Open-mouth Position Research Articles

Respiratory rate measurement by pressure variation in the high flow nasal cannula-system in healthy volunteers.

This study tests if the pressure variation in the HFNC-system may allow for monitoring of respiratory rate and the pressure difference during breathing may be a marker of respiratory effort. A HFNC system (Fisher & Paykel Optiflow Thrive 950) was modified by adding a GE Healthcare D-Lite spirometry sensor attached to a respiratory module and a pressure transducer. Participants were instructed to breathe regularly, quickly and slowly during 4 different conditions (HFNC flow 30l/min and 70l/min and with an open and closed mouth). Respiratory rate was counted based on pressure variation shown on the monitor graphs and compared with the count by observation of the participant. The pressure difference between inspiration and expiration was tested for correlation with the respiratory rate, as a surrogate marker for respiratory effort. Twenty five participants were included in this study. False detection of apnea in pressure-based measurements occurred in 10% and 11% of the measurements with open mouth position at 30l/min and 70l/min HFNC-flow, respectively, but not with a closed mouth. The 95% Limits of Agreement were - 1.85;1.91, -13.72;9,88, -2.25;2.47, -30.32;19.93 for the conditions of 30l/min -closed mouth, 30l/min - open mouth, 70l/min - closed mouth and 70l/min - open mouth, respectively. There was a correlation between pressure difference and respiratory effort, except for the condition of 30l/min with open mouth. The pressure variation in the HFNC system allows for respiratory rate and effort monitoring, but requires further development to increase precision. ClinicalTrials.gov (NCT05991843).

Arthroscopic reduction and rigid fixation of the anteriorly displaced temporomandibular joint disc without reduction using titanium screw: a case series.

To evaluate the effectiveness of arthroscopic reduction and rigid fixation (ARRF) using a suture-free titanium screw as a treatment approach to temporomandibular joint's (TMJ) anterior disc displacement without reduction (ADDwoR) and assess its impact on clinical outcomes, including improvements in symptoms related to TMJ disorders. A series of twenty patients presented to the Department of Orthognathic and Temporomandibular Surgery at West China Hospital of Stomatology between September 2022 and January 2023, complaining of symptoms such as pain, clicking, and limited mouth opening. Standard magnetic resonance image (MRI) imaging T1 and T2 sequences in both sagittal and coronal views study with closed and maximal open mouth positions were taken preoperatively to assess the disc's position, integrity, and shape. Also, cone-beam computed tomography (CBCT) scans images to find any degenerative changes and evaluate the condylar bone's features and volume. Additionally, the clinical examination assesses limited oral opening, mechanical pain, and the presence of any noises such as clicking and crepitus. All cases were treated under general anesthesia using the arthroscopic release, reduction, and rigid fixation of the TMJ's ADDwoR to establish a normal disc-condyle relationship and to restore the functional position. Patients' symptoms, such as pain and mouth opening, improved significantly following the arthroscopic treatment. Postoperative MRI and CBCT imaging follow-up conducted at 6 months demonstrated the stable position of the reduced TMJ disc and the fixation screw. Notably, none of the patients exhibited signs of relapse during this follow-up period. Overall, the ARRF of TMJ's ADDwoR using a suture-free titanium screw proved to be safe and provides satisfactory results, in addition to the several advantages of using suture-free titanium screws, such as biocompatibility, strong fixation, and durability. However, it is a technically demanding procedure requiring extensive, long-term training. ARRF using a cost-effective fixation titanium screw to treat ADDwoR emerges as a clinically effective minimally invasive approach.

