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Considerations in the Diagnosis and Management of Temporomandibular Disorders in Older Adults: A Narrative Review

  • Ji-Won Ryu
    • Journal of Oral Medicine and Pain
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    • v.49 no.3
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    • pp.43-48
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    • 2024
  • This narrative review discusses the changes in the masticatory system due to the physiologic aging process in humans and how these changes should be considered when diagnosing and managing temporomandibular disorders (TMDs) in older adults. Age-related changes in the masticatory system, specifically the temporomandibular joint (TMJ) and masticatory muscles, are associated with an increased prevalence of degenerative TMJ osteoarthritis in older adults, changes in muscle function and often affect masticatory function. Considering older adults' physiologic changes and comorbidities and their quality of life, diagnosing and managing TMDs in older adults needs a more comprehensive approach than in younger adults. Managing TMDs in older adults can improve orofacial function, such as mastication, leading to improved physical function and quality of life by reducing the risk of frailty.

MITIGATION OF MAXILLARY ANTERIOR TEETH PROTRUSION WITH CEREBRAL PALSY USING REMOVABLE APPLIANCE : A CASE REPORT (뇌성마비환자에서 가철성장치를 이용한 상악 전치부 돌출 완화 : 증례보고)

  • Min, Boram;Lee, Jae-Ho
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.9 no.2
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    • pp.122-126
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    • 2013
  • Cerebral palsy is one of the primary handicapping conditions of childhood. The prevalence of malocclusions in patients with cerebral palsy is approximately twice than in general population. Even though these high rates of malocclusions, most clinicians may feel uncomfortable about treating such problems to reduce inclination of anterior teeth because to reduce of protrusion makes to decrease risk of trauma. This is the case report about mitigation of maxillary anterior teeth protrusion in patient with cerebral palsy. A 14 year old boy who had cerebral palsy visited our dental hospital. He had severe protrusive maxillary anterior teeth and narrow arch form. He was experienced at using Castillo morales appliance in early childhood. He had mild mental retardation and was able to learn simple skills. He and his parents had willing to improve his dental problems. A gentle impression taking on maxilla was done. Removable appliance was made including median screw and labial bow. We provide a period of adaption for 3 weeks. After of anterior teeth through activation of labial bow was done once a month by dentist. The treatment carried out for 10 months and we could observe reduced labial inclination of maxillary right central incisor and more wide arch form. Hawley type retainer was set at maxilla for retention. In conclusion, accompanying careful case selection and treatment, patient with cerebral palsy can be treated and should not be ignored their orthodontic needs.

EFFECTS OF ADMINISTRATION PLATELET RICH PLASMA ON THE DISTRACTED MANDIBLE IN RABBITS (가토에서 신장된 하악골에 대한 혈소판농축혈장의 효과)

  • Bae, Kum-Hyu;Kook, Min-Suk;Park, Hong-Ju;Oh, Hee-Kyun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.27 no.4
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    • pp.315-323
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    • 2005
  • For reconstruction of the bony defect, distraction osteogenesis has many advantages in comparison with bone graft. However, it needs long consolidation period for sufficient bone maturity. This study is performed to evaluate the effect of PRP injection into the distracted mandible on bone formation in rabbits. Twelve house rabbits, weighing 2 kg, were used. All animals underwent bilateral mandibular osteotomy under general anesthesia. A internal distractor divice was positioned along a plane perpendicular to the line of osteotomy. After 5 days of latency period, distraction osteogenesis was started at a rate of 1 mm/day for 9 days which was distracted 9 mm totally. After completion of distraction, 0.5 ml of PRP which collected in rabbit blood was injected into the distracted mandible on experimental group, whereas no injection was done in control group. Macroscopical, radiographical, and histological, and histomorphometric examinations were performed 2, 4 and 8 weeks after distraction. All animals showed distracted mandible and severe anterior cross-bite. In radiographical findings 2 weeks after distraction, more radiopacity in the distracted gap was found in experimental group than that of control group. At 4 weeks after distraction, distracted bone was similar to normal bone in experimental group. In histological findings, 1) At 2 weeks after distraction, number of osteoblasts and angiogenesis in the distracted gap was found in experimental group than that of control group. 2) At 4 weeks after distraction, more active and distinct bone in the distracted gap was found in experimental group than that of control groups. 3) At 8 weeks after distraction, more dense and matured lamellated bone in the distracted gap was found in experimental group than that of control group. In histomorphometrical findings 8 weeks after distraction, more bone formation was observed in experimental group than control group (p<0.01). These results indicate that administration of PRP into the distracted mandible can promote bone formation.

