Joint Sounds Research Articles

Ultrasound Elastography in Temporomandibular Disorders: A Narrative Review.

A class of intricate musculoskeletal diseases known as temporomandibular disorders (TMDs) affects the temporomandibular joint (TMJ) and its supporting structures. The majority of individuals will at some point in their lives experience some degree of TMD symptoms, as these diseases are highly prevalent in the general population. TMDs are multifactorial and are attributed to various physical and biopsychosocial factors. The TMD patients typically experience preauricular pain, tenderness of masticatory muscles, and joint sounds, and these in turn affect their quality of life. To carry out the appropriate course of treatment, it is critical to make an accurate and timely diagnosis. The TMDs are classified as myofascial pain, internal disc derangement, and degenerative disorders of TMJ. Myofascial pain, which is identified by palpating the affected muscles of mastication and tenderness, is one of the most common findings. The muscles in this condition become stiff due to the contraction of myofibrils and are known as trigger bands. The diagnosis of trigger bands involving the masticatory muscles commonly involving the masseter muscle in myofascial pain to date is subjective, and palpation is the only tool used for its diagnosis. An objective assessment of the masticatory muscles is desirable for accurate diagnosis and treatment planning. Various tools like electromyography and hardness meters have been for assessing muscle stiffness, but their application in TMJ muscle disorders has not yielded valuable results. A novel diagnostic method called ultrasound elastography evaluates muscle stiffness both qualitatively and quantitatively using an elastogram and the muscular elasticity index. In this paper, we will review the ultrasound elastographic techniques utilized for the diagnosis and management of TMDs.

Efficacy of hyaluronic acid in temporomandibular disorders evaluated with diagnostic criteria for temporomandibular disorders (DC/TMD).

The study aimed to retrospectively assess the efficacy of hyaluronic acid (HA) in managing temporomandibular disorders (TMD) using the diagnostic criteria for temporomandibular disorders (DC/TMD). There has been an ongoing debate regarding the effectiveness of HA as a treatment option for TMD, which necessitated a thorough evaluation. The review adhered to PRISMA guidelines conducted across eight different databases, including PubMed, Embase, Web of Science, Cochrane Library, Scopus, ScienceDirect, PsycINFO and CINAHL. The selection criteria included studies that evaluated the efficacy of HA in TMD patients, utilised DC/TMD, and were published in English. Data extraction and quality assessment were performed independently by two reviewers. ROB-2 tool was employed to assess methodological quality of the assessed studies. A total of 10 studies met the inclusion criteria. They demonstrated that HA was effective in improving various symptoms of TMD, such as pain, mouth opening and joint sounds over control group. But on the other end, platelet-rich plasma (PRP) was found to be better than HA intervention in alleviation of TMD symptoms. However, the degree of improvement varied across the studies. Some studies reported adverse effects, but these were typically minor and transient. Risk of bias assessment was low in all the included studies. The findings suggest that HA can be an effective treatment for TMD when evaluated with DC/TMD. However, the variation in effectiveness across studies indicates the need for individualised treatment planning and careful monitoring of adverse effects. Further research is needed to refine the treatment protocols and understand the long-term effectiveness and safety of HA in TMD management.

The Role of Malocclusion and Oral Parafunctions in Predicting Signs and Symptoms of Temporomandibular Disorders-A Cross-Sectional Study.

The aim of this study was to examine to what extent malocclusion and parafunctional habits contribute to the development of signs and symptoms associated with temporomandibular disorders (TMD) in schoolchildren with mixed dentition in Croatia in a sample of 338 children, aged 9 to 15 years. TMD signs and symptoms assessed by the clinician were joint function and pain, masticatory muscles tenderness, range of mandibular motion, and joint sounds. To evaluate subjective symptoms and parafunctions, children and parents were asked about the presence of headaches, jaw locking, temporomandibular joint (TMJ) sounds, pain during mouth opening, or bruxism, as well as parafunctions like biting pencils or nails, chewing hard candies or ice, daily gum chewing, opening bottles with teeth, engaging in jaw play, thumb-sucking, and clenching/grinding teeth. At least one symptom of a TMD was pronounced in 142 participants (42.0%). The most commonly reported parafunction was pencil or nail biting, present in 25.1% of participants. Class II malocclusion increased the likelihood by 2.6 times, pencil or nail biting by 2.34 times, and clenching/grinding teeth by 8.9 times that the subject would exhibit at least one TMD symptom. Every child with mixed dentition should undergo a brief examination of the TMJ, especially in cases of Class II malocclusion, pencil or nail biting, and teeth clenching or grinding, as these have all been identified as significant risk factors that increase the likelihood of experiencing TMD symptoms. This highlights the need for proactive screening and assessment by healthcare providers to reduce the risk and prevalence of TMDs in affected children and ensure timely diagnosis and treatment.

