• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권1호
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• pp.50-58
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• 2022

Objectives: Osteoarthritis (OA) is the most prevalent and disabling joint disease in the world. Temporomandibular joint (TMJ) exercise is a widely used treatment and could be a beneficial and long-term tool for treating TMJ OA. The present study aims to evaluate the effects of therapeutic exercise in the conservative treatment of TMJ OA. Materials and Methods: A single-group experimental pre-post test was performed. We included patients who met the diagnostic criteria for TMJ OA. Outcome variables were pain intensity (visual analogue scale), functionality (Helkimo index), and structural changes (ultrasound). Follow-up periods were at months 1, 3, and 6. The intervention included a home-based program with thermotherapy, manual therapy, and therapeutic exercise during the entire follow-up period. Results: We included 15 patients and 26 joints, all women with a median age of 57 years (range, 49-62 years). Median change in pain intensity on joint palpation, mouth opening, and at rest at the first month was 47.5 mm, 51 mm, and 60 mm, respectively, and 48 mm, 49.5 mm, and 42.5 mm, at six months (P=0.001). The Helkimo index showed significant improvement in medians from baseline severe dysfunction (17 points) to minimal dysfunction at three and six months (2 points) (P=0.001). Ultrasound showed improved disc position. Conclusion: This study demonstrated significant improvements in pain, function, and joint disc position and represents a valuable tool for the long-term treatment of patients with TMJ OA.

• Journal of Oral Medicine and Pain
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• 제22권1호
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• pp.95-109
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• 1997

The purpose of this research is to investigate the influence on mandibular movements and TMJ sounds with changes of head and neck posture. For the research, twenty patients who had complained of TMJ sounds without any other symptoms of cranio-mandibular disorders, were selected as subjects for measurements of TMJ sounds, and radiographs on transcranial view of TMJ were taken on ten of the subjects. From NHP, UHP, DHP and FHP, aspects of mandibular movement and TMJ sound were investigated from each posture. Aspects of mandibular movement and TMJ sound were observed by measuring total vibration energy(Integral), peak amplitude, maximum amound of mouth opening, and TMJ sound-emitting point using Sonopak for windows (version 1.33) and Bio-EGN(Bioresearch Inc. WI. U.S.A.). Head and neck movement-measuring instrument, CROM(perfomance attainment Inc. U.S.A.) was to maintain even head posture. Degrees of inclination of UHP and DHP were determined at 30' and distance of FHP was 4cm. The results obtained were as follows. 1. Total vibration energy and peak amplitude of TMJ sounds were decreased more on UHP and on UHP and increased more on DHP and FHP than that on NHP. 2. At the maximum mouth opening, distance of TMJ sound-emitting point were decreased more on UHP and increased more on DHP and FHP than that on NHP. 3. The amounts of the maximum mouth opening were increased more on UHP and decreased more on DHP and FHP than that on NHP. 4. For the changes of the head posture with mouth opening observed in radiograph, condylar head was positioned more lower-anteriorly on UHP, and more upper-posteriorly on DHP and FHP than that on NHP. From the results obtained as above, considering positive influence of the change of head and neck posture, avoiding down-head and forward-head posture, and recommending upper- head posture can prevent the progress of temporomandibular disorder and lead to successful treatment for the patients with temporomandibular joint sounds.

• International Journal of Oral Biology
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• 제35권3호
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• pp.83-89
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• 2010

We investigated the role of the central MAPK pathways in extra-territorial (referred) pain resulting from inflammation of the temporomandibular joint (TMJ). Experiments were carried out on male Sprague-Dawley rats weighing 220-280 g. Under anesthesia, these animals were injected with $50\;{\mu}L$ of complete Freund's adjuvant (CFA) into the TMJ using a Hamilton syringe. In the control group, saline was injected into the TMJ. To identify the extent of inflammation of the TMJ, Evans blue dye (0.1%, 5 mg/kg) was injected intravenously at 1, 3, 6, 9, 12 and 15 days after CFA injection. The concentration of Evans blue dye in the extracted TMJ tissue was found to be significantly higher in the CFA-treated animals than in the saline-treated group. Air-puff thresholds in the vibrissa pad area were evaluated 3 days before and at 3, 6, 9, 12, 15 and 18 days after CFA injection into the TMJ. Referred mechanical allodynia was established at 3 days, remained until 12 days, and recovered to preoperative levels at 18 days after CFA injection. This referred mechanical allodynia was observed in contralateral side area. To investigate the role of central MAPK pathways, MAPK inhibitors ($10\;{\mu}g$) were administrated intracisternally 9 days after CFA injection. SB203580, a p38 MAPK inhibitor, significantly attenuated referred mechanical allodynia, as compared with the vehicle group. PD98059, a MEK inhibitor, also reduced CFA-induced referred mechanical allodynia. These results suggest that TMJ inflammation produces extra-territorial mechanical allodynia, and that this is mediated by central MAPK pathways.

