• Title/Summary/Keyword: Disc displacement with reduction

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EVALUATION OF CLINICAL METHODS IN THE DIAGNOSIS OF TEMPOROMANDIBULAR JOINT DISORDERS: A COMPARISON STUDY WITH MAGNETIC RESONANCE IMAGING (측두하악관절 장애에 대한 임상진단의 유효성 연구)

  • Kim, Hyung-Wook;Shin, Sung-Soo;Kim, Jong-Sik;Kim, Ki-Young;Kim, Yoon-Ji;Hong, Soon-Min;Cheon, Se-Hwan;Park, Yang-Ho;Choi, Won-Cheul;Park, Jun-Woo
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.33 no.4
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    • pp.367-374
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    • 2007
  • Purpose: The diagnostic relevancies and characteristics and of clinical methods in the diagnosis of internal derangement(ID) were tested by comparing the results of them with those of magnetic resonance imaging(MRI). Methods: 75 patients(150 temporomandibular joints; TMJs), who were suspected to have ID by clinical diagnoses, were included. Clinical diagnoses including mouth opening pathway and TMJ sound were conducted and MRI takings were done. Accuracies, sensitivities, specificities, positive predictive values, and negative predictive values of clinical diagnosis, mouth opening pathway, and TMJ sound were calculated by comparing with diagnoses with MRIs. Results: Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis were 59.3%, 83%, 49%, 81%, and 51%. They were 59%, 82%, 25%, 73%, and 35% for mouth opening pathways. Although deviation was somewhat accurate for representing disc displacement with reduction(ADDWR), other discrepancies on opening pathways were not clinically relevant. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clicking sounds were 85%, 49%, 78%, 85%, and 37%. TMJs with crepitus were only three. But all TMJs with crepitus were diagnosed to have disc displacement without reduction(ADDWOR). Conclusion: When compared with diagnoses with MRIs, clinical diagnoses for ID were not so accurate. But they were suitable for screening tests for ID. Opening pathways and TMJ sounds were not so relevant in the diagnoses of IDs and so it was concluded that considerations for other factors must be included in the diagnoses of IDs.

THE APPEARENCE OF PROINFLAMMATORY CYTOKINES IN TEMPOROMANDIBULAR JOINT DISORDERS AFTER ARTHROCENTESIS AND LAVAGE (측두하악장애환자에서 악관절 세척술후 관절활액의 전구염증성 Cytokines의 발현)

  • Kim, Cheol-Hun;Hwang, Hie-Sung;Shin, Sang-Hoon;Chung, In-Kyo;Hwang, Tae-Ho
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.31 no.5
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    • pp.370-378
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    • 2005
  • The purpose of this study is that evaluate the distribution and biological roles of TNF-a, interleukin-1${\beta}$(IL-1${\beta}$), interleukin-6(IL-6) and tissue inhibitors of metalloproteinase-1(TIMP-1) in the synovial fliud of patients with non-inflammatory chronic temporomandibular joint(TMJ) disorders in relation to pain during joint movements and magnetic resonance imaging(MRI) findings. TMJ synovial fluids aspirates were obtained from 36 patients (36 joints) with chronic TMJ disorders and from 8 controls(8 joints). Patients were divided to four groups. The control group was from healthy volunteers(8 joints), group I(18 joints) was patients with anterior disc displacement with reduction, group II(5 joints) was patients with disc displacement without reduction and group III (5 joints) was osteoarthritis. The TNF-${\alpha}$, IL-1${\beta}$ and IL-6 levels in the aspirates were determined by using an enzyme-linked immunosorbent assay and the TIMP-1 level was measured by an enzyme immunoassay. Following examinations for pain during joint movements and MRI observations, these cytokines' level and frequencies of detection were compared. The level of IL-1${\beta}$was not significant different in all groups. but the level of TNF-${\alpha}$, IL-6 and TIMP-1 were significant different among groups. The level of IL-6 and TIMP-1 were correlated to pain during movement(p<0.01) and the level of TNF-a(p<0.05). Also, the level of IL-6 was correlated to the level of TIMP-1(p<0.01). Especially, The level of the TIMP-1 level was significantly correlated to the pain during movement and showed very high levle of Pearson's correlation coefficient (r=0.833)(p<0.001). The results indicated that the TNF-${\alpha}$, IL-6 and TIMP-1 levels in the TMJ aspirates of patients with chronic TMJ disorders have been raised. Especially, IL-6 and TIMP-1 were very high levels in the patients who were degraded in the TMJ. Also, TNF-${\alpha}$, IL-6 and TIMP-1 showed the significant correlation in the chronic temporomandibular joint disorders. Therefore I suggest that these cytokines were also correlated to the pain during movement in the chronic temporomandibular joint disorders.

