Temporomandibular Joint Region Research Articles

Role of transcutaneous electrical nerve stimulation in temporomandibular joint disorders.

To co mpare the e ffica cy of transcutaneous elec trica l ner ve stimulation with commercially ava ilab le analgesics in alleviating symptoms of temporomandibular disorders. The cross-sectional, interventional study was conducted from March 11, 2020, to August 31, 2023, at the Oral and Maxillofa cial S urger y Department of the Armed Forces Institute o f Den tist r y, Rawalpindi, Pakistan, and comprised patients aged 18-65 years who were experiencing pain or distress in the temporomandibular joint region. The par ticipants were divided into intervention group A and control group B. Group A treatment involved applying electrodes near the temporomandibular joint, with parameters adjusted as per the treatment guidelines. Group B subjects received only analgesics along with basic care recommendations. Pain intensit y was assessed using visual analogue scale, while functional impairment and adverse effects were monitored. Data was analysed using SPSS 24. Of the 130 patients initially assessed, 100(77%) were included; 50(50%) in each group. In group A, there were 33(66.0%) fema les and 17(34.0 %) male s wit h overal l mean age 42.8±10.12 years. In group B, there were 30(60%) females and 20(40%) males with overall mean age 46.98±14.09 years. Pain intensity was significantly lower in group A compared to group B post-inter vention (p=0.009). Group A sub jec ts also showed significant post-intervention improvement in terms of mouth opening compared to group B patients (p<0.05). There was no significant intergroup difference with respect to adverse effects (p>0.05). Transcutaneous electrical nerve stimulation was significantly more effective than commercially available analgesics in alleviating symptoms of temporomandibular disorders.

Chondroid Synoviocytic Neoplasm: A Clinicopathologic, Immunohistochemical, and Molecular Genetic Study of a Distinctive Tumor of Synoviocytes

Tumors resembling tenosynovial giant cell tumor (TGCT) but additionally forming chondroid matrix are rare and most often involve the temporomandibular joint (TMJ). We studied 21 tumors consisting of synoviocytes (large, eosinophilic mononuclear cells containing hemosiderin) and chondroid matrix to better understand these unusual neoplasms. The tumors occurred in 10 males and 11 females, in the age group of 31 to 80 years (median, 50 years) and involved the TMJ region (16), extremities (4), and spine (1). As in conventional TGCT, all were composed of synoviocytes, small histiocytes, foamy macrophages, siderophages, and osteoclast-like giant cells in variably hyalinized background. Expansile nodules of large, moderately atypical synoviocytes were present, in addition to “chondroblastoma-like,” “chondroma-like,” or “phosphaturic mesenchymal tumor-like” calcified matrix. The synoviocytes expressed clusterin (17/19) and less often desmin (3/15). The tumors were frequently CSF1 positive by chromogenic in situ hybridization (8/13) but at best weakly positive for CSF1 by immunohistochemistry (0/3). Background small histiocytes were CD163 positive (12/12). All were FGF23 negative (0/10). Cells within lacunae showed a synoviocytic phenotype (clusterin positive; S100 protein and ERG negative). RNA-Seq was successful in 13 cases; fusions were present in 7 tumors, including FN1::TEK (5 cases); FN1::PRG4 (2 cases); and MALAT1::FN1, PDGFRA::USP35, and TIMP3::ZCCHC7 (1 case each). Three tumors contained more than 1 fusion (FN1::PRG4 with TIMP3::ZCCHC7, FN1::TEK with FN1::PRG4, and FN1::TEK with MALAT1::FN1). Clinical follow-up (17 patients; median follow-up duration 38 months; range 4-173 months) showed 13 (76%) to be alive without evidence of disease and 4 (24%) to be alive with persistent/recurrent local disease. No metastases or deaths from disease were observed. We conclude that these unusual tumors represent a distinct category of synoviocytic neoplasia, which we term “chondroid synoviocytic neoplasm,” rather than simply ordinary TGCT with cartilage. Despite potentially worrisome morphologic features, they appear to behave in at most a locally aggressive fashion.

