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Temporomandibular Joint Diseases: Diagnosis and Management

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 49260

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Dr. Luis Eduardo Almeida

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School of Dentistry, Marquette University, Milwaukee, WI, USA
Interests: temporomandibular joint; immunohistochemistry; inflammation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

The temporomandibular joint (TMJ) is capable of remodeling even after growth has stopped, allowing it to make structural changes and adapt to different physiological demands.

Temporomandibular disorders (TMD) are a group of degenerative disorders involving the components of the TMJ, which can lead to displacement of the disc, joint remodeling, and eventually osteoarthritis.

Different methods of diagnosis and treatments of TMD have been described in the literature in the past years.

The aim of this Special Edition is to bring updated information regarding all methods of diagnosis of TMD, from clinical exams to immunohistologic and molecular diagnosis and novel treatments for this disease, ranging from non-invasive techniques, such as physical therapy, ultrasound, low-level laser therapy, and splints, to minimally invasive techniques, such as corticosteroid injections, arthrocentesis of the joint, with or without platelet-rich plasma or hyaluronic acid injections, and arthroscopic surgery, to invasive procedures for the more advanced stage of TMD, which include discectomy, disc replacement, and total joint replacement.

Prof. Dr. Luis Eduardo Almeida
Guest Editor

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Keywords

Temporomandibular joint
Temporomandibular disease
Inflammation
Occlusion

Published Papers (13 papers)

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10 pages, 1871 KiB

Open AccessArticle

A Novel Quantitative Method for Tooth Grinding Surface Assessment Using 3D Scanning

by Benedikt Sagl, Ferida Besirevic-Bulic, Martina Schmid-Schwap, Brenda Laky, Klara Janjić, Eva Piehslinger and Xiaohui Rausch-Fan

Diagnostics 2021, 11(8), 1483; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11081483 - 16 Aug 2021

Cited by 1 | Viewed by 2071

Abstract

Sleep bruxism is an oral parafunction that involves involuntary tooth grinding and clenching. Splints with a colored layer that gets removed during tooth grinding are a common tool for the initial diagnosis of sleep bruxism. Currently, such splints are either assessed qualitatively or using 2D photographs, leading to a non-neglectable error due to the 3D nature of the dentition. In this study we propose a new and fast method for the quantitative assessment of tooth grinding surfaces using 3D scanning and mesh processing. We assessed our diagnostic method by producing 18 standardized splints with 8 grinding surfaces each, giving us a total of 144 surfaces. Moreover, each splint was scanned and analyzed five times. The accuracy and repeatability of our method was assessed by computing the intraclass correlation coefficient (ICC) as well reporting means and standard deviations of surface measurements for intra- and intersplint measurements. An ICC of 0.998 was computed as well as a maximum standard deviation of 0.63 mm² for repeated measures, suggesting an appropriate accuracy of our proposed method. Overall, this study proposes an innovative, fast and cost effective method to support the initial diagnosis of sleep bruxism. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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11 pages, 2032 KiB

Open AccessArticle

Electromyography-Guided Adjustment of an Occlusal Appliance: Effect on Pain Perceptions Related with Temporomandibular Disorders. A Controlled Clinical Study

by Simona Tecco, Vincenzo Quinzi, Alessandro Nota, Alessandro Giovannozzi, Maria Rosaria Abed and Giuseppe Marzo

Diagnostics 2021, 11(4), 667; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11040667 - 08 Apr 2021

Cited by 4 | Viewed by 2219

Abstract

Background: The purpose of this study is to evaluate the effect of an electromyography-guided adjustment of an occlusal appliance on the management of Temporomandibular disorder-related pain. Methods: Data from 40 adult patients (20 males and 20 females), who underwent treatment with occlusal appliances, were recorded. A total of 20 appliances were adjusted according to electromyographic data (group 1), while the others were adjusted by a clinical conventional procedure (group 2). Muscle pain to palpation, pain during articular movements and headache were recorded by a VAS score (from 0 to 100) before the beginning of treatment (T0), at T1 (4 weeks) and T2 (8 weeks). Results: Results showed a reduction of pain in both groups, with a better trend for group 1, where better results were achieved at T1 and maintained stability at T2, with an improved mean value regarding all parameters studied. After 8 weeks, only small recurrences started to occur in muscle pain to palpation in group 2. Conclusions: An occlusal appliance seems to be able to achieve a clinical improvement of Temporomandibular disorder (TMD)-related pain and headache, independently from the adjustment procedure adopted. However, the use of a surface electromyographic activity of masticatory muscles (sEMG) device as an aid in the calibration procedure seems to allow a better trend because the improvement of symptoms was obtained before, after the first four weeks, with an improvement in percentages of all the variables investigated. While the conventional procedure obtained later the improvement. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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38 pages, 3138 KiB

