Range Of Mouth Opening Research Articles

Comparative analysis of myoelectric activity and mandibular movement in healthy and nonpainful articular temporomandibular disorder subjects.

Temporomandibular disorders (TMDs) are one of the leading causes of craniofacial pain, and a high incidence of TMDs in young adults has been reported. Previous studies have used surface electromyography (sEMG) and mandibular kinematic analysis for TMDs diagnosis. This study aimed to provide normal reference values of sEMG and mandibular kinematics in Han Chinese adults, compare the sex differences and assess their diagnosis value on pain-free articular TMDs. This observational study recruited healthy young adults with individual normal occlusion and nonpainful articular TMDs patients with disc displacement. The sEMG signals of the anterior temporalis (TA), masseter (MM), and sternocleidomastoid and digastric were recorded in the mandibular postural positions (MPP) and during maximal voluntary clenching (MVC) with K7 electromyograph. Mandibular kinematics, including maximum opening and opening/closing velocities, were assessed by K7 kinesiograph. The sEMG reference values ranged from 3.0 to 4.3 µV in the MPP (n = 90) in healthy subjects. The sEMG values during MVC, maximum opening, and opening velocity were significantly higher in males than in females. Also, these indices showed good diagnostic efficiency for pain-free articular TMDs (n = 26). Reference values and sex differences in sEMG and mandibular kinematics in healthy subjects were determined. Compared with them, articular TMDs patients showed significantly lower myoelectric activity during maximal biting and restricted mouth opening range and velocity, which may assist in TMDs diagnosis. By analyzing sEMG of masticatory muscle and mandibular kinematics data from healthy Han Chinese young adults and TMDs patients with disc displacement, this study evaluated the sex difference and their diagnosis value on nonpainful TMDs with disc displacement. NCT06372769.

A 3D-Planned Inward Fragmentation Technique for the Removal of Impacted Mandibular Third Molars: A Case Series.

Background/Objectives: The extraction of impacted mandibular third molars (M3Ms) carries significant risks, especially regarding the inferior alveolar nerve (IAN). This study aimed to evaluate the effectiveness of a 3D-planned inward fragmentation technique (3Dp-IFT) to improve surgical outcomes, reduce complications, and preserve bone structure in cases involving complex M3M impactions. Methods: Twenty-three patients aged between 18 and 36 years requiring M3M removal were included. Preoperative planning involved the use of cone-beam computed tomography (CBCT) for precise localization of the furcation area, followed by the creation of a 3D navigation template using PlastyCAD software version 1.7. The surgical procedure was performed under local anesthesia, with meticulous endoscopic assistance to ensure accurate access and minimize trauma. Postoperative outcomes, such as bone loss, pain, swelling, and mouth opening range, were carefully measured. The data were systematically organized and analyzed descriptively using Microsoft Excel. Results: No disturbances to the IAN or lingual nerve were observed. The mean buccal bone loss was 2.2 mm, with a standard deviation of 1.2 mm. Postoperative pain and swelling were generally low, with significant reductions within the first week. The use of the 3D navigation template significantly improved surgical access, enhancing safety and minimizing complications. Conclusions: The 3Dp-IFT technique represents a significant advancement in the minimally invasive removal of M3M by allowing precise access to critical anatomical areas while minimizing bone loss and postoperative complications. This approach is particularly beneficial for complex cases involving M3M near the IAN, thereby improving surgical safety and patient outcomes.

Effects of different treatments for obstructive sleep apnea on temporomandibular joint: a randomized clinical trial

