Temporomandibular joint disorder (TMJD or TMD)

Temporomandibular disorders (TMD) are characterized by several signs and symptoms, such as pain and changes in the electrical activity of masticatory muscles. Considering that transcutaneous electrical nerve stimulation (TENS) is a resource indicated to promote analgesia, the objective of this study was to evaluate the effect of TENS on pain and electromyographic (EMG) activity of the jaw elevator muscles in TMD patients. This study evaluated 35 female volunteers: 19 TMD patients (mean age = 23.04 ± 3.5) and 16 normal subjects (mean age = 23.3 ± 3.0). Transcutaneous electrical nerve stimulation (conventional mode, 150 Hz) was applied once to each group for 45 minutes. Surface electromyography (gain of 100 times and 1 kHz sampling frequency) and the visual analogue scale (VAS) were applied before and immediately after TENS application. Both VAS data and root mean square (RMS) values were analyzed using Student's t-test. The TMD group, compared to the control group, showed higher EMG activity of the jaw elevator muscles at rest. No difference was observed between the groups regarding maximum voluntary clenching (MVC). In TMD patients, TENS reduced both pain and EMG activity of the anterior portion of the temporal muscle, increasing the activity of the masseter muscles during MVC. It is possible to conclude that a single TENS application is effective in pain reduction. However, it does not act homogeneously on the features of the electric activity of the muscles evaluated.

To investigate the prevalence of bruxism and signs of temporomandibular disorders (TMDs) among psychiatric patients compared with a healthy population and to assess the effect of psychiatric medications on the parameters studied. Study design. Subjects included 77 psychiatric patients under treatment at 2 psychiatric hospitals in Israel and 50 healthy individuals (control). One experienced calibrated examiner performed the clinical examination (presence of bruxism and signs of TMD). Results. Abnormal attrition was evident in 46.8% of the psychiatric patients compared with 20% in the controls (P Ͻ .005). Significant differences between groups were apparent for mean muscle sensitivity to palpation, joint sensitivity to palpation, and range of mouth opening. There were no differences between groups in the prevalence of joint clicks and no association between time of receiving treatment with dopamine antagonists (or any other psychotropic drugs) and TMD signs and symptoms. Conclusion. The higher prevalence of bruxism and signs of TMD in psychiatric patients is a major clinical comorbidity. Whether it is a manifestation of the abnormal central nervous system of psychiatric patients or neuroleptic-induced phenomenon deserves further attention. The exact factors that affect the pain experience in these patients should be evaluated as well.

The temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD) have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss. Methods: The study involved 464 healthy Greek university students (156 men and 308 women) with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests. Results: The overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 < 0.05). The number of aural symptoms was associated to the TMD severity (p-value 0.0001 < 0.05) as well as maximum mouth opening (p-value 0.004 < 0.05). Audiometry showed that moderate and severe TMD was associated with hearing loss of median and low tones respectively (p-value 0.0001 < 0.05). TMJ pain (p-value 0.0001 < 0.05), TMJ ankylosis (p-value 0.0001 < 0.05), bruxism (p-value 0.0001 < 0.05) and ear itching (p-value 0.0001 < 0.05) were also found to be statistically different between TMD and non-TMD subjects. Conclusions: TMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.

The aim of the study was to analyze the relationship between stress measured by the perceived stress scale (PSS-10) questionnaire and masticatory muscle activity. Experimental design assumed the study of healthy young women without temporomandibular disorders, dividing them into three groups depending on the result of the stress level and then comparing these groups in terms of bioelectrical activity of the masticatory muscles. After the exclusion criteria were applied, 63 female students (mean age: 22.3 ± 2.4 years) from Medical University of Lublin were included in the study. The subjects were then divided into 3 groups: with low (n = 18), medium (n = 18) and high stress level (n = 27), according to PSS-10 results. Resting and functional activity of temporalis anterior (TA) and masseter (MM) muscles were measured by electromyograph BioEMG III. There were statistically significant effects of group on the absolute value of asymmetry index (AsI) of TA and MM during maximum voluntary ...