• 치위생과학회지
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• 제15권6호
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• pp.800-806
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• 2015

이 연구는 triptolide와 L-NAME의 측두하악관절 통증조절효과를 확인하기 위하여 포르말린으로 유도된 측두하악관절 통증모델에서 triptolide와 L-NAME의 소뇌연수조 내 각각의 얄물의 단독 투여에 따른 통증행위반응과 두 약물의 병용 투여에 따른 상호작용이 통증행위반응에 미치는 영향을 평가하여 다음과 같은 결과를 얻었다. 먼저, 관절강 내로 주입한 5% 포르말린($30{\mu}l$)은 유의한 통증행위반응을 유발하였고, 2차 통증행위반응 관찰 시 포르말린 주입 전 $1{\mu}g/10{\mu}l$ triptolide 투여군($163.33{\pm}29.11$회)은 포르말린군($308{\pm}33.04$회)과 비교 시 통증행위반응이 유의하게 감소하였다. $0.1{\mu}g/10{\mu}l$의 L-NAME 투여군의 1, 2차 통증행위반응의 결과, 각각 $5.80{\pm}3.75$회, $92.30{\pm}16.04$회로 포르말린 주입군 $25.4{\pm}6.59$회, $285.60{\pm}29.93$회와 비교 시 유의하게 감소되었다. 다음으로, $1{\mu}g/10{\mu}l$의 triptolide와 $0.01{\mu}g/10{\mu}l$의 L-NAME 병용 투여군에서 1, 2차 통증행위반응이 $0.80{\pm}0.80$회, $96.50{\pm}26.16$회로 나타나 $22.50{\pm}19.15$회, $163.33{\pm}29.11$회로 나타난 $1{\mu}g/10{\mu}l$ trtiptolide군과 비교 시 유의하게 통증행위반응이 경감되었다. 이러한 연구결과는 측두하악관절 통증조절의 예방 및 치료에 있어 활용가능한 천연물로 triptolide가 제시될 수 있으며, 천연물과 화합물들의 병용 투여를 통해 그 효과를 증가시킬 수 있을 것으로 기대된다.

• Imaging Science in Dentistry
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• 제44권4호
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• pp.293-299
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• 2014

Purpose: This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. Materials and Methods: The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the $X^2$ test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results: Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p<0.05). However, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ (G1) was not related to joint effusion in TMD patients (p>0.05). Conclusion: Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

• 치위생과학회지
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• 제17권1호
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• pp.65-72
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• 2017

실험동물의 TMJ 내에 포르말린으로 유도한 염증성 통증 모델에서 홍삼 및 흑삼 추출물이 통증 발생과 조절에 미치는 영향을 평가하고자 하였다. 홍삼 혹은 흑삼 추출물을 TMJ 내에 투여한 후 통증 행위반응의 변화를 관찰하였고, 또한 실험동물의 연수를 적출하여 Nrf2 경로의 활성 변화를 단백정량분석법을 활용해서 분석한 결과 먼저, 포르말린을 TMJ에 주입한 결과 안면부 통증행위반응이 유의하게 증가되었다. 이것을 토대로 홍삼 및 흑삼 추출물의 경구 투여한 결과 포르말린에 의해 유도된 실험동물에서 통증행위 반응이 효과적으로 감소되었고, 단회투여보다 반복투여가 포르말린 2차 통증행위반응 경감에 더 효과적으로 나타났다. 또한 홍삼 및 흑삼 추출물의 반복 투여 시 포르말린에 주입에 의해 증가된 연수에서의 Nrf2 단백 발현량을 감소시켰고, 간과 신장의 독성검사에서도 영향을 미치지 않는 것으로 나타났다. 따라서, 본 연구에서 홍삼 및 흑삼 추출물은 간과 신장을 부작용을 나타내지 않으면서 포르말린으로 유도된 안면부 통증과 Nrf2의 발현의 조절에 효과적인 것으로 나타났다.

