Temporomandibular Dysfunction Research Articles

APPLICATION OF BOTULINUM TOXIN IN CONSERVATIVE TREATMENT OF MASTICATORY MUSCLES DYSFUNCTION

The purpose of this paper is to describe the application of the botulinum toxin in diseases of the temporomandibular system of a muscular type such as masticatory hypertrophy, spasm, bruxism, and tension headaches of idiopathic etiology. The masticatory system is a complex apparatus with great adaptive capacity. Still, when that capacity is exceeded, functional disorders occur followed by a series of symptoms that depend on individual, local, and systemic etiological factors. Occlusal trauma exceeding the physiological limits of the teeth, periodontium, and TMJ leads to a series of functional disorders. Temporomandibular dysfunctions (TMD) are used to describe a large, heterogeneous group of diseases of the temporomandibular joint (TMJ) and its adjacent tissues and organs. Botulinum toxin type A, hemagglutinin complex with 500 IU (DISPORT Ipsen Biopharm, UK) was used for the therapy of muscle disorders like bruxism or night teeth clenching in female patient 26 years old. Depending on the dose that was applied to the targeted muscle, a complete or partial reduction in contraction occurs with reduced function and weakening of the muscle. Two weeks after applying the neuromodulator, the patient reported a reduction in pain and episodes of teeth grinding and clenching. Bilateral hypotrophy of left and right masseter muscles was noticeable after 2 months. We concluded that botulinum toxin could be used as an effective treatment for reducing nocturnal bruxism and myofascial pain in patients with bruxism.

Relationship between Botulinum Toxin and Temporomandibular Dysfunction: a Literature Review

AbstractTemporomandibular dysfunction (TMD) encompasses several conditions affecting the temporomandibular joint and jaw muscles, leading to orofacial pain and other symptoms. Botulinum toxin is a potential therapy for relieving pain, improving jaw function, and reducing the use of analgesics. This study aims to systematically illustrate the application of botulinum toxin in the therapeutic context of TMD. This study took the form of a literature review, in which an analysis of knowledge repositories was conducted, including Medline (U.S. National Library of Medicine), accessed via PubMed, as well as Lilacs (Latin American and Caribbean Literature in Health Sciences), Scielo (Scientific Electronic Library Online), and Google Scholar. The selection involved the inclusion of studies published from 2015 to 2023. The literature review identified botulinum toxin as an effective and safe therapeutic alternative for TMD patients. The manifestation of side effects, when reported, was predominantly mild and transient in nature, granting botulinum toxin the prospect of establishing itself as a promising therapeutic option in refractory cases to conventional approaches. However, it is important to emphasize the need for further studies and clinical trials to further consolidate the efficacy and safety associated with the use of botulinum toxin as a treatment for TMD.Keywords: Temporomandibular Dysfunction. Masticatory Muscles. Botulinum Toxin. ResumoA disfunção temporomandibular (DTM) engloba várias condições que acometem a articulação e os músculos da mandíbula, causando dor orofacial e outros sintomas. A toxina botulínica é uma potencial terapia para aliviar a dor, melhorar a função mandibular e reduzir o uso de analgésicos. Este estudo visa ilustrar de forma sistemática a aplicação da toxina botulínica no contexto terapêutico da DTM. Este estudo assumiu a forma de uma revisão bibliográfica, na qual foi realziado uma análise de repositórios de conhecimento, incluindo o Medline (Biblioteca Nacional de Medicina dos Estados Unidos), acessado por meio do PubMed, assim como o Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), o SciELO (Scientific Electronic Library Online) e o Google Scholar. A seleção envolveu a inclusão de estudos publicados no período de 2015 a 2023. A revisão bibliográfica identificou a toxina botulínica como uma alternativa terapêutica eficaz e segura para pacientes com DTM. A manifestação de efeitos colaterais, quando relatados, revelou-se predominantemente de natureza branda e transitória, outorgando à toxina botulínica a perspectiva de se consagrar como um recurso terapêutico promissor em situações refratárias às abordagens convencionais. No entanto, é importante enfatizar a necessidade de estudos prévios e ensaios clínicos para uma maior consolidação da eficácia e segurança associadas à utilização da toxina botulínica como tratamento para a DTM. Palavras-chave: Disfunção Temporomandibular. Músculos Mastigatórios. Toxina Botulínica.