This study to assessed the prevalence of signs and symptoms of temporomandibular disorders (TMD) by means of the frequency distribution of data for 218 dentistry students from a Brazilian public university using the Fonseca&#39;s questionnaire. The group consisted of 96 men and 122 women, with an average age of 20 years. Of the students, 53.21% showed some level of TMD: 35.78% mild TMD 11.93% moderate and 5.5% severe. Women were the most affected group, with 63.11% showing some level of TMD, against 40.62% of men. When considering only severe TMD, women are approximately 9 times more affected than men. Students with any level of TMD showed marked characteristics: 76.72% considered themselves tense people; 71.55% reported to clench or grind their teeth; 65.52% reported clicking of the temporomandibular joint; 64.66% reported frequent headache and 61.21% neck pain. In conclusion, clinical signs and symptoms of TMD can occur in young population and this information is of great importan...

Parafunctions of the masticatory system are increasingly common disorders diagnosed in the 21st century by dentists. Such functional disorders occur in both children and adults. Among the causes of occlusal and non-occlusal parafunctions are psychological factors that affect the masticatory muscle activity: personality, stress, depression and anxiety disorders. These factors may coexist with somatic symptoms, making it difficult to diagnose. Therefore, interdisciplinary, medical and psychological therapy should be considered in the diagnosis and treatment of oral parafunctions, with the participation of specialists in the field of dentistry in neurology, psychiatry, physiotherapy and psychology.

This article studied the relationship among respiratory, masticatory and cervical muscles and the factors that contribute for TMD. It consists in a review of studies approaching dysfunctional breathing and TMD, enclosing mouth breathing syndrome, anxiety, respiratory mechanics changes, diaphragmatic muscular dystonia and overuse of accessory inspiratory muscles. It also stresses the importance of breathing evaluation and the multiprofessional intervention in

This review, divided into two parts, for the role of occlusion in the aetiology of TMD. evaluates the literature on the relationship be-Experienced clinicians also repudiate the need for occlusal adjustment in the management of TMD, tween dental occlusion and temporomandibular disorders (TMD) and the need for occlusal therapy whereas (less experienced) general dentists adhere in the management of TMD. The first part of the to a concept focusing on the occlusion in diagnosis and treatment of TMD. There is a consensus review focuses on the aetiological importance of that generalized prophylactic occlusal adjustment occlusal interferences and the place of occlusal adis not justified. There is an obvious need for re-justment in the management and prevention of signs and symptoms of TMD. This has long been a search with evidence-based methods, to be able to controversial issue, which has not yet been re-answer the many remaining questions in this field. solved. The literature does not give strong support

Masticatory muscle activity during teeth clenching is associated with changes in many physiological parameters throughout the body. Clenching can improve muscle activity, force production, rate of force development, and joint fixation. Hence, teeth clenching and masticatory muscle activity can be important in competitive sports activities. Sport climbing is becoming increasingly popular and will be included for the first time in the Summer Olympic Games, Tokyo, 2020. However, masticatory muscle activity in sport climbers has not yet been studied. The aim of the presented study is to compare the bioelectrical activity of the masticatory muscles in sport climbers and non-climbers in order to determine the relationship between these muscles and climbing activity. 44 subjects without masticatory system disorders (16 women and 28 men, average age 26.3) were divided into two groups of 22 sport climbers (8 women, 14 men, climbing experience &gt;4 years), while 22 people (8 women, 14 men, w...

The aim of this study was to describe the distribution of occlusal contacts in subjects with signs or symptoms of temporomandibular disorder (TMD), and to assess whether any difference exists with healthy subjects. Twenty-five university dental students with complete natural dentition who exhibited TMD (13 females and 12 males, age from 19 to 30 years) and 25 age-and sex-matched controls entered the study. Occlusal contacts were evaluated in the intercuspal position and wax registrations were made in all subjects. Occlusal contacts were classified according to location and intensity. No differences were found between TMD and control groups for the overall number and distribution of contacts or for any side and intensity of contact. An intra-subject analysis showed that TMD subjects had significantly greater bilateral asymmetry in the number of contacts than controls. Median absolute difference of the number of contacts on right and left sides was 3 (95% CI, 2-4) in TMD subjects and 2 (95% CI, 1-2) in controls. In TMD subjects with mono-lateral TMD there was a significant concordance (88AE9%) between the side of disorder and the side of higher number of contacts. These findings, while confirming that a significant relationship exists between distribution of occlusal contacts and TMD, further suggest that in young adults it may be primarily expressed by asymmetries in occlusal contact patterns. Existence and aetiology of any association of TMD with occlusal contacts should be further investigated.

