Temporomandibular joint(TMJ)disc displacement is one of the most significant subtypes of temporomandibular joint disorders,but its etiology and mechanism are poorly understood.In this study,we elucidated the mechanism...Temporomandibular joint(TMJ)disc displacement is one of the most significant subtypes of temporomandibular joint disorders,but its etiology and mechanism are poorly understood.In this study,we elucidated the mechanisms by which destruction of inflamed collagen fibrils induces alterations in the mechanical properties and positioning of the TMJ disc.By constructing a rat model of TMJ arthritis,we observed anteriorly dislocated TMJ discs with aggravated deformity in vivo from five weeks to six months after a local injection of Freund’s complete adjuvant.By mimicking inflammatory conditions with interleukin-1 beta in vitro,we observed enhanced expression of collagen-synthesis markers in primary TMJ disc cells cultured in a conventional two-dimensional environment.In contrast,three-dimensional(3D)-cultivated disc cell sheets demonstrated the disordered assembly of inflamed collagen fibrils,inappropriate arrangement,and decreased Young’s modulus.Mechanistically,inflammation-related activation of the nuclear factor kappa-B(NF-κB)pathway occurs during the progression of TMJ arthritis.NF-κB inhibition reduced the collagen fibril destruction in the inflamed disc cell sheets in vitro,and early NF-κB blockade alleviated collagen degeneration and dislocation of the TMJ discs in vivo.Therefore,the NF-κB pathway participates in the collagen remodeling in inflamed TMJ discs,offering a potential therapeutic target for disc displacement.展开更多
The reconstruction of the temporomandibular joint presents a multifaceted clinical challenge in the realm of head and neck surgery,underscored by its relatively infrequent occurrence and the lack of comprehensive clin...The reconstruction of the temporomandibular joint presents a multifaceted clinical challenge in the realm of head and neck surgery,underscored by its relatively infrequent occurrence and the lack of comprehensive clinical guidelines.This review aims to elucidate the available approaches for TMJ reconstruction,with a particular emphasis on recent groundbreaking advancements.The current spectrum of TMJ reconstruction integrates diverse surgical techniques,such as costochondral grafting,coronoid process grafting,revascularized fibula transfer,transport distraction osteogenesis,and alloplastic TMJ replacement.Despite the available options,a singular,universally accepted‘gold standard’for reconstructive techniques or materials remains elusive in this field.Our review comprehensively summarizes the current available methods of TMJ reconstruction,focusing on both autologous and alloplastic prostheses.It delves into the differences of each surgical technique and outlines the implications of recent technological advances,such as 3D printing,which hold the promise of enhancing surgical precision and patient outcomes.This evolutionary progress aims not only to improve the immediate results of reconstruction but also to ensure the long-term health and functionality of the TMJ,thereby improving the quality of life for patients with end-stage TMJ disorders.展开更多
Background A temporomandibular disorders(TMDs)is a musculoskeletal and neuromuscular condition that affects the temporomandibular joint,masticatory muscles,and associated tissues.Non-pharmacological interventions are ...Background A temporomandibular disorders(TMDs)is a musculoskeletal and neuromuscular condition that affects the temporomandibular joint,masticatory muscles,and associated tissues.Non-pharmacological interventions are currently considered as potential therapies for TMDs.However,high-quality systematic reviews and meta-analyses evaluating their clinical efficacy are lacking.Objective This study aimed to evaluate the clinical efficacy of non-pharmacological interventions for TMDs,focusing on their impact on pain relief,jaw mobility,and functional improvement.Specifically,we aimed to compare the effectiveness of four non-pharmacological interventions,including acupuncture,exercise,occlusal splinting,and laser therapy,for treating TMDs.Methods Comprehensive searches for randomized controlled trials(RCTs)were conducted in PubMed,Web of Science,Scopus,Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,China Biomedical Literature Database(SinoMed),VIP,and Wanfang databases.The primary outcome was visual analog scale(VAS)score.The secondary outcomes included pain-free mouth opening,maximum assisted and unassisted mouth opening,and occurrence of adverse events.We used the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment,Development,and Evaluation approach to assess the risk of bias and the quality of evidence.The meta-analysis was performed using RevMan 5.4 software.Results A total of 22 RCTs involving 717 patients with TMDs were included.Non-pharmacological interventions significantly reduced VAS scores(n=19;mean difference[MD]=–1.86,95%confidence interval[CI]–2.40 to–1.31;Z=6.68;P<0.05)and improved the pain-free mouth opening(n=6;MD=6.92,95%CI 4.91 to 8.94;Z=6.73;P<0.05)and maximum unassisted mouth opening(n=10;MD=4.05,95%CI 2.08 to 6.02;Z=4.04;P<0.05)in patients with TMDs.However,non-pharmacological interventions did not show a significant effect on maximum assisted mouth opening(n=2;MD=0.33,95%CI–4.16 to 4.82;Z=0.15;P=0.88).Only one RCT reported the occurrence of adverse events.Subgroup analysis showed that acupuncture(n=6;MD=–1.52,95%CI–2.86 to–0.18;Z=2.22;P=0.03),exercise(n=4;MD=–1.12,95%CI–1.94 to–0.31,Z=2.70;P<0.05),occlusal splint(n=5;MD=–2.00,95%CI–2.67 to–1.33,Z=5.88;P<0.05),and laser therapy(n=4;MD=–2.81,95%CI–3.89 to–1.73,Z=5.10,P<0.05)were significantly superior to control treatments in reducing VAS scores.In addition,acupuncture(n=2;MD=6.50,95%CI 3.87 to 9.13;Z=4.85;P<0.05),occlusal splint(n=2;MD=8.33,95%CI 4.41 to 12.24;Z=4.17;P<0.05),and laser therapy(n=2;MD=6.09,95%CI 0.86 to 11.32;Z=2.28;P=0.02)significantly improved pain-free mouth opening,whereas exercise(n=2;MD=6.84,95%CI 3.16 to 10.51;Z=3.65;P<0.05)and occlusal splint(n=2;MD=4.93,95%CI 1.66 to 8.19;Z=2.96;P<0.05)increased maximum unassisted mouth opening.Conclusion Nonpharmacological interventions have significant efficacy in relieving pain and enhancing pain-free mouth opening and maximum unassisted mouth opening in patients with TMDs.Specifically,acupuncture,exercise,occlusal splinting,and laser therapy significantly alleviate pain in patients with TMDs.Occlusal splinting showed good effects in improving pain-free mouth opening and maximum unassisted mouth opening,while acupuncture and laser therapy helped improve pain-free mouth opening.Exercise significantly improved maximum unassisted mouth opening.These findings support the application of these treatments in clinical practice and provide evidence to inform future conservative management guidelines for TMDs.展开更多
