Anterior Disc Displacement Without Reduction Research Articles

Morphologic Analysis of Condyle among Different Disc Status in the Temporomandibular Joints by Three-dimensional Reconstructive Imaging: A Preliminary Study

ObjectivesMorphological study is a common approach in the field of anterior disc displacement (ADD) pathology; however, analysis based on three-dimensional reconstructive imaging has not been investigated. This study investigated the association between ADD and the status of the mandibular condyle and articular fossa.MethodsThirty-four patients were divided into three groups: normal articular disc position (NADP), anterior disc displacement with reduction (ADDwR), and anterior disc displacement without reduction (ADDwoR). Multiple grouped comparisons of three different disc statuses were performed by Kruskal–Wallis H test and variance analysis respectively. Receiver-operating characteristic curve was plotted to assess the diagnostic efficacy of the morphological parameters. Multivariate logistic regression analysis was used to investigate the interfering factors of ADD.ResultsThe condylar volume (CV) and condylar superficial area (CSA) in the NADP, ADDwR, and ADDwoR groups exhibited obvious changes (P < 0.05). Both CV and superior joint space (SJS) presented a good diagnostic accuracy for NADP-ADDwoR [area under the curve (AUC)CV = 0.813; AUCSJS = 0.855)], and ADDwR-ADDwoR (AUCCV = 0.858; AUCSJS = 0.801). CSA presented a good diagnostic accuracy for ADDwR-ADDwoR (AUC = 0.813). A multivariate logistic ordinal regression model showed that the CV [odds ratio (OR) = 1.011; regression coefficient (RC) = 0.011, P = 0.018], SJS (OR, 8.817; RC = 2.177; P < 0.001), and medial joint space (MJS) (OR, 1.492; RC = 0.400; P = 0.047) had a significantly impact on the groups.ConclusionCV, CSA, SJS, and MJS were significantly associated with the different disc status, and the condyle in ADD exhibited 3-dimensionally altered dimensions. They could be considered as promising biometric markers to assess the ADD.

The Effect of Disc Displacement on Temporomandibular Joint Morphology in Patients with Disc Displacement

Objective: To examine the morphological properties of temporomandibular joint structures by magnetic resonance imaging (MRI) on patients with and without disc displacement (DD). Methods: Thirty-eight patients with disc displacement and 13 patients without disc displacement were included. Age, gender, and clinical findings such as pain, joint sounds of patients were recorded. The patients were classified as anterior disc displacement with reduction (ADDWR) group, anterior disc displacement without reduction (ADDWoR) group, and control group on MRI. Disc morphology was categorized as biconcave, hemiconvex, biconvex, biplanar, or folded. Condyle morphology was characterized as convex, angled, flat, or rounded. Articular eminence morphology was classified as sigmoid, flattened, box, or deformed. A one-way analysis of variance was used to establish the differences between the values. Results: Biconcave disc and sigmoid articular eminence were the greatest incidence both in ADDWR and control group, folded disc and deformed articular eminence were the most in ADDWoR group. The most frequent types of condyle in DD and control group were flattened and convex, respectively. Statistical difference was found between pain and articular eminence morphology (p=0.02). The statistical difference regarding articular disc (p=0.001) and articular eminence morphology (p=0.02) was determined among the groups. A significant difference between condyle morphology and the presence of self-reported bruxism was detected (p= 0.03). Conclusion: The morphological characteristics of the articular disc and articular eminence are related to DD. It can be said that the morphological changes of temporomandibular joint structures point to DD.

Disc-condyle relationship alterations following stabilization splint therapy or arthrocentesis plus hyaluronic acid injection in patients with anterior disc displacement: a retrospective cohort study.

The objective of this study was to quantitatively evaluate the efficacy of stabilization splint (SS) therapy or arthrocentesis plus hyaluronic acid (HA) injection in the treatment of anterior disc displacement (ADD) through magnetic resonance imaging (MRI). 99 subjects were collected in this study. 46 subjects received SS treatment (SS group), 53 subjects received arthrocentesis plus HA injection (HA group). Joints with anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR) were compared separately. MRI before the beginning of the treatment and after a set of treatment were used for measurement. Disc-condyle relationship and positions of condyles and discs were determined by disc-condyle angles and X-Y coordinates. The disc-condyle angles decreased significantly in the SS group (P < .0001). Whereas no significant change was found in the HA group. Substantial anteroinferior condyle movement was detected in the SS group, slight anterior movement of condyles was discovered in the HA group. Anterior shift of discs position was observed in HA group and joints with ADDwoR in the SS group. SS was effective in improving the disc-condyle relationship in ADD subjects, while significant improvement of disc-condyle relationship cannot be achieved through arthrocentesis plus HA injection.

