Techniques and modifications for TMJ arthrocentesis: A literature review

Objectives: To discuss advantages and disadvantages of TMJ arthrocentesis techniques, identifying modifications as reported in the literature.

Methods: A PubMed web-based search was carried out, using the terms TMJ and arthrocentesis, to determine the scope of coverage in well-documented articles in English.

Results: Among 237 articles, 12 distinct techniques were described for TMJ arthrocentesis in 12 articles. Among 12 techniques, 5 were classified as double puncture arthrocentesis (DPA) and 7 as single puncture arthrocentesis (SPA). In total, 17 well documented articles about SPA were found in literature.

Discussion: Arthrocentesis of the temporomandibular joint (TMJ) was first described in 1991. To make the traditional procedure even less invasive, many arthrocentesis methods have been described. However, in 2015, TMJ arthrocentesis techniques were divided into two groups to limit the complexities surrounding the concepts related to TMJ arthrocentesis techniques.     

Age,gender and parafunctional habits as prognostic factors for temporomandibular joint arthrocentesis

Objective: Arthrocentesis is an effective procedure for management of symptomatic patients with temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDWOR), but its prognostic factors are still under investigation.

Methods: Thirty-six patients with ADDWOR underwent arthrocentesis of the TMJ and hyaluronic acid injection. They were divided into groups based on three prognostic factors: Age, gender, and the presence of parafunctional habits. The procedure outcome (success or failure) was based on pre-set criteria for improvement in pain and maximum mouth opening (MMO) one month preoperatively.

Results: Patients with parafunctional habits had a lower success rate than patients without these habits. Interesting trends were noted with age and gender as prognostic factors for arthrocentesis for patients with ADDWOR.

Conclusion: Arthrocentesis is an effective management method for symptomatic patients with ADDWOR at one-month post treatment, especially in the absence of parafunctional habits.     

Comparison of the efficiency of irrigation of single and double-needle techniques of temporomandibular joint arthrocentesis: A cadaver study

Objective: To compare the efficacy of the double- and single-needle arthrocentesis techniques in removing methylene blue from the temporomandibular joint (TMJ) space.

Methods: This study was performed in 20 TMJs from 10 fresh cadavers. A total of 1 ml of 10 μM methylene blue solution was injected into the upper joint spaces, just prior to irrigation. Ten arthrocentesis procedures were carried out using the double-needle technique, and the remaining 10 were completed using the single-needle technique. The photo-absorbance values of methylene blue solution injected into and removed from the joint space were measured at a 665 nm wavelength. Statistical analysis was performed using Shapiro–Wilks test and t-test.

Results: The t-test analysis showed no statistically significant difference between the two methods in the removal of methylene blue.

Conclusion: According to the results of the present study, the single-needle technique may be a good alternative with the advantages of easier application in cases where it is not possible to perform the double-needle technique.     

Conservative reduction by lever action of chronic bilateral mandibular condyle dislocation

Aims:

The treatment of long-standing dislocation of the temporomandibular joint is broadly classified into open reduction and closed reduction. The current study presents a case of long-standing dislocation of the temporomandibular joint treated 3 years after dislocation. In this study, the authors evaluated the long-term outcome of conservative reduction by lever action of chronic bilateral mandibular condyle dislocation.

Methodology:

Manual repositioning of temporomandibular joint dislocation lasting for 3 years in a 31-year-old woman was attempted without success; therefore, conservative reduction by lever action was carried out because the patient declined treatment under general anesthesia.

Results:

The treatment was discontinued after 6 days because of the subluxation of the retaining tooth. The retainer was changed from tooth to screw for intermaxillary fixation, and treatment was reinstituted. Fifteen days later, reduction was achieved and retention was started and continued for 2 months. The outcome was good, with no recurrent dislocation within 24 months of the treatment.

Conclusions:

Conservative reduction by lever action, involving minimally invasive treatment and little dysfunction, should be considered an optional conservative treatment.     

The effect of reduced disclusion time in the treatment of myofascial pain dysfunction syndrome using immediate complete anterior guidance development protocol monitored by digital analysis of occlusion

Statement of problem:

Chronic myofascial pain dysfunction syndrome (MPDS) has been a nightmare for patients suffering from it, who have been treated with various treatment options with varied outcomes. This population of patients has been neglected, due to nagging revisits to a clinician and decreased percentage of success.