Orthokinetic splint as treatment of trigeminal neuralgia associated with temporomandibular dysfunction

Orthokinetic splint as treatment of trigeminal neuralgia associated with temporomandibular dysfunction

Bichectomy Surgery and EMG Masticatory Muscles Function in Adult Women: A Longitudinal Study

Bichectomy Surgery and EMG Masticatory Muscles Function in Adult Women: A Longitudinal Study

Temporomandibular dysfunction and bruxism in patients with early rheumatoid arthritis and at-risk patients: a cross-sectional study

What is the prevalence of temporomandibular dysfunction in patients with early rheumatoid arthritis and individuals at risk of rheumatoid arthritis? 3 groups (of 50 participants each) were examined for a possible TMD diagnosis: 1. patients with early rheumatoid arthritis, 2. at-risk individuals, and 3. healthy controls. A possible association with bruxism, determined on the basis of self-reporting and clinical features, was also examined. At-risk patients had a higher prevalence of TMD pain diagnoses compared to healthy controls (p = 0.046). Within the early rheumatoid arthritis group, seronegative patients had a higher prevalence of TMD pain diagnoses than seropositive patients (p = 0.048). No further differences in the prevalence of TMD diagnoses were found between the groups. Participants with a TMD pain diagnosis were more often diagnosed with probable sleep bruxism than those without a TMD pain diagnosis. The prevalence of TMD pain is increased in individuals at risk of rheumatoid arthritis and seronegative early rheumatoid arthritis patients, and is associated with signs of bruxism.

Effect of Photobiomodulation Therapy Dosage on Orthodontic Movement, Temporomandibular Dysfunction and Third Molar Surgery Outcomes: A Five-Year Systematic Review

(1) Background: This five-year systematic review seeks to assess the impact of oral and peri-oral photobiomodulation therapies (PBMTs) on the adjunctive management of deeper tissue biofunction, pathologies related to pain and inflammatory disorders and post-surgical events. (2) Methods: The search engines PubMed, Cochrane, Scopus, ScienceDirect, Google Scholar, EMBASE and EBSCO were used with appropriate Boolean operatives. The initial number of 14,932 articles was reduced to 261. Further exclusions performed to identify PBM therapy in third molar surgery, orthodontic and TMJ articles resulted in 19, 15 and 20 of these, respectively. Each paper was scrutinised to identify visible red–NIR laser wavelength PBM applications, concerning dosimetry and outcomes. (3) Results: A dataset analysis was employed using post hoc ANOVA and linear regression strategies, both with a Bonferroni correction (p < 0.05). The outcomes of articles related to oral surgery pain revealed a statistically significant relation between PBMT and a positive adjunct (p = 0.00625), whereas biofunction stimulation across all other groupings failed to establish a positive association for PBMT. (4) Conclusions: The lack of significance is suggested to be attributable to a lack of operational detail relating to laser operating parameters, together with variation in a consistent clinical technique. The adoption of a consistent parameter recording and the possible inclusion of laser data within ethical approval applications may help to address the shortcomings in the objective benefits of laser PBM.

Pain and salivary biomarkers of stress in temperomandibular disorders were affected by maxillary splints.

Longitudinal intervention studies on treatment options in temporomandibular dysfunction (TMD) including self reports and salivary biomarkers of stress are rare and the exact therapeutic function of occlusal splints widely unknown. We examined the therapeutic effects of a Michigan splint with occlusal relevance in patients with TMD using a placebo-controlled, delayed-start design. Two intervention groups received a Michigan splint, while one of them had a placebo palatine splint for the first 3 weeks. We collected pain intensities (at rest and after five occlusal movements), salivary measures associated with stress (cortisol and alpha-amylase) and self-reported psychological distress (stress, anxiety, catastrophizing) at baseline and 3 and 7 weeks after onset of intervention. At baseline, we observed increased pain intensity and psychological distress in TMD patients compared to 11 matched healthy controls. Baseline anxiety was linked to movement pain intensity through stress. Over therapy reductions in pain intensity and morning cortisol were more pronounced in those patients starting immediately with the Michigan splint, while psychological distress decreased similarly in both groups. Our results suggest that perceived stress plays a role for the association between anxiety and TMD pain and underlines the need for an interdisciplinary perspective on the pathogenesis and therapy of TMD in a setting where psychotherapeutic knowledge is still scarce or rarely applied.

Virtual Surgical Planning for Temporomandibular Joint Reconstruction with Stock TMJ Prostheses: Pilot Study.