Evaluation of aggrecan and adipokine levels in temporomandibular joint synovial fluid

The aim of this study was to investigate the effect various mediators in synovial fluid (SF) on the pathogenesis of temporomandibular disorders (TMD) and to evaluate the relationship between clinical and radiological features of temporomandibular joint (TMJ) diseases.Patients who had received SF sample during arthrocentesis because of TMD were included in this study. Clinical and radiological records were evaluated retrospectively. Enzyme-Linked ImmunoSorbent Assay (ELISA) method was used for analysis of aggrecan, adiponectin, resistin, apelin, Vascular Endothelial Growth Factor (VEGF) and Prostaglandin E2 (PGE2) in SFs.59 joints of 41 patients were included in the study. Anterior disc displacement with reduction (ADDwR) was detected in 22 joints, anterior disc displacement without reduction (ADDwoR) was detected in 29 joints and osteoarthritis (OA) in 8. In OA group, PGE2 level was significantly higher than the other groups (p = 0.029). Aggrecan and PGE2 levels were statistically higher in joints with localized pain (p = 0.030, p = 0.029). The aggrecan level was statistically significant higher in patients who had degenerative changes in radiological examinations (p = 0.044). Resistin was correlated with PGE2 and aggrecan (p = 0.011), and apelin showed positive correlation with VEGF (p˂0.001).The detection of aggrecan and adipokines in SF may be a precursor of degenerative joint disease and it should be taken into account that the presence of localized pain in the joint area may be an early sign of degenerative changes.

Assessing Evaluating and Correlating the Clinical Findings of Temporomandibular Joint Pathology with Orthopantomogram and Magnetic Resonance Imaging – A Cross-Sectional Study

Background: Because of the anatomic complexity of the temporomandibular joint (TMJ) clinician cannot arrive at the accurate diagnosis only by clinical evaluation of TMJ hence would require some special imaging methods and techniques which would facilitate the accurate clinical diagnosis. One such imaging method is orthopantomography (OPG) of TMJ. Even though OPG has various limitations, it provides valuable information of TMJ and seems to be the primary choice of imaging modality for the diagnosis of TMJ pathologies. Magnetic Resonance Imaging (MRI) is considered to be the one of the best imaging technology to assess the soft tissue structures surrounding the TMJ and evolved as the best imaging modality for the diagnosis of disc displacement of TMJ. Aim: The aim of the study is to evaluate the clinical findings of the TMJ pathologies and to compare the findings of the OPG and MRI of the TMJ pathologies. Methodology: This is a cross-sectional observational study with comprised of multi-ethnic groups, selected from amongst those attending our dental c. Fifty subjects reporting to the Department of Oral Medicine and Radiology with TMJ pathologies were selected. Radiological bone changes were evaluated for flattening (flat bony contour deviating from normal convex form) and erosion (area of decreased density of cortical bone and adjacent subcortical bone) by OPG. After that, MRI of TMJ been taken and changes in the disk position was recorded with the help of radiologist. Statistical Analysis: Statistical presentation and analysis of the present study were done using the p value and Chi-square test by SPSSV20. Results: Result obtained from our study showed that pain was present in 28 (56%) patients and only 44% patients having chief complain other than pain such as noise in front of ear while mastication or restricted mouth opening [Table 1] Out of 28 patients with a chief complain of pain, 22 patients (78.57%) were having abnormal/flattened condylar head surface but out of 22 patients with a chief complain other than pain 18 patients (81.82%) were having abnormal/flattened condylar head surface [Table 2]. Out of 28 patients with a chief complain of pain, 18 patients (64.28%) were with an shortened condylar neck and also out of 22 patients with a chief complain other than pain 16 patients (72.72%) were having shortened condylar neck. The result showed statistically non-significant (P &gt; O.05) [Table 3]. Results also showed that 40% patients with Anterior Disc Displacement With Reduction (ADDR) and 50% with Anterior disc displacement without reduction (ADDWR) had abnormal condylar head surface [Table 4]. About 47.05% patients with ADDR and 41.17% with ADDWR had abnormal condylar neck [Table 5]. Even though there was a positive correlation between the OPG and MRI findings of the TMJ pathologies with the clinical findings of TMJ pathologies, result was not statistically significant which might be due to the reduced sample size. Conclusion: Based on the observation, it can be concluded that OPG and MRI provide valuable information regarding the temporomandibular disorders (TMD) and can play a key role in arriving at accurate clinical diagnosis of complex TMJ pathologies. It also makes the clinical diagnosis easy by correlating the clinical findings of the TMD with this imaging modality and helps clinician to arrive at the proper diagnosis and treatment plan at the earliest. This type of studies should be done on large scale in future based on specific parameters for early diagnosis and treatment planning for patients suffering with TMD to provide quality treatment to the patients at initial stage.