CONFUTER-AIDED CASTING DESIGN FOR IMPLANT TITANIUM SUPERSTRUCTURES (컴퓨터 시뮬레이션을 이용한 임플란트 상부 티타늄 구조물의 주조방안)

  • Oh Se-Wook;Lee Ho-Yong;Lee Keun-Woo;Shim Jun-Sung
    • The Journal of Korean Academy of Prosthodontics
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    • v.41 no.4
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    • pp.421-439
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    • 2003
  • Statement of problem : It is difficult to obtain a good titanium casting body using the traditional sprue design because of high melting point of Ti, and the low fluidity and high reactivity of molten Ti. Purpose : A new sprue design for titanium casting bodies needs more trial and error. In order to decrease the number of trial and error, computer simulation(MAGMASOFT, Magmasoft Giessereitechnologie GmbH, Achen, Germany) was used to optimize sprue design in U-shaped implant superstructures. Material and method : Five kinds of sprue were examined for the design of the sprue former for titanium casting: Sprue design A(sprue length 4 mm, rectangular shape, 4 sprues), Sprue design B(sprue length 4 mm. round shape. radius 2 mm, 7 sprues), Sprue design C (sprue length 2 mm, round shape, radius 2 mm, 7 sprues). Sprue design D (sprue length 2 mm, cone shape, large radius 3mm. small radius 2mm, 7 sprues), and Sprue design E( sprue length 2 mm. one unit channel shape). Sprue design F(sprue length 2mm, one unit channel shape) was also examined for the design of the customized sprue former in the Biotan system(Schutz Dental Gmbh, Germany). The casting bodies were taken in Sprue design A, Sprue design D, Sprue design E, and Sprue design F in the Biotan casting system. The numerically predicted defects were compared with the experimental dental castings by the radiographic and sectional view observations. Results : 1. According to the result of computer simulation, turbulence during mold filling was decreased in the sequence of Sprue design F, Sprue design E, Sprue design D, Sprue design C, Sprue design B, and Sprue design A. 2. The calculated solidification time contours indicate that hot spot was moved from the casting body to the sprue button in the sequence of Sprue design A, Sprue design B, Sprue design C, Sprue design D, and Sprue design E. The filling pattern of Sprue design F was similar to that of Sprue design E. 3 The predicted filling pattern shows that less turbulence was found in the customized sprue former than in the standard sprue former. 4. According to the results of the radiographic and cross sectional observations, casting defects less than 1mm were found at the center of a casting body with Sprue design E and Sprue design F. However, larger casting defects of 4mm were found in a casting with Sprue design A. 5. The predicted casting porosity was similar to that of the real casting. Conclusion : One unit channel-type and customized sprue former can be recommended. Further research and developement of various sprue designs using computer simulation in necessary to optimize casting design, in order to reduce the formation of casting defects in implant titanuim super-structures.

The Study on the Physical Property of Provisional Prosthesis using Modified Temporary Abutment (변형된 임플란트 임시 지대주의 물성에 대한 연구)

