• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권5호
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• pp.370-378
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• 2005

The purpose of this study is that evaluate the distribution and biological roles of TNF-a, interleukin-1${\beta}$(IL-1${\beta}$), interleukin-6(IL-6) and tissue inhibitors of metalloproteinase-1(TIMP-1) in the synovial fliud of patients with non-inflammatory chronic temporomandibular joint(TMJ) disorders in relation to pain during joint movements and magnetic resonance imaging(MRI) findings. TMJ synovial fluids aspirates were obtained from 36 patients (36 joints) with chronic TMJ disorders and from 8 controls(8 joints). Patients were divided to four groups. The control group was from healthy volunteers(8 joints), group I(18 joints) was patients with anterior disc displacement with reduction, group II(5 joints) was patients with disc displacement without reduction and group III (5 joints) was osteoarthritis. The TNF-${\alpha}$, IL-1${\beta}$ and IL-6 levels in the aspirates were determined by using an enzyme-linked immunosorbent assay and the TIMP-1 level was measured by an enzyme immunoassay. Following examinations for pain during joint movements and MRI observations, these cytokines' level and frequencies of detection were compared. The level of IL-1${\beta}$was not significant different in all groups. but the level of TNF-${\alpha}$, IL-6 and TIMP-1 were significant different among groups. The level of IL-6 and TIMP-1 were correlated to pain during movement(p<0.01) and the level of TNF-a(p<0.05). Also, the level of IL-6 was correlated to the level of TIMP-1(p<0.01). Especially, The level of the TIMP-1 level was significantly correlated to the pain during movement and showed very high levle of Pearson's correlation coefficient (r=0.833)(p<0.001). The results indicated that the TNF-${\alpha}$, IL-6 and TIMP-1 levels in the TMJ aspirates of patients with chronic TMJ disorders have been raised. Especially, IL-6 and TIMP-1 were very high levels in the patients who were degraded in the TMJ. Also, TNF-${\alpha}$, IL-6 and TIMP-1 showed the significant correlation in the chronic temporomandibular joint disorders. Therefore I suggest that these cytokines were also correlated to the pain during movement in the chronic temporomandibular joint disorders.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권1호
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• pp.35-42
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• 2003

Purpose: This study was aimed to investigate the relationship between the mandibular asymmetry and the internal derangement of temporomandibular joint. Materials and methods: One hundred and sixty eight patients had been assessed through clinical examinations, panoramic radiographs and magnetic resonance imagings (MRIs), were selected. The samples were classified into three subgroups according to the severity of the mandibular asymmetries in the panoramic radiographs and the status of TMJ discs on the MRI were compared among each groups. Results: In an apparent asymmetry group, there was a significant difference in the number of temporomandibular disk displacement without reduction between the long and short side (66.7%, 18/27 joints on the short side) when the ratio of condylar process and coronoid process was used (p<0.05), but there was no statistically significant difference when the ratio of condyle and ramus was used. Conclusion: The probability of the disc displacement without reduction was higher at the side with relatively shorter condylar process on the panoramic radiograph, and also it might be more effective to use ratio of condylar process and coronoid process in the assessment of mandibular asymmetry. Therefore, a careful assessment on the temporomandibular disorders is necessary to diagnose and establish the treatment plans for the patients with a mandibular asymmetry and the panoramic radiograph can be used effectively on that way.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권6호
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• pp.403-410
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• 2009

Those composing temporomandibular joint (TMJ) complex such as the temporal bone, the disc and the mandibular condyle perform their own functions with organic relation. The retrodiscal tissue is the main area of pain induction and contributes to compositional change of synovial fluid. If displacement of the disc lasts long time, not only adaptive changes, but also destructive or degenerative changes may happen. It was reported that these changes and symptoms appear mostly to female rather than male and especially, in the case of patients suffering from TMJ disorder, a large quantity of female sex hormone is found in the joint synovium. And that may play a role in bone resorption and inflammation. Also, the frequency and the intensity of pain perception for female is reported to be much more than for male. In this study, we investigated the expression extents of estrogen receptors (ER) and progesteron receptors (PR) in retrodiscal tissue with immunohistochemistry among the patients received TMJ surgery and compared with MRI findings and surgical findings. We report the relations between the expression of ER in retrodiscal tissue and the pathological change in TMJ, such as inflammation, internal derangement and osteoarthritis.