BackgroundIn recent years, obstructive sleep apnea (OSA) has been increasingly recognized as a significant health concern. No previous studies assessed the effect of recommended treatment modalities of patients with OSA on the temporomandibular joint (TMJ). The current study aimed to evaluate the effect of different treatment modalities of OSA, such as continuous positive airway pressure (CPAP), mandibular advancement device (MAD), and oral myofunctional therapy (OMT) on subjective symptoms, clinical, and radiographic signs of temporomandibular disorders.Patients & MethodsThis hospital-based prospective randomized controlled clinical trial study was approved by the institutional review board and formal patient consent, 39 OSA patients, ranging in age from 19 to 56 after confirmation with full night Polysomnography (PSG) with healthy TMJ confirmed clinically and radiographically with magnetic resonance imaging (MRI) were randomly allocated into three treatment groups. Group 1: 13 patients were managed with CPAP after titration, group 2: 13 patients were managed with digitally fabricated MAD, and group 3: 13 patients were managed with OMT. The following parameters were evaluated before and 3 months after the intervention. Pain using a visual analogue scale (VAS), maximum inter-incisal opening (MIO), lateral movements, and clicking sound of TMJ. MRI was done before and 3 months after the intervention.ResultsOut of the 83 patients enrolled, 39 patients completed the treatment. There were no statistically significant differences in lateral jaw movements or clicking, and no significant difference in MRI findings between the three studied groups before and after the intervention. The OMT group showed a statistically significant difference in pain (p = 0.001), and MIO (p = 0.043) where patients experienced mild pain and slight limitation in mouth opening after 3 months of follow-up in comparison to MAD and CPAP groups.ConclusionCPAP and MAD are better for preserving the health of TMJ in the treatment of OSA patients. While OMT showed mild pain and slight limitation of MIO (that is still within the normal range of mouth opening) compared to CPAP and MAD.Trial registrationThe study was listed on www.clinicaltrials.gov with registration number (NCT05510882) on 22/08/2022.

Transoral endoscopic assisted reduction and internal fixation of mandibular condylar neck fractures with short condylar segment

This study aimed to assess the reliability and safety of transoral endoscopic-assisted reduction internal fixation (TERIF) for treating short-segment condylar neck fractures (CNF), including hardware removal.Patients with displaced CNF and short condylar segments treated using TERIF were included in the study. Clinical evaluation covered dental occlusion, range of mouth opening, deviation during mouth opening, protrusion, laterotrusion, pain, and chewing. Radiological evaluation was used to assess fracture displacement, angulation, head dislocation, postoperative reduction, fixation stability, and bone healing. The same technique was used to treat 15 patients with 18 CNF and short condylar segments. Hardware removal was performed for nine fractures in eight patients after fracture healing using the same approach.All patients regained satisfactory, pain-free mouth opening with no deviation and complete bone healing. Computed tomographic images displayed adequate reduction and stable fixation during the follow-up period for all patients. No temporary or permanent facial nerve impairment occurred in any of the patients.TERIF is a reliable and safe treatment for CNF with short condylar segments, even in the presence of head dislocation, medial override, and malunited fractures; hardware can be safely removed after healing using the same approach.

Quality of life, craniomandibular function, and psychosocial factors related to pain and movement in patients with head and neck cancer.

To describe the characteristics of and the associations between health-related quality of life, pain, craniomandibular function, and psychosocial factors related to pain and fear of movement in patients with head and neck cancer. Seventy-eight patients diagnosed with HNC were recruited. Measurements of the maximum mouth opening range and pressure pain thresholds on the masseter muscle and the distal phalanx of the thumb were conducted, as well as a battery of self-report questionnaires were administrated, including the QoL Questionnaire (EORT QLQ-H&N35), Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), the Spanish translation of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD), and the short version of the Craniofacial Pain and Disability Inventory (CF-PDI-11). The study sample (66.7% men, mean age 60.12 [11.95] years) experienced a moderate impact on their QoL levels (57.68 [18.25] EORT QLQ-H&N35) and high kinesiophobia values (20.49 [9.11] TSK-TMD). Pain was present in 41% of the patients, but only 3.8% reported severe pain. 26.4% had a restricted mouth opening range, and 34.62% showed significant catastrophism levels. There were strong positive correlations between EORT QLQ-H&N35 and CF-PDI-11 (r = 0.81), between NRS and CF-PDI-11 (r = 0.74), and between PCS and CF-PDI-11 (r = 0.66). Patients with HNC experience negative effects in their QoL, related to their impairment in craniomandibular function. Fear of movement, pain intensity, and catastrophism are associated with poorer functionality; relationships that should be considered when attempting to improve health care.

Role of Low-Level Laser Therapy in the Management of Temporomandibular Joint Arthralgia.

