Cranio-The Journal of Craniomandibular & Sleep Practice最新文献

Objective: Brief behavioral interventions targeting pain (Physical Self-Regulation, PSR) or sleep (Brief Behavioral Intervention for Insomnia, BBTI) show promise for interdisciplinary management of chronic pain, though their feasibility with chronic musculoskeletal orofacial pain (MSK-OFP) populations remains underexplored. This pilot study assessed the feasibility of a randomized clinical trial (RCT) of these interventions in a university-affiliated tertiary OFP clinic and explored clinical changes in pain, sleep, and other secondary outcomes.

Methods: Treatment-seeking participants (N=19) with chronic MSK-OFP and insomnia were randomized to three-session PSR or BBTI. At pre- and post-intervention, participants completed questionnaires (assessing pain intensity, insomnia symptomatology, sleep quality, headache disability, fatigue, jaw-movement limitations, and quality of life), 8 consecutive days of actigraphy and morning/evening diaries. Feasibility outcomes were recruitment, retention, and adherence rates. Clinical outcomes included clinically-meaningful reductions in insomnia symptoms (Insomnia Severity Index [ISI]<15) and pain intensity (>2.5 point on 0-10 Numerical Rating Scale).

Results: Over a 17-month period, of 19 consenting participants (88.9% females, 38.4±12.2y/o, recruitment rate: 1.1/month),12 (92% females, 38.5±11.5y/o) completed the study (retention rate: 63.2%) with high completion rate (questionnaires: 95.8%, daily diaries: 95%, actigraphy: 100%). Despite no significant changes in pain, ISI scores decreased by 6.0 and 4.8-points among BBTI and PSR groups. Improvements in sleep quality, headache disability, fatigue, jaw-movement limitations, and quality of life wereobserved.

Conclusion: RCTs of brief behavioral interventions are feasible in tertiary-OFP clinics.

Background: The MyotonPRO is a valid, portable device to assess musculoskeletal tissue properties, but its reliability for cervico-mandibular muscles remains unclear.

Objective: To evaluate the intra/inter-rater and intra/inter-session reliability of the MyotonPRO in cervico-mandibular muscle assessment.

Methods: A total of 30 measurements were performed on 15 healthy participants by two raters at two moments. MyotonPRO evaluated tone, stiffness, elasticity, relaxation time, and creep. Reliability was calculated using intraclass correlation coefficients (ICC), standard error of measurement, and minimal detectable change.

Results: Intra-rater intra-session reliability was good to excellent (ICC = 0.753-0.976). Inter-session values were moderate to good (ICC = 0.585-0.888), with excellent reliability for ECOM relaxation time (ICC = 0.955) and masseter elasticity (ICC = 0.910). Inter-rater reliability was moderate to good (ICC = 0.686-0.896).

Conclusion: The MyotonPRO is a reliable tool for assessing cervico-mandibular muscle mechanical properties across different raters and sessions.

Introduction: Discussions related to the diagnosis and management of temporomandibular joint (TMJ) disorders (TMDs) have always been interesting, and at times controversial, since they involve combinations of dental, medical, and surgical etiological theories and management strategies. Amongst the various recommendations that emerged over the years was that any dental and surgical procedures that are primarily focused on mandible repositioning and irreversible changes to dental occlusion should be avoided. This statement has important implications for appraising the validity of physiopathology concepts and treatment proposals centered around the evaluation of TMJ disc position, since they also generally lead to performing irreversible procedures.

Methods: A review of the pertinent TMJ literature related to the articular disc position and its association with TMD symptoms was carried out by the authors.

Results: For many practitioners, the position of the TMJ disc has been regarded as a primary cause of TMJ pain and dysfunction. For decades, incoordination between the TMJ disc, the condylar head and the articular eminence was indeed considered the main factor for the etiology of intracapsular TMD symptoms and consequently an important target for therapy. However, research has shown that synovitis is the more important variable in dealing with those conditions.