Do symptoms and signs of temporomandibular disorders have an association with breathing pattern: a cross-sectional study on Turkish children and adolescents

BackgroundThis paper aimed to explore the prevalence of temporomandibular disorders (TMDs) signs/symptoms, and to investigate the possible link between signs/symptoms of TMDs and mouth breathing (MB) by evaluating along with other risk factors, in a Turkish subpopulation of children and adolescence.MethodsThis study was conducted with the archival data of the patients who applied with orthodontic complaints. Data on demographic characteristics, family-related factors, systemic status, occlusion, breathing patterns, oral habits, and bruxism were retrieved from the archival records.ResultsNine hundred forty-five children and adolescents with a mean age of 14.82 ± 2.06 years were included in the study. Of the participants, 66% were girls, 60.4% were delivered by C-section, 8.4% of the participants had at least one systemic disease, 9.2% of the participants had allergy, and 4.3% of the participants’ parents were divorced, 18.7% have an oral habit, 6.6% have bruxism, 29.8% have malocclusion and 14.1% have MB. Eight-point-five percent of participants have signs/symptoms of TMD. Among them 2.9% have pain, 3.7% have joint sounds, 1.4% have deflection, and 3.9% have deviation. Evaluation of the risk factors revealed a significant relation between the signs/symptoms of TMD and bruxism (OR 8.07 95% CI 4.36–14.92), gender (OR 2.01 95% CI 1.13–3.59), marital status of parents (OR 2.62 95% CI 1.07–6.42), and MB (OR 3.26 95% CI 1.86–5.71).ConclusionsAccording to the study’s findings, girls and those with bruxism, divorced parents, and MB behavior are more likely to have signs/symptoms of TMD. Age found to have significant effect on the occurrence of the signs/symptoms of TMD alone, but together with other factors the effect of the age is disappeared. Early screening and intervention of MB as well as the signs/symptoms of TMD can help to limit detrimental effects of these conditions on growth, and quality of life of children and adolescents.

Efficacy of TENS Therapy, Therapeutic Ultrasound and Stabilization Splint as an Adjuvant to Pharmacotherapy for Temporomandibular Disorders

INTRODUCTIONThis study aims to assess the effectiveness of adjunctive treatments like transcutaneous electric nerve stimulation (TENS), therapeutic ultrasound (ThUs), and stabilization splint (SS) in combination with pharmacotherapy (PT) in enhancing pain relief, mouth opening, lateral excursion, joint sound reduction, muscle tenderness improvement, and jaw deflection in patients with temporomandibular disorders (TMDs), affecting the temporomandibular joint and masticatory muscles. MATERIAL AND METHODSThe study involved 90 patients divided into three groups. Pharmacotherapy (Tab. Myospaz) was prescribed to all patients, each group received either TENS, ThUs, or SS as adjunctive treatment. Outcomes were measured at baseline and various intervals post-treatment. RESULTSTMDs were more prevalent in younger age group (21-30 years) with female predilection (F:M =2.21:1). Significant differences were observed in pain scores, with TENS and ThUs groups showing greater reductions compared to SS. ThUs demonstrated superior results in mouth opening, while TENS showed better outcomes in lateral excursion and muscle tenderness reduction. CONCLUSIONThis study concluded that both TENS and therapeutic ultrasound effectively reduced pain with therapeutic ultrasound showing better results in improving mouth opening, and TENS demonstrating better results in lateral excursion and muscle tenderness reduction. No significant difference among three groups were found in reducing joint sounds and deviation/deflection.