To study the efficacy of low-level laser therapy in the management of temporomandibular joint arthralgia. Design Interventional study (pre-post study), Setting Meenakshi Medical College And Hospital, Research Institute. Subjects 50 patients with temporomandibular joint arthralgia were evaluated for pain, mouth opening and clicking sound while mouth opening before and after treatment. Method Patients are subjected to undergo low-level laser therapy with Infrared and red rays with a therapeutic dosage ranging from 8J/cm2 to 15J/cm2 up to 3-5 sessions for a month each session lasts for 15-20min. The patients are to be followed up regularly after 1, 3, 6 and 8months in the study.The study measured the range of mouth opening in patients before and after undergoing low-level laser therapy. Before treatment, the range of mouth opening was from 2.78 to 3.97cm, with a mean value of 2.78cm and a standard deviation of 0.22. After treatment, the range of mouth opening was from 2.78 to 3.97cm, with a mean value of 3.97cm and a standard deviation of 0.24. The study also measured the VAS score for pain, with a mean and standard deviation of 7.9 ± 0.73 before treatment and 0.88 ± 0.718 after treatment. There was a significant difference between the pretreatment and post-treatment VAS scores, with a P-value of 0.05. Low-level laser therapy is an effective non invasive treatment modality for temporomandibular joint arthralgia. The patients who underwent this procedure had symptomatic relief and no remissions were observed.

Effectiveness of Laser Acupuncture for Reducing Pain and Increasing Mouth Opening Range in Individuals with Temporomandibular Disorder: A Systematic Review and Network Meta-Analysis.

Laser acupuncture (LA) demonstrates promising results in the treatment of musculoskeletal disorders. However, its effects on temporomandibular disorder (TMD) are not yet fully understood. Thus, the aim of this systematic review and network meta-analysis was to assess the effectiveness of LA on pain intensity and maximum mouth opening range (MMO) related to TMD. A search was carried out in 11 electronic databases and references of included studies to locate randomized clinical trials (RCTs) that evaluated LA as a primary treatment for TMD. The risk of bias was assessed using the RoB 2 tool. Network meta-analysis was conducted on the MetaInsight platform, considering the pain intensity and counseling (C) as the outcome of reference. The GRADE system was used to assess the certainty of the evidence. Five studies evaluated pain intensity, four with a high risk of bias and one with a low risk. Two studies evaluated pain intensity on palpation (one with high and one with low risk of bias), and one study with high risk of bias evaluated MMO. Laser parameters were: 690-810nm, 40-150 mW, and 7.5-112.5J/cm2. Occlusal splint (OS) [- 2.47; CI 95% - 3.64, - 1.30] and Physiotherapy (PT) [-2.64; CI 95% - 3.94, - 1.34] reduced pain intensity compared to C. The ranking of treatments in order of effectiveness was PT > OS > LA > C > CR (craniopuncture). The certainty of the evidence was very low or low. The data do not support the indication of LA for the treatment of TMDs and new placebo-controlled RCTs must be conducted to demonstrate its effectiveness more precisely.

Ultrasound-guided arthrocentesis for condylar head fracture: a technical report.

Double puncture arthrocentesis (DPA) of the temporomandibular joint (TMD) is considered an effective preservative option for managing mandibular condylar head fractures. However, the procedure is commonly performed by a traditional "blind" method using anatomical characteristics. In the present study, an ultrasonography (US) device was applied for the treatment of a case with a fractured mandibular condyle. A 79-year-old female was diagnosed right side condylar head fracture complaining pain of right TMD and reduced mouth opening range: inter-incisor distance of 20mm. Since the fracture position was high and inoperable, the decision was made to perform DPA of the TMD. The US probe was positioned parallel and slightly oblique to the major axis of the mandibular ramus. Both the posterior and anterior insertions into the joint space were performed according to the axis mentioned above, which enabled the operator to visualize the entirety of the needle. The device offered safety and ensured accuracy by providing real-time visual aid to the surgeon. The procedure provided an early increase in the inter-incisor distance (31mm) and pain relief. Hence, for the preservative treatment of mandibular condylar head fractures, based on the present study, we recommend US-guided arthrocentesis as a safe, feasible, and effective therapeutic option instead of the conventional "blind" method.

Effectiveness of Topical Ozone Gel Application in the Management of Postextraction Wound Healing: An In Vivo Study.