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 or...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.展开更多
Objective To observe the application of acupuncture at distal points combined with medicated cupping on the affected parts in the treatment of temporomandibular disorders（TMD） and to evaluate its effectiveness. Meth...Objective To observe the application of acupuncture at distal points combined with medicated cupping on the affected parts in the treatment of temporomandibular disorders（TMD） and to evaluate its effectiveness. Methods A total of 120 patients with TMD were randomly divided into two groups according to the random number table and random number remainder method. Sixty-two patients in acupuncture combined with cupping group（group A） were treated with acupuncture at Hég（合谷 LI 4） and Tàichōng（太冲 LR 3） combined with medicated cupping on the affected parts with Sānqī（三七 Radix et Rhizoma Notoginseng） and Báizh（白芷 Radix Angelicae Dahuricae）. Fifty-eight patients in cupping group（group B） were just treated with medicated cupping. Patients were treated for 30 min each time, once daily, and 10 times were considered as one course of treatment. After one course of treatment, the therapeutic effect was evaluated. Before and after treatment, craniomandihular index（CMI）, dysfunction index（DI）, palpation index（Pl） and changes in pain degree（VAS score） were compared. Results Before and after treatment, CMI in group A were 0.27±0.02 and 0.04±0.01, respectively, and in group B were 0.29±0.02 and 0.06±0.01, respectively; PI in group A were 0.19±0.01 and 0.05±0.03, respectively, and in group B were 0.18±0.02 and 0.11±0.02, respectively; DI in group A were 0.33±0.04 and 0.06±0.02, respectively, and in group B were 0.34±0.05 and 0.11±0.04, respectively; VAS in group A were 5.39±0.24 and 2.13±0.47, respectively, and in group B were 5.70±0.31 and 3.97±0.26, respectively. After treatment, CMI, DI, PI and VAS in both groups significantly decreased when compared with those before treatment（all P0.01）, and the indices in group A were significantly lower than that in group B after treatment（all P0.05）, indicating that the difference was significant. Conclusion The therapeutic effect of acupuncture at distal points combined with cupping at adjacent points in treatment of TMD is superior to that of single medicated cupping therapy.展开更多
A finite element model of the temporomandibular joint （TMJ） and the human mandible was fabricated to study the effect of abnormal loading, such as awake and asleep bruxism, on the articular disc. A quasilinear visco...A finite element model of the temporomandibular joint （TMJ） and the human mandible was fabricated to study the effect of abnormal loading, such as awake and asleep bruxism, on the articular disc. A quasilinear viscoelastic model was used to simulate the behaviour of the disc. The viscoelastic nature of this tissue is shown to be an important factor when sustained （awake bruxism） or cyclic loading （sleep bruxism） is simulated. From the comparison of the two types of bruxism, it was seen that sustained clenching is the most detrimental activity for the TMJ disc, producing an overload that could lead to severe damage of this tissue.展开更多
The objectives of this study were to （1） determine the distribution and synthesis of pericellular matrix （PCM） molecules （collagen VI, collagen IV and laminin） in rat temporomandibular joint （TMJ） and （2） in...The objectives of this study were to （1） determine the distribution and synthesis of pericellular matrix （PCM） molecules （collagen VI, collagen IV and laminin） in rat temporomandibular joint （TMJ） and （2） investigate the effects of PCM molecules on chondrocytes against inflammation in osteoarthritis. Four zones （fibrous, proliferating, mature and hypertrophic） of condylar cartilage and three bands （anterior, intermediate and posterior） of disc were analysed by immunohistochemistry for the presence of PCM molecules in rat TMJs. Isolated chondrocytes were pre-treated with PCM molecules before being subjected to interleukin （IL）-II~ treatment to stimulate inflammation. The responses of the chondrocytes were analysed using gene expression, nitric oxide release and matrix metalloproteinase （MMP）-13 production measures. Histomorphometric analyses revealed that the highest areal deposition of collagen VI （67.4%）, collagen IV （45.7%） and laminin （52.4%） was in the proliferating zone of TMJ condylar cartilage. No significant difference in the distribution of PCM molecules was noted among the three bands of the TMJ disc. All three PCM molecules were expressed intracellularly by chondrocytes cultured in the monolayer. Among the PCM molecules, pre-treatment with collagen VI enhanced cellular proliferation, ameliorated IL-lp-induced MMP-3, MMP-9, MMP-13 and inducible nitric oxide synthase gene expression, and attenuated the downregulation of cartilage matrix genes, including collagen I, aggrecan and cartilage oligomeric matrix protein （COMP）. Concurrently, collagen VI pretreatment inhibited nitric oxide and MMP-13 production. Our study demonstrates for the first time the distribution and role of PCM molecules, particularly collagen VI, in the protection of chondrocytes against inflammation.展开更多
Imaging of the temporomandibular joint(TMJ) is continuously evolving with advancement of imaging technologies. Many different imaging modalities are currently used to evaluate the TMJ. Magnetic resonance imaging is co...Imaging of the temporomandibular joint(TMJ) is continuously evolving with advancement of imaging technologies. Many different imaging modalities are currently used to evaluate the TMJ. Magnetic resonance imaging is commonly used for evaluation of the TMJ due to its superior contrast resolution and its ability to acquire dynamic imaging for demonstration of the functionality of the joint. Computed tomography and ultrasound imaging have specific indication in imaging of the TMJ. This article focuses on state of the art imaging of the temporomandibular joint. Relevant normal anatomy and biomechanics of movement of the TMJ are discussed for better understanding of many TMJ pathologies. Imaging of internal derangements is discussed in detail. Different arthropathies and commontumors are also discussed in this article.展开更多
