RESUMO
OBJECTIVE: To assess the influence of unilateral open disc repositioning surgery (ODRS) of the temporomandibular joint (TMJ) on the internal derangement (ID) of the contralateral joint. METHODS: Patients with bilateral ID of TMJ who underwent unilateral ODRS were enrolled and followed-up for one year. They were divided into two groups based on the contralateral disease: the anterior disc displacement with reduction (ADDWR) and without reduction (ADDWoR). Postoperative evaluation included clinical and MRI evaluation. Indices measured were unilateral intermaxillary distance (UID), visual analogue scale (VAS), disc length (DL), condylar height (CH), and disc-condyle angle (DCA). Paired t tests were used to compare the clinical and MRI indices between different time points. RESULTS: Ninety-six patients were enrolled, including 47 in the ADDWR group and 49 in the ADDWoR group. One-year post-surgery, ODRS led to significant increases in MMO, DL, and CH, and decrease in VAS and DCA on the operated side (P < 0.05). In ADDWR group, UID, DL, and CH increased significantly, and VAS decreased (P < 0.05), with no significant change in DCA (P > 0.05). In ADDWoR group, clinical and MRI variables worsened slightly, except for UID, which remained unchanged (P > 0.05). CONCLUSIONS: ODRS is a promising method for correcting TMJ ID and may improve condition of ADDWR and decrease progress of ADDWoR at the contralateral joint. Preoperative bilateral TMJ evaluation is essential for better outcomes. CLINICAL RELEVANCE: ODRS can effectively treat TMJ ID and produce adaptive changes in the contralateral ID, for which continuous monitoring of the contralateral joint is essential.
Assuntos
Imageamento por Ressonância Magnética , Disco da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular , Humanos , Feminino , Masculino , Estudos Prospectivos , Transtornos da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Adulto , Disco da Articulação Temporomandibular/cirurgia , Disco da Articulação Temporomandibular/diagnóstico por imagem , Resultado do Tratamento , Luxações Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Pessoa de Meia-Idade , Medição da Dor , AdolescenteRESUMO
Temporomandibular joint (TMJ) disorder (TMD) is a chronic progressive disease that is commonly seen in clinical settings. TMJ disc degeneration is an important manifestation of TMD, and further aggravates the progression of TMD. However, treatments on TMJ disc degeneration are very limited till now. In this study, we first observed the effects of bone marrow stem cells (BMSC) conditioned medium on functions of TMJ disc fibroblasts. Then BMSC-derived small extracellular vesicles (BMSC-EVs) were isolated and exposed to TMJ disc fibroblasts. RNA-sequencing was used to further investigate the mechanisms. BMSC-EVs were finally injected into a rat model with TMD. Results showed that in the transwell co-culture system, the medium derived from BMSC reduced inflammation and enhanced chondrogenesis in TMJ disc fibroblasts. BMSC-EVs promoted proliferation, migration, and chondrogenic differentiation of TMJ disc fibroblasts, and inhibited apoptosis and inflammatory responses. Local injection of BMSC-EVs into the TMD model alleviated TMJ disc degeneration. Therefore, BMSC-EVs were a potentially effective, sustainable and clinically translational-promising option for TMJ disc degeneration, and further reduce the progression of TMD.
Assuntos
Exossomos , Células-Tronco Mesenquimais , Ratos Sprague-Dawley , Disco da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular , Animais , Células-Tronco Mesenquimais/metabolismo , Células-Tronco Mesenquimais/citologia , Exossomos/metabolismo , Exossomos/transplante , Transtornos da Articulação Temporomandibular/terapia , Transtornos da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/metabolismo , Ratos , Disco da Articulação Temporomandibular/patologia , Disco da Articulação Temporomandibular/metabolismo , Fibroblastos/metabolismo , Fibroblastos/patologia , Masculino , Meios de Cultivo Condicionados/farmacologia , Células Cultivadas , Condrogênese , Modelos Animais de Doenças , Humanos , Diferenciação Celular , Proliferação de CélulasRESUMO
Multiple techniques for disc fixation through temporomandibular joint arthroscopy have been described. They can be classified as non-rigid, semi-rigid, and rigid. They all offer different advantages and disadvantages, and some have greater difficulties than others. Currently, multiple modifications to the basic techniques have been described in order to facilitate the technique since disc fixation corresponds to one of the procedures that most require skill. However, each technique requires extensive evaluation and monitoring in order to avoid complications and find the benefits of each technique. For this reason, the objective of this letter to the editor is to discuss two situations observed in the previously described fixation technique with osteosynthesis screws. The first issue is the fixation mechanism, and the second is the fixation time. This is in order to continue searching for the truth among all to achieve the best results and the benefit of patients.