MRI-Based Assessment of Masticatory Muscle Changes in TMD Patients after Whiplash Injury.

Objective: to investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury, based on magnetic resonance imaging (MRI), and to correlate them with other clinical parameters. Methods: ninety patients (64 women, 26 men; mean age: 39.36 ± 15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results: TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p < 0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r = 0.346, p = 0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p < 0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion: abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying pathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.

Diffusion Tensor Imaging of the Lateral Pterygoid Muscle in Patients with Temporomandibular Joint Disorders and Healthy Volunteers.

ObjectiveThis study aimed to explore the feasibility of functional evaluation of the lateral pterygoid muscle (LPM) using diffusion tensor imaging (DTI) in patients with temporomandibular joint disorders (TMDs).Materials and MethodsA total of 119 patients with TMD (23 male and 96 female; mean age ± standard deviation, 41 ± 15 years; 58 bilateral and 61 unilateral involvements for a total of 177 joints) and 20 healthy volunteers (9 male and 11 female; 40 ± 13 years; 40 joints) were included in this prospective study. Based on DTI of the jaw in the resting state, the diffusion parameters, apparent diffusion coefficient (ADC), fractional anisotropy (FA), λ1, λ2, and λ3 of the superior and inferior heads of the LPM (SHLPM and IHLPM) were measured. Patients with TMD with normal disc position (ND), anterior disc displacement with reduction (ADWR), and anterior disc displacement without reduction (ADWOR) were compared.ResultsPatients with TMD overall, and ADWR and ADWOR subgroups had significantly higher ADC, λ1, λ2, and λ3 in both the SHLPM and IHLPM than those in volunteers (p < 0.05 for all), whereas the ND subgroup only had significantly higher ADC and λ1 (p < 0.001). Meanwhile, significant differences in FA in the SHLPM and IHLPM were found between volunteers and ADWOR (p = 0.014 and p = 0.037, respectively). Among the three TMD subgroups, except for λ3 and FA in the ADWR subgroup, ADWR and ADWOR subgroups had significantly higher ADC, λ1, λ2, and λ3 and lower FA than those in the ND group (p < 0.050). There was no significant difference in diffusion variables between ADWR and ADWOR. In ADWOR, the osteoarthritis group had significantly higher λ3 and lower FA values in the IHLPM than those in the non-osteoarthritis group.ConclusionDTI successfully detected functional changes in the LPM in patients with TMD. The unsynchronized diffusivity changes in the LPM in different subgroups of TMD signified the possibility of using diffusion parameters as indicators to identify the severity of LPM hyperfunction at various stages of TMD.

