Left Lateral Excursions Research Articles

Clinical effectiveness of polynucleotide TMJ injection compared with physiotherapy: a 3-month randomised clinical trial

Joint visco-supplementation is an effective therapeutic approach against the degenerative signs and symptoms of osteoarthrosis/osteoarthritis of the mandibular condyle. Supplements of choice are usually delivered inside the temporomandibular joint (TMJ) by intra-articular infiltration. The present study aimed to assess the clinical effectiveness of pericapsular injection of polinucleotides (PN) and hyaluronic acid (HA). Sixty patients suffering from TMJ osteoarthrosis were recruited and divided into two groups (test group: n = 30, pericapsular injection; control group: n = 30, self-delivered physiotherapeutic exercises). For each patient, maximum opening, right and left lateral excursion, and visual analogue scale (VAS) scores were recorded at four different timepoints by a blinded investigator. Paired Student’s t tests were used to compare consecutive measurements of the parameters evaluated within the groups, and unpaired Student’s t tests were used for between-group comparisons. All investigated parameters displayed a progressive clinical improvement in both groups, which was more accentuated in the test group. The decrease in VAS score differed significantly between groups (p < 0.0001). Maximum opening showed a continuous increase from baseline (mean (SD) 37.70 (8.33) mm) to T3 (39.68 (7.64) mm), reflecting a progressive improvement, but it was not statistically significant (p = 0.089 at T3 with respect to T0). PN HA pericapsular injection is a minimally invasive treatment that effectively reduces pain and improves mandibular kinematics.

Evaluation of intra-articular injection of injectable platelet-rich fibrin, anterior repositioning splint and arthrocentesis in treatment of temporomandibular joint internal derangement

The current research paper was designed to assess the impact of an intra-articular injection of injectable platelet-rich fibrin (I-PRF) following arthrocentesis and the use of an anterior repositioning splint (ARS) as a proposed treatment approach for addressing symptomatic internal derangement of the temporomandibular joint (TMJ). This study comprised thirty patients who presented with bilateral disc displacement without reduction. The patients were evenly distributed into two groups: Group I underwent treatment involving ARS and arthrocentesis alone, while Group II underwent treatment with ARS, arthrocentesis, and the injection of I-PRF. Clinical assessment of all patients was done postoperatively in the following intervals; first week, first month, third month, and six months for maximum mouth opening (MMO), right and left lateral excursion, and pain score. Magnetic resonance imaging (MRI) assessment for all joints was done at the sixth month postoperatively. Both groups demonstrated improvement in MMO, lateral excursion, and pain. Significant statistical differences were observed in the mean values of MMO and Visual Analogue Scale (VAS), favouring the I-PRF group. MRI postoperatively showed no significant changes in disk position or morphology at the end of the sixth month. Administering an intra-articular I-PRF injection subsequent to arthrocentesis demonstrates effectiveness as a treatment approach for alleviating the signs and symptoms associated with internal derangement of the TMJ.

A prototype smartphone jaw tracking application to quantitatively model tooth contact

ABSTRACT This study utilised a prototype system which consisted of a person-specific 3D printed jaw tracking harness interfacing with the maxillary and mandibular teeth and custom jaw tracking software implemented on a smartphone. The prototype achieved acceptable results. The prototype demonstrated a static position accuracy of less than 1 mm and 5°. It successfully tracked 30 cycles of a protrusive excursion, left lateral excursion, and 40 mm of jaw opening on a semi-adjustable articulator. The standard error of the tracking accuracy was reported as 0.1377 mm, 0.0449 mm, and 0.9196 mm, with corresponding values of 0.98, 1.00, and 1.00, respectively. Finally, occlusal contacts of left, right, and protrusive excursions were tracked with the prototype system and their trajectories were used to demonstrate kinematic modelling (no occlusal forces) with a biomechanical simulation tool.

Comparative effectiveness of low-level laser therapy and transcutaneous electrical nerve stimulation in symptomatic Temporomandibular Disorders: A Randomised Control Trial.