Аналіз комп’ютерних томограм після лікування дисфункції скронево- нижньощелепного суглоба

The aim. To define the dimensions of upper joint space during TMJ disc displacement, associated with limited mouth opening by analyzing computer tomography images. Materials and methods. 79 patients were clinically examined by means of an anamnesis collection, isometric tests, palpation of TMJ and masticatory muscles, detection of occlusal supra contacts in habitual and dynamic occlusion. For all the examined patients with permanently limited mouth opening up to 35 mm between incisors a TMJ computer tomography (CT) in habitual occlusion was performed before and after gnathological treatment. Computer tomogram images are represented by sagittal plane where dimensions of upper joint space were measured. The distance between the upper and lower central incisors was measured in millimetres at the largest mouth opening position during clinical examination. Results. For 48 (60, 7%) examined patients chewing food wearing a gnathological splint was considered as an optional recommendation and was aimed at maintaining the therapeutic effect achieved during the first three months of treatment, and for 31 (39,2%) patients consuming food in a gnathological splint was a necessity for achieving physiological measurements of mouth opening, within 43-53 mm between the incisors. Conclusions. During the comparison of TMJ computer tomogram images in the closed jaws position on both sides before and after treatment of TMJ disc displacement, which is accompanied by limited mouth opening, it was found out that the maximum admissible asymmetry in articular condyle position after gnathological treatment, measured along the upper joint space was 2,8 ± 0,31 mm and was found in 11,3% of examined patients. Key words: TMJ (Temporomandibular joint), limited mouth opening, computer tomography (CT).

X-ray diagnosis of temporomandibular disorders combined with the pathology of the cervical spine

Relevance. Given the high prevalence of temporomandibular disorders and the multiple causes of the disease, specialists assign an important role to the rational diagnosis of temporomandibular disorders.Material and methods. The study included 84 patients aged 21 to 55 years old. Of these, 69 patients were diagnosed with temporomandibular disorders. They formed group 1. The 2nd control group included 15 patients without TMDs (with no complaints of the dentoalveolar system). All patients underwent X-ray diagnosis: cone beam computed tomography (CBCT) 200 x 170 mm of the skull, including the area of C1 and C2 cervical vertebrae in the closed and open mouth position. The study used the Planmeca ProMax® 3D CT scanner.Results. All examined patients with TMDs showed the spinous process deviation angles α from the Y axis (p ≤ 0.001), which indicated 100% involvement of the cervical spine in this pathology. Subgroup A comprised 60.1% of the subjects, where the mean angle in the closed mouth position was 12.90 ± 0.55 degrees, and in the open mouth position, the mean value was 9.2 ± 0.48 degrees, the deviation angle decreased by an average of 3.7 degrees. Subgroup B included 39.9% of the subjects, where the average value was 4.50 ± 0.66 degrees in the closed mouth position and 8.40 ± 0.75 degrees in the open mouth position. The angle of deviation increased by 3.9 degrees.Conclusion. In patients with temporomandibular disorders, the proposed method of CBCT diagnosis (200 x 170) allows detection of the cervical spine (C2 region) pathology by one axial view image in the closed and open mouth position.

Magnetic resonance imaging of the temporomandibular joint: An integrative approach

BACKGROUND: According to various data, orofacial diseases occur in the population in 20%85% of cases. The most common cause of maxillofacial pain unrelated to the dental system is temporomandibular joint (TMJ) dysfunction, which is defined as a disruption of the anatomical relationship during natural movements. Magnetic resonance imaging (MRI) is the method of choice for diagnosing joint pathology.
 AIM: MRI with static, pseudodynamic, and dynamic protocols were optimized for targeted diagnosis of TMJ dysfunction.
 METHODS: Classical examination of the TMJ is performed in a closed and open mouth position. However, the images obtained do not reflect the location of the intra-articular disc at all stages of mandibular motion.
 RESULTS: After a static examination in two oral positions, pseudodynamic sagittal T1 weighted imaging (WI) scans were obtained. The patient was asked to divide the movements from full closure to full mouth opening into five steps. The examination was conducted with the MRI operator and the patient acting together. The scans assessed the position and shape of the meniscus at five stages of mandibular movements. The performed program is leading in the assessment of the disc shape changes at each stage of the mouth opening. Wide coverage of the studied area allows to visualize both articular relations of internal structures and surrounding soft tissues, including contraction of the lateral wing muscle and superficial and deep parts of the masseter muscle. The final stage was a dynamic T2 WI scan performed by the patient individually. The obtained series of images represents sequential movements of the condyle, maximally approximating the natural mouth opening. The pulse sequence helps to assess the amplitude of motion of the mandibular condyle and hypermobility, which can be difficult when performing static images with standard mouth expanders.
 CONCLUSIONS: An optimized dynamic and pseudodynamic TMJ study protocol is an essential part of the precise diagnosis of TMJ dysfunction and allows for differential diagnosis between muscle spasm and intra-articular disc adhesion and reliable visualization of intra-articular relationships during mouth opening.

