Temporomandibular Research Articles

Determining the articulatory parameters in the "Avantis 3D" software, taking into account the position of the individual hinge axis.

In modern dentistry, the tactics of treating patients with occlusion and TMJ pathology are based on complex diagnostics. The key factor for the planned treatment of a patient depends on the accuracy of recording the individual parameters of the movement of the lower jaw. One of the methods for diagnosing the work of the temporomandibular joint and obtaining individual parameters for setting up the articulator is axiography (condylography). With the introduction of digital technologies into the practice of a dentist, such as CBCT, intraoral scanning, and the necessary software for creating 3D projects, the well-known method of registering protrusion and laterotrusion for setting the angles of the sagittal articular path and the angles of the Bennett joint angles in the articulator, based on the Christensen phenomenon, has found a new application. The creation of a virtual twin of the patient, the determination of his individual articulatory parameters greatly simplifies the procedure and reduces the time of diagnosis for the subsequent full rehabilitation of a patient with TMJ dysfunction.

Intra-Articular Physiological Saline in Temporomandibular Disorders May Be a Treatment, Not a Placebo: A Hypothesis, Systematic Review, and Meta-Analysis

Background: Intra-articular injections reduce pain in patients with temporomandibular joint (TMJ) disorders who are unresponsive to conservative treatment. Hyaluronic acid, blood products, and medications provide rapid relief when administered this way, although their mechanisms of action remain unclear. In control groups, which are intended to be untreated, 0.9% NaCl is typically delivered. The hypothesis that “normal saline injections in TMJ cavities produce a therapeutic effect” is proposed, with an exploration of its potential verification, alongside a systematic review and meta-analysis of studies on intra-TMJ 0.9% NaCl. Methods: Randomized controlled trials (RCTs) on patients with TMJ internal derangement, arthritis, or degeneration were selected under PRISMA 2020 and assessed with RoB2. Results: Seven RCTs with 359 patients were included. Weekly follow-ups revealed a decrease in articular pain by 23.72% (SE: 0.84%; 95% CI: 24.38–21.06%; p < 0.01), and monthly follow-ups indicated a decrease of 34.01% (SE: 1.09%; 95% CI: 36.16–31.86%; p < 0.01) compared to the baseline values. These findings were grounded in low-risk-of-bias evidence on 267 patients in five RCTs and 222 patients in four RCTs, respectively. Conclusions: The hypothesis warrants further testing to determine whether, in addition to the known biological activity of typical injectables, the mechanical action also contributes to pain relief.

Septic Arthritis of the Temporomandibular Joint in a Geriatric Patient: A Case Report

Septic Arthritis of the Temporomandibular Joint in a Geriatric Patient: A Case Report

Temporomandibular Joint Disc Replacement with Acellular Dermal Matrix for Irreparable Disc

Temporomandibular Joint Disc Replacement with Acellular Dermal Matrix for Irreparable Disc

Optimizing the treatment of patients with intrinsic temporomandibular joint disorders

Temporomandibular joint (TMJ) dysfunctions are conditions in which there is a disruption in the anatomical and functional relationship between the various structures of the joint, including the articular disc, intra-articular ligaments, mandibular head and capsule. These disorders have a negative impact on the patient’s quality of life, resulting in limitations in masticatory function and articulation. The multifactorial nature of this pathology emphasizes the need for an individualized and comprehensive approach to the treatment of each patient. In most cases, treatment includes both surgical and orthopedic methods. Currently, combined treatment approaches aimed at synergistic effects are being actively developed to maximize therapeutic Results.The purpose of this study. To evaluate the efficacy of the combination of treatment with a repositioning mouthguard and the use of the hydraulic articular disk repositioning method in patients with internal TMJ disorders combined with dental row end defects.Materials and methods. The study included 6 patients with TMJ dysfunction and end defects of the dentition. The study was conducted between September 2023 and May 2024. As part of the study, each patient underwent cone beam computed tomography (CBCT) to evaluate the bony structures of the TMJ and ultrasound (US) to evaluate the soft tissue structures of this joint.Results. The CBCT data showed that the mean posterior temporomandibular joint displacement before treatment was 1.67, while this value increased to 3.02 after treatment. The US results showed a significant decrease in the mean value of mandibular head displacement after treatment ranging from 0.21 to 0.03, indicating a positive effect of treatment. In addition, there was a decrease in the difference in the size of the anterior and posterior parts of the articular disc, confirming the elimination of its displacement.Conclusion. The treatment combination of using a repositioning mouth guard with the hydraulic repositioning method brought about a synergistic effect on the restoration of TMJ function.

