Protocols for orthodontic treatment of patients with temporomandibular joint disorders

Lee, Gye Hyeong; Park, Jae Hyun; Moon, Danal; Lee, Sang Mi

doi:10.1016/j.ajodo.2020.09.023

Cited by 19 publications

(18 citation statements)

References 37 publications

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“…Additionally, numerous studies have also demonstrated improvement of clinical symptoms during orthodontic treatment by virtue of therapeutic effects of the splint and elimination of the impact of occlusal interferences, thereby allowing for physiologic-seated condylar position and optimizing final treatment results by attaining maximum intercuspation-seated condylar position coincidence. 48,[50][51][52] The findings of this study, showing improvement in all variables of mandibular movement in the splint orthodontic group in comparison to the other 3 groups, further indicate that orthodontics play a limited role in management of TMD in orthodontic patients. Similar findings have also been reported by Imai et al 50 who also found significant beneficial effects of combination of splint therapy and orthodontic treatment in reducing pain and restriction of mandibular movement.…”

Section: Discussionmentioning

confidence: 85%

“…29 Stabilization of the TMJ structures by splint therapy is necessitated in such patients to identify and maintain the true mandibular position and predict patients' response before institution of orthodontic mechanotherapy. 48 Among the 3 splint designs, namely, the anterior repositioning appliance (ARA), the CSS, and the soft splint, correct choice of the splint design is often a unique challenge for a clinician. 24 In accordance with the recommendations of Chang et al who reported fewer problems with CSS in comparison to ARA after treatment, we used CSS for a period varying from 12 weeks to 24 weeks depending on severity of pretreatment TMJ symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Biometric Assessment of Temporomandibular Disorders in Orthodontics: A Multi-arm Randomized Controlled Trial

et al. 2022

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Main Points• The use of biometric equipment is a viable diagnostic and therapeutic modality, offering the advantages of non-radiating and easily reproducible digital quantitative assessment and documentation of temporomandibular disorder (TMD) signs and symptoms. • Comprehensive fixed orthodontic mechanotherapy does not aggravate TMDs. Temporomandibular disorders attributable to unstable orthodontic malocclusion can be treated successfully with comprehensive orthodontic treatment. • Temporomandibular disorders due to multifactorial temporomandibular joint (TMJ) and muscular components may usually require adjunctive splint therapy for at least 3 months.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Biometric Assessment of Temporomandibular Disorders in Orthodontics: A Multi-arm Randomized Controlled Trial

et al. 2022

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“…This method is innovative in how it combines mandibular voxel-based superimposition and a maxilla-based coordinate system to successfully eliminate the pseudo positional changes caused by occlusal change and achieve precision in measuring mandibular structural changes. As a process of occlusal reconstruction, orthodontic treatment may cause changes in the spatial position of the mandible, especially in cases of functional-appliance treatment, splint therapy and orthognathic surgery [ 26 , 27 , 28 ]. Additionally, condylar position may change due to multiple factors, including ages, disc displacement and teeth extraction [ 29 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

A Novel Method to Combine Maxilla-Based Coordinate System and Mandibular Voxel-Based Superimposition with Cone-Bean Computed Tomography

Zhang

et al. 2022

JCM

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Background: The objective of this study was to propose a method that combines a maxilla-based coordinate system and mandibular voxel-based superimposition for an accurate evaluation of mandibular structural and positional changes and a direct comparison between maxillary and mandibular structural changes with the same 3D vectors. Methods: Mandibular voxel-based superimposition was firstly performed to reorient the mandibles and eliminate the mandibular positional changes. Then, a maxilla-based coordinate system was constructed with four maxillary skeletal landmarks (ANS, PNS, OrL and OrR). After settling the reoriented mandibles into this coordinate system, the mandibular structural changes were accurately evaluated. To assess the accuracy and reproducibility of this method, CBCT images of a skull specimen before and after orthodontic treatment (which was simulated by rearranging the skull and the mandible) were collected. Five mandibular skeletal landmarks, three mandibular dental landmarks and two mandibular measurement planes of this skull were used to evaluate the linear and angular changes in the mandibular structures. Results: There were significant differences in the linear and angular measurements of the mandibular structures of the skull (p ˂ 0.05), which indicated mandibular positional changes after orthodontic treatment. After mandibular voxel-based superimposition, there were no significant differences in the linear and angular measurements of mandibular structures, which indicated that the mandibular positional changes were eliminated. The intraclass correlation coefficient (ICC) value of the inter- and intra-observer agreement of all measurements was 0.99. Conclusions: This method has proven advantages in terms of accuracy, reproducibility and validity; with this method, mandibular structural and positional changes can be accurately evaluated and maxillary and mandibular structural changes can be directly compared with same 3D vectors.

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“…In orthodontic clinical practice, the usual treatment procedure for DJD patients, especially for those in the progressive stage, involves SS therapy before orthodontics. 18,19 However, most past studies were case reports.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease

Qin¹,

He²,

Zhang³

et al. 2022

The Angle Orthodontist

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Objectives To compare two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease. Materials and Methods A total of 47 patients were included in this study. Group anterior repositioning splint (ARS) was treated with temporomandibular joint (TMJ) disc surgery followed by an ARS and camouflage orthodontic treatment. Group stabilization splint (SS) was treated with an SS followed by orthodontic treatment combined with orthognathic surgery. Cephalometric analysis of lateral radiographs and measurements of condylar height were evaluated before and after splints. Results In group ARS, mandibular advancement was observed after treatment in 21 of 24 patients (87.5%). The SNB angle increased by an average of 1.40 ± 1.01°. The ANB angle, overjet, Wits, and convexity decreased. Facial angle and soft tissue N Vert to pogonion increased. Vertically, MP-FH, MP-SN, y-axis, and vertical ratio decreased and ANS-Me/N-Me and S-Go/N-Me increased, suggesting a counterclockwise rotation of the mandible. In group SS, 18 of 23 patients (78.3%) showed a backward change tendency. The SNB angle reduced by 0.90 ± 0.93°. The ANB angle, overjet, Wits, convexity, and y-axis increased. The facial angle and soft tissue N Vert to soft tissue pogonion (ST N Vert to ST pogonion) decreased. Magnetic resonance imaging showed condylar height increased by 1.45 ± 3.05 mm (P = .002) in group ARS. In group SS, condylar height change was not consistent. Conclusions TMJ disc surgery followed by ARS promoted condylar bone remodeling and regeneration. The SNB angle increased, and the severity of skeletal Class II was improved. The SS enabled the mandible to withdraw backward and revealed a retrognathic but true mandible position.

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Protocols for orthodontic treatment of patients with temporomandibular joint disorders

Cited by 19 publications

References 37 publications

Biometric Assessment of Temporomandibular Disorders in Orthodontics: A Multi-arm Randomized Controlled Trial

Biometric Assessment of Temporomandibular Disorders in Orthodontics: A Multi-arm Randomized Controlled Trial

A Novel Method to Combine Maxilla-Based Coordinate System and Mandibular Voxel-Based Superimposition with Cone-Bean Computed Tomography

Comparison of two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease

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