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In this report, the authors describe a case of the acute anterior disc displacement without reduction treated by manipulative reduction combined with the disc-condyle repositioning splint to improve the limited mouth opening and relieve the pain, including diagnostic images and treatment performed.

Numerous factors have been indicated as possible causes of alterations in the articular disc of the temporomandibular joint (TMJ). The main aim of the present study was to demonstrate the effectiveness of arthroscopic osteoplasty of the medial TMJ wall associated with myotomy of the superior head of the lateral pterygoid muscle for treating TMJ internal derangement.A retrospective and comparative study was performed analyzing patients diagnosed with TMJ internal derangement and underwent TMJ arthroscopic surgery in our Hospital. These patients presented signs and symptoms of TMJ internal derangement along with pathological magnetic resonance imaging images, and underwent either arthroscopic osteoplasty of the medial TMJ and myotomy of lateral pterygoid muscle (group 1) or arthroscopic eminoplasty (group 2) in our center.The sample consisted of 109 patients (21 male, 88 females) who agreed to voluntarily participate in our study. The results revealed that the patients who had undergone arthroscopic osteoplasty of the medial TMJ and myotomy of lateral pterygoid muscle showed better outcomes in terms of pain reduction when compared with patients who had undergone arthroscopic eminoplasty. No statistically significant differences were found between the 2 groups in terms of postoperative mouth opening.Arthroscopic osteoplasty of the medial and anterior medial wall of TMJ associated with arthroscopic myotomy of the SLEM represent an effective treatment option for TMJ internal derangement even in advanced stages (Wilkes IV and V).

Objectives: to evaluate the efficiency of intra-articular concentrated growth factor (CGF) injection in comparison with conventional arthrocentesis in the treatment of TMD. Subjects and Methods: Twenty patients suffering from TMD were included in the study diagnosed according to The Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD) and divided into two groups as follow; ten patients underwent intra-articular injections of 2 ml CGF into the temporomandibular joint (TMJ) (group I) and the other ten patients were treated by the conventional arthrocentesis (group II). The patients were clinically evaluated preoperatively and postoperatively at the intervals of 1 month, 3, and 6 months. Results: The differences between the two groups in all the measured parameters were statistically insignificant throughout the postoperative period. But CGF group showed superior result than arthrocentesis group regarding pain, mouth opening and inferior result in clicking. Conclusion: CGF injection is a safe and effective method in the treatment of TMDs.

Background: Temporomandibular disc displacement is a widely faced clinical condition and the management options are vast with varying difficulty and success rates. This study aims to evaluate the use of Botulinum Toxin injection and dextrose prolotherapy for such cases. Methods: 20 joints were included in this study divided into 2 groups; Group 1 receiving 25% 3mL Dextrose injection (with local anesthetic and saline solution) into the retrodiscal region while group 2 received 35 U Botulinum Toxin – Type A injection in the lateral pterygoid muscle. Pain (according to the visual analogue scale), clicking and maximal interincisal opening were assessed preoperatively and at 4 months followup. Results: The results showed no statistically significant differences between the 2 groups. The click disappeared in 7/10 joints in group 1 and 9/10 in group 2. The maximal interincisal opening was regained and slightly increased in all participants of the study. All patients reported better pain scores at the end of the followup period. Conclusions: Within the limitations of this study, we conclude that both treatment options tested are considered acceptable in the management of TMJ anterior disc displacement with reduction. Moreover, the results do not allow recommending one over the other as no statistically significant differences were found.

The aim of this study was to evaluate the outcomes of temporomandibular joint (TMJ) arthroscopic and open disc repositioning procedures in the management of anterior disc displacement (ADD). All consecutive patients treated with arthroscopic (group I) or open (group II) disc repositioning between April 2014 and August 2018 were included prospectively. The patients were assessed clinically (1, 3, 6, 12, 24, and 36 months postoperative) and with magnetic resonance imaging (MRI). The statistical analysis was performed using IBM SPSS Statistics v.22.0; P 0.05 was considered significant. A total of 177 patients (227 joints) were included: 104 patients (130 joints) in group I and 73 patients (97 joints) in group II. There were statistically significant improvements in pain score, clicking, quality of life, diet, and maximum inter-incisal opening when comparing pre- and postoperative clinical parameters within the two groups (P 0.05 at all time-points for all clinical parameters); however, improvements occurred earlier in group I (at 1 month) than in group II (6 months). Postoperative MRI revealed an overall success rate of 98.1% in group I and 97.3% in group II. New bone formation was found in 70.2% in group I and 30.1% in group II. Arthroscopy may be a better choice for ADD patients, with the advantages of faster clinical improvement and recovery, minimal invasiveness, and better condylar remodelling.