A 40-year-old woman was admitted to the clinical service with a report of "exquisite" left facial pain of 3 months' duration. She had been healthy with no significant complaints before the onset of pain, except for a similar episode of the same symptoms 1 year earlier that persisted for 3 weeks and then stopped without treatment. She described her pain as being severe and brief, and she said it was commonly brought on by rapid movement of her jaw, face, lips, and tongue. Usual opening and closing of her jaw did not initiate the pain, and when the pain was not present, chewing and eating were not affected. The pain was located in several areas of her face, all on the left side, and included her face, gingiva, tongue, upper jaw, temporomandibular joint, and mandible. Her jaw also felt stiff, and the pain limited her ability to open wide. She described her pain as sharp, splitting, shooting, and exquisite, and rated the severity as 10 on a scale of 0 to 10. Physical exercise seemed to help decrease her symptoms, but the pain was not reduced with the use of any analgesic medications, including opioids. At the time of the first episode she was examined by her dentist, who found no specific dental pathology and referred her to a dental specialist. Her symptoms were inconsistent at the time of that examination, and the pain stopped before a diagnosis could be established. During the recurrence of her pain, she was referred to an endodontist, who was unsure of the origin of the symptoms and referred her to a TMJ specialist. This specialist conducted a history and physical examination that took several hours and concluded that she had had a temporomandibular disorder. Treatment was initiated, which included upper and lower acrylic splints, carisoprodol (350 mg, 4 tablets/d), and amitriptlyine (50 mg, hs). After using the splints and taking these medications as prescribed, her symptoms increased in both severity and frequency, and, after several weeks she became dissatisfied with the failure of this treatment. Her general dentist then referred her to our clinical service.

Introduction: Myofascial pain syndrome (MPS) is part of temporo-mandibular disorders (TMDs), which involve the masticatory muscles and cervical muscles around neck can also be affected. There are a lot of etiologies of MPS. Therefore, diagnostic procedures are very critical to make a proper treatment in treating TMDs. This paper aims to describe diagnostic and treatment procedures with special attention given to clinical importance of TMDs and the fabrication of Michigan splint. Case Report: A clinical case with a 68-years-old female patient undergo a pain on right cheek area, especially while mouth opening for too long, there will be more pain and stiffness, also ever up to headache. On clinical examinations, there is no clicking, nor crepitus, and no pain on temporo-mandibular joint. However, there is pain by palpating multiple muscles around face and neck and limited jaw opening. Discussion: Etiology factor of MPS on this patient was extrusion of lower right third molar leads to traumatic occlusion. Patient was treated with analgesics, muscle relaxants, fabrication of Michigan splint also occlusal adjustment. Michigan splint is also known as stabilization splint with cuspid rise and increasing the occlusal vertical dimension by the amount thickness of occlusal part of the splint, which is mostly indicated for patient with TMDs of arthrogenic/myogenic origin and nocturnal bruxism. Conclusion: There are several ways which participate in management of TMDs. The occlusal splint may provide behavioral effects about the position, function and parafunction of the mandible as well as placebo effect.