The temporomandibular joint (TMJ) is one of the most complex joints in the human anatomy. In advanced degenerative stages, conservative or minimally invasive surgical therapies have failed to restore joint function, and joint replacement with prostheses has been required. Stock prostheses, compared to custom-made prostheses, are much less expensive and require less pre-operative preparation time. Four patients followed for years for temporomandibular dysfunction and previously operated on by arthroscopy or open joint surgery that have been reconstructed with stock TMJ prostheses (STMJP) through virtual surgical planning (VSP) and an STL model with surgical and positioning guides were included. The median follow-up was 15 months; the median number of previous TMJ surgeries was 2. The mean preoperative MIO was 24.6 mm and at longest follow-up was 36.4 mm. The median preoperative TMJ pain score was 8, and the median postoperative TMJ pain was 3. All patients have improved their mandibular function with a clear improvement of their initial situation. In conclusion, we believe that stock TMJ prostheses with virtual surgical planning and surgical guides are a good alternative for TMJ reconstruction at the present time. Nonetheless, prospective and randomized trials are required with long-term follow up to assess their performance and safety.

Applicability of Infrared Thermography in Dentistry: Mini Review

Infrared thermography is a precise, non-invasive and safe method for measuring superficial temperature, with increasing application in different areas of dentistry, such as endodontics, implantology, restorative dentistry, periodontics, prosthodontics, surgery and principally, for the diagnosis of temporomandibular dysfunction. The aim of this study is to briefly present how thermographic imaging has been used in dentistry. The use of thermography is still restricted in dentistry, but it has great potential for use in daily practice.

Effects on temporomandibular disorder in the treatment of tension-type headache with acupuncture and therapeutic exercises. A secondary analysis from a randomized controlled trial

Objectives To examine the effects of acupuncture and therapeutic exercise alone and in combination on temporomandibular joint symptoms in tension-type headache and to evaluate the potential interaction of existing temporomandibular dysfunction on the success of headache treatment. Design Pre-planned secondary analysis of a randomized controlled, non-blinded trial. Setting Outpatient clinic of a German university hospital. Subjects Ninety-six Participants with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups. Interventions Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months. Main measures Subjective temporomandibular dysfunction symptoms were measured using the Functional Questionnaire Masticatory Organ, and the influence of this sum score and objective initial dental examination on the efficacy of headache treatment interventions was analyzed. Results Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up (usual care: 0.05 [SD 1.435]; acupuncture: −5 [SD 1.436]; therapeutic exercise: −4 [SD 1.798]; combination: −3 [SD 1.504]; P = 0.03). After 6 months, only acupuncture (−6 [SD 1.736]) showed a significant improvement compared to the usual care group (P < 0.01). Subjective temporomandibular dysfunction symptoms had no overall influence on headache treatment. Conclusions Only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental findings seem to inhibit the efficacy of acupuncture for tension-type headache.

Relationship between temporomandibular dysfunction (TMD) and sleep disorders: an overview of systematic reviews

Relationship between temporomandibular dysfunction (TMD) and sleep disorders: an overview of systematic reviews

Can nano-fat injection in patients with tempromandibular disorder alters salivary matrix metalloproteinases 2 and 9?

Temporomandibular disorder (TMD) is a musculoskeletal condition that affects temporomandibular joint, causing pain and dysfunction in the jaw area, jeopardizing the ability to eat and even sleep comfortably. A key factor in the pathogenesis of TMD is the enhanced breakdown of extracellular matrix components, such as collagen and elastin. This breakdown is mediated by enzymes known as matrix metalloproteinases (MMPs), specifically MMP2 and MMP9. Elevated expression of MMP2 and/ or MMP9 may be involved in the pathophysiology of TMD. Methodology: Stimulated saliva samples were obtained from Thirty-two TMD patients. MMPs in collected samples were analyzed by ELISA. Results: Three months after nano-fat injection, Means of MMP2 and MMP9 were significantly decreased compared to that before procedure (139.59 versus 128.46 ng/ml, P= 0.003; and 545.37 versus 469.09 ng/ml, P= 0.001 respectively). Conclusion: this study provides evidence for a significant reduction in salivary MMP2 and MMP9 levels among TMD patients following nano-fat injection therapy. These findings suggest that nano-fat injections may have therapeutic potential for managing TMD by modulating ECM remodeling processes through their effects on these enzymes.