Myofascial pain is one of the most common facial region pains, presenting itself with various signs and symptoms like tenderness of masticatory muscles and difficulty in mouth opening. Considering its multifactorial aetiology various treatment modalities are present. The aim of this study is to compare the effectiveness of transcutaneous electrical nerve stimulation (TENS)and low-level laser therapy (LLLT) for the patients of temporomandibular disorders (TMDS). The study was conducted with 20 patients diagnosed with TMDS. Group A received LLLT at 660 nm, 6 J/point, two sessions/week for 4 weeks and group B received TENS at 2-250 Hz, two sessions/week for 4 weeks. Pain Score decreased and mouth opening increased in both groups with time, however, the difference between the two groups was not statistically significant. Right and left lateral excursions showed improvement at different intervals in both groups. However, the LLLT group showed significant improvement. Clinical trial showed improvement in visual analogue scale (VAS), maximum mouth opening (MMO) and lateral excursion in the different time intervals in both the groups with LLLT showed more improvement with lateral excursions movements.

Impact of Small Incision Reduction and Suture Linked with Functional Appliance of Sufferers with Irrecoverable TMJ Anterior Disc Displacement.

Methods 90 patients with irreducible ADD of TMJ treated from August 2020 to August 2021 were acquired in our hospital. They were randomly divided into control group and trial group randomly. There were 45 patients in each group. The sufferers in the control group were treated with oral drug therapy and small incision reduction and suture, while those in the trial group were treated with small incision reduction and suture linked with functional appliance. The pain score, dysfunction, joint function recovery, facial improvement, and clinical impacts of the two groups were contrasted. Results Compared with that in the control group at 1 week, 4 weeks, and 6 months after therapy, the pain score in the trial group was markedly higher. After therapy, in the two groups, maximum vertical opening (MVO), left lateral excursion (LLE), and right lateral excursion (RLE) levels were markedly higher than those in the control group. The MRI score of the trial group was markedly higher than that of the control group at 1 week, 4 weeks, and 6 months after therapy, and the total effective rate of the trial group was markedly higher than that of the control group. Conclusion The use of small incision reduction and suture linked with functional appliance in the therapy of sufferers with irreducible ADD of TMJ is beneficial to relieve pain, promote the recovery of body function, and contribute to the recovery of joint function.

Efficacy of Botulinum Toxin Type-A I in the Improvement of Mandibular Motion and Muscle Sensibility in Myofascial Pain TMD Subjects: A Randomized Controlled Trial.

This study assessed the effects of botulinum toxin type A (BoNT-A) in mandibular range of motion and muscle tenderness to palpation in persistent myofascial pain (MFP) patients (ReBEC RBR-2d4vvv). Eighty consecutive female subjects with persistent MFP, were randomly divided into four groups (n = 20): three BoNT-A groups with different doses and a saline solution group (placebo control group). Treatments were injected bilaterally in the masseter and anterior temporalis muscle in a single session. Clinical measurements of mandibular movements included: pain-free opening, maximum unassisted and assisted opening, and right and left lateral excursions. Palpation tests were performed bilaterally in the masseter and temporalis muscle. Follow-up occurred 28 and 180 days after treatment. For the statistical analysis the Mann–Whitney U-test with Bonferroni correction was used for groups comparisons. Regardless of dose, all parameters of mandibular range of motion significantly improved after 180 days in all BoNT-A groups, compared with the control group. Palpation pain over the masseter and temporalis muscles were significantly reduced in all BoNT-A groups regardless of dose, compared with the control group, after 28 and 180 days of treatment. Independent of doses, BoNT-A improved mandibular range of motion and muscle tenderness to palpation in persistent MFP patients.

Evaluation of dental occlusion as an etiological factor in temporomandibular joint disorders

Introduction: Temporomandibular joint disorder (TMD) is a musculoskeletal disorder characterized by pain, limited mouth opening, joint sounds, mandibular deviation, and chewing disability. Premature contacts may lead to TMD. Role of dental occlusion as an etiological factor for TMD is still controversial. Aim of this study is to analyze the relationship between occlusion time and clinical symptoms of TMD using digital occlusion scan and analysis systems. Methodology: This observational study included patients of any gender, between 18-35yrs of age with TMD but otherwise healthy. Patients with periodontal disease, systemic inflammatory conditions, bruxism and tooth wear, patients undergoing treatment for TMD, orthognathic surgery and orthodontic therapy were excluded from the study. Occlusion and disocclusion time were the parameters assessed. The total sample size of this study was 30. Result: There is significant difference between study and test groups in occlusion and disocclusion time during centric occlusion, disocclusion time in protrusion, right and left lateral excursion. Conclusion: Occlusal interferences may affect the TMJ and can cause TMD.

