张口训练对伴张口受限的颞下颌关节紊乱病患者最大开口度恢复的短期影响

目的研究主动与被动结合的张口训练对伴张口受限的患者透明质酸钠关节腔注射治疗后短期最大开口度（MMO）恢复的影响。 方法收集2017—2018年就诊于广州医科大学附属口腔医院颞下颌关节科伴张口受限的颞下颌关节紊乱病（TMD）患者49例，所有患者均接受透明质酸钠关节腔注射治疗。其中25例患者术后接受常规健康宣教方案（对照组），另外24例患者术后在常规健康宣教方案基础上结合主动、被动张口训练治疗（张口训练组），并使用t检验、卡方检验、线性回归模型对两组患者MMO恢复情况进行比较。 结果对照组患者在术后2周MMO较张口训练组小3 mm，差异有统计学意义（t = 2.049，P = 0.046），对照组患者在术后4周MMO较张口训练组小4 mm，差异有统计学意义（t = 3.128，P = 0.003）。 结论张口训练对TMD患者术后张口度恢复有积极作用，并可在4周内体现出辅助MMO恢复的优势。     

Efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial

Stabilisation splint therapy has long been thought to be effective for the management of temporomandibular disorders (TMD). However, the superiority of stabilisation splint therapy compared to other TMD treatments remains controversial. The aim of this study was to determine the efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for TMD. A total of 181 TMD participants were randomly allocated to a non‐splint multimodal therapy (NS) group (n = 85) or a non‐splint multimodal therapy plus stabilisation splint (NS+S) group (n = 96). Non‐splint multimodal therapy included self‐exercise of the jaw, cognitive–behavioural therapy, self‐management education and additional jaw manipulation. Three outcome measurements were used to assess treatment efficacy: mouth‐opening limitation, oro‐facial pain and temporomandibular joint sounds. A two‐factor repeated‐measures analysis of variance (anova ) was used to evaluate the efficacy of the two treatment modalities (NS vs. NS+S), and Scheffe's multiple comparison test was used to compare the treatment periods. Subgroup analyses were performed to disclose the splint effects for each TMD diagnostic group. All three parameters significantly decreased over time in both groups. However, there were no significant differences between the two treatment groups in the total comparison or subgroup analyses; an exception was the group with degenerative joint disease. No significant difference between the NS and NS+S treatment approaches was revealed in this study. Therefore, we conclude that the additional effects of stabilisation splint are not supported for patients with TMD during the application of multimodal therapy.     

Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review

Temporomandibular disorders (TMD) are characterized by the presence of temporomandibular joint (TMJ) and/or masticatory muscle pain and dysfunction. Low-level laser is presented as an adjuvant therapeutic modality for the treatment of TMD, especially when the presence of inflammatory pain is suspected.

Objective

To systematically review studies that investigated the effect of low level laser therapy (LLLT) on the pain levels in individuals with TMD.

Material and Methods

The databases Scopus, embase, ebsco and PubMed were reviewed from January/2003 to October/2010 with the following keywords: laser therapy, low-level laser therapy, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, temporomandibular joint, temporomandibular, facial pain and arthralgia, with the inclusion criteria for intervention studies in humans. exclusion criteria adopted were intervention studies in animals, studies that were not written in english, Spanish or Portuguese, theses, monographs, and abstracts presented in scientific events.

Results

After a careful review, 14 studies fit the criteria for inclusion, of which, 12 used a placebo group. As for the protocol for laser application, the energy density used ranged from 0.9 to 105 J/cm², while the power density ranged from 9.8 to 500 mW. The number of sessions varied from 1 to 20 and the frequency of applications ranged from daily for 10 days to 1 time per week for 4 weeks. A reduction in pain levels was reported in 13 studies, with 9 of these occurring only in the experimental group, and 4 studies reporting pain relief for both the experimental group and for the placebo.

Conclusion

Most papers showed that LLLT seemed to be effective in reducing pain from TMD. However, the heterogeneity of the standardization regarding the parameters of laser calls for caution in interpretation of these results. Thus, it is necessary to conduct further research in order to obtain a consensus regarding the best application protocol for pain relief in patients with TMD.     