Clinical profile of Brazilian patients with temporomandibular joint disorder and orofacial pain: A 20-year retrospective study

ObjectiveTemporomandibular joint disorder (TMD) comprises several musculoskeletal conditions in the orofacial region, with chronic pain and/or dysfunction involving the temporomandibular joint (TMJ) and masticatory muscles. This study assessed the clinical characteristics of patients with TMD treated at a public tertiary care facility in Brazil. MethodsIn this retrospective study, we assessed data from adult patients attending the Center for Occlusion, TMD, and Orofacial Pain at a Brazilian school of dentistry, from 2000 to 2020. Data from eligible charts were collected: demographic variables, clinical complaints, location of pain, pain intensity (10-point VAS), duration of treatment, and therapeutic procedures. Data were analyzed using descriptive and inferential statistics at the 0.05 significance level. ResultsThe sample consisted of 2324 patients (79.4 % females) with a median age of 38 years and median duration of treatment of 35 days. Major clinical complaints were craniofacial pain (including in the TMJ region) (82.9 %), self-reported bruxism (clenching/grinding) (44.6 %), and clicking/crepitation (39.1 %). Craniofacial pain was associated with female gender and age of 39 years and older, but not with bruxism. The most frequent procedures were counseling (96.5 %), exercises (47.5 %), occlusal splints (18.5 %), and physiotherapy (13.8 %). Reduction in pain intensity was moderately associated with multiple (3 or more) therapies and longer duration of treatment. ConclusionIt can be concluded that the patients presented a diversity of clinical characteristics requiring individualized treatment. A multimodal, interdisciplinary therapeutic approach, including counseling, appears to benefit most patients with TMD-related pain.

Chondrosarcoma of Temporomandibular Joint: Report of Two Cases.

Chondrosarcoma of the head and neck region is a rare malignant tumor which occurs from 1 to 12% of all of chondrosarcomas. There are only a few case reports of chondrosarcoma in the temporomandibular joint region. This report describes two cases of chondrosarcoma of the temporomandibular joint (TMJ) in a 27-year-old man and a 35-year-old woman. In both cases signs of temporal bone resorption were noticed, and in the first case tumor had intracranial spread. In both cases the tumor was resected in a single block with peritumoral tissues. The aim of this paper is to emphasize the diagnostic and therapeutic difficulty in this pathology.

Assessment of articulation parameters settings repeatability in Avantis 3D software

BACKGROUND: The three-dimensional (3D) space of a virtual articulator requires precise adjustment considering individual parameters for the precision work of orthopedic dentists, orthodontists, and dental technicians. A modern solution that includes a virtual articulator is the domestic Avantis 3D software, which simplifies and speeds up functional diagnostics by creating a 3D scene of the patient. AIM: To compare a repeatability of articulation parameters obtained when adjusting the domestic virtual articulator Avantis 3D using laboratory and intraoral scans of terminal positions of the lower jaw. MATERIALS AND METHODS: A group of 30 volunteers aged 18–35 years participated in this study. The group consisted of 18 women and 12 men. Each participant underwent a computed tomography of the maxillofacial region, including the temporomandibular joint region in a state of habitual occlusion; one-stage A-silicone impressions were obtained, plaster models were cast, and silicone bite registers of three terminal positions were made. An intraoral scan of the upper and lower jaws was performed, and optical bite scans were obtained in the position of maximum fissure-tubercle contact and in the terminal positions of the lower jaw, fixed by previously obtained silicone registers. The same protocol was conducted for plaster models of the patient’s dentition and silicone registers of terminal positions. Using intraoral scans, optical recorders of terminal positions and computer tomograms in the Avantis 3D program and 3D scenes were created, and a virtual articulator was configured. For each patient, the virtual articulator was adjusted in the Avantis 3D software, seven times using data from the intraoral scanner level and seven times from the laboratory level. The reproducibility of articulatory parameters was assessed for all types of scans obtained, examining the standard and individual intercondylar distances for each patient. RESULTS: The average values of the standard square deviation of articulatory parameters obtained when creating 3D scenes using laboratory scans at individual and standard intercondylar distances were higher than the similar values obtained using intraoral scans. CONCLUSION: The accuracy of creating a virtual copy of a patient can be influenced by several factors: the error in combining scans, repeated scanning, the error in combining scans and computer tomograms, the error in combining jaw and bite scans, and the presence of penetrating occlusal contacts between scans of the dentition.

