Effectiveness of Mesotherapy on Temporomandibular Joint Disorders

TMJDs （Temporomandibular joint disorders） are a common pathology but best treatment remains unclear. The goal of this study was to evaluate the effectiveness of mesotherapy on TMJD. We conducted a case review of all TMJD patients treated since 2006 with mesotherapy procedures only and using a cocktail of drugs composing of lidocaine, piroxicam and pentoxifylline. Patients were treated every 15 days until symptomatic relief was achieved and thereafter every two months. Main outcome was complete symptomatic relief, and associated factors were analysed. 27 patients were included. Complete pain relief was achieved in 26. The necessary number of procedures to get pain relief ranged from 1 to 6 （median of 1） and the total number of treatments from 1 to 40 （median of 11）. 19 patients had other painful complains mainly related with anxiety disorders. A weak correlation （r = 0.357; p = 0.05） between anxiety disorders and the required months of treatments was found. Mesotherapy is a valuable option on pain relief in a temporomandibular pain syndrome with none of the systemic effects of oral medication. Anxiety may have a role on the aetiology and therapeutic success highlights the holistic approach of these patients. Future comparative studies are necessary.

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.

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.

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.

Effect of Disc Position for Acute Closed Lock of the Temporomandibular Joint

In this manuscript, the authors have studied the Disc Displacement (DD) status of patients with acute Closed Lock (CL) to determine differences between DD with Reduction (DDwR) and DD without Reduction (DDwoR). Among the acute CL patients who visited our hospital within 2 weeks of the onset of CL, we studied 10 patients whose CL was released (DDwR) and 13 patients whose CL was not released (DDwoR). The DDwoR group was significantly older than the DDwR group. Although the mouth opening distance was significantly greater in the DDwoR group than in the DDwR group, the two groups were identical in the duration of CL. Sagittal MRI images showed no significant differences between the two groups in disc length and disc thickness (anterior band, intermediate zone, and posterior band). Multisection sagittal and coronal images identified lateral DD in 7 of the 10 patients in the DDwR group, although no specific direction of the DD was observed in the DDwoR group. Furthermore, deformation of the medial disc was common in the DDwoR group but uncommon in the DDwR group.

Expression of Dickkopf-related Protein 1 in Patients with Temporomandibular Osteoarthritis after Treatment with Hyaluronic Acid

We previously reported that the increased expression of Dickkopf-related protein 1(DKK1)is positively related to vascular endothelial growth factor in the synovial fluid from patients with temporomandibular joint disorders(TMDs).DKK1 is involved in angiogenic activities in the TMD synovium in vitro,but the expression of DKK1 after treatment of TMD-osteoarthritis(TMD-OA)with hyaluronic acid(HA)remains unknown.In this study,we assessed the expression of DKK1 in the synovial fluid of TMD-OA patients before and after treatment with HA via enzyme-linked immunosorbent assay.We also investigated the role of DKK1 in TMD-OA via immunohistochemical staining.The relationship between the expression of DKK1 and the clinicopathological characteristics was determined by Pearson analysis.The results showed that the expression of DKK1 was significantly decreased after treatment with HA.Correlation analyses indicated that the expression of DKK1 in the TMD-OA samples was closely correlated with mouth opening and pain.These findings suggest that DKK1 could play an important role in the pathogenesis and treatment of TMD.Reduction of the pain by HA treatment may be correlated with the decreased expression of DKK1.

