The effect of mandibular advancement on signs and symptoms of the temporomandibular joint
Abstract
Statement of Problem: TMJ disorder is counted as one of the most problem in dentistry treatment with high prevalence. This disorder causes to pain. Since all of the structural defects do not lead to pain, therefore in differential diagnosis of TMD, the signs and symptoms should be considered. Purpose: The purpose of this study is to inspect the effect of mandibular advancement on signs and symptoms of the temporomandibular joint disorders (TMDs). Because of various etiologies of TMJ disorder, the researchers have not reached to agreement yet about the effect of orthognathic surgery on TMJ. Materials and Methods: A prospective descriptive trail of 81 patients with the range age between 19 and 31 years old with skeletal Cl II malocclusion that undergoes orthognathic surgery is carried out. For this purpose, the numbers of the male and female were considered to be 26 (32.1%) and 55 (67.9%). The most common features of TMDs are including pain, limitation of mandibular movement and joint sound which are assessed at three times pre surgery, three and six months post surgery. Result: The incidence of TMDs at these three times is statistically analyzed by McNemar test. It is noteworthy that 11.1 % of the patients had TMJ pain pre surgery which changed to 2.5 % in duration of three months and 7.4 % after six months post surgery. The obtained results show that incidence of TMJ pain is greatly reduced at three months post surgery in comparison with pre surgery results (p=0.02). In addition, the average of maximum mouth opening is reported as 47.6, 32.4 and 40.1 (mm) before surgery, three and six months afterwards (significant difference). Click disorder is reported 34.6% before surgery and 12.3% three months and 23.5% six months after surgery which demonstrates the remarkable reduction at time of three months later (p=0.0001) and six months after (p=0.004) in comparison with pre surgery. Conclusion: This study is also illustrated that although orthognathic surgery has no significantly effect on the limitation of maximum mouth opening, it causes to improve the TMJ pain and temporomandibular click of patients with skeletal Cl II malocclusion.
[1] Chuang SY. Incidence of temporomandibular disorders (TMDs) in senior dental students in Taiwan. J Oral Rehabil. 2002; 29: 1206-11.
[2] Okeson JP. Management of Temporomandibular Disorders and Occlusion-E-Book. Elsevier Health Sciences. 2014.
[3] Kaplan, Andrew S, Leon A, et al. Assael :Temporomandibular disorders: diagnosis and treatment. WB Saunders Company. 1991.
[4] Fonseca RJ, Barber HD, Powers MP, Frost DE, et al. Oral Maxillofac Trauma-E-Book. Elsevier Health Sciences. 2013.
[5] Dujoncquoy JP, Ferri J, Raoul G, Kleinheinz J, et al. Temporomandibular joint dysfunction and orthognathic surgery: a retrospective study. Head & face medicine. 2010; 6:27.
[6] Fang B, Shen GF, Yang C, Wu Y, Feng YM, Mao LX, Xia YH, et al. Changes in condylar and joint disc positions after bilateral sagittal split ramus osteotomy for correction of mandibular prognathism. Int J Oral Maxillofac Sur. 2009; 38:726-30.
[7] Abrahamsson C, Ekberg EC, Henrikson T, Nilner M, Sunzel B, Bondemark L, et al. TMD in consecutive patients referred for orthognathic surgery. Angle Orthod. 2009; 79:621.
[8] Farella M, Michelotti A, Bocchino T, Cimino R, Laino A, Steenks MH, et al. Effects of orthognathic surgery for class III malocclusion on signs and symptoms of temporomandibular disorders and on pressure pain thresholds of the jaw muscles. Int J Oral Maxillofac Sur. 2007; 36:583-7.
[9] Wolford LM, Reiche-Fischel O, Mehra P, et al. Changes in temporomandibular joint dysfunction after orthognathic surgery. J Oral Maxillofac sur 2003; 61:655-60.
[10] Dervis E, Tuncer E. Long-term evaluations of temporomandibular disorders in patients undergoing orthognathic surgery compared with a control group. Oral Sur Oral Med Oral Pathol Oral Radiol. 2002; 94:554-60.
