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1.
End-stage disease of the temporomandibular joint (TMJ) can be managed successfully with alloplastic total replacements, but these can fail because of allergy, infection, wear, fracture, and heterotopic development of bone. We prospectively reviewed the outcome data of all patients who required revision of previously placed replacement joints between 2004 and 2016. Data included pain and diet scores using 100 mm visual analogue scales (VAS), and interincisal distance recorded before, and at six weeks, six months and 12 months after operation. The reasons for failure and the number of previous procedures were also noted.Twenty patients (26 joints) had revisions. The reasons included infection (n = 9), reankylosis (n = 5), wear of the existing prosthesis (n = 2), fracture of the prosthesis (n = 2), foreign body reaction (n = 1), and allergy to the prosthesis (n = 1). The mean (range) age of the patients was 53.3 (47-68) years, and 15 were female and five male. Preoperatively, the mean (SD) pain score was 73.1 (22.4), mouth opening was 20.9 (10.2) mm, and diet score 41.7 (23.6). At 12-month follow up, all the measurements had improved significantly (p  0.05), with the pain score improving to a mean (SD) of 18.4 (25.2), mouth opening to 32.2 (9.3) mm, and diet score to 89.4 (18.5). Revision replacements done by an experienced team result in considerably improved outcomes with limited complications, but the improvements in function and pain are not as marked as they are after primary replacement.  相似文献   

2.
The aims of the study were to investigate the alteration of temporomandibular disorders (TMD) after correction of dentofacial deformities by orthodontic treatment in conjunction with orthognathic surgery; and to compare the frequency of TMD in patients with dentofacial deformities with an age and gender matched control group. TMD were evaluated in 121 consecutive patients (treatment group), referred for orthognathic surgery, by a questionnaire and a clinical examination. 18 months after treatment, 81% of the patients completed a follow-up examination. The control group comprised 56 age and gender matched subjects, of whom 68% presented for follow-up examination. TMD were diagnosed according to research diagnostic criteria for TMD. At baseline examination, the treatment group had a higher frequency of myofascial pain (P = .035) and arthralgia (P = .040) than the control group. At follow-up, the frequencies of myofascial pain, arthralgia and disc displacement had decreased in the treatment group (P = .050, P = .004, P = .041, respectively). The frequency of TMD was comparable in the two groups at follow-up. Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, seem to have a positive treatment outcome in respect of TMD pain.  相似文献   

3.
The aim of the study was to compare interpositional arthroplasty using a dermis fat graft with gap arthroplasty in the management of ankylosis of the temporomandibular joint (TMJ). We organised a prospective randomised study of 22 patients who presented with ankylosis of the TMJ. They were randomised to be treated with either plain gap arthroplasty or dermis fat arthroplasty, and the predictor variable was the method of treatment. The primary outcome variables were mouth opening and pain on jaw exercises. Pain and interincisal opening were measured on day 5, day 14, at the end of one month, and at six months, one year, two years, and three years. There was a significant difference between the two groups on two occasions: postoperative day 5 (p = 0.013) and at one year (p = 0.018). The mean (SD) scores for mouth-opening were higher in the dermis fat group at all times (41.20 (4.69) mm compared with 39.50 (2.46) mm in gap arthroplasty at two years, and 41.40 (3.60) mm compared with 38.9 (2.02) mm at three years). The visual analogue pain scores were also lower in the dermis fat graft group. The groups showed similar results at the end of three years follow up, with no significant difference in mouth opening. We conclude therefore that the two techniques have similar outcomes in the management of ankylosis of the TMJ.  相似文献   

