• Journal of Periodontal and Implant Science
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• 제47권4호
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• pp.211-218
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• 2017

Purpose: The purpose of the present study was to perform a pattern analysis in patients with temporomandibular disorder (TMD) resulting from unilateral mastication due to chronic periodontitis. Methods: Thirty participants with signs or symptoms of TMD who engaged in unilateral mastication due to periodontitis-related discomfort (test group) were selected. Another 30 subjects exhibiting signs or symptoms of TMD resulting from unilateral mastication not due to chronic periodontitis (control group) were also recruited. An interview-based questionnaire was administered, and an examination of the temporomandibular joint (TMJ) with determination of periodontal status was performed. Results: The duration of unilateral mastication was significantly longer in the control group than in the test group. There was a significant negative correlation between the duration of unilateral mastication and the Community Periodontal Index score. Using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I algorithms, all the subjects were assigned to 3 main groups. The test group exhibited significantly a higher diagnostic distribution of group III (arthralgia, osteoarthritis, or osteoarthrosis), and in both the test and control groups, the number of diagnoses was larger for the non-chewing side. The control group showed a significantly higher diagnostic distribution of group I (myofacial pain), and in both the test and control groups, the number of diagnoses was larger for the chewing side. Conclusions: The results of the present study indicate that unilateral mastication due to chronic periodontitis could induce not only pain but also structural TMJ changes if adequate treatment is not administered and supported within a short time from the onset of the condition. Therefore, immediate treatment of chronic periodontitis is recommended to prevent not only the primary progress of periodontal disease, but also secondary TMJ-related problems. Furthermore, subjects who have suffered chronic long-term periodontitis without treatment should be urged to undergo a TMJ examination.

• Journal of Oral Medicine and Pain
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• 제20권1호
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• pp.141-158
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• 1995

This study was performed to invetigate the relationship between clinical manifestations related to temporomandibular joint sounds and temporomandibular joint vibrations that occurred synchronously with sounds. There have been reported in many articles that joint sounds indicate internal joint pathology. Therefore, it is necessary to evaluate type and patterns of joint sounds, and radiographic changes of temporomandibular joint(TMJ) in order to diagnose and deal with the Temporomandibular Disorders(TMD). For this study 142 patients with TMDs were collected and they were examined by routine diagnostic procedure for TMDs. The author classified TMJ sounds clinically into 3 types : click, popping, and crepitus. Transcranial and panoramic radiographs were taken for observein bony changes of TMJ, and for observing vibrations of TMJ Sonopak of Biopak system was used. The obtained results were as follows : 1. Female subjects with crepitus were older than those with click or popping and their mean ages were about 45 years old. But in male subjects, there was no age difference. 2. For all subjects, mean value of maximal mouth opening were above 40mm, which are lower limit of normal vertical opening. But in subjects with L-type opening deviation, mouth opening capacity were about 36mm of range. 3. Symptom duration stated when patient presented first were slightly longer in subjects with crepitus but there were no statistical differences. And there were also no radiographic differences among 3 types of joint sounds in regard to symptom duration. 4. In subjects wih click, it might have been interpreted that 12% had closed lock, 12% had degenerative joint disease, and about 17% of he subjects had normal joints by Sonopak. 5. There were no significant relationships between subjective loudness of joint sounds and magnitude of joint vibrations. 6. The highest value of Integral and peak amplitude were observed in popping sounds and though it was not significant, value of peak frequency was highest in crepitus. 7. Amount of mandibular positional change were differed between click and crepitus on frontal plane, between click, crepitus and popping on horizontal plane in rotational movement, respectively. However, there no difference among them in translational movements.

• 치과방사선
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• 제14권1호
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• pp.121-134
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• 1984