Temporomandibular Disorder (TMD) is the main cause of pain of non-dental origin in the oro-facial region including head, face and related structures. The aetiology and the pathophysiology of TMD is poorly understood. It is generally accepted that the aetiology is multifactorial, involving a large number of direct and indirect causal factors. Among such factors, occlusion is frequently cited as one of the major aetiological factors causing TMD. It is well known from epidemiologic studies that TMD-related signs and symptoms, particularly temporomandibular joint (TMJ) sounds, are frequently found in children and adolescents and show increased prevalence among subjects between 15 and 45 years old. Aesthetic awareness, the development of new aesthetic orthodontic techniques and the possibility of improving prosthetic rehabilitation has increased the number of adults seeking orthodontic treatment. The shift in patient age also has increased the likelihood of patients presenting with signs and symptoms of TMD. Because orthodontic treatment lasts around 2 years, orthodontic patients may complain about TMD during or after treatment and orthodontists may be blamed for causing TMD by unsatisfied patients. This hypothesis of causality has led to legal problems for dentists and orthodontists. For these reasons, the interest in the relationship between occlusal factors, orthodontic treatment and TMD has grown and many studies have been conducted. Indeed, claims that orthodontic treatment may cause or cure TMD should be supported by good evidence. Hence, the aim of this article is to critically review evidence for a possible association between malocclusion, orthodontic treatment and TMD.

The possible association between orthodontic treatment and temporomandibular disorders (TMD) is a topic of great interest in the current literature. The true role of orthodontic therapy on the etiology of TMD, however, is still uncertain. From the clinical prospective, a thorough examination of the stomatognathic system is always necessary in order to detect possible TMD signs and symptoms prior to the beginning of the orthodontic therapy. Caution should be exercised when planning, performing and finalizing orthodontics, especially in patients who with history of signs and symptoms of TMD. The clinician must always eliminate patient's pain and dysfunction before initiating any type of orthodontic mechanics. Muscle incoordination, unstable disc-condyle relationship and bone alterations are usual TMD conditions that can interfere with the presenting occlusal relationship. This article reviews these aspects and presents a detailed clinical guide for the examination of the orthodontic patient, considering aspects related to facial pain and dysfunction.

L'insorgenza di alcune patologie dell'apparato stomatognatico è spesso favorita da particolari posizioni viziate assunte dai pazienti durante il sonno. Le pressioni anomale, che si esercitano sulla mandibola e sui denti di questi pazienti, con il concorso di altri fattori, determinano patologie di tipo articolare, muscolare, occlusale, dentale, parodontale ed ortodontico, spesso associate ad alterazioni della simmetria del volto.
Questi quadri patologici non rispondono in modo adeguato alle terapie convenzionali sintomatiche, che non ne rimuovono la causa, ma vanno incontro a risoluzione o a notevole miglioramento con la posizione di decubito assunta durante il sonno.
www.decubitosumandibola.it
Contatti: decubitosumandibola@gmail.com

The onset of some pathologies of the stomatognathic system is often favored by particular spoiled positions taken by patients during sleep. The abnormal pressures, which are exerted on the jaws and teeth of these patients, with the help of other factors, determine joint, muscle, occlusal, dental, periodontal and orthodontic pathologies, often associated with alterations in the symmetry of the face.
These pathological pictures do not respond adequately to conventional symptomatic therapies, which do not remove the cause, but undergo resolution or considerable improvement with the decubitus position assumed during sleep.
www.galiffasyndrome.com
Contacts: decubitosumandibola@gmail.com

Several studies have reported that musculoskeletal disorders of the stomatognathic system, commonly known as temporomandibular disorders (TMD) resemble musculoskeletal disorders and chronic pain disorders in general. There is also general consensus that combined biomedical and biopsychosocial methods best support the assessment and management of the cardinal features of TMD, i.e., pain and dysfunction or physical (peripheral) and psychosocial (central) factors. This overview of the aetiology of TMD will outline conceptualizations of past models and present the current view that patients with TMD should be assessed according to both the physical disorder and the psychosocial illness impact factors. The conceptual theories outlined in this review include biomedical models related to temporomandibular joints, muscles of mastication and occlusal factors, psychological models and the biopsychosocial models. An integrated and multidimensional approach concerning physical and psychosocial factors in temporomandibular pain and dysfunction is presented as an example of how the biopsychosocial model and information processing theory may apply in the conceptualization and management of TMD for various health care professionals.