Four-dimensional visualization of mandibular movement in the Class III patient before and after combined orthodontic and orthognathic treatment

To analyze the results of jaw motion before and after combined orthodontic and orthognathic surgical treatment in the Class III patient. A 33-year-old male with Class III malocclusion (ANB -2°, Wits -3 mm) was referred for facial deformity and malocclusion. After orthodontic preparation, a bimaxillary mandibular first orthognathic surgery was performed. After bilateral sagittal split osteotomy (BSSO) the lower jaw was shifted on the right for 3 mm right and was cw rotated for 4 mm. Le Fort I osteotomy with segmentation was performed to move the maxilla forward for 6 mm and cw rotate for 4 mm. Four-dimensional visualization of the mandibular movement was made using Planmeca 4D jaw motion system. The valuable quantitative data regarding lower jaw movement and measurement information were exported and analyzed. The maximum aperture during opening-closing movement differ before (38.7 mm) and after surgery (32.1 mm) for 6.6 mm. After surgery horizontal displacement in the maximum left lateral excursion increased by 7.6 mm and in the maximum right lateral side by 4.6 mm. Protrusion increased by 0.9 mm after surgery. Combined orthodontic and orthognathic treatment can improve soft tissue, skeletal, dental relationship, and functional results.

Evaluation of eccentric tooth contact on a semi-adjustable articulator by using an occlusal analysis system

Statement of problemDuplicating mandibular movement with a semi-adjustable articulator has been reported to lack accuracy. However, although previous studies have analyzed articulator movement, few have compared excursive tooth contact on the articulator with tooth contact during actual mandibular movement. PurposeThe purpose of this clinical study was to evaluate the concordance of semi-adjustable articulator contacts with intraoral contacts during eccentric movements by using a T-scan occlusal analysis system. Material and methodsForty-two participants with normal occlusion and without signs of temporomandibular disorder were analyzed for the reproducibility of eccentric tooth contact on a semi-adjustable articulator. Maxillary casts made from irreversible hydrocolloid impressions were mounted on a semi-adjustable articulator with the facebow. The condylar inclination of the articulator was set by using interocclusal records. Three recordings of right and left excursive mandibular movement and protrusive mandibular movement were made in the supine position by using the T-scan v9.1. The same procedure was then performed with the articulator. The results of complete mandibular movement from T-scan measurements were divided into 4 time points for analysis: T0, T1, T2, and T3. The concordance of intraoral and articulator occlusal contacts was evaluated at each point, and the occlusal force for each tooth was compared. Overall concordance and concordance of the working and nonworking sides were also calculated. Repeated measures analysis of variance was used to analyze differences between the concordance of intraoral and articulator contacts according to mandibular movement direction, time, and working and nonworking sides (α=.01). ResultsFor all teeth, concordance between the intraoral and articulator occlusal contacts during excursive mandibular movement was greatest at T0, decreasing at T1 and T2, and increasing at T3. No significant differences were found in the concordance among the right lateral, left lateral, and protrusive excursion (P>.01). The concordance of working side occlusal contacts during lateral excursion was significantly lower at T3 than that at T0 (P<.01). ConclusionsWhen comparing intraoral and articulator contacts during lateral eccentric mandibular movement, concordance was affected by time and working or nonworking side. Reproducibility of initial eccentric tooth contact on a semi-adjustable articulator appeared to be reliable. However, occlusal adjustment of the working side might be required after prosthesis delivery.

Correlation Between Prolonged Nasogastric Feeding and Temporomandibular Joint Dysfunction

Background: Nutrition is administered via enteral feeding in the form of fluid supplements to overcome malnutrition in hospitalized patients, or enteral tubes are intubated into the stomach and small bowel if the patient is unable to feed orally. The most common procedure performed by doctors across all medical specialties is nasogastric intubation. However, it has its own complications such as nasopharyngeal pain, aspiration, and trauma while insertion of the tube, but the impact of prolonged nasogastric tube feeding on temporomandibular joint (TMJ) is unknown. There is paucity of literature focusing on the TMJ; therefore, this study focuses on the correlation of prolonged nasogastric tube feeding and temporomandibular joint dysfunction. Materials and Methods: This was an observational study conducted among 59 participants. Patients undergoing nasogastric feeding for more than a week and having pain during mouth opening and left right lateral excursion were included in the study. Subjects with previous trauma to TMJ were excluded from study. Patients who were unconscious or uncooperative, had previous trauma to TMJ, and had facial surgery were excluded from the study. Result: Multivariate analysis revealed that there was no significant limitation of range of motions (ROMs; mouth opening [P = 0.232, t = 8.800], protrusion [P = 0.315, t = 17.130], right lateral excursion [P = 0.511, t = 16.768], and left lateral excursion [P = 0.5108, t = 18.143]) when compared to the ROMs at the time of insertion of nasogastric tube and 5–14 days after the removal of nasogastric tube. Also, there was significant TMJ pain. Conclusion: The study concludes that there was a significant correlation between duration of intubation and pain in masticatory muscles such as the temporalis and masseter, and medial and lateral pterygoid muscles and weak correlation between prolonged nasogastric intubation and TMJ movements.

