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PubMed1993

Facial plastic surgery, temporomandibular disorders, and orthodontics: a note.

The complexities introduced into the practice of orthodontics with the advent of the newer orthognathic surgery procedures are now being better understood. Widespread discovery of temporomandibular disorders further complicates this situation. Lack of understanding about dental problems and practice by some physicians may result in less than satisfactory patient care. Two case reports are presented that illustrate these problems.

Adult↗
PubMed1994

Improvement of masticatory function after orthodontic treatment. Two case reports.

In patients with temporomandibular joints dysfunction (TMD), the masticatory function is often altered in that: (1) the intercuspal position (ICP) is less frequently achieved; (2) the mean vertical displacement from ICP at the end of opening is above normal; and (3) the isometric muscle contraction pattern during closure tends to be suppressed. We describe two cases of growing patients with severe malocclusion, who showed the same functional alterations as patients with TMJ before treatment, and normalization of the masticatory function after orthodontics.

Child↗
PubMed1997

Comparison of two dental devices for treatment of obstructive sleep apnea syndrome (OSAS).

Previous case reports have indicated dental devices can be an effective nonsurgical treatment for snoring and obstructive sleep apnea. This pilot study evaluated the effectiveness of two intraoral devices in reducing the Respiratory Disturbance Index (RDI) and Epworth Sleepiness Scale (ESS) scores in a group of 24 adult volunteers with a history of loud snoring. Subjects were randomly assigned to two groups. Twelve subjects were fitted with a dental device designed to increase vertical dimension and protrude the mandible (device A). The other 12 subjects received a different device designed to minimally increase vertical opening without protruding the mandible (device B). Unattended home sleep monitoring (Edentrace II Digital Recorder, Edentech Corp.) was used to compute RDI at two time periods: (T0) before using any dental device and (T1) while using a dental device 2 weeks after the initial delivery date. The mean RDI and ESS scores at T0 for subjects in the device A group were 35.6 +/- 28.4 and 12.0 +/- 3.9, respectively. Means for the same measures at T1 were 21.1 +/- 21.4 and 8.2 +/- 4.0. For subjects in the device B group, means for RDI and ESS scores at T0 were 36.5 +/- 43.7 and 13.0 +/- 4.5, the means at T1 were 46.8 +/- 47.0 and 12.5 +/- 5.7. The effectiveness of the two devices was estimated by comparing the difference in RDI scores from T0 to T1 for the 10 subjects who were using device A and completed the study and the 8 subjects who were using device B and completed the study. Six subjects withdrew for various reasons. From T0 to T1, device A reduced RDI scores in 9 of 10 subjects, with a mean reduction in RDI of 14.5 (p < or = 0.05) and in ESS score of 3.8 (p < or = 0.005). Device B showed no change or an increased RDI score in 8 of 8 subjects. Seven of the eight subjects who showed no improvement in RDI with device B were then fitted with device A. Four of these seven subjects showed a reduction in RDI and five showed a reduction in ESS after using device A for 2 weeks. The mean reduction in RDI and ESS was 2.4 +/- 19.8 and 2.4 +/- 3.0, respectively. Hence, we conclude that a dental device that advances the mandible and increases the vertical dimension to open the upper airway is more effective in reducing the number of apneic and snoring events during sleep than one which does not.

Adult↗
PubMed1998

Functional treatment of condylar fractures in adult patients.

Functional treatment of condylar fractures in adult patients usually follows the closed reduction/maxillomandibular fixation approach. Some of the problems arising when functional appliances (i.e., activator) are used have been identified and presented here, especially in patients where fractured parts are dispositioned/dislocated. The cause is discussed and a different functional approach is proposed that yields good results.

Activator Appliances↗
PubMed1999

Condylar positional changes after mandibular advancement surgery with rigid internal fixation.

The purpose of this retrospective investigation was to describe condylar positional changes in patients after mandibular advancement surgery. By superimposing on clearly identifiable cephalometric landmarks (ie, mandibular symphysis and rigid fixation screws), condylar positional changes from immediately after surgery to orthodontic appliance removal were extrapolated. Although the mandibular symphysis generally moved in either an anterior or posterior direction after surgery, condylar movements were exclusively in an upward vertical direction. Correlations were found between several measured variables, including a tendency for increased superior postsurgical movement of the condyles with increasing magnitudes of surgical advancement of the mandible. This long-term instability of skeletal relationships may be caused by a wide variety of interacting factors and events.

