Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders:A case report and review of literature

BACKGROUND The relation between orthodontic treatment and temporomandibular disorders(TMDs)is under debate;the management of TMD during orthodontic treatment has always been a challenge.If TMD symptoms occur during orthodontic treatment,an immediate pause of orthodontic adjustments is recommended;the treatment can resume when the symptoms are managed and stabilized.CASE SUMMARY This case report presents a patient(26-year-old,female)with angle class I,skeletal class II and TMDs.The treatment was a hybrid of clear aligners,fixed appliances and temporary anchorage devices(TADs).After 3 mo resting and treatment on her TMD,the patient’s TMD symptom alleviated,but her anterior occlusion displayed deep overbite.Therefore,the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves.After the levelling,the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion.After careful examination of temporomandibular joints(TMJ)position,the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion.Eventually,the improved facial appearance and relatively stable occlusion were achieved.The 1-year follow-up records showed there was no obvious change in TMJ morphology,and her occlusion was stable.CONCLUSION TMD screening and monitoring is of great clinical importance in the TMD susceptible patients.Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.

An Overview of Anterior Repositioning Splint Therapy for Disc Displacement-related Temporomandibular Disorders

Anterior repositioning splint(ARS)therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders(TMDs),which account for a large proportion of TMD cases.Owing to the wide application of this therapy,the exact mechanism of remission has increasingly drawn attention.Given that practitioners have different views on ARS therapy,its indications are broadened,and operating methods diverged.This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods.Representative views in the past 10 years were summarised,and conclusions were drawn as follows:The mechanism of ARS therapy is mainly attributed to internal derangement correction,improvement of stress distribution and recently reported joint remodeling.It has an evident effect in the short term,and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3-6 months.However,long-term stability is not optimal,and thus indications should be selected carefully.Notably,most of the clinical studies in this field are case analyses with low-quality evidence.Well-designed RCTs are required to further validate relevant theories.

Relationship between uncertainty in illness,mood state and coping style in patients with temporomandibular disorders

Objective:To investigate the relationship between uncertainty in illness,mood state and coping style in patients with temporomandibular disorders(TMD)in the hospital,in order to identify nursing measures.Methods:Chinese versions of the Mishel Uncertainty In Illness Scale(MUIS),Brief Profile Of Mood States(BPOMS)and Medical Coping Modes Questionnaire(MCMQ)were used to assess uncertainty in illness,mood state and coping style,respectively,in 126 patients with TMD.Results:The total score of uncertainty in illness of the patients was 91.33±16.38,which was at middle level.The total score of mood state was 37.93±17.0.The order of coping style rated from high to low was confrontation(18.81±3.65),avoidance(15.44±4.26)and acceptance(10.41±5.04).Acceptance was positively correlated with uncertainty in illness(r=0.463,p<0.001),and mood state(r=0.187,p<0.05).Avoidance and confrontation were negatively correlated with uncertainty in illness and mood state(r=0.286,p<0.01),(r=0.175,p<0.05),(r=0.171,p<0.05),(r=0.221,p<0.01).Conclusions:Both uncertainty in illness and mood state were related to coping style.These data suggest that nurses should be trained to offer appropriate guidance to help decrease patients'uncertainty in illness and relieve their negative emotions.

Screening Survey of Pain Intensity in Patients with Temporomandibular Disorders

Objective: Pain tends to be the chief complaint in patients suffering temporomandibular disorders (TMD). Previous studies on pain and psychosocial factors have reported on the relationship between presence of pain and mental disorders. To date, however, few studies have addressed the relationship between intensity of pain and psychosocial factors. In this study, we investigated the relationship between intensity of pain and age, gender, palpation scores (PPS), tendencies toward depression, anxiety, and somatization, and oral parafunctional habits. Methods: This screening survey encompassed 104 patients (70 women and 34 men;mean age of 46.1 ± 19.3) who visited our clinic. We gathered the following data: age;gender;PPS included in Axis I diagnosis;and characteristic pain intensity (CPI), depression, anxiety, somatization, and oral parafunctional habits (assessed by the Oral Behavior Checklist) included in Axis II diagnosis. Based on the results of CPI, we divided patients into two groups: those experiencing low pain intensity (LP group) and those experiencing high pain intensity (HP group). The statistically significant level was set to below 5%. IBM SPSS Statistics V25 was used to perform all statistical analyses. Results: We observed no gender differences between LP and HP groups. The HP group included significantly more patients with higher scores for depression, anxiety, somatization, and oral parafunctional habits than the LP group. While no gender differences were observed in CPI, depression, anxiety, somatization, and oral parafunctional habits were significantly more common in women than in men. We observed no differences in age or PPS between the LP and HP groups. However, scores for depression, anxiety, somatization, and oral parafunctional habits were significantly higher in the HP group than in the LP group. We performed multiple regression analysis using the CPI score as the dependent variable and scores for depression, anxiety, somatization, and oral parafunctional habits as independent variables in both the LP and the HP groups. We identified no significant predictors for the LP group, but extracted depression as a significant predictor in the HP group. On evaluating the correlation of PPS with depression, anxiety, somatization, and oral parafunctional habits in both the LP and the HP groups, we found no correlation between the PPS and the seven-item generalized anxiety disorder (GAD-7) scale in the LP group but identified a significant correlation between the PPS and GAD-7 scores in the HP group. Moreover, the correlation coefficient between the patient health questionnaire (PHQ)-9 and GAD-7 scores was higher in the HP group than in the LP group. Conclusion: In those reporting more intense pain, we found a stronger correlation among psychological factors in patients diagnosed with TMD. Greater tendency toward depression was directly associated with pain intensity. The results point to the need to consider differences in psychosocial factors associated with pain intensity when treating TMD.