Efficiency of chewing load deficiency correction in clinical dental practice

Weakening of the chewing act, typical for modern humans due to consumption of soft food, causes a deficit of chewing load and has a negative effect on the dental system. To combat hypodynamia of the masticatory apparatus with the aim of preventing destructive processes in its structures, a gnathotraining system was developed, including electrical stimulation of the masticatory muscles themselves in physiological parameters, which develops the effect of “imaginary chewing”, and gnathotraining using chewing gum. In addition, functional training of the masticatory apparatus using chewing exercises was proposed. Considering that chewing gum practically does not compensate for the deficit of chewing load observed in modern society, the staff of the Kazan State Medical University and the Kazan National Research Technological University developed the “Denta Fit” dental trainer and a dental training system. It has been established that dental and jaw training stimulates secretion of saliva, its mineralizing potential, functional resistance of tooth enamel, allows achieving a good level of oral hygiene, reduces the rate of increase in the intensity of dental caries, as well as the severity of muscular-articular disorders of the temporomandibular joints, enhances neuromuscular activity of the masticatory muscles and regional blood flow. In children with permanent bite, dental and jaw training maintains the hydrogen index (pH) of oral fluid at a neutral level and provides, in combination with a toothbrush, optimal hygienic dental care, contributes to the formation of a correct dental occlusion. Thus, the effects of increased neuromuscular activity of the masticatory muscles, as well as regional vascular tone, arising during dental and jaw training, indirectly indicate that the dental and jaw system receives adequate mechanical loads necessary for the normal functioning of all its links. The results of the conducted studies indicate the effectiveness and feasibility of using dental training to improve dental status, which serves as a new approach to the prevention and treatment of dental diseases.

Clinical experience of the carboxytherapy method in the treatment of patients with temporomandibular joint pain dysfunction syndrome (К07.60)

Objective. Improving the effectiveness of treatment of patients with TMJ PDS myogenic origin. Material and methods. According to the purpose of the study, a group of 10 patients (8 women and 2 men aged 14 to 60 years) was formed with the coincidence of a triad of signs: pain during movements of the lower jaw, a feeling of heaviness and tension in the chewing and facial muscles, restriction of mouth opening. A set of diagnostic measures has been implemented in the following scope: clinical and radiological examination methods, TMJ MRI, ultrasound and surface EMG of the chewing muscles, digital axiography. In the treatment of patients in the study group, the method of invasive carboxytherapy was used, based on dosed injections of CO2 in the projection of trigger points of the masticatory muscles. The research examines the therapeutic value of using of CO2 in the protocol of functional rehabilitation of patients with TMJ diseases of myogenic origin. Results. The analysis of the effectiveness of treatment of patients in the study group was carried out to assess the dynamics of key parameters: the severity of the pain syndrome according to VAS, the magnitude of the IMPACT index values and the magnitude of mouth opening. The severity of pain in patients in the study group, according to average values, decreased by 86% from the initial values, an increase in the amplitude of mouth opening by 28.5%, a decrease in the IMPACT index values by 42.5% from the initial values of hypertonicity of the masticatory muscles, an increase in blood flow speed of superficial temporal artery at 52.5%. Conclusion. The results of the clinical application of the carboxytherapy method in the treatment of patients with TMJ PDS allow us to recommend this method for implementation in the rehabilitation protocols of patients with TMJ PDS of myogenic origin, trismus and hypertonus of the masticatory muscles. Carboxytherapy as a method of etiopathogenetic rehabilitation contributes to the early relief of pain syndrome, normalization of the bioelectric activity of the chewing muscles and restoration the physiological kinematics of the lower jaw’s movements.

