Arthrogenous Temporomandibular Disorders Research Articles

Arthroscopic Assessment of Temporomandibular Joint Pathologies-Is It Possible for Non-Specialists in Arthroscopy? Analysis of Variability and Reliability of Dental Students' Ratings after a Comprehensive One-Semester Introduction.

Background: Arthroscopy of the temporomandibular joint (TMJ) plays a long-established role in the diagnostics and therapy of patients suffering from arthrogenic temporomandibular disorders (TMDs), which do not respond adequately to conservative/non-invasive therapy. However, the interpretation of arthroscopic findings remains challenging. This study investigates the reliability and variability of assessing arthroscopic views of pathologies in patients with TMDs by non-specialists in arthroscopy and whether a standardized assessment tool may improve correctness. Methods: Following a comprehensive one-semester lecture, dental students in the clinical stage of education were asked to rate 25 arthroscopic views (freeze images and corresponding video clips) regarding the severity of synovitis, adhesions, and degenerative changes on a scale of 0-10 (T1). The results were compared to ratings stated by two European-board-qualified academic OMF surgeons. In a second round (T2), the students were asked to repeat the ratings using a 10-point rating scheme. Results: With regard to all three subcategories, congruency with the surgeons' results at T1 was at a low level (p < 0.05 in 19/75 cases) and even decreased at T2 after the implementation of the TMDs-SevS (p < 0.05 in 38/75 cases). For both T1 and T2, therefore, the inter-rater agreement was at a low level, showing only a slight agreement for all three subcategories (Fleiss' Kappa (κ) between 0.014 and 0.099). Conclusions: The judgement of the arthroscopic pathologies of the TMJ remains an area of temporomandibular surgery that requires wide experience and training in TMDs to achieve expertise in TMJ arthroscopic assessments, which cannot be transferred by theoretical instruction alone.

Baseline masticatory muscles' performance may predict pain relief in temporomandibular disorders.

To compare masticatory muscles' recruitment in patients with temporomandibular disorders and asymptomatic control subjects. To evaluate if the masticatory muscles' recruitment pattern may predict symptoms' improvement after temporomandibular disorders treatment. Standardized surface electromyography of anterior temporalis and superficial masseters muscles were recorded and compared at baseline in 26 patients with arthrogenous temporomandibular disorders (study group) and 26 asymptomatic subjects (control group). The study group was treated pharmacologically and by means of five arthrocentesis sessions. Pre-, during-, and post-treatment pain and mandibular function were assessed and compared among timepoints. Clinical improvement in terms of pain and mandibular function was correlated with pre-treatment standardized surface electromyography values. Temporomandibular disorders patients showed improved maximum mouth opening and pain during and after treatment with arthrocentesis compared to baseline (T-test p < 0.01). Standardized surface electromyography values were significantly different in temporomandibular disorders subjects compared to controls (T-test p < 0.05). Improvement in pain at rest after treatment was inversely correlated with pre-treatment masseters standardized surface electromyography symmetry (R-coefficient 0.3936; p < 0.05). Temporomandibular disorders patients showed a different muscular recruitment pattern compared to controls. The lesser the pre-treatment masseters symmetry, the greater the improvement of pain at rest after treatment.

Arthroscopic Disc Suturing and Repositioning Technique for Treating Anteriorly Displaced Disc in Temporomandibular Joint Disorders: A Posterior Anchorage Technique

Several treatment modalities have been reported for patients with arthrogenous temporomandibular disorders. The most common temporomandibular disorder is internal derangement, usually accompanied by displacement of the articular disc. Most often anteriorly and medially displaced, patients may develop clicking, impaired jaw function, and pain. Articular disc repositioning has been described as an effective method to eliminate interference during mandibular translation, improving mandibular range of motion, and eliminating pain. In this article, we present a new, simple, and reproducible technique without requiring specific instruments for repositioning and suturing the articular disc with posterior anchorage fixed to the tragus cartilage. It has the advantages of a better anteroposterior vector of traction force, without adverse effects as lateralization of the articular disc and skin depression, commonly presented in other techniques.

Advantages of ultrasound guidance for TMJ arthrocentesis and intra-articular injection: A narrative review.

