Temporomandibular Joint Pain Research Articles

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

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

Ultrazvučna terapija u zbrinjavanju poremećaja temporomandibularnog zgloba

Introduction: Temporomandibular joint disorder (TMD) is a collective term given to the disorders affecting the Temporomandibular joint (TMJ), masticatory muscles and their related structures. The aetiology of TMD is complex and their management includes various invasive and non-invasive methods. The increasing trend in non-invasive, non-pharmacological interventions for the management of TMJ pain has led to the development of modalities of physical therapy. Ultrasound is an electrophysical treatment modality used in the management of TMD. The aim of this study is to provide an insight into ultrasound based treatment modalities used for the effective management of TMD. Materials and methods: Electronic database search was carried out in Google Scholar and PubMed using the search terms "ultrasound therapy", "therapeutic ultrasound" and "temporomandibular joint disorders". The results obtained from the database search were screened and included for the review. Commonly used therapeutic ultrasound methods in the management of temporomandibular joint disorders with the treatment protocols, advantages, limitations and other factors to be considered for an effective treatment outcome is discussed in the present review. Conclusion: Various new ultrasound-based TMJ therapeutic modalities may be developed in the near future.

Management of temporomandibular joint diseases: a rare case report of coexisting calcium pyrophosphate crystal deposition and synovial chondromatosis

BackgroundThe coexistence of calcium pyrophosphate dihydrate crystal deposition (CPP) and synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is rarely reported. CPP disease (CPPD) is complex arthritis synonymous with excessive pyrophosphate production and variable aberrations in mineral and organic phase metabolism of the joint cartilage, leading to local inundated CPP and crystal deposition of partially deciphered predispositions. Meanwhile, SC is a rare benign synovial joint proliferative disease of unclear etiology and has a low risk of malignant transformation. However, SC manifests severe joint disability and dysfunction because of connective tissue metaplasia of the synovial membrane, which forms cartilaginous nodules with or without calcifications or ossifications. These nodules often detach and form intra-articular loose bodies and very rarely within extraarticular spaces.Case presentationWe report the case of a 61-year-old man to expand the body of literature on these unusual coexisting arthropathies of the TMJ. The patient presented to our hospital in 2020 with complaints of pain in the right TMJ and trismus for over 6 months. Radiographic assessments of the TMJ provided a preoperative provisional diagnosis of SC. However, the histopathology of the open biopsy revealed tumor-like lesions comprising several deposits of rhomboid and rod-shaped crystals that displayed positive birefringence in polarized light, confirming a coexistence of CPPD. A second-stage operation was performed for the complete removal of the loose bodies and chalk-like lesions including synovectomy. No evidence of recurrence was recorded after a follow-up of nearly 1.5 years.ConclusionsIsolated CPPD and SC of the TMJ are prevalent in the literature however, monoarticular coexistence of these diseases is rare, due to the lack of consistency in the diagnostic criteria in clinical practice. Moreover, optimal treatment depends on several considerations. This report delineated the molecular etiopathology and underscored the need for continued deciphering of the causal mechanisms of coexisting CPPD and SC of the TMJ. In addition, the importance of confirmatory testing for accurate diagnosis, and appropriate management of these diseases were discussed.

Common therapeutic approaches in sleep and awake bruxism - an overview.

Bruxism, a common medical condition characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible, can occur during sleep, when it is known as sleep bruxism (SB), or during wakefulness, when it is known as awake bruxism (AB). Although bruxism often causes headaches, temporomandibular joint pain, masticatory muscle pain, mechanical tooth wear, prosthodontic complications and cracked teeth, there is still not enough data to define and support a standardised approach to its treatment. The aim of this review was to present the pathophysiology, consequences, types and treatment methods of bruxism in order to increase readers' knowledge of this topic. Differences between awake and nocturnal bruxism are included, as well as risk factors and indicators visible during the clinical examination of affected patients. Among the causes we consider are genetics, stress, oral parafunctions and changes in the Central Nervous System (CNS). Potential and common methods of treatment are presented, along with suggested guidelines that should be followed when determining an appropriate treatment method. We draw attention to the notably dynamic development of bruxism in today's society and the importance of informational and preventive projects, especially those targeted at high-risk patients as well as those targeted at specialists, in order to better tackle the bruxism 'epidemic'.

