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1.
J Biol Regul Homeost Agents ; 34(1 Suppl. 1): 151-160, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32064850

RESUMEN

Clicking may appear in the initial, middle, or final phase of mandibular opening. Magnetic Resonance Imaging (MRI) is the most appropriate diagnostic imaging for diagnosing disc position. With anterior repositioning splint (ARS), disc recapture is achieved through a change in the position of the condyle to encourage adaptation of the retrodiscal tissues. Three patients reported pain and sounds during movement and clicking in the final phases; also, the MRI confirmed anteriorized disc position and the treatments consisted of an ARS. The post-treatment examination confirmed a normal opening without deviations and deflections. After 2 years, the conditions were stable, and the MRI showed thickening of the retrodiscal tissues, including extra fibrous tissue, resulting in a pseudodisc. Treatment using ARS can stimulate tissue fibrosis and the formation of a pseudodisc. MRI is the gold standard for diagnosis and treatment planning of disc displacement cases.


Asunto(s)
Ferulas Oclusales , Trastornos de la Articulación Temporomandibular/terapia , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Disco de la Articulación Temporomandibular/diagnóstico por imagen
2.
Clin Oral Investig ; 24(1): 61-70, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31729577

RESUMEN

OBJECTIVES: To evaluate the effectiveness of surgical and nonsurgical treatment of temporomandibular joint (TMJ) luxation. MATERIALS AND METHODS: This systematic literature review searched PubMed, the Cochrane Library, and Web of Science databases to identify randomized controlled trials on TMJ luxation treatment published between the inception of each database and 26 March 2018. RESULTS: Two authors assessed 113 unique abstracts according to the inclusion criteria and read nine articles in full text. Eight articles comprising 338 patients met the inclusion criteria, but none of these evaluated surgical techniques. Three studies including 185 patients concerned acute treatment with manual reduction of luxation while five studies including 153 patients evaluated minimally invasive methods with injection of autologous blood or dextrose prolotherapy for recurrent TMJ luxation. These studies reported that mouth opening after treatment was reduced and that independent of type of injection, recurrences of TMJ luxation were rare in most patients. CONCLUSIONS: In the absence of randomized studies on surgical techniques, autologous blood injection in the superior joint space and pericapsular tissues with intermaxillary fixation seems to be the treatment for recurrent TMJ luxation that at present has the best scientific support. Well-designed studies on surgical techniques with sufficient numbers of patients, long-term follow-ups, and patient experience assessment are needed for selection of the optimal surgical treatment methods. CLINICAL RELEVANCE: Autologous blood injection combined with intermaxillary fixation can be recommended for patients with recurrence of TMJ luxation.


Asunto(s)
Luxaciones Articulares/terapia , Trastornos de la Articulación Temporomandibular/terapia , Femenino , Humanos , Inyecciones Intraarticulares , Masculino , Recurrencia , Articulación Temporomandibular , Resultado del Tratamiento
3.
J Craniomaxillofac Surg ; 48(1): 9-23, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31870713