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.Ow...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.展开更多
There is currently no effective medical treatment for temporomandibular joint osteoarthritis(TMJ-OA) due to a limited understanding of its pathogenesis. This study was undertaken to investigate the key role of transfo...There is currently no effective medical treatment for temporomandibular joint osteoarthritis(TMJ-OA) due to a limited understanding of its pathogenesis. This study was undertaken to investigate the key role of transforming growth factor-β(TGF-β)signalling in the cartilage and subchondral bone of the TMJ using a temporomandibular joint disorder(TMD) rat model, an ageing mouse model and a Camurati–Engelmann disease(CED) mouse model. In the three animal models, the subchondral bone phenotypes in the mandibular condyles were evaluated by μCT, and changes in TMJ condyles were examined by TRAP staining and immunohistochemical analysis of Osterix and p-Smad2/3. Condyle degradation was confirmed by Safranin O staining, the Mankin and OARSI scoring systems and type X collagen(Col X), p-Smad2/3 a and Osterix immunohistochemical analyses. We found apparent histological phenotypes of TMJ-OA in the TMD, ageing and CED animal models, with abnormal activation of TGF-βsignalling in the condylar cartilage and subchondral bone. Moreover, inhibition of TGF-β receptor I attenuated TMJ-OA progression in the TMD models. Therefore, aberrant activation of TGF-β signalling could be a key player in TMJ-OA development.展开更多
Collagen is the building component of temporomandibular joint(TMJ) discs and is often affected by inflammation in temporomandibular disorders. The macromechanical properties of collagen are deteriorated by chronic inf...Collagen is the building component of temporomandibular joint(TMJ) discs and is often affected by inflammation in temporomandibular disorders. The macromechanical properties of collagen are deteriorated by chronic inflammation. However,the mechanism by which inflammation influences disc function remains unknown. The relationship between the ultrastructure and nanomechanical properties of collagen in inflamed discs should be clarified. Seven-week-old female Sprague–Dawley rats were randomly divided into two groups. Chronic TMJ inflammation was induced by intra-articular injection of complete Freund's adjuvant, and samples were harvested after 5 weeks. Picrosirius staining revealed multiple colours under polarized light, which represented alternative collagen bundles in inflamed discs. Using atomic force microscopy scanning, the magnitude of Young's modulus was reduced significantly accompanied with disordered collagen fibril arrangement with porous architecture of inflamed discs. Transmission electron microscopy scanning revealed a non-uniform distribution of collagen fibres, and oversized collagen fibrils were observed in inflamed discs. Fourier transform infrared microspectroscopy revealed a decrease in 1 338 cm^(-1)/amide II area ratio of collagen in different regions. The peak positions of amide I and amide II bands were altered in inflamed discs,indicating collagen unfolding. Our results suggest that sustained inflammation deteriorates collagen structures, resulting in the deterioration of the ultrastructure and nanomechanical properties of rat TMJ discs.展开更多
In temporomandibular disorders（TMD）, pain takes place when neuropeptides stimulate synovial tissue to produce several cytokines such as interleukin（IL）-1β, IL-6 and tumor necrosis factor（TNF）-α, which activate...In temporomandibular disorders（TMD）, pain takes place when neuropeptides stimulate synovial tissue to produce several cytokines such as interleukin（IL）-1β, IL-6 and tumor necrosis factor（TNF）-α, which activate neurons and glia of synovial membrane at the bilaminar regions of temporomandibular joint（TMJ）. It has been reported that, after neurogenic differentiation, the synovial mesenchymal stem cells（SMSCs）, deriving from TMJ, possess the same cytological features as the neuronal cells. This study examined the ability of substance P（SP） and calcitonin gene-related peptide（CGRP） to stimulate SMSCs and neurogenic SMSCs secreting inflammatory cytokines during TMD, evaluated the mutual effects of inflammatory cytokines and neuropeptides and tested the analgesic effect of hyaluronic acid（HA）. The levels of IL-1β, IL-6 and TNF-α in SMSCs and neurogenic SMSCs in the presence of neuropeptides were measured by ELISA. SP and CGRP produced by SMSCs and neurogenic SMSCs were determined by RT-PCR and Western blotting. The results showed that the expression of SP and CGRP was significantly enhanced in the neurogenic SMSCs in response to IL-1β, IL-6 and TNF-α, and the effect was remarkably inhibited by HA. IL-1β, IL-6 and TNF-α, in return, could be enhanced in the neurogenic SMSCs upon stimulation by SP and CGRP. Neuropeptides and inflammatory cytokines might work mutually on the TMD pain. The HA-mediated analgesic effect may be implicated in the inhibition of SP and CGRP expression in neurogenic SMSCs.展开更多
Objective： To observe the clinical efficacy of thumb-tack needle on temporomandibular joint dysfunction（TMD）.Methods： A total of 43 outpatients of TMD were treated with thumb-tack needle. After the skin routine st...Objective： To observe the clinical efficacy of thumb-tack needle on temporomandibular joint dysfunction（TMD）.Methods： A total of 43 outpatients of TMD were treated with thumb-tack needle. After the skin routine sterilization, the intradermal needles, 0.2 mm x 1.5 mm（the SEIRIN-thumb-tack needle） were embedded subcutaneously at Zúlinqì（足临泣GB 41）, Zhōngzhǔ（中渚 TE 3） and Xiàguān（下关 ST 7） on the affected side. The acupoints were pressed and kneaded gently to induce mild soreness and distention.When pressing and kneading GB 41 and TE 3, the patients were required to open and close the mouth in small amplitude to achieve the effects of kinetic acupuncture. The treatment was given twice a week.The needles were retained for 24 h. A total of 6 treatments were required.Results： A total of 22 cases were cured, accounting for 51.16%, 15 cases effective remarkably, accounting for 34.88% and 6 cases failed, accounting for 13.95%. The total effective rate was 86.05%.Conclusion： The thumb-tack needle is significantly effective on TMD.展开更多
AIMTo 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 ...AIMTo 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.METHODSBetween 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.RESULTSWe enrolled 91 IBS patients (23 IBS-D, 30 IBS-C and 38 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.CONCLUSIONIBS patients had a more than three times greater risk of TMD compared to HC. The risk of having TMD was 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.展开更多