Evaluation of the pattern of fracture formation from trauma to the human mandible with finite element analysis. Part 1: Symphysis region.

The mandible is the largest, strongest bone in the maxillofacial region. When a fracture occurs in the mandible, its location depends on several factors: the direction of the trauma, the angle of the trauma, masticatory muscles and the quality of the bone. The aim of this study was to evaluate the stresses caused by trauma to the symphysis region from different angles. Computer-based mandible models were created, and a 2000 N force was applied to the symphysis at three different angles using finite element analysis. Six trauma situations were simulated with the mouth open or closed. Forces were applied to the symphysis at 90° (Model 1) in the anteroposterior direction, 45° (Model 2) in the anteroposterior-inferosuperior direction and 90° (Model 3) in the inferosuperior direction, when the mouth was open or closed. The resulting stress intensity was assessed using finite element analysis. As a result of trauma applied to the symphysis region, maximum stresses were found where the impact originated and at the condyle region (Model 2, open mouth: condyle 1 [1172 MPa]). The open mouth position caused higher stress values than the closed mouth position (Model 2, open mouth: condyle 1 [1172 MPa]; closed mouth: symphysis 4 [82 MPa]). The Model 2, open-mouth state (Model 2, open mouth: condyle 1 [1172 MPa]) sustained higher stresses than all the other models. The stress values in the mandible were affected by the force applied to the symphysis region, the angle of impact arrival and the open or closed state of the mouth. Keeping the mouth closed at the time of trauma reduced the stress value. A closed mouth during trauma directed at the symphysis reduced the possibility of mandible fractures.

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging.

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

Quantitative volume and area assessment of masticatory muscles through magnetic resonance imaging in patients with temporomandibular joint disorders

To compare volume and surface area measurements of the lateral pterygoid (LPM), medial pterygoid (MPM), and masseter muscles (MM) as calculated on magnetic resonance imaging (MRI) based on the position of the temporomandibular joint disk, mouth position, and patient sex, and to calculate the correlations of the measurements among the muscles. Measurements of muscle volume and area were performed on the MRIs of 51 patients. Wilcoxon, Kruskal-Wallis, and Mann-Whitney U tests were used to calculate the significance of differences in measurements. The Spearman correlation coefficient calculated the correlation of measurements among the muscles. The significance of difference was established at P < .05. Volume and area of the left MPM in patients with disk displacement without reduction (DDWOR) were larger than in patients with normal disk position (P ≤ .040). MM volumes were smaller with DDWOR than with DD with reduction bilaterally (P ≤ .031). The volume and area of LPM and MM were significantly different between closed and open mouth positions (P < .001). Differences in volume and area between females and males were significant for all muscles in volume (P ≤ .021) and for MPM and MM in area (P ≤ .021). Significant positive correlations were found among all muscles for volume and area. Volume and area measurements of the masticatory muscles varied according to disk and mouth position and patient sex and exhibited significant positive correlations.