The Relationship between Anterior Disc Displacement without Reduction and Development of Anterior Open Bite (비정복성 관절원판변위와 전치부 개교합 발생간의 관계)

  • Hur, Yun-Kyung;Ko, Myung-Yun;Ahn, Yong-Woo
    • Journal of Oral Medicine and Pain
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    • v.32 no.3
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    • pp.293-303
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    • 2007
  • The purpose of this paper is to evaluate if there is a relationship between anterior disc displacement without reduction and development of anterior open bite, and a relation between occurrence of open bite and occlusal appliance therapy. In general, the statistically significant differences were found between the Group 1 and 2 and normal mean group. The variables that represent mandibular size and form, showed a statistical significance in all 3 groups. Also 3 groups patients had a smaller ANB, a larger FMA than normal mean group. When we compared the 3 groups with respect to all cephalometric measurements by One-way analysis of variance (ANOVA), group 1 and 2 patients had a larger FMA, a larger SN to mandibular plane angle, a larger maxillomandibular plane angle, a larger occlusal plane to mandibular plane angle, a smaller total posterior facial height/total anterior facial height(%), and a larger gonial angle than group 3. The statistically significant differences were not found between the Group 1 and 2, and skeletal patterns were similar. Thus, morphologic features of patients with vertical discrepancies may represent a risk factor for the development of anterior open bite with or without occlusal appliance treatment. In case of patients with vertical discrepancy, we may have to be more careful when inducing a change of the vertical dimension.

Effect of simultaneous therapy of arthrocentesis and occlusal splints on temporomandibular disorders: anterior disc displacement without reduction

  • Lee, Hye-Sung;Baek, Hyun-Su;Song, Dong-Suk;Kim, Hee-Chul;Kim, Hyo-Geun;Kim, Bok-Joo;Kim, Myung-Soo;Shin, Sang-Hoon;Jung, Sung-Hee;Kim, Chul-Hoon
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.39 no.1
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    • pp.14-20
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    • 2013
  • Objectives: This study sought to evaluate the effect of simultaneous application of arthrocentesis and occlusal splint. Materials and Methods: A retrospective study of 43 patients (3 males, 40 females) whose symptoms had improved was conducted at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital between 2008 and 2010. Subjects were divided into three groups: Group A (17 patients with arthrocentesis and occlusal splints simultaneously applied), Group B (13 patients whose symptoms did not improve with occlusal splints, undergoing arthrocentesis after occlusal splint use for 8 weeks), and Group C (13 patients that only used occlusal splints). We compared these groups in maximum comfortable opening (MCO) and the visual analogue scale of pain and noise. Follow-up was performed at 1 week, 1 month, 3 months, and 6 months. Results: The improvement of symptoms was noted in all three groups, but Group A had a quicker improvement than the other groups, in terms of pain reduction and MCO increases. Conclusion: The simultaneous application of arthrocentesis and occlusal splints can reduce patient discomfort more quickly.

MRI study of temporomandibular joint disorder in orthodontic patients (교정환자에서 MRI를 이용한 측두하악관절 장애의 연구)