Evaluation of electrognathography indicators in patients with decreased height of the lower part of the face and symptoms of intolerance to the structural materials of dentures

Purpose of the study: to conduct a comparative assessment of electrognathography indices in elderly patients with a decrease in the height of the lower part of the face with symptoms characteristic of intolerance to the structural materials of dentures, before and during the diagnostic and treatment stages of using occlusal-stabilizing devices. Material and methods. We examined 76 patients aged 61 to 74 years with a decrease in the height of the lower part of the face and the presence of symptoms characteristic of intolerance to the structural materials of dentures. Based on the results of a short “Hamburg” examination, 30 patients were selected with the possibility of dysfunctional disorders of the temporomandibular joint, for whom occlusal-stabilizing devices were made. Results. A study of elderly patients with a decrease in the height of the lower part of the face and symptoms characteristic of intolerance to the structural materials of dentures revealed the effectiveness of the use of occlusal-stabilizing devices at the treatment and diagnostic stages due to a decrease in complaints of dry mouth more than in twice, a decrease in the intensity of burning of the mucous membrane, a decrease in the number of complaints accompanying dysfunctional disorders of the temporomandibular joint, as well as an improvement in electrognathography indicators to physiological norms. Conclusion. The obtained results of treatment with occlusal-stabilizing devices for patients with a decrease in the height of the lower part of the face, presenting complaints characteristic of intolerance to the structural materials of dentures, at the treatment and diagnostic stages indicate the feasibility and effectiveness of their use in this category of people.

Structural MRI findings in the brain related to pain distribution in chronic overlapping pain conditions: An explorative case-control study in females with fibromyalgia, temporomandibular disorder-related chronic pain and pain-free controls.

Few neuroimaging studies have investigated structural brain differences associated with variations in pain distribution. To explore structural differences of the brain in fibromyalgia (FM), temporomandibular disorder pain (TMD) and healthy pain-free controls (CON) using structural and diffusion MRI. A case-control exploratory study with three study groups with different pain distribution were recruited: FM (n = 16; mean age [standard deviation]: 44 [14] years), TMD (n = 17, 39 [14] years) and CON (n = 10, 37 [14] years). Participants were recruited at the University Dental Clinic in Malmö, Sweden. T1-weighted and diffusion MRIs were acquired, clinical and psychosocial measures were obtained. Main outcome measures were subcortical volume, cortical thickness, white matter microstructure and whole brain grey matter intensity. Patients with FM had smaller volume in the right thalamus than patients with TMD (p = .020) and CON (p = .030). The right thalamus volume was negatively correlated to pain intensity (r = -0.37, p = .022) and pain-related disability (r = -0.45, p = .004). The FM group had lower cortical thickness in the right anterior prefrontal cortex than CON (p = .005). Cortical thickness in this area was negatively correlated to pain intensity (r [37] = - 0.48, p = .002). This study suggests that thalamus grey matter alterations are associated with FM and TMD, and that anterior prefrontal cortex grey matter alterations are associated with FM but not TMD. Studies on chronic overlapping pain conditions are needed in relation to possible nociplastic pain mechanisms in the brain and central nervous system.