4.
AimThis clinical report aimed to introduce a novel vibratory stimulation-based occlusal splint (VibS) for management of chronic and untreatable masticatory myofascial pain (MMFP).MethodsThis study was conducted on four chronic MMFP patients (mean age: 27.5 ± 5.56 years, females) who were diagnosed according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD), and who were using stabilization splints for more than 6 months and still complained of pain above 40 mm in a 100-mm VAS scale. The included subjects utilized the active VibS and subsequently the inactive VibS during 30 days in each trial, separated by a wash-out period of at least 8 months. VAS pain levels were the only measured dependent variable, and were recorded before and after the use of active VibS and inactive VibS.ResultsAt baseline, mean VAS pain levels before using the active or inactive splint were 54.5 ± 19.8 mm and 44.0 ± 13.6 mm, respectively. After using the active VibS, mean pain level decreased by 77% (VASpos-pre = ?42.0 ± 30.3 mm). On the other hand, after using the inactive VibS, severe pain aggravation of 67% in magnitude was observed (VASpos-pre = +29.5 ± 21.5 mm).ConclusionThis case-series study demonstrated a good tendency of this novel VibS in chronic MMFP alleviation after a 4-week management period compared to a control inactive VibS.  相似文献   

5.
To evaluate and compare outcomes and complications associated with reconstruction of the temporomandibular joint (TMJ), we prospectively analysed the data of 70 patients who had their joints replaced with stock prostheses during the period 2004-14 and who had been followed up for five years. We used two types of stock prostheses: the metal-on-metal Christensen system (CS), and the ultra-high-molecular-weight-polyethylene-on-metal Biomet® system (BS). Data were collected at 3, 6, 12, 24, 36, 48, and 60 months postoperatively and compared with preoperative measurements. Five years after the replacement there was an increase in mean (SD) mouth opening from 2.0 (0.6) to 4.0 (0.5 cm) (p = 0.012) in the CS, and from 2.5 (1.0) cm to 4.1 (0.6) cm (p = 0.018) in the BS. The mean (SD) reductions in visual analogue pain scores were from 6.9 (1.6) to 2.0 (1.4) (p = 0.001) in the CS, and 6.5 (1.4) to 1.5 (1.1) (p = 0.001) in the BS. There were no significant differences in improvements in mouth opening or reduction in pain between the two groups. However, there were differences in the number of implants that failed, which led to removal and replacement of 2/14 prostheses in the CS group and 3/77 in the BS group (p = 0.06). The results supported the placement of stock prostheses, as evidenced by a low incidence of complications and adverse events, and a long-term improvement in function and reduction in pain in the TMJ. The BS group had significantly fewer prosthetic failures than the CS group.  相似文献   

6.
This retrospective study examined whether arthrocentesis combined with 10 sessions of low-level laser therapy (LLLT) improved the clinical outcomes of patients with temporomandibular joint osteoarthritis (TMJ-OA) compared with arthrocentesis alone. Data from two groups of patients (total: n = 36) with unilateral TMJ-OA were evaluated. The groups were established according to their treatment regimens: Group 1 (arthrocentesis alone; n = 19) and Group 2 (arthrocentesis plus LLLT; n = 17). All patients had been diagnosed in accordance with the Research Diagnostic Criteria for Temporomandibular Joint Disorders (RDC/TMD) (Axis I Group IIIb) protocol. They all underwent the same arthrocentesis protocol, but those in Group 2 also received 10 sessions of LLLT immediately afterwards. The outcome variables were the visual analogue scale scores (VAS 1, VAS 2) for various treatment outcomes and millimetric measurements of mandibular movements over both the short and long term. Intra-group comparisons showed significant short and long-term improvements for both groups, but outcomes were better over the long term than the short term in both. In addition, greater improvements in muscle palpation scores and mandibular movements were achieved in Group 2 than in Group 1. In conclusion, although both techniques improved joint pain and function, a combination with LLLT seemed to have an additional benefit for myofascial components.  相似文献   