Objective:

T-Scan-based immediate complete anterior guidance development (ICAGD) has been shown by a researcher to reduce the muscle hyperactivity consistent with MPDS. The purpose of this study is to evaluate the effect of reduced disclusion time in lateral excursions in treating the MPDS symptoms.

Materials and methods:

Fifty-one myofascial pain patients with symptoms in the area of the head and neck region were treated with ICAGD. The quantified force and time data from T-Scan records were used to correct the prolonged disclusion time, and the subjects were assessed for the symptom relief. The Wilcoxon Signed Ranks Test was used for statistical analysis (P<0·05 denotes significant changes).

Results:

The changes in disclusion time and intensity of various symptoms were found to be statistically significant (P<0·05) from Day 1 onwards, and patients were relieved of their symptoms after reduction of disclusion time of less than 0·5 seconds.

Conclusion:

The results clearly indicated that ICAGD protocol reduces musculoskeletal-based symptoms of MPDS patients, and this protocol can prove beneficial for the clinical treatment success.     

Interrelationship between temporomandibular joint osteoarthritis (OA) and cervical spine pain: Effects of intra-articular injection with hyaluronic acid

Objective: The aim of this study was to evaluate cervical spine pain and function after five sessions of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) osteoarthritis.

Methods: Forty-nine patients, (79% females, aged between 43–81 years), affected by TMJ osteoarthritis and concurrent cervical spine pain and limited function were recruited. All patients underwent a cycle of five weekly arthrocenteses and viscosupplementation with 1 ml of medium molecular weight HA according to the single-needle arthrocentesis technique. Outcome variables were TMJ pain (VAS), cervical active ranges of motion, cervical disability (NPDS), and presence of painful palpation sites. Assessments were carried out at baseline and at one, three and six months after the end of treatment protocol.

Results: A significant reduction over time was shown both in TMJ pain levels and in NPDS values with respect to baseline (p < 0.001). Most parameters of active cervical range of motion showed an improvement with time. Benefits remained stable throughout six months after the viscosupplementation protocol.

Conclusions: A protocol of TMJ intra articular arthrocentesis and viscosupplementation improved cervical function and reduced disability in patients with concurrent cervical spine pain. These findings add to the complex amount of literature on the relationship between temporomandibular disorders and cervical spine disorders.     

Features and management of intracranial mandibular condyle dislocation after trauma

Background:

Dislocation of the mandibular condyle into the middle cranial fossa is rare in clinics. It often occurs when the mouth is open wide during the injury. It causes restriction of mandibular motion, lower facial asymmetry, pain in the temporomandibular joint (TMJ), etc.

Objective:

To introduce the features of intracranial mandibular condyle dislocation and discuss the management to this kind of trauma.

Major findings:

In this paper, the authors present two cases, describing the diagnosis, surgical management, and 1-year follow-up evaluation. The results of the authors' treatment to intracranial mandibular condyle dislocation were satisfactory and stable, and no surgical complications were detected.

Conculsion:

Advanced imaging studies are mandatory for exact diagnosis and successful treatment of intracranial mandibular condyle dislocation, and individualized management is recommended.     

Oral appliances for the treatment of obstructive sleep apnea in patients with low C-PAP compliance: a long-term case series

Objectives:

To assess the effectiveness of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea syndrome (OSAS) over a long-term follow-up in patients non-compliant with continuous positive airway pressure (CPAP) and to identify potential predictive factors of response to MADs.

Methods:

Fifteen OSAS patients were enrolled. Apnea-hypopnea index (AHI) and daytime sleepiness were assessed at baseline and at the end of follow-up. Potential baseline predictors of treatment effectiveness were assessed.

Results:

AHI and Epworth Sleepiness Scale (ESS) scores improved significantly with MADs. Sixty per cent of patients were ‘responders’, of whom 33% were ‘full responders’. Sixty-seven per cent of patients showed total compliance. No correlations between the potential predictors and the response to MAD therapy were found.

Discussion:

Effectiveness of MAD therapy was shown over a long-term follow-up in OSAS patients with low compliance to CPAP. Efforts to identify predictive success factors fell short.     