Evaluation of morphometric and volumetric measurements of temporomandibular joint structures on patients with disc displacement

Introduction: To evaluate the morphometric and volumetric measurements of the temporomandibular joint (TMJ) structures, of healthy, anterior disc displacement with reduction (ADDWR) and anterior disc displacement without reduction (ADDWoR) joints using magnetic resonance imaging (MRI). Material and Methods: Fifty-two TMJs of 38 patients with TMJ disorders and 26 TMJs of 13 healthy patients were evaluated on MRI images. The disc length and volume, the condylar height, width and volume, and the height and inclination of the articular eminence were measured on MRI. A one-way analysis of variance was used to establish the differences between the values with regard to the ADDWR, ADDWoR, and control groups. The differences in the disc volumes of each group with respect to open and closed mouth position statuses were evaluated using the Bonferroni test. Results: The articular disc mean volume was larger in the control group than the other two groups for both the closed and open mouth positions (P

ESTROGEN RECEPTOR 1 POLYMORPHISMS (PVUII AND XBAI) AND TEMPOROMANDIBULAR JOINT INTERNAL DERANGEMENT SUSCEPTIBILITY IN A GROUP OF TURKISH PATIENTS

Ponte Academic JournalFeb 2020, Volume 76, Issue 2 ESTROGEN RECEPTOR 1 POLYMORPHISMS (PVUII AND XBAI) AND TEMPOROMANDIBULAR JOINT INTERNAL DERANGEMENT SUSCEPTIBILITY IN A GROUP OF TURKISH PATIENTSAuthor(s): Ayca Dilara YILMAZJ. Ponte - Feb 2020 - Volume 76 - Issue 2 doi: 10.21506/j.ponte.2020.2.16 Abstract:Aims: Temporomandibular joint internal derangement (TMJ-ID) is the impairment of the metabolic processes in the extracellular matrix of the articular disc causing progressive tissue breakdown. Objective: The aim of this study was to investigate the association of XbaI and PvuII polymorphisms with TMJ-ID and to evaluate susceptibility to the disorder. Methods: Unrelated TMJ-ID patients (age= 31.7±7.9) (n=48; 38 female, 10 male) and healthy controls (age=28.22 ± 5.9) (n=70; 33 female, 37 male) were included in the study. DNA extraction was done by standard proteinase K/phenol-chloroform method. Polymorphisms of the Estrogen receptor 1 gene (ESR1) was investigated by a polymerase chain reaction based restriction fragment length polymorphism assay. Results: TMJ-ID patients, and the subgroups; TMJ-ID anterior disc displacement with reduction (ADDwR) and TMJ-ID anterior disc displacement without reduction (ADDwoR) cases carrying the Pp and pp genotype had a 1.28/1.27, 1.43/1.90 and 1.18/0.81-fold odds ratio (p>0.05), respectively. ESR1 polymorphisms revealed five different genotypes in both the patient and the control groups; PXpx (45.6%/47.05%), PXPX (21.7%/27.9%), pxpx (13.04%/13.2%), PXpX (15.2%/8.83%) and PXPx (4.3%/2.94%). The pxpx genotype had a 2.30 fold odds ratio in women. Conclusion: The results from this study did not confirm susceptibility of VDR polymorphisms to TMJ-ID, however, these variations should be further evaluated in a larger cohort study. Keywords: Temporomandibular joint internal derangement, temporomandibular joint osteoarthritis, anterior disc displacement with reduction, anterior disc displacement without reduction, ERα, ESR1 Download full text:Check if you have access through your login credentials or your institution Username Password

Clinical outcomes of patients with bilateral anterior disc displacement without reduction and erosive change of the temporomandibular joint after performance of unilateral arthrocentesis and stabilisation splint therapy.

The efficacy of a combination treatment of arthrocentesis and stabilisation splint for patients with bilateral anterior disc displacement without reduction (ADDWoR) and erosive change of the TMJ remains controversial. To evaluate clinical outcomes of patients with ADDWoR and erosive change of the TMJ after performance of unilateral arthrocentesis and stabilisation splint therapy. A retrospective study of 44 patients (37 females, 7 males, mean age of 34years) with bilateral ADDWoR and erosive change of the TMJ were included in this study. Their clinical outcomes before and after arthrocentesis and stabilisation splint therapy were compared. Evaluation criteria were as follows: (a) Maximal mouth opening (MMO); (b) Right and left maximal lateral movement (RLM, LLM) and maximal protrusive movement (PM); (c) Visual analog scale (VAS) pain score during MMO, RLM, LLM and PM; and (d) VAS pain score during palpation of masticatory muscles. Wilcoxon signed-rank test, Mc Nemar test and paired t test were used for statistical analysis. Differences in VAS pain score between arthrocentesis and non-arthrocentesis sites were not statistically significant except MMO and LLM (P<.05) after 6months. Differences in mean VAS pain scores for all variables between before arthrocentesis and 6months follow-up in the arthrocentesis site were statistically significant. (P<.01). Unilateral arthrocentesis on more symptomatic TMJ and subsequent stabilisation splint therapy was highly successful for pain and achievement of normal range of mandibular movements in patients with both ADDWoR and bony change.