• 치과방사선
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• 제22권2호
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• pp.351-364
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• 1992

Internal derangement of the temporomandibular joint can be defined an abnormal relationships of the meniscus relative to the mandibular condyle, articuar fossa and eminence. This may cause variable mandibular dysfunctions and pain. For diagnosis, arthrography, computed tomography and magnetic resonance imaging are used. In this study, the author reviewed 98 TMJs of 88 patients who were diagnosed as internal derangement througth inferior joint space arthrography at the department of Oral & Maxillofacial Radiology, Dental Hospita, Dankook university through 1986 to 1992. 98 TMJs consisting of 30 disc displcement with reduction, 48 disc displcement without reduction and 20 perforation were studied about clinical and radiological findings. The results were as follows: 1. Internal derangement was found most frequently in the 2nd 3rd decades and the average age of perforation was higher than that of disc displcement with higher than that of disc displcement with reduction. The sexual predilection was 2 times hiher in females. 2. The most frequent chief complaints were TMJ sound in disc displcement with reduction, pain and limitation of mouth opening in disc displcement without reduction and pain in perforation. The duration of the chief complaints was longer in disc displcement with reduction with than in preforation and disc displcement without reduction. 3. Reciprocal click was the most frequently TMJ sound in disc displcement with reduction. History of joint sound in disc displcement without reduction an crepitus in perforation was the most frequent one. 4. The average maximum opening was 45.4㎜ in disc displcement with reduction, 31.4㎜ in disc displcement without reduction and 33.8㎜ in perforation. 5. In the centric occlusion, posterior condylar position was the most frequent in disc displcement with reduction. posterior and concentric condylar position was frequent in disc displcement without reduction, concentric and anterior condylar position in perforation. At 1 inch opening, the same position to articular eminence was most frequently found in disc displcement with reduction, posterior position in disc disp1cement without reduction, posterior and nterior position in perforation was frequently found. 6. Bony changes, especially sclerosis and flattening, was most frequently found in perforation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권3호
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• pp.139-144
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• 2012

This study was performed in order to evaluate the occurrence of temporomandibular joint disorder after surgical correction of skeletal class II malocclusion. Materials and Methods: This study included 21 patients who underwent orthognathic surgery for the correction of dentofacial deformities by a single surgeon at Mokdong Hospital, Ewha Womans University from 2000 to 2010. They underwent bilateral sagittal split ramus osteotomy for the treatment of undesirable mandibular advancement. The temporomandibular disorder (TMD) symptoms prior to surgery were recorded and the radiographic evaluation (panorama, bone scan, and magnetic resonance imaging [MRI]) of the post-surgery temporomandibular joint (TMJ) were assessed in order to evaluate condylar resorption, remodeling and disc displacement. The minimum follow-up period, including orthodontic treatment, was 12 months. Orthognathic procedures included 1-jaw surgery (n=8 patients) and 2-jaw surgery (n=13 patients). The monocortical plate was used for bilateral sagittal split ramus osteotomy fixation. Results: Among class II malocclusion patients with TMD symptom, clicking improved in 29.1%, and maximum mouth opening increased from $34.5{\pm}2.1$ mm to $37.2{\pm}3.5$ mm. The differences were not statistically significant, however. Radiographic changes in bone scan improved slightly based on the report by radiologist but not in TMJ dynamic MRI. Conclusion: No particular improvements were found in patients with joint sound only. Patients with limitation of mouth opening showed an increase in the degree of opening, but the difference was not statistically significant (P>0.05).

• Journal of Oral Medicine and Pain
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• 제30권2호
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• pp.239-246
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• 2005

본 연구는 측두하악장애환자와 정상인 간 그리고 측두하악장애환자의 분류에 따른 하악과두와 하악지 비대칭지수를 파노라마 방사선사진에서 비교하여 측두하악장애환자의 진단 및 치료계획 수립에 도움이 되고자 본 연구를 시행하였다. 측두하악장애환자 120명과 정상인 30명의 파노라마 방사선사진을 촬영후, 투사도를 작성하였다. 그리고 파노라마 방사선사진 계측항목 계측치의 평균값과 표준편차를 측두하악장애환자와 정상인으로 구분하여 산출한 다음 비대칭지수식을 이용하여 비대칭지수를 산출하여 양군 간의 비교분석을 시행하여 다음과 같은 결과를 얻었다. 1. 측두하악장애군과 대조군 간 하악과두 수직비대칭지수는 유의한 차이를 보였으나, 하악지 수직비대칭지수에서는 유의한 차이를 보이지 않았다. 2. 관절장애군과 근육장애군의 하악과두 수직비대칭지수는 대조군에 비해 더 크게 나타났지만, 관절장애군과 근육장애군 간의 하악과두 수직비대칭지수는 유의한 차이를 보이지 않았다. 3. 관절장애군, 근육장애군, 그리고 대조군 간의 하악지 수직비대칭지수 비교에서는 군간 유의한 차이를 보이지 않았다. 4. 관절원판변위군, 정복성관절원판전위군, 그리고 비정복성관절원판전위군 간의 하악과두 그리고 하악지 수직비대칭지수 비교에서는 유의한 차이를 보이지 않았다. 5. 하악과두와 하악지 수직비대칭지수 모두 연령증가와 관련이 없었다. 이상의 결과는 측두하악장애군이 정상인에 비해 하악과두 수직비대칭지수가 높게 나타나, 이러한 차이가 측두하악장애와 관련이 있음을 시사하였다. 따라서 파노라마 방사선사진을 이용한 하악과두 수직비대칭지수 측정은 측두하악장애 진단과 치료시 고려해야 할 중요한 부분으로 사료된다.