Assuntos
Artroscopia , Parafusos Ósseos , Disco da Articulação Temporomandibular , Titânio , Humanos , Artroscopia/métodos , Titânio/química , Disco da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgiaRESUMO
Disc displacement without reduction (DDwoR) can cause pain and limitations in mouth opening, with a significant impact on function. The optimal management strategy for DDwoR is unclear. Treatments include conservative management such as mandibular manipulation, occlusal splints, and patient education/self-management, as well as arthrocentesis, which is a minimally invasive procedure. The aim of this systematic review and meta-analysis was to ascertain whether there is a role for arthrocentesis in the management of DDwoR. Studies analysing the outcomes pain and maximum mouth opening (MMO) in patients with DDwoR treated by arthrocentesis or occlusal coverage devices were eligible for inclusion. Following a database search, six studies with a total of 343 participants were found to be eligible for analysis (three prospective observational studies, one retrospective observational study, one non-randomized single-blind clinical trial, and one unblinded randomized clinical trial). When compared to occlusal coverage splints, arthrocentesis demonstrated a slight improvement in pain, although this was statistically non-significant (standardized mean difference (SMD) -0.50, 95% confidence interval (CI) -1.04 to 0.05, P = 0.07; I2 = 81%), and a significant improvement in MMO (SMD 0.79 mm, 95% CI 0.24-1.35 mm, P = 0.005; I2 = 79%). However, due to the significant heterogeneity between studies and the high risk of bias, along with the paucity of double-blind randomized controlled clinical trials, definitive conclusions cannot be drawn for this clinical question.
Assuntos
Artrocentese , Placas Oclusais , Transtornos da Articulação Temporomandibular , Humanos , Transtornos da Articulação Temporomandibular/terapia , Artrocentese/métodos , Luxações Articulares/terapia , Disco da Articulação Temporomandibular , Medição da DorRESUMO
INTRODUCTION: Anterior displacement of the temporomandibular joint (TMJ) disc is a disorder in which the articular disc is dislocated from its correct position relative to the mandibular condyle and mandibular fossa. Traditionally, the initial treatment of disc displacements involves various conservative measures, including the use of a stabilizing interocclusal splint. However, in cases where there is associated limited mouth opening, as in the case of anterior disc displacement with reduction and intermittent block (ADDwRIB), and anterior disc displacement without reduction (ADDw/oR), arthrocentesis has been suggested as another modality of initial treatment due to its faster effect in preventing disease progression to a more advanced stage, as well as reducing the chances of pain chronification and central sensitization. OBJECTIVES: This study aimed to analyze whether there is a preponderance in efficacy between treatments with a stabilizing interocclusal splint or arthrocentesis in these patients. METHODS: A randomized, prospective, longitudinal clinical trial was conducted. The sample was obtained by convenience, between June 2021 and January 2023. Twenty-four patients with diagnoses of ADDwRIB and ADDw/oR were included. The diagnosis and clinical evaluations followed the DC/TMD criteria, and TMJ MRI was performed. Patients were randomly allocated to 2 treatment groups. Group 1 (n = 13): stabilizing interocclusal splint. Group 2 (n = 11): arthrocentesis. Patients were evaluated after 1, 2, 3, and 6 months for clinical parameters of pain, functionality, and psychosocial status. RESULTS: Both treatments were effective in reducing pain levels, with no statistically significant differences. Group 1 showed significantly greater mouth-opening levels compared to Group 2 (P = .041). CONCLUSION: Both groups showed significant improvements in various parameters evaluated throughout the study, indicating they are equally effective in pain control and most functional and quality of life parameters. However, the stabilizing interocclusal splint treatment was superior in restoring mouth opening.
