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PubMed1988

The role of the general practitioner in restoring patients with temporomandibular joint dysfunction.

Treatment of temporomandibular joint pain, resulting from occlusal dysfunction, is divided into two phases. First, occlusal splint therapy is used to eliminate the initial signs and symptoms and to achieve stability in centric relation. In the second phase of treatment the occlusion is adjusted and, if indicated, restored by means of crown and bridge procedures. Casts, properly mounted in a semi-adjustable articulator, with the lower cast mounted in centric relation, can be extremely helpful for an occlusal analysis and a diagnostic occlusal adjustment in the articulator. Each occlusal adjustment procedure in the mouth should be preceded by an initial study, occlusal analysis and occlusal adjustment on articulator mounted casts. The two main criteria for restoring the occlusion are: maximum intercuspation occurring in centric relation and disocclusion of the posterior teeth during excursive movements by means of anterior guidance. Patients with a history of temporomandibular joint pain and dysfunction usually have a limited adaptive capacity of even the smallest occlusal imperfection. In order to cope with the occlusal restoration of patients with such a low level of occlusal tolerance the final crowns and bridges should be cemented temporarily for a period of at least 3 months. A matt gold surface will be very helpful to locate undesirable occlusal contacts during temporary cementation.

Dental Articulators↗
PubMed1988

Arthroscopic diagnosis and surgery of the temporomandibular joint.

Arthroscopy of the temporomandibular joint (TMJ) has advanced to the point that excellent diagnostic examination and a number of surgical procedures can be performed. A refined technique is presented and instrumentation for surgical arthroscopy is discussed. Short-term results are also presented.

Adolescent↗
PubMed1999

The long-term effect of oromaxillofacial trauma on the function of the temporomandibular joint.

Thirty patients with temporomandibular disorders (TMD) after trauma to the orofacial region were followed for 6 months. They were assessed at 10 days, 1 month, and 6 months. It was found that patients with combined fractures of the mandible and condyle showed more effects on function of the temporomandibular joint after 1 month than patients with condylar fracture only. This difference was not so apparent after 6 months. Patients with trauma but no fracture showed similar effects to those with non-condylar fractures. There was a tendency for arthrogenous patients to develop myogenous problems with time. A group of patients with TMD but no trauma, showed more favourable long-term response to conservative treatment. Long-term follow-up of these patients for TMD problems is recommended.

Adolescent↗
PubMed1998

Prosthodontic and surgical management of a patient with an osteoma of the temporomandibular joint.

Osteomas of the temporomandibular joint are rare. This article presents a case report delineating treatment of a partially edentulous patient using a team approach for an osteoma originating from the anterolateral aspect of the glenoid. The tumor was diagnosed with the aid of a panoramic radiograph and a computerized axial tomograph. Interim prostheses with anterior teeth and posterior teeth with nonanatomic occlusal surfaces were fabricated before surgery. After surgical excision of the osteoma, the interim prostheses were periodically adjusted as the mandibular condyle gradually shifted into the space that was previously occupied by the tumor. Final removable prostheses were fabricated after the condyle had stopped shifting.

Aged↗
PubMed1993

Evaluation of temporomandibular joint internal derangement.

The incidence of internal derangement of the temporomandibular joint has been documented in patients with temporomandibular disorders. However, the detection and diagnosis of a displacement of the temporomandibular joint disc in relation to internal derangement is not always accurate, and it varies according to the method of examination. A prospective clinical investigation of 26 patients (45 temporomandibular joints) with signs and symptoms of temporomandibular joint pain and dysfunction was completed to examine the accuracy of clinical examination, sagittal recording device tracings, arthrography, and magnetic resonance imaging in detecting internal derangement in the temporomandibular joint. A group of 16 asymptomatic control subjects (32 temporomandibular joints) was examined for the presence of internal derangement by the methods under consideration. Incidence of bilateral internal derangement in the temporomandibular joints of the symptomatic patients was also assessed. Findings obtained through clinical examination and sagittal recording device tracings agreed most often with the arthrographic findings of internal derangement. Magnetic resonance imaging often failed to detect the presence of arthrographically detected internal derangement. Internal derangement was identified bilaterally in a significant number of patients, despite the absence of bilateral symptoms. This incidence varied according to the technique used. In the control group, 9% of the temporomandibular joints that had been assessed as normal according to clinical examination and sagittal recording device tracings were found to have internal derangement according to magnetic resonance imaging.

Arthrography↗
PubMed2005

Soft tissue mechanics of the temporomandibular joint.

