Three-Dimensional Assessment of the Temporomandibular Joint Changes Following Reversed Twin Block Therapy of Patients With Skeletal Class III Malocclusion in Conjunction With the Photobiomodulation Therapy: A Randomized Controlled Clinical Trial

Abstract

Background: Despite the positive effect of the photobiomodulation therapy (PBMT) application on animals, the primary role of this technique on the human condyle is still unclear. Several experimental reports have shown the efficacy of PBMT in inducing cellular changes in the temporomandibular joint (TMJ) region during functional treatment of patients with skeletal deformities. Still, the lack of information about its effects on human condyles requires further studies. Objectives: This study aimed to evaluate the effect of PBMT on the TMJ components following Class III treatment with the reversed twin block (RTB) appliance in growing patients. Materials and Method: Forty children (12 females, 28 males) between the age of nine and eleven years with skeletal Class III were assigned randomly to the RTB group with photobiomodulation (RTB+PBMT) or the control group (RTB). The PBMT was applied to the TMJ region using an 808-nm wavelength Ga-Al-As semiconductor laser device with 5 Joules/cm 2 energydensity on days 1, 3, 7, and 14 of the first month. Afterwards, the irradiation was conducted every 15 days until the end of the treatment. Cone-beam computerized tomography (CBCT) images were taken before (T1) treatment and following the end of treatment (T2) to assess TMJ and skeletal changes. Results: Condylar volume was significantly increased in the RTB group only by a mean of 287.97 mm 3 (p<0.001). The significantly backward and upward condylar movement was observed in the RTB and RTB+PBMT groups (superior joint space (SJS): 0.26 mm, 0.15 mm; posterior joint space (PJS): 0.42mm, 0.11mm, respectively). The RTB group showed the most remarkable changes. Significant improvement of the sagittal maxilla-mandibular relationship was greater in the RTB+PBMT group compared to the RTB group (p=0.02). Conclusion: There were no considerable differences in the condylar position after Class III treatment between the RTB and the RTB+PBMT groups. But a difference in the condylar volume was noticed between the two group.

Efectos del tratamiento ortopédico en la articulación temporomandibular en pacientes clase III con mordida cruzada anterior: una revisión de literatura.

“…La MCA fue evaluada por un over jet negativo (< 0 mm) 9 , 27 o de -1,7 mm, 25 mordida borde a borde 8 , 24 y consideraron el overjet negativo que comprometieran tres a cuatro dientes antero inferiores sobre los dientes antero superiores. 2 , 8 , 22 , 23 , 24 Algunos estudios incluyeron el prognatismo mandibular, (19.24) retrognatismo maxilar, 8 , 22 , 23 patrón de crecimiento horizontal 8 , 9 y relación molar Clase III según Angle 9 , 19 , 27 o Superclase I 9 .…”

“…Tres estudios analizaron la presencia de cambios en el ATM, el aparato funcional evaluado fue el twin block reverso (TBR) 2 , 19 y el jasper jumper modificado (JJM) 8 . La cantidad de pacientes en el TBR estudiado oscilaba de 20 a 32.…”

“…La cantidad de pacientes en el TBR estudiado oscilaba de 20 a 32. El tiempo de uso fue de 22 h/día, excepto durante las comidas, para TBR 19 y 14 h/día para el JJM 8 . Los resultados cualitativos revelaron un incremento de la distancia entre espacios articulares en el TBR a diferencia del TBR más terapia de fotobiomodulación (TF) (p < 0,05), un aumento del volumen condilar en TBR (p<0,01) y ambos grupos (TBR y TBR más TF) presentaron una disminución del espacio articular posterosuperior y un aumento del espacio articular anterior y mediolateral (p < 0,001) después de 258,68 ± 16,43 días de tratamiento 19 .…”

Cone-Beam Computed Tomography for Temporomandibular Joint Imaging

“…Khwanda et al [ 34 ] evaluated the effect of photobiomodulation therapy (PBMT) on the TMJ components following class III treatment with the reversed twin block (RTB) appliance in growing patients. Their results indicated that condylar volume was significantly increased in the RTB group only by a mean of 287.97 mm cube.…”

“…Their results indicated that condylar volume was significantly increased in the RTB group only by a mean of 287.97 mm cube. There were no considerable differences in the condylar position after the class III treatment between the RTB and RTB+PBMT groups [ 34 ].…”