Assuntos
Artrocentese , Placas Oclusais , Medição da Dor , Transtornos da Articulação Temporomandibular , Humanos , Feminino , Masculino , Transtornos da Articulação Temporomandibular/terapia , Artrocentese/métodos , Adulto , Estudos Prospectivos , Resultado do Tratamento , Luxações Articulares/terapia , Disco da Articulação Temporomandibular , Estudos Longitudinais , Pessoa de Meia-Idade , Amplitude de Movimento ArticularRESUMO
This article aims to analyze which of the main arthroscopic discopexy techniques has the best results and if there are differences between the techniques for both pain and maxillary intercuspid opening. A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed with no publication date restriction in PubMed, Ovid and Embase. The PICO criteria: (P) Patients: With temporomandibular internal disorders with discopexy indication. (I) Intervention: Temporomandibular joint arthroscopic discopexy. (C) Comparison: Arthroscopic discopexy among different techniques classified as non-rigid, semi-rigid and rigid. (O) Outcomes: Impact in clinical conditions such as pain and maximum mouth opening. The inclusion criteria were Patients with temporomandibular internal disorders with discopexy indication performed with different techniques classified as non-rigid, semi-rigid and rigid. The outcomes evaluated were pain and maximum mouth opening. Case series, cohort studies, quasi-experimental studies, and randomized clinical trials with at least 3 months of follow-up were included. The exclusion criteria considered were patients with related concomitant surgeries, patients with associated neoplastic disease or connective tissue disease. A total of 1515 joints where 1400 discopexies were performed including 849 females and 204 males. The most common diagnostic was Wilkes stage III in 257 joints. For pain and oral opening, the semi-rigid technique shows the best results median (MD) 4.84 (CI 2.52-7.16; p = 0.001, I2:100%), MD -2.78 (CI -4.34, -1.21; p = 0.001, I2:99%), respectively. The rigid technique has the greatest probability for complications MD 0.14 CI 95% (0.00, -0.28). Although the semi-rigid technique showed better results, there is no statistically significant difference. However, due to the heterogeneity of the studies, the results should be interpreted with caution.
Assuntos
Artroscopia , Transtornos da Articulação Temporomandibular , Humanos , Artroscopia/métodos , Disco da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgiaRESUMO
The aim of this study was to evaluate the reliability of magnetic resonance imaging (MRI) in detecting disc perforations in the temporomandibular joint (TMJ), and to establish diagnostic criteria for this purpose. The retrospective analysis included patients who had undergone preoperative MRI and TMJ arthroscopy at the same hospital. Direct and indirect signs of disc abnormalities on MRI were compared with arthroscopic findings of disc perforation. Out of 355 joints evaluated in 185 patients, arthroscopy confirmed disc perforations in 14.7% of cases. Several MRI findings were significantly associated with disc perforation, including anterior disc displacement without reduction (ADDwoR), signal alterations in the mid-disc area, disc deformity (SAMD), retrocondylar disc fragments, osteophytes, condylar bone marrow degeneration (CBMD), and joint effusion in both joint spaces (ESJS-EIJS). Regression analysis revealed that SAMD, osteophytes, and CBDM were strongly associated with disc perforation. The ROC curve showed that MRI had an AUC = 0.791, with a sensitivity of 88.5% and a specificity of 61.5%. Two diagnostic methods, one based on three findings (osteophytes, ADDwoR, and SAMD) and one based on two direct signs (ADDwoR and SAMD), yielded high sensitivity and specificity values of 80.4% and 69.8%, and 84.3% and 62.5%, respectively. In conclusion, MRI demonstrated acceptable accuracy in the detection of TMJ disc perforations, with specific diagnostic criteria offering high sensitivity and specificity. Significant MRI indicators of disc perforation included SAMD, osteophytes, and CBDM. This study provides valuable information on the use of MRI as a diagnostic tool for TMJ disc perforations.