Direct measurement of temporomandibular joint (TMJ) tissue deformation requires animal experimentation. Most of the available data pertain to the mechanical strain on the bone surfaces around the joint. However, bone is rarely the first joint tissue to show injury, being affected after damage to collagenous tissues such as the disc or capsule. Capsular ligaments guide or limit movement, while the intra-articular disc may also distribute joint loads. However, these tissues are difficult to visualize dynamically and not suitable for strain gage attachment, so in vivo deformations are poorly understood. Using pigs as the best nonprimate model for human TMJ function, we implanted differential variable reluctance transducers to measure antero-posterior strain in the lateral aspect of the intra-articular disc. The results were compared to previously published data on the TMJ capsule. Passive manipulation in anesthetized animals indicated that opening, protrusion, and contralateral movements caused the disc to elongate. On the contrary, closing, retrusion and ipsilateral movements caused disc shortening. These strains are opposite to those observed in the capsule and are expected on anatomical grounds. Surprisingly, disc strain during mastication differed from that during manipulation. The disc elongated during jaw closure, more on the retruding balancing side (16% +/- 1) than on the working side (8% +/- 2). This anomalous behavior may reflect compressive loading, such that the disc elongates as a result of the Poisson effect rather than condylar movement. Because the capsule also elongates during the power stroke, especially on the balancing side, both disc and capsule are maximally loaded on the same side at the same moment.

Animals↗
PubMed1997

Effects of capsaicin in temporomandibular joint arthritis in rats.

Temporomandibular joint (TMJ) arthritis was induced in female Lewis rats by unilateral injection of a suspension of heat-killed Mycobacterium butyricum in paraffin oil into the TMJ. Control rats received paraffin oil by the same route. Arthritic and control rats were pretreated either with capsaicin or denervation of the mandibular branch of the trigeminal nerve. Tissues were collected for neuropeptide extraction and analysed by radioimmunoassay and reverse-phase high-performance liquid chromatography. In all groups, the levels of substance P-(SP), calcitonin gene-related peptide- (CGRP) and neuropeptide Y- (NPY) like immunoreactivity (LI) were higher in the trigeminal ganglia than in the TMJs. In control rats, capsaicin significantly lowered the levels of SP-LI in the trigeminal ganglia and TMJ, but not CGRP-LI and NPY-LI. In the arthritic rats, capsaicin pretreatment significantly lowered the SP-LI and CGRP-LI in the trigeminal ganglia and TMJ, but not the NPY-LI. In the trigeminal ganglia the unilateral denervation significantly lowered SP-LI in control rats, and in arthritic rats SP-LI and CGRP-LI. On the denervated side of the arthritic TMJ, NPY-LI, SP-LI and CGRP- LI were significantly lowered as compared to the arthritic control rats and to the contralateral side. In this rat model, pretreatment with capsaicin and surgical denervation decreased the neuropeptide content in the trigeminal ganglia and the TMJ. The results clearly demonstrate a close interaction between increased neuropeptide release from sensory and sympathetic neurones after induction of arthritis in the rat.

Animals↗
PubMed2001

[Traumatic temporomandibular joint injuries].

Injuries of the temporomandibular joint are mostly due to injuries or fractures of the mandibular condyle. Fractures of the skull base involving the temporomandibular joint are rare. Classification of fractures refers to their anatomical positions and the presence or absence of a luxation. Further, it is important whether the fracture is intra- or extra-capsular. The primary imaging method should be orthopantomography. As for therapy planning, especially surgery, also evaluation of soft tissue is necessary, computed tomography is the imaging method of choice. For diagnosis of complications or internal derangement of the temporomandibular joint, magnetic resonance imaging is to be recommended.

Humans↗
PubMed1986

Arthroscopy of the rabbit temporomandibular joint.

Arthroscopy of the rabbit temporomandibular joint was evaluated experimentally on 22 rabbits. A small arthroscope with so-called "Selfoc"-system was employed. The reaction to arthroscopy was analyzed clinically. Macroscopic dissection and histology were then employed to detect possible pathological changes in the joints at periodic intervals. The established criteria for evaluation of postoperative reactions were erythema, suppuration, weight changes and chewing capacity. The results of this study indicate that the rabbit temporomandibular joint may be arthroscoped with subsequent minor reversible changes. It also seems feasible to assume that temporomandibular joint arthroscopy in humans runs a low risk for postoperative complications.

Animals↗
PubMed1985

Internal derangement of the temporomandibular joint: morphologic description with correlation to joint function.

Internal derangement of the temporomandibular joint has mainly been studied arthrographically from the standpoint of anterior disk displacement with or without reduction. Frequent clinical observations of disk deformation in joints with internal derangement implied the need for a systematic study of morphologic alterations associated with internal derangement. Therefore, morphology, internal derangement, and joint function were studied in 58 randomly selected autopsy specimens of the temporomandibular joint. The results showed that joints with superior disk position rarely demonstrated morphologic alterations. In joints with partially anterior disk position, disk deformation occurred somewhat more frequently (31%) and was consistently located in the part of the disk that was positioned anteriorly. Joints with completely anteriorly positioned disks showed disk deformation in 77% and irregularities of the articular surfaces in 65%. It appears that anterior disk position precedes disk deformation. Therefore, early causal treatment to correct symptomatic internal derangement appears indicated to decrease the possibility of development of disk deformation. Disk deformation was also closely associated with disturbed joint function and should therefore be an important consideration when one is planning treatment of internal derangement of the temporomandibular joint.