Open AccessArticle

Proteomic Expression Profile in Human Temporomandibular Joint Dysfunction

by Andrea Duarte Doetzer, Roberto Hirochi Herai, Marília Afonso Rabelo Buzalaf and Paula Cristina Trevilatto

Diagnostics 2021, 11(4), 601; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11040601 - 28 Mar 2021

Cited by 5 | Viewed by 2108

Abstract

Temporomandibular joint dysfunction (TMD) is a multifactorial condition that impairs human’s health and quality of life. Its etiology is still a challenge due to its complex development and the great number of different conditions it comprises. One of the most common forms of TMD is anterior disc displacement without reduction (DDWoR) and other TMDs with distinct origins are condylar hyperplasia (CH) and mandibular dislocation (MD). Thus, the aim of this study is to identify the protein expression profile of synovial fluid and the temporomandibular joint disc of patients diagnosed with DDWoR, CH and MD. Synovial fluid and a fraction of the temporomandibular joint disc were collected from nine patients diagnosed with DDWoR (n = 3), CH (n = 4) and MD (n = 2). Samples were subjected to label-free nLC-MS/MS for proteomic data extraction, and then bioinformatics analysis were conducted for protein identification and functional annotation. The three TMD conditions showed different protein expression profiles, and novel proteins were identified in both synovial fluid and disc sample. TMD is a complex condition and the identification of the proteins expressed in the three different types of TMD may contribute to a better comprehension of how each pathology develops and evolutes, benefitting the patient with a focus–target treatment. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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11 pages, 481 KiB

Open AccessArticle

Electromyographic Patterns of Masticatory Muscles in Relation to Active Myofascial Trigger Points of the Upper Trapezius and Temporomandibular Disorders

by Grzegorz Zieliński, Aleksandra Byś, Jacek Szkutnik, Piotr Majcher and Michał Ginszt

Diagnostics 2021, 11(4), 580; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11040580 - 24 Mar 2021

Cited by 15 | Viewed by 2346

Abstract

The presented study aimed to analyze and compare the electromyographic patterns of masticatory muscles in subjects with active myofascial trigger points (MTrPs) within upper trapezius, patients with temporomandibular disorders (TMDs) and healthy adults. Based on the diagnostic criteria of MTrPs according to Travell & Simons and the Research Diagnostic Criteria for Temporomandibular Disorders, 167 people were qualified for the study. Subjects were divided into 3 groups: with active MTrPs in the upper trapezius, with diagnosed temporomandibular disorders (TMDs) and healthy adults. Measurements of the bioelectric activity of the temporalis anterior (TA) and masseter muscle (MM) were carried out using the BioEMG III ™. Based on statistical analysis, significantly lower values of TA resting activity were observed among controls in comparison to MTrPs (1.49 μV vs. 2.81 μV, p = 0.00) and TMDs (1.49 μV vs. 2.97 μV, p = 0.01). The POC index values at rest differed significantly between MTrPs and TMDs (86.61% vs. 105%, p = 0.04). Controls presented different electromyographic patterns within AcI in comparison to both MTrPs (4.90 vs. −15.51, p = 0.00) and TMDs (4.90 vs. −16.49, p = 0.00). During clenching, the difference between MTrPs and TMDs was observed within MVC TA (91.82% vs. 116.98%, p = 0.02). TMDs showed differences within AcI in comparison to both MTrPs group (−42.52 vs. 20.42, p = 0.01) and controls (−42.52 vs. 3.07, p = 0.00). During maximum mouth opening, differences between MTrPs and TMDs were observed within the bioelectric activity of masseter muscle (16.45 μV vs. 10.73 μV, p = 0.01), AsI MM (0.67 vs. 11.12, p = 0.04) and AcI (13.04 vs. −3.89, p = 0.01). Both the presence of MTrPs in the upper trapezius and TMDs are related to changes in electromyographic patterns of masticatory muscles. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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13 pages, 3267 KiB

Open AccessArticle

Temporomandibular Joint Osseous Morphology of Class I and Class II Malocclusions in the Normal Skeletal Pattern: A Cone-Beam Computed Tomography Study

by Xiao-Chuan Fan, Lin-Sha Ma, Li Chen, Diwakar Singh, Xiaohui Rausch-Fan and Xiao-Feng Huang