Invasive carboxytherapy effectiveness in the treatment of painful temporomandibular joint dysfunction

Relevance. Today, more than 15-20% of patients suffer from chronic pain in painful temporomandibular joint disorder. Temporomandibular arthralgias are poorly treatable, excruciating, and often recurrent. Therefore, optimization of treatment is paramount in such patients.Aim: To evaluate the invasive carboxytherapy effectiveness for the treatment of pain syndrome in the temporomandibular joint.Materials and methods. The study diagnosed 33 patients (15 men and 18 women) aged 28 to 47 years old suffering from pain syndrome in the temporomandibular joint. Group 1 (control) patients (12 patients) received indomethacin tablets (25 mg/tid) for nine days [8]. The second (main) group (21 patients) had invasive carboxytherapy, which consisted of a 3 ml carbon dioxide subcutaneous injection administered five times every other day. The study evaluated the therapeutic effect persistence on the 15th day of observation.Results. The invasive carboxytherapy proved to be more effective in pain syndrome relief in painful TMJ dysfunction than indomethacin prescription. The invasive carboxytherapy was 12.02%, 9.17% and 4.29% more effective than the NSAID on the 3 rd, 9th and 15th day of observation, respectively.Conclusion. The invasive carboxytherapy is highly effective in relieving pain symptoms in pain dysfunction, which was 44.9% on the 3rd day, 83.5% – on the 9th day, and 100% – on the 15th day of observation. The advantages of carboxytherapy were noted, namely, its good tolerability with a small number of contraindications related to the general state of health, as well as the condition of the skin at the injection site. It is possible to use invasive carboxytherapy in the comprehensive treatment of patients with painful temporomandibular joint di sorder.

Detection and effectiveness of treatment of myofascial pain and temporomandibular joint pathologies in adult patients with orthodontic pathology

BACKGROUND: At the orthodontists clinic, patients with pain in the maxillofacial region and internal disorders of the temporomandibular joint (TMJ) are not uncommon. These pathological conditions are characterized by the complexity of interdisciplinary therapy and frequent recurrence.
 AIM: To analyze the detectability and effectiveness of treatment of myofascial pain disorders and internal disorders of the TMJ in adult patients with dental anomalies.
 MATERIAL AND METHODS: Case histories of 300 adult patients with dental anomalies who underwent examination and treatment in a multidisciplinary dental clinic were retrospectively analyzed. The study included patients who received orthodontic treatment for at least 5 years. The prevalence and structure of internal disorders of the TMJ and myofascial pain disorders were assessed, and their correlation was analyzed.
 RESULTS: Orthodontic treatment was more often needed by patients with myofascial pain (71.5%), followed by those with myofascial facial pain syndrome (28.3%). In these patients, internal TMJ disorders and maxillary anomalies of class II according to Engl with unilateral distal occlusion, deep bite, and class I with crowding of teeth were more often detected. Internal TMJ disorders with concomitant myofascial pain disorders in the form of myofascial pain were observed in 82.4% of the patients. Myofascial pain disorders without internal TMJ disorders were registered in 17.4% of the patients. The overall effectiveness of the treatment of internal TMJ disorders and myofascial pain disorders was 46.4%, no lasting improvement was observed in 35.7%, deterioration was recorded in 17.8%, and relapses were noted in 60.7%. In the treatment of myofascial pain disorders without internal TMJ disorders, the overall effectiveness of treatment was 5.5%; stabilization, 50.0%; and deterioration, 44.4%.
 CONCLUSION: Myofascial facial pain is very difficult to treat. The combination with internal TMJ disorders creates significant and sometimes insurmountable difficulties in the orthodontic treatment of adults. All these forces specialists to look for new approaches to optimizing orthodontic treatment of TMJ pathology and myofascial pain disorders.

Comparative Benefits of Open versus Closed Reduction of Condylar Fractures: A Systematic Review and Meta-Analysis.