  • Kim, Tae-Woo;Byun, Eun-Sun;Baek, Seung-Hak;Chang, Young-Il;Nahm, Dong-Seok;Yang, Won-Sik
    • The korean journal of orthodontics
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    • v.30 no.2 s.79
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    • pp.235-243
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    • 2000
  • Magnetic resonance imaging(MRI) of the temporomandibular joint(TMJ) is very useful method to diagnose internal derangement of the TMJ because of its high specificity foy identification of condyle-disc relationships. The purpose of this study was to evaluate the existence, incidence and severity o』 internal derangement o』 the TMJ by the MRI of Patients who are suspected to have TMJ disorder. MRI sample was composed of 50 subjects(10 males, 40 females) and the mean age was 22.9 years. 43 subjects of the sample were found to have positive findings. $56\%$ of the subjects with positive findings had ADD(anterior disc displacement) without reduction, and $65\%$ had internal derangement of bilateral joints. Distributions in the types of malocclusion in patients with positive findings, the Angle's classification had shown : the largest $41.9\%$ for Cl II ($39.6\%$ for Cl II div 1 and $2.3\%$ for Cl II div 2), $37.2\%$ for Cl I, $18.6\%$ for Cl III, and $2.3\%$ for the unidentified. $8.6\%$ of the subjects with positive findings had facial asymmetry and $55.8\%$ had openbite. We can conclude that the percentage of Cl II is the highest in patients with internal derangement of the TMJ. Openbite or facial asymmetry is considered to be uncompensated or compensated deformity which results from facial skeleton remodeling in the process of degenerative joint disease(DJD) due to TMJ degeneration. Therefore it is recommended to screen the patients with facial asymmetry or openbite by MRI before the beginning of orthodontic treatment. Differential diagnosis is essential because the tendency of relapse is high after the orthodontic treatment and continuous observation of TMJ is needed in patients with TMJ disorder.

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Evaluation of TMJ sound on the subject with TMJ disorder by Joint Vibration Analysis

  • Hwang, In-Taek;Jung, Da-Un;Lee, Jae-Hoon;Kang, Dong-Wan
    • The Journal of Advanced Prosthodontics
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    • v.1 no.1
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    • pp.26-30
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    • 2009
  • STATEMENT OF PROBLEM. Qualitative and semi-quantitative methods have been developed for TMJ sound classification, but the criteria presented are completely inhomogeneous. Thus, to develop more objective criteria for defining TMJ sounds, electroacoustical systems have been developed. We used Joint vibration analysis in the BioPAK system(Bioresearch Inc., Milwaukee, USA) as the electrovibratography. PURPOSE. The aim of this study was to examine the TMJ sounds with repect to frequency spectra patterns and the integral > 300 Hz /< 300 Hz ratios via six-months follow-up. MATERIAL AND METHODS. This study was done before and after the six-months recordings with 20 dental school students showed anterior disk displacement with reduction. Joint vibrations were analyzed using a mathematical technique known as the Fast Fourier Transform. RESULTS. In this study Group I and Group II showed varied integral > 300 /< 300 ratios before and after the six-months recordings. Also, by the comparative study between the integral > 300 /< 300 ratios and the frequency spectrums, it was conceivable that the frequency spectrums showed similar patterns at the same location that the joint sound occurred before and after the six-months recordings. while the frequency spectrums showed varied patterns at the different locations that the joint sound occurred before and after six-month recordings, it would possibly be due to the differences in the degree of internal derangement and/or in the shape of the disc. CONCLUSIONS. It is suggested that clinicians consider the integral > 300 /< 300 ratios as well as the frequency spectrums to decide the starting-point of the treatment for TMJ sounds.

Reduction of headache intensity and frequency with maxillary stabilization splint therapy in patients with temporomandibular disorders-headache comorbidity: a systematic review and meta-analysis

  • Manrriquez, Salvador L.;Robles, Kenny;Pareek, Kam;Besharati, Alireza;Enciso, Reyes
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.21 no.3
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    • pp.183-205
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    • 2021
  • This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA frequency in patients with temporomandibular disorders (TMD)-HA comorbidity. Randomized controlled trials (RCTs) using full-arch coverage, hard resin, and maxillary SS therapy were included. Electronic databases, including Cochrane Library, MEDLINE through PubMed, Web of Science, and EMBASE, were searched. The risk of bias was analyzed based on Cochrane's handbook. The search yielded 247 references up to January 28, 2020. Nine RCTs were included at a high risk of bias. The comparison groups included other splints, counseling, jaw exercises, medications, neurologic treatment, and occlusal equilibration. Four studies reported a statistically significant reduction in HA intensity, and five studies reported significant improvement in HA frequency from baseline at 2-12 months in patients with TMD-HA comorbidity treated with a full-arch hard maxillary SS. HA frequency in tension-type HA (TTH) comorbid with TMD diagnoses of myofascial pain (MFP) or capsulitis/synovitis improved significantly with SS than that with full-arch maxillary non-occluding splint (NOS) in two studies. Comparison groups receiving hard partial-arch maxillary splint nociceptive trigeminal inhibition (NTI) showed statistically significant improvements in HA intensity in patients with mixed TMD phenotypes of MFP and disc displacement comorbid with "general HA." Comparison groups receiving partial-arch maxillary resilient/soft splint (Relax) showed significant improvements in both HA intensity and frequency in patients with HA concomitant with MFP. The meta-analysis showed no statistically significant difference in the improvement of pain intensity at 2-3 months with comparison of the splints (partial-arch soft [Relax], hard [NTI], and full-arch NOS) or splint use compliance at 6-12 months with comparison of the splints (partial-arch Relax and full-arch NOS) versus the SS groups in patients with various TMD-HA comorbidities. In conclusion, although SS therapy showed a statistically significant decrease in HA intensity and HA frequency when reported, the evidence quality was low due to the high bias risk and small sample size. Therefore, further studies are required.

