Temporomandibular Joint Region Research Articles

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.

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.

Diagnosis and differentiation diagnosis of primary temporomandibular joint cartilage and giant cell related tumor lesions

Cartilage and giant cell-related neoplastic lesions originating in the temporomandibular joint region have similar clinical, imaging and pathological manifestations, making the diagnosis of these disorders challenging to varying degrees. Diagnostic findings can influence treatment procedures and a definitive pathological diagnosis is important for the prognosis of these conditions. In this article, we discuss the pathological diagnosis and differentiation of four benign cartilage and giant cell related tumors and tumor-like lesions that occur in the temporomandibular joint, namely synovial chondromatosis, tumoral calcium pyrophosphate deposition disease, pigmented villonodular synovitis and chondroblastoma, taking into account their clinical features and histological manifestations, with a view to providing a basis for clinical management.

Das Eagle-Syndrom

In patients with chronic pain in the temporomandibular joint (TMJ) and/or upper cervical region, particularly when they also complain of a foreign body feeling in their throat and dysphagia, treating physicians should always consider Eagle’s syndrome as part of the differential diagnosis. An elongated or unfavourably angled styloid process and/or ossifications of the stylohyoid ligament can be the causes of symptoms. In most cases, panoramic imaging is sufficient to diagnose this condition. Given the diagnosis, resection of the elongated process via an intraoral approach should be considered. For oral and maxillofacial surgeons, it is important to keep Eagle’s syndrome in mind as part of the differential diagnosis, especially in patients with chronic, treatment-refractory pain.

Degenerative bony changes in the temporal component of the temporomandibular joint - review of the literature.

Temporomandibular joint (TMJ) changes are quite frequent in adults, but not all changes are degenerative. A high prevalence of bone alterations in the TMJs was reported by different research groups. Disturbed remodeling of bony articulating structures occurs because of overloading masticatory forces or because the mechanical loading in the area out-weighs the adaptive capacity of the TMJ structures. Although most of the degenerative TMJ alterations are identified at the level of the condylar process, a complete evaluation of the degenerative modifications encountered in the temporal TMJ region should not be forgotten as they are important for a comprehensive assessment and further management of the clinical situation. Several research groups have described osseous remodeling in the temporal component of the TMJ. Evidence is scarce for degenerative modifications at the level of the articular eminence and thickening of the roof of the glenoid fossa has been associated with osteoarthritis.

Evaluation of temporal bone pneumatization using panoramic radiography and cone beam computed tomography

Aim: To evaluate the presence and characteristics of pneumatizations in the roof of the mandibular fossa and articular eminence by panoramic radiography and cone beam computed tomography (CBCT). Methods: This study analyzed CBCT images of the temporomandibular joint of 705 patients, In 60 exams, it was possible to compare tomographic with panoramic images. For cases where pneumatization was present, laterality and pattern of manifestation were considered. A chi-square test was used to compare the differences between CBCT and panoramic radiography in the diagnosis of pneumatization. Results: Descriptive analysis revealed a sample profile that was predominantly female (75.9%), with a mean age of 42.6 years (± 17.4). The presence of pneumatizations in the roof of the mandibular fossa and articular eminence in CBCT images was identified in 330 (46.8%) and 154 (21.8%) exams, respectively, and the most frequent pneumatization pattern was the multilocular type in both locations. Bilateral pneumatization was more prevalent in the roof of the mandibular fossa. Considering the analysis of 60 pairs of exams, in panoramic radiography, pneumatizations in the roof of the mandibular fossa and articular eminence were identified in 22 (36.7%) and 12 (20.0%) examinations, respectively. Regarding CBCT images, pneumatizations in the roof of the mandibular fossa was observed in 24 (40.0%) exams, while articular eminence was found in 14 (23.3%) images. There were no statistically significant differences between the proportion of pneumatization identified by panoramic radiography and CBCT (p &gt; 0.05). Conclusion: This study suggests that panoramic radiography may be an imaging method used to evaluate pneumatization in the temporomandibular joint region. Uniterms: Temporal bone. Temporomandibular joint. Panoramic radiography. Cone beam computed tomography.

UYKU BRUKSİZMİ OLAN MİYOFASYAL TEMPOROMANDİBULAR DİSFONKSİYON TANILI HASTALARDA MANUEL TEDAVİ İLE SPLİNT TEDAVİSİNİN KARŞILAŞTIRILMASI