Many fractures of the mandibular condylar neck are amenable to both open reduction and internal fixation (ORIF) and closed treatment. Clinical outcomes following these two modalities remains a topic of debate. This systematic review critically appraises the literature to compare them following these treatment options. A systematic review and meta-analysis was performed to test the null hypothesis of no difference in clinical outcomes in ORIF versus closed treatment of mandibular condyle fractures. The PubMed, Embase, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried from 1946 to 2020. The quality of evidence was determined using Grading of Recommendations Assessment, Development, and Evaluation methodology. Of 1507 screened articles, 14 met inclusion criteria. ORIF was favored significantly when evaluating temporomandibular joint pain [relative risk (RR), 0.3; 95% CI, 0.1 to 0.7] (number needed to treat to prevent an outcome in one patient, 3; 95% CI, 2 to 6), laterotrusive movements of the mandible (mean difference, 2.3; 95% CI, 1.7 to 3.0) (standardized mean difference, 0.9; 95% CI, 0.4 to 1.3), and malocclusion (RR, 0.5; 95% CI, 0.4 to 0.7) (number needed to treat to prevent an outcome in one patient, 19; 95% CI, 10 to 200). However, ORIF yielded a higher incidence of postoperative infection (RR, 3.6; 95% CI, 0.9 to 13.8) and must be weighed against the understood risk of facial nerve injury. Meta-analysis of high-level evidence in randomized controlled trial suggests that ORIF significantly improves functional outcomes, decreases pain, and restores occlusion and jaw symmetry. These long-term benefits must be weighed against the increased risk of postoperative infection and exposure of the facial nerve to potential injury.

Relationship between Posterior Permanent Dentition Pattern and Radiographic Changes of the Mandibular Condyle.

This study assessed the relationship between posterior permanent dentition and radiographic changes of the mandibular condyle. This descriptive, cross-sectional study was conducted on 300 panoramic radiographs of patients over 40 years of age (188 females and 112 males). Panoramic radiographs were evaluated for condylar changes such as flattening, subcortical sclerosis, subcortical cyst, erosion, osteophytes, and generalized sclerosis. Presence of muscle pain and temporomandibular joint (TMJ) pain and sounds, and history of TMJ trauma were also assessed. The occlusal scheme of posterior teeth was analyzed according to the Eichner's index. The frequency of condylar changes was calculated in the right and left sides, and their association with posterior permanent dentition was analyzed by the Chi-square test (alpha = 0.05). The frequency of flattening, muscle pain, TMJ sounds, and erosion was 11.7%, 9.7%, 5.7%, and 3.7% in the right side, respectively. The frequency of flattening, muscle pain, erosion, and subcortical cyst was 12%, 9.3%, 5%, and 5% in the left side, respectively. The frequency of bilateral muscle pain, flattening, TMJ sounds, and TMJ pain was 18%, 16.7%, 11.7%, and 9.3%, respectively. Cases with TMJ trauma, generalized sclerosis, and osteophytes were few. According to the Eichner's index, most patients with condylar changes had classes A and B, and a smaller percentage had class C. No significant difference was noted between healthy individuals and those with condylar changes regarding dentition patterns. No relationship existed between condylar changes and posterior permanent dentition pattern.

Clinical Evaluation of Intra-Articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in the Management of Degenerative Osteoarthritis of Temporomandibular Joint

AIM: This study aims to evaluate the effectiveness of intra-articular injection of chondroitin sulfate and sodium hyaluronate in cases of temporomandibular joint (TMJ) degenerative osteoarthritis. MATERIAL AND METHODS: Thirty patients ASA I of both sexes, who were selected from outpatient clinic of Oral Surgery Department, Faculty of Dentistry – Suez Canal University, complaining of painful TMJ, presence of unilateral or bilateral TMJ pain, impairment of jaw movements, and joint sounds. Clinical examination was performed to all patients and pre-operative measurements of visual analog scale (VAS) for morning pain, pain with movement and spontaneous pain, maximum mouth opening, and presence or absence of clicking. Patients were randomly divided into two groups; (a) Study group consisted of 15 patients, they had intra-articular injection of chondroitin sulfate and sodium hyaluronate once weekly for 3 weeks and (b) control group consisted of 15 patients, they had intra-articular injection of sodium hyaluronate once weekly for 3 weeks. Post-operative measurements of VAS for previous pain types, maximum mouth opening, and clicking were obtained at 1 month, 3 months, and 6 months post-injection. RESULTS: There was a statistically significant reduction of all types of pain in the study group compared to the control group at all time intervals (p ≤ 0.05), for maximum mouth opening, there was a significant improvement in mouth opening in the study group for all time intervals (p ≤ 0.05), but for the clicking, there was not statistically significant difference between the study and control groups after 1 month, 3 months, and 6 months. The difference between groups was barely statistically significant (p = 0.05). CONCLUSION: Intra-articular injection of a combination of chondroitin sulfate and sodium hyaluronate is an effective tool in reducing pain, clicking, limited mouth opening, and other symptoms associated with degenerative TMJ diseases.