The purpose of the current study was to determine the effectiveness of topical ozone gel application in the management of postextraction wound healing. The current study involved a total of 40 participants. The patients were randomly placed into two groups with sample size estimated as n = 20 in each group. Group A: Control: patients received only saline irrigation and group B: patients receiving topical ozone gel. The surgical procedure was standardized for all groups, and local anesthesia was used during the procedure. After the removal of the mandibular third molar, the control group irrigated the socket with saline, whereas in the study group, the socket was filled with ozone gel. On the first, third, fifth, and seventh postoperative days, a single examiner evaluated each participant for postoperative mouth opening, discomfort, and patient satisfaction. The t-test was used to analyze quantitative data, whereas the Fisher exact test was employed to analyze qualitative data. Statistical significance was defined as a p value less than 0.05. On comparison of patient satisfaction, in the ozone gel group, 13 patients were very satisfied but in the control group, 8 patients were very satisfied. On comparison of pain intensity, on the 5th day, the complete absence of pain patients was more in the ozone gel group (12 patients) compared with the control group (4 patients). There was a statistically significant difference found between these two groups (p < 0.001). On comparison of mouth opening, on the 3rd and 5th day, mouth opening was better in the ozone gel group (29.22 ± 1.28 and 34.06 ± 0.09) compared with the control group (27.38 ± 1.03 and 31.14 ± 0.82), respectively. And there was a statistically significant difference found between these two groups (p < 0.001) on both the days. The current study came to the conclusion that using ozone gel significantly improves postoperative pain, mouth opening range, and promotes faster wound healing. The primary goals of postoperative care for exodontia patients have always been pain management and infection control. The most frequent postoperative consequences are pain and edema. Hence, ozone therapy can be used as an effective topical agent to manage postextraction pain and swelling in healthy patients without the need for excess medications. How to cite this article: Varghese LJ, Lahiri B, Penumatsa NV, et al. Effectiveness of Topical Ozone Gel Application in the Management of Postextraction Wound Healing: An In Vivo Study. J Contemp Dent Pract 2023;24(11):887-890.

Gross, organoleptic and histologic assessment of cadaveric equine heads preserved using chemical methods for veterinary surgical teaching.

Preservation of biological tissues has been used since ancient times. Regardless of the method employed, tissue preservation is thought to be a vital step in veterinary surgery teaching and learning. This study was designed to determine the usability of chemically preserved cadaveric equine heads for surgical teaching in veterinary medicine. Six cadaveric equine heads were collected immediately after death or euthanasia and frozen until fixation. Fixation was achieved by using a hypertonic solution consisting of sodium chloride, sodium nitrite and sodium nitrate, and an alcoholic solution containing ethanol and glycerin. Chemically preserved specimens were stored at low temperatures (2°C to 6°C) in a conventional refrigerator. The specimens were submitted to gross and organoleptic assessment right after fixative solution injection (D0) and within 10, 20, and 30 days of fixation (D10, D20, and D30, respectively). Samples of tissue from skin, tongue, oral vestibule, and masseter muscle were collected for histological evaluation at the same time points. Physical and organoleptic assessments revealed excellent specimen quality (mean scores higher than 4 on a 5-point scale) in most cases. In some specimens, lower scores (3) were assigned to the range of mouth opening, particularly on D0 and D10. A reduced the range of mouth opening may be a limiting factor in teaching activities involving structures located in the oral cavity. The excellent physical, histologic, and organoleptic characteristics of the specimens in this sample support their usability in teaching within the time frame considered. Appropriate physical and organoleptic characteristics (color, texture, odor, and flexibility) of the specimens in this study support the use of the method described for preparation of reusable anatomical specimens.

Global Postural Exercise Program Versus Muscle Energy Technique on Management of Temporomandibular Joint Disorders

Objective: To compare between the effects of global postural exercise program against muscle energy technique on maximum pressure pain threshold, maximal mouth opening range of motion as well as quality of life on patients with temporomandibular joint disorders. Methods: 63 patients having temporomandibular disorders were randomized into three groups; Group (A) were given global postural exercise program in addition to conventional therapy (in the form of LASER and hot packs), Group (B) were given muscle energy technique as well as traditional therapy and the Group (C) control were given traditional therapy only. All patients were examined by the pressure algometer, paquimeter and Arabic version of Oral health impact profile 14 questionnaire as well as the duration of treatment were 6 weeks. Results: there were no significant statistical differences revealed pretreatment for all variables, Mmaximal mouth opening range of motion, quality of life scale, as well as pain) as in mouth opening (P=0.130), OHIP-14 (P=0.642), right temporalis muscles (P=0.384), left temporalis muscles (P=0.930), right masseter muscles (P=0.790), left masseter muscles (P=0.064), right trapezius muscle (P=0.403), and left trapezius muscle (P=0.058) among groups where (P&gt;0.05). While after-treatment and follow up , there were significant statistical differences were P value was (P&lt;0.05), in mouth opening (P=0.0001 and P=0.0001, respectively), OHIP-14 (P=0.0001 and P=0.0001, respectively), right temporalis muscles (P=0.035 and P=0.020, respectively), left temporalis muscles (P=0.0001 and P=0.0001, respectively), right masseter muscles (P=0.001 and P=0.0001, respectively), left masseter muscles (P=0.004 and P=0.035, respectively), right trapezius muscle (P=0.0001 and P=0.0001, respectively), and left trapezius muscle (P=0.031 and P=0.001, respectively) between groups. Conclusion: Both Muscle energy technique and global postural exercise program improved mouth opening, pressure pain threshold, as well as quality of life in temporomandibular joint disorders patients, with the superiority of muscle energy technique over global postural exercise program.

