• Journal of Oral Medicine and Pain
• /
• v.38 no.1
• /
• pp.29-34
• /
• 2013

Objective: All patients who have the disc displacement with reduction (DDwR) are always not progressive but some of them with significant catching or locking progress to disc displacement without reduction (DDw/oR). In this study, we suggest opening exercise therapy using Locking-free Appliance (LA) to be helpful to prevent progressive derangement. Methods: Retrospectively, a total 37 patients who received exercise treatment using LA was analyzed from January 2010 to December 2011. Patients had been instructed in proper exercise technique to practise for opening and closing of mouth wearing the appliance 30 times a day in locking-free position. Results: None of the patients took a turn for worse to DDw/oR (37 patients). The 16 patients (43.2%, locking-free group) of them could open their mouth without intermittent condylar locking. Measurement of data was analyzed using and Mann-Whitney test. There was no statistically significant difference for age, gender, presence of palpational pain, locking period, VAS quantitative pain score between locking-free group and locking group. Conclusions: In this study, some patients could open their mouth without intermittent locking and did not take a turn for worse to DDw/oR after opening exercise therapy with LA. Furthermore, LA had advantages which were short wearing time, low costs and minimizing patients' uncomfortable compared to conventional treatment method. This therapy can be more appropriate new treatment to prevent progress to DDw/oR.

• Journal of Oral Medicine and Pain
• /
• v.25 no.3
• /
• pp.293-303
• /
• 2000

앵글씨 분류에 따른 최대개구시 하악의 수직 변위에 대한 차이를 확인하고, 수직 하악운동에 영향을 주는 골격요소를 확인하기 위하여, 측두하악관절 및 저작계 이상에 대한 증상 및 병력이 없으며 발치 및 교정치료의 경험이 없는 광주지역 대학에 재학중인 학생들을 대상으로, 앵글씨 구치부 관계에 근거하여 1급군(남:30명, 여:49명), 2급군(남:18명, 여:24명)과 3급군(남:18명, 여:33명)으로 분류하여 총 172명(연령 범주:20-30세)의 학생을 선택하였다. 전남대학교 병원 구강내과에서 사용하는 계측용자를 이용하여 최대 개구시 상하악 중절치 절단면간의 거리를 측정하였다. 대상자들의 진단모형을 만들어 상하악궁 길이와 폭경를 측정하였다. 대상자들에 대한 두부 규격방사선 사진을 촬영, 작도하고 방사선학적 지표를 계측, 비교분석하였다. 앵글씨 분류 1급군, 2급군 그리고 3급군 절치간 최대개구량은 3급군이 가장 컸으며 모든 군에서 남자가 여자보다 컸다. 구치간 최대개구량은 앵글씨 분류 1급군, 2급군 그리고 3급군에서 각 군간의 유의한 차이는 없었으나, 모든 군에서 남자가 더 컸다. 앵글씨 분류 1급군과 2급군의 하악운동에서 총 하악골 길이, 하악지 길이, 하악 하연부 길이 그리고 상악궁 폭경이 변수로 나타났으며, 상하악궁 길이와는 역상관관계를 나타내었다. 앵글씨 분류 3급군의 하악운동에서 상하악궁 길이와 안면 부길이가 1급군과 2급군과는 다른 중요한 변수로 나타났으며, 상악궁의 폭경과는 역상관관계를 나타내었다. 이상의 결과로 보아 앵글씨 분류 각 군에서 하악개구운동은 안면 골격구조의 영향을 받으며, 각 군간에 영향을 주는 안면 골격 요소들은 차이가 있었다. 따라서 이러한 골격적 요소들은 개구량 개선을 위한 진단과 치료시 고려되어야 할 것으로 사료된다.