Quality of life patients after treatment of mandibular fractures with ORIF in oral surgery departement of Dr. Sardjito general hospital

Management of mandibular fracture using open reduction Internal fixation (ORIF) method is one of the ideal treatments for single and multiple mandibular fractures. The aim of this study was to determine the quality of life of patients after the treatment of mandibular fractures with ORIF using miniplate in single and multiple mandibular fractures. This research used case-control by recalling 43 research subjects in the oral surgery department Dr Sardjito general hospital between 2013 and 2017, that consisted of patients suffering from 23 single fractures and 20 multiple mandibular fractures. Each fracture would be examined clinically and subjectively. Clinical examination parameters were conducted using the mandibular mobility index (MMI) consisting of mouth opening assessment, left and right lateral mandibular excursion, and mandibular protrusive movement. Subjective parameters were performed based on general oral health asseesment index (GOHAI) questionnaire to assess physiological aspects, psychosocial aspects, and pain. The results of the chi-square test statistic study showed that the quality of life of a patient with a single mandibular fracture was better than that of multiple mandibular fractures based on MMI and GOHAI examinations. It was concluded that patients with a single mandibular fracture had a younger age, longer time adaptation and have a better quality of life.

Temporomandibular Disorders and Oral Features in Early Rheumatoid Arthritis Patients: An Observational Study.

Aims: Temporomandibular disorders (TMD) represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. Rheumatoid Arthritis (RA) is an autoimmune polyarthritis characterized by the chronic inflammation of synovial joints and oral implications such as hyposalivation, difficulty in swallowing and phoning, feeling of burning mouth, increased thirst, loss of taste or unpleasant taste and smell, dental sensitivity.The aim of this observational study was to investigate the prevalence of TMD symptoms and signs as well as oral implications in patients with Early Rheumatoid Arthritis (ERA), that is a RA diagnosed within 12 months, compared with a control group.Methods: The study group included 52 ERA patients (11 men, 41 women) diagnosed according to the 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis. A randomly selected group of 52 patients not affected by this disease, matched by sex and age, served as the control group. The examination for TMD signs and symptoms was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) by means of a questionnaire and through clinical examination.Results: Regarding the oral kinematics, the left lateral excursion of the mandible was restricted in statistically significant way in ERA patients (p=0.017). The endfeel values were significantly increased in ERA group (p=0.0017), thus showing the presence of a higher muscle contracture. On the other side, the study group complained less frequently (67.3%) of TDM symptoms (muscle pain on chewing, pain in the neck and shoulders muscles, difficulty in mouth opening, arthralgia of TMJ, tinnitus) than controls (90.4%) (χ2= 8.301 p=0.0039). The presence of TMJ noises was significantly lower in the study group (χ2= 3.869 p=0.0049), as well as presence of opening derangement (χ2= 14.014 p=0.0002).The salivary flow was significantly decreased in the study group respect to the control one (p<0.0001).Conclusions: The data collected show a weak TMJ kinematic impairment, a paucisymptomatic muscle contracture (positive endfeel) and a remarkable reduction of salivary flow in ERA patients. Myofacial pain (MP) evoked by palpation was more frequent and severe in the control group than in the study one, this result being highly significant.