Condylar and Ramal Vertical Asymmetry of Temporomandibular Disorders in Panoramic (파노라마 방사선사진을 이용한 측두하악관절장애 환자의 하악과두와 하악지 비대칭에 관한 연구)

  • Jong, Ji-Woong;Kim, Byung-Gook;Kim, Jae-Hyung
    • Journal of Oral Medicine and Pain
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    • v.30 no.2
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    • pp.239-246
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    • 2005
  • The purpose of this study was to examine the difference of condylar and ramal vertical asymmetric indices on paonramic radiographs between temporomandibular disorder patients and normal group and according to classification of temporomandibular disorders. One hundred and twenty temporomandibular disorder patients and thirty normal individuals were selected. After tracing the panoramic radiographs, measurements for asymmetric indices were identified. The means and standard deviations of the measurement of each group were calculated and compared between two groups. Through the comparison of the measurement between two groups, following results were obtained 1. As a result of comparing condylar and ramal vertical asymmetry indices of the temporomandibular disorder patients with that of normal group, there was significant difference in condylar vertical asymmetry index between two groups and no significant difference in ramal vertical asymmetry index between two groups. 2. Condylar and ramal vertical asymmetry indices of temporomandibular joint disorder and muscle disorder patients showed greater value than normal group, but there was no significant difference between temporomandibular joint disorder patients and muscle disorder patients. 3. Among temporomandibular joint disorder patients, muscle disorder patients, and normal group, there was only significant difference in condylar vertical asymmetry index between temporomandibular joint disorder patients and normal group. 4. Among disc displacement, disc dislocation with reduction, and disc dislocation without reduction, there were no significant difference in condylar and ramal vertical asymmetry indices. 5. There were no correlation between aging and condylar and ramal vertical asymmetry indices. The results of the present study showed that condylar vertical asymmetry index of temporomandibular disorder patients showed greater values than normal group, and this difference could be considered as the features of temporomandibular disorders. Thus measuring the condylar vertical asymmetry index on panoramic radiographs is considered as the important factor for diagnosis and treatment of temporomandibular disorders.

Processing of Water Activity Controlled Fish Meat Paste by Dielectric Heating 1. Formulation and Processing Conditions (내부가열을 이용한 보장성어육(고등어) 연제품의 가공 및 제품개발에 관한 연구 1. 원료${\cdot}$첨가물의 배합 및 가공조건)