Hyperactivity of the lateral pterygoid muscle (LPM) is one of the theories postulated to explain anterior disc displacement, which can result in difficulty in jaw opening, jaw protrusion, or jaw-deviation dystonias and interferes with mastication, speech, and swallowing. Injection of botulinum toxin of the LPM is considered a conservative therapeutic modality for this condition. The LPM is a deep facial structure and several techniques have been described that use magnetic resonance imaging, arthroscopic, or electromyographic guidance to perform intramuscular botulinum toxin injection safely this to prevent incorrect injection or complications, such arterial bleeding. This study provided a described step-by-step description of the computer-aided design and manufacturing procedure for the fabrication of an in-house guide to simplify the method of botulinum toxin injection in the LPM and ensure accuracy and safety in medical office.

To assess jaw and neck function, pressure pain threshold (PPT), and the presence of trigger points (TrPs) in disc displacement with reduction (DDWR) subjects compared to healthy subjects.One hundred DDWR subjects and 100 matched controls were studied. Clinical evaluations included demographic data, range of motion, jaw and neck disability, PPT, and muscle TrPs.DDWR subjects have limited pain-free opening limitation (DDWR subjects present a limited pain-free mouth opening, higher jaw and neck disability, lower PPT, and major presence of active and latent TrPs compared to healthy subjects. Cervical spine and TMJ evaluation and treatment should be considered in DDWR patients.

The aim of the study is to assess the efficacy of the Lingual Ring Splint (LS), anterior repositioning splint (ARS) and stabilizing splint (SS) in management of anterior disc displacement with reduction (DDWR) for the relief of pain and improving mandibular movements. Thirty patients diagnosed with DDWR were included in this study. The participants were randomly assigned into one of three equal groups using a computer-generated randomization schedule receiving the assigned splint for each group, with specific instructions regarding the time of using it and exercises. Follow up was made after 1 and 6 months to test pain score and mandibular range of motion. Pain score improved in all 3 groups with statistical significance with better results is SS group than other two splints. Also, there was an increase in maximum mouth opening (MMO) with the highest measurements in SS group with statistical significance difference. There was no statistical difference regarding lateral excursion between all groups.

Purpose: To compare the effect of Stabilization Splint (SS), Anterior repositioning splint (ARS), and Ultrasound (US) therapy in improving pain, limited mouth opening and clicking in patients with Anterior Disc Displacement with Reduction (ADDwR). Materials and Methods: 30 subjects were enrolled in this randomized clinical trial. Participants were randomly allocated into one of the three study groups of 10 patients each; Group I received a SS, Group II received ARS and Group III were treated with US. All the patients were recalled at baseline (before treatment), 1m, 3m and 6m follow-up periods to evaluate pain, maximum mouth opening (MMO) and clicking. Pain level was evaluated using Visual Analogue Score (VAS). MMO was measured in mm. as the distance between maxillary and mandibular incisors. Detection of TMJ sounds was performed on opening or closing and was recorded. Results: There was a significant decrease in the pain scores in the three groups with P Conclusion:The use of occlusal splints in the management of painful ADDwR is a successful mode of treatment and helps in decreasing pain, improving MMO and clicking yet, is better to be used in combination with other treatment modalities.

Introdução: Em função da importância do diagnóstico precoce e correto das inúmeras patologias que podem afetar a Articulação Temporomandibular e das dificuldades em diagnosticar apresentadas pelos profissionais da Odontologia, mostra-se necessário propor mecanismos que sejam auxiliadores nesse procedimento. Objetivo: Desenvolver um aplicativo móvel com ênfase no diagnóstico das Disfunções Temporomandibulares Articulares, tendo como público alvo os profissionais de saúde bucal e graduandos em Odontologia. Material e Método: Foi desenvolvido um sistema caracterizado pelo preenchimento de um questionário contendo as principais características das DTMs segundo a Academia Americana de Dor. Em relação à plataforma, optou-se por utilizar o sistema Android, e, quanto ao gerenciador de dados, foi utilizado o MySQL. O questionário inicia-se com o Índice de Fonseca a fim de identificar se o paciente é portador de DTM. Caso o paciente seja portador de DTM, o questionário seguirá para questões relacionadas ao diagnóstico de DTMs articular. Neste primeiro momento do protótipo, foram introduzidas dez perguntas no questionário sobre o deslocamento do disco com redução. Resultados: O aplicativo móvel para diagnóstico das desordens temporomandibulares articulares apresentou funcionalidade capaz de disponibilizar um escore de severidade de DTMs articular do paciente e diagnóstico de deslocamento do disco com redução. Conclusão: O desenvolvimento de aplicativos móveis direcionados ao manejo da DTM é relevante, já que a prevalência desta patologia é crescente em termos populacionais, sendo necessário que o cirurgião-dentista esteja capacitado para realizar o diagnóstico correto e propor estratégias de tratamento.