Ultrasound (US) is a widely available, low-cost, non-invasive, and safe medical imaging method that enables real-time observation. Ultrasound offers several advantages for dentomaxillofacial images, such as portability, the possibility of dynamic and repeated examinations, patient comfort, and availability. It is a useful tool for recognizing the temporomandibular joint (TMJ) structures and their involvement during the course of different pathological processes, such as articular disk displacement, joint effusion and cortical erosion. In addition to its diagnostic use, US has been proposed as an auxiliary tool in minimally invasive procedures for arthrogenic temporomandibular disorders (TMD) to achieve an accurate puncture, recognize joint spaces and reduce surgical trauma. While US is widely used for large joints to visualize internal structures and guide the injection, this technique has only recently gained popularity for the TMJ procedures. Hence, the literature on this topic is scarce. The present review describes the potential advantages and the clinical technique of US guidance for TMJ arthrocentesis and intra-articular injection (IAI).

Are neck pain, disability, and deep neck flexor performance the same for the different types of temporomandibular disorders?

ABSTRACT Objective To evaluate neck pain, disability, and deep neck flexor (DNF) performance of individuals with temporomandibular disorders (TMD). Methods Eighty individuals were divided into the following: arthrogenic TMD (n = 40), myogenic TMD (n = 12), and mixed TMD (n = 28). Neck pain intensity, neck disability, and DNF performance were evaluated. Results Individuals with arthrogenic TMD reported lower intensity of neck pain when compared to mixed TMD (p = 0.01). Individuals with arthrogenic TMD had less neck disability than individuals with myogenic TMD (p = 0.037) and mixed TMD (p < 0.001). A moderate positive correlation was found between neck pain and neck disability (p < 0.001). No differences were found for DNF performance. Conclusion Neck pain and disability differs according to subtype of TMD, but performance of the deep neck flexors does not. Neck pain intensity and neck disability were correlated in patients with TMD.

Static Balance in Participants with Temporomandibular Joint Disc Displacement without Reduction Versus Healthy Participants: A Cross-Sectional Study.

BackgroundThere is no consensus on the association between body posture and temporomandibular disorders (TMDs). This study aimed to assess differences in static balance between healthy participants and patients with temporomandibular joint disc displacement without reduction.Material/MethodsSixteen patients with temporomandibular joint disc displacement without reduction and 14 healthy participants were included. Static balance tests were performed in the rest and “cotton rolls” (participants biting 2 cotton rolls with their upper and lower teeth) mandibular positions. The mean body’s center of gravity (COG) sway velocity was tested in each mandibular position on a firm surface with and without eyes open and on a foam surface with and without eyes open.ResultsThe COG sway velocity did not differ between the TMD and healthy groups regarding mandibular position or testing condition (P>0.05). However, in the control group, the COG sway velocity in the mandibular rest position was significantly higher than that in the “cotton rolls” mandibular position when standing on a foam surface with the eyes closed (P=0.024). In the TMD group, there was no difference in the COG sway velocity between the 2 mandible positions under any condition (P>0.05).ConclusionsThis study provides new evidence for static balance alterations in patients with temporomandibular joint disc displacement without reduction. Further studies are needed to investigate postural control changes in patients with arthrogenous TMDs. This study was registered in the Chinese Clinical Trial Registry (no. ChiCTR1800018369).

INTEGRATED EVALUATION OF ANAMNESTIC DATA IN THE DIFFERENTIAL DIAGNOSIS OF TEMPOROMANDIBULAR DISORDERS AND DISEASES THAT AFFECT THEM