The writer has treated 30 cases of temporomandibular articular dysfunction syn-drome with only auricular pressing therapy. The method: A seed of vaccaria segetalis is used to tapethe Antitratic Apex point and the Shen...The writer has treated 30 cases of temporomandibular articular dysfunction syn-drome with only auricular pressing therapy. The method: A seed of vaccaria segetalis is used to tapethe Antitratic Apex point and the Shenmen point of ear, then the practitioner presses the seed withhand to produce sensations, such as distension, numbness, heat, and a little sweating etc.. Exchangtwo sides of the ears alternatively. The treatment is performed once every two or three days and threetimes are constituted one course. In one or three courses we can obtain the therapeutic effectiveness as50% cured, 43% improved and 6.7% failed.展开更多
Treatment of bone tumors in the mandible often involves extensive excavation of affected bone, followed by mandibular reconstruction. Prosthetic implants may be needed to restore jaw functionality. The challenges of m...Treatment of bone tumors in the mandible often involves extensive excavation of affected bone, followed by mandibular reconstruction. Prosthetic implants may be needed to restore jaw functionality. The challenges of making prosthetic bone implants include stress shielding and extending the mechanical life of the implant. We have developed a design algorithm to improve the efficiency of prosthesis design. A finite element model of the patient case is constructed from a computer tomography scan, and the computer implements topology optimization techniques to design the prosthesis with limited stress shielding affected by highly biomechanical compatibility. Topology optimization facilitates the design of low weight structures by automatically introducing holes into the structure. This is governed by engineering predetermined constraints to meet certain job specifications. Such a design will be tested for fatigue life before it is ready to be manufactured and used. Topology optimization can be performed as a design process to achieve a final design that takes stress shielding into consideration. The problem of stress shielding is solved by matching the stiffness of the orthopedic implant to the original bone that is being replaced. The material we used was titanium alloy (Ti-6Al-7Nb). Volume fraction of the orthodox implant was used (0.2872 for the studied case) as volume constraints. Compliance of the bulk bone was set as a further constraint to match the stiffness of the bone with the designed structure. Our results show a good life expectancy for the designed parts, with 12% higher life expectancy for stress-based topology optimization than for compliance-based topology optimization.展开更多
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 o...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.展开更多
Objective: To observe the clinical efficacy of treatment for temporomandibular disorders with warmingneedle moxibustion on ginger at Xiàguan(下关ST 7).Methods: Twenty patients with temporomandibular disorders wer...Objective: To observe the clinical efficacy of treatment for temporomandibular disorders with warmingneedle moxibustion on ginger at Xiàguan(下关ST 7).Methods: Twenty patients with temporomandibular disorders were given acupuncture at ST 7 of the affected side, and then the self-prepared round cake-shaped ginger with moxa was set on the needle closing to skin surface, Ignited moxa, burn out as one cone, three cones were given for once. The treatment was performed once a day, 7 times was 1 course, and the curative effect was evaluated after 1 course of treatment.Results: Among 20 patients, 12 were cured, improvement was observed in 7 patients, and 1 case had no response to treatment. The effective rate was up to 95.0%;improvement was observed in 14 patients after treatment for 3 times. According to follow-up visit 1 month after treatment, 1 patient relapsed due to excessive mouth opening, but the symptom was mild and relieved after rubbing.Conclusion: The clinical efficacy of treatment for temporomandibular disorders with warming-needle moxibustion on ginger at ST 7 was ideal.展开更多
Septic arthritis of the temporomandibular joint (TMJ) is a rare disease that is characterized by preauricular pain, edema, malocclusion, trismus and abscess formation in the TMJ region. An 85-year-old male visited our...Septic arthritis of the temporomandibular joint (TMJ) is a rare disease that is characterized by preauricular pain, edema, malocclusion, trismus and abscess formation in the TMJ region. An 85-year-old male visited our hospital with the complaint of left-sided TMJ swelling, pain and trismus. Septic arthritis of the left TMJ was diagnosed on the basis of considerable elevation of CRP (Creactive proteins) and CT imaging findings. The patient was treated with oral Faropenem at 450 mg daily, but CRP increased three days after the initial visit. He was hospitalized and treated with intravenous administration of cefazolin at 2 g and clindamycin at 1.2 g daily for six days. Propionibacterium species and Veillonella species grew in a culture of the joint aspirate, but there was no apparent source of infection. After acute infectious symptoms had passed, the patient was treated with oral amoxicillin at 750 mg daily for eight weeks and was instructed to do jaw opening exercise. The patient was discharged on the 11th hospital day. After three weeks of the hospital discharge, the patient healed completely. To avoid serious complications, clinicians should include septic arthritis of the TMJ in the differential diagnosis of preauricular pain, trismus and swelling.展开更多
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:Chine...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.展开更多
基金supported by the National Natural Science Foundation of China Nos.82370983,81671015(X.W.),82230030(Y.L.),82101043(S.C.)and 82370922(Y.F.)Beijing International Science and Technology Cooperation Project No.Z221100002722003(Y.L.)+4 种基金Beijing Natural Science Foundation Nos.L234017,JL23002(Y.L.),No.7242282(S.C.)and 7232217(Y.G.)Clinical Medicine Plus X-Young Scholars Project of Peking University No.PKU2024LCXQ039(Y.L.)National Program for Multidisciplinary Cooperative Treatment on Major Diseases No.PKUSSNMP-202013(X.W.)Hygiene and Health Development Scientific Research Fostering Plan of Haidian District Beijing No.HP2023-12-509001(J.Z.)Young Clinical Research Fund of the Chinese Stomatological Association No.CSA-02022-03(J.Z.).