Added value of dynamic 3T-MRI to conventional static MRI in evaluation of internal derangement of tempromandibular joint

PurposeThis prospective study aimed at comparing dynamic T1W fast field echo sequence to the standard static sequences in the evaluation of TMJ disorders using 3T MRI. Methods8 patients, 14 with bilateral symptomatic internal derangement of TMJ and 4 with unilateral symptoms (32 TMJs) were examined, including 17 females and one male. Static T1W, T2W and PD turbo spin-echo sequences in closed and open mouth positions as well as dynamic T1W-FFE sequence were acquired on 3T MRI unit and images were assessed for the articular disc position, morphological disc changes, condylar morphology and translation. Marginal homogeneity test was used to analyze difference between dynamic and static imaging findings and significant results were considered at p ≤ 0.05. ResultsThe study shows statistically significant difference between static and dynamic MRI in the evaluation of condylar position (p < 0.005). Out of the examined 32 joints, 28 joints (87.5%) had normal condylar position and 4 joints (12.5%) had a subluxated condyle. Dynamic MRI showed 24 joints (75%) had normal condylar position and 8 joints (25%) had a subluxated condyle. Regarding disc morphology and position, dynamic MRI added no significant superior information compared to standard static images. ConclusionStatic MRI of TMJ provides proper accurate assessment of pathological changes in TMJ disorders and considered the gold standard. Dynamic MRI added superior information regarding joint biomechanics even in normal static MRI cases and valuable findings regarding the movement patterns of the condyle and disc in different types of TMJ internal derangement.

THE EFFECT OF MANDIBULAR CONDYLE SIZE ON DISC DISPLACEMENT AND GENDER RELATIONSHIP

Objective: Our aim in this study is to analyze the association between anterior disc displacement and mandibular condyle size. It was also aimed to examine the influence of gender factor on condyle size.Material and Methods: Images of patients who underwent magnetic resonance imaging of the temporomandibular joint in the radiology department between January 2018 and November 2021 were analyzed retrospectively. The articular disc was evaluated in terms of displacement on sagittal oblique images in closed and open mouth positions. Following, anteroposterior and mediolateral dimensions were measured at the head of the mandibular condyle.Results: Among the 200 individuals in the study, 44 were male and 156 were female. A total of 400 temporomandibular joints of 200 patients were analyzed. In 279 joints, the disc was in its normal position, and there was no disc displacement. There was disc displacement with reduction in 54 joints and disc displacement without reduction in 67 joints. The anteroposterior and mediolateral sizes of the mandibular condyle were higher in the group with normal disc position compared to the groups with disc displacement. In the disc displacement without reduction group, the mean values of anteroposterior and mediolateral dimensions were the lowest (p=0.001). Male individuals had a mandibular condyle anteroposterior size of 6.706±2.588 cm while female subjects had a size of 5.786±1.288 cm, which was significantly lower in females (p=0.001). Mandibular condyle mediolateral size was 18.779±2.848 cm in male subjects, 17.016±2.290 cm in female subjects, and was significantly lower in females (p=0.001).Conclusion: We determined that the mandibular condyle size was smaller in joints with anterior disc displacement than in joints with normal disc position. In addition, we observed that the condyle size was significantly lower in females than in males. Low mandibular condyle size may be a risk factor for anterior disc displacement.

Correlative analysis of cervical curvature and atlantoaxial instability

To investigate the correlation between the changes of cervical curvature and atlantoaxial instability. The correlation between the changes of cervical curvature and atlantoaxial instability was retrospectively studied in 50 outpatients with abnormal cervical curvature (abnormal cervical curvature group) from January 2018 to December 2019. There were 24 males and 26 females in abnormal cervical curvature group, aged from 18 to 42 years old with an average of(30.62±5.83) years. And 53 patients with normal cervical curvature (normal cervical curvature group) during the same period were matched, including 23 males and 30 females, aged from 21 to 44 years with an average of(31.98±6.11) years. Cervical spine X-ray films of 103 patients were taken in lateral position and open mouth position. Cervical curvature and variance of bilateral lateral atlanto-dental space(VBLADS) were measured and recorded, Pearson correlation coefficient analysis was used to study the correlation between the changes of cervical curvature and atlantoaxial instability. Atlantoaxial joint instability accounted for 39.6%(21/53) in normal cervical curvature group and 84.0%(42/50) in abnormal cervical curvature group. There was significant difference between two groups(P<0.01). VBLADS in abnormal cervical curvature group was (1.79±1.01) mm, which was significantly higher than that in normal cervical curvature group(0.55±0.75) mm(P<0.01). Pearson correlation coefficient analysis showed that the size of cervical curvature was negatively correlated with VBLADS. Cervical curvature straightening and inverse arch are the cause of atlantoaxial instability, the smaller the cervical curvature, the more serious the atlantoaxial instability.