Conclusion: In this commentary, the biological rationale to consider synovitis, rather than disc position, as the linchpin for clinical symptoms is presented in detail. Hopefully, this might contribute to putting the elusive butterfly characteristics of this topic finally to rest.

Objective: This research aims to introduce using antegonial notch angular measurements on lateral cephalometry as a simple low-dose radiographic approach for monitoring mandibular growth in children after TMJA treatment.

Methods: This retrospective cohort study used dental records to identify eligible patients: healthy children with true unilateral TMJA who underwent conservative gap arthroplasty followed by post-operative physiotherapy. The primary outcome was changes in antegonial notch angular measurements over time. Secondary outcomes included correlations between antegonial notch angular measurements and two growth-related conventional cephalometric angles (SNB and ANB). We also explored the relationship between changes in antegonial notch angle over time and study covariates.

Results: Eleven patients aged 4 to 9.5 years with unilateral bony TMJA for periods ranging from 9 to 20 months who had undergone conservative gap arthroplasty followed by physiotherapy were included. Significant increases were observed in antegonial notch angles on both the affected and non-affected sides after treatment (p < .05), indicating resumed mandibular growth. Although the affected side remained significantly smaller than the non-affected side at both timepoints (p= 0.033 and 0.005), asymmetry did not change significantly over time (p= 0.273), suggesting parallel bilateral growth. Positive correlations were found between antegonial notch changes and SNB (p= 0.039-0.047). Multivariate regression indicated that TMJA duration significantly influenced changes in the affected-side notch angle (p= 0.004).

Conclusion: Based on these preliminary data, antegonial notch angular measurements on lateral cephalometric radiographs may offer a simple, reliable, and low-radiation alternative for monitoring mandibular growth in children after TMJA treatment. Further studies with larger sample sizes are required to support our findings.

Objective: The aim of the present study was to evaluate the effects of occlusal splint therapy in addition to physical therapy in improving pain in patients affected by myogenous temporomandibular disorders (TMD).

Methods: In this pilot trial, myofascial pain patients were randomly allocated into experimental group (education, physical therapy, and occlusal splint - PT+OS) and control group (education and physical therapy - PT). The primary outcome was the TMD pain intensity. All outcomes were assessed at baseline (T0), at the end of the physical therapy (T1), after 6 months from the end of the physical therapy (T2).

Results: Twenty-seven subjects (7 male and 20 females, mean aged 35.81 ± 16.57 years) were enrolled and allocated into two groups: 14 patients in the PT+OS group and 13 patients in the PT group. The RM ANOVA showed statistically significant differences between groups from T0 to T2 in favor of the PT+OS group in terms of TMD pain (p = .033), Neck Disability Index (NDI) (p = .025), and EuroQol-Visual Analogue Scale (p = .039).

Conclusion: Findings from the present study demonstrated that pain, NDI, and health-related quality of life improved in both groups after therapy, but only in the experimental group these outcomes improved significantly further after 6-months follow-up. Thus, our results showed that adding occlusal splint therapy to the physical therapy may produce higher positive effects in patients affected by myogenous TMD. Further studies with a larger sample size should be carried out to confirm our results.

Objective: Studies have highlighted variability and deficiencies in temporomandibular disorders (TMD) predoctoral education, with limited student clinical exposure. However, no research has examined changes following CODA inclusion of TMD instruction in predoctoral curricula. We investigated current scope, instructional modalities, and extent of TMD curricula in U.S. predoctoral dental programs.

Methods: A 17-item REDCap^TM survey was distributed in September-October 2024 to deans/associate deans of academic affairs at 72 CODA-accredited U.S. predoctoral dental schools, investigating TMD curricula, modalities, and extent.