Adaptive alterations of elastic fibers in the bilaminar zone of rabbit temporomandibular joint following disc displacement

OBJECTIVE: To study the adaptive alterations of elastic fibers in the bilaminar zone (BZ) of rabbit temporomandibular joint (TMJ) following disc displacement. METHODS: Twenty-eight Japanese white rabbits were used in this study. The right temporomandibular joints of 20 of 28 rabbits were subjected to the surgical procedure of anterior disc displacement (ADD). Four rabbits in the surgical group were sacrificed at 2, 4, 6, 8 and 12 weeks after operation. Their temporomandibular joints were studied histochemically. RESULTS: Elastic fibers were reduced in number and ran irregularly in the superior lamina of BZ from ADD rabbits. The jungly elastic fibers (EFs) could still be seen at 2 weeks after operation. At 4 weeks, the number of EFs decreased significantly; EFs lost their jungly arrangement and were shaped like rough dots, of which the arrangement and the lengths were different. Six weeks after operation, many EFs were replaced by distorted, uneven, non-oriented fine EFs, distributed unevenly and some thick or fine EFs that ran irregularly. The number of EFs decreased further and their arrangement was more deranged at 8 weeks. At 10 and 12 weeks, EFs in the superior lamina of BZ were similar to those at 8 weeks. CONCLUSION: Our results show that EFs lost their function as well as their distribution and arrangement after disc displacement.

Clinical observation of tuina plus heat-sensitive moxibustion for temporomandibular disorders

Objective： To observe the clinical efficacy of tuina plus heat-sensitive moxibustion in treating temporomandibular disorders （TMD）. Methods： Fifty patients with TMD were randomized into a treatment group and a control group, 25 cases in each group. The treatment group was intervened by tuina plus heat-sensitive moxibustion, while the control group was by medication. The Fricton-Shiffman craniomandibular index （CMI） was observed before and after intervention, and the clinical efficacies of the two groups were also evaluated. Results： There was no significant difference in comparing the CMI score between the two groups before intervention （P^0.05）. After a treatment course, there were significant improvements in evaluating the CMI score in both groups （P^0.01）, and the improvement was more significant in the treatment group than that in the control group （P〈0.01）. The total effective rate of the treatment group was significantly higher than that of the control group （P〈0.01）. Conclusion： Tuina plus heat-sensitive moxibustion is effective in treating TMD, and it＇s safe, without adverse reactions, thus worth promoting in clinic.

Distraction osteogenesis for correction of post ankylosis mandibular deformities

Temporomandibular joint ankylosis, a debilitating disease mainly affecting children, is characterized by progres- sive restriction of mouth opening and maxilla-mandibular developmental deformities. Craniofacial distraction osteo- genesis has been developed as a standard surgical strategy for rectification of craniofacial deformities. The purpose of this study was to assess mono-planar distraction devices for the correction of various mandibular asymmetries in patients with unilateral temporomandibular joint ankylosis who developed restricted mouth opening and mandibular retrognathia. All patients were treated using one-stage distraction osteogenesis followed by temporalis fascia inter- positional arthroplasty under general anesthesia. A significant increase in mandibular ramus and base length was observed. Although an increase in anterior lower facial height was observed, it was not significant statistically. A decrease in posterior lower facial height and corpus was observed. Oblique distraction with angular osteotomy allowed lengthening of both the ramus and corpus, yielding satisfactory results and hence eliminating the need of secondary surgery. In conclusion, univector internal distractors are effective for correction of multi-planar mandib-ular deficiencies by optimizing its placement through meticulous planning.

Warm Needling Combined with Iontophoresis of Chinese Medicine for Temporomandibular Joint Disorder

Objective: To observe the clinical efficacy of warm needling combined with iontophoresis of Chinese medicine for temporomandibular joint disorder(TMD). Methods: A total of 100 TMD cases were randomly allocated into a treatment group and a control group, 50 in each group. Cases in the treatment group were treated with warm needling combined with iontophoresis of Chinese medicine, whereas cases in the control group were treated with Western medication. The therapeutic efficacies in two groups were assessed after three courses of treatment. Results: The recovery rate and total effective rate were 54.0% and 98.0% respectively in the treatment group, versus 30.0% and 82.0% in the control group, showing significant differences(both P<0.05). The recovery rates in the treatment group were higher than those in the control group respectively after 1, 2 and 3 courses of treatment, indicating that warm needling combined iontophoresis of Chinese medicine could substantially shorten the course of treatment. Conclusion: Warm needling combined with iontophoresis of Chinese medicine is remarkably effective for TMD and deserves further clinical application.