文摘Temporomandibular joint(TMJ)disc displacement is one of the most significant subtypes of temporomandibular joint disorders,but its etiology and mechanism are poorly understood.In this study,we elucidated the mechanisms by which destruction of inflamed collagen fibrils induces alterations in the mechanical properties and positioning of the TMJ disc.By constructing a rat model of TMJ arthritis,we observed anteriorly dislocated TMJ discs with aggravated deformity in vivo from five weeks to six months after a local injection of Freund’s complete adjuvant.By mimicking inflammatory conditions with interleukin-1 beta in vitro,we observed enhanced expression of collagen-synthesis markers in primary TMJ disc cells cultured in a conventional two-dimensional environment.In contrast,three-dimensional(3D)-cultivated disc cell sheets demonstrated the disordered assembly of inflamed collagen fibrils,inappropriate arrangement,and decreased Young’s modulus.Mechanistically,inflammation-related activation of the nuclear factor kappa-B(NF-κB)pathway occurs during the progression of TMJ arthritis.NF-κB inhibition reduced the collagen fibril destruction in the inflamed disc cell sheets in vitro,and early NF-κB blockade alleviated collagen degeneration and dislocation of the TMJ discs in vivo.Therefore,the NF-κB pathway participates in the collagen remodeling in inflamed TMJ discs,offering a potential therapeutic target for disc displacement.
基金supported by NSFC(82370932)Research and Develop Program of West China Hospital of Stomatology Sichuan University(RD-03-202102,LCYJ2019-20)Natural Science Foundation of Sichuan Province(2023NSFSC1512,2024NSFSC1588)。
文摘The reconstruction of the temporomandibular joint presents a multifaceted clinical challenge in the realm of head and neck surgery,underscored by its relatively infrequent occurrence and the lack of comprehensive clinical guidelines.This review aims to elucidate the available approaches for TMJ reconstruction,with a particular emphasis on recent groundbreaking advancements.The current spectrum of TMJ reconstruction integrates diverse surgical techniques,such as costochondral grafting,coronoid process grafting,revascularized fibula transfer,transport distraction osteogenesis,and alloplastic TMJ replacement.Despite the available options,a singular,universally accepted‘gold standard’for reconstructive techniques or materials remains elusive in this field.Our review comprehensively summarizes the current available methods of TMJ reconstruction,focusing on both autologous and alloplastic prostheses.It delves into the differences of each surgical technique and outlines the implications of recent technological advances,such as 3D printing,which hold the promise of enhancing surgical precision and patient outcomes.This evolutionary progress aims not only to improve the immediate results of reconstruction but also to ensure the long-term health and functionality of the TMJ,thereby improving the quality of life for patients with end-stage TMJ disorders.
基金Supported by Capital's Funds for Health Improvement and Research:CFH2024-2-2235China National Natural Science Foundation:82074179,82374575+3 种基金Beijing Natural Science Foundation:7232270Outstanding Young Talents Program of Capital Medial University:B2207Beijing Hospital Management Center "peak" Talent Training Plan Team:DFL20241001Fifth Batch of National TCM Clinical Outstanding Talents Project。
文摘Background A temporomandibular disorders(TMDs)is a musculoskeletal and neuromuscular condition that affects the temporomandibular joint,masticatory muscles,and associated tissues.Non-pharmacological interventions are currently considered as potential therapies for TMDs.However,high-quality systematic reviews and meta-analyses evaluating their clinical efficacy are lacking.Objective This study aimed to evaluate the clinical efficacy of non-pharmacological interventions for TMDs,focusing on their impact on pain relief,jaw mobility,and functional improvement.Specifically,we aimed to compare the effectiveness of four non-pharmacological interventions,including acupuncture,exercise,occlusal splinting,and laser therapy,for treating TMDs.Methods Comprehensive searches for randomized controlled trials(RCTs)were conducted in PubMed,Web of Science,Scopus,Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,China Biomedical Literature Database(SinoMed),VIP,and Wanfang databases.The primary outcome was visual analog scale(VAS)score.The secondary outcomes included pain-free mouth opening,maximum assisted and unassisted mouth opening,and occurrence of adverse events.We used the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment,Development,and Evaluation approach to assess the risk of bias and the quality of evidence.The meta-analysis was performed using RevMan 5.4 software.Results A total of 22 RCTs involving 717 patients with TMDs were included.Non-pharmacological interventions significantly reduced VAS scores(n=19;mean difference[MD]=–1.86,95%confidence interval[CI]–2.40 