Parkia platycephala Lectin (PPL) Inhibits Orofacial Nociception Responses via TRPV1 Modulation.

Lectins are a heterogeneous group of proteins that reversibly bind to simple sugars or complex carbohydrates. The plant lectin purified from the seed of Parkia platycephala (PPL) was studied. This study aimed to investigate the possible orofacial antinociceptive of PPL lectin in adult zebrafish and rodents. Acute nociception was induced by cinnamaldehyde (0.66 μg/mL), 0.1% acidified saline, glutamate (12.5 µM) or hypertonic saline (5 M NaCl) applied into the upper lip (5.0 µL) of adult wild zebrafish. Zebrafish were pretreated by intraperitoneal injection (20 µL) with vehicle (Control) or PPL (0.025; 0.05 or 0.1 mg/mL) 30 min before induction. The effect of PPL on zebrafish locomotor behaviour was evaluated in the open field test. Naive groups were included in all tests. In one experiment, animals were pre-treated with capsazepine to investigate the mechanism of antinociception. The involvement of central afferent C-fibres was also investigated. In another experiment, rats pre-treated with PPL or saline were submitted to the temporomandibular joint formalin test. Other groups of rats were submitted to infraorbital nerve transection to induce chronic pain, followed by induction of mechanical sensitivity using von Frey. PPL reduced nociceptive behaviour in adult zebrafish, and this is related to the activation of the TRPV1 channels since antinociception was effectively inhibited by capsazepine and by capsaicin-induced desensitization. PPL reduced nociceptive behaviour associated with temporomandibular joint and neuropathic pain. The results confirm the potential pharmacological relevance of PPL as an inhibitor of orofacial nociception in acute and chronic pain.

Functional orthopedic device type Sn20 – a therapeutic resource in the control of chronic temporomandibular dysfunction – case report

The literature indicates that patients with a history of Temporomandibular Disorder (TMD), who experience sudden occlusal changes, may worsen their parafunctional habits and develop TMD again. In this sense, the aim of this study is to present a clinical case of recurrent chronic TMD after oral rehabilitation (increase of vertical dimension in all teeth) using Simões Network 20 (SN20) functional orthopedic appliance as one of the resources therapies. The patient was female, 62 years old, and complained of disabling pain, anxiety symptoms, hypervigilant and history of TMD. The patient reported failure of other treatment modalities, including use of the smooth stabilizer device. The diagnosis was chronic TMD – primary osteoarthritis of the temporomandibular joint and related myofascial pain and orofacial migraine. Treatment included physical measurements, instructions, peripheral and central medication, AOF type SN20 (night use). After three months of therapy, the patient showed significant improvement with complete pain reduction. The use of the AOF SN20 together with conservative measures represents a valuable therapeutic modality for patients with chronic TMD.

Occlusal Analysis in Natural Dentition: Systematic Review.

This study aimed to evaluate the effectiveness of conventional occlusal analysis in contrast with digital occlusal analysis in natural dentition. Occlusal analysis allows the identification of normal and abnormal occlusal contact points that alter the craniomandibular cervical system. We searched for articles with keywords [[dental occlusion]], [[natural dentition]], [[occlusal adjustment]], [[Immediate Complete Anterior Guidance Development]] [[mastication]], [[bite force]], [[premature contact]], [[occlusal balance]] [[articulating paper]]], [[spray]], [[Occlusal contacts]], and [[bite strength]]. They were considered observational , odds ratio and case control studies. We found 189 items. After evaluating the abstracts and full texts of the articles, 10 papers met the inclusion criteria. It was found that occlusal analysis allows the identification of the relationship between poor occlusion and the sensitivity of the teeth due to occlusal trauma, which is also related to temporomandibular joint pain in dynamic occlusion. The contacts of greater strength were observed in nonfunctional cusps, 48%, without ruling out the functional cusps, 24%. Despite being the universal method of occlusal control to date, the use of joint paper, remains subjective compared to the digital occlusal control device. Posture is considered directly related to occlusal trauma and temporomandibular disorders; without proper occlusal analysis, a clear diagnosis of the patient's joint condition cannot be obtained. Digital occlusal analysis is more objective than traditional occlusal analysis.