  • Yang, Byung-Duk;Yoon, Tae-Ho;Choi, Un-Jae;Park, Ju-Mi
    • Journal of Dental Rehabilitation and Applied Science
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    • v.22 no.4
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    • pp.329-340
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    • 2006
  • Statement of problem: Damping of the peak force transmitted to implants has been reported by in vitro studies using impact forces on resin-veneered superstructures. Theoretical assumptions suggest that use of acrylic resin for the occlusal surfaces of a prosthesis would protect the connection between implant and bone. Therefore, the relationship between prosthesis materials and the force transmitted through the implant system also needs to be investigated under conditions that resemble the intraoral mechanical environment. Purpose: The purpose of this study was to analyze the fracture strength and modes of temporary prosthesis when a flange or occlusally extended structure were connected on the top of the abutment. Material and method: Modified abutments of winged and bulk design were made by casting the desired wax pattern which is made on the UCLA type plastic cylinder. Temporary crowns were made using templates on the modified abutments, and its fracture toughness and strain were compared to the traditional temporary prosthesis. To evaluate the effect of aging, 5.000 times of thermocycling were performed, and their result was compared to the 24hours specimen result. Results: The following conclusions were drawn from this study: 1. In the fracture toughness test, temporary crown's fracture line located next to the screw hole while modified designs with metal support showed fracture line on the metal and its propagation along the metal-resin interface. 2. Wing and bulk structure didn't show significant difference in the fracture toughness (p>0.05), but wing structure showed stress concentration on the screw hole area compared to bulk structure which showed even stress distribution. 3. In the fracture toughness test after thermocycling, wing and bulk structure showed increased or similar results in metal supported area while off-metal area and temporary crown showed decreased results. 4. In the strain measurement after thermocycling, its value increased in the temporary and bulk structure. However, wing structure showed decreased value in the loading point while increased value in the screw hole area. Conclusion: Wing type design showed compatible result to the bulk type that its application with composite resin prosthesis to the implant dentistry is considered promising.

GENE EXPRESSION FOR LYMPHANGIOGENIC FACTORS IN ORAL MUCOSAL SQUAMOUS CELL CARCINOMA (구강점막 편평상피세포암에서 림프관형성 유전자 발현)

  • Park, Young-Wook;Kim, Seong-Gon;Kim, So-Hee;Kim, Han-Seok;Kim, Min-Keun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.31 no.6
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    • pp.453-460
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    • 2009
  • Background and Purpose: Vascular endothelial growth factor (VEGF)-C, VEGF-D and their tyrosine kinase receptor, VEGF receptor (VEGFR)-3 are recently known to have lymphangiogenic activities in various tumor types. Oral mucosal squamous cell carcinoma (OMSCC) easily metastasizes to cervical lymph nodes, so we determined the expression levels of VEGF-C, VEGF-D and VEGFR-3 in oral squamous cell carcinoma. Materials and Methods: We performed Western blot analyses with 4 OMSCC cultured tumor cell lines (SCC9, KB, YD-10B, YD-38), and with 7 surgical specimens of OMSCC for the detection of VEGF-C, VEGF-D and VEGFR-3 proteins. Expression of VEGF-C mRNA as well as mRNA for VEGFR-3 in 4 OMSCC cell lines (KB, SCC-4, SCC-9, YD-10B) was investigated by RT-PCR. We also measured VEGFC/VEGF-D protein concentrations in the media and protein concentration of VEGFR-3 in cell lysates of 4 OMSCC cell lines (SCC9, KB, YD-10B, YD-38) using commerical ELISA kits. Finally, we performed immunoprecipitation for the detection of VEGF-C in cell lysates of 4 OMSCC cells (KB, SCC-4, SCC-9, YD-10B) and real-time RT-PCR for the quantification of VEGF-C mRNA. Results: In the result of Western blotting with cell lysates of 4 OMSCC cells, we could not detect the protein expression of VEGF-C, VEGF-D, and VEGFR-3. But, all tumor tissues demonstrated VEGF-C and VEGFR-3. VEGF-C mRNA was detected at various levels in 4 OMSCC cell lines. Moreover, OMSCC cells secreted VEGF-C, not VEGF-D and VEGFR-3 was also detected in cell lysates of OMSCC by ELISA. Immunoprecipitation and real-time RT-PCR revealed VEGF-C was also expressed in 4 OMSCC cell lines. Conclusion: Taken together, tumor cells of OMSCC secrete VEGF-C, not VEGF-D. And VEGFR-3 is expressed tumor cells as well as OMSCC tumor tissues, needs further study.