  • LEE Kang-Ho;LEE Byeong-Ho;You Byeong-Jin;SUH Jae-Soo;JO Jin-Ho;JEONG In-Hak;JEA Yoi-Guan
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.17 no.5
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    • pp.353-360
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    • 1984
  • As an effort to expand the utilization of mackerel which has been thought disadvantageous to processors due to the defects in bloody dark color of meat, high content of lipid, and low stability of protein, and to develope a new type of product, so called, preservative fish meat paste, the processing method was studied in which dielectric heating was applied by means of cooking, pasteurization, dehydration, and control of water activity. The principle of this method is based on that dielectric heating can initiate a rapid dispersion or displacement of moisture in the meat tissue so that the level of water acivity can be controlled by dehydration with hot air meanwhile the product is cooked, pasteurized, and texturized. And the product is finally heated with electric heaters and vacuum sealed to stabilize water activity and storage stability. In present paper, a formula for preparing the fish meat-stach paste, the conditions of dielectric heating and dehydration, shape and size of the product, and other parameters were tested to optimize the process operation. A formula of the fish meat-starch paste to provide proper textural properties and water activity was $10\%$ starch, $1.5\%$ salt, $3\%$ soybean, $0.6\%$ MSG, $2\%$ sucrose, and $3\%$ sorbitol against the weight of fish meat. A proper shape and size of the product to avoid foaming and case hardening during heating was sliced disc of 8 cm $diameter{\times}0.8$ cm thickness or $10{\times}10$ cm square plate with 1.0 cm thickness. The disc shape was recommended because it resulted more uniform heating, minimum foaming and case hardening. And it was also advantageous that disc was simply provided when the fish meat disc was stuffed in the same, solidified in boiling water for 2 to 3 minutes, and sliced. Condition of dielectric heating was critical to decide the levels of sterility, water activity, and textural property of the product. The temperature at the center of the meat disc slices was raised up to $95^{\circ}C$ in 1.5 minutes so that continuous exposure to microwave caused expanded tissue and hardening ending up with a higher water content. Heating for 5 to 6 minutes was adequate to yield the final water activity of 0.86 to 0.83(35 to $40\%$ moisture). It is important, however, that heating had to be done periodically, for instance, in the manner of 2.0, 1.5, 1.5, and 1.0 minute to give enough time to displace or evaporate moisture from the meat tissue. The product was dehydrated for 2 to 3 minutes by hot air of $60^{\circ}C$, 3 to 5m/sec and finally exposed to electric heaters for 5 to 6 minutes until the surface was roasted deep brown. These conditions of heating and dehydration resulted in a complete reduction of total plate count from an initial count of $5.3{\times}10^6/g$ to less than $3{\times}10^2/g$. General composition of the product was $40.1\%$ moisture, $20.8\%$ protein, $17.4\%$ lipid, $16.2\%$ carbohydrate, and $5.5\%$ ash. Textural properties revealed folding test AA, hardness 42, cohesiveness 0.53, toughness 4.6, and elasticity 0.8.

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Self-administration of an Analgesic Does Not Alleviate Pain in Beak Trimmed Chickens

  • Freire, Rafael;Glatz, Philip C.;Hinch, Geoff
    • Asian-Australasian Journal of Animal Sciences
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    • v.21 no.3
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    • pp.443-448
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    • 2008
  • Beak trimming in laying hens is a routine practice in which about 1/3-1/2 of the upper and lower beak is removed with the aim of reducing cannibalism. This experiment aimed to identify if this procedure causes pain by examining self-administration of an analgesic (carprofen) and pecking behaviour in 80 laying pullets beak-trimmed by two different methods at one day of age using hot-blade cauterisation or infra-red cauterisation. We also tested a control treatment, pullets with intact beaks, and a positive control treatment of pullets beak trimmed at 10 weeks of age which were expected to experience some pain due to recent severing of the underlying nerves in the beak. At 11 weeks of age birds trimmed at 10 weeks of age pecked more (p<0.001) gently ($0.6{\pm}0.06N$) at a disc attached to a force-displacement transducer than birds trimmed at 1 day of age with an infra-red machine ($0.9{\pm}0.1N$) or a hot blade ($1.1{\pm}0.07N$) and intact birds ($1.2{\pm}0.1N$). Maximum force of pecks recorded was also lower (p<0.001) in birds trimmed at 10 weeks of age than birds trimmed at 1 day of age with an infra-red method or a hot blade and intact birds. However, the pecking force in birds trimmed at 10 weeks of age was not increased by providing them with analgesic-treated feed, though birds that ate more carprofen had a higher maximum force of peck (p = 0.03). Pecking force in birds beak-trimmed at 1 day of age was the same as the pecking force of intact birds, and was unaffected by feeding pullets carprofen. A method of self-administration of an analgesic had previously revealed that chickens in neuromuscular pain arising from lameness consumed more of a feed containing carprofen than healthy chickens. However, we found no evidence that beak-trimmed pullets consumed more carprofen-treated feed than pullets with an intact beak. It should be noted that the three beak trimming methods resulted in an average 34% reduction in beak length, considered a light trim, and is perhaps not representative of commercial birds where greater portions of the beak are removed. We conclude that although carprofen has been reported to have an analgesic effect on neuromuscular pain in chickens, it appears to have no analgesic effect on potential neuropathic pain arising from the nerves severed by a light beak trim.