• 치과방사선
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• 제23권1호
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• pp.7-14
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• 1993

The Internal derangement of temporomandibular joint disc was evaluated by using magnetic resonance imaging and arthrogram in 5 patients having reciprocal clicking or locking and in 5 normal subjects. Parasagittal multisections on both closed and open mouth were serially obtained by using a 1.5 Tesla MR system and surface coil with CSMEMP, MPGR. MR images obtained were analized by correlating with images of arthrograms. The obtained results were as follows: 1. Displaced meniscus was clearly delineated as dark structure on MR images other than on arthrograms of closed mouth view of patient having clicking or locking. 2. The deltoid white images of synovial fluid were identified in the glenoid fossa and on the posterior surface of condyle on open mouth view and partly depicted on closed mouth view, of parasagittal sections by MPGR. 3. The greyish image of joint fluid was identified on the posterior surface of condyle on the open mouth view of parasagittal sections by CSMEMP. 4. The structural relationship among condyle, meniscus, and fluid showed the variety of images on each parasagitta1 view.

• 대한치과보철학회지
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• 제37권1호
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• pp.71-92
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• 1999

This study is to analyze the stress and displacement on the jaws during the bilateral and unilateral clenching task on three dimensional finite element model of the dentated skull. For this study, the computed tomography(G.E.8800 Quick, USA) was used to scan the total length of human skull in the frontal plane at 1.9mm intervals. The CAD data were extracted from the tomograms through digitizer(Summa Sketch III, USA) and then reconstructed by means of the spline method in the CAD program. In this project, a commercial software I-DEAS(Master Series ver-sion 3.0, SDRC Inc, USA) was used for three-dimensional stress analysis on the finite element model. which consists of articular disc, maxilla, mandible, teeth, periodontal ligament and cranium. The results are as follows. ; 1. During the bilateral clenching, each major muscle forces caused high stresses on various areas of skull: masseter muscle on articular disc and teeth ; temporal muscle on mandible and periodontal ligament ; medial pterygoid muscle on the temporomandibular joint. During the unilateral clenching, masseter muscle induced the maximum stress ; medial pterygoid muscle the minimum stress. 2. During the bilateral clenching, higher compressive stresses on articular disc were generated by the masseter muscle and higher deformation occurred on the most front outer sites. And during the unilateral clenching, temporal muscle and medial pterygoid muscle exerted their forces to twist temporomandibular joint area of the balancing side and induced a higher compressive stresses on the front outer sites of articular disc. 3. During the bilateral clenching, the masseter muscle bended the mandible outwardly, and then caused tensile stresses on the lingual surface of mandibular symphysis. And the medial pterygoid muscle caused tensile stresses on the labial surface of mandibular symphysis. 4. When each muscles were simultaneously applied on jaws, a high stress and displacement took place on mandible rather than on the maxilla. Also, a high stress and displacement took place during the unilateral clenching rather than during the bilateral clenching.

• 대한치과의사협회지
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• 제23권12호통권199호
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• pp.1023-1026
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• 1985

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권4호
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• pp.270-274
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• 2010

Introduction: Limited mouth opening is a representative clinical symptom of temporomandibular disorders (TMD) with anterior disc displacement without reduction (ADDWOR). Various treatment methods have been proposed for patients with ADDWOR. This study examined the clinical effectiveness of template therapy for patients with mouth opening difficulty due to the ADDWOR. Material and Methods: A total of 14 patients (female 12, male 2, average age: $29.1{\pm}14.4$), who had been treated in the template clinic, Sooncheonhyang University Bucheon Hospital, from January of 2006 to December of 2008, were enrolled in this study. The subjects were selected according to the following criteria: more than 2 weeks after the onset of locking, mouth opening range <35 mm, and confirmed ADDWOR without a synovial pathology by magnetic resonance imaging (MRI). All patients were treated with the template appliance, instructed to wear it while sleeping and exercise for at least 10 hours per day. The maximum mouth opening (MMO) range and pain recognition scores before and after template therapy were recorded and compared. A paired t-test and Wilcoxon's signed rank test were used for statistical analysis. Results: After the periodical follow up, significant improvement in the opening range was observed in the template treatment group. The average MMO range before treatment was $30.2{\pm}3.5mm$ and the average MMO after treatment and follow up was $47.1{\pm}4.7mm$. The mean amount of mouth opening increment was $16.9{\pm}5.4mm$ (P<0.01) and the pain recognition scores before and after treatment was also improved.(P=0.001) Conclusion: The template appliance proved to be efficient for the treatment of TMD with a closed lock and painful joint due to ADDWOR.