Influence of clinical remounting of complete dentures on occlusion and disocclusion times as indicators of occlusal balance: A computerised occlusal analysis

Background: Occlusal balance in complete dentures is usually achieved by eliminating occlusal discrepancies through selective grinding. The main challenge lies in the accurate detection of the premature contacts to be able to achieve true and proper occlusal balance. There are several ways to detect occlusal errors and premature contacts including the intra-oral clinical assessment methods and remounting procedures. Purpose: Dental literature lacks studies that objectively investigated the accuracy of occlusal adjustment after clinical remounting procedures as compared with that done only by intra-oral assessment using articulating paper. The aim of this study was to quantitatively and objectively assess the influence of clinical remounting on occlusion (OT) and disocclusion (DT) times, as objective indicators of occlusal balance, using computerized occlusal analysis. Methods: This clinical study included 20 completely edentulous patients, 11 males and 9 females (aged 51 to 64, with an average of 57.6 years). Two sets of conventional complete dentures were constructed for each patient with a total of 40 dentures. Occlusal adjustment of 20 denture sets was done based on intra-oral assessment using articulating paper (control group) while occlusal adjustment of the other 20 denture sets was done based on clinical remounting procedures (experimental group). Occlusal parameters including OT, DT during right excursion (DT-Right) and DT during left excursion (DT-Left) were recorded for each set of dentures. Paired t-test was used to statistically analyze and compare the OT, DT-Right and DT-Left values between the two denture groups. A probability value of less than 0.05 was considered statistically significant. Results: The mean recorded OT was 0.48 seconds in the intra-oral method (articulating paper) group and decreased to 0.32 seconds in the clinical remounting group. This decrease was statistically significant. The mean recorded DT was 0.6 and 0.62 seconds for DT-Right and DT-Left respectively in the intra-oral method group. However they decreased to 0.36 and 0.37 seconds in the clinical remounting group. Again this decrease was statistically significant for both right and left lateral excursions. Conclusion: Occlusal adjustment based on clinical remounting procedures is more accurate and achieves more occlusal balance, as represented by shorter occlusion and disocclusion times, when compared to the intra-oral adjustment method using an articulating paper.

Temporomandibular Joint Ankylosis Can Be Successfully Treated With TMJ Concepts Patient-Fitted Total Joint Prosthesis and Autogenous Fat Grafts

To measure and identify factors associated with treatment outcomes for patients with temporomandibular joint (TMJ) ankylosis treated with TMJ Concepts patient-fitted total joint prostheses and autogenous fat grafts. This retrospective cohort study evaluated records of patients with TMJ ankylosis from a single private practice, treated from 1992 to 2011, who met the following inclusion criteria: 1) radiographic evidence of bony ankylosis, 2) limited incisal opening, 3) minimum of 12months' follow-up, and 4) treatment with TMJ Concepts (Ventura, CA)/Techmedica (Camarillo, CA) total joint prostheses and fat grafts. For each patient, the number of previous TMJ surgical procedures, as well as the estimated age of ankylosis onset, age at surgery, and length of postoperative follow-up, was recorded. Subjective evaluations were made with Likert-like scales (from 0 to 10) for 1) TMJ pain, 2) headache and facial pain, 3) jaw function, 4) diet, and 5) disability. Objective evaluations included maximal incisal opening and excursion movements. Nonparametric statistics were used for analysis. There were 32 patients (22 female and 10 male patients) with 48 ankylosed TMJs (16 bilateral and 16 unilateral) in this study, with a mean age of 39years (range, 11 to 68years), 2 or more previous TMJ surgical procedures in 69%, and a mean follow-up period of 68months (range, 12 to 168months). Trauma was the major etiology of TMJ ankylosis, occurring in 17 of 32 patients (53%). The following improvements occurred: The median value for TMJ pain changed from 8.0 preoperatively to 1.5 at longest follow-up; headache, from 8 to 3.5; facial pain, from 8 to 4; jaw function, from 8 to 2.5; diet, from 7 to 3; and disability, from 7 to 1.5. The median incisal opening was 14.5mm (interquartile range, 6.3 to 20mm) preoperatively and 35mm (interquartile range, 30 to 40mm) at longest follow-up. The median left lateral excursion improved from 0.5 to 2mm, and the median right lateral excursion improved from 1 to 1.3mm. All of these improvements were highly significant (P < .001, Wilcoxon tests). Equally favorable outcomes were found in patients with 12 to 48months of maximal follow-up and patients with more than 48months of maximal follow-up. The treatment of TMJ ankylosis with the TMJ Concepts patient-fitted total joint prosthesis in combination with fat grafting around the articulation area of the prosthesis is a viable and predictable method for improving pain levels, function, and quality of life, as well as prevention of reankylosis of the TMJ.