Automatic detection of anteriorly displaced temporomandibular joint discs on magnetic resonance images using a deep learning algorithm.

This study aimed to develop models that can automatically detect anterior disc displacement (ADD) of the temporomandibular joint (TMJ) on MRIs before orthodontic treatment to reduce the risk of developing serious complications after treatment. We used 9009 sagittal MRI of the TMJ as input and constructed three sets of deep learning models to detect ADD automatically. Deep learning models were developed using a convolutional neural network (CNN) based on the ResNet architecture and the "Imagenet" database. Five-fold cross-validation, oversampling, and data augmentation techniques were applied to reduce the risk of overfitting the model. The accuracy and area under the curve (AUC) of the three models were compared. The performance of the maximum open mouth position model was excellent with accuracy and AUC of 0.970 (±0.007) and 0.990 (±0.005), respectively. For closed mouth position models, the accuracy and AUC of diagnostic Criteria 1 were 0.863 (±0.008) and 0.922 (±0.009), respectively significantly higher than that of diagnostic Criteria 2 with 0.839 (±0.013) (p = 0.009) and AUC of 0.885 (±0.018) (p = 0.003). The classification activation heat map also improved our understanding of the models and visually displayed the areas that play a key role in the model recognition process. Our CNN model resulted in high accuracy and AUC in detecting ADD and can therefore potentially be used by clinicians to assess ADD before orthodontic treatment, and hence improve treatment outcomes.

Automatic segmentation of the temporomandibular joint disc on magnetic resonance images using a deep learning technique.

The aims of the present study were to construct a deep learning model for automatic segmentation of the temporomandibular joint (TMJ) disc on magnetic resonance (MR) images, and to evaluate the performances using the internal and external test data. In total, 1200 MR images of closed and open mouth positions in patients with temporomandibular disorder (TMD) were collected from two hospitals (Hospitals A and B). The training and validation data comprised 1000 images from Hospital A, which were used to create a segmentation model. The performance was evaluated using 200 images from Hospital A (internal validity test) and 200 images from Hospital B (external validity test). Although the analysis of performance determined with data from Hospital B showed low recall (sensitivity), compared with the performance determined with data from Hospital A, both performances were above 80%. Precision (positive predictive value) was lower when test data from Hospital A were used for the position of anterior disc displacement. According to the intra-articular TMD classification, the proportions of accurately assigned TMJs were higher when using images from Hospital A than when using images from Hospital B. The segmentation deep learning model created in this study may be useful for identifying disc positions on MR images.

Evaluation of Lateral Pterygoid Muscle Contraction in Patients with Temporomandibular Disorders Based on 3D-T2 Weighted Imaging