Nocturnal Delta Power is Associated With Lower Next-Day Pain But Not Pain Catastrophizing: Results From a Cohort of Female Participants With Temporomandibular Joint Pain

Existing data demonstrate reduced delta power during sleep in patients with depression and chronic pain. However, there has been little examination of the relationship between delta power and pain-reports, or pain-catastrophizing. We recruited female participants (n = 111) with insomnia and temporomandibular disorder, and measured nocturnal and daytime measures of pain and pain catastrophizing, and calculated relative nocturnal delta (0.5–4 Hz) power during sleep. We fit linear regression models, and further examined the moderating effect of depressive symptom severity. Lower relative delta power across the whole night was significantly associated with greater nocturnal pain (B = -20.276, P = .025, R2 = 0.214). Lower relative delta power during the first-third of the night, was associated with greater nocturnal pain (B = -17.807, p = 0.019, R2 = 0.217), next-day pain (B = 13.876, P = .039, R2 = 0.195), and next-morning pain (B = -15.751, P = .022, R2 = 0.198). Lower relative delta power during the final-third of the night was significantly associated with greater nocturnal (B = -17.602, P = .029, R2 = 0.207) and next-morning pain (3rd: B = -14.943, P = .042, R2 = 0.187). Depressive symptom severity did not moderate these relationships. Delta power was not significantly associated with nocturnal or daytime pain catastrophizing. These findings demonstrate that greater relative delta power during sleep is associated with lower nocturnal and next-day pain in patients with temporomandibular disorder. This data may guide the use of sleep interventions in clinical pain populations, with the aim of improving pain outcomes. PerspectiveThis article presents data demonstrating an association between increased nocturnal delta power and reduced next-day pain. These findings may help promote interventions which aim to increase nocturnal delta power in clinical pain populations, with the goal of improving pain outcomes.

Symptom Localization May Differentiate Subtypes of Eustachian Tube Dysfunction.

To evaluate the predictive ability of symptom self-localization to distinguish obstructive eustachian tube dysfunction from non-obstructive salpingitis. Adult (age ≥18 years) patients with a primary complaint of aural discomfort who underwent diagnostic nasal endoscopy and tympanometry at a tertiary academic center were enrolled. Symptoms were self-localized by using a single finger on the affected side. All patients completed the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and underwent scoring of eustachian tube inflammation using the Endoscopic Evaluation of the Eustachian Tube (3ET) system. Seventy-three patients were included in the study. Symptoms were localized to the external auditory canal (EAC) in 28 (38.4%), to the infratemporal fossa (ITF) below the lobule in 37 (50.7%), and to the preauricular region in 8 (11.0%). Demographics and medical history were similar between groups. The EAC group had significantly more negative tympanometric peak pressure (TPP) (median, -92.0 daPa; IQR, 95.5) and higher 3ET scores. In contrast, the ITF group had normal TPP (median, -2.0 daPa; IQR, 7.0) and higher 3ET scores. The preauricular group was more likely to have temporomandibular joint or pterygoid muscle pain. ETDQ-7 scores did not differ significantly between groups. Symptom localization is associated with specific objective findings in the evaluation of aural discomfort. Patients with pain localizing to the ITF are more likely to have findings of eustachian tube salpingitis without obstruction whereas patients with symptoms deep in the EAC are more likely to have findings consistent with obstructive eustachian tube dysfunction. 3 Laryngoscope, 133:1818-1823, 2023.

Temporal Summation and Aftersensations of Second Pain in Women with Myofascial Temporomandibular Disorder Differ by Presence of Temporomandibular Joint Pain.

PurposeMechanisms underlying myofascial temporomandibular disorder (mTMD) are poorly understood. One theory is dysfunction in the central mediation of pain, specifically in enhanced facilitatory pain modulation. Because mechanisms leading to central sensitization may differ for joint and muscle pain, this study of mTMD addressed phenotypic heterogeneity by temporomandibular (TM) joint pain in the examination of quantitative sensory testing (QST).Patients and MethodsThe stimulus dependent increase in second pain (temporal summation (TS)) and associated aftersensations (AS) were examined across groups of women with mTMD with TM joint pain and without, and a demographically matched control group.ResultsTS was slightly more evident in mTMD without joint pain vs with (p = 0.035), but AS were most robustly persistent in the group with joint pain vs without (p < 0.002).ConclusionWhile both subgroups demonstrated evidence of central sensitization relative to controls on one of two measures, differences in QST results, if replicated, may point to possible differences in the mechanisms that yield central sensitization. Alternatively, it may represent methodological artifacts that need to be addressed. Therefore, greater consideration should be given to symptom-based phenotypes in studies examining TS and AS.

