• Journal of Oral Medicine and Pain
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• v.38 no.3
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• pp.267-274
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• 2013

This study was performed to investigate the skeletal factors related to open lock of the temporomandibular joint(TMJ). We compared the skeletal measurements on the cephalogram and transcranial radiograph among 3 groups, open lock group consisting of consecutively filed 50 patients with at least one open lock episode within recent 1 year, temporomandibular disorder(TMD) group of 50 TMD patients without open lock diagnosed by Research Diagnostic Criteria for TMD (RDC/TMD) Axis I, and normal group of 50 patients without TMD or open lock. The patients of TMD and normal group were randomly selected in an age-and-gender-matched way with ones of open lock group. Open lock group showed smaller saddle angle than normal group on cephalograms and steeper inclination of the articular eminence than TMD and normal groups on transcranial radiographs. These results imply that the patients with the joint located more anterior and the articular eminence with steeper inclination might be riskier to TMJ open lock.

• Journal of Oral Medicine and Pain
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• v.38 no.1
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• pp.29-34
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• 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
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• v.22 no.1
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• pp.31-44
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• 1997

저자들은 악관절내장증의 증상과 징후의 객관적 평가법을 개발하기 위하여 서울대학교치과 병원 구강진단과 악안면동통진료실을 내원한 환자중 좌우 양 관절중 한 관절 이상의 관절에 악관절내장이 있는 남자 8명(평균연령 19.9$\pm$2.9세), 여자 34명(평균연령:32.8$\pm$11.8세) 총 42명(84개 관절)에 대하여 VAS 및 압통역치 측정, 악관절조영술, 골신티그래피 검사 및 악관절 활액의 분석을 시행하였다. 악관절 동통의 심도는 VAS로 측정을 하였으며 PPT는 electronic algometer로 평가를 하였다. 악관절조영사진을 얻기 직전 활액을 채취하였으며 그 성분중 Hyaluronic acid, 총단백질, IgG, IgM과 albumin을 분석하여 그 상관관계를 분석한 결과 다음과 같은 결론을 얻었다. 1. 악관절 내장증으로 내원한 환자 42명, 총 84개 관절중, 무통성이고 관절잡음이 없는 경우가 7개 관절, 무통성이고 단순관절음만 존재하는 경우가 18개 관절, 동통 및 단순관절음이 존재하는 경우가 18개 관절, 간헐적인 폐구 과두걸림이 있는 경우가 11개 관절, 급성 폐구성 과두걸림의 경우가 11개 관절, 만성 폐구성 과두걸림의 경우가 3개 관절, 퇴행성 관절질환이 존재하는 경우가 16개 관절이었다. 2. 연구대상중 18명의 환자, 총 36개 관절에 대한 골 신티그래피 검사 결과, 활동성으로 나타난 경우가 33개 관절이었고 이중 23개 관절이 동통성이었으며, 활동 상태 관절의 VAS 항목과 압통역치 항목 및 여러 검사 항목들은 비활동 상태 관절의 항목과 유의한 차이를 나타내지 않았다. 3. 악관절내장의 진행정도에 따른 악관절부위의 동통의 측정에 있어서는 압통역치의 측정보다는 VAS에 의한 방법이 더 유용하며 특히, 후방부의 촉진시에 유의한 정보를 얻을 수 있었다. 4. 악관절 내장즈으이 진행 단계에 따라, VAS항목과 압통역치 항목을 비교해 본 결고, 주기적인 과두걸림(II) 단계에서 가장 높은 VAS 수치와 가장 낮은 압통역치를 나타내었으며 상방 촉진시 VAS 항목에서 주기적인 과두걸림(II) 단계와 증상 및 징후가 없는(0) 단계 사이와 후방 촉진시 VAS 항목에서 주기적인 과두걸림(II) 단계 및 퇴행성 관절 질환(V) 단계와 증상 및 징후가 없는(0) 단계 사이에서만 유의성을 나타내었다. 5. 활액내 총단백질량, albumin 량, IgG 및 IgM 농도는 악과？ㄹ 내장증의 진행에 따라 유의성을 나타내지는 않았으나 퇴행성 관절 질환(V) 단계에서 증가되는 양상을 나타내었다. 6. 활액내 hyaluronic acid의 농도는 악관절 내장증의 진행에 따라 유의성을 나타내지는 않았으나 만성 폐구성 과두걸림(IV) 단계에서 감소되는 양상을 나타내었다.

