Relevance. Treatment of the temporo-mandibular joint (TMJ) dysfunctions still stays an urgent issue of modern stomatology. Its significance is predisposed for its high incidence and annual increase in patients’ referrals as well as diversity of it clinical manifestations, complexity of diagnosis and treatment, variability of clinical pattern, which requires a multi-disciplinary approach. According to Ukrainian and foreign authors, the TMJ pathologies take up the third place after caries and parodontal diseases, being diagnosed in 20 % of children and almost 87 % of adults. The share of patients with the TMJ dysfunction increases every year. The 79 % are represented with the intra-capsular disorders of the temporo-mandibular joints. The study was necessitated by the fact that there is still no single agreement in the treatment methods and definite treatment protocols regarding the intracapsular TMJ disorders. Objectives: analysis of efficiency of the TMJ intracapsular disorders patients’ treatment using the pathogenetically rationalized conservative and mini-invasive surgical methods. Methods and materials. The study includes the data of 38 patients with complaints of the TMJ region pain and the TMJ dysfunction. All patients were examined according to the common protocol. According to the disorder stage, the patients were administered either the conservative treatment course using the treatment tray on the mandible or maxilla, with the subsequent orthopedic or prosthetic treatment, or the splint therapy with subsequent surgical intervention. Results. Having analyzed the dynamical pattern of the treatment outcomes within the study, it has been detected that the surgical injection correction of the TMJ disorders was effective in all examined patients. To provide for the long-term steady treatment outcome the prosthetic-orthopedic rehabilitation measures were indicated, aimed at preserving the correct occlusion relation. Conclusion. The method of hyaluronic acid preparations injection into the TMJ cavity as a stage of the TMJ dysfunction therapy has proven its effectiveness in all the examined patients. In order to achieve the long-term steady result, the patients were recommended prosthetic-orthopedic rehabilitation for producing and supporting the occlusion relation.
Annotation. The pathology of the temporomandibular joint (TMJ) is one of the most difficult in the practice of the dentist, so patients go to different doctors. Often, the disease is psychosomatic, so patients have a history of stress, sleep disorders, headaches, chronic fatigue. The aim of the study is to study and comparatively analyze the nature and extent of psychological manifestations in patients with dysfunction of the temporomandibular joint according to the degree of clinical manifestations of the pathology irritability. In total, we examined 834 people with CNS dysfunction who had different etiologic causes, different complaints, and different clinical manifestations. To assess the psychological status of patients used: Gissen somatic complaints questionnaire, Toronto alexithymic scale, the method of studying the type of attitude to the disease Tobol, projective methodology “I am healthy and I am sick”, modified 10-point FPS-R (Bayers-based) subjective pain analysis scale. It was found that in the group of patients with pathology of the TMJ, the main complaint was pain (77.1%), the type of attitude to the disease is mainly alarming (59.5%), and the level of alexithymia is high (78%). Based on the received data on the general condition of the patient, they form a plan of providing comprehensive medical and psychological care, in which during the basic treatment psycho-corrective measures are combined with psychoprophylaxis of secondary disorders of the psychological health of patients.