Diagnostics 2021, 11(3), 541; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11030541 - 18 Mar 2021

Cited by 8 | Viewed by 2739

Abstract

(1) Background—The aim of the present study was to evaluate the correlation between the temporomandibular joint (TMJ) osseous morphology of normal skeletal pattern individuals with different dental malocclusions by using cone-beam computed tomography (CBCT). (2) Methods—The CBCT images of bilateral TMJs in 67 subjects with skeletal class I and average mandibular angle (26 males and 41 females, age range 20–49 years) were evaluated in this study. The subjects were divided into class I, class II division 1, and class II division 2 according to the molar relationship and retroclination of the maxillary incisors. Angular and linear measurements of TMJ were evaluated and the differences between the groups were statistically analyzed. (3) Results—Intragroup comparisons showed statistical differences for articular eminence inclination, the width of the glenoid fossa, the ratio of the width of the glenoid fossa to the depth of the glenoid fossa, the condylar angle, and the intercondylar angle between the malocclusion groups. The measurements of the glenoid fossa shape showed no significant difference between the left and right sides. Females showed more differences in the morphological parameters of TMJ between the three malocclusion groups than the males. (4) Conclusion—The present study revealed differences in the TMJ osseous morphology between dental class I and class II malocclusions in the normal skeletal pattern. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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12 pages, 8083 KiB

Open AccessArticle

SPECT/CT Correlation in the Diagnosis of Unilateral Condilar Hyperplasia

by Diego Fernando López, Valentina Ríos Borrás, Juan Manuel Muñoz, Rodrigo Cardenas-Perilla and Luis Eduardo Almeida

Diagnostics 2021, 11(3), 477; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11030477 - 08 Mar 2021

Cited by 4 | Viewed by 2693

Abstract

Objective: To evaluate the correlation between metabolic bone activity measured by single photon emission computed tomography (SPECT) and the anatomic condylar characteristics acquired by computed tomography (CT), in patients with unilateral condylar hyperplasia (UCH). Method and Materials/Patients: Observational, descriptive study in a group of 71 patients with clinical diagnosis of UCH and indication of SPECT/CT. Bone SPECT images obtained in a gamma-camera GE Infina and processed in a station Xeleris 3 with the program Volumetrix MI Evolution for bone. CT images acquired in a PET/CT Biograph mcT20 equipment (Siemens) processed in a station Osirix V 7.5.1 (Pixmeo, Bomex, Switzerland). Results: The sample included 24 men (33.8%) and 47 women (66.2%). Active state UCH was detected in 40 (56.3%) cases (over 55% uptake in the affected condyle) and 38 (53.5%) presented mandibular deviation to the right side. No significant differences related to sex, age, or mandibular deviation side were found. Mandibular deviation was the only morphologic feature related to active/inactive UCH (p = 0.003). The likelihood of active CH was significantly higher in patients with mandibular deviation higher than 6 mm compared with <6 mm (odds ratio (OR): 3.51, confidence interval (CI) 95%: 1.27–9.72). Conclusion: There is a significant correlation between the magnitude of mandibular deviation quantified on CT and metabolic findings obtained by SPECT in patients with UCH. The risk of active UCH is 3.5 times higher in patients with a mandibular deviation ≥6 mm. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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10 pages, 1051 KiB

Open AccessArticle

Validity and Reliability of the Helkimo Clinical Dysfunction Index for the Diagnosis of Temporomandibular Disorders

by Roger Alonso-Royo, Carmen María Sánchez-Torrelo, Alfonso Javier Ibáñez-Vera, Noelia Zagalaz-Anula, Yolanda Castellote-Caballero, Esteban Obrero-Gaitán, Daniel Rodríguez-Almagro and Rafael Lomas-Vega

Diagnostics 2021, 11(3), 472; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11030472 - 08 Mar 2021

Cited by 14 | Viewed by 3624

Abstract

The Helkimo Clinical Dysfunction Index (HCDI) is a simple and quick test used to evaluate subjects affected by temporomandibular disorders (TMDs), and its psychometric properties have not been tested. The test evaluates movement, joint function, pain and musculature, providing a quick general overview that could be very useful at different levels of care. For this reason, the aim of this study was to validate the use of the HCDI in a sample of patients with TMD. Methods: The sample consisted of 107 subjects, 60 TMD patients and 47 healthy controls. The study evaluated concurrent validity, inter-rater concordance and predictive values. Results: The HCDI showed moderate to substantial inter-rater concordance among the items and excellent concordance for the total scores. The correlation with other TMD assessment tests was high, the correlation with dizziness was moderate and the correlation with neck pain, headache and overall quality of life was poor. The prediction of TMD showed a sensitivity of 86.67%, a specificity of 68.09% and an area under the curve (AUC) of 0.841. Conclusions: The HCDI is a valid and reliable assessment instrument; its clinimetric properties are adequate, and it has a good ability to discriminate between TMD-affected and TMD-unaffected subjects. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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14 pages, 2441 KiB