Evaluation of mandibular condylar movement exercise for patients with internal derangement of the temporomandibular joint on initial presentation

The aim of the present study was to evaluate mandibular condylar movement in a group of Japanese women who presented with closed lock of the temporomandibular joint. A total of 148 women aged between 19 and 75 years were included in the study. We examined mouth-opening, protrusion, and lateral excursive movements, and divided the patients into two groups (74 experimental cases and 74 controls). The experimental group was treated with exercises of the mandibular condyle, and the median (range) maximum mouth-opening increased from 27 (range 11-34) mm to 38 (24-47) mm. In control cases, it increased from 29 (range 20-35) mm to 30 (20-39) mm without exercise. In the experimental group, the median (range) maximum lateral movement on the opposite (unaffected) side increased from 8 (3-12) mm to 9 (5-13) mm. In the control group it remained similar at 7 (3-12) mm and 7 (3-12) mm. In the experimental group, the median (range) lateral movement on the affected side increased from 6 (2-13) mm to 8 (3-13) mm. In controls it remained similar at 6 (2-12) mm and 6 (2-12) mm. In the experimental group, the median (range) maximum protrusion increased from 6 (3-12) mm to 7 (4-12) mm, and in the control group from 6 (2-10) mm to 7 (2-10) mm. There was a significant difference between the experimental (50/74, 68%) and control groups (3/74, 4%) in the degree of increased mouth-opening. Exercise of the first mandibular condylar seems to be useful in the treatment of closed lock on initial treatment.     

The effectiveness of cognitive-behavioural therapy for temporomandibular disorders: a systematic review

Cognitive-behavioural therapy (CBT) and its effects on temporomandibular disorders (TMD) have been examined in several studies. We are trying to combine results of these studies and to explore the effectiveness. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trial, Pubmed and the Chinese Biomedical Literature Data were searched to collect randomised and semi-randomised controlled trials (RCTs), comparing CBT with any control group receiving other dental treatments. Two authors independently retrieved, extracted and assessed the quality of included studies. The search strategy resulted in 323 studies, of which five met the inclusion criteria, including three RCTs and two semi-RCTs. The quality of the included studies was diverse. Meta-analysis was not performed owing to five studies involving different comparison groups and follow-up periods. The effect of CBT on patients with TMD is inconsistent among the studies, so no firm conclusion could be drawn in this systematic review. There is insufficient evidence to make firm recommendations for the use of CBT over other intervention for the treatment of TMD. Further high-quality RCTs are clearly needed for this theme.     

手法复位配合运动与(牙合)垫治疗急性颞下颌关节盘不可复性前移位的近期疗效评价

目的:探讨手法复位关节盘继以运动与验垫治疗对急性不可复性盘前移位患者的短期疗效;通过MRI评价复位后短期内颞下颌关节盘-髁关系.方法:选取44例患者急性开口受限(病程在2个月以内)且经MRI证实颞下颌关节盘不可复性关节盘前移位的患者(男7侧,女37侧),施予软组织放松技术,随后行手法复位关节盘.复位后指导患者进行为期2周的下颌运动轨迹训练、关节稳定性训练和软管盘复位训练.白天自我维持下颌休息位,夜间配戴硬质热塑再定位(牙合)垫,以保持良好的盘-髁关系.分别在治疗前、后评估患者的最大主动开口度和疼痛视觉类比评分(visual analogue score,VAS)(0～10分),治疗结束后1～3个月内MRI复查盘-髁关系.采用SPSS 17.0软件包对数据进行t检验.结果:经过2周治疗后,患者开口度明显改善,由治疗前的(22.6±6.1) mm增加到(43.9±3.3)mm;疼痛明显缓解,由治疗前的3.6±1.5下降到0.7±0.25.44例患者在治疗结束后平均4.6±4.7周经MRI复查显示,20例(占46％)为正常盘-髁关系;16例(占36％)为可复性关节盘前移位;8例(占18％)仍为不可复性关节盘前移位.结论:关节盘手法复位后继以运动治疗及配戴(牙合)垫.对急性盘前移位患者能够恢复开口度,缓解疼痛,对维持正常盘-髁关系有一定疗效.     

The implementation of a decision-tree did not increase decision-making in patients with temporomandibular disorders in the public dental health service

Objective: Many patients with temporomandibular disorders (TMD) seem to go undetected within primary dental health care. Primarily we evaluated if the implemented intervention increased the clinical decision-making for TMD patients; secondarily we evaluated if other factors could be identified that predicted performed or recommended TMD treatment.

Material and Methods: This case–control study was carried out within the Public Dental Health service in Västerbotten County, Sweden. An intervention based on a decision-tree with three screening questions for TMD (3Q/TMD) was implemented during 2015 in four clinics and compared with the remaining county. A total of 400 individuals were selected—200 3Q-positives and 200 3Q-negatives. The 3Q/TMD consists of Q1—frequent jaw pain, Q2—frequent pain on function, and Q3—frequent catching and/or locking of jaw. The 3Q/TMD answers were analyzed in relation to TMD treatment and any TMD related decision that was collected from the digital dental records.