Assuntos
Imageamento por Ressonância Magnética , Disco da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular , Humanos , Estudos Retrospectivos , Imageamento por Ressonância Magnética/métodos , Masculino , Feminino , Adulto , Disco da Articulação Temporomandibular/diagnóstico por imagem , Disco da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adolescente , Adulto Jovem , Artroscopia , Idoso , CriançaRESUMO
Failures in orthognathic surgery are associated with different factors, including those related to untreated or undiagnosed preoperative temporomandibular joint (TMJ) disorders. This systematic review aimed to assess potential alterations in the condylar head following orthognathic surgery. A systematic search for randomised controlled trials and retrospective studies was performed. For inclusion in the review, studies had to meet the following eligibility criteria according to the PICO framework: Patients: patients with orthognathic deformity and temporomandibular dysfunction (or temporomandibular osteoarthritis); Intervention: patients submitted to orthognathic surgery concomitantly with TMJ disjunction; Control: patients undergoing only orthognathic surgery with or without presurgical data; and Outcome: changes in temporomandibular joint position and volume. Nine studies met all the inclusion criteria and were selected for qualitative analysis. The results of this review show that simultaneous articular disc repositioning and orthognathic surgery provide better results in patients with preoperatively diagnosed condylar osteoarthritic changes. In conclusion, condylar remodelling (resorption/deposition) and its extent are determined by the direction of condylar displacement during surgery. Other factors such as age are also associated with the development of condylar resorption.
Assuntos
Côndilo Mandibular , Procedimentos Cirúrgicos Ortognáticos , Disco da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular , Humanos , Côndilo Mandibular/cirurgia , Côndilo Mandibular/patologia , Procedimentos Cirúrgicos Ortognáticos/métodos , Transtornos da Articulação Temporomandibular/cirurgia , Disco da Articulação Temporomandibular/cirurgia , Disco da Articulação Temporomandibular/patologia , Osteoartrite/cirurgiaRESUMO
BACKGROUND: Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet. OBJECTIVE: The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD? METHODS: The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases. RESULTS: The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I2 = 22%; TMJ pain: p = .0003, I2 = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I2 = 0%; TMJ pain: p = .28, I2 = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence. CONCLUSION: Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.
Assuntos
Luxações Articulares , Procedimentos Cirúrgicos Minimamente Invasivos , Disco da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular , Humanos , Transtornos da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/terapia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Luxações Articulares/cirurgia , Disco da Articulação Temporomandibular/cirurgia , Resultado do Tratamento , Artrocentese/métodos , Amplitude de Movimento Articular/fisiologia , Ácido Hialurônico/uso terapêutico , Ácido Hialurônico/administração & dosagem , Injeções Intra-ArticularesRESUMO
OBJECTIVES: To evaluate the effectiveness of arthroscopic reduction and rigid fixation (ARRF) using a suture-free titanium screw as a treatment approach to temporomandibular joint's (TMJ) anterior disc displacement without reduction (ADDwoR) and assess its impact on clinical outcomes, including improvements in symptoms related to TMJ disorders. MATERIALS AND METHODS: A series of twenty patients presented to the Department of Orthognathic and Temporomandibular Surgery at West China Hospital of Stomatology between September 2022 and January 2023, complaining of symptoms such as pain, clicking, and limited mouth opening. Standard magnetic resonance image (MRI) imaging T1 and T2 sequences in both sagittal and coronal views study with closed and maximal open mouth positions were taken preoperatively to assess the disc's position, integrity, and shape. Also, cone-beam computed tomography (CBCT) scans images to find any degenerative changes and evaluate the condylar bone's features and volume. Additionally, the clinical examination assesses limited oral opening, mechanical pain, and the presence of any noises such as clicking and crepitus. All cases were treated under general anesthesia using the arthroscopic release, reduction, and rigid fixation of the TMJ's ADDwoR to establish a normal disc-condyle relationship and to restore the functional position. RESULTS: Patients' symptoms, such as pain and mouth opening, improved significantly following the arthroscopic treatment. Postoperative MRI and CBCT imaging follow-up conducted at 6 months demonstrated the stable position of the reduced TMJ disc and the fixation screw. Notably, none of the patients exhibited signs of relapse during this follow-up period. CONCLUSION: Overall, the ARRF of TMJ's ADDwoR using a suture-free titanium screw proved to be safe and provides satisfactory results, in addition to the several advantages of using suture-free titanium screws, such as biocompatibility, strong fixation, and durability. However, it is a technically demanding procedure requiring extensive, long-term training. CLINICAL RELEVANCE: ARRF using a cost-effective fixation titanium screw to treat ADDwoR emerges as a clinically effective minimally invasive approach.