RESUMEN

PURPOSE: Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness. MATERIAL AND METHODS: An electronic search on three major databases was undertaken to identify RCTs published before August 2019, comparing up to fourteen different treatments against control/placebo patients for arthrogenous TMDs with respect to pain reduction and improved mouth opening. The treatment variables were controls/placebo, conservative treatment (muscle exercises and occlusal splint therapy), occlusal splint therapy alone, intraarticular injection (IAI) of hyaluronic acid (HA) or corticosteroid (CS), arthrocentesis with or without HA, CS and platelet-rich plasma (PRP), arthroscopy with or without HA and PRP, open joint surgery, and physiotherapy. Frequentist NMA was performed using STATA software. Studies meeting the inclusion criteria were divided according to the length of follow-up (short-term (≤5 months) and intermediate-term (≥6 months to 4 years) and type of TMJ arthrogenous disorders; internal derangement (ID) and TMJ osteoarthritis (OA). The standardized mean differences (SMD) in post-treatment pain reduction and maximum mouth opening (MMO) were analysed. RESULTS: Thirty-six RCTs were identified that performed comparative outcome assessments for pain and 33 RCTs for MMO. At the short term (≤5 months), IAI-HA (SMD = -2.8, CI: -3.7 to -1.8) and IAI-CS (SMD = -2.11, CI: -2.9 to -1.2) (all very low quality evidence) achieved a substantially greater pain reduction than control/placebo. At intermediate term (≥6 months), a statistically significant decrease in posttreatment pain intensity was observed following Arthroscopy-PRP (SMD = -3.5, CI: -6.2 to -0.82), Arthrocentesis-PRP (SMD = -3.08, CI: -5.44 to -0.71), Arthroscopy-HA (SMD = -3.01, CI: -5.8 to -0.12), TMJ surgery (SMD = -3, CI: -5.7 to -0.28), IAI-HA (SMD = -2.9, CI: -4.9 to -1.09) (all very low quality evidence), Arthroscopy-alone (SMD = -2.6, CI: -5.1 to -0.07, low quality evidence) and Arthrocentesis-HA (SMD = -2.3, CI: -4.5 to -018, moderate-quality evidence) when compared to the control/placebo groups. Relative to MMO, the most effective treatments for short- and intermediate-term improvement were the arthroscopy procedures (PRP > HA > alone, all very low-quality evidence) followed by Arthrocentesis-PRP (very low-quality evidence) and Arthrocentesis-HA (moderate-quality evidence). The non-invasive procedures of occlusal splint therapy, physical therapy, conservative therapy, placebo/control provided significantly lower quality outcomes relative to pain and MMO. CONCLUSION: The results of the present meta-analysis support a paradigm shift in arthrogenous TMJ disorder treatment. There is a new evidence (though on a very low to moderate quality level) that minimally invasive procedures, particularly in combination with IAI of adjuvant pharmacological agents (PRP, HA or CS), are significantly more effective than conservative treatments for both pain reduction and improvement of MMO in both short (≤5 months) and intermediate term (6 months-4 years) periods. In contrast to traditional concepts mandating exhaustion of conservative treatment options, minimally invasive procedures, therefore, deserve to be implemented as efficient first-line treatments (e.g. IAIs and/or arthrocentesis) or should be considered rather early, i.e. as soon as patients do not show a clear benefit from an initial conservative treatment.


Asunto(s)
Trastornos de la Articulación Temporomandibular/terapia , Artrocentesis , Humanos , Inyecciones Intraarticulares , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto
4.
Cir. plást. ibero-latinoam ; 45(4): 435-445, oct.-dic. 2019. graf, ilus, tab
Artículo en Español | IBECS | ID: ibc-186032

RESUMEN

Introducción y objetivo: El bruxismo (BRX) se define como rechinar y/o apretar los dientes, involuntaria e intensamente, debido a hipertrofia y/o contracción reiterada de los músculos masticatorios, especialmente los maseteros. Puede suceder durante el sueño o de día indistintamente. Los tratamientos empleados tienen la finalidad de limitar el daño sobre diferentes estructuras biológicas, especialmente la articulación témporo-mandibular (ATM), y oscilan desde oclusión irreversible, interposición de férulas, tratamiento farmacológico y/o terapias cognitivas, así como el empleo de toxina botulínica tipo A (TB-A). El objetivo de nuestro estudio fue investigar el efecto de relajación inducido por la inyección de TB-A en los maseteros y su relación con el alivio de los síntomas referidos por los pacientes con BRX. Material y método. Estudio clínico, prospectivo y longitudinal en 25 pacientes, mujeres, de 24 a 67 años (37.2 ± 10.7), desde setiembre de 2018 a marzo de 2019.Los controles de evaluación se realizaron antes, 2 semanas y 4 meses después del tratamiento con TB-A. Se tomaron fotografías digitales, se valoró el índice de desgaste dental de Smith-Knigth y se realizó ortopantomografía. Algunas pacientes aportaron resonancia magnética nuclear. Se tomaron medidas del diámetro bigonial mediante calibre digital y se valoró el grosor de los maseteros en reposo y contracción, por medición ecográfica. Resultados: Después del tratamiento con TB-A, el 24% de las pacientes se vieron libres de BRX y el 76% restante obtuvo gran mejoría; hubo escasos y transitorios efectos adversos. Conclusiones: La TB-A protege las estructuras orofaciales (dientes, músculos mandibulares, ATM) del daño inducido por el BRX, al tiempo que alivia el dolor y los síntomas relacionados con la excesiva contracción muscular