Anterior Disc Displacement without Reduction (ADDwoR) in adolescence can result in condylar resorption which produces mandibular retrusion/deviation (MR/D) in adulthood. This study aims to analyze the therapeutic effect of simultaneous genioplasty and temporomandibular joint (TMJ) anchorage surgery on ADDwoR with MR/D patients.During 2016-2018, ADDwoR with MR/D cases were included and underwent TMJ anchorage surgery and genioplasty guided by digital design. Pre-/Post-surgical clinical manifestations, facial photography, radiographic data, facial shape satisfaction of clinicians/patients/third-party were recorded and analyzed.A total of 32 cases (52 joints) were included. The average age was 24.09. Ratio of male/female was 4/28. Visual analog pain scale (VAS) score pre-/post-surgical ranged from 3 to 9 and 0-3, with an average of 6.03 and 1.18 (p 0.01). Maximal mouth opening pre-/post-surgical ranged from 16 to 33 mm and 33-40 mm, with an average of 22.43 mm and 36.46 mm (p 0.01). MRI was completed and showed stable disc reduction without recurrence 1 year postoperatively. MR/D was corrected and a better face shape was obtained. The satisfaction rate of clinicians, patients and third-parties was 92.375%, 94.156% and 94.218%, with an average of 93.583%.For ADDwoR with MR/D patients, simultaneous TMJ anchorage surgery and genioplasty can improve TMJ symptoms/functions, correct facial appearance, and enhance the degree of satisfaction. The postoperative effect is stable, safe and reliable, which is worthy of clinical promotion.

Purpose The aim of this study was to evaluate the morphology of the temporomandibular joint (TMJ) articular eminence and disc and the relationship between morphology and inclination in patients with disc displacement. Methods TMJ magnetic resonance images (MRI) of 30 patients with disc displacement with reduction (DDWR) on one side and disc displacement without reduction (DDWOR) on the other side were analyzed. Articular eminence morphology was subdivided as box, sigmoid, flattened and deformed. Articular disc configuration was characterized as biconcave, biplanar, biconvex, hemiconvex and folded. The articular eminence inclination was measured as the angle between the Frankfurt plane and a line drawn from the glenoid fossa roof to the lowest point of the articular eminence. Results Regarding articular eminence shape, in both DDWR and DDWOR groups, the most frequent articular eminence shape was flattened shape. Regarding to the disc morphology, biplanar shape was the most frequently observed in both DDWR side and DDWOR side. The mean articular eminence inclination was 32.62 and 33.85 in the DDWR and DDWOR side, respectively. Conclusions Disc and articular eminence morphology was found to have no relationship with TMJ internal derangement except the relationship between flattened type and internal derangement. The articular eminence inclination have no influence on disc reduction.

In this manuscript, the authors have studied the Disc Displacement (DD) status of patients with acute Closed Lock (CL) to determine differences between DD with Reduction (DDwR) and DD without Reduction (DDwoR). Among the acute CL patients who visited our hospital within 2 weeks of the onset of CL, we studied 10 patients whose CL was released (DDwR) and 13 patients whose CL was not released (DDwoR). The DDwoR group was significantly older than the DDwR group. Although the mouth opening distance was significantly greater in the DDwoR group than in the DDwR group, the two groups were identical in the duration of CL. Sagittal MRI images showed no significant differences between the two groups in disc length and disc thickness (anterior band, intermediate zone, and posterior band). Multisection sagittal and coronal images identified lateral DD in 7 of the 10 patients in the DDwR group, although no specific direction of the DD was observed in the DDwoR group. Furthermore, deformation of the medial disc was common in the DDwoR group but uncommon in the DDwR group.

[Purpose] We investigated the short-term effects of an exercise therapy program that combined a range-of-motion exercise for the temporomandibular joint with self-traction therapy for patients with temporomandibular joint disorders who undergo disc displacement with reduction of the painful temporomandibular joint. [Participants and Methods] The program involved 31 patients with moderate or higher functional pain. The range-of-motion exercise for the temporomandibular joint was performed at the first visit by the therapist, and the patients were instructed to perform self-traction therapy in the morning and while bathing for the next 2 weeks, until their next visit. The maximum mouth opening distance and the visual analog scale scores at the first consultation and 2 weeks later were compared to assess the changes in pain on motion and mastication as well as the impact of the program on daily activities. [Results] All symptoms of the patients showed significant improvements after 2 weeks of starting the treatment. [Conclusion] The results of this study suggest that an exercise therapy program combining range-of-motion exercises for the temporomandibular joint and self-traction therapy may be an effective conservative therapy for reducing the pain and obstacles experienced by patients with temporomandibular joint disorders who undergo disc displacement with reduction of the painful temporomandibular joint.