In modern dentistry, temporomandibular disorders (TMD) are the third most common dental disease after caries, its complications and periodontal pathology. Despite the fact that a significant amount of research has been devoted to this problem, the etiology and pathogenesis have still not fully derermined.&#x0D; The aim is to carry out an integrated assessment of anamnestic data in the differential diagnosis of temporomandibular disorders and diseases that affect them and to determine their clinical significance in the diagnosis.&#x0D; Material and methods. 178 patients with suspected temporomandibular disorders were examined who were referred by other medical institutions in Lviv, Lviv region and other regions of Ukraine to the Department of Orthopedic Dentistry of Danylo Halytsky Lviv National Medical University aged 9 to 76 years. 142 female patients and 36 male ones were involved in this examination. During clinical examination and processing of the obtained material, it was identified a number of factors that could affect the occurrence of myogenic, arthrogenic, combined and affected disorders.&#x0D; Results. During clinical examination and processing of the obtained material, a number of factors that could affect the appearance of arthrogenic disorders have been identified. During the method of logistic regression, 13 factors were singled out from among them, which, when combined, have a probable influence on the development of this disorder. Only two of them have a preventive effect (their presence reduces the patient’s risk of arthrogenic TMD): hypermobility of all joints and pain on palpation of the muscles. All other 11 factors have a provocative effect - if they are present, the patient has an increased risk of arthrogenic TMD. Similarly, 11 factors have been identified that, when combined, have a probable effect on the development of myogenic disorder. The values of their regression coefficients are given in table 3. From 11 ones, only three have a preventive effect (their presence reduces the patient’s risk of myogenic TMD): exercise, intubation anesthesia over the past year and a history of rheumatism. All other eight factors have a provocative effect - if they are present, the patient increases the risk of myogenic TMD. Similarly, 17 factors have been identified that, when combined, have a likely impact on the development of a combined disorder. From these 17 factors, only two have a preventive effect (their presence reduces the patient’s risk of combined TMD): exercise and a past history of rheumatism. Other 15 factors have a provocative effect - if they are present, the patient increases the risk of combined TMD. Similarly, 13 factors were identified that, when combined, have a likely impact on the development of this affected disorder. The values of their regression coefficients are given in table 5. From these 13 factors have been analyzed, five ones have a preventive effect (their presence reduces the patient’s risk of affected TMD): limited mouth opening; crunch, click or crepitation on auscultation of the joints; and pain on palpation of the muscles. All other eight factors have a provocative effect - during their presence, the patient increases the risk of affected TMD. Using the method of logistic regression, it has been identified a number of factors that, when they were combined, affect the development of these disorders. It will increase the efficiency of diagnosis of temporomandibular disorders by substantiating clinical and diagnostic criteria and the development of diagnostic complexes in the diagnosis of TMD.

Fabrication of a three-dimensional temporomandibular joint model for arthrocentesis and arthroscopy simulation

Arthrocentesis and arthroscopy are relatively safe treatments for arthrogenic temporomandibular disorders. Hands-on training in both procedures is essential for surgeons to become competent. In this study, a three-dimensional (3D) temporomandibular joint (TMJ) prototype was developed at a relatively low cost, and arthrocentesis and arthroscopy were performed successfully on the model. Despite its limitations, this model is a viable adjunct to TMJ surgical training and can be fabricated easily by any training centre with a 3D printer.

Myogenous temporomandibular disorders and salivary markers of oxidative stress-A cross-sectional study.

BackgroundThe clinical care of chronic pain requires personalised understanding of the mechanisms involved. Temporomandibular disorders (TMD) are the most common chronic orofacial pain conditions, and oxidative stress has been proposed to be implicated in their pathophysiology, especially in arthrogenous TMD. However, few studies have explored oxidative stress in myogenous TMD (TMDM).ObjectiveThe aims of this study were to compare the salivary oxidative stress profiles between individuals with TMDM and healthy controls, and to explore associations of these markers with clinical characteristics.MethodologySaliva samples were collected from 39 individuals with TMDM and 37 age and sex‐matched healthy volunteers. Psychological stress levels and clinical characteristics were assessed in all participants. The samples were analysed for total oxidant status (TOS), total antioxidative capacity (TAC) and superoxide dismutase activity (SODa). Comparisons between groups were performed using parametric and non‐parametric tests depending on data distribution.ResultsPsychological stress was higher in TMDM compared to controls (P < .001). TAC levels were significantly higher (P < .05) whereas TOS levels were significantly lower (P < .05) in TMDM compared to controls. There were no differences in SODa levels between groups and no correlations were found between clinical characteristics and oxidative stress markers.ConclusionIndividuals with TMDM showed higher levels of antioxidative markers, but lower levels of oxidative markers. These results can be explained in part by chronicity and adaptation to the disease and other factors, such as psychological stress. Longitudinal studies must be conducted to clarify the role of oxidative stress in TMDM.

There does not seem to be a most effective treatment for arthrogenous temporomandibular disorders

There does not seem to be a most effective treatment for arthrogenous temporomandibular disorders

Eye Pain in Patients with Arthrogenous Versus Myogenous Temporomandibular Disorder Presenting to An Otolaryngology Clinic.