7.
ObjectiveThe aim of this study was to evaluate changes in pain and muscle force, and the relationship between them, in patients with muscle pain and bruxism, prior to and after treatment.MethodsThirty women with bruxism and myofascial pain (Ia) were included in this study. Sleep bruxism diagnosis was made based on clinical diagnostic criteria, and awake bruxism diagnosis was made by patient questionnaires and the presence of tooth wear. The diagnosis of myofascial pain was established according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD). Dentulous or partially edentulous patients (rehabilitated with conventional fixed prostheses) were included in the study according to the inclusion and exclusion criteria. The pain treatment protocol included occlusal splints, patient education, and physiotherapy for 30 days. Bite force was measured using a dynamometer at the central incisor and the first molar regions on both sides. The exams were performed at baseline, after 7 days, and 30 days after treatment. The Wilcoxon test was used to compare patient pain level response among the periods analyzed in the study. Bite force data were submitted to two-way repeated-measures ANOVA, followed by the Tukey HSD test (p < 0.05). A simple regression analysis was performed to verify the relation between pain level and bite force.ResultsResults revealed that there was a statistical difference in pain level over time for both muscles and sides (p < 0.01). In the molar region, the bite force exhibited significantly higher values after 30 days of treatment, when compared with the baseline (p < 0.001). There was a correlation between pain level and bite force only for the temporal muscle in all periods analyzed (p < 0.05). There was no strong correlation in the response level points to support the association of pain and bite force.ConclusionsPain level decreased and bite force increased in the molar region after treatment. No strong correlation or dispersion in the relationship between pain levels and bite force was seen in women with myofascial pain and bruxism.  相似文献   

8.
Post-traumatic trigeminal neuropathy (PTTN) is a known complication of common oral and maxillofacial procedures. The burden on the patient and society is often underestimated. This retrospective study included 29 patients with PTTN who underwent surgical treatment. Symptoms were differentiated, pre- and postoperatively, into neuropathic discomfort and loss of perceptive function. Clinical and patient-reported outcomes were recorded. The Brief Pain Inventory questionnaire was completed at the last follow-up. The effect of different variables was evaluated through subgroup analysis. The mean time interval between injury and surgery was 19 weeks. Overall, 20 patients (69%) showed improvement during a mean follow-up of 49 months. Neuropathic pain decreased in most patients (13/18; 72%) and two patients became pain-free. However, 16 patients reported persistent pain on the Brief Pain Inventory questionnaire. Medication use decreased postoperatively. Subgroup analysis showed a positive association between improvement and male sex (Fisher’s exact test, P = 0.033), and between improvement and the buccal fat nerve wrapping procedure (Fisher’s exact test, P = 0.02). In conclusion, surgery showed substantial benefit in the treatment of PTTN, even when neuropathic pain was present. The effect of different variables and the potential of buccal fat nerve wrapping should be evaluated further in future research.  相似文献   

9.
ObjectivesThis in vitro study compared the dimensional accuracy of stone index (I) and three impression techniques: tapered impression copings (T), squared impression copings (S) and modified squared impression copings (MS) for implant-supported prostheses.MethodsA master cast, with four parallel implant abutment analogs and a passive framework, were fabricated. Vinyl polysiloxane impression material was used for all impressions with two metal stock trays (open and closed tray). Four groups (I, T, S and MS) were tested (n = 5). A metallic framework was seated on each of the casts, one abutment screw was tightened, and the gap between the analog of implant and the framework was measured with a stereomicroscope. The groups’ measurements (80 gap values) were analyzed using software (LeicaQWin – Leica Imaging Systems Ltd.) that received the images of a video camera coupled to a Leica stereomicroscope at 100× magnification. The results were statistically analyzed with Kruskal–Wallis One Way ANOVA on Ranks test followed by Dunn's Method, 0.05.ResultsThe mean values of abutment/framework interface gaps were: Master Cast = 32 μm (SD 2); Group I = 45 μm (SD 3); Group T = 78 μm (SD 25); Group S = 134 μm (SD 30); Group MS = 143 μm (SD 27). No significant difference was detected among Index and Master Cast (P = .05).ConclusionUnder the limitations of this study, it could be suggested that a more accurate working cast is possible using tapered impression copings techniques and stone index.  相似文献   