[11] Westermark A, Shayeghi F, Thor A, et al. Temporomandibular dysfunction in 1,516 patients before and after orthognathic surgery. Int J Adult Orthodod Orthog Sur. 2001; 216:145-51.
[12] Panula K, Somppi M, Finne K, Oikarinen K, et al. Effects of orthognathic surgery on temporomandibular joint dysfunction. Int J Oral Maxillofac Sur. 2000; 29:183-7.
[13] Gaggl A, Schultes G, Santler G, Kärcher H, Simbrunner J, et al. Clinical and magnetic resonance findings in the temporomandibular joints of patients before and after orthognathic surgery. Br J Oral Maxillofac Sur. 1999; 37:41-5.
[14] Egermark I, Blomqvist JE, Cromvik U, Isaksson S, et al. Temporomandibular dysfunction in patients treated with orthodontics in combination with orthognathic surgery. Euro J Orthod. 2000; 22:537-44.
[15] Yamada K, Hanada K, Hayashi T, Ito J, et al. Condylar bony change, disk displacement, and signs and symptoms of TMJ disorders in orthognathic surgery patients. Oral Sur Oral Med Oral Patho Oral Radiol Endod. 2001 ; 91:603-10.
[16] Aoyama S, Kino K, Kobayashi J,Yoshimasu H, Amagasa T, et al. Clinical evaluation of the temporomandibular joint following orthognathic surgery—Multiple logistic regression analysis—. J Med Den Sci. 2005; 52:109-14.
[17] Lee JA, Yun KI, Kim CH, Park JU, et al. Articular disc position in association with mandibular setback surgery. Oral Sur Oral Med Oral Pathol Oral Radiol Endod. 2008; 105:19-21.
[18] Al-Riyami S, Cunningham SJ, Moles DR, et al. Orthognathic treatment and temporomandibular disorders: a systematic review. Part 2. Signs and symptoms and meta-analyses. Am J Orthod Dentofac Orthop. 2009; 136:626-e1.
[19] Kalha A. Orthognathic treatment and temporomandibular disorders–part 1. Evidence-based dentistry. 2010; 11:82-3.
[20] Abrahamsson C, Henrikson T, Nilner M, Sunzel B, Bondemark L, Ekberg E, et al. TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment. Int J Oral Maxillofac Sur. 2013 ;42:752-8.
[21] Scolozzi P, Wandeler PA, Courvoisier DS, et al. Can clinical factors predict postoperative temporomandibular disorders in orthognathic patients? A retrospective study of 219 patients. Oral Sur Oral Med Oral Pathol Oral Radiol. 2015; 119:531-8.
[22] Han YS, Jung YE, Song IS, Lee SJ, Seo BM, et al. Three-dimensional computed tomographic assessment of temporomandibular joint stability after orthognathic surgery. J Oral Maxillofac Sur. 2016; 74:1454-62.
[2] Okeson JP. Management of Temporomandibular Disorders and Occlusion-E-Book. Elsevier Health Sciences. 2014.
[3] Kaplan, Andrew S, Leon A, et al. Assael :Temporomandibular disorders: diagnosis and treatment. WB Saunders Company. 1991.
[4] Fonseca RJ, Barber HD, Powers MP, Frost DE, et al. Oral Maxillofac Trauma-E-Book. Elsevier Health Sciences. 2013.
[5] Dujoncquoy JP, Ferri J, Raoul G, Kleinheinz J, et al. Temporomandibular joint dysfunction and orthognathic surgery: a retrospective study. Head & face medicine. 2010; 6:27.
[6] Fang B, Shen GF, Yang C, Wu Y, Feng YM, Mao LX, Xia YH, et al. Changes in condylar and joint disc positions after bilateral sagittal split ramus osteotomy for correction of mandibular prognathism. Int J Oral Maxillofac Sur. 2009; 38:726-30.
[7] Abrahamsson C, Ekberg EC, Henrikson T, Nilner M, Sunzel B, Bondemark L, et al. TMD in consecutive patients referred for orthognathic surgery. Angle Orthod. 2009; 79:621.