to–1.31;Z=6.68;P<0.05)and improved the pain-free mouth opening(n=6;MD=6.92,95%CI 4.91 to 8.94;Z=6.73;P<0.05)and maximum unassisted mouth opening(n=10;MD=4.05,95%CI 2.08 to 6.02;Z=4.04;P<0.05)in patients with TMDs.However,non-pharmacological interventions did not show a significant effect on maximum assisted mouth opening(n=2;MD=0.33,95%CI–4.16 to 4.82;Z=0.15;P=0.88).Only one RCT reported the occurrence of adverse events.Subgroup analysis showed that acupuncture(n=6;MD=–1.52,95%CI–2.86 to–0.18;Z=2.22;P=0.03),exercise(n=4;MD=–1.12,95%CI–1.94 to–0.31,Z=2.70;P<0.05),occlusal splint(n=5;MD=–2.00,95%CI–2.67 to–1.33,Z=5.88;P<0.05),and laser therapy(n=4;MD=–2.81,95%CI–3.89 to–1.73,Z=5.10,P<0.05)were significantly superior to control treatments in reducing VAS scores.In addition,acupuncture(n=2;MD=6.50,95%CI 3.87 to 9.13;Z=4.85;P<0.05),occlusal splint(n=2;MD=8.33,95%CI 4.41 to 12.24;Z=4.17;P<0.05),and laser therapy(n=2;MD=6.09,95%CI 0.86 to 11.32;Z=2.28;P=0.02)significantly improved pain-free mouth opening,whereas exercise(n=2;MD=6.84,95%CI 3.16 to 10.51;Z=3.65;P<0.05)and occlusal splint(n=2;MD=4.93,95%CI 1.66 to 8.19;Z=2.96;P<0.05)increased maximum unassisted mouth opening.Conclusion Nonpharmacological interventions have significant efficacy in relieving pain and enhancing pain-free mouth opening and maximum unassisted mouth opening in patients with TMDs.Specifically,acupuncture,exercise,occlusal splinting,and laser therapy significantly alleviate pain in patients with TMDs.Occlusal splinting showed good effects in improving pain-free mouth opening and maximum unassisted mouth opening,while acupuncture and laser therapy helped improve pain-free mouth opening.Exercise significantly improved maximum unassisted mouth opening.These findings support the application of these treatments in clinical practice and provide evidence to inform future conservative management guidelines for TMDs.
基金Natural Science Foundation of Jiangsu Province, No. SBK2021021787the Major Project of the Health Commission ofJiangsu Province, No. ZD2022025and the Key Project of the Nanjing Health Commission, No. ZKX20048.
文摘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.
文摘Objective To observe the application of acupuncture at distal points combined with medicated cupping on the affected parts in the treatment of temporomandibular disorders（TMD） and to evaluate its effectiveness. Methods A total of 120 patients with TMD were randomly divided into two groups according to the random number table and random number remainder method. Sixty-two patients in acupuncture combined with cupping group（group A） were treated with acupuncture at Hég（合谷 LI 4） and Tàichōng（太冲 LR 3） combined with medicated cupping on the affected parts with Sānqī（三七 Radix et Rhizoma Notoginseng） and Báizh（白芷 Radix Angelicae Dahuricae）. Fifty-eight patients in cupping group（group B） were just treated with medicated cupping. Patients were treated for 30 min each time, once daily, and 10 times were considered as one course of treatment. After one course of treatment, the therapeutic effect was evaluated. Before and after treatment, craniomandihular index（CMI）, dysfunction index（DI）, palpation index（Pl） and changes in pain degree（VAS score） were compared. Results Before and after treatment, CMI in group A were 0.27±0.02 and 0.04±0.01, respectively, and in group B were 0.29±0.02 and 0.06±0.01, respectively; PI in group A were 0.19±0.01 and 0.05±0.03, respectively, and in group B were 0.18±0.02 and 0.11±0.02, respectively; DI in group A were 0.33±0.04 and 0.06±0.02, respectively, and in group B were 0.34±0.05 and 0.11±0.04, respectively; VAS in group A were 5.39±0.24 and 2.13±0.47, respectively, and in group B were 5.70±0.31 and 3.97±0.26, respectively. After treatment, CMI, DI, PI and VAS in both groups significantly decreased when compared with those before treatment（all P0.01）, and the indices in group A were significantly lower than that in group B after treatment（all P0.05）, indicating that the difference was significant. Conclusion The therapeutic effect of acupuncture at distal points combined with cupping at adjacent points in treatment of TMD is superior to that of single medicated cupping therapy.
基金provided by the Junta de Andalucí'a for the research project P07TEP-03115 titled Biomeca'nica de la Mandí'bula Humana,for which this articlehas been prepared
文摘A finite element model of the temporomandibular joint （TMJ） and the human mandible was fabricated to study the effect of abnormal loading, such as awake and asleep bruxism, on the articular disc. A quasilinear viscoelastic model was used to simulate the behaviour of the disc. The viscoelastic nature of this tissue is shown to be an important factor when sustained （awake bruxism） or cyclic loading （sleep bruxism） is simulated. From the comparison of the two types of bruxism, it was seen that sustained clenching is the most detrimental activity for the TMJ disc, producing an overload that could lead to severe damage of this tissue.