Open AccessArticle

Synovial Tissue Proteins and Patient-Specific Variables as Predictive Factors for Temporomandibular Joint Surgery

by Mattias Ulmner, Rachael Sugars, Aron Naimi-Akbar, Nikolce Tudzarovski, Carina Kruger-Weiner and Bodil Lund

Diagnostics 2021, 11(1), 46; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11010046 - 30 Dec 2020

Cited by 3 | Viewed by 3445

Abstract

Our knowledge of synovial tissues in patients that are scheduled for surgery as a result of temporomandibular joint (TMJ) disorders is limited. Characterising the protein profile, as well as mapping clinical preoperative variables, might increase our understanding of pathogenesis and forecast surgical outcome. A cohort of 100 patients with either disc displacement, osteoarthritis, or chronic inflammatory arthritis (CIA) was prospectively investigated for a set of preoperative clinical variables. During surgery, a synovial tissue biopsy was sampled and analysed via multi-analytic profiling. The surgical outcome was classified according to a predefined set of outcome criteria six months postoperatively. Higher concentrations of interleukin 8 (p = 0.049), matrix metalloproteinase 7 (p = 0.038), lumican (p = 0.037), and tissue inhibitor of metalloproteinase 2 (p = 0.015) were significantly related to an inferior surgical outcome. Several other proteins, which were not described earlier in the TMJ synovia, were detected but not related to surgical outcome. Bilateral masticatory muscle palpation pain had strong association to a poor outcome that was related to the diagnoses disc displacement and osteoarthritis. CIA and the patient-reported variable TMJ disability might be related to an unfavourable outcome according to the multivariate model. These findings of surgical predictors show potential in aiding clinical decision-making and they might enhance the understanding of aetiopathogenesis in TMJ disorders. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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11 pages, 729 KiB

Open AccessArticle

Increased Risk of Migraine in Patients with Temporomandibular Disorder: A Longitudinal Follow-Up Study Using a National Health Screening Cohort

by Soo-Hwan Byun, Chanyang Min, Dae-Myoung Yoo, Byoung-Eun Yang and Hyo-Geun Choi

Diagnostics 2020, 10(9), 724; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10090724 - 20 Sep 2020

Cited by 9 | Viewed by 3634

Abstract

Background: The aim of this study was to investigate the association between temporomandibular disorder (TMD) and migraine through a longitudinal follow-up study using population data from a national health screening cohort. Methods: This cohort study used data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015. Of the 514,866 participants, 3884 TMD patients were matched at a 1:4 ratio with 15,536 control participants. Crude models and models adjusted for obesity, smoking, alcohol consumption, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, and Charlson Comorbidity Index (CCI) scores were calculated. Chi-squared test, Kaplan–Meier analysis, and two-tailed log-rank test were used for statistical analysis. Stratified Cox proportional hazard models were used to assess hazard ratios (HR) and 95% confidence intervals (CIs) for migraine in both control groups. Results: The adjusted HR for migraine was 2.10 (95% CI: 1.81–2.44) in the TMD group compared to the control group, which was consistent in subgroup analyses according to age, sex, and Kaplan–Meier analysis. Conclusions: This study demonstrated that TMD patients have a higher risk of migraine. These results suggest that dentists can decrease the risk of migraine in TMD patients by managing TMD properly. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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Review

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16 pages, 1169 KiB

Open AccessReview

Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management

by Dion Tik Shun Li and Yiu Yan Leung

Diagnostics 2021, 11(3), 459; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11030459 - 06 Mar 2021

Cited by 69 | Viewed by 11125

Abstract

Temporomandibular disorders (TMD) are a group of orofacial pain conditions which are the most common non-dental pain complaint in the maxillofacial region. Due to the complexity of the etiology, the diagnosis and management of TMD remain a challenge where consensus is still lacking in many aspects. While clinical examination is considered the most important process in the diagnosis of TMD, imaging may serve as a valuable adjunct in selected cases. Depending on the type of TMD, many treatment modalities have been proposed, ranging from conservative options to open surgical procedures. In this review, the authors discuss the present thinking in the etiology and classification of TMD, followed by the diagnostic approach and the current trend and controversies in management. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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23 pages, 2036 KiB