Evaluating stress and displacement in the craniomandibular complex using Twin Block appliances at varied angles: A finite element study

ObjectivesThe objective of this investigation was to assess the stress and displacement pattern of the craniomandibular complex by employing finite element methodology to simulate diverse angulations of inclined planes that are incorporated in the Twin Block appliance. MethodsA 3D finite element representation was established by use of Cone Beam Computed Tomography (CBCT) scans. This comprehensive structure included craniofacial skeletal components, the articular disc, a posterior disc elastic layer, dental elements, periodontal ligaments, and a Twin Block appliance. This investigation is the first to incorporated inclined planes featuring three distinct angulations (45, 60, and 70°) as the study models. Mechanical impacts were evaluated within the glenoid fossa, tooth, condylar, and articular disc regions. ResultsIn all simulations, the stress generated by the Twin Block appliance was distributed across teeth and periodontal ligament, facilitating the anterior movement of mandibular teeth and the posterior displacement of maxillary teeth. Within the temporomandibular joint region, compressive forces on the superior and posterior facets of the condyle diminished, coinciding with the stress configuration that fosters condylar and mandibular growth. Stress dispersion homogenized in the condylar anterior facet and articular disc, with considerable tensile stress in the glenoid fossa's posterior aspect conforming to stress distribution that promote fossa reconfiguration. The 70° inclined plane exerts the highest force on the tissues. The condyle's maximum and minimum principal stresses are 0.36 MPa and −0.15 MPa, respectively, while those of the glenoid fossa are 0.54 MPa and −0.23 MPa. ConclusionThree angled appliances serve the purpose of advancing the mandible. A 45° inclined plane relative to the occlusal plane exerts balanced anteroposterior and vertical forces on the mandibular arch. Steeper angles yield greater horizontal forces, which may enhance forward growth and efficient repositioning.

Pain symptoms are associated with two-point discrimination threshold in patients with temporomandibular disorders.

This study aimed to explore the associations of orofacial two-point discrimination (2-PD) test result with pain symptoms and psychological factors in patients with Temporomandibular Disorders (TMDs). 193 patients with TMDs were included in this study. Patients' demographics, pain intensity, and psychological status were recorded. The 2-PDs in the bilateral temporal, zygomatic, mandibular, and temporomandibular joint (TMJ) regions of the patients were measured. Statistical analyses were conducted to observe the associations between variables. For Pain-related TMDs (PT) patients, Monthly Visual Analogue Scale (VAS-M) and Current Analogue Scale (VAS-C) were correlated with TMJ, zygomatic and temporal 2-PDs. Patients with PT tended to have higher TMJ 2-PDs[Right: β = 1.827mm, 95%CI(0.107, 3.548), P = 0.038], zygomatic 2-PDs[Right: β = 1.696mm, 95%CI(0.344, 3.048), P = 0.014], temporal 2-PDs[Left: β = 2.138mm, 95%CI(0.127, 4.149), P = 0.037; Right: β = 1.893mm, 95%CI(0.011, 3.775), P = 0.049]. Associations were also observed between VAS-C and TMJ 2-PDs[Left: β = 0.780, 95%CI(0.190, 1.370), P = 0.01; Right: β = 0.885, 95%CI(0.406, 1.364), P = 0.001], Zygomatic 2-PDs[Right: β = 0.555, 95%CI(0.172, 0.938), P = 0.005]; VAS-M and TMJ 2-PDs[Left: β = 0.812, 95%CI(0.313, 1.311), P = 0.002; Right: β = 0.567, 95%CI(0.152, 0.983), P = 0.008], zygomatic 2-PDs[Left: β = 0.405, 95%CI(0.075, 0.735), P = 0.016; Right: β = 0.545, 95%CI(0.221, 0.870), P = 0.001], and temporal 2-PDs [Left: β = 0.741, 95%CI(0.258, 1.224), P = 0.003; Right: β = 0.519, 95%CI(0.063, 0.975), P = 0.026]. TMJ, zygomatic, and temporal 2-PDs were significantly associated with PT and pain intensity. Age, gender and psychological factors were not associated with orofacial 2-PDs. PT patients exhibited weaker tactile acuity compared to Non-PT patients. Further discussion on the underlying mechanism is needed. Orofacial tactile acuity of TMDs patients was associated with their pain symptoms, which researchers should take account into when performing 2-PD tests for TMDs patients. The 2-PD test can be considered as a potential tool along with the current procedures for the differentiations of PT and Non-PT.