Background and objective: Bruxism (BRX) is defined as grinding or clenching of teeth, involuntarily and intensely, due to hypertrophy and/or contraction of muscles related to chewing, with particular involvement of masseters. It can happen during sleep or wakefulness indistinctly. Treatments are intended to limit destructive effects of BRX on different biological structures, especially the temporomandibular joint; are variable and range from irreversible occlusion, interposition of splints, pharmacological therapies, cognitive-behavioral approaches and the use of botulinum toxin type A (BoNT-A). The aim of this study was to investigate the relaxation effect of BoNT-A injection in masseter muscles and its relation to relief of symptoms in patients with BRX. Methods: This study is a clinical, prospective and longitudinal trial on 25 adult female patients between age ranges 24 to 67 (3.,2 ± 10.7), carried out from September 2018 to March 2019.Evaluation controls were done before, 2 weeks and 4 months after treatment with BoNT-A. Examination protocol in the trial included digital photography, Smith and Knight tooth wear index, orthopantomogra- phy and magnetic resonance imaging. Measurements of bigonial diameters were taken by calliper, at rest and during contraction, and the thickness of each masseter muscle was also evaluated in the same conditions, by ultrasound at every control. Results.As a result, after BoNT-A treatment, 24% of the patients were free of BRX, while the remaining 76% obtained a significant improvement, with few and transient adverse effects. Conclusions: BoNT-A can be used to protect oral-facial structures (such as teeth, jaw muscles, temporomandibular joint), from excessive forces and harmful damage caused by BRX, and to relieve accompanying pain and related complaints by decreasing the muscle forces exerted during contraction


Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Toxinas Botulínicas Tipo A/uso terapéutico , Bruxismo del Sueño/terapia , Trastornos de la Articulación Temporomandibular/terapia , Estudios Prospectivos , Estudios Longitudinales , Músculo Masetero/efectos de los fármacos , Síndromes del Dolor Miofascial/terapia , Bruxismo/diagnóstico por imagen , Desgaste de los Dientes/complicaciones , Equimosis/complicaciones
7.
Medicine (Baltimore) ; 98(46): e17934, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31725647

RESUMEN

BACKGROUND: Numerous treatment modalities have been attempted for masticatory muscle pain in patients with temporomandibular disorders (TMD). To compare the treatment efficacy of more than 2 competing treatments, a network meta-analysis (NMA) was conducted. METHODS: This study was reported with reference to the extended Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting of systematic reviews incorporating network meta-analyses. Medline via Pubmed, Embase via OVID, and Cochrane Library Central were searched (up to February 11, 2019). Axis I protocol of Diagnostic Criteria or Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD, RDC/TMD) were chosen as diagnostic standards. The PICOS (Problem/patient, Intervention, Comparison, Outcome, Study design) method was used to screen trials under eligibility criteria. And the NMA was performed with mvmeta commands in Stata (StataCorp, Tex). RESULTS: Of 766 studies searched, 12 randomized clinical trials (RCTs) were finally included. Nineteen different therapies were found and further categorized into 9 treatment modalities. The general heterogeneity was not found among included trials. But predictive intervals (PrIs) were conspicuously wider than confidential intervals (CIs) of all pairwise comparisons, indicating that heterogeneity may exist between studies. Complementary therapy showed the greatest probability (42.7%) to be the best intervention. It also had the highest mean rank (2.3) in the rankogram and the biggest value of surface under the cumulative ranking (SUCRA, 84.1%). CONCLUSIONS: Based on the limited evidence of available trials, complementary therapy seemed to be slightly more effective than remaining treatment modalities for pain reduction in TMD patients with masticatory muscle pain. High-quality randomized controlled trials are expected to validate the findings.