s u m m a r y Temporomandibular disorder is a generic and inadequate conception to be used as a diagnosis. It fails to express the etiology or the pathophysiology and it is mainly associated with the anatomical site. Moreover, the clinical condition presents a mandibular motor problem and not a joint problem. The hypothesis presents the new diagnosis stomatognathic motor adaptive syndrome, which comprehend a motor response and the adaptive processes it induces. Inadequate occlusal contacts cause the mandible to shift in order to reach an ideal intercuspal position. The condylar displacements are proportional to such movements. Temporomandibular joint (TMJ) receptors respond to the capsular mechanical stress and the information reaches the trigeminal sensory nuclei. The mandibular modified position seems to be relevant information and may interfere with catecholaminergic neurotransmission in basal ganglia. The main motor responses comprise increased jaw muscle tone, decreased velocity of movements and incoordination. The overload of muscle function will produce adaptive responses on many stomatognathic structures. The muscle adaptive responses are hypertonia, pain, fatigue and weakness. Temporomandibular joint presents tissue modification, disc alteration and cracking noise. Periodontium show increased periodontal membrane, bone height loss and gingival recession. Teeth manifest increased wear facets, abfraction and non-accidental fractures. The periodontal and teeth adaptive processes are usually identified as occlusal trauma. The altered stomatognathic functions will show loss of velocity during mastication and speech. Fatigue, weakness in jaw muscle and difficulties to chew hard food are related to hypertonia. Incoordination between stomatognathic muscles groups is found, causing involuntary tongue/cheek biting and lateral jaw movements on speech. Otologic complaints, as aural fullness and tinnitus, are related to the tensor tympani muscle, innervated by the trigeminal nerve.

Most treatment methods for myofascial pain are empirical and aimed at the painful trigger points with the purpose of ablating muscle spasm and restoring normal muscle length. The current study conducted on 72 patients suffering from pain and decreased mouth opening as result of temporo mandibular joint dysfunction. Patients divided into four groups and low level laser, dry needling, injection of local anesthetic agent and pulsed electromagnetic field were tried for treatment of myofascial trigger point's pain. Results showed that pulsed electromagnetic field is the most effective treatment modality regarding pain relief. In conclusion; pulsed electromagnetic field should be used as adjunctive treatment with other treatment modalities for better inactivation of myofascial trigger points.

Introduction: This hypothesis-generating study was performed to determine which items in the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and additional diagnostic tests have the best predictive accuracy for joint-related diagnoses. Methods: One hundred forty-nine TMD patients and 43 symptom-free subjects were examined in clinical examinations and with magnetic resonance imaging (MRI). The importance of each variable of the clinical examination for correct joint-related diagnosis was assessed by using MRI diagnoses. For this purpose, "random forest" statistical software (based on classification trees) was used. Results: Maximum unassisted jaw opening, maximum assisted jaw opening, history of locked jaw, joint sound with and without compression, joint pain, facial pain, pain on palpation of the lateral pterygoid area, and overjet proved suitable for distinguishing between subtypes of joint-related TMD. Measurement of excursion, protrusion, and midline deviation were less important. Conclusions: The validity of clinical TMD examination procedures can be enhanced by using the 16 variables of greatest importance identified in this study. In addition to other variables, maximum unassisted and assisted opening and a history of locked jaw were important when assessing the status of the TMJ. (Am J Orthod Dentofacial Orthop 2008;133:796-803)

Mandible articulates with the cranium via the TMJ, all the component of the TMJ, including the TMJ disc, seems to be associated with altered characteristics of the craniofacial complex and its growth, but it is not clear yet the exact role of the TMJ disc thickness during the process of the facial growth. Aim The aim of this study is to investigate the association between the TMJ disc thickness and the facial growth determined according to Jarabak in adult male subjects with no clinical or MRI symptoms of Temporomandibular Joint Disorders. Materials and methods: 20 males from 19 to 25 years of age, were selected as volunteers from pretreatment patients undergoing orthodontic evaluation at the Department of Orthodontics and Dentofacial Orthopedics at Tishreen University with no clinical or MRI symptoms of TMDs., cephalometric growth study was performed according to Jarabak. MRI study was performed of both TMJ for calculating disk thickness Pearson's Correlation Coefficient was calculated to investigate the relationship between the TMJ disc thickness's measurements (left & right) and cephalometric measurements determined according to Jarabak's analysis for estimating facial growth. Results: no significant relationship between the measurements of TMJ disc thickness (left &right) with the cephalometric measurements determined according to Jarabak for estimating facial growth in adult male subjects with no clinical or MRI symptoms of TMDs. Conclusions No relationship between the measurements of TMJ disc thickness (both sides) with the cephalometric measurements determined according to Jarabak for estimating facial growth in adult male subjects with no clinical or MRI symptoms of TMDs Key Words: Facial growth cephalometric evaluating by Jarabak , TMJ disc thickness, male subjects with no clinical or MRI symptoms of TMDs.