Assuntos
Prótese Articular , Titânio , Humanos , Disco da Articulação Temporomandibular/diagnóstico por imagem , Disco da Articulação Temporomandibular/cirurgia , Parafusos Ósseos , DorRESUMO
There is currently no consensus on the best treatment for painful temporomandibular disc displacement without reduction (DDwoR), and no network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing all types of treatments for this condition has been conducted. The objective of this study was to compare and rank all treatments for DDwoR, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), arthrocentesis (Arthro) alone, Arthro plus intra-articular injection (IAI) of platelet-rich plasma (PRP), Arthro plus IAI of hyaluronic acid (HA), Arthro with exercises, Arthro plus occlusal splints, and manipulative therapy. Outcome variables were pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm). The mean difference with 95% confidence interval was estimated using Stata software. The GRADE system was used to assess the certainty of the evidence. A total of 742 patients from 16 RCTs were included in the NMA. Both direct meta-analysis and NMA showed that Arthro with IAI of co-adjuvants provided better pain reduction in the short term (≤3 months) than Arthro alone. However, the quality of the evidence was very low. In the intermediate term, Arthro alone or combined with co-adjuvants provided better pain reduction than conservative treatment, but with low-quality evidence. Conservative treatment significantly increased MMO in the short term compared to other treatments. In conclusion, the results of this NMA suggest that arthrocentesis with intra-articular injection of adjuvant medications may be superior to conservative treatments in reducing pain intensity at long-term follow-up, while no significant differences were found for the MMO outcome. However, the quality of evidence was generally low to very low, and further RCTs are needed to confirm these findings.
Assuntos
Artrocentese , Ácido Hialurônico , Metanálise em Rede , Medição da Dor , Plasma Rico em Plaquetas , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos da Articulação Temporomandibular , Humanos , Transtornos da Articulação Temporomandibular/terapia , Injeções Intra-Articulares , Artrocentese/métodos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Placas Oclusais , Luxações Articulares/terapia , Disco da Articulação Temporomandibular , Dor Facial/terapia , Dor Facial/etiologia , Terapia CombinadaRESUMO
BACKGROUND AND OBJECTIVE: Open suturing (OSu) and mini-screw anchor (MsA) are two commonly used open disc repositioning surgeries for anterior disc displacement (ADD) of the temporomandibular joint (TMJ). This study assesses the differences in disc position stability (DPS) and condylar bone remodelling (CBR) between these two surgical procedures in a single centre. METHODS: A retrospective cohort study using MRI scans (pre-operation, 1 week and 12 months post-operation) of all patients who had open TMJ disc repositioning surgery from January 2016 to June 2021 at one centre through two surgical techniques (OSu and MsA) was performed. The predictor variable was technique (OSu and MsA). Outcome variables were DPS and CBR. During follow-up, DPS was rated as good, acceptable and poor, and CBR was graded as improved, unchanged, and degenerated. Multivariate analysis was used to compare the DPS and CBR at 12 months after adjusting five factors including age, sex, Wilkes stage, preoperative bone status (normal, mild/moderate abnormal) and the degree of disc repositioning (normal, overcorrected, and posteriorly repositioned). Relative risk (RR) for DPS and CBR was calculated by multivariate logistic regression. RESULTS: Three hundred eighty-five patients with 583 joints were included in the study. MRIs at 12 months showed that 514 joints (93.5%) had good DPS, and 344 joints (62.5%) had improved CBR. Multivariate analysis revealed that OSu had higher DPS (RR=2.95; 95% CI, 1.27-6.85) and better CBR (RR=1.58; 95% CI, 1.02-2.46) than MsA. Among the factors affecting DPS, females had better results than males (RR=2.63; 95% CI, 1.11-6.26) and overcorrected or posteriorly repositioned discs were more stable than normally repositioned discs (RR=5.84; 95% CI, 2.58-13.20). The improvement in CBR decreased with age increasing (RR=0.91; 95% CI, 0.89-0.93). Preoperative mild/moderate abnormal bone status had a higher probability of improved CBR compared to normal preoperative bone status (RR=2.60; 95% CI, 1.76-3.83). CONCLUSION: OSu had better DPS and CBR than MsA. Sex and the degree of disc repositioning impacted DPS, while age and preoperative bone status affected CBR.