Internal derangements of the temporomandibular joint

An internal derangement of the temporomandibular joint is described as a deviation in the position or shape of the joint tissues. Such a change is only functionally manifest if it interferes with smooth movements of the jaw joint. There are a number of internal derangements associated with jaw movements in which popping jaw joint sounds can occur. Examples are an anteriorly or posteriorly displaced disc and hypermobility of the condylar head. Although most internal derangements are harmless and only cause minor discomfort to patients, disc displacements can in some cases develop into a clinical problem, for example when there is a limitation of mouth opening (so-called closed lock) or an inability to close the mouth (so-called open lock). Most patients with these conditions do not require any or only conservative treatment.

Dental Attrition and its Association With the Signs and Symptoms of TMJ Dysfunction and Radiographic Condylar Changes – An Observational Study

ABSTRACT To determine the level of dental attrition and its relation to signs of TMJ dysfunction adding to condylar alterations analyzed by conventional TMJ Tomography and to propose the correlation between dental attrition and signs of TMJ dysfunction and condylar changes. Patients for the study were selected from the regular outpatient Department of Oral Medicine, Diagnosis and Radiology, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, with performed criteria. The radiographic examination of TMJ is performed by the PLANMECA OPG machine using the tomographic program. Statistical analysis was performed using a Chi-square test to determine the relation between attrition and temporomandidular disorders [TMD] signs and symptoms. The study group comprises 60 subjects who are having dental attrition, and they are divided into three groups according to their age: Group I, 20-40 age; Group II, 41-60 age; Group III, more than 60 age 80% of the samples had one or more tooth with significant attrition with grades of two or more on a 0-4 scale The prevalence of changes in condylar morphology was more in individuals above 40 yrs (33.33%) as compared to those below the age of 40 with a total prevalence of 41.67%. The most common symptom reported is tooth sensitivity, joint sounds, and muscle tenderness. The last reported are scalloped tongue, buccal mucosa ridging, referred pain, and limitation of mouth opening. Out of the 25 subjects who showed condylar changes, 10 subjects had symptoms of TMD. The symptoms reported are strain in the mouth opening, tenderness in jaw movements, and TMJ clicking sounds. Attrition is not a predictable sign of TMJ dysfunction, yet a finite association was defined between attrition and signs and symptoms of TMJ dysfunction. Studies involving larger samples compared with additional radiographic modalities are recommended.

Impact of professional, recreational and nonsinging on temporomandibular disorders - a comparative study based on a self-assessment questionnaire

BackgroundThis study investigates the relationship between professional and recreational singing on temporomandibular disorders (TMDs) in women compared to a nonsinging control group.MethodsA total of 288 female subjects between the ages of 18 and 45 participated in the self-assessment questionnaire including demographic data, as well as questions on vocal practice and TMDs symptoms. Depending on the singing time per week, the (non)vocalists were assigned to the groups professional (n = 96), recreational (n = 96) and nonsingers (n = 96).ResultsThe TMDs prevalence in professional singers (42%) was higher than that in recreational singers (31%) and noticeably higher than that in nonsingers (25%). The Fisher-Freeman-Halton exact test showed that the differences between the groups were not noticeable (p = .053) but could be formulated as tendencies. The professionals suffered much more from restricted jaw movement (p = .004; OR = 2.718; 95% CI = 1.409–5.242), temporomandibular joint sounds (p < .009; OR = 2.267; 95% CI = 1.264–4.064) and temporomandibular pain (p = .010; OR = 2.333; 95% CI = 1.264–4.308) than nonsingers.ConclusionsSinging might have an enhancing effect on the appearance of TMDs. In particular, professional singers suffered more from self-reported TMDs than recreational singers and nonsingers. In addition to the high level of physical workload if participating in professional singing, the psychosocial impact should be investigated more in further studies. No new treatment strategies resulted from this study, as the etiological significance of singing is still unclear. Knowledge about risk factors for multifactorial TMDs can help practitioners and patients prevent and treat TMDs.