Asunto(s)
Terapias Complementarias/métodos , Músculos Masticadores/fisiopatología , Trastornos de la Articulación Temporomandibular/terapia , Analgésicos/uso terapéutico , Toxinas Botulínicas/uso terapéutico , Terapias Complementarias/efectos adversos , Humanos , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Medicine (Baltimore) ; 98(46): e18013, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31725674

RESUMEN

INTRODUCTION: Severe temporomandibular joint disorder (TMD) could induce dysphagia, which could lead to aspiration pneumonia. However, no clinical study has reported that TMD-related dysphagia could result in aspiration pneumonia. Integrative Korean medicine (KM) is suggested to be an effective treatment for patients with severe TMD. PATIENT CONCERNS: A 76-year-old female could not open her mouth because of TMD and subsequently experienced dysphagia. To clearly identify the cause of dysphagia and to treat the symptoms, she was admitted to the neurology department. However, she eventually developed aspiration pneumonia. Despite the inpatient treatment and even after pneumonia was cured, TMD symptoms and dysphagia persisted. DIAGNOSIS: Based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the magnetic resonance imaging findings, the patient was diagnosed as having severe TMD with disc displacement without reduction and with limited opening. INTERVENTIONS: Integrative KM treatment, including acupuncture, herbal acupuncture, cupping therapy, Chuna manual therapy, and herbal medicine, was performed during the admission period (23 days). OUTCOMES: The following clinical improvements were detected: maximal unassisted opening from 8 to 28 mm, right lateral movement from 3 to 11 mm, left lateral movement from 10 to 15 mm, and protrusion movement from 5 to 7 mm. Dysphagia disappeared when the TMD symptoms improved. CONCLUSION: Patients with severe TMD might experience dysphagia, which could lead to aspiration pneumonia. Symptoms of severe TMD could be treated with integrative KM treatment.


Asunto(s)
Trastornos de Deglución/complicaciones , Neumonía por Aspiración/etiología , Trastornos de la Articulación Temporomandibular/complicaciones , Anciano , Trastornos de Deglución/diagnóstico , Femenino , Humanos , Rango del Movimiento Articular , República de Corea , Trastornos de la Articulación Temporomandibular/terapia
9.
Indian J Dent Res ; 30(4): 512-515, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31745044

RESUMEN

Aim: The aim of this study is to determine the efficacy of phonophoresis in patients with temporomandibular disorders. Objective: To prove that phonophoresis could be an effective treatment modality in in patients with temporomandibular disorders. Procedure: Fifty patients diagnosed clinically and radiographically as temporomandibular disorder were randomly assigned into either of the two groups, namely, (Group A) plain ultrasound and (Group B) phonophoresis. Acoustic gel containing no pharmacological agent was applied in the ultrasound group, whereas a gel containing aceclofenac was applied in the phonophoresis group. Each group was treated three times a week for 2 weeks. The assessment of pain and inflammation both before and after treatment were done using the visual analog scale (VAS) and Creactive protein (CRP). Results: Intergroup comparison was done and analyzed statistically using independent ttest. Intragroup comparison was done using paired ttest. A significant difference in VAS scores and CRP levels before and after treatment were seen within both ultrasound phonophoresis PH groups. No significant difference was noted statistically between ultrasound and phonophoresis group. Conclusion: The results of this study suggests that though plain ultrasound as well as phonophoresis with aceclofenac gel are effective in the management of temporomandibular disorders. Phonophoresis was found be slightly superior as evident in VAS scores and CRP levels though not statistically significant.


Asunto(s)
Fonoforesis , Trastornos de la Articulación Temporomandibular , Terapia por Ultrasonido , Analgésicos , Humanos , Dimensión del Dolor , Trastornos de la Articulación Temporomandibular/terapia , Resultado del Tratamiento
10.
Am J Orthod Dentofacial Orthop ; 156(4): 475-484, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582119