Spindle cell carcinoma arising at the buccal mucosa: a case report and review of the literature

Aims:

Spindle cell carcinoma (SPCC) is a subtype of squamous cell carcinoma, and it mainly occurs in the upper aerodigestive duct. On the other hand, it rarely arises in the head and neck region. The prognosis of this tumor is usually poor because of its highly malignant behavior, such as its high incidence of recurrence or metastasis to cervical lymph nodes. However, the number of accumulated cases is still too low to provide the full details of SPCC.

Methodology:

The case of SPCC was counted by using database, PubMed. The authors also present a case of SPCC arising at the left buccal mucosa in a 72-year-old Japanese female in the current study.

Results:

Only six cases of SPCC arising at the buccal mucosa have been reported previously. The authors’ patient died from a recurrent tumor 15 months after the first operation.

Conclusion:

The authors have added this case to the previous knowledge of SPCC arising at the buccal mucosa, and discuss the clinical behavior of SPCC to help suggest a standard treatment strategy for the disease.     

The effect of a mandibular advancement appliance on cervical lordosis in patients with TMD and cervical pain

Aims:

A preliminary study to compare cervical lordosis by means of cervical cephalometric analysis, before and after six months of continuous mandibular advancement appliance (MAA) use, and to show how physical therapy posture re-education would improve the cervical lordosis angle.

Methodology:

Twenty-two female patients with temporomandibular disorders (TMD) and cervical pain with lordosis <20° were included. Patients had to have a muscle pain history for at least six months, and with an intensity ≥6, measured by means of a visual analog scale (a horizontal 0–10 numeric rating scale with 0 labeled as ‘no pain’ and 10 as ‘worst imaginable pain’). Patients had to present the angle formed by the posterior tangents to C2 and C7 of equal or less than 20°. Cephalometric and clinical diagnostics were performed initially (baseline) and at the end of the study period (six months). During the third month with MAA treatment, a physical therapist evaluated the postural deficit and performed a program of postural re-education. Angular and linear dimension data presented a normal distribution (P>0·05; Shapiro Wilk Test), so the paired comparison of the cephalometric measurements was made by t-test for dependent samples.

Results:

Angle 1 (OPT/7CVT); angle 3 (CVT/EVT) and angle 4 (2CL/7CL) showed a significant increase in the cervical lordosis. Angle 2 (MGP/OP), angle 5 (HOR/CVT) and the distances C0–C2 and Pt–VER, presented no significant changes.

Conclusions:

The increase in cervical lordosis implies that six months of continuous MAA use, together with a program of postural re-education, promotes the homeostasis of the craniocervical system.     

Oral pre-trigeminal neuralgia pain: clinical differential diagnosis and descriptive study results

Aims:

To better quantify oral pre-trigeminal neuralgia (PTN) symptoms, attempt to identify PTN symptoms that could reliably differentiate between PTN and odontogenic tooth pain, and determine whether an anesthetic test would reliably differentiate these disorders.

Methodology:

This was accomplished through a survey of symptom recall for 49 trigeminal neuralgia patients who had PTN tooth and/or gum pain.

Results:

The variability of oral PTN symptoms, factors that worsened or improved them, and how dental anesthesia affected them, explain the reason for variations found in the literature. A throbbing pain quality is not in the literature, but present for 63% of respondents.

Conclusions:

No specific PTN symptom would reliably differentiate PTN from odontogenic tooth pain. The results also suggest that an anesthetic test would not be totally reliable for differentiating these disorders. A protocol is provided that should help practitioners identify the tooth pain source when there is no dental pathology.     

Single-needle arthrocentesis (Shepard cannula) vs. double-needle arthrocentesis for treating disc displacement without reduction

Objectives: To compare single- vs. double-needle arthrocentesis with viscosupplementation for treating disc displacement without reduction of the temporomandibular joint.

Methods: Fifty-six patients with a magnetic resonance imaging diagnosis of non-reducing disc displacement were included. Arthrocentesis with viscosupplementation was performed on patients in group I using the Y-shaped needle (Shepard cannula) technique; the standard double-needle technique was performed on patients in group II. Patients were evaluated on postoperative day 1, and 1, 3, and 6 months later, patient- and procedure-related parameters were assessed.