Introduction: Playing certain kinds of musical instruments may cause disturbances around the oral cavity. Blowing activity in wind players involves contractions of the muscles around the mouth. Continuous or repetitive muscle contraction can cause muscle fatigue that triggers the onset of symptoms of temporomandibular joint disorders (TMD). The aim of this study was to determine the description of diagnosis of TMD in wind players. Method: The research was conducted to 30 brass instrument players at Gema Wibawa Mukti Marching Band Community (22 boys, 8 girls) aged 13-27 who had been actively playing wind instruments in the last 6 months. The research method used was descriptive. Examination and diagnosis were based on physical examination category and the algorithm of DC-TMD Axis I revision of 2014. Results: The results showed that for 30 samples of wind players, the number of diagnose of Group Ie (arthralgia) was 4 players, Group IIa (disc displacement with reduction) was 8 players, and Group III (degenerative joint disease) was 4 players. Conclusion: The conclusion of this study was 43.33% of wind players at Gema Wibawa Mukti MBC suffered from temporomandibular joint disorders, in which the highest diag-nosis was disc displacement with reduction, followed by arthralgia and degenerative joint disease.

OBJECTIVE The aim of this study was to compare the effectiveness of two types of treatment (counselling programme versus counselling programme plus jaw exercises) to improve the quality of life of patients with disc displacement with reduction (DDWR). MATERIALS AND METHODS Patients were divided into two groups. The test group received guidelines for temporomandibular disorders (TMD) plus jaw exercises for DDWR, and the control group received only guidelines for TMD. The total number of investigated patients was 70, thus 35 per group. The oral health-related quality of life was assessed by the OHIP-14 questionnaire. Both groups were evaluated at the baseline and 30 days post-treatment. RESULTS In the counselling group, there was statistically significant decrease in pain (P = .015) and social disability (P = .046) subscales. In the counselling plus jaw exercise group, there was statistically significant decrease in all subscales (P

Stress is known as a risk factor for temporomandibular disorder. Prisoners who live in Correctional Institutions have a high risk of experiencing stress because of the existing pressure. The purpose of this study was to determine the relationship between stress and temporomandibular disorder in prisoners at Class IIB Correctional Institutions in Padang. This study was a cross-sectional study. The instrument that use to measured stress on inmates was the Perceived Stress Scale 10 (PSS-10), while to determine the diagnosis of TMD using RDC/TMD Axis I. The result showed that 7 respondents (23,3%) had mild stress, 20 respondents (66,7%) had moderate stress, and 3 respondents (10%) had severe stress. Respondents who experienced TMD were 19 respondents (63,3%). The most common type of TMD diagnosis is the disc displacement with reduction. Kolmogorov-Smirnov statistical test results obtained p=0,164 (p>0,05) which means there is no significant relationship between stress and temporomandibular disorder in prisoners at Class IIB Women’s Penitentiary in Padang. This study concludes that stress is not related to the temporomandibular disorder in prisoners at Class IIB Women’s Penitentiary in Padang.

Purpose: This study investigated the relationships among characteristics of maxillomandibular asymmetry in patients with menton deviation and temporomandibular joint (TMJ) disc conditions, includin...

Aim Verification of the interrater reliability of axis I diagnoses of the German version of the DC/TMD. The hypothesis was that the DC/TMD protocol yields comparable results, if examiner instructions are closely followed. Material and methods A culturally equivalent German translation of the DC/TMD was developed. During a 1-day calibration workshop at the University of Heidelberg, three examiners were trained by the DC/TMD Training and Calibration Center. According to the calibration guidelines, 16 models (11 cases, five non-cases) were examined by four experienced TMD specialists. Reliability was calculated with reference to the reference standard examiner as percentage agreement and kappa coefficients for DC/TMD diagnoses and intraclass correlation coefficients (ICCs) for findings. Results Excellent reliability was achieved for the diagnoses myalgia, myofascial pain with referral, arthralgia, headache attributed to TMD, disc displacement (DD) with reduction, DD without reduction without limited opening (κ = 0.85…1.00). Degenerative joint disease was diagnosed with substantial agreement (κ = 0.64), DD with reduction with intermittent locking and DD without reduction with limited opening were not present in our sample. Overall percentage agreement was 94%-100% for all diagnoses. Conclusion The German version of the DC/TMD shows very good reliability and can be recommended for the use in clinical and research settings.