Results: The intervention did not increase the frequencies of traceable clinical decisions among patients with TMD.

Conclusions: Despite the implemented intervention aimed, the indicated undertreatment of patients with TMD remains. Future studies are still needed to gain a deeper understanding of the clinical decision-making process for TMD patients in general practice dentistry.     

盐酸氨基葡萄糖片联合玻璃酸钠治疗颞下颌关节骨关节炎的临床随机对照试验

目的初步探索通过双盲临床随机对照试验评估盐酸氨基葡萄糖治疗颞下颌关节骨关节炎的有效性和安全性。方法28例被诊断为颞下颌关节骨关节炎的患者被随机分到试验组和对照组。试验组14例接受口服盐酸氨基葡萄糖片（每日服1.44 g）4周;对照组14例口服安慰剂。2组均同时接受颞下颌关节上下腔注射玻璃酸钠治疗（每周1次,共4次）。在试验基线和治疗后第2、3、4周分别测量2组的最大张口度、张口疼痛和张口偏斜;在试验基线和第4周使用OHIP-14量表测量患者的生存质量。统计分析采用意向性分析的方法。结果除对照组2例失访,其余患者均完成治疗及随访。2组基线各指标无明显差异。口服盐酸氨基葡萄糖能显著增加患者的最大张口度（P=0.03）、降低张口疼痛（P=0.02）,但在改变张口偏斜和患者生存质量方面其短期效果不明显（P=0.67,P=0.77）。试验过程中未发现严重不良事件。结论盐酸氨基葡萄糖口服与玻璃酸钠关节内注射在颞下颌关节骨关节炎的治疗上有显著的效果和安全性。     

The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial

BACKGROUND: Treatment recommendations for patients with painful temporomandibular disorders (TMDs) range from conservative treatments such as physiotherapy to aggressive and irreversible treatments such as restorative reconstruction and joint surgery. METHODS: The authors randomized 200 subjects diagnosed with TMD into three groups: usual conservative, dentist-prescribed self-care treatment without any intraoral splint appliance (UT); UT plus a conventional flat-plane hard acrylic splint (HS); and UT plus a soft vinyl (a low-cost athletic mouth guard) splint (SS). Subjects completed questionnaires and clinical examinations at three, six and 12 months. RESULTS: The authors observed no significant differences among the groups in TMD-related pain levels or other common signs and symptoms of TMD at baseline (BL) or at any follow-up. The changes from BL were comparable for all three groups. The authors did not note any significant differences at any follow-up for compliance with study protocols or for occurrences of adverse effects from either splint type. For HS versus SS, there were significant differences in rates of splint use, but these differences were not accompanied by differences in either self-reported symptoms or in clinical findings. CONCLUSIONS: All patients improved over time, and traditional splint therapy offered no benefit over the SS splint therapy. Neither splint therapy provided a greater benefit than did self-care treatment without splint therapy. CLINICAL IMPLICATIONS: These findings suggest that clinicians who treat patients with TMD should consider prescribing low-cost nonsplint self-care therapy for most patients.     

Double puncture versus single puncture arthrocentesis for the management of unilateral temporomandibular joint disc displacement without reduction: A randomized controlled trial

Purpose

To compare the clinical efficacy of the conventional double puncture versus single puncture type 2 arthrocentesis for management of temporomandibular joint disc displacement without reduction (DDWOR).

Bone marrow nucleated cell concentrate autograft in temporomandibular joint degenerative disorders: 1-year results of a randomized clinical trial

Objectiveto 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 methodsthis 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.ResultsThirty 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.Conclusionintra-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.     

Stability of anterior crossbite correction: A randomized controlled trial with a 2-year follow-up

Objective:To compare and evaluate the stability of correction of anterior crossbite in the mixed dentition by fixed or removable appliance therapy.Material and Methods:The subjects were 64 consecutive patients who met the following inclusion criteria: early to late mixed dentition, anterior crossbite affecting one or more incisors, no inherent skeletal Class III discrepancy, moderate space deficiency, a nonextraction treatment plan, and no previous orthodontic treatment. The study was designed as a randomized controlled trial with two parallel arms. The patients were randomized for treatment with a removable appliance with protruding springs or with a fixed appliance with multibrackets. The outcome measures were success rates for crossbite correction, overjet, overbite, and arch length. Measurements were made on study casts before treatment (T0), at the end of the retention period (T1), and 2 years after retention (T2).Results:At T1 the anterior crossbite had been corrected in all patients in the fixed appliance group and all except one in the removable appliance group. At T2, almost all treatment results remained stable and equal in both groups. From T0 to T1, minor differences were observed between the fixed and removable appliance groups with respect to changes in overjet, overbite, and arch length measurements. These changes had no clinical implications and remained unaltered at T2.Conclusions:In the mixed dentition, anterior crossbite affecting one or more incisors can be successfully corrected by either fixed or removable appliances with similar long-term stability; thus, either type of appliance can be recommended.     