• Journal of Oral Medicine and Pain
• /
• v.32 no.4
• /
• pp.441-447
• /
• 2007

Internal derangement of the temporomandibular joint(TMJ) is defined as an abnormal relationship of the articular disc to the condyle. Mandibular manipulation is one of the conservative treatments to be considered first to manage the patients with anterior disc displacement without reduction. Mandibular manipulation is used to increase articular mobility and to restore the displaced disc into an anatomically normal position. While Farrar's technique has been popularly used, Minagi et al., Mongini and Suarez introduced the manipulation technique conducted by the patients themselves. But there is no study on the efficacy of self-manipulation technique, comparing with conventional one. The aim of this study was to investigate the efficacy of the conventional and self-manipulation technique, which was modified to complement the previously described technique by Minagi et al., in the treatment of patients with anterior disc displacement without reduction. TMD patients, who visited Department of Oral Medicine of Seoul National University Dental Hospital from December, 2002 to November, 2004 and were diagnosed as anterior disc displacement without reduction by TMJ magnetic resonance imaging (MRI) were enrolled. Conservative treatments including physical therapy, exercise, behavioral therapy, stabilization splint therapy, and manipulation therapy were done to every single patient until the symptomsimproved enough to discharge the patient. The charts were reviewed retrospectively according to the type of manipulation. In the results, patients whose maximum mouth opening was more than 40 mm was higher in the self-manipulation group(69.9%) than in the conventional manipulation group(42.9%). But difference between two groups was not significant. According to the fact that we decided to discharge the patients whentheir mouth opening increased to more than 40 mm and subjective symptoms such as pain and discomfort were improved as well, treatment period of discharged patients was significantly shorter in the self-manipulation group($29.2{\pm}12.3$ weeks) than in the conventional manipulation group ($61.0{\pm}38.0$ weeks) (p<0.01). In conclusion, in the treatment of TMD patients with anterior disc displacement without reduction, the self-manipulation technique which is performed by patients themselves is an effective treatment modality for increasing the range of mouth opening and shortening the total treatment period.

• The Journal of Korean Academy of Prosthodontics
• /
• v.37 no.4
• /
• pp.399-415
• /
• 1999

임플랜트 보철 환자의 하악 운동에 관한 연구를 위해 완전 고정성 보철 치료를 한 8명의 환자와 상하악 총의치를 장착한 8명의 환자, 그리고 5명의 자연치아 피검자를 대상으로 Sirognathograph(Siemens, Benshiem, Germany)와 BioPAK program(BioResearch, Milwaukee, U.S.A.)으로 한계운동과 당근시편에 대한 편측 저작운동에 대한 검사를 시행하였다. 편측 저작 운동은 전두면에서의 저작운동의 높이와 폭, 전두면에서의 저작각도, 시상면에서의 절치기준점의 최대 이동거리, 시상면에서의 저작운동의 전후방 이동거리, 최대개구속도, 최대폐구속도의 기준점으로 각 저작주기의 성적을 평균처리 하여 다음과 같은 결론을 얻었다. 1. 전두면에서의 저작운동의 높이는 자연치, 총의치, 임플랜트 군간에 유의성있는 차이가 없었다(p>0.05). 2. 전두면에서의 저작운동의 폭은 임플랜트 군이 자연치, 총의치 군에 비해 유의성있게 작은 수치를 보였다(p<0.05). 3. 전두면에서의 저작각도 분석시 임플랜트 군과 자연치 군, 임플랜트 군과 총의치 군간에 유의성있는 차이가 없었다(p>0.05). 4. 시상면에서의 절치기준점의 최대 이동거리 분석시 임플랜트 군과 자연치 군, 임플랜트 군과 총의치군간에 유의성 있는 차이가 없었다(p>0.05). 5. 시상면에서의 전후방이동거리는 자연치 군이 임플랜트 군, 총의치 군에 비해 유의성 있게 크게 나타났다(p<0.05). 6. 최대개구속도는 자연치 군이 총의치 군과 임플랜트 군에 비해 유의성 있게 작은 수치를 보였다(p<0.05). 7. 최대폐구속도는 각 군간에 유의성 있는 차이가 없었다(p>0.05). 8. 저작운동은 개인간의 차이가 커서 명확한 결론을 유추하기가 어려웠다.