In this study we investigated the relation between anterior disc displacement (ADD) and maxillomandibular morphology in skeletal anterior open bite with changes to the mandibular condyle. Thirty female patients (60 joints) with both conditions were evaluated. Magnetic resonance imaging of the temporomandibular joint (TMJ) was used to diagnose both ADD and changes to the mandibular condyle (erosion, osteophyte, and deformity). The relations among ADD, changes to the mandibular condyle, and maxillomandibular morphology were examined statistically. Changes to the mandibular condyle had a higher score than sym anterior open bite, the deviated side in asymmetric anterior open bite, and the non-deviated side. The score for disc displacement on the non-deviated side was lower than both the sym side and the deviated side. Unilateral changes to the mandibular condyle and unilateral disc displacement were not apparent in sym anterior open bite, but a unilateral non-displaced disc was seen only on the asymmetric side. Mandibular condylar changes were significantly more common on the deviated, than on the non-deviated, side. The SNB angle was significantly smaller, and the ANB, GZN, and SN-mandibular plane angles were significantly larger in sym anterior open bite. Overjet, ANB angle, GZN angle, and SN-MP angle were significantly larger, and the SNB angle was significantly smaller, in the presence of ADD without reduction and mandibular condylar deformity. We conclude that the prevalence of ADD without reduction and changes to the mandibular condyle were related to mandibular asymmetry and mandibular morphology in anterior open bite. This retrospective study suggests that ADD without reduction and mandibular condylar bone changes may be related to the progression of skeletal class II open bite and mandibular asymmetry in cases of skeletal open bite.

Background Some authors state that above-normal surface electromyography (SEMG) levels during mandibular rest (MR) are a general sign of temporomandibular disorders (TMD). Objective The aim was to compare SEMG levels in the masseter and anterior temporalis areas during MR between patients with disc displacement (DD) and subjects identified as healthy. The hypothesis was that average SEMG levels would be higher in the patients during MR before and after repeated clenches with maximal effort. Methods Thirty-six healthy subjects, and 42 patients with DD, were included. SEMG levels were recorded bilaterally in the temporalis and masseter areas during MR before clenching and after repeated clenches with maximal effort. Multivariate analysis of variance (MANOVA) was used to compare the means of the log-transformed SEMG-values for the subject groups. Results The mean MR levels in the four areas before clenching ranged from -0.19 log (µV) to 1.20 log(µV) in healthy subjects and from -0.22 log(µV) to 0.96 log(µV) in patients. The mean MR levels in the four areas after repeated clenches ranged from -0.19 log (µV) to 1.04 log(µV) in healthy subjects and from -0.27 log(µV) to 0.93 log(µV) in patients. The MANOVA test showed no significant differences in the means for MR for the four areas between the groups at the 5% significance level. Conclusion The hypothesis that jaw muscle SEMG levels during MR are on average generally higher in TMD patients is not supported. A possible explanation for the previous findings is that activity in other muscles was mislabelled as jaw muscle activity.

AIMS To investigate the effectiveness of a novel jaw-opening-force measuring device as a screening tool to aid in the diagnosis of temporomandibular disorders (TMD). METHODS Symptomatic TMD patients (n = 58) and control TMD-free participants (n = 56) were screened by an oral medicine specialist according to the Diagnostic Criteria for TMD (DC/TMD). TMD patients were divided into three subcategories based on TMD symptoms (myofascial pain, disc displacement, and both combined). Jaw-opening forces were measured in both groups with an adjustable head device connected to a 1,000-N-load cell. Seven attempts were recorded at 10-second intervals by a data-capturing system. The geometric mean force values were obtained after discarding the first and last attempts. RESULTS TMD-free participants had greater jaw-opening forces than TMD patients both without and with adjustments for age, sex, height, and weight (both P < .001). The geometric mean ± standard deviation values for TMD patients were 18.5 ± 1.62 N and 47.7 ± 1.53 N for TMD-free participants. Differences in jaw-opening forces among the three TMD subcategories were not statistically significant; however, patients with disc displacement (23.7 ± 1.46 N) had greater jaw forces than patients with myofascial pain (17.0 ± 1.74 N) and both myofascial pain and disc displacement (17.0 ± 1.56 N). CONCLUSION This study demonstrated that differences in jaw-opening forces could be used as a diagnostic tool for TMD. Future studies should explore the potential of this device to measure improvement in jaw-opening forces following TMD treatment.

Objectives: The objective of this study is to examine the benefit of an intra-articular platelet-rich plasma (PRP) injection and to compare this with arthrocentesis in Patients with Temporomandibular Disc Displacement with Reduction. Subjects and Methods: Twenty four patients who did not respond to conservative treatment of anterior disc displacement with reduction were included in this study. They were randomly allocated to one of two study arms: the 'intervention' group who treated with intra articular PRP injection or the control group who treated with Arthrocentesis. Results: In this study, both groups showed significant improvement in TMJ pain, maximum mouth opening (MMO) and clicking 2 weeks after treatment that maintained thereafter. Conclusion: It is possible to conclude that intra-articular PRP injection was equivalent to arthrocentesis regarding reduction of TMJ pain with more beneficial effects of arthrocentesis on MMO and TMJ sound.