The authors analyzed the morphological change of bone structure from 3,140 radiographs (1570 joints) of 785 patients with temporomandibular joint arthrosis, which were obtained by the oblique lateral transcranial projection and orthopantomographs. The interrelation of bone change and clinical symptoms, duration of the diseases were examined. Also, the bone changes of articular eminence, condyle, articular fossa were examined according to positional change of the condyle in the mouth open and close state. The results were as follows. 1. In the 785 patients with TMJ arthrosis, 782 patients (99.62%) show the positional change of the condyle. Among them 691 patients (88.03%) show the bone change. 2. In TMJ arthrosis patients with bone changes 451 patients (65.27%) showed both the condylar positional changes and bone changes bilaterally. 198 patients (28.65%) show the condylar positional changes bilaterally and bone changes unilaterally. 3. The bone changes in the TMJ arthrosis were in order of frequency eburnation (647 cases, 32.8%), erosion (548 cases, 27.79%), flattening (418 cases, 21.20%), deformity (138 cases, 6.99%). sclerosis (115 cases, 5.83%), marginal proliferation (106 cases, 5.38%). The region of bone change in TMJ arthrosis with condylar positional changes were in order of frequency the articular eminence (43.97%) condylar head (38.64%), articular fossa (17.39%). In the patients with bone changes, their clinical symptoms were pain (44.34%), clicking sound (33.5%), limitation of mouth opening (22.52%). In the patients complaining pain the most frequent bone change was erosion (28.60%), in the patients complaining clicking sound, eburnation (28.97%) in the patients complaining the limitation, eburnation (29.40%). Also in the patients with the duration below 1 year most common bone change was eburnation. 5. The most common condylar positional change was downward position (39.94%) in closed state, restricted movement of condyle (30.07%) in open state. The condylar positional changes and bone changes according to the region were as follows: a) In the condylar head the most frequent bone change was erosion (30.45%) and the most frequent condylar positional change was downward position (37.40%) in closed state, restricted movement of condyle (33.2%) in open state. b) In the articular eminence the most frequent bone change was eburnation (39.91%) and the most frequent condylar positional change was downward position (39.79%) in closed state, restricted movement of condyle (27.22%) in open state. c) In the articular fossa the most frequent bone change was eburnation (53.94%) and the most frequent condylar positional change was downward position (42.57%) in closed state, restricted movement of condyle (30.32%) in open state.

• Journal of Oral Medicine and Pain
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• 제32권2호
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• pp.227-239
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• 2007

1994년부터 2006년까지 부산대학교병원 구강내과에 내원하여 측두하악골관절염으로 진단받고 보존적 치료를 받은 환자 101명과 저작근장애로 진단받고 보존적 치료를 받은 환자 74명의 진료기록부를 통해 초진 시와 치료 종결 시의 증상, 시행된 치료방법, 치료기간, 치료횟수에 따른 치료 결과를 조사하였다. 그리고, 측두하악골관절염 환자의 초진 시 방사선 사진, 전산화 단층사진 및 단광자 방출 전산화 단층사진의 양성도, 관절잡음의 치료 전후 변화를 평가하여 다음과 같은 결과를 얻었다. 1. 골관절염군은 보존적 치료에 의해서 치료 결과가 좋았으나, 치료 종결 시 근육장애군에 비해서 증상의 개선이 미흡하였다. 2. 골관절염군의 파노라마 방사선 사진과 경두개 촬영사진의 양성도는 60%정도였으나, 전산화 단층사진과 단광자 방출 전산화 단층사진의 양성도는 90%이상이었다. 3. 치료 종결 시의 골관절염군의 관절잡음은 초진 시에 비해 유의하게 감소하였다. 4. 골관절염군은 대부분 물리치료, 투약, 교합안정장치로, 근육장애군은 대부분 물리치료, 투약으로 증상이 현저히 개선되었다. 5. 골관절염군은 6개월에서 2년의, 근육장애군은 6개월 미만의 치료가 필요하였다. 6. 골관절염군은 10회 이상으로, 근육장애군은 10회 미만의 치료로도 예후가 좋았다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.14.1-14.11
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• 2020