Assuntos
Remodelação Óssea , Disco da Articulação Temporomandibular , Humanos , Feminino , Estudos Retrospectivos , Masculino , Adulto , Disco da Articulação Temporomandibular/cirurgia , Disco da Articulação Temporomandibular/diagnóstico por imagem , Pessoa de Meia-Idade , Remodelação Óssea/fisiologia , Transtornos da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Imageamento por Ressonância Magnética , Côndilo Mandibular/cirurgia , Côndilo Mandibular/diagnóstico por imagem , Adulto Jovem , Adolescente , Resultado do Tratamento , Luxações Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Estudos de Coortes , Âncoras de SuturaRESUMO
BACKGROUND: Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc-condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients. AIM: The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc-condyle relationship. MATERIALS AND METHODS: We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software. RESULTS: A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04-5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31-5.95) and long term (MD 0.00, 95% CI-2.86-2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level. CONCLUSION: Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor.
Assuntos
Doenças das Cartilagens , Transtornos da Articulação Temporomandibular , Humanos , Placas Oclusais , Contenções , Odontólogos , Mialgia , Disco da Articulação Temporomandibular , Papel Profissional , Revisões Sistemáticas como AssuntoRESUMO
Disc perforation represents the result of the degenerative process in joint structures that may lead to pain, joint noise, restricted mouth opening, osteoarthritis, and even dentofacial anomalies. Even though discectomy has proven benefits, with promising outcomes reported, it is mainly described using an open approach. While some arthroscopic techniques have been published, they are limited to managing perforation, edge widening, and inflammation treatment and do not describe complete disc removal. We describe a novel step-by-step arthroscopic discectomy technique utilizing two operative cannulas that completely remove nonfunctional cartilaginous tissue.
Assuntos
Luxações Articulares , Prótese Articular , Transtornos da Articulação Temporomandibular , Humanos , Disco da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Discotomia , Cartilagem , Luxações Articulares/cirurgia , Articulação Temporomandibular/cirurgia , Artroscopia , Amplitude de Movimento ArticularRESUMO
PURPOSE: This study aimed to assess the correlation between temporomandibular joint (TMJ) disc position and skeletal stability and identify the cephalometric measurements associated with relapse after bimaxillary surgery. METHODS: The participants were 62 women with jaw deformities (124 joints) who underwent bimaxillary surgery. The TMJ disc position was classified into four types (anterior disc displacement (ADD), anterior, fully covered, and posterior) using magnetic resonance imaging, and cephalometric analysis was performed preoperatively and 1 week and 1 year postoperatively. The differences between pre- and 1-week postoperative values (T1) and 1-week and 1-year postoperative value (T2) were calculated for all cephalometric measurements. Moreover, the relationship between skeletal stability using cephalometric measurements, skeletal class, and TMJ disc position was analyzed. RESULTS: The participants included 28 patients in class II and 34 in class III. There was a significant difference in T2 in SNB between class II mandibular advancement cases and class III mandibular setback cases (P = 0.0001). In T2, in ramus inclination, there was a significant difference between the ADD and posterior types (P = 0.0371). Stepwise regression analysis revealed that T2 was significantly correlated with T1 for all measurements. However, the TMJ classification was not applied to all measurements. CONCLUSION: This study suggested that TMJ disc position, including ADD, could not affect skeletal stability, including the maxilla and distal segment after bimaxillary osteotomy, and short-term relapse could be related to the movement amount or angle change by surgery for all measurements.