Abstract Objective: The issue of eye pain in patients with temporomandibular disorders (TMD) had not been previously addressed; specifically, in relation to the two major subgroups of TMD; arthrogenous and myogenous. The present study aimed to compare the incidence and pattern of eye pain in arthrogenous versus myogenous TMD. Methods: The study involved 314 consecutive patients with TMD, prospectively examined over a period of 6 months. These were stratified into 193 patients with arthrogenous TMD and 121 patients with myogenous TMD. The pattern of any eye pain in each patient was studied. Results: Eye pain was present in 78 per cent of TMD patients. It was more commonly encountered in myogenous versus arthrogenous TMD patients. Approximately one-quarter of patients in either group had TMD-related eye pain. Conclusion: Eye pain is significantly associated with TMD. The presence of eye pain augments the morbidity of TMD in patients afflicted with both disorders.

Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials

A network meta-analysis (NMA) of randomized controlled trials (RCTs) was performed to assess the effectiveness of various types of occlusal splint in the management of temporomandibular disorders (TMDs) and to rank them according to their effectiveness. An electronic search was undertaken to identify RCTs published until August 2019. Predictor variables were control, non-occluding splint, hard stabilization splint (HSS), soft stabilization splint (SSS), prefabricated splint, mini-anterior splint, anterior repositioning splint (ARS), and counselling therapy (CT) with or without HSS. Outcome variables were pain improvement, post-treatment pain intensity, improvement in mouth opening, and disappearance of temporomandibular joint (TMJ) sounds. Forty-eight RCTs were included. There was a significant decrease in post-treatment pain intensity in arthrogenous TMDs after ARS (low quality evidence), CT+HSS (moderate quality evidence), mini-anterior splints (very low quality evidence), and HSS alone (low quality evidence), when compared to the control. There was a significant decrease in post-treatment pain intensity in myogenous TMDs with mini-anterior splints (very low quality evidence), SSS (very low quality evidence), CT alone (moderate quality evidence), CT+HSS (moderate quality evidence), and HSS alone (moderate quality evidence), when compared to control. ARS and CT were superior in decreasing TMJ clicking than control and HSS alone. The three highest-ranked treatments for post-treatment pain reduction in arthrogenous TMDs were ARS (92%, very low quality evidence), CT+HSS (67.3%, low quality evidence), and HSS alone (52.9%, moderate quality evidence). For myogenous TMDs, they were mini-anterior splints (86.8%, low quality evidence), CT+HSS (61.2%, very low quality evidence), and HSS alone (59.7%, moderate quality evidence). Based on this NMA of 48 RCTs, there is moderate to very low quality evidence confirming the effectiveness of occlusal splint therapy in the treatment of TMDs. Multimodal therapy consisting of CT+HSS may produce the maximum improvement for TMD patients.

Cervical Muscle Tenderness in Temporomandibular Disorders and Its Associations with Diagnosis, Disease-Related Outcomes, and Comorbid Pain Conditions.

To analyze cervical tenderness scores (CTS) in patients with various temporomandibular disorders (TMD) and in controls and to examine associations of CTS with demographic and clinical parameters. This case-control study included 192 TMD patients and 99 controls diagnosed based on a questionnaire and a clinical examination following the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines. CTS, adapted from the widely used total tenderness score, was the mean sum of the palpation scores from the suboccipital, sternocleidomastoid, and trapezius muscles. Depending on the variables, data were analyzed using Pearson chi-square, analysis of variance, t test, Bonferroni post hoc adjustment, and/or multivariate linear regression analyses. CTS was higher in TMD compared to controls (P < .001). Across TMD subgroups, CTS was notable only in those with a myogenous TMD diagnosis, but not in arthrogenous TMD (P = .014). CTS was positively associated with: female sex (P = .03), whiplash history, higher verbal pain scores, comorbid headaches, body pain, increased pain on mouth opening, and higher masticatory muscles tenderness scores (MTS) (P < .001 for all). Sex (P < .001), MTS (P < .001), comorbid headache (P = .042), and pain on opening (mild: P = .031; moderate: P = .022) retained significant associations with CTS in the multivariate analysis, and these main effects were influenced by interactions with whiplash history and comorbid body pain. CTS differentiated between TMD patients and controls and between TMD diagnoses. Specific patient and pain characteristics associated with poor outcome in terms of CTS included effects of interactions between myogenous TMD, female sex, whiplash history, comorbid body pain and headaches, and pain on opening. It can therefore be concluded that routine clinical examination of TMD patients should include assessment of the cervical region.