10.
Total temporomandibular joint replacement is a surgical procedure for patients with severe temporomandibular joint afflictions affecting quality of life, which have not responded beneficially to previous conventional surgery. The aim of this study was to assess the long-term outcome of the Groningen temporomandibular joint (TMJ) prosthesis in patients with chronic pain and mutilated temporomandibular joints following multiple surgical procedures, with respect to prosthesis failure, the patient's postoperative level of satisfaction and longitudinal changes in maximum mouth opening, functional mandibular impairment and pain. Eight female patients were studied in whom Groningen TMJ prostheses were inserted, two unilaterally and six bilaterally.The Groningen TMJ prosthesis was mechanically successful during 8 years of follow-up in seven out of eight patients with a disc dislocation being seen in one patient (7%). Patients were satisfied, despite the limited improvement of the maximum mouth opening, and pain scores.Although the decline of MFIQ scores during 8 years of follow-up was significant compared to baseline (p = 0.027), the effects of the prosthesis on maximum mouth opening, function and pain were limited. This may be due to persistent chronic pain and the adverse effects of multiple previous surgical procedures.  相似文献   

11.
The effect of combined orthodontic and orthognathic treatment was studied retrospectively in 24 patients with skeletal class III malocclusions with mandibular hyperplasia, particularly the effect on temporomandibular joint (TMJ) disc position. The patients underwent preoperative orthodontic treatment, orthognathic surgery, and postoperative orthodontic treatment. The patients were studied clinically, radiographically with lateral cephalometric radiograph and MRI to locate the position of the TMJ disc in relation to the glenoid fossa. One patient had less pain after treatment, one lost abnormal joint clicking sounds after treatment. There were no TMJ symptoms in 20 of the 24 preoperatively and postoperatively. 48 sagittal MRI images showed that the disc length before treatment was 3.040–12.928 (mean 8.289 ± 2.028) and after treatment was 3.699–11.589 (mean 8.097 ± 1.966); results were not significant (p > 0.05). Maximum disc displacement before treatment was 6.090 (mean 1.383), after treatment it was 11.931 (mean 2.193); results were not significant (p > 0.05). The results suggest that combined orthodontic and orthognathic treatment (including bilateral SSRO and rigid internal fixation) can be used safely to correct skeletal class III malocclusion with mandibular hyperplasia without causing additional TMJ symptoms.  相似文献   

12.
The objective of this study was to determine whether the effectiveness of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) degenerative disorders depends on the presence of intra-articular effusion. In this study of case–control design, two groups of 25 patients were recruited: patients with a clinical diagnosis of painful chronic TMJ osteoarthritis and magnetic resonance imaging (MRI) signs of TMJ degeneration, with (effusion group) or without (no effusion group) MRI evidence of TMJ effusion. All patients underwent five weekly single-needle arthrocenteses plus medium molecular weight HA and 6 months of follow-up. Several clinical outcome parameters were assessed. For all variables, analysis of variance (ANOVA) for repeated measures was performed to assess the existence of significant within-group and between-group treatment effects. Over time, both groups showed significant improvements in all outcome parameters, which were maintained at the 6-month follow-up (P < 0.05). Between-group comparisons showed that the treatment effects did not differ significantly for either the primary outcome variable (pain levels: F = 0.849, P = 0.548) or secondary outcome variables (chewing efficiency: F = 0.854, P = 0.544; functional limitation: F = 1.35, P = 0.226; mouth opening: F = 0.658, P = 0.707). The null hypothesis that there are no differences in treatment effectiveness between patients with and without effusion could not be rejected.  相似文献   

13.
Somatosensory sensitivity and postoperative endogenous pain modulation have not been investigated in temporomandibular joint (TMJ) prosthesis patients. The objectives of this study were to assess somatosensory function at the TMJ and examine possible differences in conditioned pain modulation (CPM) between patients with total TMJ prostheses (n = 7) and a reference group of healthy controls (n = 20). Somatosensory abnormalities were assessed using quantitative sensory testing (QST), which encompasses thermal and mechanical testing procedures. CPM was tested by comparing pressure pain thresholds (PPT) before (baseline), during, and after the application of painful and non-painful cold stimuli. PPTs were measured at the TMJ and thenar eminence (control). The effect of CPM on PPT values was tested with analysis of variance. Three patients exhibited mixed somatosensory loss (i.e., decreased thermal and mechanical detection) with mixed hyperalgesia (i.e., increased sensitivity to thermal and mechanical pain) and two patients exhibited mixed loss with only mechanical hyperalgesia. There was a significant decrease in pressure pain sensitivity at both sites during painful cold application in healthy controls (P < 0.001) but not in patients (P = 0.476). In conclusion, QST measures demonstrated somatosensory abnormalities in patients with total TMJ prostheses. Noxious conditioning cold stimuli evoked CPM-like effects in healthy subjects but not in patients with TMJ reconstruction.  相似文献   