Purpose: The aim of this study was to examine the effect of manual therapy on temporomandibular pain, range of motion, functionality level of the jaw, sleep quality, and patient satisfaction, and to compare the efficacy with splint therapy among female patients with myofascial temporomandibular dysfunction (M-TMD) accompanied by sleep bruxism (SB). Methods: A total of 29 female patients, aged 18-50 years, diagnosed with M-TMD were separated into two groups using a simple random sampling method as the manual therapy group (MT; n:15) and the splint therapy group (ST; n:14). All the patients were informed about bruxism and its effects and were given home exercises. The patients in the ST group were instructed to use a static splint for one month. The MT group patients received a total of 8 sessions, 45 minutes twice a week of treatment, including joint and soft tissue mobilizations to the temporomandibular joint (TMJ) and cervical region. Pain severity, symptoms, TMJ range of motion, jaw functionality, sleep quality, and patient satisfaction were evaluated. The evaluations were repeated after 4 weeks and compared with baseline values. Results: A statistically significant difference was determined in both groups in pain, TMJ range of motion, and sleep quality (p&amp;lt;0.05). In the comparison between the groups after treatment, the pain, TMJ range of motion values, and sleep quality were seen to be statistically significantly better in the MT group (p&amp;lt;0.05). The patient satisfaction measurements of mean general satisfaction, interpersonal attitude, mean healthcare services score, and general satisfaction total points were found to be statistically significant in the MT group (p&amp;lt;0.05). Conclusion: The applications of both MT and ST were seen to be effective in patients with M-TMD with bruxism. In the comparisons between the groups, the MT method was seen to be more effective than ST. It can be thought that the application of stabilization splint therapy together with manual therapy would significantly increase the treatment efficacy in patients with M-TMD.

Effects of orofacial applications of low-magnitude, high-frequency mechanical vibration on cranial sutures and calvarial bones: A micro-computed tomography study in rats

The purpose of this study was to assess the effects of orthodontically aimed low-magnitude, high-frequency mechanical vibration (OLMHFMV) on intact calvarial bone, specifically the parietal and temporal, and cranial sutures, including the sagittal and parietotemporal, of rats in differing stages of growth and development. Forty Wistar rats were divided into 4 groups: 2 control groups and 2 OLMHFMV groups. Subsequently, 0.3 cN of force with a frequency of 30 Hz was applied as OLMHFMV on the temporomandibular joint region in the rats in the OLMHFMV-1 group, with the protocol of 20 min/d for 5 d/wk for 1 month, whereas the rats in the OLMHFMV-2 group received mechanical stimuli for 2 months with the same protocol. Morphometric and structural analyses, including suture width, cranial width and height, bone mineral density, bone volume/tissue volume, trabecular number, trabecular separation, and trabecular thickness analyses, were carried out using micro-computed tomography. The width of the parietotemporal and sagittal sutures and the cranial height and width increased significantly by OLMHFMV (P<0.021). The structural analysis revealed that trabecular number and trabecular separation increased, whereas trabecular thickness decreased in the OLMHFMV groups compared with the control groups (P<0.048). Bone volume/tissue volume remained unchanged despite reducing the bone mineral density of the OLMHFMV groups. OLMHFMV had a potential for modulating sutural and cranial growth in adolescent rats. OLMHFMV increased the structural quality of the temporal and parietal bones. These effects may have clinical implications as a treatment option for patients suffering from craniofacial anomalies such as craniosynostosis or a supportive approach for dentofacial orthodontic treatments.

Three-Dimensional Assessment of the Temporomandibular Joint Changes Following Reversed Twin Block Therapy of Patients With Skeletal Class III Malocclusion in Conjunction With the Photobiomodulation Therapy: A Randomized Controlled Clinical Trial.

Background: Despite the positive effect of the photobiomodulation therapy (PBMT) application on animals, the primary role of this technique on the human condyle is still unclear. Several experimental reports have shown the efficacy of PBMT in inducing cellular changes in the temporomandibular joint (TMJ) region during functional treatment of patients with skeletal deformities. Still, the lack of information about its effects on human condyles requires further studies.Objectives: This study aimed to evaluate the effect of PBMT on the TMJ components following Class III treatment with the reversed twin block (RTB) appliance in growing patients. Materials and Method: Forty children (12 females, 28 males) between the age of nine and eleven years with skeletal Class III were assigned randomly to the RTB group with photobiomodulation (RTB+PBMT) or the control group (RTB). The PBMT was applied to the TMJ region using an 808-nm wavelength Ga-Al-As semiconductor laser device with 5 Joules/cm2 energydensity on days 1, 3, 7, and 14 of the first month. Afterwards, the irradiation was conducted every 15 days until the end of the treatment. Cone-beam computerized tomography (CBCT) images were taken before (T1) treatment and following the end of treatment (T2) to assess TMJ and skeletal changes.Results: Condylar volume was significantly increased in the RTB group only by a mean of 287.97 mm3 (p<0.001). The significantly backward and upward condylar movement was observed in the RTB and RTB+PBMT groups (superior joint space (SJS): 0.26 mm, 0.15 mm; posterior joint space (PJS): 0.42mm, 0.11mm, respectively). The RTB group showed the most remarkable changes. Significant improvement of the sagittal maxilla-mandibular relationship was greater in the RTB+PBMT group compared to the RTB group (p=0.02).Conclusion: There were no considerable differences in the condylar position after Class III treatment between the RTB and the RTB+PBMT groups. But a difference in the condylar volume was noticed between the two group.