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Biomedical subjects

B Stegenga

Publications and source records attributed to B Stegenga.

At least 73 records · Page 4Linked to original sources
PubMed1993

Short-term outcome of arthroscopic surgery of temporomandibular joint osteoarthrosis and internal derangement: a randomized controlled clinical trial.

Various types of treatment have been proposed for patients with temporomandibular joint (TMJ) osteoarthrosis and internal derangement. We examined the suitability of several assessment instruments developed in previous investigations for treatment-evaluation in a clinical trial comparing arthroscopic surgery with non-surgical treatment for a specific subgroup of TMJ osteoarthrosis and internal derangement, characterized by joint pain and restricted mobility. Twenty-one patients appeared to obey strict criteria for participation, and were randomly assigned to receive arthroscopic surgery followed by post-operative physical therapy (n = 9), or non-surgical treatment (n = 12). Individual outcome was assessed immediately following treatment and after 6 months based on a priori defined criteria. Patients treated with arthroscopic surgery reported more pain relief and more improvement of mobility than patients treated non-surgically, although clinical assessment results were comparable between the two groups. No major changes were observed regarding general well-being and interference with daily activities. The results of this pilot study indicate that the assessment methods are sufficiently sensitive for changes in pain, mobility, and functional ability. Despite the higher degree of subjective pain relief and appreciation of improvement of mobility in the arthroscopic surgery group, with these more formal assessment instruments this difference could not be confirmed. It is concluded that the preliminary results should be verified in a larger trial with a slightly adjusted design.

Adolescent↗
PubMed1993

Computed tomography in differential diagnosis of temporomandibular joint disorders.

Computed tomography (CT) has great potential for imaging intra- and extracapsular hard-tissue abnormality of the temporomandibular joint (TMJ). CT is not the best method of imaging disk position and form. For differential diagnosis of TMJ disorders, CT is especially successful in bony lesions. The study includes 16 examples of TMJ hard-tissue abnormality. In the differential diagnosis of all cases, CT played a decisive role.

Adolescent↗
PubMed1993

Pathology of temporomandibular joint internal derangement and osteoarthrosis.

Temporomandibular joint (TMJ) osteoarthrosis and disk displacement seem to be strongly related, but they may also represent mutually independent temporomandibular disorders. This paper presents relevant aspects of normal physiology and degeneration of synovial joints, aspects of normal temporomandibular articular disk physiology and of displacement of the disk, the relationship between TMJ osteoarthrosis and disk displacement, and a general classification of temporomandibular disorders.

Cartilage, Articular↗
PubMed1993

Temporomandibular joint osteoarthrosis: clinical and radiographic characteristics 30 years after nonsurgical treatment: a preliminary report.

Thirty years after being treated nonsurgically for osteoarthrosis and internal derangement, 14 women and seven men were re-examined clinically and radiographically. The results of this examination were compared with those recorded before and after treatment 30 years ago, and with those of a matched control group. The number and degree of subjective and objective signs and symptoms decreased, and was comparable to that of the controls. However, the patients reported significantly more pain and difficulty on opening the mouth wide. This was reflected in the radiographically assessed joint mobility, which increased significantly over the years, but was still significantly less than that of the controls. The occurrence and extent of radiographically visible osteoarthrotic alterations increased over the years, and differed significantly from those of the controls. Therefore, the authors conclude that few symptoms and clinical signs of osteoarthrosis are found many years after treatment, although radiographic alterations may be extensive.

Aged↗
PubMed1993

Temporomandibular joint osteoarthrosis and temporomandibular joint hypermobility.