RESUMEN

INTRODUCTION: This project was undertaken to accomplish 2 objectives: (1) to identify whether there is a discrepancy between orthodontists and experts in temporomandibular disorders (TMD) related to diagnosis and treatment of TMD patients, and (2) to influence the manner in which TMD curricula are taught in orthodontic residency programs, better preparing future orthodontic specialists to diagnose and treat (and refer) patients with TMD. METHODS: A survey invitation was e-mailed to 8870 members of the American Association of Orthodontists. Items were answered on a 6-point scale (0 = I don't know; 1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree). A group consensus was attributed when more than 50% of the orthodontists supported a response. Previously published responses of TMD experts were used as a reference to evaluate the orthodontists' responses. Comparisons between the responses from the 2 groups were assessed using a z-test. RESULTS: Among the participants who responded to the questionnaire, 148 were residents, 1132 were private practitioners, and 61 were full-time faculty. Sixty-two percent of the participants did not think they received enough training in TMD during their orthodontic residency. Although 62% of participants indicated that they feel comfortable diagnosing TMD patients, 50.2% do not feel comfortable treating TMD patients. There was no significant difference between the 2 groups' responses under one-third of the questions. CONCLUSIONS: It is clear that orthodontic residencies in the U.S. need to improve methods of teaching TMD concepts. Although most orthodontists feel comfortable diagnosing TMD patients, less than half feel comfortable treating those patients, and the difference in responses with the TMD expert group was significant in 71% of the questions.


Asunto(s)
Educación de Posgrado en Odontología/normas , Ortodoncistas/educación , Ortodoncistas/psicología , Trastornos de la Articulación Temporomandibular/diagnóstico , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Actitud del Personal de Salud , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Estados Unidos
11.
Am J Orthod Dentofacial Orthop ; 156(4): 531-544, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582125

RESUMEN

Progressive condylar resorption, also known as idiopathic condylar resorption, is an uncommon, aggressive, degenerative disease of the temporomandibular joint (TMJ) seen mostly in adolescent girls and young women. This condition leads to loss of condylar bone mass, decrease of mandibular ramal height, steep mandibular and occlusal plane angles, and an anterior open bite. In 3 case reports, we review the pathogenesis of TMJ degenerative disease and the clinical management of TMJ arthrosis. We emphasize that TMJ arthritic disease should be discussed in dental circles as a pathologic entity in the same way that orthodontists discuss arthritic disease in orthopedic circles. Regarding the degenerative pathology of the TMJ, treatment goals include restored function and pain reduction. The treatment methods used to achieve these goals can range from noninvasive therapy to minimally invasive and invasive surgery. Most patients can be treated noninvasively, and the importance of disease prevention and conservative management in the overall treatment of TMJ disease must be acknowledged. The decision to manage TMJ osteoarthrosis surgically must be based on evaluation of the patient's response to noninvasive treatments, mandibular form and function, and effect of the condition on his or her quality of life.


Asunto(s)
Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Resorción Ósea/patología , Niño , Terapia Combinada , Progresión de la Enfermedad , Femenino , Humanos , Cóndilo Mandibular/patología , Cóndilo Mandibular/cirugía , Osteoartritis/patología , Calidad de Vida , Trastornos de la Articulación Temporomandibular/patología , Resultado del Tratamiento
12.
Am J Orthod Dentofacial Orthop ; 156(4): 555-565, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582127

RESUMEN

A common dilemma when treating anterior open bite is understanding its etiology. Idiopathic condylar resorption (ICR) can cause open bite in affected individuals. Although it is prudent to not treat patients with ICR until active resorption has ceased, orthodontists may begin treating them because anterior open bite from ICR may not appear before or during their orthodontic treatment. This article reports a 12-year-old female who was diagnosed with ICR 10 months after completion of her orthodontic treatment for a Class II Division 1 malocclusion. When a young patient with a high mandibular angle and previous skeletal or dental Class II malocclusion returns with an open bite during the retention phase, the patient's condyles must be carefully examined to determine whether any temporomandibular joint disorder, such as ICR, is present. Currently, the controversy over the cause and the cure for ICR is continuing to challenge orthodontists in diagnoses and treatments. Orthodontists should closely monitor and offer informed treatment options to patients with risk factors for ICR or signs of its pathology that might develop at any stage of orthodontic treatment, including the retention period.


