• Imaging Science in Dentistry
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• 제36권2호
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• pp.73-79
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• 2006

Purpose : To describe the MRI findings of the antero-superior attachment of the disc in patients with internal derangement. Materials and Methods : One hundred fifty-six MR images from 40 normal subjects and 55 abnormal subjects were classified into three study groups of normal, anterior disc displacement with reduction and anterior disc displacement without reduction. On both closed- and open-mouth proton density sagittal images, the depiction of the antero-superior attachment of the disc and its demarcation from the disc were evaluated in three cuts of lateral, central and medial one thirds of the condyle. Results : The depiction of antero-superior attachment was more frequent by the order of normal, anterior disc displacement with reduction and anterior disc displacement without reduction groups, and the significant differences were found on lateral cut of the closed images and lateral and central cuts of the open images. In study for the demarcation between the antero-superior attachment and the disc the lateral cut of the closed images and all three cuts of the open images showed significant differences. Conclusion : Open images are useful to show the difference in depiction of the antero-superior attachment of the disc among the TMJ groups.

• 한방재활의학과학회지
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• 제23권4호
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• pp.129-141
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• 2013

Objectives The aim of this review is to investigate clinical studies for manual therapy on Temporomandibular Joint Disorder and to propose for the better method of studies in the future. Methods We investigated recent clinical studies for manual therapy on Temporomandibular Joint Disorder via searching Pubmed, KISS, KISTI, KERIS, KMBASE and National Assembly Library. 21 domestic and overseas articles were analyzed and the journals, the authors, the published years, countries, methods, periods, techniques of chiropractic, outcome measures, and purpose of those articles were examined. Results Studies on manual therapy were mainly published via Cranio. The diagnostic criteria that most frequently adopted in the overseas articles were research diagnostic criteria for temporomandibular disorders, The technique of chiropractic that most frequently adopted in the articles was passive traction and translation of TMJ. Many of the studies were researched for effectiveness of the manual therapy as the secondary treatment. Conclusions Reviewing the recent clinical studies for manual therapy on temporomandibular joint disorder and figuring out the strong points and weak points of those studies are necessary to future studies. It is anticipated that this review would benefit the in-depth treatments for temporomandibular joint disorder in terms of Korean medicine.

• Journal of Oral Medicine and Pain
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• 제37권3호
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• pp.183-188
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• 2012

노인층에서의 턱관절장애의 증상과 징후에 관한 이전 연구에서 일관된 결론을 제시하지 못하고 있다. 본 연구의 목적은 연령에 따른 턱관절의 증상과 징후의 유병률을 분석하는 것이다. 젊은층을 대조군으로 평가하였다. 40명의 노인층 환자 (28명 여자, 12명 남자, 평균연령: $65.2{\pm}2.5$)와 40명의 젊은층 환자 (30명 여자, 10명 남자, 평균연령: $23.3{\pm}2.6$)로서 턱관절장애(temporomandibular disorders, TMD)로 진단받은 질환자를 대상으로 하였다. 실험 대상자는 다음과 같은 평가기준을 적용하였다. 주관적 평가인 주소에서 구강안면 통증의 정도(VAS), 객관적인 평가에서 하악 개구 시 운동량, TMJ 관절잡음 (관절음, 염발음), TMJ 촉진 시 통증, 저작과 관련된 근육(교근, 측두근)과 목 근육, 견부근의 촉진 시 통증에 관한 것을 포함한다. 두 그룹 간 차이점 분석은 t 검정과 카이제곱 검정 방법을 사용하였다. (SPSS v. 17) P 값이 0.05 이하인 것을 통계적으로 유의성 있게 보았다. 주관적인 평가에서 주소에 나타난 구강안면 통증 정도에서는 두 그룹 간 유의한 차이는 발견되지 않았다. 객관적인 평가에서 노인층 환자에서 개구 시 염발음이 25%에서 관찰되었고 저작근 촉진 시 통증은 82.5%에서 관찰되었으며 측두근 촉진시에 60%에서 통증을 보였다. 반대로, 젊은층에서 62.5%에서 관절잡음이 관찰되었고 개구 시 좀 더 큰 운동량을 보였다. (p=0.043) 관절잡음과 촉진 시 근육 통증, 하악 운동량에서 두 그룹 간 차이는 현저했다. 노인층에서 TMD에 대한 개구 시염발음, 근육 촉진 시 통증이 자주 관찰되는 반면 젊은 층에서는 하악 운동 시 관절잡음, 운동 시 개구량의 증가가 보다 많이 관찰되었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권4호
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• pp.373-382
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• 2000