Histological healing after grafting of bilayer artificial dermis in the oral environment (치은부에 이식한 이중인공진피의 조직학적 치유)

  • Kim, Min-Jeong;Chung, Hyun-Ju;Kim, Ok-Su;Kim, Young-Joon
    • Journal of Periodontal and Implant Science
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    • v.33 no.2
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    • pp.289-299
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    • 2003
  • The autogenous free gingival graft is the most predictable procedure currently used to increase the width of the attached gingiva in periodontics. But the major disadvantage of the procedure is to create the multiple surgical wounds at both a donor site and a recipient site. The other problem is the limited amount of available graft material in oral cavity. Therefore, recent researches have been focused to develop the biomaterial to substitute the autogenous gingival tissue. The purpose of this study was to evaluate the histologic healing after grafting of bilayer artificial dermis, compared to the free gingival graft. Four non-smoking subjects (mean age, 32.5 years) in systemically healthy state and good oral hygiene were selected according to their particular needs for correction of mucogingival problems as suggested by Nabers(1966). The recipient sites were prepared through the procedure for the free gingival graft and were grouped according to the graft materials: Experimental group(n=5) - bilayer artifcia1 dermis ($Terudermis^{(R)}$; Terumo Co. Japan) and Control group(n=6) - free gingival graft with autogenous palatal mucosa. Biopsies were harvested at 1,2,3 and 6 weeks postsurgery to evaluate histologically. At the third week in the experimental group and at the second week of in the control group, the grafts has been clinically stabilized on the recipient bed and the graft border has been blended into the surrounding tissue. In the experimental group after 1 week of grafting, the epithelial migration from the adjacent tissue to graft material was seen and after 3 weeks of grafting, the : nflmmation decreased, collagen layer of the artificial dermis was lost and the basement membrane of epithelium was formed. After 6 weeks of grafting, both groups demonstrated orthokeratinized epithelium and increased thickness of epithelial tissue and the rete peg formation, similar to the adjacent tissue, Histologic evaluation revealed a biologic acceptance and incorporation of the collagen layers of the graft tissue to the host tissue, without foreign body reaction. In conclusion, a bilayer artificial dermis is essentially similar to autogeneous free gingival graft in the correction of mucogingival problems, and has the advantages of decreased patient morbidity (no donor site) and availability of abundant amounts of graft material when needed.

Effects of Periodontal Disease on Cardio-Cerebrovascular Disease: A Focus on Personal Income and Social Deprivation (치주질환이 심뇌혈관질환 발생에 미치는 영향: 지역결핍과 개인소득을 중심으로)

  • Kim, Min-Young;Shin, Hosung
    • Journal of dental hygiene science
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    • v.17 no.4
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    • pp.375-381
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    • 2017
  • The study aimed to investigate the effects of differences between personal income and social deprivation on the association between cardio-cerebrovascular disease (hypertension, stroke) and periodontal disease. This study used 12 years of cohort data from the Korea National Health Insurance Service covering the years 2002 to 2013. Among the patients aged more than 40 years who had received treatment for periodontal disease 224,067 and 284,730 who had not received treatment for hypertension and stroke, respectively, were included in the analysis. The Kaplan-Meier analysis revealed differences in the rate of treatment for cardio-cerebrovascular disease (hypertension, stroke) according to regional differences, the rate of treatment increased as the composite deprivation index value increased. The difference in treatment rates for cardio-cerebrovascular disease (hypertension, stroke) according to income was found to be higher in the treatment group with low income. This study empirically proved that the association between systemic disease and periodontal disease varies depending on personal income and the regional socioeconomic deprivation level. This shows that the clinical influence of periodontal illness on systemic disease differs according to the personal socio-demographic characteristic and residential area and that an individual's characteristic (income and the regional) needs to be considered along with the patient's clinical intervention in the disease treatment process.

The Role of Specific IgG in Phagocytosis of Actinobacillus(Haemophilus) Actinomycetemcomitans Y4 by Human Neutrophils (다형핵 백혈구의 Actinobacillus actinomycetemcomitans Y4 균주 탐식시 특이항체의 역할)