Asunto(s)
Resorción Ósea/complicaciones , Resorción Ósea/terapia , Maloclusión de Angle Clase II/terapia , Cóndilo Mandibular/patología , Enfermedades Mandibulares/patología , Enfermedades Mandibulares/terapia , Mordida Abierta/etiología , Mordida Abierta/terapia , Ortodoncia Correctiva/métodos , Trastornos de la Articulación Temporomandibular/terapia , Resorción Ósea/diagnóstico por imagen , Cefalometría , Niño , Terapia Combinada , Estética Dental , Femenino , Humanos , Maloclusión de Angle Clase II/diagnóstico por imagen , Enfermedades Mandibulares/diagnóstico por imagen , Mordida Abierta/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Resultado del Tratamiento
13.
Dent Med Probl ; 56(3): 265-272, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31577070

RESUMEN

BACKGROUND: Disk displacement without reduction (DDwoR) is one of the most common temporomandibular joint disorders (TMDs); it can manifest itself in joint pain and limited mouth opening. Nowadays, many arthrocentesis techniques are used with no consensus on which technique is optimal. OBJECTIVES: The aim of this study was to investigate the efficacy of 3 techniques in the treatment of TMD known as DDwoR and to compare them in order to determine whether one is superior to the others. MATERIAL AND METHODS: A prospective study was conducted between May 2015 and June 2018. The sample consisted of 30 adult patients (6 males and 24 females; mean age: 38.87 ±6.40 years) with DDWoR, confirmed with magnetic resonance imaging (MRI). The patients were randomly divided into 3 groups according to the treatment technique applied: arthrocentesis only (control); arthrocentesis plus hyaluronic acid (HA); and arthrocentesis plus platelet-rich plasma (PRP). The maximum mouth opening (MMO) as well as pain intensity and masticatory efficiency on a visual analog scale (VAS) were measured at the time of diagnosis (baseline) and at 1-month, 3-month, 6-month, and 9-month follow-up appointments. The significance level was set at 0.05 for all statistical tests. RESULTS: The 3 techniques resulted in significant improvement in MMO and all VAS parameters. The one-way analysis of variance (ANOVA) revealed significant differences (p < 0.05) in the variables between the 3 groups. The increase in MMO in the PRP and HA groups was significantly greater than in the case of the control group, whereas no significant difference was found between the PRP and HA groups. The pain intensity and masticatory efficiency results were significantly better in the PRP group than in the HA group or the control group; at the same time, no significant differences were noted between the HA group and the control group. CONCLUSIONS: Despite the fact that patients benefited from all of the 3 techniques, arthrocentesis plus PRP appeared to be superior to arthrocentesis plus HA or arthrocentesis alone.


Asunto(s)
Artrocentesis , Ácido Hialurónico , Plasma Rico en Plaquetas , Trastornos de la Articulación Temporomandibular , Adulto , Femenino , Humanos , Ácido Hialurónico/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Articulación Temporomandibular , Trastornos de la Articulación Temporomandibular/terapia , Resultado del Tratamiento
14.
Rev Prat ; 69(4): 432-437, 2019 Apr.
Artículo en Francés | MEDLINE | ID: mdl-31626502

RESUMEN

Temporo-mandibular disorders -TMD- involve a whole set of anatomical, physiological and clinical disorders that exceed by far the sole temporo-mandibular joint. The main symptom of this condition, most frequent in female patients, is pain. Three syndromes are associated with TMD: a muscular syndrome, not only involving masticatory muscles but also muscles of the neck and pain in seemingly unrelated anatomical regions, which can be misleading; an inflammatory articular syndrome; a mechanical syndrome affecting mouth-opening path. The main treatment of this very common and benign disorder is based on physical therapy. However, physicians should be warned that some patients might exhibit similar symptoms in rare cases of malignant tumor.