For studying the relationship between condylar hypermobility of the temporomandibular joint (TMJ) and osteoarthrosis (OA), 13 patients with bilateral condylar hypermobility were evaluated clinically and radiographically, 30 years after non-surgical treatment. The evaluation included range of motion, joint and muscle tenderness to palpation, joint sounds and masticatory function. Radiographs of the TMJs were evaluated for the absence or presence of degenerative changes. The hypermobile group (HG) was compared with a control group (CG) (n = 13). The CG was evaluated in the same way as the HG. Statistics included t-tests (to compare ranges of motion in the HG over time and to compare ranges of motion in HG and CG), non-parametric tests (to compare tenderness of muscles and joints, joint sounds, masticatory function and radiographic changes over time in the HG). The tests were also used to compare the same variables between the HG and CG group. The groups' only difference was the presence of radiographic signs of OA. In the HG the number of joints with radiographic degenerative changes increased significantly over time and was significantly higher than the CG. Clinically and functionally, the HG and CG did not differ. Therefore, it is concluded that TMJ hypermobility is a subsidiary factor in the development of TMJ OA.

Adolescent↗
PubMed1993

Strategies for coping with pain and psychological distress associated with temporomandibular joint osteoarthrosis and internal derangement.

OBJECTIVE: To analyse the relationship among a variety of emotional, cognitive, and behavioral coping strategies and pain/suffering and psychological distress in patients with temporomandibular joint (TMJ) pain. DESIGN: Cross-sectional, correlational study. SETTING: Department of Oral and Maxillofacial Surgery, University Hospital Groningen. SUBJECTS: A consecutive sample of 53 patients with a mean age of 25 with TMJ osteoarthrosis and internal derangement or synovitis without internal derangement. There were seven men and 46 women. No patient was excluded. MAIN OUTCOME MEASURES: Pain/suffering was assessed using the West Haven-Yale Multidimensional Pain Inventory and visual analogue scales. Psychological distress was assessed by the General Health Questionnaire and the Symptom Checklist. Coping with pain was assessed by the Coping with Specific Symptoms Questionnaire. RESULTS: Psychological distress and pain severity were low, and there was little interference by pain with daily life. While none of the coping strategies were frequently used, these strategies did explain a significant proportion of the variance in pain and psychological distress measures (27-58% of the variance). Stepwise regression analysis showed that patients scoring high on expression of emotions and wishful thinking had significantly higher levels of pain/suffering and psychological distress. CONCLUSIONS: Previous studies of other subgroups of patients with temporomandibular disorders (TMDs) report higher degrees of psychological distress. The need to distinguish between specific subgroups of patients with TMD is emphasized by the results of this study. Cognitive-behaviorial interventions to improve ways of coping is not very useful for the subgroup in this study.

Adaptation, Psychological↗
PubMed1993

[Radiology of the temporomandibular joint. Diagnostic imaging of the temporomandibular joint].

Diagnostic imaging plays an important role in the diagnosis of disorders of the masticatory system. The most frequent disorders are osteoarthrosis and internal derangements. The clinical diagnosis of these disorders may be confirmed by diagnostic imaging. In addition, diagnostic imaging contributes to the staging of the degenerative changes. Techniques for examination of the temporomandibular joint, including conventional (panoramic, transpharyngeal, transcranial) as well as more sophisticated techniques (tomography, fluoroscopy, arthrography, computed tomography, scintigraphy and magnetic resonance imaging) are briefly described. The interpretation of the radiological image of the joint in health and when affected by osteoarthrosis and internal derangement is presented.

Humans↗
PubMed1993

Assessment of mandibular function impairment associated with temporomandibular joint osteoarthrosis and internal derangement.

Clinical assessment of function impairment associated with temporomandibular disorders should not only comprise diagnostic assessment of symptoms and signs but also function impairment assessment in the patient's value system. Regarding clinical assessment methods, the range of opening movement has been demonstrated to be one of the few variables that can be measured reliably. However, this variable allows no distinction to be made between articular and muscular causes of movement restriction. To assess joint mobility, a combination of indirect and direct assessments is proposed, including the range of opening movement after passive stretch, the range of horizontal excursion toward the opposite side, and the condylar translatory capacity by palpation. In clinical practice, signs and symptoms needed for diagnosis are frequently used as the only basis for mandibular function assessment. Function assessment in the patient's value system, however, is a neglected area in outcome assessment. The main objective of this study was to design and clinimetrically evaluate a mandibular function impairment questionnaire. The relationship between jaw function impairment and measures of pain, movement restriction, and psychological distress was assessed. The questionnaire appears to be a reliable and valuable complementary tool for assessing mandibular function impairment.