高渗葡萄糖关节盘后附着注射治疗TMD慢性关节痛临床观察

目的:观察高渗葡萄糖关节盘后附着注射(增生疗法)治疗颞下颌关节紊乱病(TMD)慢性关节痛的疗效。方法:2012年6月起纳入患者244例(16~75岁),按照DC/TMD标准分类。于关节盘后附着处,注射利多卡因1.5~2 mL,张闭口活动5~10 min,同法注射50%葡萄糖1.5~2 mL。治疗后2周、2月、6月、12月定期复诊,2023年3月终期随访。结果:终期完成随访221例(失访率9.4%),平均随访时间(75.7±25.1)月。治疗后2周患者即可有关节痛明显缓解,2月时多数患者张口/咀嚼功能明显改善,随后复查多数患者保持稳定恢复。186例经注射治疗后疼痛基本消失、张口/咀嚼功能基本正常,17例后期有张口/咀嚼功能障碍和关节痛复发表现,由于有注射恐惧改为接受咬合垫治疗,16例述注射治疗无明显效果,但也未再作其他治疗,2例后续接受手术治疗。无病例出现治疗后疼痛加重或其他并发症。结论:关节盘后附着注射高渗葡萄糖治疗TMD及慢性关节痛简单易行,安全有效。

Subconscious temporomandibular dysfunction therapy: A new therapeutic approach for temporomandibular disorders

AIM: To evaluate a new therapeutic approach that may permanently address excessive involuntary muscle activity which causes temporomandibular disorders(TMD). METHODS: A cohort of 69 TMD patients(33 men and 36 women, age range 14-71 years) was treated with Subconscious Temporomandibular Dysfunction(STe Dy) therapy. A thick awareness splint assisted patients to gradually recognize the interdependence between psychological pressure and subconscious muscle activity. The STe Dy therapy lasted for one year and involved three stages:(1) data collection including medical history, clinical examination and psychological evaluation;(2) application of the awareness splint and consultation on a monthly basis; and(3) final evaluation.RESULTS: About 10% of patients(3 men and 4 women) quit the STe Dy therapy within the first 3-6 modue to severe health problems or psychosocial reasons. Based on the absence of objective and subjective clinical symptoms as well as on radiographic findings, the temporomandibular dysfunction treatment was successful in all remaining 62 patients that completed the year-long therapy. Symptoms, including recurrent headache, morning fatigue, clicking sound or painful temporomandibular joint disorders, were eliminated in all patients within the first six months. By completion of the STe Dy therapy, all patients had learned to recognize stressful conditions and cognitively avoided displaying excessive bruxism or other subconscious activity of the stomatognathic muscles. A follow-up after at least one year indicated the permanent nature of the cognitive treatment in all patients, illustrating the fact that subconscious muscle activity due to stress plays a principal role in the great majority of TMD, at least in adults.CONCLUSION: The STe Dy therapy successfully and permanently resolved TMD problems of all patients that completed the year-long treatment.

Research progress of Kinesiophbia in patients with temporomandibular disorders

This article reviews the source and concept of Kinesiophbia,the assessment tools,the adverse effects on temporomandibular disorders,the influencing factors and intervention methods,and provides a reference for clinical practitioners to choose appropriate intervention regimes.Nursing staff provide information support for effective health education,thereby reducing the level of patients with Kinesiophbia,promoting the recovery of mandibular function and improving their quality of life.