Complications in patients with facial bone fractures before and after conservative and surgical treatment, their comparison and correlation with different factors.

This study aims to determine the occurrence of complications before and after the treatment of facial fractures, as well as the impact of the factors on the treatment results and evaluation of their relationships. This is a prospective case-control study comprising 90 patients aged between 18 and 65 with facial fractures. Depending on the treatment method, patients were divided into three groups: those treated surgically using a transcutaneous approach, those treated surgically using a transmucosal approach, and those treated conservatively (control group). Following complications before and after treatment were compared: malocclusions, paresthesias, facial asymmetry, diplopia, and limited mouth opening. The follow-up period after the treatment of choice was six months. There was a significant reduction in complications after treatment: malocclusion, paresthesia, facial asymmetry, and limited mouth opening. Regarding the transcutaneous approach, there is a substantial reduction in the number of complications after treatment, such as malocclusions (p=0.008), paresthesias (p=0.004), and facial asymmetries (p<0.001). Similar results were obtained for the transmucosal approach. Pain intensity positively correlated with preoperative complications: malocclusion, paresthesias, and facial asymmetry. The range of mouth opening had a negative interdependence with malocclusion before and after treatment with infection, fractura male sanata, malocclusion, paresthesias, postoperative level of mouth opening, and damage to the facial nerve. There is no difference in the reduction of preoperative and postoperative complications related to surgery when an incision is made through the skin or mucosa. Malocclusions, paresthesias, and facial asymmetry are reduced through surgical methods.

The normal range of maximum mouth opening and its correlation with age, gender, height, and weight in Turkish children

ABSTRACT Objective The aim is to measure the maximum mouth opening (MMO) of healthy children between the ages 4 and 18 years. Methods Six hundred seventy-four children between ages 4 and 18 years were included in the study. Individuals with dentofacial anomaly, temporomandibular joint disease, infection, trauma, and rheumatic disease were not included in the study. The MMO of the participants was measured with a vernier caliper. Demographic information such as weight, height, and age was recorded. Results The MMO was calculated to be 46.62 mm in boys and 45.96 mm in girls. The MMO value increased with increasing age. However, no difference was observed in terms of gender in the same age group. Conclusion In this study, normal MMO values between the ages 4 and 18 years were determined. It is to have differences in age group and society-based examinations. For this reason, it is important to know the normal values of each society in terms of age groups.

Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures.

The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.

Postoperative Complications following Open Reduction and Rigid Internal Fixation of Mandibular Condylar Fracture Using the High Perimandibular Approach.

The high perimandibular approach is a feasible surgical technique for treating mandibular condylar fractures with open reduction and internal fixation, followed by fewer complications. Temporary trismus is the only postoperative complication that may occur. This study evaluated postoperative complications following open reduction and rigid internal fixation (OR-IF) of mandibular condylar fractures using the high perimandibular approach. Twenty consecutive patients undergoing OR-IF were included in this study. They included 11 male and 9 female patients, of an average age of 58.5 years, all of whom responded to a follow-up call at least 12 months after the surgery. All patients were evaluated for range of mouth opening, postoperative complications, and radiological findings. A statistical analysis of the relationship between range of mouth opening and related clinical parameters at 6 months postoperative evaluation was conducted. The fracture of the condylar neck was associated with a limited range of mouth opening and longer operation time. However, longer operation time was not associated with a limited range of mouth opening. The high perimandibular approach with OR-IF in mandibular condylar fractures is a feasible and safe technique; however, prolonged surgery and mandibular condylar neck fractures could affect the postoperative range of mouth opening.