Objective To evaluate lateral pterygoid muscle(LPM)contraction in the patients with temporomandibular disorders(TMD)based on 3D-T2 weighted imaging(3D-T2WI).Multiplanar reconstruction(MPR)was employed to measure the length of LPM in the images taken in closed-and open-mouth positions. Methods Seventeen TMD patients [age of(29.82±10.70)years,males/females=8/9] and 13 normal volunteers [control,age of(23.54±3.31)years,males/females=6/7] received 3D-T2WI of the temporomandibular joints in closed-and open-mouth positions from November 2019 to April 2020 in Department of Radiology,Hainan Hospital of Chinese PLA General Hospital.According to the position of the discs,the subjects were classified into the following groups:TMD with disc displacement without reduction(TMD-DDwoR),TMD with disc displacement with reduction(TMD-DDwR),TMD without disc displacement(TMDwoDD),and normal control without disc displacement(NCwoDD).MPR was employed to measure the maximal length of the superior belly of LPM.One-way analysis of variance,receiver operating characteristic curve,and permutation test were employed for the statistical analyses. Results The contraction of LPM was significantly shorter in TMD-DDwoR group [(3.36±1.96)mm] than in TMDwoDD group [(7.90±3.95)mm],NCwoDD group [(8.77±3.13)mm](F=12.891,P=0.000),and TMD-DDwR group[(7.12±3.69)mm](χ2=5.314,P=0.031). Conclusion This study confirmed that the contraction of LPM decreased in patients with TMD-DDwoR,which provided imaging evidence for the study of disc displacement mechanism in TMD patients.

Efficacy of Low-Level Laser Therapy in Management of Temporomandibular Joint Pain: A Double Blind and Placebo Controlled Trial.

Stomatognathic system is an interaction of the muscles of mastication, dentition, neural component, and temporomandibular joint. Any dysfunction in this system may lead to temporomandibular disorders (TMDs). Various non-surgical modalities have been employed for treating TMDs. The aim of the study was to objectively evaluate the effects of low-level laser therapy (LLLT) in treatment of patients with TMDs. Sixty individuals diagnosed with TMDs were divided randomly into two groups (Group I-placebo and Group II -LLLT). A series of 20 sessions of LLLT applied both in closed mouth and maximum mouth opening position were given over a period of 08weeks. Assessment was done in terms of improvement in mouth opening, pain, clicking, and deviation of mandible. The data collected were analyzed statistically. The results showed improvement in the pain reduction, improvement in the maximum mouth opening, reduction in deviation, and clicking in both groups but better treatment outcome in the low-level laser group. Though conservative measures improved the symptoms in TMD but LLLT has shown better results in comparison with the placebo group. Being non-surgical can be employed in combination with other modes for effectively treating such disorders. Keywords: Pain, Dysfunction, Temporomandibular joint disorders (TMDs), Low-level laser therapy (LLLT).

Quantitative assessment of temporomandibular disc and masseter muscle with shear wave elastography.

To assess the normal stiffness values of temporomandibular joint disc (TMJ) and masseter muscle by shear wave elastography (SWE) in a healthy adult population. This may be helpful in diagnosing and understanding the mechanism of temporomandibular disorders (TMD). This prospective study evaluated a total of 160 healthy adult volunteers (77 males, 83 females). The stiffness values of anterior, intermediate and posterior parts of the TMJ disc and masseter muscle were measured. Study cohort was classified into four groups based on age. Additionally, we investigated the changes in mean shear wave elasticity (kPa) and shear wave velocity(m/s) values of disc parts and masseter muscle in closed and open mouth positions, and the correlation of these SWE values with age and gender. Mean stiffness values of the disc were 37.02 ± 23.75kPa and 3.28 ± 1.09m/s in the anterior part, 30.47 ± 18.89kPa and 2.97 ± 1.04m/s in the intermediate part, 22.61 ± 13.97kPa and 2.55 ± 0.88m/s in the posterior part. Stiffness values showed significant decrease in the posterior part compared to the rest of the disc both in males and females. No significant differences in mean stiffness values of masseter muscle related to mouth position, age or gender. This study provides the normative quantitative elasticity values of disc and masseter muscle which could be a reference point for upcoming studies. Disc elasticity values are higher in women than men. Maybe this is one of the reason why TMD is more common in women. TMJ disc stiffness was significantly lower in the posterior part. SWE is a useful imaging method that can be used with routine ultrasonography in evaluation of the TMJ disc and masticatory muscles .

Shear wave elastography of temporomandibular joint disc and masseter muscle stiffness in healthy children and adolescents: a preliminary study.