Background: The purpose of this study is to introduce our modified disc plication technique using MITEK mini anchors and to evaluate the clinical outcome for patients with internal derangement (ID) of the temporomandibular joint (TMJ). Patients and methods: We evaluated 65 joints in 46 patients, comprised 32 women and 14 men, who first visited the Asan Medical Center from December 2012 to December 2016. The age of the patients ranged from 14 to 79 years, with a mean age of 36.6 years. The patients presented with joint problems including pain, joint noise, and mouth opening limitation (MOL). Patients who met our inclusion criteria underwent unilateral or bilateral disc repositioning surgery with our minimally invasive disc plication technique using MITEK mini anchors and No. 2-0 Ethibond^® braided polyester sutures. The variables taken into account in this study were the range of maximum mouth opening (MMO), painful symptoms (evaluated with the visual analog scale, VAS), and the type of noise (click, popping, crepitus) in the TMJ. Results: Preoperative examination revealed painful symptoms in 50.7% (n = 35) of the operated joints (n = 69) and the presence of clicks in 56.5% (n = 39). Postoperative examination revealed that 4.3% (n = 3) of the operated joints had painful symptoms with lower intensity than that in the preoperative condition. Additionally, 17.4% (n = 12) had residual noise in the TMJ, among which two were clicking and the other 10 had mild crepitus. The intensity of the postoperative residual noise was significantly decreased in all cases compared to that in the preoperative condition. Among patients with MOL below 38 mm (n = 18), the mean MMO was 31.4 mm preoperatively and 44.2 mm at 6 months postoperatively, with a mean increase of 13.8 mm. A barely visible scar at the operation site was noted during the postoperative observation period, with no significant complications such as facial palsy or permanent occlusal disharmony. Conclusion: Subjective symptoms in all patients improved following the surgery. TMJ disc plication using MITEK mini anchors with our minimally invasive approach may be a feasible and effective surgical option for treating TMJ ID patients who are not responsive to conservative treatment.

• Journal of Oral Medicine and Pain
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• 제37권4호
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• pp.205-211
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• 2012

35세 여자환자가 갑작스런 개구장애와 함께 발생한 급성 교합변화를 주소로 내원하였다. 환자는 이전 수년 동안의 관절잡음의 병력을 가지고 있었으며 관절잡음의 소실과 동시에 개구제한이 발생하였음을 보고하였다. 환자는 개구제한과 함께 개구시 우측 악관절의 통증을 호소하였으며 구강내 교합 검사 시 전치부의 개교합과 함께 하악이 우측으로 전위된 양상이 관찰되었다. 또한 좌측으로의 측방운동량 또한 감소된 것으로 관찰되었다. 자기공명영상에서 우측 악관절에서 비정복성 관절 원판 전방 변위가 관찰되었으며 후방 관절강의 협착이 관찰되었다. 이 환자는 우측 악관절의 비정복성 관절원판 전방변위로 진단되었으며, 급성 교합변화는 변위된 관절원판에 의해 야기된 과두위치의 변화로 초래된 것으로 추정하였다. 처음 3개월간의 물리치료와 약물치료와 병행된 안정교합장치요법에서는 만족할 만한 치료결과를 얻지 못하였으나, 그 다음 약 8개월간 사용된 악간견인장치 치료를 통해서 통증 및 교합변화가 해소되었으며 정상적인 개구량으로 회복되었다. 술후 촬영된 자기공명영상에서 우측 과두가 재형성된 양상을 관찰할 수 있었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권4호
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• pp.758-770
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• 1996

Discectomy is the oldest and most commonly performed operation for the painful temporomandibular joint with internal derangement. It is the one operation for which there are longest follow-up study, with Eriksson, Silver, and Tolvanen et al reporting good results in patients about 30 years after discectomy. About 80% to 90% of patients clinically experience relief from pain and dysfunction after discectomy, and interestingly, the results may improve with time. However such as Myrhaug found headache and Poswillo supposed pain and limitation of movement as postoperative complications, even though this operation had the longest follow-up term, several aspects of discectomy remain unclear. The controversies to discectomy for TMJ with pain and dysfunction have laid emphasis only upon clinical results, and then the histomorphological study was planned to evaluate the morphologic change of TMJ after discectomy. To clarify the nature of the change through an observation on the morphologic changes of articular cartilage and subchondral bone of the condyle resulting from experimental unilateral discectomy in rabbit, the author excised the left articular discs of 12 male rabbits(control 4 rabbits), weighing about 3kg, and at 1, 3, 6, 9 weeks following surgery, harvested both(left surgical site and right nonsurgical sits) TMJ. The specimens were examined with light microscope after H-E and MT stain and the obtained results were as follows. 1. Histopathological features showed thickening of articular zone and active proliferation of fibrocartilaginous zone associated with slight proliferative zone in surgical site than control group. Also replacement of chondrocytes in calcified cartilaginous zone into bone cells was observed. 2. There were thinning of thickness of each zone of articular cartilage except calcified cartilagnous zone was observed in nonsurgical site. 3. In MT stain of condylar trabeculae, there was increased calcification in nonsurgical site than control and surgical site and the degree of calcification was similar in surgical site and control group. 4. In both site of experimental group no features of degenerative changes were observed. From the above results, it is presumed that the morphologic changes of surgical site discectomy are compensatory remodeling process characterized by an hyperplastic reaction of the articular zone and fibrocartilaginous zone filling the void created by removing the disc, and the bone changes are secondary to changes in the cartilage. Increased degree of calcification seen in condylar trabeculae of nonsurgical site results from the excessive use of condyle of that site.