Microstomia- A Review Of Published Case Reports On The Proposed Management Of Microstomia

Introdcution: microstomia, or the reduction of oral opening, can indeed present challenges for patients across various contexts, from eating and speech to prosthetic treatment. It's essential for clinicians to understand the underlying causes and tailor their approach accordingly. By synthesizing existing evidence, this review aims to provide insights into the effectiveness and feasibility of different prosthetic interventions, thereby guiding clinicians in their decision-making process for optimal patient care. Materials and methods: published case reports and case series reporting on prosthetic rehabilitation of microstomia patients were included in the present review. Only cases with a reduction in the size of the oral aperture were included, and cases with reduced mouth opening with a normal oral aperture (e.g., oral submucous fibrosis, temporal-mandibular joint ankylosis, etc.) Were excluded. Case reports: (case report1) a 93-year-old woman without teeth was referred from the local hospital to the department of oral rehabilitation at the faculty of dentistry, university of otago, dunedin, new zealand. The woman's surgeries on her lower lip resulted in a significant reduction in the vertical opening distance between her upper and lower lips, now at 30 mm. This condition, known as microstomia. (case report 2) a 62-year-old male patient, completely without teeth, presented to the prosthodontic department due to functional difficulties. Discussion: a planned and step-by-step approach is crucial when dealing with cases of microstomia. The outcome greatly depends on the complexity of the case and the utilization of recommended materials and equipment hence, diagnosis and treatment planning play pivotal roles in the management process. Conclusion: although the utilization of flexible denture materials holds promise in enhancing patient comfort and treatment outcomes, further research is warranted to evaluate their long-term success rates. Longitudinal studies can furnish valuable insights into the durability, stability, and overall performance of these materials over time, assisting clinicians in decision-making and optimizing patient care.

The Goat as a Model for Temporomandibular Joint Disc Replacement: Techniques for Scaffold Fixation

The Goat as a Model for Temporomandibular Joint Disc Replacement: Techniques for Scaffold Fixation

EARLY DETECTION OF DISEASES OF THE TEMPOROMANDIBULAR JOINT IN PATIENTS UNDERGOING DENTAL TREATMENT

The problem of early diagnosis of temporomandibular joint dysfunction remains important in dentistry today. The prevalence rate of diseases of the temporomandibular joint ranges from 35% to 83% according to various researchers.

Diagnostic significance of the method of computerized joint vibration analysis in studying the functional state of temporomandibular joints

polyetiology, progressive course and high frequency of relapses is one of the urgent problems of modern dentistry. Different conceptual approaches to the analysis of etiological and pathogenetic aspects of the development of dysfunctional TMJ disorders predetermine the increased interest in the search for highly informative diagnostic methods, especially at the stage of preclinical manifestations.Goal. Evaluation of possibilities of computerized joint vibration analysis method in diagnostics of TMJ functional state.Materials and methods. The study involved 42 people of both sexes with physiologic types of bite, preserved tooth rows, no signs of functional disorders in TMJ and masticatory muscles. The patients underwent clinical dental examination, «Hamburg test», selective grinding of teeth, and measurement of mouth opening amplitude. Joint vibration analysis was performed on the hardware-software complex «BioPAK» with registration of TMJ noise oscillations according to the following indices: «Total Integral», «High Integral», «Low Integral», «Ratio». A flow chart (Ishigaki S. et al., 1993) was used to interpret the numerical values. The functional state of TMJ was de-termined according to the flowchart using numerical parameters in accordance with the classification of TMJ disorders (Wilkes С.Н., 1989).Results. In patients with physiologic occlusion, according to joint vibration analysis, Me «Total Integral» of the right TMJ was 11.7 PaHz, left TMJ – 12.6 PaHz, [Q-25; Q-75] – [9.3; 15.1] PaHz and [10.5; 18.3] PaHz respectively, Me «High Integral» of the right TMJ – 1.3 PaHz, left TMJ – 1.4 PaHz, [Q-25; Q-75] – [1.0; 1.8] PaHz and [1.2; 2.1] PaHz respectively, with no statistically significant (p≤0.05) differences in the studied parameters between the right and left TMJ.Conclusions. The diagnosis of «structurally intact» TMJ, corresponding to stage I of the American classification of TMJ disorders (Wilkes S.N., 1989) in people with physiologic types of bite, is confirmed by the numerical values [Q-25; Q-75] of «Total Integral», «High Integral» (block diagram of S. Ishigaki et al., 1993), the degree of maximum mouth opening [43; 50] mm in the absence of pronounced signs of facial asymmetry.