The relation between persistent foramen tympanicum and degenerative bone alterations in temporomandibular joint region.

The aim of this study was to evaluate, using cone-beam computed tomography (CBCT), the relationship of persistent foramen tympanicum (PFT) with degenerative changes in the temporomandibular joint (TMJ) and the presence of pneumatized glenoid fossae and articular eminences. Two experienced oral and maxillofacial radiologists evaluated 510 CBCT scans, from which 94 patients were divided into two groups: G1-patients with PFT and G2-control group. The location of the PFT, presence, or absence of degenerative TMJ changes and morphology were evaluated. Similarly, all images were evaluated for the presence of pneumatized articular eminence and glenoid fossa. The Chi-square test and Fisher's Exact test were used for the categorical variables. A multinomial logistic regression model was performed for subgroup analysis. To assess the estimation-chance occurrence of TMJ alterations the Odds Ratio analysis was used. Statistically significant results were found for erosion, planning, and subchondral cyst. Regarding TMJ morphology, significant results were found for: round, flat, and others. Moreover, it was possible to observe that patients who had the PFT were approximately 48 times more likely to manifest TMJ alterations and approximately 3 times more likely to manifest articular eminence pneumatization. Since individuals who have FTP have a greater chance of having TMJ and PEA changes, it is important for the dental radiologist to be aware of these signs in CBCT scans for a correct diagnosis. CAAE: 34328214.3.0000.0104 (11/30/2014).

Association Between Temporomandibular Joint Disorders and Metastatic Breast Cancer—A Mapping Review

Aim: The authors of the present study speculate that metastasis of breast cancer cells to the temporomandibular joint (TMJ) region mimics classical signs and symptoms of temporomandibular disorders (TMD). The aim of this mapping review was to investigate the association between metastatic breast cancer (MBC) and TMD. Materials and Methods: The focused question was, “Is there an association between MBC and TMD?” Indexed databases (PubMed/Medline, EMBASE, OVID, Scopus, Google Scholar, and Web of Science) were electronically searched up to and including March 2022. These databases were searched using different combinations of the following keywords: cancer, carcinoma, temporomandibular disorders, temporomandibular joint, disc displacement disorder, nociception, and tumor. Original clinical studies that meet the inclusion criteria were included. The risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for case reports. The structure of this current evidence-based review was tailored to primarily condense the relevant information. Results: Fifteen case reports were selected after screening the retrieved records from the electronic search. Fifteen out of 16 patients were women aged between 32 and 78 years. All patients were diagnosed with MBC, and most presented with adenocarcinoma. The symptoms identified in patients with TMD included: (a) preauricular pain; (b) preauricular swelling; (c) limited mouth opening; and (d) malocclusion. Fourteen of the included studies had a low RoB, while one had a moderate RoB. Conclusion: Based on the currently available evidence, a direct association between TMD and MBC or vice versa cannot be established. Routine visits to medical and oro-dental healthcare providers can contribute toward early diagnosis and management of TMD and MBC.

Application of panoramic radiographs in the diagnosis of temporomandibular disorders.

To evaluate the feasibility of temporomandibular disorder (TMD) diagnosis with panoramic radiography, and provide standardized data for artificial intelligence-assisted diagnosis by measuring the differences in the condylar and mandibular ramus heights. A total of 500 panoramic radiographs (219 male and 281 female participants) of healthy individuals were examined. The panoramic machine compatible measurement software, SCANORA 5.2.6, was used to measure the bilateral condylar height and mandibular ramus height, and SPSS 27.0 was used to calculate the left- and right-side differences in condylar height and mandibular ramus height of healthy individuals. Magnetic resonance images of the temporomandibular joint region obtained from 46 outpatients in the Stomatology Department were selected along with their corresponding panoramic radiographs. The left- and right-sided differences were measured and compared with the magnetic resonance imaging results. The measurement data are expressed as mean ± standard deviation (mm). t Tests were used to analyze data from healthy male and healthy female groups. The findings revealed that while there was no significant difference (P > .05) in the height of the condyle between men and women, there was a significant difference (P < .05) in the height of the mandibular ramus. In healthy population, the difference in height between the left and right condyle was 1.09 ± 0.99 mm. The difference in height of mandibular ramus in men was 1.26 ± 0.85 mm and that in women was 1.19 ± 0.87 mm. For the diagnosis of TMD, the sensitivity of panoramic radiographs was 94.74% (36/38), specificity was 75.00% (6/8), and diagnostic accuracy was 91.30% (42/46). The height of the right and left lateral condyles was not identical in healthy individuals, resulting in a discernible height discrepancy. In addition, the height of the mandibular ramus varied. By considering the left-right lateral height differences identified in this study along with clinical examination, it is possible to employ this metric as a preliminary screening tool for patients with TMD. Further, the use of panoramic radiographs for initial TMD screening is both viable and significant.