The prevalence of dysfunction of the temporomandibular joint (TMJ), especially in people aged 18-65 years, reached 95-98% among all dental applications. The course of the pathology is usually hidden, with periodic recurrences, and has a long nature, which is accompanied by a decrease in overall quality of life. Treatment of this pathology of the TMJ is a set of complex therapeutic, orthopedic and psychological measures. The literature describes many ways to treat TMJ dysfunction, and one of the modern ones is the use of occlusal splints, which enables to change the position of the mandible, diagnose and eliminate musculoskeletal dysfunction of the TMJ. The aim of the study was to determine the effectiveness of treatment of musculoskeletal dysfunction of the TMJ with occlusal splints according to axiography. Material and methods. 274 patients aged 18 to 65 years were diagnosed with temporomandibular joint (TMJ) pain syndrome before and after treatment.Results. All patients with signs of TMJ dysfunction before treatment had a violation of the trajectory of the mandible (deviation – 68.7%, dyslexia – 31.3%). When opening and closing the mouth, asymmetrical shifts of the lower jaw to the sides of more than 2 mm (deviation from the midline – more than 2 mm) were observed. After treatment with occlusal splints there was an improvement in the trajectory of opening and closing the mouth: the number of patients with a violation of the trajectory decreased by 89.1%, and the displacement of the mandible during opening and closing the mouth in 92.4% of patients decreased on average to 0, 9 mm. When analyzing the movements of the mandible in the sagittal plane in 79 % of cases, deviations of the trajectory of the mandible were detected. After treatment with occlusive muscle relaxation splints, elimination of violations of the trajectory of the mandible in the transverse plane was noted in 93.4% of cases, reduction of displacement to 0.9 mm in 78.1% of patients. Сonclusions. The trajectory of the mandible in the sagittal plane improved in 80.1% of patients, normalization of the position of the mandible relative to the neuromuscular trajectory was achieved in 93.4% of clinical cases. According to the analysis of parameters, such treatment should be considered effective.
Electromyographic substantiation of feasibility of application of myorelaxing tires of EXOCAD technology in the treatment of tempoal-mandibular joint (TMJ) dysfunction. Our study allowed us to trace and analyze changes in the chewing muscles of patients that occur during the treatment of TMJ dysfunction and indicate its effectiveness. In patients with TMJ dysfunction, qualitative and quantitative indicators of electromyography closely correlate with the stages of development of pathology and correspond to its clinical manifestations. In this study, for the first time, the relationship between changes in the parameters of the frequency of muscle contractions and the subjective sensation of pain in the area of the specified chewing muscle in patients was analyzed. The purpose of this study is comparative analysis of the nature and degree of changes in electromyographic activity of the main and auxiliary chewing muscles in patients with TMJ dysfunction before and after the use of myorelaxing spleen. TMJ dysfunction five-year study covered 274 patients, which were divided into 3 clinical groups (CG I–III). The general analysis provided 1024 electromyograms before and at the stages of patients’ treatment. The results of the analysis of the effectiveness of the use of myorelaxation tires in the treatment of TMJ dysfunction can improve the quality of treatment of this pathology in patients. The results obtained after 12 months indicate that the effectiveness of treatment of patients with CG I (with the lowest intensity of symptoms of TMJ dysfunction) reached 89.1±1.3%; CG II – up to 78.3±1.3%; CG III – 77.3±1.3%. Keywords: electromyography, dysfuction, temporomate-mandibular joint, chewing muscles, facial muscles, bioelectrical activity.
The purpose of the study was to study and comparatively analyze the nature and degree of changes in electromyographic activity of the main and auxiliary chewing muscles in patients with temporomandibular joint dysfunction before and after the use of treatment with myorelaxant splints. Materials and methods. Five-year study on the basis of Stomatological Medical Center of Bogomolets National Medical University of patients with temporomandibular joint dysfunction (274 people) was conduscted. The general analysis provided 1024 detailed electromyograms before, after and at the stages of treatment of patients with temporomandibular joint dysfunction. Results and discussion. The results and conclusions of the analysis of the effectiveness of the treatment with the use of myorelaxant splints in the treatment of temporomandibular joint dysfunction indicate an increase in the quality of treatment of this pathology in patients and a reduction in the period of achievement of the result. The results obtained after 12 months indicate that the effectiveness of treatment of patients of control group I (with the lowest