Asunto(s)
Trastornos de la Articulación Temporomandibular , Articulación Temporomandibular/fisiopatología , Diagnóstico Diferencial , Femenino , Humanos , Músculos Masticadores/patología , Dolor , Articulación Temporomandibular/fisiología , Trastornos de la Articulación Temporomandibular/diagnóstico , Trastornos de la Articulación Temporomandibular/terapia
15.
J Craniomaxillofac Surg ; 47(11): 1728-1738, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31601466

RESUMEN

OBJECTIVE: to assess the reliability of bone marrow nucleated cell (BMNc) intra-articular injection in patients with degenerative temporomandibular joint disorders (TMDs), and to compare its efficacy with that of hyaluronic acid (HA). MATERIALS AND METHODS: this study was designed as a randomized, controlled trial of parallel groups. Patients affected by degenerative joint mandibular disorders were enrolled in this prospective clinical trial and randomly divided into two groups. The HA group underwent temporomandibular joint (TMJ) arthrocentesis and HA injection, whilst patients in the BMNc group were inoculated with BMNc inside the joint after lavage. Outcome measures were: assessing pain at rest and during motion, joint noises, chewing efficiency, and maximum interincisal opening. A postoperative MRI scan was performed and compared with the preoperative one, while examining for cartilage regeneration. Clinical and radiological data were collected from baseline to 12 months follow-up. RESULTS: Thirty patients, 15 for each group, complaining of different degrees of unilateral TMD with internal derangement, were enrolled and treated. In both groups, significant clinical improvements were detected after the procedure up to 1 year postoperatively. The BMNc group presented significantly better pain relief than the HA group after 6 months (p = 0.028) and 12 months (p = 0.000). No significant differences were observed in terms of joint noises. In terms of chewing efficiency, the BMNc group showed positive significant differences after 12 months (p = 0.000). Maximum interincisal opening presented significantly better values in the BMNc group after 6 months (p = 0.001) and 12 months (p = 0.000). No MRI evidence of cartilage regeneration was reported. CONCLUSION: intra-articular TMJ BMNc injection improved clinical outcomes in TMD treatment. The Results of this first human-model study are promising but further studies are needed to determine whether BMNc can represent the best treatment for TMDs.


Asunto(s)
Artrocentesis , Autoinjertos , Médula Ósea , Ácido Hialurónico/administración & dosificación , Trastornos de la Articulación Temporomandibular/terapia , Humanos , Ácido Hialurónico/uso terapéutico , Inyecciones Intraarticulares , Dimensión del Dolor , Estudios Prospectivos , Rango del Movimiento Articular , Reproducibilidad de los Resultados , Articulación Temporomandibular , Resultado del Tratamiento
16.
J Radiol Case Rep ; 13(8): 31-39, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31558968

RESUMEN

Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of the synovium that usually involves joints, tendon sheaths, and bursae. It presents rarely, however, in the temporomandibular joints (TMJs). This paper reports a 59-year-old female patient with PVNS of the TMJ and its clinico-pathologic features are discussed. The patient was treated with surgery and postoperative radiotherapy (PORT). Follow-up was conducted, and there were no recurrences, metastases, skin changes or joint stiffness noted. The main treatment of PVNS is surgical resection. However, postoperative radiotherapy is important for local control of extensive tumors or positive margins. We conducted a literature review for postoperative radiotherapy case reports related to PVNS of the TMJ.


Asunto(s)
Sinovitis Pigmentada Vellonodular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Femenino , Pérdida Auditiva/etiología , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Radioterapia Ayuvante , Sinovitis Pigmentada Vellonodular/patología , Sinovitis Pigmentada Vellonodular/terapia , Trastornos de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/terapia , Acúfeno/etiología
17.
BMC Oral Health ; 19(1): 205, 2019 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-31484524

RESUMEN

BACKGROUND: Bruxism is among the habits considered generally as contributory factors for temporomandibular joint (TMJ) disorders and its etiology is still controversial. METHODS: Three-dimensional models of maxilla and mandible and teeth of 37 patients and 36 control subjects were created using in-vivo image data. The maximum values of stress and deformation were calculated in 21 patients six months after using a splint and compared with those in the initial conditions. RESULTS: The maximum stresses in the jaw bone and head of mandible were respectively 4.4 and 4.1 times higher in patients than in control subjects. Similar values for deformation were 5.8 and 4.9, respectively. The maximum stress in the jaw bone and head of mandible decreased six months after splint application by up to 71.0 and 72.8%, respectively. Similar values for the maximum deformation were 80.7 and 78.7%, respectively. Following the occlusal splint therapy, the approximation of maximum deformation to the relevant values in control subjects was about 2.6 times the approximation of maximum stress to the relevant values in control subjects. The maximum stress and maximum deformation occurred in all cases in the head of the mandible and the splint had the highest effectiveness in jaw bone adjacent to the molar teeth. CONCLUSIONS: Splint acts as a stress relaxer and dissipates the extra stresses generated as well as the TMJ deformation and deviations due to bruxism. The splint also makes the bilateral and simultaneous loading possible and helps with the treatment of this disorder through regulation of bruxism by creating a biomechanical equilibrium between the physiological loading and the generated stress.