The relationship between the facial type and the state of chewing muscles in children with cerebral palsy

Relevance. The modern development of practical dentistry and the emergence of new techniques and methods of diagnosis and treatment determine the necessity and expediency of studying the anatomical features of the head, skull, structure of dental arches, and dental segments in general. Knowledge of the patterns and characteristics of the skull structure and their relationship with morphometric, clinical and functional parameters will allow the diagnosis of various forms of maxillofacial disorders based on comorbidity.Materials and methods. The study examined 30 children aged 6 to 12 y.o. to determine the relationship between the type of face and the state of the chewing muscles in children with cerebral palsy. Maxillofacial anthropometric measurements were made, e.g., the bitragional length (t-t) and the distance between the tragion and subnasale landmarks (t-sn); the gnathic index of the face was calculated, and the mouth opening range was measured. The surface electromyography determined the mean biopotential amplitude of the right and left proper masticatory and temporal muscles using the "bruxism" test.Results. The anthropometric measurement data indicate the prevalence of a brachygnathic facial type in children with cerebral palsy. The electromyographic study data evidence spasticity of the masticatory muscles.Conclusion. The obtained data indicate functional overload of the chewing muscles. Masticatory muscles' hypertonicity determined the brachygnathic facial type in children with cerebral palsy.

Patient experience and satisfaction with different temporomandibular joint treatments: A retrospective study

This retrospective study aimed to evaluate patient satisfaction with different temporomandibular joint (TMJ) treatments. Patients were included in the study according to the following inclusion criteria: 1) arthrogenous and/or myogenous temporomandibular disorders (TMD); 2) Dimitroulis classification category between 1-4; 3) conservative treatment without any improvement at least for 3 months; 4) indication for one of the following TMD treatments: injection of botulinum toxin; arthrocentesis; arthroscopy, and open surgery without alloplastic material; and 5) age ≥16 years. An independent satisfaction questionnaire with 11 queries was applied via phone call to all patients, which included 6 questions using a 10-point Likert scale and 5 yes-or-no questions. The principal outcome was the overall satisfaction with the clinical result of the treatment, and the secondary outcomes were specific satisfaction with the following: 1) pain reduction; 2) range of mouth opening; 3) chewing ability; 4) postoperative recovery; 5) the fulfillment of expectations; 6) treatment choice; 7) treatment recommendation to a friend; and 8) the need for another intervention. Anxiety and depression were also included as variables. Data were analyzed using descriptive statistics, non-parametric Kruskal-Wallis and Spearman rank correlation coefficient tests. A total of 120 patients (mean age 41.20 ± 17.78 years) were enrolled, comprising 109 women (90%) and 11 men (10%). The overall clinical satisfaction of all patients was 8.24 ± 2.23 (mean ± SD), and 97 patients (80.8%) stated that they would repeat the treatment. Patients submitted to TMJ arthrocentesis and arthroscopy had higher overall clinical satisfaction (9.09 ± 0.971 and 9.03 ± 1.13, p = 0.021) followed by open surgery (8.38 ± 1.84). The authors observed three statistically significant correlations: 1) overall clinical satisfaction and patient expectations (r = 0.803; p < 0.0001); 2) overall clinical satisfaction and post-treatment pain (r = −0.299; p = 0.003); and (3) the presence of depression and the need for further TMJ treatment (r = 0.186; p = 0.043). Within the limitations of the study it seems that patient expectations should be addressed ad initium, and the presence of a diagnosis of depression with concomitant TMD must alert the clinical team and patient for the possible need of additional treatment.

Consideration of mouth opening when using positioning stents during radiotherapy for tongue cancer: a retrospective study.

The aim was to clarify the range of mouth opening required to minimize the development of oral mucositis on the palate while using a positioning stent during radiotherapy in patients with tongue cancer. A positioning stent is used to reduce the severity of oral mucositis; however, requirements for fabricating the device have not been standardized. In particular, the range of mouth opening required while using a stent to prevent radiation-induced oral mucositis has not been determined. We retrospectively analyzed medical records and computed tomography (CT) images of nine patients who had undergone radiotherapy for tongue cancer. Irradiation dose for the palate and range of mouth opening while using the positioning stent was calculated from CT images and the radiotherapy treatment planning program. The irradiation dose presented as medians and interquartile range (IQR) for the palate was 1.6 (IQR: 1.1-2.2) Gy with the use of the positioning stent and 37.2 (IQR: 17.5-44.1) Gy without the use of the positioning stent. The range of mouth opening was 19-37 [mean ± standard deviation (SD): 26 ± 5.6] mm, and it correlated with the attenuation amount of irradiation dose to the palate (r = 0.673, p = 0.0467). Regression equation was y = 0.21x + 19. Our study may be useful for deriving the relationship between the attenuation amount of irradiation of the palate with the positioning stent and the amount of mouth opening required for this attenuation.