Thread Embedding Acupuncture for Temporomandibular Disorder: Protocol for a Pilot Randomized Controlled Trial.

BackgroundTemporomandibular disorder (TMD) affects multiple tissues of the temporomandibular joint complex and manifests as orofacial pain and functional disturbance. While thread embedding acupuncture (TEA) is used for the treatment of TMD in clinical practice, sufficient clinical evidence is lacking. This pilot trial will explore the feasibility of a confirmatory randomized controlled trial (RCT) by considering the efficacy, safety, and cost-effectiveness of TEA to address pain, function, and quality of life in patients with TMD.MethodsThis randomized, assessor-blinded, controlled trial will include two parallel arms. Thirty patients with TMD and temporomandibular joint pain more severe than 40 mm on the 100-mm visual analog scale (VAS) and aged 19–70 years will be recruited and randomly allocated to either TEA or usual care groups. The TEA group will receive treatment at 14 predefined acupoints once weekly for 4 weeks. The usual care group will receive physical therapy consisting of transcutaneous electrical nerve stimulation and infrared therapy. The average VAS score over the last week for temporomandibular pain after four sessions will be assessed as the primary outcome. Furthermore, maximum pain VAS, vertical opening movement, Graded Chronic Pain version 2, Jaw Functional Limitation Scale 20, Patient Global Impression of Change, Korean version of Beck’s Depression Index, Short Form-12 Health Survey, EuroQol 5-Dimension 5-level, treatment expectation, rescue medication consumption, adverse events, and medical costs for economic evaluation will be measured and analyzed as secondary outcomes during four follow-up visits and after the termination of all sessions.ConclusionThe results of this trial will help evaluate the feasibility of a confirmatory RCT considering efficacy, safety, and cost-effectiveness and verify the effect size required to determine an appropriate sample size.Trial Registration NumberKCT0007421.

Data on ultrasound therapy as an adjuvant pain control method among Indian TMDS patients.

It is of interest to evaluate the efficacy of ultrasound therapy as an adjuvant pain control modality in dysfunctions of the temporomandibular joint. The study comprised 20 patients with TMJ issues who had received a clinical diagnosis of temporomandibular disorders (TMDS). These patients underwent independent VAS evaluations for the intensity of pain, opening and closing of the mouth, and soreness of the muscles of mastication, including the masseter muscle, medial pterygoid muscle, lateral pterygoid muscle, and temporalis muscle, as well as additional auxiliary muscles. The chosen patients received ultrasonic treatment. The mean value of mouth opening before therapy was 39.51cm, with SD values of 7.61 cm. The mean value of mouth opening after therapy was 42.91 cm with SD values of 6.08.The findings were statistically significant, with a p-valueof0.021. The mean value of VAS in the TMJ area before therapy was 8.41 with SD values of 2.11.There was a reduction in the mean values of VAS after therapy, which was 3.11 with SD values of 1.12. The findings were significant statistically, with a p-value equal to 0.001. Thus, ultrasonographic therapy for temporomandibular joint pain demonstrated a considerable improvement in pain reduction and mouth opening. It is possible to view this therapy as the adjuvant methodology to control pain in disorders of TMJ.

Comparison of symptoms, signs, gender, and magnetic resonance images of temporomandibular joint disorder patients

ABSTRACT Objective To compare patients’ complaints, clinician’s examination findings, and magnetic resonance imaging (MRI) findings by considering gender. Methods Temporomandibular joint (TMJ) pain, difficulty in mouth opening, masseter tenderness, deviation, clicking sound, bruxism, restriction, normal occlusion and normal mouth opening symptoms, and findings of temporomandibular disorder (TMD) patients who came to the author’s outpatient clinic were recorded. These recordings were compared with MRI. Results In the study, symptoms, signs, and MRIs of 276 TMD patients were analyzed, including gender. No difference was observed in terms of symptoms, signs, or MRI results for either gender. MRI findings were correlated with restriction and normal mouth opening in both groups (p < 0.05). Normal MRI findings were observed in 52.5% of the MRI results. Conclusion Except for normal mouth opening and limitation, MRI findings did not provide a significant result. Therefore, careful detection of symptoms and signs rather than MRI helps in diagnosis.