Novel Apocynin regulates TRPV1 activity in the trigeminal system and controls pain in a temporomandibular joint neurogenic model.

Herein, we investigate the potential analgesic effect of a newly synthesized chalcone-derived apocynin in a neurogenic pain model. Molecular docking was used to foretell the apocynin binding features and dynamics with the TRPV1 channel, and the activity was tested in vitro, using transfected HEK 293T cells with the rat TRPV1 receptor. The analgesic effect of apocynin was investigated using a capsaicin-induced pain model. The expression of TRPV1, TRPA1, TRPM8, and MAPKs was assessed by electrophoresis, and immunosorbent assays were performed to quantify the neurotransmitters Substance P, Glutamate, and CGRP. A survival assay using Galleria mellonella was carried out to determine the toxicity. We observed that apocynin exhibits greater thermodynamic stability. Upon apocynin ligand binding, it changes the electrostatic potential for a predominantly electronegative state in the interior and neutral in its external vanilloid pocket. Treatment of apocynin induces antinociceptive effects against the noxious challenge of capsaicin. Histologically, apocynin decreased the number of TRPV1+ immunopositive cells. Electrophoresis showed reduced phosphorylation of p44/42 (ERK1/2) and decreased protein levels of substance P, and CGRP. In the survival assay, apocynin showed low toxicity. In conclusion, we provide proof-of-principles that the newly synthesized apocynin compound effectively prevented nociception in a neurogenic model of orofacial pain.

AI and radiologist assessments on the prevalence of TMJ osteoarthritis using radiographic images: A comparative study

Objectives: This study aims to address the significant discomfort and functional impairment associated with temporomandibular joint osteoarthritis (TMJ OA), which negatively impacts the quality of life. It emphasizes the importance of prompt diagnosis and explores the potential of an Artificial Intelligence (AI) system to enhance TMJ OA diagnosis. Methods: The prevalence of TMJ OA was evaluated using 3 diagnostic tools: the gold standard, the AI model, and an examiner. In total, 132 patients who performed 190 cone-beam computed tomography (CBCT) images were included. Results: The prevalence of TMJ OA was 62.11% using the gold standard, 63.68% using the AI model, and 58.42% when assessed by the examiner. No gender variation in TMJ OA diagnosis was reported (p-value>0.05). Age variations were reported with the gold standard and the examiner diagnosis. When compared to the gold standard, the AI model had remarkable sensitivity (97.46%) and specificity (91.67%). Conclusions: The AI model shows promise in enhancing the accuracy of TMJ OA diagnosis, offering potential benefits for early detection and improved patient outcomes.

Intraoperative Non-Opiate Anesthesia for Patients Undergoing Arthroscopic Temporomandibular Joint Surgery: A Randomized Controlled Trial

Intraoperative Non-Opiate Anesthesia for Patients Undergoing Arthroscopic Temporomandibular Joint Surgery: A Randomized Controlled Trial

Association between temporomandibular joint dysfunction signs and symptoms, mental health indices, and MRI diagnoses: should we scan patients?

Association between temporomandibular joint dysfunction signs and symptoms, mental health indices, and MRI diagnoses: should we scan patients?

Efficacy of dextrose prolotherapy on temporomandibular disorder: a retrospective study.

Dextrose prolotherapy is one of the most promising minimally invasive interventions for temporomandibular disorder (TMD), particularly in refractory cases where other conservative treatments have failed. The purpose of this study was to demonstrate the efficacy of a new treatment, temporomandibular joint (TMJ) prolotherapy, in patients with TMD to alleviate symptoms. A retrospective analysis was conducted on TMD patients with chronic pain who did not respond to conventional treatments. TMJ prolotherapy was performed using hypertonic dextrose in the TMJ area, targeting the retrodiscal attachment tissue, anterior disc attachment tissue, lateral capsule, origin of the masseter muscle, and the stylomandibular ligament. Pain or discomfort intensity in the TMJ was evaluated using a numerical rating scale (NRS). Maximum mouth opening and subjective satisfaction were also analyzed. Nineteen patients (6 males, 13 females, average age 43 years) participated in this study. All patients experienced pain improvement with a maximum of three prolotherapy sessions. The initial mean NRS was 5.7, which ultimately decreased to a final mean TMJ discomfort score of 1.7 postintervention. The patients' maximum mouth opening increased from an initial 34.5 mm to 38.8 mm, and they reported positive satisfaction with the prolotherapy treatment. The clinical outcomes were positive regardless of main origin of TMD symptoms. Hypertonic TMJ prolotherapy is an effective minimally invasive intervention for TMJ disorders with chronic pain.