Current Status and Risk Factors of Kinesiophobia in Patients with Temporomandibular Disorders in Tianjin,China:a Cross-Sectional Study

Objective:To investigate the current status of kinesiophobia in patients with temporomandibular disorders(TMD)and analyze its risk factors.Methods:The Tampa Scale for kinesiophobia for patients with Temporomandibular Disorders(TSK-TMD),Numerical Rating Scale(NRS),Hospital Anxiety and Depression Scale(HADS),General Self-Efficacy Scale(GSES),Simplified Coping Style Questionnaire(SCSQ),and Social Support Rating Scale(SSRS)were adopted to measure patient's kinesiophobia,pain intensity,anxiety,depression,self-efficacy,coping styles and social support.Multiple linear regression was used to analyze the risk factors of kinesiophobia in patients with TMD.Results:A total of 307 participants were included in the present study.The average score of patients with kinesiophobia was(34.37±6.96)points.Multiple linear regression analysis showed that pain duration,worst pain intensity,mouth opening limitation,joint noise,joint trauma,self-efficacy,depression,negative coping style,support utilization and education level are independent risk factors for kinesiophobia.Conclusion:Patients with TMD have higher levels of kinesiophobia and poor recognition of the disease.Longer pain duration,pain intensity,mouth opening limitation,joint noise,joint trauma,lower self-efficacy,depression,negative coping style,lower support utilization and lower educational level can be used to predict the degree of kinesiophobia.

DC/TMD推荐心理量表在颞下颌关节紊乱病诊疗中的应用

目的:采用新版DC/TMD推荐的心理量表,评估颞下颌关节紊乱病(temporomandibular disorders, TMD)患者焦虑、抑郁及躯体症状等心理状况,探讨新版量表作为TMD心理轴诊断依据的临床意义。方法:选择100例TMD初诊患者作为实验组,100例无TMD症状的普通门诊患者作为对照组。收集2组患者的一般信息,包括年龄、性别、受教育程度、个人收入等。采用广泛性焦虑症量表(GAD-7)、抑郁症状量表(PHQ-9)和健康问卷量表15(PHQ-15)对患者心理因素进行评估。采用SPSS 20.0软件包对数据进行统计学分析。结果:<30岁组和30~50岁组TMD发病率显著高于50岁以上年龄组(P<0.05)。实验组高学历者比例显著高于对照组(P<0.05),而收入水平不是罹患TMD的危险因素(P=0.642)。实验组焦虑发生率与平均得分显著高于对照组(P<0.05),而两组间抑郁和躯体症状得分无统计学差异(P>0.05)。疼痛性TMD患者的焦虑和抑郁程度显著高于关节疾病患者(P<0.05),而两组间躯体症状无显著差异(P>0.05)。结论:性别(女)、年龄(<50岁)和高学历(本科及以上)是罹患TMD的高危因素,而与收入水平无关。TMD患者的焦虑发生率和评分均高于普通口腔门诊患者,但抑郁和躯体症状与普通患者的发生率无显著差异。

Orthodontic retreatment of an adult woman with mandibular backward positioning and temporomandibular joint disorder:A case report

BACKGROUND The role of occlusal factors on the occurrence of temporomandibular joint disorders(TMDs)is still unclear and it is tricky for orthodontists to treat malocclusions in patients with TMDs.We report the case of the second orthodontic treatment of an adult female with Class II division 2 malocclusion associated with TMD.With the removal of anterior occlusal interference,TMD symptoms were alleviated and cone beam computed tomography(CBCT)images showed the bilateral condyles shifted forward.CASE SUMMARY This case report presented an orthodontic retreatment of an adult female with TMD and mandibular backward positioning based on CBCT examination and Joint Space Index(JSI)analysis.The left and right JSI values of-38.5 and-52.6 indicated that the position of bilateral condyles had posterior displacement.Ten years prior to this evaluation,she underwent orthodontic treatment resulting in the extraction of two upper premolars and one lower central incisor.The joint symptoms,including pain and sounds,were alleviated along with verified mandibular forward repositioning by extraction of another lower central incisor.CONCLUSION Mandibular backward positioning could be associated with TMD.JSI analysis based on CBCT is a convenient way to examine condylar positions quantitatively.

Survey of Temporomandibular Disorder in Male Candidates of Conscription Age

[Objectives] To study the temporomandibular disorder(TMD) in male candidates of conscription age. [Methods] The TMD was surveyed in 2 152 young males who participated in 2015, 2016 and 2017 physical examinations for conscription in Qingzhou City, Weifang of Shandong Province. [Results] Cases with previous positive symptoms and with positive clinical signs respectively accounted for 5.02% and 18.91% of the whole respondents. Among the three major symptoms, the occurrence of clicking, accounting for 17.7% of the total case amount, ranked the first; among 407 cases with positive clinical signs, the top two symptoms were simple clicking(50.86%) and clicking with abnormal mandibular movement(36.85%). [Conclusions] TMD occurs in male candidates of conscription age with a relatively high occurrence, but most cases are mild with clicking as the major symptom.