Comparative study of clinical and MRI features of TMD patients with or without joint effusion: a retrospective study

BackgroundThe relationship between joint effusion and temporomandibular disorders (TMD) remains unclear. The purpose of this study was to investigate the correlation among joint effusion, clinical features and MRI imaging features of TMD.MethodsA total of 1532 temporomandibular joints (TMJs) from 766 patients (605 females and 161 males) with the mean age of 31.68 ± 13.71 years from January 2022 to June 2023 were included in the study. Clinical and MRI features were collected and analyzed. Chi-Square test, Spearman correlation coefficient and binary logistic regression analysis were performed.ResultsPatients with joint effusion were significantly older and had smaller value of MIO (p < 0.001). There were significant differences in the distribution of joint sounds (with or without), joint pain (with or without), disc morphology (biconcave, contracture, irregular and lengthened) and disc position between joint effusion group (JE) and non-joint effusion group (NA) (P < 0.05).The odds of having joint effusion were 1.726 higher in patients with joint sounds when compared to those without joint sounds. The odds of having joint effusion were 8.463 higher in patients with joint pain when compared to those without joint pain. The odds of having joint effusion were 2.277 higher in patients with contracture when compared to those with biconcave. The odds of having joint effusion were 1.740 higher in patients with anterior disc displacement with reduction (ADDWR) when compared to those with normal disc position. The prediction accuracy of this model is 74.9%, and the area under curve (AUC) is 79.5%, indicating that it can be used for the prediction and the judgment effect is average.ConclusionsThe results demonstrated that joint sounds, joint pain, contracture, and ADDWR are high risk factors for joint effusion, especially joint pain.Trial registrationThis study was retrospectively registered on 28/03/2022 and endorsed by the Ethics Committee of Affiliated Stomatology Hospital of Guangzhou Medical University (LCYJ2022014).

Does Liquid/Injectable Platelet-Rich Fibrin Help in the Arthrocentesis Treatment of Temporomandibular Joint Disorder Compared to Other Infusion Options? A Systematic Review of Randomized Clinical Trials.

Temporomandibular joint disorders (TMDs) are prevalent musculoskeletal conditions involving pain and dysfunction of jaw mobility and function, which have proven difficult to treat satisfactorily. The present study aimed to assess the effectiveness of a liquid platelet-rich fibrin (i-PRF) infusion during arthrocentesis versus other options using coadjuvant materials to reduce TMD symptoms. A literature search was conducted using PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov for RCTs published before January 2024, comparing i-PRF to any other TMD treatment. This systematic review was registered on PROSPERO (CRD42023495364). The searches generated several recent RCTs that compared i-PRF injection combined with arthrocentesis (AC) to AC-only or AC with platelet-rich plasma (PRP). The outcomes analyzed included measures of pain (visual analog scale, VAS), maximum mouth opening, joint sounds, and MRI-verified changes in joint structure. Across the RCTs, the addition of i-PRF injection to AC resulted in significant improvements in pain relief, joint function, mouth opening, and structural changes compared to AC-only or with PRP over follow-up periods ranging from 6 to 12 months. Current clinical evidence favors using i-PRF as an adjunct to AC rather than AC-only or AC with PRP for the treatment of TMDs. The improvements in subjective and objective outcome measures are clinically meaningful. Still, additional high-quality RCTs with larger sample sizes and longer follow-ups are required to strengthen the evidence base and better define the role of i-PRF in TMD management guidelines.

Accuracy of temporomandibular disorders diagnosis evaluated through the diagnostic criteria for temporomandibular disorder (DC/TDM) Axis II compared to the Axis I evaluations: a systematic review and meta-analysis

BackgroundThe temporomandibular joint (TMJ) is a complex joint that facilitates mandibular movements during speech, chewing, and swallowing activities. The Axis I evaluation of the DC/TMD focuses on assessing physical diagnoses related to TMDs. It includes an assessment of pain and functional limitations, such as jaw opening range, joint sounds, and joint tenderness. The Axis II evaluation of the DC/TMD provides information on the patient’s psychological status and quality of life. This Systematic Review with Meta-Analysis aimed to evaluate the accuracy of Temporomandibular Disorders diagnosis considered through the Diagnostic Criteria for Temporomandibular Disorder (DC/TDM) axis II compared to the Axis I evaluations.MethodsA search was made in PubMed, Web of Science and Lilacs for articles published from the inception until 20 January 2023. We applied the Population, Exposure, Comparator, and Outcomes (PECO) model [1] to assess document eligibility. Only studies that evaluated patients by DC/TMD Axis I and Axis II were considered. Review Manager version 5.2.8 (Cochrane Collaboration) was used for the pooled analysis. We measured the odds ratio (OR) between the two groups (Axis I and Axis II).ResultsFifty-one articles were selected because of the search. Four papers were excluded before the screening: 2 pieces were not in English, and two were reviewed. The remaining 47 articles were selected for the title and abstract screening to evaluate whether they met the PECO criteria. Among these, four papers were established; the overall effect showed that there was no difference in TMD diagnosis between Axis I and Axis II (RR 1.17; 95% CI: 0.80– 1.71; Z:0.82; P = .41), suggesting that there is no difference between Axis I and Axis II.ConclusionIn conclusion, DC/TMD is an effective tool for the diagnosis of TMD. It improves the accuracy of TMD diagnosis, allows for the classification of subtypes, and assesses psychosocial factors that may impact the development or maintenance of TMD symptoms.