Adolescent↗
PubMed1999

Management of severe cleft maxillary deficiency with distraction osteogenesis: procedure and results.

Distraction osteogenesis has become an important technique to treat craniofacial skeletal dysplasia. In this study, the technique of maxillary distraction with a rigid external distraction device is presented. Cephalometric results in the first 14 consecutive patients are analyzed. The study sample consisted of 14 patients with various cleft types and maxillary hypoplasia treated with the rigid external distraction technique. Analysis of the predistraction and postdistraction cephalometric radiographs revealed significant skeletal maxillary advancement. All patients had correction of the maxillary hypoplasia with positive skeletal convexity and dental overjet after maxillary distraction. The morbidity for the procedure was minimal. Surgical and orthodontic procedures are thoroughly described.

Adolescent↗
PubMed1992

Long-term stability after inferior maxillary repositioning by miniplate fixation.

Nineteen patients underwent Le Fort I osteotomy and inferior maxillary repositioning. Miniplates were used to maintain the maxilla in its new position. The patients were followed from 12 to 58 months, postoperatively. Fourteen patients were considered to be stable over the long term. Five patients had a long-term relapse of more than 30%. A tendency towards greater relapse was seen in patients with more than 5 mm inferior repositioning, and in patients who had concurrent segmental osteotomies of the maxilla. In spite of the use of miniplates, there continues to be an element of unpredictability with regard to vertical relapse after inferior maxillary repositioning, and this may be related to soft-tissue influences.

Adolescent↗
PubMed1997

Morphometric and morphological changes in the temporomandibular joint after orthognathic surgery: a magnetic resonance imaging and computed tomography prospective study.

The possible morphological and morphometric changes in the different components of the temporomandibular joint (TMJ) after orthognathic surgery were analysed using computed tomography (CT) transverse scans and sagittal and coronal magnetic resonance imaging (MRI) images. Twenty-four patients with class III dentofacial deformity were studied. Nine had isolated maxillary osteotomies and 15 had combined maxillary and mandibular subcondylar osteotomies (MSO). Ten patients were studied as a control group. The patients were studied clinically, radiographically and with CT and MRI in four different phases in order to locate the position of the mandibular condyle in relation to the glenoid fossa. No statistically significant differences were found in the group of patients who had had isolated maxillary osteotomies throughout the four phases of the study. Patients treated by bimaxillary surgery showed different condylar movements after surgery. Intra-articular effusion was evident during the early postoperative period in patients treated by bimaxillary surgery. Although different changes in the position of the bony components of the TMJ occurred after MSO, these seemed to be transient, with no major alterations in the final outcome in the patients.

Adolescent↗
PubMed1995

Management of masticatory myofascial pain.

Masticatory myofascial pain is a relatively frequent occurrence in patients seen by the orthodontist. Thus it is important to understand the management of this condition. Treatment is generally directed toward the restoration of a more physiological state in the muscles of mastication and involves medications, appliances, various forms of behavioral modification, as well as the use of muscle exercises and trigger point therapy. This article focuses on the role of the latter modalities in the management of myofascial pain and dysfunction.

Behavior Therapy↗
PubMed1999

Complex orthodontic problems: the orthognathic patient with temporomandibular disorders.

The diagnosis and treatment of temporomandibular disorders (TMD) remain controversial despite considerable research and publication in this area. The relationship of these problems to dental and skeletal malocclusion is equally debatable. Recent studies suggest that although malocclusion may have a role, it is a small one. Accordingly, treatment of TMD with occlusion-altering therapy, such as orthodontics and orthognathic surgery, should be limited to specific situations. This report discusses the management of patients with coexisting TMD and skeletal malocclusion. Current concepts in clinical and radiographic diagnosis are discussed, as well as an overview of noninvasive therapy. A case report is used to illustrate an approach to diagnosis and treatment planning in an individual with active TMD and a skeletal malocclusion requiring orthognathic surgery for correction.