Sex-related differences in symptoms of temporomandibular disorders and structural changes in the lateral pterygoid muscle after whiplash injury.

Whiplash injury is an initiating or aggravating factor of temporomandibular disorder (TMD). Although there are sex-related differences in the mechanism of pain perception and pain control, there is a lack of research on differences in TMD after whiplash injury. We aimed to evaluate sex-related differences in the clinical symptoms and magnetic resonance imaging (MRI) findings of patients with TMD attributed to whiplash injury. This retrospective, cross-sectional study included 100 patients (50 women; 50 men; mean age, 37.60years) who visited our oro-facial pain clinic with symptoms of TMD after whiplash injury. All patients underwent detailed evaluations for history of trauma, and their clinical and MRI findings were comprehensively assessed. Women with TMD after whiplash injury perceived more pain and presented more tenderness upon palpation than did men with TMD. In addition, women showed higher volume (58% vs 26%) and signal changes (54% vs 20%) in the lateral pterygoid muscle (LPM) and more anterior disc displacement without reduction (ADDWoR) (40% vs 20%) than did men. The presence of ADDWoR (odds ratio, 10.58; P=0.007) and condylar degeneration (odds ratio, 9.30; P=0.015) predicted LPM volume; stressful conditions (beta=1.34; P=0.011) correlated with increased visual analogue scale scores, and sleep problem was associated with an increased palpation index (PI) (beta=0.42; P<0.001) and neck PI (beta=0.49; P<0.001) scores only in women. Our results showed sex-specific differences in pain intensity, distribution of clinical and abnormal MRI findings, and their relationships, and these differences should be considered when treating patients with TMD.

The Effect Evaluation of Functional Appliance Used for Class II Patients With Temporomandibular Joint Anterior Disc Displacement.

Orthopedic functional appliances are usually used to correct patients with retrognathic mandible. However, a part of cases have a trend of relapse after splint treatment. The aim of this study was to explore the role of temporomandibular joint disc position in functional appliance treatment. This study included 8 patients who had 1 joint anterior disc displacement with reduction (ADDWR) and the other joint anterior disc displacement without reduction (ADDWoR) confirmed by magnetic resonance imaging (MRI). Only the ADDWR joint could return to its normal position after wearing the anterior repositioning appliances (ARAs). Condylar morphology, condylar height, and disc length were evaluated 6 months after ARA treatment. The MRI showed that new bone appeared on 7 joints with ADDWR and on 1 joint with ADDWoR. The condylar height has increased 1.4 mm in the ADDWR group, while 0.1 mm shorter in the ADDWoR group. Disc length has increased from 8.5 to 8.7 mm in the ADDWR group and 0.4 mm shorter in the ADDWoR group after wearing the ARA. Our results suggested that it is noneffective of functional appliance used for class II malocclusion adolescents with ADDWoR and only a normal disc-condyle relationship benefits condyle growth by functional appliance. Thus it is important to reposition the disc as soon as possible.

Analysis of the Correlation between Morphology and Kinematics of Anteriorly Displaced TMJ Discs Using Cine-MRI and ARCUSdigma Systems