Temporomandibular disorders arised from joint itself was caused by inflammation or mechanical irritation of the retrodiskal tissues. Histologic changes of the retrodiskal tissues of temporomandibular joint(TMJ) internal derangement, such as inflammatory cell infiltration, hyalinization, myxoid change, fatty change, arterial obliteration, and so on, were reported, but relationships between magnetic resonance imaging(MRI) findings and histologic findings of the retrodiskal tissue were few reported. The purpose of this study was to find histologic changes of the retrodiskal tissues for status of joint and joint effusion in MRI of the temporomandibular joint which had surgical treatment. Materials were surgically treated 52 temporomandibular joints with internal derangement or osteoarthritis in TMJ clinic, Yongdong Severance Hospital. All joints were confirmed by magnetic resonance T1- and T2-weighted imagings bofere surgery. Status of joint was categorized by normal position, disc displacement with reduction, disc displacement without reduction, disc displacement without reduction associated with osteoarthrosis using preoperative MR T1-weighted images. Magnetic resonance evidence of joint effusion was observed in T2-weighted images and classified by its amount; degree 0(not observed), degree 1(small amount), degree 2(moderate amount), degree 3(large amount). Histologic features were observed whether the retrodiskal tissue has inflammatory cell infiltration, myxoid change, hyalinization, chondroid metaplasia and arterial obliteration. The distribution of elastic fibers were also observed. The results were as follows; 1. Inflammatory cell infiltration was not observed in any retrodiskal tissues. 2. MRI findings such as status of joint and evidence of joint effusion did not have significant relationship with myxoid change, hyalinization, chondroid metaplasia, arterial obliteration of the retrodiskal tissues. 3. Hyalinization and chondroid metaplasia were found in 8 joints(15.4%) and 5 joints(9.6%). All of them were found in disc displacement without reduction and disc displacement without reduction associated with osteoarthrosis. 4. Arterial obliteration was observed more frequently in disc displacement without reduction(55.6%) than disc displacement without reduction associated with osteoarthrosis(28.6%). Further studies with proper controls and more materials will be necessary.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권6호
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• pp.401-406
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• 2017

Objectives: Headache is the most common complaint of patients suffering from temporomandibular joint disorders (TMDs). Thus, temporomandibular joint (TMJ) examinations maybe necessary in patients with headache. Considering the high prevalence of bruxism and TMDs in patients with headache the effects of conservative TMD treatment on headache should be assessed. Materials and Methods: Patients were questioned about headaches in the past three months. Those responding affirmatively to this question were examined for TMD and bruxism. After the examinations, 219 patients remained in the study and received self-management instructions. Patients were requested to modify oral habits except when eating or sleeping. The degree of pain (visual analogue scale), headache disability index (HDI), frequency of headaches (FH) per month and TMD intensity were evaluated. Results: The median levels of pain, HDI, FH, and TMD intensity were 8, 44, 8, and 7, respectively, before modifying oral habits and decreased to 4, 24, 2, and 3, respectively, after intervention. These decreases were statistically significant. Conclusion: Having patients maintain free space between the teeth and relax muscles can be an efficient method to treat headache and TMD, especially when repeated frequently.

• PNF and Movement
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• 제20권3호
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• pp.451-459
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• 2022

Purpose: Temporomandibular disorder (TMD) is a common musculoskeletal problem that causes pain in and disability of masticatory muscles, the temporo-mandibular joint (TMJ), and related structures. The purpose of this study was to compare pressure pain thresholds (PPTs) of masticatory muscles, cervical ranges of motion (ROM), and pelvic mobility during gait of subjects with or without TMD. Methods: In this study, pain thresholds and changes in the mobility of the cervical vertebrae and pelvis were measured in 25 patients with TMD and 25 healthy controls. Using a pressure algometer, the pressure pain thresholds (PPTs) of the masseter and temporalis muscles were measured in both groups. A gyroscope sensor with a mobile application was used to determine cervical ROM in the frontal and sagittal planes. A 3D-motion analysis system was used to evaluate pelvic mobility in the sagittal, frontal, and transverse planes during gait. Results: The TMD group showed significantly decreased PPTs of masseter and temporalis muscles compared with the control group (p < 0.05). Cervical ROM in flexion, extension, and lateral bending were significantly decreased in the TMD group compared with the control group (p < 0.05). In addition, antero-posterior pelvic tilt was significantly decreased in the TMD group (p < 0.05). Conclusion: The results of the current study suggest that there are close anatomical and functional relationships between TMD and muscle chains related to the cervical spine and pelvis. Therefore, more comprehensive body posture assessments, especially of painful areas, should be undertaken when studying TMD patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권1호
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• pp.35-42
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• 2003