Activities of Daily Living↗
PubMed1993

Temporomandibular joint pain assessment.

The aim of this study was to evaluate pain characteristics of patients with temporomandibular joint-related pain and propose a rationale for the assessment of pain and its impact on patients with temporomandibular disorders. Based on anamnestic information, the 88 patients in the sample were classified according to pain grade: (1) acute/subacute nonrecurrent or recurrent pain, n = 41 (46.6%); (2) persistently recurring pain in relatively high frequency, or nonsevere persistent pain, n = 32 (36.4%); (3) persistent and impairing pain, n = 8 (9.1%); (4) persistent and disabling pain, n = 7 (7.9%); and (5) persistent and handicapping pain, n = 0. Regarding TMJ pain provoked during the clinical examination, there was a significant difference among diagnostic subgroups, subgroups with different pain intensity levels, and pain grade subgroups, but no significant differences could be found based on the duration of the pain symptoms. Subgroups also did not significantly differ in scores on the Multi-dimensional Pain Inventory and the General Health Questionnaire. Based on the results of the study, the assessment of nonchronic TMJ pain may generally be limited to an accurate description of the pain complaint and thorough clinical assessment. Multidimensional assessment may be useful when the TMJ pain persists or is persistently recurring. Depending on individual circumstances, additional assessment procedures may prove to be useful. A general strategy for pain assessment in temporomandibular disorders is proposed.

Adolescent↗
PubMed1992

Classification of temporomandibular joint osteoarthrosis and internal derangement. 1. Diagnostic significance of clinical and radiographic symptoms and signs.

In the clinical setting, diagnosis primarily depends on the history and present status of the patient, and on the examiner's expertise in physical examination and interpretation of conventional radiographs. In order to evaluate the diagnostic significance of clinical and radiographic variables, the authors used magnetic resonance imaging as the 'golden standard' for articular disk position. A total of 90 temporomandibular joints (TMJs) were available for the study. Group I (representing 'normal' disk position) comprised eight joints (8.9%); group II (representing reducing disk), 34 joints (37.8%); and group III (non-reducing disk), 48 joints (53.3%). Nine anamnestic, 15 clinical, and three radiographic variables obeyed pre-defined univariate selection criteria. Relatively high sensitivities were found for clicking-related variables in MR-group II, and for variables related to movement restriction in MR-group III. None of the symptoms or signs appeared to be pathognomonic for either one of the diagnostic groups. Principal component analysis revealed 13 factors that could be grouped into three major categories, representing impairment of joint mechanics, joint pain and tenderness, and radiographically detectable degenerative changes, respectively. Discriminant analyses showed that symptom combinations, which included clinical variables related to joint mechanics, appeared to provide the most useful diagnostic information. It is concluded that reducing and permanent disk displacement can be distinguished in many cases using clinical and radiographic variables. However, there is considerable variability within these groups. To establish a specific clinical diagnosis, a more detailed classification of osteoarthrosis and internal derangement is desirable.

Adolescent↗
PubMed1992

Classification of temporomandibular joint osteoarthrosis and internal derangement. 2. Specific diagnostic criteria.

Separate entities of temporomandibular joint osteoarthrosis and internal derangement are operationally defined. Criteria are based on an analysis of the diagnostic significance of symptoms and signs, principles of synovial joint pathology in general, and on therapeutic considerations. The primary goal was to enable identification of characteristic stages of osteoarthrosis and internal derangement using diagnostic tools readily available in practice.

Cartilage, Articular↗
PubMed1992

Temporomandibular joint osteoarthrosis and generalized joint hypermobility.

Peripheral joint mobility of temporomandibular joint (TMJ) osteoarthrosis and internal derangement patients (n = 25) and of a control group (n = 29) was measured according to a rigidly standardized protocol, in order to study the relationships between TMJ osteoarthrosis and internal derangement and generalized joint hypermobility. No significant differences in peripheral joint mobility between the two groups were found. Therefore, generalized joint hypermobility cannot be considered as a predisposing factor for TMJ osteoarthrosis.