Open AccessReview

Comprehensive Management of Rheumatic Diseases Affecting the Temporomandibular Joint

by Lauren Covert, Heather Van Mater and Benjamin L. Hechler

Diagnostics 2021, 11(3), 409; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11030409 - 27 Feb 2021

Cited by 16 | Viewed by 6072

Abstract

The temporomandibular joint (TMJ) is a synovial joint and thus is vulnerable to the afflictions that may affect other joints in the fields of rheumatology and orthopedics. Too often temporomandibular complaints are seen strictly as dental or orofacial concerns. Similarly, patients with known rheumatic disease may not have their TMJs included in routine screening and monitoring protocols. The purpose of this review is to highlight the rheumatic conditions likely to affect the TMJ and outline medical and surgical management in these patients with a focus on the need for continued patient reassessment and monitoring. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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20 pages, 944 KiB

Open AccessReview

Is There an Association between Temporomandibular Disorders and Articular Eminence Inclination? A Systematic Review

by Xiao-Chuan Fan, Diwakar Singh, Lin-Sha Ma, Eva Piehslinger, Xiao-Feng Huang and Xiaohui Rausch-Fan

Diagnostics 2021, 11(1), 29; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11010029 - 26 Dec 2020

Cited by 4 | Viewed by 3009

Abstract

(1) Background: In order to determine the correlation between the inclination of articular eminence (AEI) and the development of temporomandibular disorders (TMDs), a systematic review was performed. (2) Methods: A systematic literature research was conducted between 1946 and January 2020, based on the following electronic databases: PubMed, Cochrane Library, Embase, Medline, Scope, SciELO, and Lilacs. Observational studies, analytical case-control studies, and cohort studies written in English were identified. The articles were selected and analyzed by two authors independently. The PICO format was used to analyze the studies and the Newcastle-Ottawa Scale (NOS) was used to verify the quality of the evidence. (3) Results: Sixteen articles were included in this review, ten case-control studies and six cohort studies. Eight articles (50%) established a positive relation between AEI and TMDs and eight (50%) did not. The scientific quality was medium-low, mainly influenced by the exposure to the risk of bias and the lack of clinical methods with adequate consistency and sensitivity on the diagnosis of TMDs. (4) Conclusions: It is controversial to establish a causal relationship between the TMDs and the AEI in the field of stomatology, due to limited and inconclusive evidence. However, it is suggested that the AEI defined by some specific methods may be associated with some special pathological stages of TMDs. High-quality prospective studies are required to draw any definitive conclusions. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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Other

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10 pages, 4497 KiB

Open AccessCase Report

Chemical Diagnosis of Calcium Pyrophosphate Deposition Disease of the Temporomandibular Joint: A Case Report

by Masahiko Terauchi, Motohiro Uo, Yuki Fukawa, Hiroyuki Yoshitake, Rina Tajima, Tohru Ikeda and Tetsuya Yoda

Diagnostics 2022, 12(3), 651; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030651 - 07 Mar 2022

Cited by 3 | Viewed by 1946

Abstract

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a benign disorder characterized by acute gouty arthritis-like attacks and first reported by McCarty. CPPD deposition disease rarely occurs in the temporomandibular joint (TMJ), and although confirmation of positive birefringence by polarized light microscopy is important for diagnosis, it is not reliable because other crystals also show birefringence. We reported a case of CPPD deposition disease of the TMJ that was diagnosed by chemical analysis. A 47-year-old man with a chief complaint of persistent pain in the right TMJ and trismus was referred to our department in 2020. Radiographic examination revealed destruction of the head of the mandibular condyle and cranial base with a neoplastic lesion involving calcification tissue. We suspected CPPD deposition disease and performed enucleation of the white, chalky masses. Histopathologically, we confirmed crystal deposition with weak birefringence. SEM/EDS revealed that the light emitting parts of Ca and P corresponded with the bright part of the SEM image. Through X-ray diffraction, almost all peaks were confirmed to be CPPD-derived. Inductively coupled plasma atomic emission spectroscopy revealed a Ca/P ratio of nearly 1. These chemical analyses further support the histological diagnosis of CPPD deposition disease. Full article

(This article belongs to the Special Issue Temporomandibular Joint Diseases: Diagnosis and Management)

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