Automatic detection of degenerative changes in the temporomandibular joint region using deep learning with panoramic radiographs

Background/Aim: The temporomandibular joint (TMJ) is a complex anatomical region composed of the mandibular condyle located in the glenoid fossa of the temporal bone and covered with fibrous connective tissue. Excessive and continuous forces lead to progressive degeneration of the bony surfaces of the TMJ. The aim of this study is to determine the success of automatic detection of degenerative changes detected on panoramic radiographs in the TMJ region with deep learning method. Material and Methods: Panoramic images of 1068 patients (1000 with normal TMJ appearance and 68 with TMJ degeneration) over 18 years of age were included in the study. CVAT, open-source annotation tool (https://www.cvat.ai/) was used for labeling image data. All images were resized using the bilinear interpolation method. With the using data augmentation techniques, the number of images data reached 1480. BSRGAN model was applied to the data to increase the resolution of the data. YOLOv5, YOLOv7 and YOLOv8 algorithms were used for TMJ degeneration detection. TP, FP, TN, FN, accuracy, precision, recall, F1-score and AUC (Area Under the Curve) metrics were used for statistical analysis. Results: YOLOv5s training resulted in 94.40% accuracy, 81.63% precision, 86.96% sensitivity, 84.21% F1 score and 91.45% AUC. YOLOv7 training resulted in 99.63% accuracy, 97.87% precision, 100% sensitivity, 98.92% F1 Score and 99.77% AUC. YOLOv8 training resulted 96.64% accuracy, 91.11% precision, 89.13% sensitivity, 90.11% F1 Score and 93.66% AUC. Conclusions: All three algorithms have high success rates, with the best results obtained in YOLOv7.

Evaluation of cortical and trabecular bone structure of the mandible in patients with ankylosing spondylitis

This study aimed to examine the difference between the fractal dimension (FD) values of the mandibular trabecular bone and the panoramic mandibular index (PMI), mandibular cortical index (MCI) and mandibular cortical thickness (MCW) of patients with ankylosing spondylitis (AS) and healthy control group. A total of 184 individuals (92 cases, 92 controls), were examined in our study. PMI, MCI, and MCW values were calculated on panoramic images of all individuals. For FD values, the region of interest (ROI) was selected with the size of 100 × 100 pixels from the right-left gonial and interdental regions and 50 × 50 pixels from the condylar region. Degenerative changes in the temporomandibular joint (TMJ) region were recorded. PMI, MCI, and MCW values showed statistically significant differences between the groups (p = 0.000, p < 0.001). The radiological signs of mandibular cortical resorption were more severe in the case group than in the control group. PMI and MCW values were found to be lower in the case group than in the control group. It was determined that the number of C3 and C2 values, among the MCI values, was higher in the case group. Only the FD values of the ROI selected from the condyle region were found to be statistically significant and were lower in the case group (p = 0.026, p < 0.05). Degenerative changes in the TMJ region were significantly more frequent in the case groups (p = 0.000, p < 0.001). The fact that the mandibular cortex shows more resorptive features in individuals with AS may require further evaluation in terms of osteoporosis. Because of the low FD values of the condylar regions of these patients and the more frequent degenerative changes, the TMJ region should be followed carefully. Detailed examination of the mandibular cortex and condylar region is beneficial in patients with AS for screening and following osteoporotic changes in these individuals, which is essential for the patient’s life quality.