Asunto(s)
Bruxismo/terapia , Ferulas Oclusales , Trastornos de la Articulación Temporomandibular/terapia , Bruxismo/diagnóstico , Análisis de Elementos Finitos , Humanos , Mandíbula/fisiopatología
19.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 54(8): 515-521, 2019 Aug 09.
Artículo en Chino | MEDLINE | ID: mdl-31378028

RESUMEN

Occlusal splint is a removable device for the treatment of oral and maxillary diseases with reversible occlusal treatment property. When patients wear the occlusal splint, the occlusal contact state can be changed and the position of the lower jaw may be adjusted, with the improvement of functions of temporomandibular joints and masticatory muscles. There are various types of occlusal splints, among which stabilization splint, soft occlusal splint and repositioning splint are widely used in the treatment of temporomandibular disorders and night bruxism. For the patients requiring occlusal reconstruction, occlusal splint can be used as an important means to adjust and verify the therapeutic jaw position. As a major trend of research in future, the digital design and production of occlusal splint are still in the initial stage and need to be further improved.


Asunto(s)
Ferulas Oclusales , Bruxismo del Sueño , Trastornos de la Articulación Temporomandibular , Humanos , Registro de la Relación Maxilomandibular , Músculos Masticadores , Bruxismo del Sueño/terapia , Trastornos de la Articulación Temporomandibular/terapia
20.
J Craniomaxillofac Surg ; 47(11): 1720-1727, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31451342

RESUMEN

The aim of the study was to compare the effectiveness of hyaluronic acid (HA) injection and arthrocentesis plus HA injection for treating disc displacement with reduction (DDwR) and disc displacement without reduction (DDwoR). In this randomized clinical trial, patients were divided into 2 main groups: group I (DDwR) and group II (DDwoR). Sub-groups were made depending on allocated treatment: group Ia (arthrocentesis plus HA), group Ib (single HA), group Ic (control), group IIa (arthrocentesis plus HA), group IIb (single HA), and group IIc (control). The primary outcome variable was maximum pain on chewing, while maximum pain at rest, maximum non-assisted and assisted mouth opening, chewing efficiency, temporomandibular joint (TMJ) sounds, quality of life, treatment tolerability, and treatment effectiveness were secondary outcomes. The influences of individual study variables (gender, involved side, and duration of symptoms) on clinical outcomes were also examined. The study consisted of 116 TMJs of 90 patients (n = 45 in both main groups, TMJs = 58) aged 15-82 years. At the 6-month follow-up, improvement in all parameters, except for TMJ sounds, was recorded in all treatment groups, with no improvements in control groups. Notably, arthrocentesis plus HA showed superior improvement in chewing efficiency (p = 0.041) and quality of life (p = 0.047) of group I and quality of life (p = 0.004) in group II, compared to single HA. Furthermore, the duration of symptoms correlated with clinical outcomes. Both procedures successfully improved the symptoms of DDwR and DDwoR patients, but arthrocentesis plus HA injection seemed superior.


Asunto(s)
Artrocentesis , Ácido Hialurónico/uso terapéutico , Trastornos de la Articulación Temporomandibular/terapia , Viscosuplementos/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada/métodos , Humanos , Inyecciones Intraarticulares , Persona de Mediana Edad , Dimensión del Dolor , Calidad de Vida , Rango del Movimiento Articular , Articulación Temporomandibular , Trastornos de la Articulación Temporomandibular/diagnóstico , Trastornos de la Articulación Temporomandibular/fisiopatología , Resultado del Tratamiento , Adulto Joven
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