Adolescent↗
PubMed1995

Short-term treatment outcome study for the management of temporomandibular joint closed lock. A comparison of arthrocentesis to nonsurgical therapy and arthroscopic lysis and lavage.

OBJECTIVE: The aim of this study is to compare the clinical short-term results and efficacy of arthrocentesis with those of nonsurgical treatments and arthroscopic surgery for the management of temporomandibular joint closed lock. STUDY DESIGN: The three groups consisted of 63 consecutive patients treated nonsurgically, 20 patients treated with arthrocentesis, and 25 patients treated with arthroscopic surgery. All patients rated their pain level on a visual analogue scale and completed a pain, jaw dysfunction, and activity-limiting questionnaire before and 6 months after the procedure. Each patient's jaw opening was also scaled. The success rate of each procedure was calculated according to our success criteria. The clinical efficacy of each procedure was evaluated in successfully treated subgroups in which the between-group and within-group differences of the obtained data were statistically tested. RESULTS: The success rate was 55.6% in the nonsurgically treated group, 70% in the arthrocentesis group, and 91% in the arthroscopy group. With respect to efficacy, all posttreatment scores showed significant improvements in within-group differences, but no between-group differences were found between the arthrocentesis group and the other two groups. CONCLUSION: Arthrocentesis was considered as an intervening treatment modality between nonsurgical treatment and arthroscopic surgery on the basis of its short-term outcome. Although the treatment efficacy was comparable with arthroscopic surgery, this procedure was thought to be indicated for the patients with acute temporomandibular joint closed lock who were refractory to medication and mandibular manipulation rather than the alternative of arthroscopic surgery.

Activities of Daily Living↗
PubMed1995

Intraoperatively fabricated bite block in the management of scar contracture hypomobility.

Intraoral surgical procedures produce scar tissue formation that may limit mandibular opening. Many procedures have been developed to release these scar contractures, but most lead to further scar formation and greater limitation in opening. The purpose of this article to describe a technique with the use of an intraoperatively fabricated self-curing acrylic bite block combined with aggressive physical therapy in the management of this difficult clinical problem.

Adult↗
PubMed1997

Psychosocial and behavioral assessment of patients with temporomandibular disorders: diagnostic and treatment implications.

The literature on chronic pain reveals that several psychosocial and behavioral factors, in addition to physical pathology, play a role in reports of pain and disability. Therefore it is important to assess patients more broadly rather than focus exclusively on physical pathology. Understanding and treatment of temporomandibular disorders has been impeded by the lack of agreement on a classification system with which to make a differential diagnosis. Research supports the appropriateness of a dual-diagnostic approach for temporomandibular disorders based on physical and psychological axes. Treatment should be directed toward the physical diagnoses supplemented by treatment that targets relevant psychosocial characteristics. This approach encourages diagnosticians to think in terms of the two relevant axes and to customize treatment to physical and psychosocial characteristics and thus should foster better outcomes.

Behavior Therapy↗
PubMed1997

The role of bioelectronic instrumentation in the documentation and management of temporomandibular disorders.

Temporomandibular disorders (TMDs) can affect the form and function of the temporomandibular joint, masticatory muscles, and dental apparatus. Electronic measurement of mandibular movement and masticatory muscle function provides objective data that are defined by commonly accepted parameters in patients with TMDs; these data can then be used to design and monitor therapy and enhance treatment therapy. In this study, data on 3681 patients with TMD are presented, including electronic test data on 1182 treated patients with TMDs. Electronic jaw tracking was used to record mandibular movement and to compare the presenting and therapeutic dental occlusal positions. Electromyography was used to analyze the resting status of masticatory muscles and occlusal function at presentation and after therapeutic intervention. Transcutaneous electrical nerve stimulation therapy relaxed masticatory muscles and aided in the determination of a therapeutic occlusal position. The data show a positive correlation between the clinical symptoms of TMD and the presenting occlusion, accompanied by muscle activity. A strong positive correlation also appears to exist between a therapeutic change in the dental occlusion to a neuromuscularly healthy position with use of a precision orthotic appliance and the significant relief of symptoms within 1 month and at 3 months.

Adolescent↗