Shear wave elastography (SWE) are promising techniques in diagnosing temporomandibular joint (TMJ) disc and masseter muscle disorders. To investigate normative stiffness values of the TMJ disc and masseter muscle by SWE in children and adolescents. This prospective study evaluated 123 TMJ discs and masseter muscles in 123 subjects. The stiffnesses of anterior, middle, and posterior parts of the disc and the masseter muscle were measured. This study investigated differences in mean elasticity [kilopascal (kPa)] and velocity [metre/second (m/s)] values of the different disc parts and the masseter muscle in closed and open mouth positions, and the correlations of these SWE values with age, body mass index (BMI), height, and weight of the subjects. The median stiffness disc values of all participants were 28.7kPa (elasticity) and 3.07m/s (velocity) for the anterior, 29.10kPa and 3.07m/s for the middle, and 23.2kPa and 2.77m/s for the posterior parts. Posterior stiffness was significantly lower than other body regions in all subjects and across all age groups. The mean stiffness values of the muscle were 16.96 ± 9.01kPa and 2.33 ± 1.2m/s for the closed mouth, and 28.7 ± 10.2kPa and 3.23 ± 1.32m/s for the open mouth. The stiffness of the TMJ disc was significantly lower in the posterior part than in the anterior or middle parts. The mean stiffness was significantly higher in the open mouth than in the closed mouth position. Neither elasticity nor velocity were associated with age, height, weight, or BMI.

Effect of low-level laser application in conjunction with splint therapy for management of temporomandibular joint disorders

This Randomized clinical trial was conducted to assess the value of using LLLT (Low level Laser Therapy) plus Splint therapy in comparison with using splint therapy alone for treatment of TMDs. Subject & methods. Twenty-six patients with TMDs were divided into 2 equal groups: Group I was the trial group where 5 LLLT sessions were done for all patients on a period of 5 weeks in conjunction with splint therapy, group II as a control group (splint therapy only). pain level, maximum mouth opening, lateral excursions, clicking sounds & disc position were all recorded and analyzed statistically. Results. There was a non-statistically significant difference after 6 Months concerning pain level, maximum mouth opening, lateral excursions & disc position However there were improvement regarding pain level initially for the trial group. Conclusion. LLLT proved to be helpful and encouraging effect in alleviating pain during acute phase of treatment of TMDs, however it has no significant effect on range of motion or disc position.

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

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

Можливості неінвазивного лікування обмеженого відкривання рота, обумовленого захворюваннями та внутрішніми порушеннями скронево-нижньощелепного суглоба

Abstract. Magnetic resonance imaging is widely used in the presence of such patient complaints as clicking, locking and pain in the temporomandibular joint. The different problems in the treatment of temporomandibular joint pathology, which is accompanied by limited mouth opening, requires certain recommendations for magnetic resonance imaging, supported by current classifications. The purpose of the study: to substantiate the need for the use of an individual mandibular fixator, made before magnetic resonance imaging in the open mouth position to systematization of the treatment outcomes. Materials and methods. On the basis of clinical examination and objectification of the temporomandibular joint status by magnetic resonance imaging the results of treatment of diseases and internal disorders of the temporomandibular joint, which can be obtained by a dentist-gnathologist using non-invasive methods, was analyzed. To obtain images after treatment of the temporomandibular joint an individual mandibular fixator was used, which provided the possibility of evidencebased determination of the articular head position in the open mouth state. To systematize the analysis results of magnetic resonance imaging of the temporomandibular joint, the most convenient classification was chosen. Results. From a clinical sight, the gnathological treatment of temporomandibular joint dislocation without reposition is considered effective if the distance between the incisors, at maximum mouth opening, is 41–50 mm, the articular head is located at the apex of articular tubercle, and in the questioning and isometric tests the patient complaints are absent. Conclusions. The most effective non-invasive treatment of limited mouth opening is possibly with early ambulation, i.e. from three to seven months after onset. Key words: temporomandibular joint, gnathologist, magnetic resonance imaging.