The aim of this systematic review was to analyze the effectiveness of exercise and manual therapy interventions in patients with disc displacement without reduction.The authors performed a systematic review of Medline, EMBASE, PEDro, CINAHL, and Google Scholar databases. Two independent reviewers conducted the eligibility and quality assessment of studies. Interventions based on exercise and manual therapy regarding pain intensity and maximum mouth opening as primary outcomes were examined.Ten articles were included, according to the inclusion criteria. Most of the interventions showed statistically significant improvements in the primary outcomes.Results show that interventions based on therapeutic exercise or manual therapy may be beneficial and play a role in the treatment of disc displacement without reduction. Limited evidence suggests that exercise significantly improves mouth opening in comparison to splints. Due to the heterogeneity of the included studies, these results should be interpreted with caution.

The focus of this literature review is to explore the process of disc displacement with reduction (DDWR) and how the treatment using anterior repositioning splint (ARS) can positively affect patients who are diagnosed with DDWR. The use of MRI as the gold standard of TMJ study allows current researcher to re-consider the common theory whereby DDWR ultimately progresses into disc displacement without reduction or other advanced internal derange-ment process. The use of ARS can produce resolution of pain in patients who are experiencing DDWR with joint pain. However, the use of ARS is shown to be effective on short term only, and its use must be accompanied by other modalities such as physical self-regulation (PSR). The lack of gold standard for the treatment of DDWR prompts healthcare worker to provide patients with conservative treatment before offering more advanced and sur-gical procedure, both of which carries additional unwanted risk. Overall, the use of ARS is shown to be very effective and non-invasive.

To compare clinical and imaging results of two needles arthrocentesis (TNA) versus double-needle cannula arthrocentesis (DNCA) in the treatment of temporomandibular joint disc displacement (DD).Twenty patients with DD were randomly divided into two groups: TNA and DNCA. Clinical data (pain scores; maximal interincisal distance [MID], and protrusion and laterality movements) were evaluated before and 24 months after the arthrocentesis. Disc and condyle position and joint effusion (JE) were evaluated by magnetic resonance exams.Both groups presented improvement in the MID, including pain reduction, modifications in disc and condyle positions, and reduction of the presence of JE, without difference between groups (Both TNA and DNCA are efficient in promoting improvement in the MID: reduction in pain, modifications in disc and condyle positions, and, in part, may account for less JE, without difference between techniques.

INTRODUCTION Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The aim of this study was to investigate the characteristics of the patients with TMJ osteoarthrosis on MR imaging. METHODS The MR images of 206 TMJs of 103 patients with temporomandibular disorders (TMD) were evaluated retrospectively in this study. The relationship between osteoarthrosis and age, gender, TMJ pain and MR imaging findings, such as disc displacement with or without reduction and TMJ effusion, was analysed. RESULTS The patients with TMJ osteoarthrosis (mean: 51.6 years) were significantly older than those without osteoarthrosis (mean: 44.8 years, P = 0.027). The incidence of the patients with TMJ osteoarthrosis was significantly different between with (10.0 %) and without reduction (57.0 %, P

This study was performed to determine whether arthrocentesis therapy has different outcomes in three groups of patients with different temporomandibular disorders (TMDs). A clinical trial was conducted including 45 patients with 45 unilaterally affected joints divided into three groups (n=15): osteoarthritis (OA), disc displacement with reduction (DDWR), and disc displacement without reduction (DDWoR). All patients underwent the same arthrocentesis treatment protocol. The outcome variables, including visual analogue scale evaluations and measurements of mandibular motion (in millimetres), were recorded at baseline and at 1 and 6 months postoperative. Inter-group assessments showed significant short-term differences in joint sounds (P=0.016) and significant long-term differences in masticatory efficiency (P=0.046) and protrusive movement (P=0.048). The estimation of mean changes between baseline and long-term follow-up revealed significant differences in joint sounds (P

Application of paraclinical methods for investigating the temporomandibular joint (TMJ) has been a subject of constant controversy due to the absence of universally-accepted criteria and lack of consensus regarding their usage. Compared with medical imaging, which provides a structural analysis of the TMJ, axiography involves the functional recording of condylar movements. The aim of the present study was to explore the diagnostic value of computerized axiography for TMJ disc displacements using MRI as the reference standard. The present study included 33 (66 TMJs) patients clinically diagnosed with TMJ disc displacements. On the same day, all patients underwent clinical examination and computerized axiography measurements using Cadiax Compact® II before undergoing MRI (1.5 T) 1-7 days later. The characteristics of the diagnostic parameters, namely sensitivity, specificity, positive and negative predictive values, accuracy, Youden index and the 95% confidence intervals (CI), were all computed. Compared with MRI, computerized axiography yielded a sensitivity of 85.11%, specificity of 94.74%, positive predictive value of 97.56%, negative predictive value of 72% and a diagnostic accuracy of 87.88% for any disc displacements. This suggests that computerized axiography can confer high sensitivity, specificity and accuracy for the diagnosis of TMJ disc displacements. However, axiographic analysis has no diagnostic significance in TMJ function if not associated with clinical examination.