Assuntos
Má Oclusão Classe III de Angle , Disco da Articulação Temporomandibular , Humanos , Feminino , Disco da Articulação Temporomandibular/diagnóstico por imagem , Disco da Articulação Temporomandibular/cirurgia , Côndilo Mandibular , Mandíbula/cirurgia , Osteotomia , Cefalometria , Recidiva , Má Oclusão Classe III de Angle/diagnóstico por imagem , Má Oclusão Classe III de Angle/cirurgia , Osteotomia Sagital do Ramo Mandibular/métodos , Articulação Temporomandibular/diagnóstico por imagem , Osteotomia de Le FortRESUMO
This study was a retrospective self-controlled study that aimed to evaluate the effect of arthroscopic discopexy on condylar height and mandibular position in adolescents with temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDwoR). Patients between 10 and 20 years of age and diagnosed with bilateral TMJ ADDwoR by magnetic resonance image (MRI) were included in this study. All patients underwent a period of natural course before arthroscopic surgery and then a follow-up period postoperatively. Changes in condylar height and mandibular position were measured by MRI and X-ray radiographs. Data were analyzed by paired t-test, Pearson correlation analysis, and generalized estimating equations. This study comprised a total of 40 patients with a mean age of 14.80 years. Pearson correlation analysis showed correlations between condylar height and mandibular position changes. The condylar height change during the post-operative period was significantly higher than that during natural course period (3.57 mm, p < 0.001). The changes in mandibular position (including ANB angle, SNB angle, and Pog-Np) were significant different (all p < 0.05) between the two periods. This study found that arthroscopic discopexy can promote condylar growth and correct dentofacial deformity in adolescents with bilateral TMJ ADDwoR.
Assuntos
Doenças das Cartilagens , Luxações Articulares , Transtornos da Articulação Temporomandibular , Humanos , Adolescente , Disco da Articulação Temporomandibular/diagnóstico por imagem , Disco da Articulação Temporomandibular/cirurgia , Estudos Retrospectivos , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/cirurgia , Imageamento por Ressonância Magnética/métodos , Articulação TemporomandibularRESUMO
Fibers of the lateral pterygoid muscle (LPM) occasionally originate on the posterior surface of the maxilla. Anatomic exploration of an adult patient's cone beam computed tomography files revealed a previously unreported unilateral anatomic variant of the LPM. The variant consisted of a distinctive muscular slip that originated on the tuberosity of the maxilla and coursed postero-laterally through the notch of the mandible to insert on an accessory pterygoid fovea on the outer condylar pole. This maxillomandibular muscle was lateral to the inferior head of the LPM. Therefore, it could contribute to the antero-inferior displacement and medial rotation of the mandibular condyle during the movements of the temporomandibular joint. The maxillomandibular muscle should be added to the extensive spectrum of anatomical variations of the LPM; however, prevalence studies should assess whether its maxillary attachment is the rule or the exception.