Portuguese translation, cultural adaptation and psychometric properties of the temporomandibular joint scale: a cross-sectional study

BackgroundThe temporomandibular joint (TMJ) scale assesses the severity of temporomandibular joint disorders (TMD), yet a European Portuguese translation is lacking.ObjectivesTo translate, cross-culturally adapt and to examine the psychometric properties (construct validity and reliability) of the TMJ scale.MethodsTranslation and cultural adaptation were carried out according to international recommendations, including initial translation, evaluation of this translation and cultural adaptation by a panel of experts, and back translation. The final Portuguese version was used to examine the reliability and validity, and participants with TMD were recruited from a Portuguese outpatient clinic. Reliability measures included internal consistency with Cronbach’s alpha and test-retest reliability with the intraclass correlation coefficient (ICC2,1). The Spearman correlation comparing the TMJ scale with the Fonseca and Helkimo indexes was used to assess the construct validity.ResultsA total of 63 participants (23 ± 2 years; 61,9% female) were included. Similar internal consistency was observed between the two moments of application (0.921 and 0.918), and test-retest reliability was excellent, with an ICC2,1 = 0.998 (95%CI: 0.988–0.999). Robust positive correlations (rho 0.554–0.611, p < 0.001) were found between the TMJ scale and Fonseca and Helkimo indexes.ConclusionThe European Portuguese version of TMJ scale is now available to improve the assessment of severity of TMD in routine clinical practice. This version is also reliable and valid.

Genome-Wide Association Study of Temporomandibular Disorder-Related Pain in Finnish Populations.

Temporomandibular disorders (TMD) are multifactorial musculoskeletal pain and dysfunctions in temporomandibular joints (TMJs) and masticatory muscles. Genetic factors play a role in TMD-related pain, but only a few genome-wide association studies (GWAS) have been conducted. The aim of this GWAS was to explore genetic factors associated with painful TMD in Finnish populations. Data from two epidemiological surveys, the Northern Finland Birth Cohort 1966 (NFBC1966) and the Health 2000 Survey in Finland, including altogether 468 cases and 6833 controls, were used. Case definition was based on pain on palpation of masticatory muscles and/or TMJs. GWASs of the whole data and stratified by sex were conducted from both cohorts using additive models, followed by meta-analysis of the two cohorts. Replications of the previously reported TMD risk loci (rs73460075, DMD; rs4794106, SGCA; rs73271865, SP4; rs60249166, RXP2; rs1531554, BAHCCI; rs5862730, OTUD4/SMAD1; rs10092633, SFRP1; rs34612513, SOX14/CLDN18; rs878962, TSPAN9) were also investigated. Four genome-wide significant loci were found in sex-stratified analysis of NFBC1966, including associations at three loci in males (rs1023114, PRIM2, p = 5 × 10-9; rs4244867, ALG10, p = 3 × 10-8; rs79841648, ADCYAP1, p = 4 × 10-9) and one locus in females (rs148476652, DNER, p = 4 × 10-9). However, the results could not be replicated in the Health 2000 Survey or in the meta-analysis of these two cohorts. The previous TMD GWAS associations did not replicate in our data either. Several TMD pain-associated variants were found in sex-stratified analysis of NFBC1966, suggesting the role of neuroendocrine stress responses and central nervous system. These findings need to be confirmed in future studies.