Effect of Orthognathic Surgery on Pre-existing Temporomandibular Disorders.

The management of patients with pre-existing temporomandibular disorders (TMDs) undergoing orthognathic surgery remains a subject of ongoing debate. This study aimed to profile these individuals and evaluate the correlation between orthognathic surgery and alterations in TMD indicators and symptoms. We conducted a retrospective cohort investigation involving patients with skeletal malocclusion and established TMDs. Variables of interest encompassed the performance of orthognathic surgery, documented TMDs (including temporomandibular joint (TMJ) sounds, TMJ pain, muscle discomfort, and jaw locking), and patients' self-assessments of TMJ and muscle pain using a visual analog scale (VAS). The primary outcome measures focused on changes in TMD indicators and symptoms. Among the study cohort, 73.4% exhibited skeletal class III malocclusion, while 26.6% presented with skeletal class II malocclusion. Notably, patients classified as skeletal class III were significantly younger than their skeletal class II counterparts (mean age: 23.06±5.37 vs. 26.71±7.33; P=0.034). The most prevalent pre-existing TMD complaint was TMJ sounds (65.5%), followed by TMJ pain (39.1%), muscle discomfort (23.4%), and jaw locking (12.5%). Skeletal class II patients were more likely to experience TMJ sounds compared to skeletal class III patients (88.2% vs. 57.4%; P=0.022). Statistically significant improvements were observed in the VAS assessments among class III patients following surgery. A majority of patients with pre-existing TMDs seeking orthognathic surgery exhibited skeletal class III malocclusion and were younger than those with skeletal class II malocclusion. Importantly, orthognathic surgery was associated with positive changes in TMD indicators and symptoms in these patients.

Feature Aggregation in Joint Sound Classification and Localization Neural Networks

Feature Aggregation in Joint Sound Classification and Localization Neural Networks

Simultaneous Audio Recording and Magnetic Resonance Imaging of the Temporomandibular Joint

Background: Temporomandibular joint disorder is a complex disease requiring multimodal treatment and often a delayed diagnosis. Purpose: The primary objective of this study is to evaluate the feasibility of simultaneously recording joint sounds while obtaining 3-tesla cine-magnetic resonance imaging (3T cine-MRI) of the temporomandibular joint (TMJ). A secondary objective pertains to optimization of a dynamic TMJ imaging protocol to maximize image quality and speed while maintaining synchronicity. Methods: Investigators enrolled four subjects (August 2018 to August 2019) eliciting audible joint sounds during continuous open-close jaw movements during clinical evaluation at the New York University College of Dentistry. A contact fiber-optic microphone (OptiRhythm 4130, Optoacoustics, Yehuda Israel) was utilized to record joint sounds elicited with functional movements during MR dynamic imaging at NYU Langone Health and all data was recorded appropriately. Results: Results of this feasibility study demonstrate the successful integration of audio and 3-Tesla MR imaging for the TMJ in all subjects. This protocol was shown to be well-tolerated by the subjects. A precise correlation of the movement of TMJ structures within cine-MRI images and with audible observations was achieved and assessed by an experienced oral and maxillofacial surgeon and an experienced radiologist. Conclusion: This protocol for simultaneous audio/cine-MRI is a viable tool for studying TMJ health and disease. In future studies, we anticipate this protocol will ultimately refine our understanding of TMJ sounds and their relation to anatomy, physiology, and pathology. In addition, we hope to establish a diagnostic aid to guide surgical and non-surgical decision-making more precisely.