• Journal of Oral Medicine and Pain
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• v.22 no.2
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• pp.241-252
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• 1997

본 연구는 임상검사 및 방사선 사진상 악관절장애로 진단된 환자중 물리치료,악관절 안정장치 등의 보존적 치료방법을 시행하였으나 증상의 개선이 별로 없는 퇴행성 관절질환이나 중등도의 개구제한을 가진 환자를 대상으로하여 aspirin을 이용한 활액성분 분석 및 악관절 도약술과 sodium hyaluronate의 주입을 시행한후 이에 따른 치료결과를 평가하기 위하여 시행되었다. 평균연령이 31.2세(21-42세)인 11명의 악관절 장애환자를 대상으로 하였다. 악관절 도약술과 sodium hyaluronate의 주입은 악관절의 동통과 개구제한의 해소를 위해 시행되었으며 그 결과를 시술전, 시술 즉시, 시술 1주후 및 4주후로 나누어 분석하였으며 활액 채취시 생리식염수의 희석에 의한 활액성분의 농도 변화에 따른 오차를 막고자 활액과 혈액내의 aspirin의 농도차를 이용하여 정확한 활액 성분농도를 측정하였다. 이상의 연구를 통하여 다음과 같은 결론을 얻었다. 1. 전체 환자의 생리식염수에 의한 악관절 활액의 희석계수는 1.4-12.9(5.5$\pm$4.2)로 상당히 넓은 범위를 나타내었다. 2. 만성 폐구성 과두걸림 환자군(n=7)의 생리식염수에 의한 활액의 희석계수 (6.2$\pm$3.5)는 퇴행성 관절질환을 갖는 환자군(4.4$\pm$5.7, n=4)과 유의한 차이가 없었다. 3. 만성폐구성 과두걸림군과 퇴행성 관절 질환군간의 활액성분의 농도는 유의한 차이가 없었으나 희석계수를 이용한 수정된 Hyaluronic acid와 총단백질의 농도는 만성 폐구성 과두걸림군의 경우에서 유의하게 더 높게 나타났다. 4. 악관절 도약술과 sodium hyaluronate의 주입 직후 만성 폐구성 과두걸림 환자군의 경우 평균 8.3mm의 추가적인 개구 증가로 유의한 차이가 관찰되었고 퇴행성 관절질환의 경우 평균 1.3mm의 추가적인 개구증가가 있었으나 유의한 차이가 관찰되지 못했다. 5. 시술전, 시술 1주후 및 4주후의 여러 검사항목을 비교한 결과 두 군에서 모두 시간의 경과에 따라 기능이상 및 동통 감소의 경향을 나타내었으나 유의하지는 않았으며 만성 폐구성 과두걸림의 경우 기능장애지수(dysfunction index) 와 최대개구시 동통의 정도는 시술전과 시술 4주후간에 유의한 차이가 관찰되었다.

• Journal of Oral Medicine and Pain
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• v.37 no.4
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• pp.221-225
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• 2012

Disc dislocation without reduction, as known as closed lock, is a clinical condition in which the disc is dislocated from the condyle and does not return to normal position during condylar movement When the condition of disc dislocation without reduction is acute, the initial therapy should include an attempt to reduce or recapture the disc by manual manipulation. When patients report a history of being locked for 1 week or less, manual manipulation is usually successful. In patients with a longer history, success rate tends to decrease rapidly. If the disc has been successfully recaptured, placing an anterior positioning appliance is recommended to prevent clenching on the posterior teeth, which would likely redislocated the disc. But it is hard to make an appliance immediately in the clinic because it takes too much time. And making an appliance using self-curing acrylic resin is not very popular because of its discomfort by odor and working time. Also, if the patient has resin allergy or is under orthodontic treatment, or if it is impossible to control behavior of the patient, it has been restricted to make an appliance immediately. Therefore, to supplement this disadvantages, we tried to confirm about successful short term use of temporary anterior positioning splint made by using putty impression material after manual manipulation in this study.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.76-82
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• 2000

In general, treatment of the patients with closed lock divides into a conservative and a surgical treatment. Surgical treatment has been often applied in case that occlusal splint therapy was not effective on the patient with closed lock. In recent, some clinicians reported good results with mandibular manipulation. Three patients complained limitation of month opening-(mean mouth opening was 22.3mm) and TMJ pain. Articular discs were displaced anteriorly on MRI. Two patients didn't improve the symptoms with long term occlusal splint therapy. We applied mandibular manipulation after injection with 2% lidocaine into the upper joint space of the affected TMJ and directly inserted occlusal splint to all patients. At the follow-up check, mean mouth opening was 41.7mm. TMJ pain decreased, condyle and disc relationship was improved functionally on MRI.

