Morphological changes in temporomandibular joint dysfunction and effectiveness of different treatment methods

Year 2020, Volume: 14 Issue: 2, 102 - 110, 31.08.2020

Fatma Duman Aynur Çiçekcibaşı , Nesrin Atci , Fatma Öztürk Keleş , Bircan Yucekaya Esra Doğru Hüzmeli İbrahim Damlar

Abstract

Objectives: Temporomandibular joint dysfunction (TMD) results in changes in anatomical structures. The aim of this study was to examine the morphological changes using magnetic resonance imaging (MRI) and evaluate the effectiveness of different treatment methods in patients with TMD.
Methods: 34 TMD patients (18–62 years of age) were randomly divided into two treatment groups. Group A (n=18) was subjected to dry needling (DN) and mobilization for 10 sessions, Group B (n=16) was instructed to use occlusal splint with home exercises for one month. The control group included MRIs of 17 healthy adults that were randomly selected from the archives of Radiology Department of Mustafa Kemal University. The length and width of the masseter, lateral and medial pterygoid muscles and the depth of the mandibular fossa were measured and mandibular condyle types were recorded. Range of motion of each temporomandibular joint was evaluated in pre- and post-treatment periods to test the effectiveness of the treatment methods.
Results: The size of the masticatory muscles in TMD group was significantly smaller than the control group (p<0.05). The depth of the mandibular fossa was significantly shallower in the TMD group (p<0.05). The most commonly encountered condylar shape was convex in the TMD group (63.6%), but flat (58.8%) in the control group. No statistically significant relationship was observed between condyle type and fossa depth (p>0.05). However, the fossa depth showed a significant correlation with muscle size (p<0.05) and this correlation decreased with dysfunction. Dry needling and mobilization significantly decreased pain and increased mandibular movements (p<0.05); however, there was no significant change for Group B.
Conclusion: The anatomical structures associated with the temporomandibular joint seems to be affected in patients with TMD. We suggest that the limited movement of the temporomandibular joint may cause atrophy of the masticatory muscles, affecting the range of motion of the joint. Dry needling and mobilization techniques might be a more effective alternative than occlusal splint in the treatment of TMD.

