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Mandibular movements in older people with rheumatoid arthritis.
Andrade, KM, Alfenas, BF, Campos, CH, Rodrigues Garcia, RC
Oral surgery, oral medicine, oral pathology and oral radiology. 2017;(5):e153-e159
Abstract
OBJECTIVE The aim of this study was to compare the mandibular movements in older people with and without temporomandibular disorder (TMD) associated with rheumatoid arthritis (RA). STUDY DESIGN Thirty partially or completely edentulous older adults (65.33 ± 4.7 years) were assigned to 2 groups: (1) with RA and TMD and (2) without RA and TMD. Chewing movements of the jaws during mastication of the test material (Optocal) and the range of mandibular movements were evaluated by using the JT-3-D kinesiographic device before and after new removable prosthesis insertion. Multiple comparisons were made with analysis of variance (ANOVA) and the Tukey-Kramer test. RESULTS Comparisons between the 2 groups before and after new prosthesis insertion revealed that the RA and TMD group had reduced opening angles (P < .05) during chewing. After insertion of new prostheses, both groups showed increased opening and closing angles during chewing (P < .05). The mandibular range of motion results showed that patients with RA and TMD exhibited lower aperture and laterality movements (P < .05) compared with controls before and after new prosthesis insertion. However, there was an increase in aperture, lefty laterality, and protrusion values after new prosthesis insertion in both groups. CONCLUSIONS TMD associated with RA may impair mandibular movements. Well-fitted prostheses may improve mandibular movements in older adults, especially those with RA.
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2.
Comparison of gap arthroplasty with and without a temporalis muscle flap for the treatment of ankylosis.
Danda, AK, S, R, Chinnaswami, R
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2009;(7):1425-31
Abstract
PURPOSE The purpose of this study was to compare gap arthroplasty with and without a temporalis muscle flap for the treatment of ankylosis. MATERIALS AND METHODS Sixteen patients with temporomandibular joint ankylosis from 2001 to 2006 were included in the study, of which 7 were female and 9 were male. Fourteen patients had unilateral ankylosis and 2 patients had bilateral ankylosis. Sixteen patients were divided into 2 groups with 8 patients in each group. In group I patients, gap arthroplasty was performed with a mean follow-up of 20.3 months and in group II patients, interpositional arthroplasty with temporalis myofacial flap was performed with a mean follow-up of 23.1 months. All patients were assessed for mouth opening, diet consistency, and weight postoperatively. All patients were subjected to postoperative mouth opening exercises from the second postoperative day. RESULTS There is no significant difference in postoperative mouth opening, diet consistency, and weight of the patients in both groups. Reankylosis occurred in 1 patient in both groups. CONCLUSIONS We conclude that there is no significant difference in maximal interincisal opening, diet scores, and weight of the patients in both groups. The overall outcome of the treatment depends on patient cooperation, active physiotherapy, and regular follow-up.
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3.
A new, noninvasive approach for successfully treating the pain and inflammation of TMJ disorders.
Hodosh, M, Hodosh, SH, Hodosh, AJ
The Journal of oral implantology. 2007;(6):365-70
Abstract
This article introduces a new topical gel and method for rapidly relieving temporomandibular joint (TMJ), muscles of mastication, and myofacial pain while uniquely inhibiting the associated destructive chronic inflammation. The gel (composed of 18% potassium complex, 10% dimethylisosorbide, and 72% aqueous hydroxyethyl cellulose gel) was applied and gently rubbed onto the facial skin over the painful TMJs, muscles of mastication, and myofacial areas. The gel was applied as soon as clinicians identified the TMJ disorder, as the authors have found that the gel routinely and predictably provides rapid pain relief and patient comfort and speeds restoration of the jaw's functional abilities, usually within 5 minutes after it is applied. The relief is attributable to the combined ability of potassium and dimethylisosorbide to inhibit inflammation and pain. These dynamic results have led the authors to recommend that the gel be applied as a first-step procedure before trying to definitively diagnose and treat the cause(s) of the patients' pain and dysfunction. Once the pain had been eliminated as a complicating factor, a diagnosis and treatment plan concerning the jaw's biomechanical problems may be identified and dealt with. The ability to remove pain and inflammation as a first measure before making a definitive diagnosis and treatment plan minimizes patient anxiety, depression, and psychological concerns. Subsequent diagnosis and treatment of the biomechanical disorder(s) related to TMJ are then more easily and effectively accomplished.
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4.
Prospective multicenter comparison of 4 temporomandibular joint operations.
Hall, HD, Indresano, AT, Kirk, WS, Dietrich, MS
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2005;(8):1174-9
Abstract
PURPOSE This study was designed to compare the outcomes of 4 operations used for the treatment of painful temporomandibular joints with an internal derangement. PATIENTS AND METHODS A prospective, controlled study of arthroscopy, condylotomy, discectomy, and disc repositioning was conducted at 3 sites. All sites used the same inclusion and exclusion criteria. Trained, independent examiners assessed pain, diet, and range of motion before operation and 1 month and 1 year after operation. RESULTS There were statistically significant reductions in the amount of pain ( P < .001) and daily time in pain ( P < .001) that were similar for all 4 operations 1 month and 1 year after the procedures. The degrees of change after each of the 4 procedures were not statistically different from each other (amount: P = .453 and time: P = .416). Ability to chew, as measured by diet visual analog scale, was substantially improved 1 year after operation ( P < .001). The degrees of change for diet at 1 year also were not different from each other ( P = .314). There were, however, statistically significant differences ( P < .05) in range of motion that varied with procedure. CONCLUSIONS All 4 operations were followed by marked improvements in pain and diet. The amounts of improvement varied slightly by operation, but these differences were not statistically significant. There were small but statistically significant differences between procedures for range of motion. If these findings are confirmed, they have an important implication for procedure selection.
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5.
Total prosthetic replacement of the TMJ: experience with two systems 1988-1997.
Speculand, B, Hensher, R, Powell, D
The British journal of oral & maxillofacial surgery. 2000;(4):360-9
Abstract
We report our experience with the Vitek VK II and the Christensen systems for total prosthetic replacement of the temporomandibular joint, in 62 patients treated between 1988 and 1997. Thirteen were treated in Birmingham and 49 in Gloucester. A total of 86 joints were replaced, of which 27 (31%) were Vitek VK II and 59 (69%) were Christensen prostheses. Just over half of the patients were treated for degenerative arthropathy or osteoarthritis, and the second most common diagnosis was rheumatoid arthritis. Twenty-five patients had had previous operations. The median follow-up was 14.5 months (range 1-120). Preoperatively only 14 patients (23%) could eat all types of food - and postoperatively this increased to 48 (77%). Thirty-nine patients (63%) reported severe pain preoperatively compared with three (5%) postoperatively. No prostheses were rejected, but four patients required replacement of Vitek VK II by Christensen prostheses; all four showed histological evidence of a foreign body giant cell reaction. The overall success rate was 58/62 patients and 81/86 joints replaced (94% in each case). However, for the Vitek VK II system alone the success rate was 14/17 patients (82%) and 24/27 joints replaced (89%).