The short-term impact of occlusal splints on the expression of temporomandibular dysfunctions (pilot study)

Introduction. Temporomandibular dysfunctions are frequently encountered in clinical dental practice, with a significant impact on the functionality of the stomatognathic system and quality of life. The rehabilitation of patients with temporomandibular dysfunction requires conservative, minimally invasive treatments, with a central objective of improving the dysfunctional symptoms. As a first-line treatment, occlusal splints are often indicated — devices with high efficiency (70-90%), but the therapeutic mechanisms and their primary effects in the short term are still not elucidated. Aim of the study: Evaluation of the short-term impact of treatment with occlusal splints on the objective and subjective level of expression of temporomandibular disorders. Results: The impact of the reversible occlusal treatment on the structure of the clinical picture in the short term (1 month of treatment) was varied, attesting to the statistically significant reduction of the mean values regarding the clinical indices of TMD expression (comfortable mouth opening amplitude, the number of joint sites /sensitive muscles, pain intensity) and subjective (perceived level of functional limitation). Conclusion: The overall analysis demonstrates impact trends of statistically significant amelioration for the studied symptoms, but the individual analysis of the cases demonstrates that the treatment with splints has an inconsistent effect per signs/symptoms, which highlights the need for studies over longer periods of time and with a wider range of clinical indices.

Effects of transcutaneous electrical nerve stimulation on maximal voluntary contraction in women with temporomandibular dysfunction: randomized clinical trial

Effects of transcutaneous electrical nerve stimulation on maximal voluntary contraction in women with temporomandibular dysfunction: randomized clinical trial

The effects of dry needling and face yoga on pain, depression, function, and sleep quality in patients with temporomandibular dysfunction

ContextTemporomandibular joint dysfunction (TMD) poses significant challenges due to its diverse symptoms and impact on patients' daily lives. ObjectiveThis study aimed to explore the effectiveness of two innovative interventions, dry needling and face yoga, in managing TMD-related issues such as pain, depression, and sleep quality. Design and study participantsNinety patients with TMD symptoms were enrolled in a prospective randomized controlled trial. The patients were divided into three groups: dry needling, face yoga, and a control group. Various assessments, including Visual Analog Scale for pain, Beck Depression Inventory for depression, and Pittsburgh Sleep Quality Index for sleep quality, were conducted before and 6 weeks after the interventions. ResultsA decrease in pain levels and a statistically significant increase in jaw joint movements (mouth opening, protrusive movement, lateral movements) were observed in the dry needling and face yoga groups after treatment (p <0.05). Additionally, improvements in sleep quality were observed (p <0.05). ConclusionDry needling and face yoga interventions demonstrated efficacy in managing TMD symptoms, including pain relief and improved jaw movement. The findings suggest that these interventions can be valuable additions to the treatment regimen for patients suffering from TMD-related issues. However, further research is warranted to explore the long-term effects and mechanisms underlying these interventions in TMD management.

Padrão de contração voluntária máxima em pacientes com disfunção temporomandibular antes e após terapia fonoaudiológica com e sem uso de bandagem elástica

ABSTRACT Purpose: to verify if there is an electromyographic difference during maximal (maximum) voluntary contraction of the masseter and temporalis muscles in patients with temporomandibular disorders, before and after speech therapy intervention with and without the use of therapeutic elastic bandages. Methods: an analysis of secondary data from a clinical intervention study, carried out with 17 adult volunteers, diagnosed with temporomandibular muscle dysfunction with or without disc displacement with reduction. The Bandage Group received manual therapy associated with elastic bandages and the No Bandage Group received only manual therapy. Surface electromyography was performed to record the Maximum Voluntary Contraction before and after four weeks of speech therapy intervention. For exploratory analysis, the Mann Whitney and Wilcoxon paired tests were used, with P&lt;0.05. Results: in the Bandage Group, there was a statistically significant decrease in electrical activity during Maximum Voluntary Contraction in the masseter and temporalis muscles on the left side at the post-therapeutic moment. Comparing the pre- and post-intervention between Bandage Group and No Bandage Group, a statistical difference was found in the electrical activity values of the Maximum Voluntary Contraction in the left temporal muscle. Conclusion: manual myofunctional speech therapy, associated or not with the use of therapeutic elastic bandages, impacts the muscle activity of the masseter and temporal muscles during Maximum Voluntary Contraction, whether the values demonstrate relaxation and/or equivalence of the electromyographic values of the masticatory muscles.