Adolescent↗
PubMed1992

Bite-force endurance in patients with temporomandibular joint osteoarthrosis and internal derangement.

The aim of this study was to investigate the potential clinical relevance of testing bite force endurance in patients with articular temporomandibular disorders. The endurance of a 50 N bite force was measured in 51 patients with painful temporomandibular joint disorders. The results were compared to those of a control group of 20 subjects. The force exerted was sustained until this task could not be continued because of intolerable pain or fatigue. The endurance test was repeated following therapy. Testing bite force endurance could be reliably carried out (paired t-test not significant, product-moment correlation coefficient 0.87). The mean endurance time in the patient group was significantly different from that of the control group (t = 7.43, df = 69, P < 0.01). The 95% confidence intervals for patients and controls did not show any overlap. No difference in endurance time between diagnostic subgroups could be detected (F = 1.30, df = 4,46, P < 0.28). Following treatment, all patients showed a significant increase of endurance time (t = 8.09, df = 50, P < 0.01) and reported a decrease in post-test pain. The mean difference between pre- and post-treatment endurance was 60s. Subjects of the control group stopped the biting effort predominantly because of muscle fatigue. By contrast, the main reason of the patients to cease the effort was TMJ pain. The results of this study indicate that the discriminatory power of the test is sufficient to justify its utility as a complementary tool in assessing the functional capacity of the masticatory system.

Adolescent↗
PubMed1991

Tissue responses to degenerative changes in the temporomandibular joint: a review.

The articular cartilage covering of the mandibular condyle and the articular eminence, as well as the tissue of the articular disc, may be affected by degenerative changes associated with osteoarthrosis. Degenerative changes of cartilage alter its physical properties and, as a result, affect its ability to withstand compressive and shearing stresses. Increased friction between the articular surfaces may impair joint movement and may elicit compensatory or pathologic responses of the cartilage and the adjacent tissues, such as capsule and ligaments, synovial membrane, subchondral bone, and associated musculature. In this review, these structural changes are described and related to common signs and symptoms of craniomandibular dysfunction, such as clicking, locking and instability, pain and tenderness, restricted ranges of mandibular motion, crepitation, deformity, muscle wasting, and changes of occlusion.

Adaptation, Biological↗
PubMed1991

Eruption disturbances of permanent molars: a review.

Eruption disturbances of permanent molars may become clinically and radiographically manifest as impaction, primary retention or secondary retention. This may result in clinical problems such as malocclusion and loss of neighboring teeth due to caries and periodontal disease. Which of these disorders will develop, depends primarily on the eruptive stage. Factors that may interfere with the eruptive stages (i.e. follicular growth, pre-emergent eruptive spurt, postemergent eruptive spurt, juvenile occlusal equilibrium, circumpubertal occlusal eruptive spurt, adult occlusal equilibrium) and the clinical consequences of that interference are reviewed. Treatment recommendations are given.

Humans↗
PubMed1990

Clinical significance of bite force reproduction ability.

The objective of this study was to evaluate the clinical relevance of measurement of bite force reproduction ability. This parameter was measured at reference force levels of 2, 10, and 50 N in a group of patients with articular and nonarticular temporomandibular disorders and in a control group. The ability to reproduce the reference forces was measured at four equidistant occasions. All subjects poorly and imprecisely reproduced the reference force levels. A trend in the matches or in their imprecision could not be found (P greater than 0.05). Bite force reproduction ability did not differ between the patient group and the control group (P greater than 0.05). It was concluded that measurement of bite force reproduction ability does not provide a useful clinical assessment tool.

Adult↗
PubMed1990

Temporomandibular joint osteoarthrosis and internal derangement. Part I: Clinical course and initial treatment.

A certain natural sequence exists in the occurrence of the major clinical symptoms of 'craniomandibular dysfunction', usually leading to a final stage in which the disease is burned out. Most clinical symptoms can be explained by an internal derangement. As long as we do not know the real cause of, and the exact relationship between, osteoarthrosis and internal derangement, management should be primarily directed at the symptoms. In this paper, the major stages of the disorder are described and illustrated with three characteristic cases.

Adolescent↗