyle, a variable degree of disc deformation, and a thinned bilaminar zone in each of the joints with ADWOR, which clearly differed from patients with anterior disc dislocation with reduction (ADWR) (P = .01) and normal disc position (NDP) (P < .001). Of 59 patients and 83 TMJs that had been investigated in a 2-year period, as shown by MRI, 22 patients (27 TMJs) had ADWOR (32%), 16 joints had NDP (19%), and 40 patients had ADWR (49%). In patients with ADWOR, the clinical history revealed pain in either of the joints and/or cervical or masticatory muscles in 25 (93%) joints. Clinical investigation revealed various abnormalities in 22 joints; five of those presented without any pathologic clinical finding. Mouth opening was unlimited in nine patients (47%), palpation of the muscles of mastication was painless in 13 patients (52%), and joint noises during mouth opening or closing were noted in 14 patients (56%). According to clinical histories, four patients were suspected to have become symptomatic only after dental treatment. ADWOR is difficult to diagnose with clinical methods alone. The indication for MRI evaluation of the TMJ should be extended for asymptomatic patients with a history of limitation in mouth opening and pathologic x-ray morphology of the condyle. Because symptoms may arise after dental treatment in these patients, aggravation of internal derangement may be avoided by careful handling.

Long-term results of surgical intervention on the temporomandibular joint.

Between 1973-1987, 40 patients (51 joints) underwent 71 surgical procedures on the temporomandibular joint (TMJ). Indications for surgery included painful TM dysfunction, not alleviated by conservative treatment of at least 12 months' duration, or complete anterior disk dislocation not responding to conservative treatment for three to six months. The incidence of surgical treatment in the period 1983-1987 was 4.1% in a group of 679 patients. The mean follow-up is 5.8 years (range 1-15 years). At the follow-up examination (37/51) 72.5% of the treated joints appeared to have an excellent or good result; however, 14/51 joints had one or more reoperations (= 14/40 patients: 35%). The first surgical procedure on the TMJ resulted in an excellent or good result in 29/51 (57%) joints: 6/14 (= 42.9%) high condylectomies; 5/8 (= 62.5%) high condylectomies with a plication procedure; 15/24 (= 62.5%) plication procedure only; 2/2 silastic implants. After one or more reoperations, these figures improved to 10/14 (71%) high condylectomies, 7/8 (87.5%) high condylectomies with a plication procedure, 17/24 (70.8%) plication procedures. Radiographic changes, including flattening of the condyle, lack of condylar contour, erosion, sclerosis, subcondral cysts, and osteophytes were seen in all (16/16) patients in which a high condylectomy was performed. Out of 22 joints in which only a disk repositioning and plication procedure was performed, only 4/22 showed radiographic changes. The radiographic status was not correlated to the clinical picture at the time of the follow-up examination.

Orthodontic/orthopedic therapy for craniomandibular pain dysfunction. Part A. Anterior disk displacement, review of the literature.

AbstractThe most common symptoms of craniomandibular pain dysfunction (CMPD) include: headaches, myospasms, cephalic and cervical pain, limited range of motion, and joint sounds. More recently, the problem of internal derangement has been brought to light. Internal derangement manifests itself in the clinical symptom of reciprocal clicking (opening and closing clicks). Anterior disk dislocation or displacement and its treatment has remained controversial. Many clinicians believe anterior repositioning of the mandible is indicated, as long as the anterior repositioning is kept to a minimum. This article presents a review of the literature and its application to orthopedic/orthodontic treatment for anterior disk dislocation. The use of various radiographs to monitor and document the treatment changes is also presented. The concept of a therapeutic range extending from concentric to the Gelb position is presented as being the physiological range for the condyle.