Stress distribution of the modified clear twin-block aligner on the temporomandibular joint, alveolar bone and teeth: A finite element analysis

The modified clear twin-block aligner (CTBA) was developed to provide a mandibular advancement appliance for the treatment of mandibular retrognathia. The objective of this study was to analyse the stress distribution changes of CTBA with 45°, 60° and 70° bite blocks. A three-dimensional model of the craniomaxillofacial bones and teeth was generated from a spiral computed tomography (CT) scan. The models of the articular disc, capsule, periodontal ligament and CTBA were constructed mathematically. After assigning the appropriate material properties and the boundary condition using ABAQUS software, we simulated the CTBA with different bite blocks to analyse the mechanical effects. In the temporomandibular joint (TMJ) region, the posterior aspect of the condyle and glenoid fossa experienced tensile stress that was approximately about 22times greater at 70° than at 45°. The Von Mises stress distribution on the articular disc tended to be uniform. The strain direction of the condyle was backward. In the maxillary bone, the stress on the labial alveolar bone was about 5.83MPa at 70° and greater than that on the lingual side. The resulting displacement of the dentition revealed a tendency for the upper teeth to shift backward and the lower teeth to move forward by 0.46 to 0.49mm. The foregoing stress and displacement rose as the angle of the bite blocks increased. CTBA with 70° bite blocks constituted an advantageous biomechanical setting for the treatment of mandibular retrognathia in teenagers and provided a superior therapeutic effect.

Impact of the COVID-19 pandemic on facial pain, anxiety, depression, quality of life, and awake bruxism in sleep bruxism patients, occlusal splint users

Introduction: The COVID-19 pandemic may lead to increased risk of developing or worsening bruxism and facial pain. Objective: To evaluate the influence of pandemic on adults with Sleep Bruxism (BS), both sexes, rigid occlusal splint users. Methods: Longitudinal observational study conducted in adults, both sexes, with Possible BS (n= 50), mean age 35.95 ± 10.35 years, before (T1) and during (T2) COVID-19 pandemic, in person and remotely, respectively. Presence and intensity of pain (Visual Analog Scale) in the masseter and temporal muscles and temporomandibular joint (TMJ) region, anxiety and depression (HADS), quality of life (QoL) (WHOQOL - Brief) and Awake Bruxism (AB) were assessed. Student's t- test, Mann-Whitney U-test, Wilcoxon, Pearson's chi-square and Mc-Nemar tests were applied (p&lt;0.05). Results: The frequency of subjects with masseter, temporal and TMJ pain was 72%, 22%, 42% at T1 and 44%, 26%, 60% at T2, respectively; AB was 78% at T1 and 70% at T2. At both times pain intensity was moderate, there was absence of anxiety and depression, and QoL was regular. At T2, the frequency of subjects with masseter pain decreased 28%, domains physical, psychological and QoL mean worsened (p&lt;0.05). The other variables showed no difference between times (p&gt;0.05). Conclusions: During the COVID-19 pandemic, the use of rigid occlusal splints contributed to pain control in masseter muscle; anxiety and depression were absent, QoL worsened, and AB frequency remained high.

Effects of complex neck therapy – kinesiotherapy and interspinal muscles massage – on tinnitus

Introduction&lt;i&gt;&lt;/i&gt;Past studies have shown connections between the somatosensory system (the neck and temporomandibular joint region) and the auditory system. It is therefore likely that tinnitus patients might benefit from neck therapy. The aim of this study was to investigate the effects of physiotherapy of the neck, comprising cervical spine kinesiotherapy and interspinal muscles massage, on subjective tinnitus. We also investigated the effects of the therapy on the range of cervical spine motion and cervical muscles tension.Material and methodsThis was a non-randomised controlled trial. Adult patients with chronic subjective tinnitus (&lt;i&gt;n&lt;/i&gt; = 118) were enrolled in an intervention group and received 10 sessions, over 2 weeks, of neck therapy comprising active exercises, massage of the cervical interspinal muscles, and post-isometric relaxation exercises. There was also a control group (waiting list). The effects of the therapy on tinnitus were assessed at baseline, immediate post-treatment, and follow-up (2 weeks after the end of therapy) using the Polish Tinnitus Functional Index (TFI-Pl, primary outcome measure), a visual analogue scale (VAS) of tinnitus loudness, and the Polish Tinnitus Handicap Inventory (THIPl). Effects of therapy on neck were assessed using two measures: the range of cervical spine movement (cervical flexion, cervical rotation, and cervical side bending measured in cm using a tape measure); and muscle tension – assessed by palpation and graded using a scale of either 0 (normal) or 1 (increased).ResultsIn the intervention group, the mean TFI score was reduced significantly from baseline (mean = 52.6, SD = 20.4) to post treatment (mean = 40.9, SD = 19.0, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and at follow-up (mean = 40.4, SD = 21.1, linear mixed model). In the control group, mean TFI score did not change significantly from baseline (mean = 46.8, SD = 20.1) to post treatment (mean = 45.8, SD = 40.9) and follow-up (mean = 45.2, SD = 26.2, linear mixed model). Improvement in tinnitus in the intervention group was accompanied by a reduction in cervical muscles tension and improvement in the range of cervical spine motion.ConclusionsComplex neck therapy of the neck appears to be a promising intervention for tinnitus treatment. Further randomised studies are needed to confirm the positive effects of the therapy on tinnitus and explore the mechanisms leading to improvement.