Anatomic Characteristics of Ultrasound Imaging of the Temporomandibular Joint at Rest and in Various Jaw Positions in Healthy Individuals: A Descriptive Study

This study examined the temporomandibular joint (TMJ) anatomy and biomechanics using Ultrasound (US) imaging to examine the TMJ anatomy at rest and in various positions of normal jaw movement in healthy individuals. A secondary aim was to describe US imaging parameters used to visually observed the TMJ. The study included 11 participants (8 M and 3 F; 22.9 ± 3.4 yrs) University with no history of TMJ problems. All 11 participants had some atypical anatomy (flat mandibular head, altered articular disc shape, displacement or deformation of the disc during movement) while using US imagining. No participants had current pain or dysfunction and none met the Diagnostic Criteria for Temporomandibular Dysfunction (DC-TMD) classifications for the condition. Most participants denied symptoms during testing, although one participant did have pain with retrusion and another had popping without pain. This study in part has added to the growing interest of using US imaging as modality to investigate the anatomy and biomechanics of the TMJ and the relationship to TMD. Future studies are warranted to examine TMJ anatomy and biomechanics via US imaging in order to provide further recommendations on the techniques and settings for the modality for the end-user.

Evaluation of cranio-mandibular dysfunction in patients with dento-maxillary anomalies using the Helkimo index

Introduction. Dento-maxillary anomalies are characterized by changes in the size, shape, position and inclination of the morphological elements that make up the stomatognathic system. Recent studies demonstrate the fact that not only traumatic occlusion (OT) is the etiological factor of TMJ dysfunction. But muscular factors, vicious habits and dento-maxillary anomalies are also involved. Created by the Marti Helkimo in 1972 to investigate the prevalence and severity of signs and symptoms of temporomandibular dysfunction. Material and method. The study was carried out on a group of 78 patients from the personal case with various dento-maxillary anomalies and TMJ suffering. We statistically processed the data obtained from the clinical examination, in order to compare the situation of patients with temporomandibular dysfunction compared to that of patients without joint disorders at the time of the initial examination. Results. Most patients with class II/2 anomalies: 42.86% presented an anamnestic index of I, and a percentage of 20.69% had a Helkimo anamnestic index of II. So with this type of anomaly, the patients indicated obvious signs of ATM dysfunction. The Helkimo anamnestic index had the highest scores in the II/2 anomaly in the female sex, followed by class II/1 anomalies in the male gender. This index correlates better with the clinical one in the female for all types of anomalies. Conclusion. The most important examination in the case of TMJ pathology is represented by the thorough clinical examination. There is a directly proportional relationship between the degree of severity of the malocclusion and the Helkimo index points.

Treatment with botulinum toxin of masseter hypertrophy, myalgia of the tendons and attrition induced by bruxism

Bruxism is a disabling condition in which unconscious contractions of the masticulatory muscles lead to teeth grinding and jaw clenching. Symptoms include toothache, temporomandibular dysfunction, headache and attrition. Treatment options range from conservative approaches to invasive interventions. Education, stress reduction, avoidance of stimulants, and relaxation techniques can help in mild cases. Wearing an occlusal splint can reduce attrition. Botulinum neurotoxin type A (BoNT-A) injections are a treatment option temporarily causing partial paralysis of the masticulatory muscles. BoNT-A is a treatment for reducing symptoms and improving the quality of life of patients with bruxism that has been proven safe and effective. The effects usually last several months. To achieve the best results and minimize side effects, BoNT-A injections should be applied by an experienced practitioner.

Volumetric differences in temporomandibular joint components in patients with facial asymmetry: A 3D tomographic segmentation study

PurposeTo determine if there are differences in condylar volume, glenoid cavity and joint space between patients diagnosed with facial asymmetry (FA), between affected and contralateral sides and with respect to subjects without FA. MethodsCross-sectional, retrospective study comparing CT/CBCT images from patients with FA diagnosis referred to a private clinic, versus a control group, age and sex matched, of patients requiring orthodontic treatment without FA. The 3D Slicer software was used for the analysis. Bivariate analysis was performed to compare qualitative variables using Chi-square or Fisher tests, and for normal distribution quantitative variables, the t-student test was used. The level of significance was p < 0.05. ResultsThe FA group (n = 138) included: Hemimandibular Elongation (HE) (n = 64), Hemimandibular Hyperplasia (HH) (n = 12), Hybrid Form (HF) (n = 20), Asymmetric Mandibular Prognathism (AMP) (n = 25), Glenoid Cavity Asymmetry (GCA) (n = 9) and Functional Laterognathism (FL) (n = 8). The control group (n = 20) had no FA and no signs or symptoms of temporomandibular dysfunction. The right condylar and glenoid cavity volumes were significantly larger in FA cases. The volumes of the right and left joint space had significant differences only in HE patients. ConclusionCondylar volumes are higher in almost all FA subgroups compared to matched controls. The glenoid cavity volume is larger in FA patients, except for the GCA right and FL left sides. Regarding articular spaces, HE was the only entity with less volume on the contralateral side. The evaluation of structural volume by 3D-CT images helps to diagnose and differentiate FA subgroups.