Background The temporomandibular joint disorders (TMD) have been a major source of pathology. Being only second to chronic low back pain as a cause of pain and disability. MRI is currently considered the gold standard method for imaging of the TMJ. USG is a non-invasive, inexpensive procedure. And can provide a potential sensitive tool for diagnosis of anterior disc displacement. Aim of the work The aim of this study is to compare between the accuracy of ultrasound and MRI in diagnosis of TMJ disc displacement. Patients and Methods This study was carried out at the Radiology Department, Ain Shams University Hospitals. Twenty one patients with clinically suspected TMJ disc displacement underwent ultrasound (US) and MRI examination. Results The overall sensitivity of the US to diagnose disc displacement compared to MRI reached (94.7%), specificity (91.3%), Positive Predictive value (90.0%), Negative Predictive Value (95%) and accuracy (92.9%). The results indicated 1.8 mm was the most accurate cut-off distance between the articular capsule and the anterior surface of the mandibular condyle for diagnosis of MR positive disc displacement.

Introduction Bruxism is often indicated as a risk factor for the occurrence of temporomandibular disorders (TMD). Despite the frequent co-occurrence of bruxism and TMD, the exact relationship between these phenomena has not been thoroughly explained, and their causal relationship is still considered controversial. Aim The aim of this study was to evaluate the distribution of TMD among sleep bruxers and non-bruxers. Materials and methods The participants of this study were 77 patients of the Clinic of Prosthetic Dentistry operating at the Department of Prosthetic Dentistry, Wroclaw Medical University who had been diagnosed with TMD and probable sleep bruxism. Patients underwent video-polysomnography to assess the intensity of sleep bruxism using the Bruxism Episode Index (BEI). Results The following TMD diagnoses were made: local myalgia, temporal tendonitis, myofascial pain, myofascial pain with referral, hypertrophy, osteoarthrosis, disc displacement with reduction, disc displacement without reduction with limited opening, subluxation, adhesions/adherence, arthralgia, headache attributed to TMD and oromandibular dystonia. None of these occurred statistically significantly more often in the studied group (bruxers; BEI ≥ 2) than in the control group (non-bruxers; BEI .05 for all comparisons). Conclusion The distribution of TMD among sleep bruxers and non-bruxers is similar. Therefore, the prevalence of sleep bruxism seems not to be a certain risk factor for TMD occurrence.

This study investigated the efficacy of a sequential combination of arthrocentesis, mandibular manipulation, and anterior repositioning splint (ARS) in the management of acute temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). Twenty-one consecutive patients diagnosed with acute DDwoR by Diagnostic Criteria for Temporomandibular Disorders and magnetic resonance imaging (MRI) were recruited and managed with this method. Clinical and MRI data were obtained before and at 1 week after treatment. The disc-condyle relationship was determined by disc-condyle angle measurement. Condyle/disc positions were described as x-y coordinates with the summit of the articular fossa as the coordinate origin. Statistical analyses including independent/paired samples t-tests were conducted; significance was set at P

Objective : The objective of this study was to compare findings from ultrasonography imaging (USI) of the temporomandibular joint (TMJ) with those from magnetic resonance imaging (MRI) and cone-beam computerized tomography (CBCT). Methods : A total of 102 patients were included in this study. USI, MRI, and CBCT were performed in the TMJ area for all patients. Results : USI showed 100% sensitivity (Se), 82.76% specificity (Sp), 93.15% positive predictive value (PPV), 100% negative predictive value (NPV) and 94.85% accuracy relative to MRI for identifying anterior disc displacement (ADD), while the Se, Sp, PPV, NPV, and accuracy were 100% for identifying joint effusion, relative to MRI. Moreover, USI showed a high agreement with CBCT, which had 98.08% Se, 94% Sp, 94.44% PPV, 97.92% NPV and 96.08% accuracy for identifying condylar irregularities, while MRI showed a 100% Se, 56.86% Sp, 69.86% PPV, 100% NPV, and 78.43% accuracy for detecting condylar irregularities, relative to CBCT. Conclusions: High-resolution USI is a useful diagnostic method for detecting TMJ pathologies; USI can supplement clinical evaluations for patients with temporomandibular joint disorders (TMDs), and this imaging modality can be used as a diagnostic tool to identify internal derangement of the TMJ.