基金supported by grants from the National University Healthcare System(R221000077733)the National University of Singapore(R221000090112)
文摘The objectives of this study were to （1） determine the distribution and synthesis of pericellular matrix （PCM） molecules （collagen VI, collagen IV and laminin） in rat temporomandibular joint （TMJ） and （2） investigate the effects of PCM molecules on chondrocytes against inflammation in osteoarthritis. Four zones （fibrous, proliferating, mature and hypertrophic） of condylar cartilage and three bands （anterior, intermediate and posterior） of disc were analysed by immunohistochemistry for the presence of PCM molecules in rat TMJs. Isolated chondrocytes were pre-treated with PCM molecules before being subjected to interleukin （IL）-II~ treatment to stimulate inflammation. The responses of the chondrocytes were analysed using gene expression, nitric oxide release and matrix metalloproteinase （MMP）-13 production measures. Histomorphometric analyses revealed that the highest areal deposition of collagen VI （67.4%）, collagen IV （45.7%） and laminin （52.4%） was in the proliferating zone of TMJ condylar cartilage. No significant difference in the distribution of PCM molecules was noted among the three bands of the TMJ disc. All three PCM molecules were expressed intracellularly by chondrocytes cultured in the monolayer. Among the PCM molecules, pre-treatment with collagen VI enhanced cellular proliferation, ameliorated IL-lp-induced MMP-3, MMP-9, MMP-13 and inducible nitric oxide synthase gene expression, and attenuated the downregulation of cartilage matrix genes, including collagen I, aggrecan and cartilage oligomeric matrix protein （COMP）. Concurrently, collagen VI pretreatment inhibited nitric oxide and MMP-13 production. Our study demonstrates for the first time the distribution and role of PCM molecules, particularly collagen VI, in the protection of chondrocytes against inflammation.
文摘Imaging of the temporomandibular joint(TMJ) is continuously evolving with advancement of imaging technologies. Many different imaging modalities are currently used to evaluate the TMJ. Magnetic resonance imaging is commonly used for evaluation of the TMJ due to its superior contrast resolution and its ability to acquire dynamic imaging for demonstration of the functionality of the joint. Computed tomography and ultrasound imaging have specific indication in imaging of the TMJ. This article focuses on state of the art imaging of the temporomandibular joint. Relevant normal anatomy and biomechanics of movement of the TMJ are discussed for better understanding of many TMJ pathologies. Imaging of internal derangements is discussed in detail. Different arthropathies and commontumors are also discussed in this article.
文摘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.
基金supported by 2016JQ0054 and NSFC grants 81470711 to L.Z.National Key Research and Development Program of China 2016YFC1102700 to X.Z.
文摘There is currently no effective medical treatment for temporomandibular joint osteoarthritis(TMJ-OA) due to a limited understanding of its pathogenesis. This study was undertaken to investigate the key role of transforming growth factor-β(TGF-β)signalling in the cartilage and subchondral bone of the TMJ using a temporomandibular joint disorder(TMD) rat model, an ageing mouse model and a Camurati–Engelmann disease(CED) mouse model. In the three animal models, the subchondral bone phenotypes in the mandibular condyles were evaluated by μCT, and changes in TMJ condyles were examined by TRAP staining and immunohistochemical analysis of Osterix and p-Smad2/3. Condyle degradation was confirmed by Safranin O staining, the Mankin and OARSI scoring systems and type X collagen(Col X), p-Smad2/3 a and Osterix immunohistochemical analyses. We found apparent histological phenotypes of TMJ-OA in the TMD, ageing and CED animal models, with abnormal activation of TGF-βsignalling in the condylar cartilage and subchondral bone. Moreover, inhibition of TGF-β receptor I attenuated TMJ-OA progression in the TMD models. Therefore, aberrant activation of TGF-β signalling could be a key player in TMJ-OA development.
基金supported by the National Natural Science Foundation of China (Grant Nos. 81671015, 81571815, 81470717)Beijing Municipal Science and Technology Commission (Grant No. Z171100001017128)
文摘Collagen is the building component of temporomandibular joint(TMJ) discs and is often affected by inflammation in temporomandibular disorders. The macromechanical properties of collagen are deteriorated by chronic inflammation. However,the mechanism by which inflammation influences disc function remains unknown. The relationship between the ultrastructure and nanomechanical properties of collagen in inflamed discs should be clarified. Seven-week-old female Sprague–Dawley rats were randomly divided into two groups. Chronic TMJ inflammation was induced by intra-articular injection of complete Freund's adjuvant, and samples were harvested after 5 weeks. Picrosirius staining revealed multiple colours under polarized light, which represented alternative collagen bundles in inflamed discs. Using atomic force microscopy scanning, the magnitude of Young's modulus was reduced significantly accompanied with disordered collagen fibril arrangement with porous architecture of inflamed discs. Transmission electron microscopy scanning revealed a non-uniform distribution of collagen fibres, and oversized collagen fibrils were observed in inflamed discs. Fourier transform infrared microspectroscopy revealed a decrease in 1 338 cm^(-1)/amide II area ratio of collagen in different regions. The peak positions of amide I and amide II bands were altered in inflamed discs,indicating collagen unfolding. Our results suggest that sustained inflammation deteriorates collagen structures, resulting in the deterioration of the ultrastructure and nanomechanical properties of rat TMJ discs.
基金supported by the National Natural Science Foundation of China(No.81071266)
文摘In temporomandibular disorders（TMD）, pain takes place when neuropeptides stimulate synovial tissue to produce several cytokines such as interleukin（IL）-1β, IL-6 and tumor necrosis factor（TNF）-α, which activate neurons and glia of synovial membrane at the bilaminar regions of temporomandibular joint（TMJ）. It has been reported that, after neurogenic differentiation, the synovial mesenchymal stem cells（SMSCs）, deriving from TMJ, possess the same cytological features as the neuronal cells. This study examined the ability of substance P（SP） and calcitonin gene-related peptide（CGRP） to stimulate SMSCs and neurogenic SMSCs secreting inflammatory cytokines during TMD, evaluated the mutual effects of inflammatory cytokines and neuropeptides and tested the analgesic effect of hyaluronic acid（HA）. The levels of IL-1β, IL-6 and TNF-α in SMSCs and neurogenic SMSCs in the presence of neuropeptides were measured by ELISA. SP and CGRP produced by SMSCs and neurogenic SMSCs were determined by RT-PCR and Western blotting. The results showed that the expression of SP and CGRP was significantly enhanced in the neurogenic SMSCs in response to IL-1β, IL-6 and TNF-α, and the effect was remarkably inhibited by HA. IL-1β, IL-6 and TNF-α, in return, could be enhanced in the neurogenic SMSCs upon stimulation by SP and CGRP. Neuropeptides and inflammatory cytokines might work mutually on the TMD pain. The HA-mediated analgesic effect may be implicated in the inhibition of SP and CGRP expression in neurogenic SMSCs.