Background: Studies of mandibular movement trajectories have provided a good understanding of the motion of the condyle but little information on the geometric relationships of the disc because they have not related the movements to anatomic structures. Objective: This study investigated the morphology and kinematic characteristics of the Temporomandibular Joint (TMJ) using Cine-MRI and ARCUSdigma systems. Methods: For this study population, preliminary clinical diagnoses were asymptomatic in 15 cases, unilateral anterior disc displacement with reduction (ADDWR) in 17 cases, and unilateral Anterior Disc Displacement Without Reduction (ADDWoR) in 14 cases. Patients were investigated with Cine-MRI and ARCUSdigma systems during physiological opening and closing of the mouth. Results: In these groups, there were 13 healthy subjects, 19 patients with unilateral ADDWR and 14 patients with unilateral ADDWoR classified by Cine-MRI. (1) To assess morphology by MRI, disc deformities were evaluated as follows: biplanar, rounded, thickening in the posterior band, lengthened and folded. (2) The opening trajectory for healthy subjects was close to the closing trajectory. Conversely, the incisal and condylar trajectories during opening and closing were obviously bounced, deviated or shortened in the ADDWR and ADDWoR groups. The pathway of the kinematic axis was not parallel, and the condylar trajectory had an inflexion. (3) The mean values of the incisal and condylar paths of the ADDWoR group were significantly different from those in the healthy group (P&lt;0.05), whereas there were no significant differences between the ADDWR and the healthy group (P&gt;0.05). Conclusion: This study combined analysis of the condylar pathways and disc-condylar relationship to provide good visualization of morphology and kinematics during jaw movement. This process helps improve our understanding of the complexity of disk-condylar movements in subjects with TMJ internal derangement and may also contribute to our knowledge of the etiology of TMJ internal derangement.

Experimental study on mandibular length and facial symmetry of low estrogen level and anterior disc displacement of temporomandibular joint

This study was aimed at elucidating the changes of mandible symmetry in a rabbit model with low estrogen levels induced by ovariectomy (OVX) combined with temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDWoR). 32 growing rabbits were randomly allocated into 4 groups; OVX group, ADDWoR group, OVX+ ADDWoR group and control group. In OVX and OVX+ ADDWoR groups, bilateral OVX was performed and then the serum level of 17β-estradiol was evaluated every week. In ADDWoR group and OVX+ ADDWoR group, the right TMJ was surgically opened and the disc was displaced anteriorly and the left TMJ was also surgically opened and closed without any manipulation of the disc. All rabbits had CT scan before and at the end of the study and the mandible measurements were performed on the 3D-reconstructed model. The mandible in ADDWoR group was consistently shorter on the right side resulting in a midline shift to the ipsilateral side. While in OVX+ ADDWoR group, the mandibular length of the right side was more shorter than in ADDWoR group, moreover, mandibular deviation was therefore more severe. In OVX group, there was no difference regarding the length of mandible compared to the control group. There was no difference regarding the mandibular length between left and right sides in the control group.

Immunohistochemical expression of TLR-4 in temporomandibular joint dysfunction

Objective Toll-like receptor 4 (TLR-4) is a transmembrane protein involved in the innate immune system and has been implicated in the pathogenesis of temporomandibular joint dysfunction (TMD). The purpose of this study was to histologically examine the level of expression of TLR-4 relative to severity of TMD.Methods Thirty-one human TMJ disc samples were immunostained for TLR-4 and evaluated for intensity of stain. Among the samples, 8 were control samples, 16 were from patients with anterior disc displacement with reduction (ADDwR), and 7 were from patients with anterior disc displacement without reduction (ADDwoR).Results There was no statistically significant difference in intensity of stain between groupings (p = 0.673).Conclusions The results indicate a negative correlation between TMD and the expression of TLR-4.

A Prognostic Nomogram for Postoperative Bone Remodeling in Patients with ADDWoR

This study aimed to establish an effective prognostic nomogram for predicting the probability of postoperative bone remodeling of patients with anterior disc displacement without reduction (ADDWoR). The nomogram was based on a retrospective study on patients underwent surgical approaches for ADDWoR at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University from January, 2007 to January, 2017. A multivariate logistic regression analysis was used to develop variables suitable for probability estimation model. The predictive accuracy and discriminative ability were determined by ROC (AUC-index) and calibration curve. Results were validated using bootstrap resampling with all statistical tests two-sided. 1110 patients were included in the analysis. The probability of postoperative bone remodeling in ADDWoR was 0.51. Six independent prognostic factors including age of onset, nocturnal bruxism, disc morphology, BMD, Wilkes’ classification, and postoperative splint therapy were integrated to construct the nomogram. The probability estimation model showed good discrimination in both internal and external validation with AUC-index of 0.84. The calibration curves for probability of postoperative bone remodeling showed optimal agreement with actual observation. In conclusion, a nomogram was established to provide individual prediction of postoperative bone remodeling for patients with ADDWoR treated by arthroscopy surgery.