Results: In both groups, significant improvement in the baseline levels was achieved (p < 0.01). Both techniques were equally effective at reducing pain and increasing the maximal mouth opening. The single-needle technique was easier to perform and required a shorter operative time (p < 0.01).

Discussion: Single-needle (Shepard cannula) arthrocentesis can be an alternative to the standard technique; however, it might add to the cost of the procedure.     

The role of occlusal factors on the occurrence of temporomandibular disorders

Aims:

The aim of this study was to investigate the relationship between occlusal factors and temporomandibular disorders (TMD).

Methodology:

One hundred patients were selected among those who sought medical or dental care in public practice in Recife, Brazil. The presence of malocclusions and absence of five or more posterior teeth were evaluated by the clinical exam. TMD diagnosis was given using Research Diagnostic Criteria (RDC/TMD). Statistics were carried out using Fisher and Mann–Whitney methods with 5% significance level, as well as multiple logistic regression analysis.

Results:

The sample was mainly comprised of women (83%), individuals over 30 years old (57%) and singles (53%). The percentage of TMD and malocclusion in total sample was 42% and 50%, respectively, while in TMD subjects, malocclusion was present in 38·1%. There was no association between TMD and the occlusal factors studied.

Conclusion:

It can be concluded that malocclusion and loss of five or more posterior teeth does not contribute to TMD.     

One-leg standing time with eyes open: comparison between the mouth-opened and mouth-closed conditions

Objective:

Many studies report a significant relationship between the one-leg standing time with the eyes open and the occlusal relationship. To determine the association between proprioception (the periodontal membrane vs muscle spindle) to the one-leg standing time, the authors compared the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions.

Methods:

The study participants were 107 healthy, elderly patients. The authors measured the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions.

Results:

The one-leg standing time was significantly shorter with the mouth opened (21·1±19·1 seconds) than with the mouth closed (25·1±21·4 seconds). Patients whose one-leg standing time was equal or shorter with the mouth opened than with the mouth closed were not different from the other patients with regard to age, handgrip strength, BMI, and the number of remaining teeth.

Discussion:

The vertical mandibular position may affect body balance.     

The craniofacial morphology and maximum bite force in sleep bruxism patients with signs and symptoms of temporomandibular disorders

Objectives:

The purpose of the present study was to compare craniofacial morphology and bite force of bruxist patients with signs and symptoms of temporomandibular disorders.

Method:

Fourteen subjects with sleep bruxism and 14 healthy subjects participated. The signs and symptoms of the temporomandibular disorders were identified according to the Craniomandibular Index (CMI). Maximum bite force was measured using strain-gage transducers. Lateral cephalometric films were taken, and linear and angular measurements were performed.

Results:

Bite force between bruxist and non-bruxist females was not significant, whereas males with bruxism revealed higher bite forces. None of the linear and angular measurements differed significantly between bruxist and non-bruxist males. However, higher mandibular corpus length and anterior cranial base length, and lower gonial angle were observed in bruxist females compared to non-bruxist females. Negative correlation between bite force and CMI values was found in both genders.

Discussion:

Bruxist females had higher CMI values than bruxist males, which could lead to relatively lower bite forces.     

Thirty-year follow-up of a TMD case treated based on the neuromuscular concept

Aim:

Occlusal therapy is employed to alleviate the symptoms of a temporomandibular disorder (TMD) at times. However, the long-term effect of occlusal therapy in the masticatory system is not well understood. This case study aims to present a 30-year follow-up of a TMD case.

Methodology:

The patient developed TMD with intermittent closed lock of the left temporomandibular joint (TMJ). Chief complaints included trismus, pain, and noise of the left TMJ during function. The patient’s occlusal disharmony was assessed with use of electronic instruments and corrected based on the neuromuscular concept. A minimum-invasive and reversible approach using adhesive occlusal restorations was used.

Results:

The jaw movement and masticatory muscle activity assessed at the 7- and 23-year follow-ups revealed that the established occlusion was well adapted, and re-established the patient’s functional occlusion system. The patient has been free from TMD symptoms with the corrected occlusion for 30 years.

Conclusions:

Occlusal reconstruction based on the neuromuscular concept can be stably integrated into the patient’s functional occlusion system.     