The effect of disocclusion time-reduction therapy to treat chronic myofascial pain: A single group interventional study with 3 year follow-up of 100 cases.

Purpose:The purpose of this study is to evaluate the longevity of reduced disclusion time in treating and removing myofascial pain dysfunction symptoms following the T-Scan-based, immediate complete anterior guidance development (ICAGD) coronoplasty. This measured occlusal adjustment has been shown to reduce the muscle hyperactivity of myofascial pain.Methods:Myofascial pain symptomatic patients were recruited as per the diagnostic criteria for temporomandibular disorders (TMDs), including the clinical protocol and assessment instruments outlined by the international RDC/TMD consortium network (version: January 20, 2014) to assess the efficacy of reduced disclusion time in left and right lateral excursions to resolve the myofascial pain symptoms. As per the inclusion and exclusion criteria, 100 cases were treated with ICAGD in three visits, each 1 week apart. Recall disclusion time measurements were recorded every 3 months over 3 years. The RDC/TMD questionnaire was used for symptom assessment at every recall visit. ICAGD brought pretreatment prolonged disclusion time down to <0.4 s, as quantified from T-Scan force and time data records, while the subjects were assessed for symptom relief. The Wilcoxon signed-rank test was used for statistical analysis (P < 0.05).Results:Changes in the intensity of many symptoms from reducing the disclusion time to <0.4 s were statistically significant from treatment day 1, and onward through the 3-year period of observation (P < 0.05).Conclusion:The results indicate that ICAGD reduces the musculoskeletal symptoms of myofascial pain, such that this methodology increases clinical therapeutic success.

Evaluation of three-dimensional mandibular movements after reconstruction with free fibula flap.

SUMMARYSeven patients who underwent mandibular reconstruction with a fibula free flap (one on the midline, six on either right or left side) and were rehabilitated with implant supported prostheses, performed free mandibular border movements (maximal mouth opening and closing, right and left lateral excursions, protrusion) that were recorded by a non-invasive motion analyser. Temporomandibular joint (TMJ) kinematic parameters were compared to those calculated in healthy control subjects using z-scores. Maximum mouth opening was reduced in all patients, with z-scores ranging from -2.742 to -0.106, and performed with a reduced sagittal plane mandibular rotation. Interincisal point forward movement during protrusion was reduced in all but one patient. Lateral mandibular movements (displacement of the interincisal point) and bilateral condylar movements during mouth opening were very variable and sometimes asymmetrical. Mandibular rotation was also variable, with z-scores ranging from -1.265 to 1.388. Together with mandibular range of motion, we investigated biomechanical characteristics of TMJ motion that can provide further information about the joint without submitting the patient to harmful procedures, and that can be followed-up during healing. The investigation indicates those areas that need to be given special attention in preoperative planning, patient information and rehabilitation.

Jaw mobility changes in patients with upper aerodigestive tract cancer undergoing radiation therapy.

BackgroundRadiation therapy is a therapeutic modality widely used for treatment of upper aerodigestive tract (UADT) neoplasms. However, its action is not restricted to tumor cells, and it may cause a variety of adverse reactions, including reduced jaw mobility.Material and MethodsA prospective cohort study was conducted to assess changes in jaw mobility in patients with UADT cancer undergoing radiation therapy.ResultsFifty-six patients completed the study. The results showed a significant reduction in mouth opening (p<0.001), right lateral excursion (p=0.038) and left lateral excursion (p=0.035) of the jaw, a significant increase in the presence (p<0.001) and severity of oral mucositis (p<0.001), and a significant decrease in performance status (p<0.001) after radiation therapy. Thirty-six patients (64.3%) exhibited reduction in mouth opening after treatment. The variables significantly associated with mouth opening reduction on bivariate analysis were: modification of diet (p=0.037), radiation field (p=0.024), presence of mucositis (p=0.003), and reduction in performance status (p=0.007). After adjustment by the multivariate model, the only variables that remained significantly associated with reduction in mouth opening were presence of mucositis (p=0.018) and reduction in performance status (p=0.47).ConclusionsThese findings indicate that patients with upper aerodigestive tract cancer experience reduced jaw mobility after radiation therapy, which is strongly correlated with mucositis and reduced functional ability. Key words:Head and neck neoplasms, vertical dimension, radiation therapy, mucositis, temporomandibular joint, joint range of motion, trismus.