Association Between Subjective Tinnitus and Cervical Spine or Temporomandibular Disorders: A Systematic Review.

Movements of the neck and jaw may modulate the loudness and pitch of tinnitus. The aim of the present study was to systematically analyze the strength of associations between subjective tinnitus, cervical spine disorders (CSD), and temporomandibular disorders (TMD). A systematic literature search of the Medline, Embase, and Pedro databases was carried out on articles published up to September 2017. This covered studies in which tinnitus and CSD or TMD were studied as a primary or a secondary outcome and in which outcomes were compared with a control group. Included articles were evaluated on nine methodological quality criteria. Associations between tinnitus and CSD or TMD were expressed as odds ratios. In total, 2,139 articles were identified, of which 24 studies met the inclusion criteria. Twice, two studies were based on the same data set; consequently, 22 studies were included in the meta-analysis. Methodological quality was generally limited by a lack of blinding, comparability of groups, and nonvalidated instruments for assessing CSD. Results indicated that patients with tinnitus more frequently reported CSD than subjects without tinnitus. The odds ratio was 2.6 (95% CI [1.1, 6.4]). For TMD, a bidirectional association with tinnitus was found; odds ratios ranged from 2.3 (95%CI [1.5, 3.6]) for arthrogenous TMD to 6.7 (95%CI [2.4, 18.8]) for unspecified TMD. Funnel plots suggested a publication bias. After adjusting for this, the odds ratios decreased, but associations persisted. There is weak evidence for an association between subjective tinnitus and CSD and a bidirectional association between tinnitus and TMD.

Correlation of gender and age with magnetic resonance imaging findings in patients with arthrogenic temporomandibular disorders: a cross-sectional study

The objective of this study was to analyse the correlation between the gender and age of individuals with arthrogenic temporomandibular disorders (TMDs) and magnetic resonance imaging (MRI) findings. A total of 199 patients were included in the study and were divided into four age groups: group A, ≤30 years; group B, 31–44 years; group C, 45–55 years; group D, ≥56 years. MRI scans were analysed for the presence or absence of the following conditions: morphological changes in the mandibular condyle and/or articular tubercle, disc displacement with (DDWR) and without reduction (DDWoR), bone oedema, effusion, and avascular necrosis. Statistical analyses were conducted using logistic regression models (P<0.05). The mean patient age was 44.47±16.39 years; 158 (79.4%) were female and 41 (20.6%) were male. Only DDWoR was more significantly found in females than in males (P<0.05). Group D showed an odds ratio three times higher for the presence of morphological changes than group A (odds ratio 3.042, 95% confidence interval 1.421–6.512; P=0.0042). No differences were found among groups for the other findings. Based on the results of the present study it may be concluded that MRI findings tend to differ according to age and gender.

Magnetic Resonance Image Evaluation of Temporomandibular Joint Osteophytes: Influence of Clinical Factors and Artrogenics Changes.

This research aims to examine the presence of osteophyte in patients with arthrogenic temporomandibular disorders through magnetic resonance imaging (MRI); to investigate the influence of sex and clinical symptoms in its prevalence; and the position of the osteophytes in the condyle. The study was based on 100 MRI and on reports of patients, which corresponded to the evaluation of 200 joints. Patients of both sexes were aged from 18 to 82 years (average = 49.48) and were subjected to the aforementioned examination from January 2006 to March 2009. The assessment considered the type of disc displacement, the presence of effusion, bone marrow edema, condyle changes, joint noise and pain. The MRI machine used was the GE Signa HDX (General Electric, Milwaukee, WI), with T1 and T2-weighted, 1.5 T magnetic field, sagittal oblique (mouth closed, mouth open) and coronal (mouth closed) imaging, with spherical surface coil and an asymmetric matrix. All images were interpreted by an experienced radiologist. A total of 28% (n = 56) of the temporomandibular joints showed osteophytes on the anterior surface of the mandible. No relationship was found between sex and osteophytes. The authors found a statistically significant difference between osteophytes and disc displacement without reduction (P < 0.001). The presence of osteophytes suggested a possible cause and effect relationship between osteoarthritis and disc displacement without reduction; the osteophyte was always located in the anterior surface of condyle, regardless of the sex variable; no significant difference was found between osteophytes and the main complaints of the patient.

