Seminars in Orthodontics最新文献

The relationship between psychological factors and the overall health of patients with Juvenile Idiopathic Arthritis (JIA) is evident, yet the specific impact of the presence of Temporomandibular Joint (TMJ) signs or symptoms is not fully understood. This article seeks to elucidate the current knowledge of the relationship between TMJ signs and symptoms, psychosocial factors, and broader clinical manifestations in JIA patients. To investigate this relationship further, the present article will also present the results of a study including a total of 73 JIA patients, consisting of 56 females and 17 males (mean age 12.2 ± 2.8 years old; range 6–16). These patients were examined according to the diagnostic criteria for temporomandibular disorders (DC/TMD). Self-reported questionnaires were used to investigate the psychosocial aspects of stress, anxiety, depression, and catastrophizing. General quality of life and disease activity were assessed with the JAMAR questionnaire (Juvenile Arthritis Multidimensional Assessment Report). For inferential statistics, the Pearson r coefficient, linear regression models and T test for unpaired data were used. The level of significance was P<0.05. Increased general disease activity and significant impacts on quality of life were associated with increased psychological distress. The four psychosocial factors examined, including anxiety, stress, catastrophizing, and depression, all had a negative impact on the quality of life, symptomatology, and disease activity. Specifically, anxiety and catastrophizing influenced the relationship between the presence of symptoms and the reported quality of life where higher levels of anxiety and catastrophizing increased the impact of the symptoms on the quality of life. Finally, the presence of TMJ signs and/or symptoms did not exacerbate the psychosocial domains but affected the functional aspect of the patient.

The aim of the present manuscript is to give a narrative overview for clinicians summarizing the knowledge concerning a phenomenon that they may frequently come across in both children and adults: sleep (SB) and awake (AB) bruxism. Indeed, prevalence rates in adults range from 8 % to 16 % for SB and 22 % to 30 % for AB, whilst in children they raise up to 40 %.

The complex relationship between bruxism, the most common underlying primary and/or comorbid conditions, and the potential clinical consequences for both AB and SB in children and adults will be considered.

In addition, in view of the fact that over the last few decades the demand for orthodontic treatment at all ages has increased, the correlation between bruxism-related masseter muscle activity (MMA) and the use of orthodontic appliances (i.e., fixed appliances and clear aligners) is also discussed, along with the proposal of some clinical recommendations.

Degenerative Joint Disorders (DJD) of the Temporomandibular Joint (TMJ) represent a challenging and multifaceted group of conditions that severely impact the joint's function and quality of life. This comprehensive review delves into the etiology, pathogenesis, clinical manifestations, and contemporary management strategies of TMJ-OA. While systemic illnesses, aging processes, hormonal factors, and behavioral factors have been implicated in its development, recent evidence highlights the pivotal role of mechanical overloading in initiating a series of degenerative changes within the TMJ.

Painful joints, a hallmark of TMJ-OA, result from the soft tissues around the affected joint and reflexive muscle spasm, following Hilton's law, which innervates the joint's muscles and overlying skin. This self-preservation reflex protects against further joint damage. Moreover, painful symptoms may arise from subchondral bone destruction.

Recognizing the importance of understanding the biomechanical environment within the TMJ, this review underscores its relevance in identifying the mechanisms behind TMJ pain and disability. Furthermore, it discusses the potential application of tissue engineering in TMJ reconstruction, emphasizing the need to learn from past TMJ implant experiences.

In the context of treatment, the review highlights the significance of managing TMJ-OA, focusing on restoring function and reducing pain. Treatment modalities span from non-invasive therapies to surgical options, with the latter reserved for cases unresponsive to conservative approaches and severely affecting an individual's quality of life.

This review serves as a vital resource for both clinicians and researchers, offering insights into the multifaceted nature of TMJ-OA and the evolving landscape of its diagnosis and management, incorporating biomechanical considerations and potential advances in tissue engineering. Understanding the complexities of TMJ-OA is instrumental in enhancing the care and well-being of individuals affected by this condition.

The field of orthodontics has seen a recent increase in the number of patients over the age of 50 seeking treatment and also an increase in the use of cone beam technology. Similar to other joints in the body, the temporomandibular joint (TMJ) is associated with age-related degeneration. However, unlike other joints, degeneration of the TMJ is rarely symptomatic and when there is pain, it is usually self-limiting. In this article, we will review: (a) the incidence and prevalence of TMJ degenerative diseases, (b) similarities and differences of TMJ vs knee degenerative diseases, and (c) current treatment recommendations for TMJ degenerative diseases. In the vast majority of people, radiographic evidence of TMJ degeneration is an incidental finding. Future longitudinal research is needed to follow the natural course of TMJ degenerative patients.