  • Kim, Jin-Myung;Chung, Chong-Pyoung;Lee, Young-Hee;Lee, Jin-Yong
    • The Journal of the Korean Society for Microbiology
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    • v.21 no.4
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    • pp.441-446
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    • 1986
  • Previous studies have demonstrated that phagocytosis of encapsulated bacteria needs the opsonization of bacteria with immunoglobulin and complement. Several investigators have studied the role of specific antibody to the bacteria. The purpose of this study is to investigate the role of specific anti-Actinobacillus actinomycetemcomitans Y4($A{\alpha}Y4$) antibody, which was obtained from the immunized rabbit serum for phagocytosis of $A{\alpha}Y4$ by PMNL. For this study, specific and nonspecific IgG were separated from the sera of the rabbits and PMNL were isolated from 15 healthy adults. By an enzyme-linked immunosorbent assay, the results showed that the binding capacity of anti-$A{\alpha}Y4$ IgG to $A{\alpha}Y4$ was much higher than that of nonspecific IgG; 0.75 and 0.14(O.D. at 400nm), respectively. The oxygen consumption of PMNL, phagocytizing $A{\alpha}Y4$ which was opsonized with specific $A{\alpha}Y4$ IgG(37.13 nmol/min/$1{\times}10^7$ PMNL), was significantly higher than that with nonspecific IgG(27.95 nmol/min/$1{\times}10^7$ PMNL, p<0.01). In immunofluorescence microscopic examination, the difference between the numbers of the ingested $A{\alpha}Y4$ opsonized with specific anti-$A{\alpha}Y4$ IgG and nonspecific IgG reached to statistically significant level; $184{\pm}11.4$ and $133.2{\pm}8.3$ per 100 PMNL, p<0.05. These results suggest that specific anti-$A{\alpha}Y4$ IgG has a significant role in PMNL phagocytosis of encapsulated $A{\alpha}Y4$ and also it can be available to adopt this system to develop anti-capsular antibody to $A{\alpha}Y4$ for enhancing and emphasizing the phagocytic activity against this bacterium.

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ACCURACY OF TRI AUTO ZX® IN LOCATING APICAL FORAMEN WITH ROTARY FILE (전동 file을 장착한 Tri Auto ZX®의 치근단공 인지 정확도 평가)

  • Park, Jeong-Won
    • Restorative Dentistry and Endodontics
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    • v.24 no.4
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    • pp.578-584
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    • 1999
  • The purpose of this experiment was to determine: (1) the safe automatic apical reverse setting that prevents overinstrumentation of the root canal, using Tri Auto ZX$^{(R)}$ and (2) the effect of various irrigant on such instrumentation. The instrumentation was carried out with the automatic apical reverse setting of 0.5, 1.0, 1.5, and 2.0. The root canal irrigants used in usual manner were normal saline(0.9%), NaOCl(2.5%), and RC Prep$^{(R)}$. For each reverse setting and each irrigant, ten teeth were used with the total of 120 teeth. The distance between the file tip and the apical constriction was determined by stereomicroscope using the point that the file began to rotate in reverse direction. When the reverse setting mode was set to 0.5, 18 of 30 were overinstrumented. If these were discriminated by irrigant, 10 of 6 with 0.9% saline, 10 of 6 with NaOCl, and 10 of 6 with RC Prep$^{(R)}$ has the file tip located 0.57${\pm}$0.30mm, 0.73${\pm}$0.39mm, and 0.26${\pm}$0.25mm beyond the apical constriction respectively. In 1.0 setting 15 of 29 were over the apical constriction, and the distribution was 6 in saline, 5 in NaOCl, and 4 in RC Prep$^{(R)}$. The mean distance over the apical constriction was 0.28${\pm}$0.13mm with saline, 0.75${\pm}$0.61mm with NaOCl, and 0.25${\pm}$0.17mm with RC Prep$^{(R)}$. When the autoatic reverse mode was set to 1.5, and 2.0, 5, and 1 teeth were found to be overinstrumented in respective settings. But there were large variations in overinstrumented distances when an attempt was made to compare the effect of irrigants on this overinstrumentations and they were meaningless for the small sample size. When all of the autoreverse setting were combined to compare the number of overinstrumented teeth with each irrigant, there were no significant differences (14 for normal saline, 12 for NaOCl, 13 for RC Prep$^{(R)}$). When 0.5 or 1.0 automatic apical reverse setting mode was used the Tri Auto ZX$^{(R)}$ in clinical application, the possibility of overinstrumentation beyond the apical constriction exists in 55.9% of cases. Therefore 1.5 or 2.0 setting is safer for the preparation inside the canal but this type setting needs additional apical hand preparation of the root canal because the accuracy is lower than 0.5 or 1.0 setting.

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