CAD/CAM and conventional reconstruction of the mandibular condyle by fibula free flap: a clinical and radiological evaluation

The aim of this study was to analyse the radiological and clinical outcomes of condylar reconstruction by fibula free flap (FFF), comparing conventional freehand and CAD/CAM techniques. Fifteen patients (nine CAD/CAM, six freehand) who underwent condylar reconstruction with a FFF were reviewed retrospectively regarding pre- and postoperative computed tomography/cone beam computed tomography scans and clinical function. After surgery, all patients were free of temporomandibular joint pain. Mean postoperative mouth opening was 30.80 mm, with no significant difference between the freehand and CAD/CAM groups. In all patients, laterotrusion was decreased to the contralateral side (P = 0.002), with no difference between freehand and CAD/CAM, while the axis of mouth opening deviated to the side of surgery (P < 0.001). All patients showed significant radiological deviation of the fibular neocondyle in the laterocaudal direction (lateral: P = 0.015; caudal: P = 0.001), independent of the technique. In conclusion, reconstruction of the mandibular condyle by FFF provided favourable functional results in terms of mouth opening, reduction of pain, and mandibular excursions. Radiological deviation of the neocondyle and deviation of laterotrusion and mouth opening did not impair clinical function. CAD/CAM planning facilitated surgery, decreased the surgery time, and improved the fit of the neocondyle in the fossa.

Retrospective analysis of the treatment of internal disorders of the temporomandibular joint and myofascial pain disorders in the conditions of adult orthodontic reception

BACKGROUND: Internal disorders of the temporomandibular joint (VN TMJ) occur at orthodontic reception no less often than with other types of dental treatment. The main clinical manifestations of VN TMJ are caused by variants of anterior displacement of the articular disc, pathology of the capsular ligamentous apparatus, hypermobility of the mandibular head, and dysfunction of the masticatory muscles. The main symptom of VN TMJ is joint pain (arthralgia) and muscle pain (myalgia). VN TMJ occupies a special place in orthodontic treatment. They can be detected at the initial treatment, and their symptoms can appear at any stage of orthodontic treatment and be a complete surprise for the doctor and the patient, arise after orthodontics, and be associated with it. Since VN TMJ significantly affects the therapeutic process, its outcomes, prognoses, and treatment problems are under the close influence of orthodontists.&#x0D; AIM: To examine the effectiveness of the treatment of VN TMJ and myofascial pain disorders in patients with dental anomalies.&#x0D; MATERIAL AND METHODS: The study retrospectively analyzed case histories of 300 adult patients with dental anomalies in need of orthodontics who underwent examination and treatment in a multidisciplinary dental clinic between 2014 and 2016. The prevalence and structure of VN TMJ were assessed, and myofascial pain disorders (MFDB) and results of their correction were analyzed.&#x0D; RESULTS: A total of 146 (71.5%) patients with myofascial pain and 58 (28.3%) with myofascial facial pain syndrome needed orthodontic treatment more often. In these patients, VN TMJ and maxillary anomalies belonging to class II according to Engle of unilateral distal occlusion, deep bite, and class I with crowding of teeth are more often detected. Internal TMJ disorders with concomitant MFDB in the form of myofascial pain were observed in 168 (82.4%) patients. Myofascial pain disorders without VN TMJ were registered in 36 (17.4%) patients. The overall effectiveness of the treatment of VN TMJ and MFBSD was 46.4% (n=78 patients). No lasting improvement was observed in 35.7% (n=60). Deterioration was registered in 17.8% (n=30). Relapses were noted in 60.7% (n=124). In the treatment of MFDB without VN TMJ, the overall effectiveness of treatment was 5.5% (n=2), stabilization in 50.0% (n=18), and deterioration in 44.4% (n=16).&#x0D; CONCLUSION: Myofascial facial pain is very difficult to treat. In combination with VN, TMJ creates significant and sometimes insurmountable difficulties in adult orthodontics. All this forces specialists to look for new approaches and develop effective ways to optimize orthodontic treatment in the case of TMJ pathology and myofascial pain disorders.