Immunohistochemical analysis of IL-1 Receptor 1 in the discs of patients with temporomandibular joint dysfunction

Objective Temporomandibular joint dysfunction (TMD) may affect a patient’s quality of life, and one of the etiologies can be anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDWoR). Interleukin 1 Receptor 1 (IL-1R1) is a membrane receptor that plays an important role on initiating immune and inflammatory response by binding the agonists ligands of IL-1 alpha and IL-1 beta. Therefore, the aim of this study was to evaluate, through immunohistochemical analysis, the association of IL-1R1 with TMD.Methods Thirty-nine human disc samples were collected and composed three different groups: ADDwR (n = 19), ADDwoR (n = 12), and control group (n = 8). The samples were immunostained with IL-1R1 antibody and evaluated on both quantity and intensity of staining.Results There was a statistically significant difference (p < 0.05) between the control and test groups for both quantity and intensity of staining.Conclusion IL1-R1 was associated with ADDwR and ADDwoR in TMD discs of humans.

Incidence of anterior disc displacement without reduction of the temporomandibular joint in patients with dentofacial deformity

The aim of this study was to investigate the incidence of anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ) in patients with dentofacial deformity. Eighty-eight female patients (176 joints) with skeletal class III malocclusion and 33 female patients (66 joints) with skeletal class II malocclusion, with or without anterior open bite and asymmetry, were evaluated. Magnetic resonance imaging (MRI) of the TMJ was used to diagnose ADDwoR. A statistical analysis was performed to examine the relationship between ADDwoR and skeletal structure. ADDwoR was present in 37 of the 66 joints (56.1%) in class II compared to 34 of the 176 joints (19.3%) in class III (P<0.05). In class III, ADDwoR was significantly more common in joints with mandibular asymmetry (24/74; 32.4%) than in joints with open bite (9/62; 14.5%) and joints with open bite and without mandibular asymmetry (1/38; 2.6%). In class II, ADDwoR was significantly less common in joints with mandibular asymmetry and without open bite (1/8; 12.5%). ADDwoR was only observed on the deviated side in both class III and class II with mandibular asymmetry. The prevalence of ADDwoR differed according to the dentofacial morphology.

Association of Temporomandibular Joint Pain According to Magnetic Resonance Imaging Findings in Temporomandibular Disorder Patients

This study investigated the associations between magnetic resonance imaging (MRI) findings and pain in the temporomandibular joint (TMJ). The study included 646 TMJs of 323 consecutive patients with temporomandibular disorders; of these, 222 (34.4%) had TMJ pain whereas 424 (65.6%) had no TMJ pain. MRIs were used to evaluate disc position, osteoarthritis, joint fluid, and bone marrow edema. Internal derangement was classified as normal, anterior disc displacement with reduction, and anterior disc displacement without reduction (ADDWOR); condylar morphology was classified as normal, moderate bony change, and severe bony change.The odds ratio (OR) for each MRI variable for nonpainful versus painful TMJs was computed using logistic regression analysis. Compared with joints with normal disc position, the OR of those with ADDWOR was 2.74 (P<.001) for TMJ pain. Similarly, compared with joints with normal condylar morphology, the OR of those with severe bony change was 4.62 (P=.02) for TMJ pain. In addition, the risk of TMJ pain increased by 2.37 in joints with joint fluid (P<.001) and by 2.34 in joints with bone marrow edema (P=.006). The risk of TMJ pain increased significantly with ADDWOR in combination with severe bony change, joint fluid, and bone marrow edema. These results suggest an association between TMJ pain and ADDWOR, severe bony change, joint fluid, and bone marrow edema. Thus, combining various MRI variables may improve the diagnostic accuracy of TMJ pain.

Physical therapy for temporomandibular joint anterior disc displacement without reduction

Temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDwoR) is a common type of temporomandibular joint disorders. Most patients experience limited mouth opening and joint pain at the same time. The standpoint of physical therapy is the function of the joint instead of the displaced disc. The treatment aims to make symptoms disappeared and joint function regained through 3M techniques, including modality, manual and movement. For ADDwoR patients with limited mouth opening within 2 month, manual therapy may reposition disc and the following splint and movement therapy can maintain disc-condyle relationship. Even so, restoring anatomical relationship is not the end of physical therapy. Enhanced health education and multidisciplinary cooperation are important for successful management of the ADDwoR patients.