• 구강회복응용과학지
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• 제22권1호
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• pp.29-36
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• 2006

As migraine pain represents a substantial personal and social burden worldwide, there has been a great deal of effort in developing a screening instrument for migraine. Lipton et al(2003) developed and validated the ID Migraine questionnaire, which is a self-administered screener for migraine in primary care, and it is brief and easy to use for a primary care provider. The aim of this study was to determine if the ID Migraine questionnaire could be applied successfully to assess the headache patients with temporomandibular disorders(TMD) and orofacial pain. This study found that nausea, photophobia and headache-related disability had the highest individual sensitivities and specificities, and the performance of the three-item screener was equivalent to that reported in a previous study. Although the sensitivity of the three-item screener in this study (0.58) was lower than in a previous study (0.81), the specificity (0.98) was higher and the positive predictive value was 93.9%. This suggest that the ID Migraine questionnaire is very efficient in this setting. In conclusion, the ID Migraine questionnaire, which is a three-item screener consisting of nausea, photophobia and headache-related disability, is effective as a self-administered report for detecting migraine headaches in patients with temporomandibular disorders(TMD) and orofacial pain.

• Journal of Oral Medicine and Pain
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• 제38권4호
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• pp.357-366
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• 2013

2009년부터 2012년까지 부산대학교치과병원 구강내과에 측두하악장애를 주소로 내원한 만 12세-19세(평균나이 : $15.75{\pm}2.17$세)의 청소년환자 중 임상검사, 방사선검사 및 전산화 단층촬영 (Cone Beam Computed Tomography, CBCT)을 통하여 측두하악관절 골관절염으로 진단되고 하나이상의 과두나 하악와의 관절하골에서 erosive change를 보이는 149명 167개의 관절을 대상으로 하였다. 치료 후 평균 9개월($9.03{\pm}4.64$ 개월) 이후 CBCT를 재촬영하고, 임상검사를 재실시하였다. 구강내과 전문의와 치과 방사선과 전문의가 영상 진단을 하였고, 임상 검사 결과와 CBCT의 영상 결과를 추적 연구 비교하여 다음과 같은 결과를 얻었다. 1. 약물치료, 물리치료, 행동조절치료, 교합안정장치치료를 병행한 환자군은 교합안정장치치료를 병행하지 않은 환자군에 비해 치료 후 통증, 개구제한 증상에서 유의한 증상 개선을 나타냈다. 2. 교합안정장치치료를 병행한 급성환자군은 교합안정장치치료를 병행하지 않은 급성환자군보다 치료 후 통증, 관절잡음, 개구제한이 더 많이 개선되었고, 그 중 통증과 개구제한은 유의한 증상 개선을 보였다. 3. 치료 후 침식을 보이는 하악과두의 골변화 양상은 치료방법에 상관없이 개선되는 방향(improved)으로 진행되었으나, 교합안정장치치료를 병행한 환자군에 비해서 교합압정장치치료를 병행하지 않은 환자군에서는 하악과두의 침식성 골 변화가 더 악화(worsen)되어 나타나는 경우가 많았으며, 반대쪽 하악과두에 새로운 침식이 나타난 경우도 더 많이 관찰되었다.

• 대한치과의사협회지
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• 제53권4호
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• pp.259-265
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• 2015

Recently, oral appliances for treating snoring and obstructive sleep apnea are widely used. Among various appliances, mandibular advancement devices are most effective without serious side effects. Advancement of mandible keep airway open and decrease snoring and/or obstructive apnea events. They can be used as stand-alone therapy or an adjunct to continuous positive air pressure for lowering air pressure. Oral appliances should be applied by dentists who have knowledges and experiences on occlusion and temporomandibular disorders and manage of side effects.