Keywords

mandibular fossa, masticatory muscle, temporomandibular joint dysfunction

References

• Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al.; International RDC/TMD Consortium Network, International association for Dental Research; Orofacial Pain Special Interest Group, International Association for the Study of Pain. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network and orofacial pain special interest group. J Oral Facial Pain Headache 2014;28:6–27.
• Davoudi A, Khaki H, Mohammadi I, Daneshmand M, Tamizifar A, Bigdelou M, Ansaripoor F. Is arthrocentesis of temporomandibular joint with corticosteroids beneficial? A systematic review. Med Oral Patol Oral Cir Bucal 2018;23:367–75.
• Mathew AL, Sholapurkar AA, Pai KM. Condylar changes and its association with age, TMD, and dentition status: a cross-sectional study. Int J Dent 2011;2011:413639.
• Van Bellinghen X, Idoux-Gillet Y, Pugliano M, Strub M, Bornert F, Clauss F, Schwinté P, Keller L, Benkirane-Jessel N, KuchlerBopp S, Lutz JC, Fioretti F. Temporomandibular joint regenerative medicine. Int J Mol Sci 2018;19:446.
• Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies. Int J Oral Maxillofac Implants 2013;28:393–414.
• Iwasaki LR, Liu H, Gonzalez YM, Marx DB, Nickel JC. Modeling of muscle forces in humans with and without temporomandibular joint disorders. Orthod Craniofac Res 2015;18 Suppl 1:170–9.
• Paknahad M, Shahidi S, Iranpour S, Mirhadi S, Paknahad M. Cone-beam computed tomographic assessment of mandibular condylar position in patients with temporomandibular joint dysfunction and in healthy subjects. Int J Dent 2015;2015:301796.
• Imanimoghaddam M, Madani AS, Mahdavi P, Bagherpour A, Darijani M, Ebrahimnejad H. Evaluation of condylar positions in patients with temporomandibular disorders: a cone-beam computed tomographic study. Imaging Sci Dent 2016;46:127–31.
• Paknahad M, Shahidi S, Akhlaghian M, Abolvardi M. Is mandibular fossa morphology and articular eminence inclination associated with temporomandibular dysfunction? J Dent (Shiraz) 2016;17: 134–41.
• Garip H, Tufekcioglu S, Kaya E. Changes in the temporomandibular joint disc and temporal and masseter muscles secondary to bruxism in Turkish patients. Saudi Med J 2018;39:81–5.
• Ivorra-Carbonell L, Montiel-Company JM, Almerich-Silla JM, Paredes-Gallardo V, Bellot-Arcís C. Impact of functional mandibular advancement appliances on the temporomandibular joint-a systematic review. Med Oral Patol Oral Cir Bucal 2016;21: 565–72.
• Ucar M, Sarp Ü, Koca ‹, Ero¤lu S, Yetisgin A, Tutoglu A, Boyac› A. Effectiveness of a home exercise program in combination with ultrasound therapy for temporomandibular joint disorders. J Phys Ther Sci 2014;26:1847–9.
• van Grootel RJ, Buchner R, Wismeijer D, van der Glas HW. Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations. BMC Musculoskelet Disord 2017;18:76.
• Gomes CA, El Hage Y, Amaral AP, Politti F, Biasotto-Gonzalez DA. Effects of massage therapy and occlusal splint therapy on electromyographic activity and the intensity of signs and symptoms in individuals with temporomandibular disorder and sleep bruxism: a randomized clinical trial. Chiropr Man Therap 2014;22:43.
• Kuzmanovic Pficer J, Dodic S, Lazic V, Trajkovic G, Milic N, Milicic B. Occlusal stabilization splint for patients with temporomandibular disorders: meta-analysis of short and long term effects. PLoS One 2017;12:e0171296.
• Gonzalez-Perez LM, Infante-Cossio P, Granados-Nunez MM, Urresti-Lopez FJ, Lopez-Martos R, Canela-Mendez PR. Deep dry needling of trigger points located in the lateral pterygoid muscle: efficacy and safety of treatment for management of myofascial pain and temporomandibular dysfunction. Med Oral Patol Oral Cir Bucal 2015;20:326–33.
• Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A. Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: systematic review and meta-analysis. Phys Ther 2016;96:9–25.
• Gawriołek K, Azer SS, Gawriołek M, Piotrowski PR. Mandibular function after myorelaxation therapy in temporomandibular disorders. Adv Med Sci 2015;60:6–12.
• Schellhas KP. MR imaging of muscles of mastication. AJR Am J Roentgenol 1989;10:829–37.
• Kai Y, Matsumoto K, Ejima K, Araki M, Yonehara Y, Honda K. Evaluation of the usefulness of magnetic resonance imaging in the assessment of the thickness of the roof of the glenoid fossa of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:508–14.
• Al-Rawi NH, Uthman AT, Sodeify SM. Spatial analysis of mandibular condyles in patients with temporomandibular disorders and normal controls using cone beam computed tomography. Eur J Dent 2017;11:99–105.
• Yale SH, Allison BD, Hauptfuehrer JD. An epidemiological assesment of mandibular condyle morphology. Oral Surg Oral Med Oral Pathol 1966;21:169–77.
• Arnett GW, Milam SB, Gottesman L. Progressive mandibular retrusion-idiopathic condylar resorption. Part II. Am J Orthod Dentofacial Orthop 1996;110:117–27.
• Oliveira-Santos C, Bernardo RT, Capelozza ALÁ. Mandibular condyle morphology on panoramic radiographs of asymptomatic temporomandibular joints. Int J Dent 2009;8:114–8.
• Wangai L, Mandela P, Butt F, Ongeti K. Morphology of the mandibular condyle in a Kenyan population. Anatomy Journal of Africa 2013;2:70–9.
• Matsumoto MAN, Bolognese AM. Bone morphology of the temporomandibular joint and its relation to dental occlusion. Braz Dent J 1995;6:115–22.
• Oeberg T, Carlsson G, Fajers CM. The temporomandibular joint. A Morphologic study on a human autopsy material. Acta Odontol Scand 1971;29:349–84.
• Ballesteros Acuña LE, Ramirez Aristeguieta LM, Munoz Mantilla G. Mandibular fossa depth variations: relation to age and dental state. Int J Morphol 2011;29:1189–94.
• Sato S, Kawamura H, Motegi K, Motegi K, Takahashi K. Morphology of the mandibular fossa and the articular eminence in temporomandibular joints with anterior disc displacement. Int J Oral Maxillofac Surg 1996;25:236–8.
• Goto TK, Yahagi M, Nakamura Y, Tokumori K, Langenbach GEJ, Yoshiura K. In vivo cross-sectional area of human jaw muscles varies with section location and jaw position. J Dent Res 2005;84:570–5.
• Grünheid T, Langenbach GE, Korfage JA, Zentner A, Van Eijden TM. The adaptive response of jaw muscles to varying functional demands. Eur J Orthod 2009;31:596–612.
• Faulkner MG, Hatcher DC, Hay A. A three-dimensional investigation of temporomandibular joint loading. J Biomech 1987;20: 997–1002.
• Herring SW, Grimm AF, Grimm BR. Regulation of sarcomere number in skeletal muscle: a comparison of hypotheses. Muscle Nerve 1984;7:161–73.