Assuntos
Disco da Articulação Temporomandibular , Articulação Temporomandibular , Adulto , Humanos , Côndilo Mandibular , Músculos Pterigoides/diagnóstico por imagem , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgiaRESUMO
The aim of this human cadaveric study was to investigate the relationship between temporomandibular joint disc perforation and bony changes of the mandibular condyle. Overall, 135 cadaveric mandibles were used (69 male, 66 female; all White). Mean age at death was 78.7 years. Perforation of the disc was investigated. Differences in the area of the perforation according to the different types of bony change (erosion, flattening, osteophyte) were evaluated. Perforation of the disc was observed in 34.8% of all mandibles, occurring unilaterally in 53.2% of cases and bilaterally in 46.8%. The prevalence of perforation was 16.4% in cadavers <80 years old (67 heads) and 52.9% in those ≥80 years old (68 heads) (P < 0.001). Osteophyte formation was always identified along with other bony changes (21.7%) and never in isolation. The area of the perforation was significantly larger in the groups with bony changes (one, two, or three changes) than in the 'no bony change' group. The group with osteophyte formation showed a significantly larger perforated area than the group without osteophyte formation; likewise, the group with flattening showed a significantly larger perforated area than the group without flattening. Osteophytes and flattening are probably secondary bony changes that occur following disc perforation. Based on this study, disc perforation should be suspected when these findings are identified on imaging.
Assuntos
Luxações Articulares , Osteófito , Transtornos da Articulação Temporomandibular , Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Disco da Articulação Temporomandibular/diagnóstico por imagem , Osteófito/diagnóstico por imagem , Osteófito/complicações , Transtornos da Articulação Temporomandibular/complicações , Imageamento por Ressonância Magnética , Luxações Articulares/complicações , Côndilo Mandibular , Articulação TemporomandibularRESUMO
The aim of this study was to investigate the treatment effects of a stabilisation splint (SS) with and without arthroscopic disc repositioning (ADR) on condylar bone remodelling in adolescent patients with anterior disc displacement without reduction (ADDwoR). Cone beam computed tomography and magnetic resonance imaging were used to analyse condylar bone remodelling, condyle position, and disc position. Twenty-two temporomandibular joints of 14 patients who underwent ADR (age range 12-20 years; mean follow-up 12.5 ± 7.8 months) and 21 temporomandibular joints of 14 patients who did not undergo ADR (age range 13-20 years; mean follow-up 11.1 ± 5.1 months) were included. The change in bone volume (P < 0.001), rate of bone volume change (P < 0.001), and change in condyle height (P = 0.031) were significantly greater in patients with ADR than in those without ADR. The changes in posterior joint space (P = 0.013), superior joint space (P = 0.020), and ratio of condyle sagittal position (P = 0.013) were significantly greater in patients with ADR than in those without ADR. All discs in patients who underwent ADR and one disc in those who did not undergo ADR were backward repositioned. In conclusion, in adolescent patients with ADDwoR, ADR with SS therapy achieved better condyle and disc position than SS therapy alone, and also induced bone generation.
Assuntos
Luxações Articulares , Transtornos da Articulação Temporomandibular , Humanos , Adolescente , Criança , Adulto Jovem , Adulto , Disco da Articulação Temporomandibular/cirurgia , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/patologia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/terapia , Transtornos da Articulação Temporomandibular/patologia , Contenções , Articulação Temporomandibular/patologia , Imageamento por Ressonância Magnética/métodos , Placas Oclusais , Remodelação Óssea , Luxações Articulares/cirurgiaRESUMO
Temporomandibular joint surgery for various pathological conditions and diseases affecting the integrity, mobility, and function of the joint has a long history. However, the greatest explosion of knowledge regarding the diagnosis and management of temporomandibular joint pain, pathology, and rehabilitation has occurred in the last 50 years. This review focuses on the incremental expansion of knowledge over time that led to the development of concepts that support our current surgical decisions and techniques, with the aim of identifying gaps in knowledge that require well-designed studies to move the field forward. Using this approach will allow an enhancement of our understanding of temporomandibular joint form and function, and enable focus to be placed on the evaluation, diagnosis, and non-surgical and surgical management strategies that are the most efficacious for our patients.