Establishment of quantitative indicators for an efficient treatment on masticatory muscle pain.

Although several studies have investigated effective treatments for masticatory muscle pain (MMP), no unified conclusion has been drawn regarding the effectiveness of these treatments. This study aimed to define quantitative indicators for predicting the outcome of MMP treatment. In total, patients aged 20-70 years were recruited and divided into the MMP (n = 24) and control (n = 36) groups, based on the presence of MMP according to the Diagnostic Criteria for Temporomandibular Disorders. At pretreatment, the MMP group was assessed using quantitative indicators such as subjective pain levels, pain duration, graded chronic pain scale (GCPS), and perceived stress scale (PSS). Salivary alpha-amylase (sAA) and interleukin-6 (IL-6) levels were analyzed. The masticatory muscle palpation score and the range of mouth opening were measured. At posttreatment, subjective pain levels, mouth opening, and treatment/medication duration were examined. The PSS and sAA levels were assessed in the control group. sAA levels in the MMP group were significantly higher than those in the control group (p < .05). The masseter muscle palpation score (MPS) showed a positive correlation with IL-6 levels (ρ = 0.503, p < .05) and a negative correlation with nonsteroidal anti-inflammatory drug (NSAID) treatment period (ρ = -0.462, p < .05). The temporalis muscle palpation score (TPS) was positively correlated with pain duration and GCPS grade (ρ = 0.483, p < .05, and ρ = 0.445, p < .05, respectively). Treatment with NSAIDs was effective in the MMP group with high MPS and IL-6 levels, but not in the MMP group with high TPS, pain duration, and GCPS grade.

Quantitative bone imaging biomarkers and joint space analysis of the articular Fossa in temporomandibular joint osteoarthritis using artificial intelligence models.

Temporomandibular joint osteoarthritis (TMJ OA) is a disease with a multifactorial etiology, involving many pathophysiological processes, and requiring comprehensive assessments to characterize progressive cartilage degradation, subchondral bone remodeling, and chronic pain. This study aimed to integrate quantitative biomarkers of bone texture and morphometry of the articular fossa and joint space to advance the role of imaging phenotypes for diagnosis of Temporomandibular Joint Osteoarthritis (TMJ OA) in early to moderate stages by improving the performance of machine-learning algorithms to detect TMJ OA status. Ninety-two patients were prospectively enrolled (184 h-CBCT scans of the right and left mandibular condyles), divided into two groups: 46 control and 46 TMJ OA subjects. No significant difference in the articular fossa radiomic biomarkers was found between TMJ OA and control patients. The superior condyle-to-fossa distance (p < 0.05) was significantly smaller in diseased patients. The interaction effects of the articular fossa radiomic biomarkers enhanced the performance of machine-learning algorithms to detect TMJ OA status. The LightGBM model achieved an AUC 0.842 to diagnose the TMJ OA status with Headaches and Range of Mouth Opening Without Pain ranked as top features, and top interactions of VE-cadherin in Serum and Angiogenin in Saliva, TGF-β1 in Saliva and Headaches, Gender and Muscle Soreness, PA1 in Saliva and Range of Mouth Opening Without Pain, Lateral Condyle Grey Level Non-Uniformity and Lateral Fossa Short Run Emphasis, TGF-β1 in Serum and Lateral Fossa Trabeculae number, MMP3 in Serum and VEGF in Serum, Headaches and Lateral Fossa Trabecular spacing, Headaches and PA1 in Saliva, and Headaches and BDNF in Saliva. Our preliminary results indicate that condyle imaging features may be more important in regards to main effects, but the fossa imaging features may have a larger contribution in terms of interaction effects. More studies are needed to optimize and further enhance machine-learning algorithms to detect early markers of disease, improve prediction of disease progression and severity to ultimately better serve clinical decision support systems in the treatment of patients with TMJ OA.