14.
The purpose of this study was to evaluate abnormal magnetic resonance imaging (MRI) findings related to temporomandibular joint (TMJ) pain. This study included 245 joints of 152 patients with temporomandibular disorders with anterior disc displacement; of these, 129 joints had joint pain whereas 116 joints had no joint pain. MRI was used to evaluate the reduction of anterior disc displacement, joint effusion, mandible condylar morphology, bone marrow oedema of the mandibular condyle, and signal intensity of the posterior disc attachment (PDA) on fat-suppressed T2-weighted images. The odds ratio (OR) for each MRI variable for the pain group versus the no pain group was computed using logistic regression analysis. Univariate logistic regression analysis showed significant correlations between TMJ pain and all MRI findings. Multivariate logistic regression analysis showed significant correlations with joint effusion (P = 0.03, OR 2.21), bone marrow oedema (P < 0.001, OR 11.75), and signal intensity of the PDA (P < 0.001, OR 6.21). These results suggest that bone marrow oedema, high signal intensity of the PDA on fat-suppressed T2-weighted images, and joint effusion, in descending order of influence, are factors related to TMJ pain.  相似文献   

15.
The purpose of this study is to evaluate coronoidectomy, masticatory myotomy and buccal fat pad graft in advanced (Stage III–IV) oral sub mucous fibrosis (OSF). 10 patients with clinically and histologically confirmed advanced OSF underwent surgery entailing bilateral coronoidectomy, masticatory muscle myotomy and closure with a pedicled buccal fat pad graft followed by vigorous mouth opening exercises. The result was evaluated using the interincisal distance at maximum mouth opening as the objective outcome measure over a follow up period of 12 months. Results showed a mean interincisal opening of 14.7 mm preoperatively and 32.5 mm at 12 months postoperatively. Relapse was encountered in one patient who did not cooperate with the postoperative exercise regime. Results suggest this regime is effective.  相似文献   

16.
The purpose of this study was to evaluate the effects of intra-articular temporomandibular joint (TMJ) treatment in patients with juvenile idiopathic arthritis (JIA). The inclusion criteria were met by 21 patients (38 joints). Joints were randomly selected for either arthrocentesis alone (n = 17) or arthrocentesis with the additional use of triamcinolone hexacetonide (n = 21) using a closed single-needle system. Measurements of pain and function were performed at baseline and at follow-up after 3 and 8 months. Pain on opening and lateral excursion improved significantly after injections. Pain decreased significantly from baseline to first and second control on a visual analogue scale (VAS) for overall pain (49–18–8) and overall function (41–19–4). Significant improvement was recorded for pain on palpation of muscles and joints. There was no statistically significant difference between the treatment modalities, with or without glucocorticoid injection. Arthrocentesis in the TMJ treatment of patients with JIA may be beneficial and steroids had no additional effect. Further studies are needed to evaluate the long-term effects on the TMJ structures and on condylar growth from arthrocentesis and intra-articular steroid injections.  相似文献   

17.
This study describes the clinical variables in 61 patients following total alloplastic temporomandibular joint reconstruction (TJR) in which the Biomet Microfixation Patient-Patient-Matched TMJ Implant was used. All patients were classified using the Wilkes classification. The visual analogue scale score for jaw pain intensity, the maximum inter-incisal opening (MIO), and the frequency of adverse events were recorded during follow-up; the mean follow-up was 14.2 ± 8.6 months. Significant improvements were found in the MIO (P < 0.0005), except at the 3-year follow-up. Additionally, a significant reduction in pain was observed both short and long term (P < 0.0005). The incidence of adverse events was low (seven of the 81 alloplastic joints); two joints needed revision. TJR appears to be a relevant treatment option in patients with a broad range of temporomandibular joint disorders in whom none of the joint components are salvageable because of significant disease. Our patients gained an almost normal range of mouth opening and experienced a significant reduction in pain. Our results are promising, however TJR is associated with some side effects. TJR should be considered when less invasive procedures fail and a comprehensive presurgical work-up has been performed. Ongoing prospective studies are needed to consolidate the possible significant treatment outcomes.  相似文献   