How do patients perceive the British orthodontic society online information resource about orthognathic treatment? A qualitative study

Objectives: To explore the accessibility, usability and relevance of the British Orthodontic Society (BOS) online information resource (OIR), Your Jaw Surgery.

Design: Qualitative, cross-sectional study.

Setting: 5 UK sites.

Participants: Patients before, during and after treatment for non-cleft skeletal discrepancy.

Methods: Patients were identified at joint clinics and recruited after having time to view the OIR. Semi-structured interviews were conducted with 17 patients (aged 16–46 years). The interviews were transcribed and thematic analysis was undertaken using a framework approach.

Results: The main themes identified were the overall usefulness, personal relevance and positive perceptions of the OIR. The OIR was seen to be useful for patients considering treatment, and potentially useful for patients undergoing treatment. Participants were looking for a personally relevant resource that would give them the best possible idea of how they would look and feel after surgery. The OIR was perceived as trusted, positive and reassuring.

Conclusions: Patients at different stages of treatment found the OIR helpful and reassuring. Clinicians may find it useful to direct patients to the OIR to complement a professional consultation, but should be aware that patients may perceive it as presenting a positive image of the long-term benefits of orthognathic surgery.     

Status of occlusal contact during sleep bruxism in patients who visited dental clinics – A study using a Bruxchecker®

Objective: Bruxism-induced mechanical load causes various dental problems, and its treatment is challenging. The present study analyzed upper and lower tooth contacts to determine actual occlusal contact during sleep bruxism.

Methods: Tooth contact patterns were analyzed in 49 patients attending dental clinics, using a Bruxchecker®, cephalograms, and condylographs.

Results: Approximately 80% of individuals demonstrated contact from the anterior teeth to the molar region (ICPM); about 96% had mediotrusive grinding and contact. The tooth contact area increased with the flatness of the anterior occlusal plane. The ratio of the contact area of the anterior teeth to the overall tooth contact area increased with overbite. Bilateral ICPM and mediotrusive contact patterns were associated with a high frequency of temporomandibular disorder symptoms, clicking, and/or pain.

Discussion: The tooth contact area, anterior occlusal plane, and overbite are closely related, suggesting that tooth contact with the anterior teeth should be controlled with occlusal therapy.     

Expression of Interleukin-1 and temporomandibular disorder: Contemporary review of the literature

Objective: Temporomandibular disorders (TMD) are a group of conditions affecting the temporomandibular joint (TMJ), leading to jaw dysfunction, joint and muscle pain, and a decrease in quality of life. A communication network of pro- and anti-inflammatory mediators called cytokines maintains the homeostasis of the TMJ. This review will focus on the Interleukin (IL) family of cytokines, which have been quantified in TMJ synovial fluids in a variety of studies. IL-1α and IL-1β have pro-inflammatory effects, while the endogenous receptor antagonist (IL-1RA) inhibits the pro-inflammatory effects of IL-1.

Methods: A literature search (2006–2016) to identify eligible studies was completed using the PubMed database. Studies identified used saline irrigation to quantify cytokine profiles in synovial fluid of healthy and/or dysfunctional joints.

Results: The initial search yielded 111 articles, 5 of which met the inclusion criteria after inter-reviewer discussion.

Conclusions: Articles that compared IL-1 concentrations in TMD vs. control groups found significant differences.     

Mandibular movement during speech of two related Latin languages

Objectives/hypothesis: This study assessed the kinesiographic recordings of jaw movements during reading a text in Galician and Spanish language.

Study design: Cross-sectional blind study.

Methods: A homogeneous healthy group of 25 normal stomatognathic system and native Galician participants was studied. Frontal and parasagittal plane recordings of the intraborder lateral jaw movements and during reading Galician and Spanish texts were recorded using a calibrated jaw-tracking device, kinesiograph.

Results: Although movements were similar in both languages, a greater retrusion of the jaw in the Spanish language was shown; moreover, a tendency exists for a left-side motion envelope in this right-handedness preference sample.

Conclusions: This study supports the hypothesis that speech is controlled by the central nervous system rather than by peripheral factors and that the hemispheric dominance influences the asymmetry of the speech envelope.