Prevalence and Clinical Characteristics of Temporomandibular Disorders in Adults: An Epidemiological Study in the Mediterranean Region of Turkiye

The prevalence and clinical characteristics of temporomandibular disorders (TMD) in the Mediterranean region of Türkiye have not yet been thoroughly investigated. Objective: This study aimed to determine the prevalence and severity of TMD in a sample of the population in this region and to characterize the clinical findings related to TMD. Methods: Four hundred and one participants were included in this study. “Presence of TMD” in the participants was evaluated using the Fonseca Anamnestic Index. Through clinical examination, the findings in the participants were classified as limited mouth opening, deviation, temporomandibular joint (TMJ) sounds, TMJ pain, and muscle pain. Results: The prevalence of TMD was found to be 66.8%, with “Mild TMD” being the most frequent diagnosis among the participants. Clinical findings related to TMD were detected in 48.6% of the participants, and TMJ sounds were the most common clinical finding. TMD was most commonly found in participants over the age of 52, and clinical findings related to TMD were most common in participants between the ages of 25 and 38. In addition, a relationship was found between “Presence of clinical findings” and the gender and age of the participants (p &lt; 0.001 for both comparisons). Conclusion: The results show that females may be more prone to TMD than males. During clinical examinations, it should be considered that “Presence of clinical findings” may be related to gender and age.

Hubungan antara kebiasaan parafungsional dan gangguan temporomandibula pada anak usia remaja (Kajian terbatas di Jakarta)

Background: Temporomandibular disorders (TMD) are musculoskeletal disorders involving the temporomandibular joints, masticatory muscles, and associated structures. The etiology of temporomandibular disorders is complex and multifactorial. Parafunctional activities are considered main factors that are associated with TMD. Objective: To examine the association between parafunctional habits and temporomandibular disorders in adolescence. Methods: An analytical observational study with a cross-sectional design was carried out on 443 children (236 men and 207 women) aged 12-13 years. The data obtained consisted of univariate and bivariate data on parafunctional habits and temporomandibular disorders based on the results of the adolescent’s questionnaire V.2. The data were analyzed by Chi-square test. Result: Bivariate analysis showed a significant association (p &lt;0.05) between sleep clenching and awake clenching with temporomandibular pain (p = 0.047 and p = 0.001). A significant association was found between sleep grinding and biting the lips / cheeks habits with joint sounds (click / pop) (p = 0.045 and p = 0.020). Analysis of the association between sleep grinding and sleep clenching with limited jaw motion also showed a significant association (p = 0.014 and p = 0.004). Conclusion: There are associations between clenching and temporomandibular pain; sleep grinding and biting the lips / cheeks with joint sounds (click / pop); and between sleep bruxism and limited jaw motion.

Persistent myogenic temporomandibular disorders: Are navigation-guided botulinum toxin-A injections into the lateral pterygoid muscles effective?

BackgroundBotulinum toxin has proven effective in treating persistent myogenous temporomandibular disorders (M-TMDs) unresponsive to conservative therapies. While the usual injection sites are the masseter and temporalis muscles, the deeper lateral pterygoid muscle (LPM) is often overlooked due to its difficulty of access and the risk of local complications. This study aims to evaluate the effectiveness of botulinum toxin-A injections (BTX-A) in the LPM with MR-guided navigation of patients with persistent M-TMDs. MethodsThis retrospective study enrolled 34 patients suffering from M-TMDs despite conservative therapies with a total of 51 injection sessions. All of them were treated by BTX-A injections in the LPM using MR-guided navigation, masseter and temporalis with clinical guidance. The effectiveness of the treatment was evaluated with measures of maximum pain-intensity scores of breakthrough and background pain, maximal interincisal mouth opening (MIO), and the presence of joint sounds. The assessment was conducted before injections, and subsequently, at 1 and 3 months postoperatively. Adverse events and perception of improvement with the treatment were also reported for each injection sessions. ResultsBTX-A injections in the LPM significantly improved pain scores intensity with a reduction of 65 % and 49 % respectively at the 1- and 3-month follow-ups, with peak effectiveness at 1 month. This study showed also a statistically significant improvement in mean MIO at 3 months post-injection and a decrease in joint sounds with persistence in 9,7 % of cases at 3-month follow-up compared to 41,2 % at baseline. No significant adverse events were observed. Patients treated with BTX-A injections in the LPM had a subjective complete improvement in their perception of treatment efficacy in 63 % of cases at the end of the follow-up period. ConclusionsThis study reports clinical experience on the use of MR-guided navigation to perform accurate, reliable, and safe BTX-A injections in the LPM. Although our results appear to be encouraging regarding symptom improvement of patients suffering from persistent M-TMDs, this approach may not be feasible as a primary standard procedure for managing M-TMDs. Further research is necessary to explore potential reproducible, safe, and cost-effective alternatives to enhance the accessibility of the LPM in clinical practice.