Management of disorder of temporomandibular joint syndrome using elastic resin occlusal pad: a clinical observation

Objective To investigate the possibility of occlusal pad in treating disorder of temporomandibular joint syndrome.Methods We treated 25 patients with disorder of temporomandibular joint syndrome using occlusal pad made of elastic resin,and evaluated the effects.Results Total effective rate was 96%.Clicking and pain dissappeared in all patients.Conclusion Occlusal pad made of elastic resin could be used for treating disorder of temporomandibular joint syndrome in clinic.

Temporomandibular Disorder in University Students of the Parque das Rosas Campus, Universidade Estácio de SáThat Practice Sports

The stomatognathic system (SS) is a functional unit of the body that depends on the balance of several tissues. It consists of various structures, including the temporomandibular joint. Temporomandibular disorder (TMD) can occur due to alterations in the SS. The Fonseca Anamnestic Index (FAI) is a scale used to evaluate and to characterize the TMD Type: no DTM, mild, moderate and severe. The aim is to evaluate the prevalence of signs and symptoms related to TMD in university students of the Parque das Rosas Campus, Universidade Estácio de Sá that practice sports. This investigation was approved (CAAE number 325678413.9.0000.5284). Two hundred eighth students (110 male and 98 female, aged 19 - 35 years) accepted to be in this investigation. All the participants answered a General Questionnaire (GQ) and the FAI. The GQ had questions about the age, sex and the presence of TMD. The FAI was used. A statistical difference (p > 0.05) was not found about the presence of TMD. Among the female, an elevated number of the students with signal or symptoms related to the temporomandibular with statistic significance (p < 0.05) was observed. In the population without TMD, the prevalence of this disorder is higher between male than female. Considering the FAI, among the female students, there is a prevalence of the Mild Type. Considering the evaluation of the type of TMD among the male and female students no difference was found between male and female to the types mild and moderate, however, the prevalence of the severe Type is higher in female than in male with statistical significance. In conclusion, TMD is a relevant clinical condition with an important prevalence among the university students. Moreover, the type of the TMD could be considered due to prevalence of the Type Severe among the women.

Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects and associated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.

High risk of temporomandibular disorder in irritable bowel syndrome: Is there a correlation with greater illness severity?

AIM To investigate the prevalence and the risk of temporomandibular disorders(TMDs)in patients with irritable bowel syndrome(IBS)(including each subtype:constipation,diarrhoea,and mixed)compared to the general population.METHODS Between January 2014 and December 2015 we enrolled consecutively adult patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy controls(HC)without IBS.At enrollment,we analyzed all patients for the presence of TMDs according to the Research Diagnostic Criteria for TMD.RESULTS We enrolled 91 IBS patients(23 IBS-D,30 IBS-C and38 IBS-M)and 57 HC in the study.We found a higher risk of having TMD(OR=3.41,95%CI:1.66-7.01)compared to the HC.The risk of having TMD was independent of IBS-subtype.Multiple regression analysis showed that facial pain was positively related to abdominal pain and higher level of depression.CONCLUSION IBS patients had a more than three times greater risk of TMD compared to HC.The risk of having TMDwas similar in different IBS subtypes.IBS patients that also fulfilled criteria for TMD seem to share along with chronic facial and abdominal pain a significant co-occurrence with psychiatric disorders and female preponderance.Key words:Temporomandibular disorders;Irritable bowel syndrome;Chronic pain;Facial pain;Abdominal pain;Irritable bowel syndrome severity score symptoms;Irritable bowel syndrome predominant diarrhea;Irritable bowel syndrome predominant constipation;Irritable bowel syndrome mixed?The Author(s)2017.Published by Baishideng Publishing Group Inc.All rights reserved.