Objectives

Occlusal Tactile Acuity (OTA) is the ability to detect small thicknesses between occluding teeth. Individuals diagnosed with Burning Mouth Syndrome (BMS) often refer an uncomfortable sensation associated with their occlusion. The aim of the current study was to measure the OTA in BMS patients, and to compare it with that of age and gender matched pain free controls.

Materials and methods

25 BMS patients and 25 controls were enrolled. The OTA was tested with 10 different thicknesses: 9 aluminium foils (8 –72 µm with a constant increment of 8 µm) and 1 sham test (without foil), each thickness being tested 10 times in random order (100 tests in total).

Results

Significantly increased OTA was observed in the BMS group, compared to the controls group, for the foil thicknesses between 8 µm and 48 µm. Furthermore, BMS patients showed substantial impairment in the detection of the sham test, even if this finding did not reach statistically significance (P = 0.743).

Conclusions

BMS patients presented increased ability to detect small thicknesses between antagonist teeth during intercuspation. These findings might explain the high somatosensory distortion referred by those patients, in absence of objective clinical findings.

Purpose

To determine if there are differences in condylar volume, glenoid cavity and joint space between patients diagnosed with facial asymmetry (FA), between affected and contralateral sides and with respect to subjects without FA.

Methods

Cross-sectional, retrospective study comparing CT/CBCT images from patients with FA diagnosis referred to a private clinic, versus a control group, age and sex matched, of patients requiring orthodontic treatment without FA. The 3D Slicer software was used for the analysis. Bivariate analysis was performed to compare qualitative variables using Chi-square or Fisher tests, and for normal distribution quantitative variables, the t-student test was used. The level of significance was p < 0.05.

Results

The FA group (n = 138) included: Hemimandibular Elongation (HE) (n = 64), Hemimandibular Hyperplasia (HH) (n = 12), Hybrid Form (HF) (n = 20), Asymmetric Mandibular Prognathism (AMP) (n = 25), Glenoid Cavity Asymmetry (GCA) (n = 9) and Functional Laterognathism (FL) (n = 8). The control group (n = 20) had no FA and no signs or symptoms of temporomandibular dysfunction. The right condylar and glenoid cavity volumes were significantly larger in FA cases. The volumes of the right and left joint space had significant differences only in HE patients.

Conclusion

Condylar volumes are higher in almost all FA subgroups compared to matched controls. The glenoid cavity volume is larger in FA patients, except for the GCA right and FL left sides. Regarding articular spaces, HE was the only entity with less volume on the contralateral side. The evaluation of structural volume by 3D-CT images helps to diagnose and differentiate FA subgroups.

Gingival recession of lower incisors is a periodontal condition that mostly develops in young adults as a result of various etiological factors, such as mechanical trauma, bacterial associated gingival inflammation, viral infection or a mixture of the above. Several predisposing factors contribute to its occurrence, including thin gingival biotype, reduced alveolar bone thickness, the presence of dehiscence and fenestrations, frenum pull, root malposition due to crowding or previous orthodontic treatment, as well as distorted fixed orthodontic retainers. The treatment approaches vary from supportive periodontal therapy alone to different surgical root coverage procedures. In situations where the root is in close proximity to or beyond the cortical bone, orthodontic repositioning of the root within the bone prior to surgical root coverage has been shown to be beneficial. Historically, such orthodontic correction required insertion of fixed orthodontic devices over an extended period, which posed challenges to patients who may have already undergone orthodontic treatment in the past and are therefore reluctant to undergo retreatment. This case series illustrates that, in contrast to certain beliefs, clear aligners are an effective tool for repositioning the lower incisors’ roots before surgical root coverage procedures. The article provides guidelines for treatment planning and aligners’ design to achieve the best outcome in the shortest duration.

Patients affected by severe periodontitis can develop a secondary malocclusion due to pathologic tooth migration that, if untreated, can hinder the maintenance of the entire dentition. In these cases, the combination of the appropriate stepwise periodontal therapy together with orthodontic treatment may become essential to re-establish health, aesthetics and function, leading to patient satisfaction and long-term stability. However, to successfully perform orthodontic tooth movement in stage IV periodontitis patients is paramount to carefully plan the treatment with a interdisciplinary approach, respecting the correct timing of the different phases of treatment, adapting biomechanics and appliance design individually, considering loss of periodontal support suffered from each patient. At the end of orthodontic treatment, after eventual prosthetic procedures, life-long retention and supportive periodontal care are needed to ensure good long-term prognosis. The present review describes the diagnostic, prognostic and therapeutic challenges associated with the combined ortho-perio treatment of stage IV periodontitis patients, providing both a literature and expert-based support for a biologically-orientated approach.