• Journal of Oral Medicine and Pain
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• 제48권1호
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• pp.25-30
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• 2023

We present the case of a 60-year-old male with post-macrotrauma disc displacement and retrodiscitis, in which temporomandibular joint (TMJ) injection and manual therapy were used to alleviate his symptoms. He visited our clinic with complaints of pain and swelling in his right facial area and malocclusion of his right side teeth after being hit on the right side of his face five days earlier. During clinical and radiological examinations, the inflammatory state of the joint and disc displacement on the right side, which led to malocclusion, were noted. At the initial visit, we performed TMJ intracapsular injection and prescribed medications to control pain and inflammation. Simultaneously, manual manipulation was performed to relocate the disc. The same treatments were employed two days later. However, 10 days after the first visit, his symptoms did not mitigate substantially. We also performed magnetic resonance imaging (MRI), prescribed nortriptyline, and created a stabilization splint. MRI images depicted inflammatory disc displacement and joint effusion in the right TMJ. Based on the accurate diagnosis, we kept administering a stabilization splint, intra-articular injection, and medication. His signs and symptoms were alleviated 20 days after the initial visit and did not reoccur for the next 40 days.

• Journal of Oral Medicine and Pain
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• 제10권1호
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• pp.63-71
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• 1985

A kinematical study of bite force during voluntary isometric contraction was investigated in 20 Korean men with TMJ dysfunction and 30 Korean men as normal subject, ranging from 20 to 27 years old. The author observed maximum bite force, slope of bite force graph, curve index and duration of maximum bite force with the use of the foil strain gauge (MPM-3000) and RS Dymograph (Beckman). The obtained results were as follows : 1. Maximum bite forces were 29kg and 29kg for left and right side of normal subject (p>0.05) and 19kg and 29kg for affected and non-affected side of TMJ dysfunction patient. 2. The slopes of bite force graph were $68^{\circ}$ and $68^{\circ}$ for left and right side of normal subject (p>0.05) and $59^{\circ}$ and $71^{\circ}$ for affected and non-affected side of TMJ dysfunction patient. (p<0.01) 3. The curve indices were 0.93 and 0.90 for left and right side of normal subject and 1.10 and 0.90 for affected and non-affected side of TMJ dysfunction patient. (p>0.05) 4. The durations of maximum bite force were 424 msec and 413 msec for left and right side of normal subject and 337 msec and 334 msec for affected and non-affected side of TMJ dysfunction patient. (p>0.05)

• 대한치과교정학회지
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• 제42권3호
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• pp.144-154
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• 2012

This article reports the orthodontic treatment of a patient with skeletal mandibular retrusion and an anterior open bite due to temporomandibular joint osteoarthritis (TMJ-OA) using miniscrew anchorage. A 46-year-old woman had a Class II malocclusion with a retropositioned mandible. Her overjet and overbite were 7.0 mm and -1.6 mm, respectively. She had limited mouth opening, TMJ sounds, and pain. Condylar resorption was observed in both TMJs. Her TMJ pain was reduced by splint therapy, and then orthodontic treatment was initiated. Titanium miniscrews were placed at the posterior maxilla to intrude the molars. After 2 years and 7 months of orthodontic treatment, an acceptable occlusion was achieved without any recurrence of TMJ symptoms. The retropositioned mandible was considerably improved, and the lips showed less tension upon lip closure. The maxillary molars were intruded by 1.5 mm, and the mandible was subsequently rotated counterclockwise. Magnetic resonance imaging of both condyles after treatment showed avascular necrosis-like structures. During a 2-year retention period, an acceptable occlusion was maintained without recurrence of the open bite. In conclusion, correction of open bite and clockwise-rotated mandible through molar intrusion using titanium miniscrews is effective for the management of TMJ-OA with jaw deformity.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.14.1-14.11
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• 2015

The aim of this article is to review temporomandibular joint symptoms as well as the effects of orthognathic surgery(OGS) on temporomandibular joint(TMJ). The causes of temporomandibular joint disease(TMD) are multifactorial, and the symptoms of TMD manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ, Joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. Treatment must be started based on the proper diagnosis, and almost symptoms could be subsided by reversible options. Minimally invasive options and open arthroplasty are also available following reversible treatment when indicated. TMD manifesting in a variety of symptoms, also can apply abnormal stress to mandibular condyles and affect its growth pattern of mandible. Thus, adaptive developmental changes on mandibular condyles and post-developmental degenerative changes of mandibular condyles can create alteration on facial skeleton and occlusion. The changes of facial skeleton in DFD patients following OGS have an impact on TMJ, masticatory musculature, and surrounding soft tissues, and the changes of TMJ symptoms. Maxillofacial surgeons must remind that any surgical procedures involving mandibular osteotomy can directly affect TMJ symptoms, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and OGS.