Adult↗
PubMed2001

A three-dimensional mathematical model of temporomandibular joint loading.

OBJECTIVE: A mathematical model of the temporomandibular joint was developed to study the magnitude and direction of the compressive loading experienced at the temporomandibular joint during clenching. DESIGN: The model was based on the principles of static equilibrium in three dimensions. BACKGROUND: Direct measurement of temporomandibular joint loading in humans is extremely difficult. Animal models have provided an alternative in the past. However, evidence suggests that primates are not the most accurate human analogues for temporomandibular joint studies. A mathematical model was used as an alternative to direct measurement. METHODS: The EMG activity of two masticatory muscles was combined with their cross-sectional areas to calculate the force exerted by each muscle. Experimentally determined forces were implemented into a quadratic programming model to solve for the compressive forces on the joint. Two objective functions were chosen and their ability to predict muscle and joint forces was evaluated. RESULTS: The maximum bite forces for normal men, normal women, and women with temporomandibular joint disorders were 300 N (SD 102 N), 210 N (SD 57.7 N), and 120 N (SD 77.1 N), respectively. The calculated joint force for normal males was 260 N (SD 84.1 N). Normal females and female temporomandibular joint disorder patients produced temporomandibular joint forces of 172 N (SD 37.5 N) and 152 N (SD 44.2 N), respectively.

Electromyography↗
PubMed1990

Managing temporomandibular joint syndrome.

Pain in the temporomandibular joint is primarily responsible for the morbidity often associated with this syndrome. Of the 448 cases in this study, 48% presented as ear pain and 46% complained of either headache, sinus pain, or neck pain. Temporomandibular joint pain and mastication muscle tenderness elicited with palpation were frequent physical findings. In this review, temporomandibular joint syndrome was successfully managed in 75% of 448 cases with conservative treatment consisting of patient education, heat, massage, non-narcotic analgesics, and occlusal splints. Seventeen percent were referred to dentists for restorations or orthodontics. The success rate for the 6% who underwent diagnostic arthroscopy and/or open joint surgery with disc replacement was 67%. Therefore, patients with ear pain or head and neck pain require an objective evaluation of medical history and physical examination to obtain the correct diagnosis and subsequent correct treatment and pain relief. Early diagnosis helps to prevent changes in the joint that can become irreversible with intractable pain. Surgery is reserved for those patients who fail to respond to conservative management.

Adolescent↗
PubMed1977

The radiologic findings in synovial chondromatosis (chondrometaplasia) of the temporomandibular joint.

Synovial chondromatosis or chondrometaplasia is a rare disease in which foci of cartilage may develop in the synovial membrane, usually of the large diarthroidal joints. However, the temporomandibular joint may be affected, with less than 15 such cases documented. It is the purpose of this presentation to define the radiologic findings in synovial chondromatosis of the temporomandibular joint, not previously recorded, which allow for definitive diagnosis. These radiologic findings are: 1) widening of the joint space; 2) limitation of motion; 3) irregularity of joint surfaces; 4) presence of calcified loos bodies (cartilage); and 5) sclerosis of the glenoid fossa and mandibular condyle.

Adult↗
PubMed2005

[Dissertations 25 years after the date 7. Temporomandibular joint ankylosis].

Ankylosis of the temporomandibular joint and the possibly associated deformation of maxillofacial bones are functionally and aesthetically serious problems. Despite the developments in oral and maxillofacial surgery, treatment of patients with ankylosis of the temporomandibular joint still remains challenging. This article presents a review of the developments in this treatment, 25 years after the publication of the thesis 'Temporomandibular joint ankylosis'. Nowadays, computer-tomography is the standard for imaging assessment, possibly combined with stereolithography. Resection of the ankylotic mass is the surgery method of choice. The gap is filled by interpositional tissue transfer of temporalis muscle or a fascia flap. Early mobilisation and intensive physiotherapy are needed. In case of maxillofacial asymmetry, distraction osteogenesis has proved to be successful.

Adolescent↗
PubMed1993

Selective imaging for the temporomandibular joint.

The dentist who manages temporomandibular disorders must choose among multiple imaging techniques when temporomandibular joint imaging is to be part of the diagnostic workup. By using a selective imaging approach, the practitioner can intelligently acquire the temporomandibular joint image that will complement his or her clinical findings. The purpose of this article is to present the advantages and technology of the more commonly available imaging techniques. Other factors that influence modality selection also will be discussed.

Humans↗