Enhancing strength and metallurgical soundness of dissimilar Al-steel FSSW joints through novel exit hole refilling technique

This study employed a novel technique of refilling exit hole in dissimilar Al-steel FSSW joints. Aluminum filler wire bits were utilized to replenish the metal for exit hole refilling. Refilling and restirring of the aluminum filler were performed using a pinless tool to compact the filled-up material. The resulting refilled joint was then examined to assess its metallurgical integrity and compared to a conventionally fabricated FSSW joint. The refilled metal exhibited strong adhesion to base metal plates and was free from cracks and voids. Furthermore, the joint strength achieved in this study surpassed the findings reported in contemporary research.

Comparison of the efficacy of occlusal splint and botulinum toxin therapies in patients with temporomandibular disorders with sleep bruxism.

This study aims to evaluate the efficacy of occlusal splint and botulinum toxin (BTX) therapies for improving the pain scores and mouth opening in patients with temporomandibular disorders (TMD) with sleep bruxism (SB). Aretrospective cohort study was conducted based on clinical record reviews of patients with TMD symptoms (e.g., temporomandibular joint [TMJ] pain, masticatory muscle pain, TMJ internal derangements, joint sounds, and limited mouth opening) and SB. The patients were divided into two groups: occlusal splint group and BTX group. Maximum unassisted mouth opening (MMO) and pain score on avisual analogue scale (VAS) before treatment and at 1‑, 3‑, and 6‑month follow-up were analyzed to evaluate the clinical outcomes. Atotal of 60patients (49women and 11men, mean age 34.63 ± 11.85 years) were enrolled. Each group had 30patients. The comparisons of the groups at 1and 3months after treatment indicated that the BTX group had higher MMO values (P = 0.013 and 0.034, respectively) and lower VAS scores than the occlusal splint group (P = 0.000 and 0.001, respectively). No difference between the two groups was observed 6months after treatment (P > 0.05). Both occlusal splint and BTX treatment methods were successful in treating TMD with SB. BTX provided patients with rapid relief in the early period; therefore, BTX can be recommended as aprimary treatment option in patients with greater pain.

Application of Rheumatic Gymnastics Therapy to Address Acute Rheumatic Pain Nursing Problems in the Elderly at Nursing Home: A Case Study

Rheumatism in the elderly occurs due to swollen joints, inflammation or damage caused by damaged joints and tense muscles. These changes include the presence of disease that causes damage to cartilage, degenerative joints and nearby bones, and can cause inflammation of the inner lining of the joint. Complaints that are often felt by someone who has arthritis are pain in the limbs, inflammation of the joints, joint stiffness, joint sounds. The purpose of this scientific work is to overcome the application of rheumatic gymnastic therapy in dealing with acute pain in rheumatic clients. The research method used was a case study through a process of assessment to evaluation of nursing related to acute pain experienced by rheumatism sufferers and given therapeutic interventions by rheumatic gymnastics. Rheumatic gymnastics is an alternative treatment for the health of the elderly body and trains the ability of joint muscles so that they do not experience joint stiffness, rheumatic gymnastics also prevents degenerative growth in aging, facilitates adjustments in health. Therapy was given for 3 days with a duration of 15 minutes, analyzed to find a reduced time in 30 minutes which was carried out at least 2 times in 1 week. And these exercises are very effective and in accordance with the energy released by the elderly. Physical exercise time that is carried out for more than 30 minutes can cause fatigue in the elderly which can cause discomfort. The results of the evaluation of the use of rheumatic gymnastics in reducing the client's acute pain were that after 3 days the evaluation of the client said it was better and in accordance with the outcome criteria where there were complaints of decreased pain. Suggestions for future researchers are expected to be able to develop the theory used and other therapies to reduce client fatigue levels.