Objective. To compare splint therapy in temporomandibular disorder (TMD) patients using two splint designs. Material and Methods. In a double-blind randomized parallel trial, 40 consenting patients were selected from the dental faculty pool of TMD patients. Two splint designs were produced: an ordinary stabilization (Michigan type) and a NTI (Nociceptiv trigeminal inhibition). The differences in splint design were not described to the patients. All patients were treated by one operator. A separate, blinded, examiner assessed joint and muscle tenderness by palpation and jaw opening prior to splint therapy, and after 2 and 6 weeks' and 3 months' splint use during night-time. The patients reported headache and TMD-related pain on a visual analog scale before and after splint use, and were asked to describe the comfort of the splint and invited to comment. Results. Thirty-eight patients with mainly myogenic problems were observed over 3 months. A reduction of muscle tenderness upon palpation and self-reported TMD-related pain and headache and an improved jaw opening was seen in both splint groups (p50.05; paired t-test and Wilcoxon signed-ranks tests). There were no changes for TM joint tenderness upon palpation. No differences were noted between the two splint designs after 3 months for the chosen criteria of treatment efficacy ( p40.05; Mann-Whitney U-test). Conclusion. No differences in treatment efficacy were noted between the Michigan and the NTI splint types when compared over 3 months.

Magnetic resonance imaging (MRI) has enabled the accomplishment of a more effective diagnostics of temporomandibular disorders (TMD). The sample included 40 patients with clinical symptoms of disc displacement (DD) of temporomandibular joint (TMJ) and 25 subjects included in our study were asymptomatic. DD were diagnosed by clinical examinations which were subsequently confirmed by MRI. DD was found in 18% of the TMJs of the asymptomatic patients. The highest prevalence of total DD without reduction was found in 44.1% of the patients&#39; joints subsequently followed by total DD with reduction comprising 34.9% of the TMJs and by partial DD with reduction comprising 21% of the TMJs. This study may help us clarify the complicated relationship which exists between the radiographic and clinical findings of TMJ disorders.

Evidence of an effect by botulinum toxins is still lacking for most pain conditions. In the present randomized, placebo-controlled, crossover multicenter study, the efficacy of botulinum toxin type A (BTX-A) was investigated in patients with persistent myofascial temporomandibular disorders (TMD). Twenty-one patients with myofascial TMD without adequate pain relief after conventional treatment participated. A total of 50 U of BTX-A or isotonic saline (control) was randomly injected into 3 standardized sites of the painful masseter muscles. Follow-up was performed after 1 and 3 months, followed by a 1-month washout period, after which crossover occurred. Pain intensity at rest was the primary outcome measure, while physical and emotional function, global improvement, side effects, and clinical measures were additional outcome measures. There was no main difference between drugs (ANOVA; P = .163), but there was a significant time effect (P < .001), so BTX-A reduced mean (SD) percent change of pain intensity by 30 (33%) after 1 month and by 23 (30%) after 3 months compared to 11 (40%) and 4 (33%) for saline. The number of patients who received a 30% pain reduction was not significantly larger for BTX-A than after saline at any follow-up visit. The number needed to treat was 11 after 1 month and 7 after 3 months. There were no significant changes after treatment in any other outcome measures, with the exception of pain on palpation, which decreased 3 months after saline injection (P < .05). These results do not indicate a clinical relevant effect of BTX-A in patients with persistent myofascial TMD pain.