intensity of symptoms of temporomandibular joint dysfunction) reached 89.1±1.3%; control group II – up to 78.3±1.3%; control group III – 77.3±1.3%. In general, a study of the state of temporomandibular joint, complex clinical and paraclinic diagnosis, modern orthopedic treatment and prevention of musculoskeletal dysfunction of the temporomandibular joints were carried out. Based on the obtained data, the effectiveness of this algorithm of complex diagnosis, treatment and prevention of musculoskeletal dysfunction of temporomandibular joint was developed, clinically implemented and evaluated. Also, the data obtained as a result of the study by the authors were the basis for finding and correcting new methods and algorithms for diagnosing and treating pathology. The original author's concept of the pathogenesis of muscular-articular dysfunction of temporomandibular joint, used in the study and scientifically substantiated by the authors, united all existing theories of the development of this disease. The multifactorial analysis revealed an increase (p <0.001) of the risk of not achieving the effect of treatment by reducing pain syndrome with an increase in scores on the Bayers scale before treatment, odds ratio = 1.6 (95% of BI 1.4–1.9) for each point of growth score (when standardizing on three other risk factors). An increase (p=0.002) of the risk of not achieving the effect of treatment by reducing pain syndrome with an increase in the asymmetry of the indicator J_MM_A_max, Index Bayers (visual analogue scale) = 1.08 (95% BI 1.03–1.12) for each point exceeding the value of the indicator for the left half above the right (when standardizing on three other risk factors). Also, an increase (p= 0.049) of the risk of not achieving the effect of treatment for a decrease in pain syndrome with an increase in the asymmetry of the J_MM_A_mean indicator, odds ratio = 1.28 (95% of BI 1.00–1.65) for each point exceeding the value of the indicator for the left side above the right side (when standardizing on three other risk factors) was found. Conclusion. Such a thorough approach to the implemented model of diagnosis and treatment of patients with temporomandibular joint dysfunction and a synchronized complex of studies and treatment of this pathology, developed in accordance with it, provided an opportunity to assess qualitative and quantitative changes in the link of the chewing apparatus and the central link of the corresponding functional biosystem that ensure the formation and implementation of the main functions of the temporomandibular joint
The prevalence of dysfunction of the temporomandibular joint, especially in people aged 18-60 years, reached 95-98 % among all dental applications. The course of the pathology is usually hidden, with periodic recurrences and has a long nature, which is accompanied by a decrease in overall quality of life. Treatment of this pathology of the temporomandibular joint is a set of complex therapeutic, orthopedic and psychological measures. The literature describes many ways to treat temporomandibular joint dysfunction, one of the modem ones is the use of occlusal splints, which allow to change the position of the mandible, diagnose and eliminate musculoskeletal dysfunction of the temporomandibular joint. The aim of the study was to determine the effectiveness of treatment of musculoskeletal dysfunction of the temporomandibular joint with occlusal splints according to axiography. 274 patients aged 18 to 65 years were diagnosed with temporomandibular joint pain syndrome before and after treatment. All patients with signs of temporomandibular joint dysfunction before treatment had a violation of the trajectory of the mandible (deviation is 68.7 %, dyslexia is 31.3 %). When opening and closing the mouth, asymmetrical shifts of the lower jaw to the sides of more than 2 mm (deviation from the midline is more than 2 mm) were observed. After treatment with occlusal splints there was an improvement in the trajectory of opening and closing the mouth: the number of patients with a violation of the trajectory decreased by 89.1 %, and the displacement of the mandible during opening and closing the mouth in 92.4 % of patients decreased on average to 0.9 mm. When analyzing the movements of the mandible in the sagittal plane in 79 % of cases, deviations of the trajectory of the mandible were detected. After treatment with occlusive muscle relaxation splints, elimination of violations of the trajectory of the mandible in the transverse plane was noted in 93.4 % of cases, reduction of displacement to 0.9 mm in 78.1 % of patients. The trajectory of the mandible in the sagittal plane improved in 80.1 % of patients, normalization of the position of the mandible relative to the neuromuscular trajectory was achieved in 93.4 % of clinical cases. According to the analysis of parameters, such treatment should be considered effective. Keywords: musculoskeletal dysfunction, temporomandibular joint, clinical dysfunction index, axiography, sagittal articular pathway angle, sagittal incisor pathway angle, Bennett’s angle (movement), duration.
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