The effect of myotonic dystrophy type 1 on temporomandibular joint and dentofacial morphology: A CBCT analysis.

Myotonic dystrophy type 1 (DM1) is a neuromuscular multisystem disease. Early involvement of facial muscles may produce an extra load on the temporomandibular joint (TMJ) in DM1. This study aimed to investigate the morphological analyses of the bone components of temporomandibular joint (TMJ), and dentofacial morphology in myotonic dystrophy type 1 (DM1) patients by cone-beam computed tomography (CBCT). Sixty-six individuals (33 DM1, and 33 healthy subjects) age ranging from 20 to 69 were included in the study. Clinical examinations of the patients' TMJ regions and evaluation of dentofacial morphology (maxillary deficiency, open-bite, deep palate and cross-bite) were performed. Dental occlusion was determined based on Angle's classification. CBCT images were evaluated regarding mandibular condyle morphology (convex, angled, flat and round) and osseous changes observed in the condyle (normal, osteophyte, erosion, flattening, sclerosis). DM1-specific morphological and bony TMJ alterations were determined. DM1 patients showed a high prevalence of morphological and osseous TMJ changes, and statistically significant skeletal alterations. The analysis of CBCT scans indicated the prevalent condylar shape among patients with DM1 was flat, the main osseous abnormality was flattening, there was a tendency towards skeletal Class II and a posterior cross-bite was frequently detected in DM1 patients. There was no statistically significant difference between the genders on the parameters evaluated in both groups. Adult patients with DM1 presented a high frequency of crossbite, tendency to skeletal Class II and morphological osseous alterations of TMJ. The analysis of the morphological condylar alterations in patients with DM1 may be beneficial in the diagnosis of TMJ disorders. This study reveals DM1-specific morphological and osseous TMJ alterations to provide an appropriate orthodontic/orthognathic treatment planning to patients.

Restriction of Mouth Opening, Reduction in Pressure Pain Thresholds and Activation of Myofascial Trigger Points in Mandibular and Cervical Regions after Root Canal Therapy: A Quasi-Experimental Study

Background: In daily clinical practice, patients often refer temporomandibular or cervical complaints after different oral procedures, especially in lengthy procedures that can result in iatrogenic postures or trauma that can affect the temporomandibular joint (TMJ). This study aimed to evaluate the clinical and functional changes of the temporomandibular joint (TMJ) and cervical region immediately after a session of root canal therapy. Methods: Twenty-nine subjects who received a session of root canal therapy were included. Clinical assessments included mouth opening, cervical mobility, pain intensity, pressure pain thresholds (PPTs), and myofascial trigger points (MTrPs) of the jaw and neck muscles. Results: After the intervention, a significant reduction in mouth opening (41.90 mm; SD = 6.21) was observed compared to baseline (46.28 mm; SD = 6.17) (p &lt; 0.001). A significant reduction in PPTs and cervical mobility (p &lt; 0.05), and an increase in MTrPs (p = 0.002–0.026) were demonstrated after the intervention. Conclusions: A session of root canal therapy can produce an immediate significant reduction in mouth opening, PPTs, and cervical mobility, and an increase in MTrPs. The risk can be higher if there is a previous TMJ limitation.