Results. The search methodology,provided a total of 102 abstracts and from these 11 full reports were required as full text. Of the 11 articles selected, 8 studied the variation of the muscu- lar activity as a consequence,of the experimental introduction of occlusal disturbances whereas the remaining three studies estimated the electrical muscular characteristics without any artificial alteration of the occlusal

Purpose: To provide a systematic review of the best available research literature investigating the relation of oral and maxillofacial surgical procedures to the onset or relief of chronic painful temporomandibular disorder (TMD). Materials and Methods: A comprehensive review of the databases CINAHL, Cochrane Library, Embase, Medline, NHS Evidence-Oral Health, PsycINFO, Web of Knowledge, and MetaLib was undertaken by 2 authors (P.S., M.H.) up to June 2009 using search terms appropriate to establishing a relation between orofacial surgical procedures and TMD. The search was restricted to English-language publications. Results: Of the 1,777 titles reviewed, 35 articles were critically appraised but only 32 articles were considered eligible. These were observational studies that fell into 2 groups; 9 were seeking to establish a surgical cause for TMD. Of these, only 2 of a series of 3 claimed that there was a significant link, but this claim was based on weak data (health insurance records) and was abandoned in a subsequent report. Twenty-three studies were seeking to achieve relief by orthognathic surgical intervention. These were also negative overall, with 7 articles showing varying degrees of mostly nonsignificant improvement, whereas 16 showed no change or a worse outcome. No published report on the putative effect of implant insertion was found. Conclusion: These apparently contradictory approaches underline a belief that oral surgical trauma or gross malocclusion has a causative role in the onset of TMD. However, there was no overall evidence of a surgical causal etiology or orthognathic therapeutic value. This review emphasizes that it is in the patients' best interest to carry out prospective appropriately controlled randomized trials to clarify the situation.

Temporomandibular joint (TMJ) dysfunction affects a large portion of the population around the world. Clinical examinations alone may not provide appropriate diagnosis in a TMJ dysfunction and therefore TMJ imaging proves to be an adjunct to clinical examination in providing the necessary information. TMJ imaging include a variety of techniques and the selection of the appropriate technique is of prime importance in obtaining the necessary information for further analysis or treatment of the patient. This paper throws light on various imaging techniques for hard and soft tissue which will help enable the clinical to choose the appropriate imaging modality for the patient.

Temporomandibular Disorder (TMD) is the main cause of pain of non-dental origin in the oro-facial region including head, face and related structures. The aetiology and the pathophysiology of TMD is poorly understood. It is generally accepted that the aetiology is multifactorial, involving a large number of direct and indirect causal factors. Among such factors, occlusion is frequently cited as one of the major aetiological factors causing TMD. It is well known from epidemiologic studies that TMD-related signs and symptoms, particularly temporomandibular joint (TMJ) sounds, are frequently found in children and adolescents and show increased prevalence among subjects between 15 and 45 years old. Aesthetic awareness, the development of new aesthetic orthodontic techniques and the possibility of improving prosthetic rehabilitation has increased the number of adults seeking orthodontic treatment. The shift in patient age also has increased the likelihood of patients presenting with signs and symptoms of TMD. Because orthodontic treatment lasts around 2 years, orthodontic patients may complain about TMD during or after treatment and orthodontists may be blamed for causing TMD by unsatisfied patients. This hypothesis of causality has led to legal problems for dentists and orthodontists. For these reasons, the interest in the relationship between occlusal factors, orthodontic treatment and TMD has grown and many studies have been conducted. Indeed, claims that orthodontic treatment may cause or cure TMD should be supported by good evidence. Hence, the aim of this article is to critically review evidence for a possible association between malocclusion, orthodontic treatment and TMD.