18.
This study analysed the relationship between complaints and mandibular function after closed treatment of fractures of the mandibular condyle in a prospective study. In a 1-year follow-up, complaints were assessed during physical examination and function was assessed using the mandibular function impairment questionnaire (MFIQ), scoring range 0–68. Data from 114 patients (41 women, 73 men), mean age 28.1 years (SD 13.3), were available. On average the MFIQ scores were low 3.4 (SD 7.3). Ten patients (9%) experienced pain and 45 (39%) patients had a MFIQ score > 0. Mean mouth opening was 51.9 mm (SD 8.4). Occlusion was perceived as moderate or poor by 24% of the patients. In the logistic regression analysis mandibular function impairment (MFIQ score > 0) was entered as a dependent variable. Risk factors for mandibular function impairment were: pain, perceived occlusion (moderate or poor), absolute difference between left and right horizontal movements and age. A protective factor was mouth opening. The results of this study show that complaints (i.e. pain, perceived occlusion, reduced mouth opening, difference between left and right lateral movements and increased age) are predictors of mandibular function impairment after closed treatment of fractures of the mandibular condyle.  相似文献   

19.
This study was performed to determine whether arthrocentesis therapy has different outcomes in three groups of patients with different temporomandibular disorders (TMDs). A clinical trial was conducted including 45 patients with 45 unilaterally affected joints divided into three groups (n = 15): osteoarthritis (OA), disc displacement with reduction (DDWR), and disc displacement without reduction (DDWoR). All patients underwent the same arthrocentesis treatment protocol. The outcome variables, including visual analogue scale evaluations and measurements of mandibular motion (in millimetres), were recorded at baseline and at 1 and 6 months postoperative. Inter-group assessments showed significant short-term differences in joint sounds (P = 0.016) and significant long-term differences in masticatory efficiency (P = 0.046) and protrusive movement (P = 0.048). The estimation of mean changes between baseline and long-term follow-up revealed significant differences in joint sounds (P < 0.001), disruption in daily activities (P = 0.002), maximum mouth opening (P = 0.008), and protrusive movement (P = 0.002) between the groups. Arthrocentesis therapy may be useful to improve clinical symptoms and range of mandibular movement in patients with all three types of TMD. However, the benefit of arthrocentesis may be greater for patients with DDWoR than for those in the other groups.  相似文献   

20.
We have investigated the effect of photobiomodulation on the recovery of neurosensory function of the lip and chin after bilateral sagittal split osteotomy (BSSO). Laser irradiation was applied with a GaAs diode laser (continuous wave 980 nm wavelength, power 100 mW, and energy density 12 J/cm2). It was maintained within a 0.5 cm2 area in a total of 12 points for 60 seconds at each visit on each point. Unilateral extraoral contact photobiomodulation treatment was applied the day before operation and then on days 1, 3, 7, 14, 21, and 28 postoperatively. One side of the mandible was the intervention side and the other the control side. On the control side, the laser probe was turned off and placed on the chosen area. Neurosensory evaluations were made before and immediately after operation, and 30 days and 60 days postoperatively. Twenty-five patients were screened, and 18 who met the inclusion criteria were included in the study; 14 were women and the mean (SD) age was 23 (5) years. Analysis of the visual analogue scales for general sensibility, pain discrimination, directional discrimination, and 2-point discrimination showed a significant difference between the intervention and control sides after 30 days (p = 0.0011, 0.0034, 0.0023, and 0.0160, respectively). The difference was also significant after 60 days (p = 0.0001, 0.0002, 0.0003, and 0.0010, respectively). The thermal discrimination rate was significantly higher in the laser group than the control group 30 days after surgery (p = 0.002), but after 60 days the difference was not significant (p = 1.000). We found no side effects from the laser radiation during the two-month follow up. The results suggest that photobiomodulation accelerated the patients’ improvement from neurosensory disturbance after BSSO.  相似文献   

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