Tumoral calcinosis in temporomandibular joint region: a case report of 2 patients

肿瘤样钙盐沉着症是一种罕见的临床病理状况，其特征是在关节内或关节周围软组织中形成钙盐沉积，鲜见颞下颌关节区受累。本文报告2例颞下颌关节区肿瘤样钙盐沉着症患者的诊疗过程及随访结果，并结合文献对本病的诊断、治疗、发病机制进行综合分析。.

Prevalence of Temporomandibular Joint Pain among Patients who Reported to Dental OPD at a Tertiary Hospital in Pondicherry, India: A Cross-sectional Study

Introduction: Temporomandibular Joint Disorder (TMJD) is a debilitating condition that affects the quality of a person’s life. However, its aetiology remains controversial. Understanding the signs and symptoms associated with this condition is crucial for better comprehension. Determining the prevalence of TMJD can emphasise the importance of routine Temporomandibular Joint (TMJ) examinations and the implementation of preventive measures. Aim: To determine the prevalence of TMJ pain among patients who reported to the dental Outpatient Department (OPD) between January 2015 and December 2019. Additionally, the study sought to identify potential predisposing factors for TMJ pain. Materials and Methods: A cross-sectional study was conducted in the Dental Department at Pondicherry Institute of Medical Sciences, Pondicherry, India. The study duration was six months, from December 2021 to May 2022. The study was done by examining the medical records of all patients who reported TMJ pain during the specified period. A total of 32,094 patients’ records were reviewed, and 322 patients reported pain in the TMJ region. The patients’ reported signs and symptoms were extracted from their case records and evaluated. Pearson’s Chi-square/Fisher’s-exact test was utilised to determine associations between the factors. Results: The mean age of the participants was 35.4±13.2 years. Out of the 32,094 patients who attended the dental OPD, 327 (1.02%; 95% CI: 0.91-1.13) reported TMJ pain. Among these patients, 207 (63.3%) were females. Joint sounds were the most common symptom, observed in 243 (74.3%) patients, followed by emotional stress or tension, reported by 205 (62.7%) patients. Most symptoms were more prevalent in females than males. Parafunctional habits and stress/tension showed a statistically significant association (p&lt;0.001) with male gender. Additionally, occlusal variation, joint sound, missing teeth, chewing with one side, parafunctional habits, and stress showed associations with age. Conclusion: The TMJ pain was more frequently reported by women than men in the studied population. The most common symptoms reported were pain and joint sounds. The highest number of patients fell within the 30 years-55 years age group. Although the prevalence identified was 1.02%, routine TMJ examination should be conducted as a standard part of oral and maxillofacial examinations to identify any predisposing factors that may lead to TMJD in the future.

CT-based retrospective cohort study for the evaluation of mandibular condylar dimensions - A pilot study.

The temporomandibular joint (TMJ) is a unique structure of the body where the mandible, one of the important facial bones, articulates with the temporal part of the skull bone. Obtaining morphometric dimensions for mandibular condyle is important for performing an accurate pre/postoperative assessment, planning temporomandibular and orthognathic surgeries, and applications in forensic sciences in context to the Indian population, which is presently based on dimensions of Caucasian population from available literature. Several investigators noticed the variation in the craniofacial morphology in different ethnic groups and vary according to age and sex. This study aims to provide the normal dimensions of the mandibular condyle in the Indian population, which would be providing racially specific values for diagnosis, treatment planning of surgeries involving condylar processes such as rigid internal fixation of TMJ region, congenital deformities, and customizing TMJ prosthesis concerning these measurements. To measure the change in dimensions of mandibular condyle according to age and sex using computed topographic scan imaging. 1. To measure the dimensions of mandibular condyle. 2. To evaluate any age-related changes in dimensions. of mandibular condyle (intercohort comparison). 3. To evaluate any sex-related changes in dimensions of mandibular condyle (intercohort comparison). A retrospective analytical cohort study. Indian adult males and females aged between 20 and 50 years who underwent facial computed tomography (CT) for any reason (e.g., head injury). Patients with congenital or acquired dentofacial deformities involving TMJ. By assessing the morphometric dimensions of condyle of mandible using CT scan images. Mean condylar dimensions for each age/sex cohort are established; however, no significant change as per age and sex in condylar dimensions in the Indian population is noted.