Results: All 33 responding programs (53.2% response rate) included TMD instruction. Formal teaching accounted for 70.6±24.9% of instruction, while patient exposure constituted 22.5±21.0%. Programs dedicated 15.7±7.1 h on average (range 4-34) to TMD instruction . About 25.0% of programs had no board-certified orofacial pain (OFP) specialist on faculty. Instruction was mostly provided by OFP (75.8%), oral medicine specialists (36.4%), prosthodontists (30.3%), and oral surgeons (27.3%). Most programs (87.9%) treated TMD patients, yet 9.1% reported no student clinical exposure to these patients. In programs offering clinical exposure, patient interactions included direct evaluation and treatment (60.6%), rotations in OFP clinics (42.4%), observation (36.4%), or elective courses (3.0%). Management of OFP patients expanded to neuropathic pain (54.5%) and primary headache (33.3%), especially among programs with OFP specialists on faculty.

Conclusions: TMD instruction varies widely across responding programs, but recent curricula have expanded instructional hours, broadened scope, and increased opportunities for patient interaction compared to previous reports.

Objective: To review the clinical success of the various prosthodontic materials (e.g., lithium disilicate, zirconia, resin composite) in patients with different frequencies of bruxism.

Methods: A systematic search in the most relevant databases to find any randomized clinical trial that assesses the outcome of prosthodontic restorations performed in subjects where an assessment of sleep bruxism (SB) and awake bruxism (AB) was Conducted.

Results: No article present in the literature met the inclusion and exclusion criteria.

Conclusion: The present systematic review unveils an important gap in the field of prosthodontics: no clinical trial in the literature has ever investigated the long-term success rate of different prosthodontic materials in patients with different frequencies of AB and SB.

Objective: To investigate possible correlations between depression, anxiety and stress in subjects with instrumental diagnosis of sleep bruxism (SB) and to identify a link between clinical data and sleep-time muscular activity.

Methods: 170 subjects underwent clinical investigation and instrumental night recordings for SB assessment with a portable electromyographyic (EMG) device. The Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS) were used for psychological evaluation.

Results: Anxiety was statistically associated with SB index and SB-related tonic contractions. Subjects with high perceived stress scores showed higher numbers of total masseter contractions and SB-related phasic contractions.

Conclusion: Emotional states showed a statistically significant association with SB events, as assessed based on the count of episodes over 10% of the maximum voluntary contraction (MVC) preceded by a 20% increase of heart rate.

Objective: Temporomandibular joint degenerative disease (TMJ-DJD) is a progressive disorder marked by cartilage loss, pain, and dysfunction. This systematic review aimed to evaluate the efficacy and safety of platelet-rich plasma (PRP) injections without arthrocentesis in adults with TMJ-DJD.

Materials and methods: Following PRISMA guidelines (PROSPERO: CRD42020183384), we included randomized controlled trials (RCTs) assessing PRP in adults with TMJ-DJD. Searches were conducted in six databases up to June 2024. Two reviewers independently selected studies, extracted data, and assessed bias. Meta-analyses and GRADE evaluations were performed.

Results: Six RCTs were included. PRP showed comparable effects to arthrocentesis and arthrocentesis + PRP in reducing pain and improving mouth opening. At 3 months, PRP may offer greater pain relief than hyaluronic acid. No trials assessed quality of life. Evidence certainty ranged from moderate to low.

Conclusions: PRP appears to be a safe and potentially effective treatment for TMJ-DJD, though further high-quality studies are needed.

Objective: To determine the Fractal Dimension (FD) and Mean Gray Value (MGV) changes caused by TMJ-OA on Cone-Beam Computed Tomography (CBCT) images.

Methods: Ninety patients were divided into three groups: Control group (bilateral unaffected joints), Unilateral group (one affected joint), and Bilateral group (bilaterally affected joints). Histogram Analysis (HA) and Fractal Analysis (FA) were performed on coronal slices of the condyles. p<0.05 was considered statistically significant.

Results: There was no statistically significant difference between the groups, and also total affected and total unaffected condyles in terms of both MGV and FD (p>0.05). There was a statistically significant difference between MGV and FD of the unaffected condyles in the Control and Unilateral groups (p<0.05).

Conclusion: Both MGV and FD of the unaffected condyles in the Unilateral group were significantly different from those in the Control group indicates that these patients may be potentially at risk for TMJ-OA in the advanced stage.