[8] Farella M, Michelotti A, Bocchino T, Cimino R, Laino A, Steenks MH, et al. Effects of orthognathic surgery for class III malocclusion on signs and symptoms of temporomandibular disorders and on pressure pain thresholds of the jaw muscles. Int J Oral Maxillofac Sur. 2007; 36:583-7.
[9] Wolford LM, Reiche-Fischel O, Mehra P, et al. Changes in temporomandibular joint dysfunction after orthognathic surgery. J Oral Maxillofac sur 2003; 61:655-60.
[10] Dervis E, Tuncer E. Long-term evaluations of temporomandibular disorders in patients undergoing orthognathic surgery compared with a control group. Oral Sur Oral Med Oral Pathol Oral Radiol. 2002; 94:554-60.
[11] Westermark A, Shayeghi F, Thor A, et al. Temporomandibular dysfunction in 1,516 patients before and after orthognathic surgery. Int J Adult Orthodod Orthog Sur. 2001; 216:145-51.
[12] Panula K, Somppi M, Finne K, Oikarinen K, et al. Effects of orthognathic surgery on temporomandibular joint dysfunction. Int J Oral Maxillofac Sur. 2000; 29:183-7.
[13] Gaggl A, Schultes G, Santler G, Kärcher H, Simbrunner J, et al. Clinical and magnetic resonance findings in the temporomandibular joints of patients before and after orthognathic surgery. Br J Oral Maxillofac Sur. 1999; 37:41-5.
[14] Egermark I, Blomqvist JE, Cromvik U, Isaksson S, et al. Temporomandibular dysfunction in patients treated with orthodontics in combination with orthognathic surgery. Euro J Orthod. 2000; 22:537-44.
[15] Yamada K, Hanada K, Hayashi T, Ito J, et al. Condylar bony change, disk displacement, and signs and symptoms of TMJ disorders in orthognathic surgery patients. Oral Sur Oral Med Oral Patho Oral Radiol Endod. 2001 ; 91:603-10.
[16] Aoyama S, Kino K, Kobayashi J,Yoshimasu H, Amagasa T, et al. Clinical evaluation of the temporomandibular joint following orthognathic surgery—Multiple logistic regression analysis—. J Med Den Sci. 2005; 52:109-14.
[17] Lee JA, Yun KI, Kim CH, Park JU, et al. Articular disc position in association with mandibular setback surgery. Oral Sur Oral Med Oral Pathol Oral Radiol Endod. 2008; 105:19-21.
[18] Al-Riyami S, Cunningham SJ, Moles DR, et al. Orthognathic treatment and temporomandibular disorders: a systematic review. Part 2. Signs and symptoms and meta-analyses. Am J Orthod Dentofac Orthop. 2009; 136:626-e1.
[19] Kalha A. Orthognathic treatment and temporomandibular disorders–part 1. Evidence-based dentistry. 2010; 11:82-3.
[20] Abrahamsson C, Henrikson T, Nilner M, Sunzel B, Bondemark L, Ekberg E, et al. TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment. Int J Oral Maxillofac Sur. 2013 ;42:752-8.
[21] Scolozzi P, Wandeler PA, Courvoisier DS, et al. Can clinical factors predict postoperative temporomandibular disorders in orthognathic patients? A retrospective study of 219 patients. Oral Sur Oral Med Oral Pathol Oral Radiol. 2015; 119:531-8.
[22] Han YS, Jung YE, Song IS, Lee SJ, Seo BM, et al. Three-dimensional computed tomographic assessment of temporomandibular joint stability after orthognathic surgery. J Oral Maxillofac Sur. 2016; 74:1454-62.
| Files | ||
| Issue | Vol 5, No 4 (Autumn 2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| Temporomandibular disorders Mandibular advancement Pain Click | ||
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How to Cite
1.
Mahmood Hashemi H, Fakhari S, Karimi Avval S. The effect of mandibular advancement on signs and symptoms of the temporomandibular joint. J Craniomaxillofac Res. 2019;5(4):169-173.