The effectiveness of splint therapy in patients with temporomandibular disorders: A systematic review and meta-analysis

PURPOSE: The authors conducted a systematic review of all published randomized controlled trials in which investigators compared the effectiveness of splint therapy with that of minimal or no treatment in patients with temporomandibular disorders (TMDs). TYPES OF STUDIES REVIEWED: The authors searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for studies published from inception of each database through August 2011. In eligible studies, investigators enrolled adult patients with TMDs and assigned them randomly to splint therapy or a control group receiving minimal or no treatment. RESULTS: Of 1,567 potentially eligible studies, 11 proved eligible and were included. Moderate-quality evidence suggests that splint therapy reduced pain in the temporomandibular joint (TMJ) area (standardized response mean = -0.93, 95 percent confidence interval [CI], -1.33 to -0.53; risk difference for having continued pain = -0.35, 95 percent CI, -0.21 to -0.46; mean change on the 100-millimeter visual analog scale = -11.5 mm, 95 percent CI, -16.5 mm to -6.6 mm). Low to very low quality of evidence showed no significant differences between the splint therapy and control groups in terms of quality of life or depression. None of the trial reports described effect on function. CONCLUSIONS: Although overall results are promising for the reduction of pain, establishing the role of splints for patients with TMDs will require large trials with stronger safeguards against bias.     

Diclofenac sodium and occlusal splint therapy in TMJ osteoarthritis: a randomized controlled trial

The aim of the study was to compare treatment with diclofenac sodium (Voltaren 3 x 50 mg) to occlusal splint therapy in a randomized, single-blind controlled trial of patients with a diagnosis of temporomandibular joint (TMJ) osteoarthritis (OA) in accordance with Research Diagnostic Criteria for temporomandibular disorders. Patients with general joint disorders or restrictions against medication with non-steroidal anti-inflammatory drug were not included. Twenty-seven females and two males (aged 36-76 years) included, answered a standardized questionnaire and were clinically examined and they underwent TMJ tomography. The treatment was randomized to either splint (n = 15) or diclofenac (n = 14). The temperatures over the TMJs were determined. The patients were re-examined 1 week, 1 month and 3 months after the start of treatment. A 1-year follow-up was carried out using questionnaires. After 1 week of treatment with diclofenac, significant reductions of pain and discomfort, TMJ tenderness and joint pain on jaw movements were noted. The splint therapy gave a significant reduction of reported symptoms after 1 month of treatment. Both treatments gave few adverse effects and were on an equal level. Estimation of the degree of inflammation by measuring the surface temperature over the TMJ was not reliable. Structural changes of the symptomatic TMJs were radiographically found in 82%, the contralateral, symptom-free TMJ had changes in 36%. There was a discrepancy between the clinical and the radiographical findings. Diclofenac gave a more rapid improvement, but both treatments gave a significant reduction of symptoms of TMJ OA within 3 months which remained at the one-year follow-up.     

Orthognathic treatment of dentofacial disharmonies: its impact on temporomandibular disorders,quality of life,and psychosocial wellness

Aim: The objective of this literature review was to assess the effect of orthognathic surgical treatment on temporomandibular disorders (TMD), quality of life (QoL), and psychosocial wellness.

Methods: Journal articles and systematic reviews published in English between 1982 and 2015 were searched using PubMed, MEDLINE, and Cochrane database using the search terms “orthognathic,” “temporomandibular disorders,” “quality of life,” and “psychosocial.” The articles were then reviewed and discussed.

Results: Both objective and subjective parameters play a role in orthognathic treatment outcome satisfaction and QoL. Psychological factors and TMD exerted a stronger influence on patients’ QoL more than objective treatment outcome measures.

Conclusion: A paradigm shift in clinical mindset from solely objective measures to a more holistic, patient-centric approach of addressing patients’ expectations and improving QoL is warranted when treating patients with dentofacial disharmonies.