• Journal of Oral Medicine and Pain
• /
• v.37 no.4
• /
• pp.205-211
• /
• 2012

A 35 year-old female presented with the complaint of sudden occurrence of bite change and concurrent opening limitation, as well as pain in the right temporomandibular joint (TMJ) during mouth opening. From her history it was revealed that she had simple clicking of right TMJ for several years before onset of these symptoms, and that the clicking sound subsided recently after development of opening limitation. On clinical examination, anterior open bite, midline shift of the mandible to right, and premature contacts on left posterior teeth were observed. Maximum mouth opening and lateral movement to left were also restricted. On magnetic resonance images, the right TMJ showed anterior disc displacement without reduction and the posterior joint space is greatly collapsed by retrusion of the condyle. It was thought that the sudden occurrence of occlusal change would be resulted from abrupt displacement of the mandible associated with development of the anterior disc displacement without reduction. The stabilization appliance traction therapy was performed initially for first 3 months along with physical and pharmacologic therapy. However, the anterior open bite and opening limitation didn't resolve and the position of mandible still remained altered. So the stabilization appliance was changed to intermaxillary traction device. Then the mandible returned progressively to normal position and the occlusion became more stable and comfortable. After 5 months of intermaxillary traction therapy, the anterior open bite was dissolved completely and the occlusion became stabilized satisfactorily along with recovery of normal mouth opening range. On post-treatment magnetic resonance image, remodeling of condylar head was observed.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.22 no.3
• /
• pp.291-296
• /
• 2021

This study examined the effects of the forward head posture on the maximum mouth opening of the jaw joint and the muscle activity and asymmetry of the temporalis and masseter. The craniovertebral angle was measured in 50 subjects (23.10±2.73 years) who met the selection requirements of the study. The maximum mouth opening, muscle activity, and muscle asymmetry were measured by reducing 0%, 10%, and 20%. As the craniovertebral angle decreased, the maximum mouth opening decreased (p<.001), the muscle activity of the right and left temporalis decreased (p<.001), and the muscle activity of the left temporalis also decreased. (p<.01). The asymmetry rate of the added muscles of the left and right temporalis, left and right temporalis, and masseter increased according to the change in condition (p<.01). The results of this study are expected to help establish a treatment strategy and comprehensive diagnosis for the temporomandibular joint and present a theoretical basis of manual therapy and therapeutic exercises used for the treatment of TMD.

• Journal of Oral Medicine and Pain
• /
• v.35 no.2
• /
• pp.155-163
• /
• 2010

Dermatomyositis (DM) is an idiopathic inflammatory connective tissue disorder and a systemic autonomic immune disease which shows a progressive muscle weakness and characteristic rash. It is identified by a characteristic rash accompanying, or more often preceding muscle weakness. Pathognomonic skin lesions are a blue-purple discoloration on the upper eyelids with edema (heliotropic rash), a flat red rash on the face and upper trunk, and erythema of the knuckles with a raised violaceous scaly eruption (Gottron's papule). The myopathy represents inflammatory and degenerative changes primarily affecting proximal muscles. DM often involves GI tract and respiratory system with as risk of 15-25% internal malignancy. It's managed with sun protection since muscle weakness as well as a rash could be aggravated by sun exposure. Systemic corticosteroid is an initial therapy and other immunosuppressive agent has been used as alternatives. Facial muscles are unaffected and masticatory muscles are rarely affected in DM. We present trismus close to muscle contracture in a patient with DM. Therefore, it needs continuous mouth-opening exercise to prevent progressive muscle contracture and to ensure normal mouth opening.