颞下颌关节盘前移位患者盘-髁复合体MRI特征及盘周附着半量化评级研究

目的通过盘-髁复合体磁共振成像(magnetic resonance imaging,MRI)特征分析及盘周附着半量化评级法,探讨颞下颌关节可复性盘前移位(anterior disc displacement with reduction,ADDWR)与不可复性盘前移位(anterior disc displacement without reduction,ADDWoR)中关节盘形态、髁突形态及盘周附着处之间的相关性。材料与方法回顾性分析2021年5月至2022年9月于福建省级机关医院行MRI检查确诊为颞下颌关节盘前移位74例患者共114侧,分为ADDWR组39侧和ADDWoR组75侧,比较关节盘形态Ⅰ~Ⅳ类型、髁突形态3类别及盘周附着处半量化评分分级6级。采用Kruskal-Wallis检验比较两组中不同关节盘形态类型、髁突形态类别及盘周附着分级之间差异。采用Mann-Whitney U检验比较两组之间关节盘形态、髁突形态、盘周附着处总评分及各处附着评分差异。采用Spearman秩相关分析关节盘形态、髁突形态、盘周附着处总评分及各附着与盘-髁复合体可复性与否的相关系数。采用二元logistic回归方法对盘周附着的模型筛选出独立危险因素,作为盘-髁复合体是否可复性的预测。结果除Ⅲ型与Ⅳ型外,两组关节盘形态类型差异均有统计学意义(P<0.05)。两组髁突形态类别差异均有统计学意义(P<0.05)。除1级至4级、5级/6级外,两组盘周附着评分分级差异均有统计学意义(P<0.05)。关节盘可复性与否和关节盘形态、髁突形态及盘周附着处总评分存在较强的正相关性(r分别为0.824,0.626及0.827,P<0.05)。盘周附着处的logistic回归预测模型筛选发现下板附着处是关节盘可复性与否的独立危险因素,回归系数为2.979(OR=19.672,P<0.05)。结论基于盘-髁复合体MRI征象分析及半量化评级法,能有效地评估关节盘可复性与否的相关性因素,为临床治疗提供可靠的影像学参考。

不同类型颞下颌关节紊乱病患者焦虑抑郁情绪的差异

目的探讨颞下颌关节紊乱病(TMD)不同亚类患者焦虑抑郁情绪的差异及其关联因素,为TMD患者的多学科治疗提供依据。方法收集TMD患者的年龄、性别、受教育水平、家庭人均月收入等社会人口学信息,使用广泛性焦虑症量表7(GAD-7)和患者健康问卷9(PHQ-9)评估患者的焦虑和抑郁情绪。基于DC/TMD诊断标准将TMD分为疼痛类TMD(PT)、关节类TMD(IT)以及同时具备PT和IT的复合性TMD(CT)3个亚类,采用R 4.2.2进行数据处理和统计分析。结果在纳入的362名TMD患者中,131人(36.2%)有焦虑情绪,153人(42.3%)有抑郁情绪。TMD患者的GAD-7和PHQ-9评分存在显著正相关(r=0.733,P<0.001;ρ=0.710,P<0.001),CT患者的GAD-7和PHQ-9评分显著高于IT患者(P<0.001,P=0.002)。GAD-7评分与男性性别、家庭人均月收入3000~6000元以及高于6000元和受教育水平为大学专科或本科显著负相关,而与CT亚类显著正相关(P<0.05);PHQ-9评分与年龄、男性性别以及家庭人均月收入高于6000元显著负相关,而与CT亚类显著正相关(P<0.05)。结论约40%的TMD患者具有焦虑抑郁情绪,临床实践中应关注疼痛类TMD患者的焦虑抑郁情绪,联合心理干预的多学科治疗可能对疼痛类TMD患者有更好的治疗效果。此外,年轻患者、女性患者、低收入和低受教育水平患者的焦虑抑郁情绪也值得注意。

颞下颌关节紊乱病的分类、诊断及治疗进展

近年来关于颞下颌关节紊乱病的分类和诊断已基本取得共识。颞下颌关节紊乱病是一种具有明显生物-心理-社会模式特点的心身疾病,除了临床诊断外,还要评价疼痛相关的功能丧失和心理状况。尽管外科手术治疗的水平有了很大的进步,但仍要强调治疗首选是非手术的保守治疗。相当一部分患者症状体征轻微或完全没有任何症状体征,颞下颌关节紊乱病治疗应充分考虑其症状体征对患者的影响程度,而不是仅仅根据临床诊断和影像检查结果而作出是否需要治疗的结论。

正畸治疗与颞下颌关节紊乱病的研究进展

颞下颌关节紊乱病(temporomandibular disorders,TMD)是一组影响颞下颌关节、咀嚼肌系统、牙齿咬合甚至全身多种结构的病症,因其病因机制不清、临床表现复杂,使其成为口腔医学领域的临床难点之一。TMD是正畸初诊患者中的常见症状之一,正畸医生在临床工作中不可避免地会接触到相关问题。因此正畸医生需要积极面对并通过深入地学习,更加深刻地理解TMD的分类、诊断及其发病机制并学习相关的治疗手段,积极应对临床中的TMD相关问题,并努力在TMD的多学科联合治疗中起到更加重要的作用。