文摘Objective： To observe the clinical efficacy of thumb-tack needle on temporomandibular joint dysfunction（TMD）.Methods： A total of 43 outpatients of TMD were treated with thumb-tack needle. After the skin routine sterilization, the intradermal needles, 0.2 mm x 1.5 mm（the SEIRIN-thumb-tack needle） were embedded subcutaneously at Zúlinqì（足临泣GB 41）, Zhōngzhǔ（中渚 TE 3） and Xiàguān（下关 ST 7） on the affected side. The acupoints were pressed and kneaded gently to induce mild soreness and distention.When pressing and kneading GB 41 and TE 3, the patients were required to open and close the mouth in small amplitude to achieve the effects of kinetic acupuncture. The treatment was given twice a week.The needles were retained for 24 h. A total of 6 treatments were required.Results： A total of 22 cases were cured, accounting for 51.16%, 15 cases effective remarkably, accounting for 34.88% and 6 cases failed, accounting for 13.95%. The total effective rate was 86.05%.Conclusion： The thumb-tack needle is significantly effective on TMD.
文摘AIMTo 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.METHODSBetween 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.RESULTSWe enrolled 91 IBS patients (23 IBS-D, 30 IBS-C and 38 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.CONCLUSIONIBS patients had a more than three times greater risk of TMD compared to HC. The risk of having TMD was 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.
文摘The writer has treated 30 cases of temporomandibular articular dysfunction syn-drome with only auricular pressing therapy. The method: A seed of vaccaria segetalis is used to tapethe Antitratic Apex point and the Shenmen point of ear, then the practitioner presses the seed withhand to produce sensations, such as distension, numbness, heat, and a little sweating etc.. Exchangtwo sides of the ears alternatively. The treatment is performed once every two or three days and threetimes are constituted one course. In one or three courses we can obtain the therapeutic effectiveness as50% cured, 43% improved and 6.7% failed.
文摘Treatment of bone tumors in the mandible often involves extensive excavation of affected bone, followed by mandibular reconstruction. Prosthetic implants may be needed to restore jaw functionality. The challenges of making prosthetic bone implants include stress shielding and extending the mechanical life of the implant. We have developed a design algorithm to improve the efficiency of prosthesis design. A finite element model of the patient case is constructed from a computer tomography scan, and the computer implements topology optimization techniques to design the prosthesis with limited stress shielding affected by highly biomechanical compatibility. Topology optimization facilitates the design of low weight structures by automatically introducing holes into the structure. This is governed by engineering predetermined constraints to meet certain job specifications. Such a design will be tested for fatigue life before it is ready to be manufactured and used. Topology optimization can be performed as a design process to achieve a final design that takes stress shielding into consideration. The problem of stress shielding is solved by matching the stiffness of the orthopedic implant to the original bone that is being replaced. The material we used was titanium alloy (Ti-6Al-7Nb). Volume fraction of the orthodox implant was used (0.2872 for the studied case) as volume constraints. Compliance of the bulk bone was set as a further constraint to match the stiffness of the bone with the designed structure. Our results show a good life expectancy for the designed parts, with 12% higher life expectancy for stress-based topology optimization than for compliance-based topology optimization.
文摘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.
文摘Objective: To observe the clinical efficacy of treatment for temporomandibular disorders with warmingneedle moxibustion on ginger at Xiàguan(下关ST 7).Methods: Twenty patients with temporomandibular disorders were given acupuncture at ST 7 of the affected side, and then the self-prepared round cake-shaped ginger with moxa was set on the needle closing to skin surface, Ignited moxa, burn out as one cone, three cones were given for once. The treatment was performed once a day, 7 times was 1 course, and the curative effect was evaluated after 1 course of treatment.Results: Among 20 patients, 12 were cured, improvement was observed in 7 patients, and 1 case had no response to treatment. The effective rate was up to 95.0%;improvement was observed in 14 patients after treatment for 3 times. According to follow-up visit 1 month after treatment, 1 patient relapsed due to excessive mouth opening, but the symptom was mild and relieved after rubbing.Conclusion: The clinical efficacy of treatment for temporomandibular disorders with warming-needle moxibustion on ginger at ST 7 was ideal.
文摘Septic arthritis of the temporomandibular joint (TMJ) is a rare disease that is characterized by preauricular pain, edema, malocclusion, trismus and abscess formation in the TMJ region. An 85-year-old male visited our hospital with the complaint of left-sided TMJ swelling, pain and trismus. Septic arthritis of the left TMJ was diagnosed on the basis of considerable elevation of CRP (Creactive proteins) and CT imaging findings. The patient was treated with oral Faropenem at 450 mg daily, but CRP increased three days after the initial visit. He was hospitalized and treated with intravenous administration of cefazolin at 2 g and clindamycin at 1.2 g daily for six days. Propionibacterium species and Veillonella species grew in a culture of the joint aspirate, but there was no apparent source of infection. After acute infectious symptoms had passed, the patient was treated with oral amoxicillin at 750 mg daily for eight weeks and was instructed to do jaw opening exercise. The patient was discharged on the 11th hospital day. After three weeks of the hospital discharge, the patient healed completely. To avoid serious complications, clinicians should include septic arthritis of the TMJ in the differential diagnosis of preauricular pain, trismus and swelling.
文摘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.