• Journal of Oral Medicine and Pain
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• v.15 no.1
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• pp.79-89
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• 1991

The author examined the patterns and various ranges of mandibular movements in TMJ lock closed patients in the frontal, sagittal and horizontal plane and obtained the following results. 1. In the frontal trajectory, the mean amount of maximum mouth opening was 24.4mm and the opening paths were deviated to the affected side in 87.1% of the patients. The mean amount of maximum laterotrusion to the affected side was 10.4mm and that of non-affected side was 7.5mm. There was a significant difference between them(p<0.001). 2. In the sagittal trajectory, the mean amount of the maximum protrusion was 7.0mm, the mean amount of the maximal retrusion was 1.0mm 3. In the horizontal trajectory, the pattern of laterotrusion showed asymmetry: the mean length of non-affected side was smaller than that of the affected side. Protrusive path were deviated to the affected side in 64.5% of the patients, the mean degree of deviation was 16.4$^{\circ}$. The mandibular movements of TMJ lock-closed patients can be characterized by decreased range of mouth opening, protrusive movement, and laterotrusive movement to the non-affected side and also characterized by deviated opening and protrusive path to the affected side.

• The Journal of the Korean dental association
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• v.37 no.6 s.361
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• pp.445-455
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• 1999

Arthrocentesis is a simple, less invasive, inexpensive, and highly efficient procedure for closed lock of the temporomandibular joint with regard to the lack of recurrence of symptoms during extended periods of follow-up and significiant improvement in pain and jaw function. It can be performed under local anesthesia. Arthrocentesis closed lock provide sustained normal joint function and marked pain relief. This study is the clinical outcome of arthrocentesis for closed lock of the temporomandibular joint. 160 patients(169 joints) who had experienced sudden-onset, persistent limited mouth opening were the subjects of this study. Arthrocentesis of the upper compartment of the affected TMJ was performed using normal saline. As results, at 3-60 months postarthrocentesis maximum mouth opening(MMO) had increased from mean of 27.7mm to 43.5mm, contralateral movements(CLM) from mean 5.74mm to 9.55mm, midline deviation during mouth opening from mean 3.04mm to 0.69mm. In 130 cases there was a history of joint noises, in 52 cases all noise had ceased after procedures.

• Journal of Oral Medicine and Pain
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• v.22 no.1
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• pp.7-13
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• 1997

In order to evaluate the outcome of conservative treatment for acute or chronic closed lock, 127 patients were subjected at the Dept. of Oral Medicine, PNUH, from 1991. All the symptoms were analyzed and the results according to treatment modalities were compared before and after treatment. 1. Closed lock patients were more often seen in women of twenty and thirty. 2. The most common reasons for treatment were functional pain, limitation of mouth opening, restricted laterotrusion to non-effected side, deflection on opening but, on the contrary, noise was the least. 3. Most of closed lock patients were curedin six months. 4. Conservative treatment including stabilization splint produced better results. 5. Functional pain and limitation of mouth opening were relieved and maximumm comfortable opening was expanded, but joint noise decreased in the chronic and increased in the acute.

• Journal of Oral Medicine and Pain
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• v.16 no.1
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• pp.113-120
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• 1991

The authors examined the patterns and various ranges of mandibular movements in TMJ lock closed patients in the frontal, sagittal and horizontal plane pre-end post-treatment. And the author obtained the following results. 1. In the frontal plane, the patterns and ranges of mandibular movement of the patients were very irregular and small before treatment. But after the treatment, the patterns were similar to the typical shield shape of the normal subjects. And the velocity of opening and closing was improved after the treatment. 2. In the sagittal plane, the mean amount of maximum mouth opening was 27.0±4.0mm before treatment and 44.0±5.4mm after treatment. And there was statistically significant improvement(p<0.005). The patterns of the movement were very irregular and small before treatment, but were similar to the shape of "Posselt's envelope of motion" after the treatment. The velocity of opening and closing was improved after the treatment 3. In the horizontal plane, the mean amount of maximum laterotrusion was 8l2±2.5mm in the affected side and 6.7±2.2mm in the non-affected side before treatment. There was a significant difference between the sides(p<0.05). After the treatment, the mean was 10.4±2.6mm in the affected side and 8.9±2.3mm in the non-affected side and there was no significant difference between the sides(p>0.05). There was no significant difference in the mean amount of maximum protrusion between the before and aftertreatment(p>0.05), but the patterns of the movements were improved.