Effect of Radiation on the Performance of the Stomatognathic System – a Pilot Study

The purpose of this study was to evaluate the Electromyography (EMG), thickness of the masseter and temporal muscles, maximal bite force in individuals with head and neck cancer treated with radiotherapy. The patterns of the muscle activity were evaluated by means of the EMG recordings of the masseter and temporal muscles; bilaterally during the following clinical conditions: rest, protrusion, right and left lateral excursions and Maximum Habitual Intercuspation (MHI). Muscle thickness was evaluated using ultrasound at rest and in MHI. Maximal bite force in the right and left molar regions of 10 fully dentate individuals with head and neck cancer was evaluated after radiotherapy and compared with a control group. The EMG means showed that at rest, protrusion, and left lateral excursion, there were statistically significant differences (p < 0.05). On evaluation with ultrasound, the muscle thickness values were higher for individuals with head and neck cancer at rest and in MIH, with statistically significant results found only for the right temporal during the MIH. Participants with head and neck cancer treatment were evaluated in the present study showed higher electromyographic activity when compared with the control group for all clinical situations. The treatment used with patients undergoing head and neck cancer increased the electromyographic activity, the muscle thickness, and the bite force when compared to control subjects. The results suggest a muscle dysfunction of the stomatognathic system in individuals with head and neck cancer treatment evaluated in the present study.

Effects of Massage Therapy and Occlusal Splint Therapy on Mandibular Range of Motion in Individuals With Temporomandibular Disorder: A Randomized Clinical Trial

ObjectiveThe purpose of this study was to investigate the effects of massage therapy compared with occlusal splint therapy on mandibular range of motion (ROM) in individuals with temporomandibular disorder (TMD) and compare the results with ROM obtained in a group of individuals without this disorder. MethodsA blinded randomized clinical trial was conducted. Twenty-eight volunteers with TMD were randomly distributed into either a massage therapy group or an occlusal splint group. Both treatments were provided for 4 weeks. Fourteen individuals without TMD were consecutively allocated to a comparison group. Fonseca anamnestic index was used to characterize TMD and allocate the volunteers to either of the intervention groups or asymptomatic comparison group. Mandibular ROM was evaluated before and after treatment using a digital caliper. Two-way repeated-measures analysis of variance with a post hoc Bonferroni testing was used for intergroup and intragroup comparisons (level of significance was set to 5%). Cohen d was used to calculate the effect size. ResultsIn the intragroup analysis, significant increases in ROM were found for all measures in both the massage and occlusal splint groups (P < .05). A small to moderate clinical effect of treatment with the occlusal splint was found regarding right and left lateral excursion in comparison with the massage therapy and asymptomatic comparison groups (0.2 <d < 0.5). ConclusionMassage therapy on the masticatory muscles and the use of an occlusal splint lead to an increase in mandibular ROM similar to that of the asymptomatic comparison group with regard to maximum active mouth opening and both right and left excursion in individuals with TMD.

Faculty-supervised measurements of the face and of mandibular movements on young adults.

PURPOSEThe purpose of this study was to determine the average facial proportions and mandibular movement capacity of 316 first-year dental students who carefully recorded them on each other.MATERIALS AND METHODSThis early exacting clinical experience was closely supervised by the authors in Columbus, Ohio during 1969-70. Five vertical and six horizontal distances were measured on each subject's face. An ala-tragus line and an occlusal line were drawn on the left side of the face to determine if these two lines were parallel. Measurements of mandibular movements involved maximum normal and hinge opening at the incisors and maximum amounts of right, left lateral and protrusive excursions of the mandible.RESULTSThe ala width and distance between the tips of upper right and left canine cusps averaged (35.2 mm and 34.8 mm) but with very large individual variations. The distance between ala to occlusal plane lines was 29.9 mm at the tragus and 31.3 mm near the ala. The angle between orbitale and ala-tragus averaged 13.6 degrees.CONCLUSIONThe upper lip length was the most variable and the distance between the pupils was the most stable of the eleven facial measurements. The ala-tragus line and the occlusal plane lines were for all practical purposes parallel. Maximum jaw opening averaged 51.2 mm which was 3.0 times larger than maximal hinge opening of 17.2 mm. The maximum right plus left side jaw excursions (9.2 and 9.4 mm) totaled 18.6 mm, 2.3 times more than the 8.0 mm mean maximum forward protrusion.