• The korean journal of orthodontics
• /
• v.27 no.2
• /
• pp.273-282
• /
• 1997

The purpose of this study was to evaluate changes in mandibular movement patterns after orthognathic surgery in skeletal Class III patients. The sample consisted of 20 Class III malocclusion patients(9 males, 11 females). Just before and after(2-7months) surgery, maximum opening & closing movement, mandibular border movement on sagittal, frontal and horizontal planes were recorded using Sirognathograph & BioPak EGN. On each record, 21 items were measured and statistically analyzed. The results were as follows 1. Angle of protrusive movement on sagittal plane showed greatest change after surgery. Also, as the incisal guidance was established by surgery, straight path of protrusive movement became curved line. 2. Maximum opening distance and maximum antero-posterior distance on maximum opening & closing movement, maximum opening distance on sagittal plane, angle of left lateral excursion on frontal plane were statistically significant after snrgery(p<0.01). 3. Maximum width of lateral excursion on frontal plane, distane of right lateral excursion and angle of maximum left lateral excursion on horizontal plane were statistiraily significant after surgery(p<0.05). 4. Maximum opening distance and maximum antero-posterior distance on maximum opening & closing movement showed significant differences according to post-surgical time(p<0.05). More recovery of range of movement occured in 5-7month group than in 2-3month group. 5. As the occlusal interferences were removed by orthognathic surgery, irregular opening & closing path became smooth curve.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.31 no.3
• /
• pp.453-458
• /
• 2004

Mandibular fracture is less common in children than in adults. However, children are more susceptible to ankylosis and developmental disorders, and don't respond as well to intermaxillary fixation compared to adults. On the other hand, bone fracture is healed more quickly in children and complications are scarce. Mandibular fracture in children is usually treated successfully with acrylic splint therapy with or without the use of eyelet wires and intermaxillary fixation. Severe complications that include ankylosis and developmental disorders may occur. The frequency and severity of such complications can be mitigated with a shorter duration of intermaxillary fixation and good post-operative care. Encouraging mandibular physical therapy by increasing patient motivation may be necessary in such cases where the patient's response is poor and the duration of intermaxillary fixation increases; when the patient is unable to undergo physical therapy, or when intermaxillary fixation is not necessary with the patient showing only minor symptoms such as trismus. In this case report, a 6 year-old girl with bilateral condylar fracture was treated with elastic in both the upper and lower jaws to allow mandibular physical therapy using a Benoist's appliance, which allows opening, lateral, and protrusive retrusive movements of the mandible. A 7-month follow-up showed beneficial therapeutic effects such as increased mandibular movement and prevention of condylar ankylosis.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.7 no.1
• /
• pp.22-26
• /
• 2007

상악과 하악이 선천적으로 붙어서 태어나는 선천성 유합증은 드문 선천성 기형으로 단순히 점막이 붙은 점막유합증에서 악골이 붙은 골유합증까지 다양하게 나타난다. 이중 상악골과 하악골의 골자체가 붙는 골유합증은 아주 드물어서 현재까지 26증례만 보고되고 있는데, 보고된 대부분의 증례는 편측에만 발생하는 불완전형으로 알려져 있다. 7세 된 여아환자가 인디아의 GSR 병원에 입이 벌어지지 않는다는 주소로 내원하였는데 환아의 턱은 완전히 움직이지 않았으며, 2-3 mm 정도 벌어지는 앞니부위에서는 2.5 cm 폭경의 3.0 mm 두께의 단단한 치조점막이 관찰되었다. 전기메스로 전방부의 부착성 섬유밴드를 잘라준 후 즉각적인 개구정도는 16 mm 정도까지 가능하여 구강으로의 기관삽관이 가능하였다. 삽관후 양쪽 후방부 협측점막의 두꺼운 밴드들을 모두 제거하여 개구량을 33 mm까지 증진시킨 후 수술을 종결하였다. 환아의 보호자에게 거즈 블록과 설압자를 이용하여 개구 연습을 능동적으로 시키도록 강조하여 교육하였으며 술후 16개월 경과시까지 특별한 합병증이나 개구량 감소는 관찰되지 않았다. 독립적으로 발생한 선천성 치조점막 유합증 환자에서 비정상적으로 커져있는 과두와 설골이 관찰되었는데, 설-하악 구조의 비정상적인 발육에 기인하여 지속적인 비정상적 운동으로 인한 이차적인 치은과 협점막의 섬유성 부착이 생긴 것으로 추측되었다. 이에 마취과와의 효율적인 협진으로 기관절개술 등의 부가적인 마취방법 없이 효과적으로 치료할 수 있었다.