This prospective clinical study assessed the effect of the Frä nkel Functional Regulator-II (FR-II) treatment on the position and shape of the articular disc of the temporomandibular joint. The sample included magnetic resonance images of 112 temporomandibular joints taken initially (T1) and after 18 Ϯ 1 months (T2). The subjects were 56 white Brazilian children who were beginning their pubertal growth spurt. They had Class II Division 1 malocclusions and were selected from 800 children in neighborhood schools. They were randomly dichotomized into either the treated group (treated with the FR-II for 18 months) or the control group (not treated during the observation period). Our findings showed a low prevalence (3.57%) of disc displacement in the 112 temporomandibular joints. Mandibular propulsion with the FR-II had no unfavorable effect on the temporomandibular joints of the treated group; 100% of the patients kept an upper and interposed disc position (closed and open mouth, respectively) at T1 and T2. The control group had 7.1% partial anterior medial disc displacement, both at T1 and T2. Regarding disc morphology, the control group showed biconcave-shaped discs in 82.1% of the joints, statistically similar to the treated group (89.3%) at the beginning of the observation period. At T2, the articular disc morphology of the control group was unchanged, but that of the treated group was significantly more normal (P ϭ .016), progressing from nonbiconcave at T1 (10.7%) to biconcave at T2 (100%). Our results showed that disc displacement is not a complication of functional appliance therapy; in fact, such treatment might help some children with incipient temporomandibular disorders. (Am J Orthod Dentofacial Orthop 2002;121:447-57) a Doctoral student in diagnostic imaging,

Modified condylotomy may be relevant in severe painful reciprocal clicking of the temporomandibular joint (TMJ) where conservative treatment is insufficient. The effect of the modified condylotomy was analyzed and compared with conventional nonsurgical treatment in a randomized pilot study of eight patients, 19-44 years of age, with severe painful reciprocal clicking. Before and after treatment, assessments were performed by subjective reports, clinical recordings, and blinded evaluations of radiography and magnetic resonance imaging (MRI). Based on the clinical evaluations before treatment, all conditions were disc displacements with reduction and arthralgia (Research diagnostic criteria for temporomandibular disorders), but based on MRI, one patient had disc displacement without reduction and another had normal disc position. The treatment effect was significantly better and the disorders were significantly more reduced with condylotomy than with conventional nonsurgical treatment (P<0.05, Mann-Whitney U test). In the surgical group, the clicking and locking had disappeared, the pain during function was significantly reduced (P<0.05, Friedman ANOVA), and in two patients the disc position was normalized. The clicking still persisted in the nonsurgical patients and the disc position was unchanged. Our conclusion is that modified condylotomy is a promising option to reduce symptoms and signs in severe painful reciprocal clicking.

cclusal stabilization appliances or splints are the most widely employed method for treatment of temporomandibular disorders (TMD). Magnetic Resonance Imaging (MRI) is the most indicated imaging modality to evaluate the components of the temporomandibular joint (TMJ). Forty patients with signs and symptoms of temporomandibular disorders were treated with splints for a mean period of 12 months, comprising regular semimonthly follow-ups. After stabilization of the clinical status, occlusal adjustments and MRI evaluation were performed. It was concluded that the success of this kind of treatment are related to the total (70%) or partial improvement (22.5%) of painful symptomatology and to the functional reestablishment of the craniomandibular complex. The MRI allowed evaluation and also the conclusion that the splints provide conditions for the organism to develop means to resist to the temporomandibular disorders by means of elimination of several etiologic factors. Moreover, after treatment the patients are able to cope with disc displacements with larger or smaller tolerance. Uniterms: Temporomandibular disorders; Occlusal stabilization appliance; Magnetic resonance imaging. placa estabilizadora é o mais difundido método de tratamento das disfunções têmporo-mandibulares. A Ressonância Magnética (RM) é o exame mais indicado para a visualização dos componentes da Articulação têmporo-mandibular (ATM). Quarenta pacientes com sinais e sintomas de disfunções têmporo-mandibulares foram tratados com as placas estabilizadoras por um período médio de 12 meses, com controles periódicos quinzenais. Após a estabilização do quadro clínico foram realizados ajustes oclusais e a avaliação por meio da RM. Concluímos que os melhores resultados dessa modalidade de tratamento são relacionados à melhora total (70%) ou parcial (22,5%) da sintomatologia dolorosa e ao restabelecimento da função do complexo crânio-mandibular. A RM permitiu avaliar e concluir que as placas possibilitam condições para que o organismo possa criar meios resistentes às disfunções da articulação têmporo-mandibular por meio da eliminação de vários fatores etiológicos. E que após o tratamento, os pacientes podem conviver com os deslocamentos do disco, alguns com maior, outros com menor tolerância.