Purpose: This study was aimed to investigate the relationship between the mandibular asymmetry and the internal derangement of temporomandibular joint. Materials and methods: One hundred and sixty eight patients had been assessed through clinical examinations, panoramic radiographs and magnetic resonance imagings (MRIs), were selected. The samples were classified into three subgroups according to the severity of the mandibular asymmetries in the panoramic radiographs and the status of TMJ discs on the MRI were compared among each groups. Results: In an apparent asymmetry group, there was a significant difference in the number of temporomandibular disk displacement without reduction between the long and short side (66.7%, 18/27 joints on the short side) when the ratio of condylar process and coronoid process was used (p<0.05), but there was no statistically significant difference when the ratio of condyle and ramus was used. Conclusion: The probability of the disc displacement without reduction was higher at the side with relatively shorter condylar process on the panoramic radiograph, and also it might be more effective to use ratio of condylar process and coronoid process in the assessment of mandibular asymmetry. Therefore, a careful assessment on the temporomandibular disorders is necessary to diagnose and establish the treatment plans for the patients with a mandibular asymmetry and the panoramic radiograph can be used effectively on that way.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권6호
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• pp.259-265
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• 2014

Purpose: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. Methods: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). Results: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. Conclusion: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases.

• Journal of Oral Medicine and Pain
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• 제12권1호
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• pp.85-93
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• 1987

The author studied on the effect of TMJ sounds to the patterns and ranges of mandibular border movements in horizontal plane with Pantograph (Denar Corp.). For study, 19 patients with TMJ sounds only and 16 students with no TM disorder were selected and classified as experimental group and control group, respectively. The subject performed right lateral movement, left lateral movement, and forward movement. Each movement were performed 3 times and the movement trajectory obtained with mechanical pantograph were observed for accordance of centric relation position, reproducibility and/or restriction of lateral movement paths, deviation of protrusive path in anterior table, restriction of protrusive condylar movement path in posterior horizontal table, presence of Fisher angle in posterior vertical table. And pantographic reproducibility Index (PRI) were obtained with pantronic by the same movement method as in the mechanical pantograph record. The obtained results were as follows : 1. In experimental group, PRI scores in those who show accordance of centric relation position were 14.4, and were 26.53 in those who did not show accordance of centric relation position. However, the PRI scores of the two subgroups show no statistically significant difference in control group. Therefore, in experimental group, the capability of accordance of centric relation position affected largely the PRI scores than in control group. 2. Deviation of protrusive path was opposite to the affected side in experimental group, and was left side in control group. 3. Restriction side of condylar movement in protrusion was ipsilateral to the deviation side in experimental group, but in control group, restriction side was not related to the deviation side. 4. PRI scores in experimental group were 23.2 (moderate dysfunction category), and in control group, were 17.8 (slight dysfunction category). The PRI scores in control group, however, implies that the evaluation of temporomandibular disorders by the PRI scores only may be unreasonable.

• 대한치과마취과학회지
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• 제14권2호
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• pp.119-126
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• 2014

Difficulty in breathing can be very disconcerting to a patient who is conscious yet unable to breath normally. The common causes of acute respiratory distress include hyperventilation, vasodepressor syncope, asthma, heart failure, and hypoglycemia. In most of these situations, the patient does not exhibit respiratory distress unless an underlying medical disorder becomes acutely exacerbated. Examples of this include acute myocardial infarction, anaphylaxis, cerebrovascular accident, hyperglycemia, and hypoglycemia. A major factor that leads to the exacerbation of respiratory disorders is undue stress, either physiologic or psychologic. Psychologic stress in dentistry is the primary factor in the exacerbation of preexisting medical problems. Therefore, the most dental patient should be cared gently as the stress reduction protocol. This is a case report of acute respiratory distress with vasodepressor syncope during alginate impression taking of mandibular teeth in a long-standing temporomandibular joint dislocated 93-years-old pneumonic patient.