Management of painful temporomandibular joint clicking with different intraoral devices and counseling: a controlled study

Objective The benefit of the use of some intraoral devices in arthrogenous temporomandibular disorders (TMD) patients is still unknown. This study assessed the effectiveness of the partial use of intraoral devices and counseling in the management of patients with disc displacement with reduction (DDWR) and arthralgia.Materials and Methods A total of 60 DDWR and arthralgia patients were randomly divided into three groups: group I (n=20) wore anterior repositioning occlusal splints (ARS); group II (n=20) wore the Nociceptive Trigeminal Inhibition Clenching Suppression System devices (NTI-tss); and group III (n=20) only received counseling for behavioral changes and self-care (the control group). The first two groups also received counseling. Follow-ups were performed after 2 weeks, 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale, pressure pain threshold (PPT) of the temporomandibular joint (TMJ), maximum range of motion and TMJ sounds. Possible adverse effects were also recorded, such as discomfort while using the device and occlusal changes. The results were analyzed with ANOVA, Tukey’s and Fisher Exact Test, with a significance level of 5%.Results Groups I and II showed improvement in pain intensity at the first follow-up. This progress was recorded only after 3 months in Group III. Group II showed an increased in joint sounds frequency. The PPT values, mandibular range of motion and the number of occlusal contacts did not change significantly.Conclusion The simultaneous use of intraoral devices (partial time) plus behavioral modifications seems to produce a more rapid pain improvement in patients with painful DDWR. The use of NTI-tss could increase TMJ sounds. Although intraoral devices with additional counseling should be considered for the management of painful DDWR, dentists should be aware of the possible side effects of the intraoral device’s design.

Surface electromyography and magnetic resonance imaging of the masticatory muscles in patients with arthrogenous temporomandibular disorders.

The purpose of this study was to verify the characteristics of surface electromyography (sEMG) of masticatory muscles in patients with temporomandibular disorders (TMDs) with differing pathology. A total of 24 patients with TMDs were categorized according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD); magnetic resonance imaging (MRI) classified the patients as having disk displacement alone (DD) (mean age, 22 years; SD, 5; 3 men, 6 women) or having osteoarthrosis with or without disk displacement (OA) (mean age, 37 years; SD, 10; 4 men, 11 women); sEMG was performed according to a standardized protocol. The MRI score was significantly correlated to the torque coefficient (r= 0.57) and the temporalis (r= 0.85) and masseter (r= 0.46) muscle standardized symmetry. The discriminating ability of participant age and sEMG scores in separating the 2 groups was assessed by receiver operating characteristic analysis. Each of the sEMG scores showed a significant ability in discriminating between osteoarthrosis and disk displacement. The recording of the masticatory muscle function through sEMG can be a first diagnostic approach to patients with TMDs, reserving MRI assessment to selected cases.

Static body postural misalignment in individuals with temporomandibular disorders: a systematic review.

BACKGROUND: The association between body postural changes and temporomandibular disorders (TMD) has been widely discussed in the literature, however, there is little evidence to support this association. OBJECTIVES: The aim of the present study was to conduct a systematic review to assess the evidence concerning the association between static body postural misalignment and TMD. METHOD: A search was conducted in the PubMed/Medline, Embase, Lilacs, Scielo, Cochrane, and Scopus databases including studies published in English between 1950 and March 2012. Cross-sectional, cohort, case control, and survey studies that assessed body posture in TMD patients were selected. Two reviewers performed each step independently. A methodological checklist was used to evaluate the quality of the selected articles. RESULTS: Twenty studies were analyzed for their methodological quality. Only one study was classified as a moderate quality study and two were classified as strong quality studies. Among all studies considered, only 12 included craniocervical postural assessment, 2 included assessment of craniocervical and shoulder postures,, and 6 included global assessment of body posture. CONCLUSION: There is strong evidence of craniocervical postural changes in myogenous TMD, moderate evidence of cervical postural misalignment in arthrogenous TMD, and no evidence of absence of craniocervical postural misalignment in mixed TMD patients or of global body postural misalignment in patients with TMD. It is important to note the poor methodological quality of the studies, particularly those regarding global body postural misalignment in TMD patients.

Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review

In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ) is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve function in patients who present arthrogenic temporomandibular disorders. This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.