WOS: 000473197100012 PubMed: 30825439 Purpose: Arthrocentesis is an effective, simple, and minimally invasive treatment in patients with temporomandibular joint (TMJ) closed lock (CL). The aim of this study was to compare the effectiveness of 1- versus 2-session arthrocentesis procedures in the management of TMJ CL. Materials and Methods: A retrospective cohort study was conducted using the files of patients with TMJ CL according to diagnostic criteria for temporomandibular disorders. Patients who underwent 1- or 2-session arthrocentesis were included in the study. The decision of whether to undergo 1- or 2-session arthrocentesis was made by the patients: Those who accepted a second arthrocentesis procedure were assigned to group 1 (repeated arthrocentesis group), and those who did not accept, to group 2 (arthrocentesis group). The primary predictor variable was treatment method. TMJ pain (scored on a visual analog scale) and maximum mouth opening (MMO) were selected as the outcome variables. To evaluate the clinical outcomes of 1- or 2-session arthrocentesis, MMO and pain score (on a visual analog scale) before treatment and at 1, 3, and 6 months' follow-up were analyzed. Descriptive, comparative, correlation, and multivariate analyses were conducted. Results: A total of 30 patients (25 female and 5 male patients) with TMJ disc displacement without reduction were enrolled in the study. Each group consisted of 15 patients. Statistically significant decreases in pain scores and increases in MMO values were observed in both treatment groups at 3 and 6 months (P < .05). At 6 months, MMO values were significantly higher and pain levels were significantly lower in patients who received 2 arthrocentesis procedures. Conclusions: Repeated arthrocentesis is more successful at reducing pain and improving MMO than a single intervention in the treatment of TMJ CL. (C) 2019 American Association of Oral and Maxillofacial Surgeons

AIM: the aim of this study was to compare patient satisfaction and the clinical outcome of single needle approach versus double needle technique in treating patients with anterior disc displacement without reduction. Patients and Methods: This was a randomized controlled trial conducted on 14 adult (13 females and 1 male) patients with anterior disc displacement without reduction with limiting opening. In control group, double needle TMJ arthrocentsesis was performed with 100 ml ringer’s lactate solution. While in the test group, single needle TMJ arthrocentsesis was performed with 21 ml ringer’s lactate solution. All patients were followed up for 3 months. Pain level and maximum mouth opening were evaluated in both groups. Results: Both groups showed a significant improvement throughout the study intervals. Conclusions: Single needle arthrocentsesis represents a reliable treatment modality for the management of patients suffering from closed lock. However the exact amount of irrigation solution needed to achieve the maximum therapeutic benefits from this technique is a point that needs further investigations.

In order to optimize the patient selection for specific treatment modality and to achieve favorable treatment outcomes, prognostic indicators impacting the results are important to analyze. This longitudinal retrospective study aimed to analyze various prognostic factors impacting the surgical outcomes following Yang’s arthroscopic discopexy for management of temporomandibular joint anterior disc displacement using success criteria based on pain, maximal interincisal opening, diet, and quality of life. Furthermore, a quantitative MRI assessment of disc position and condylar height was performed pre- and postoperatively. Multinomial analysis was used to evaluate various prognostic variables including gender, age, duration of illness, Wilkes staging, parafunctional habits, and splint/orthodontic therapy. A total of 169 patients (234 joints) were included. The outcome was categorized as excellent (n = 67/39.6%), good (n = 72/42.6%), improved (n = 22/13.01%) or poor (n = 8/4.73%) with a success rate of 95.26%. Patients aged from 11–15 years old were significantly more likely to be in the good outcome group (odds ratio (OR), 0.20; P P P

Background/aim Self-contained underwater breathing apparatus (SCUBA) diving has grown tremendously as a recreational sport over the past decade. The pain divers experience due to barometric changes is referred to as barodontalgia, and it is known to cause various oral pathoses. Furthermore, divers suffer more frequently from temporomandibular disorders than non-divers. The aim of the study was to characterize oral pathoses between military divers and military non-divers. Material and methods Data from the dental files of healthy Israel Defense Forces (IDF) soldiers aged 18-40 years were collected retrospectively for the years 2011-2020. The data for subjects exposed to diving were compared to commando and special forces soldiers. Results The study population was composed of 6398 soldiers, which included 1036 divers and 5362 non-divers. All participants were male, with a median age of 22 years (mean = 22.1 years). Overall, higher rates of faulty dental restorations were seen among divers than non-divers (9.3% vs. 6.7% p = .006). Temporomandibular disorders were more prevalent among divers, specifically Disc Displacement Without Reduction (DDWOR) (0.4% vs. 0.1% p = .003). While dental fractures showed no significant difference between divers and non-divers (3.8% vs. 3.5% p = 0.8), other oral injuries were nine times more prevalent among divers versus non-divers. Conclusion Military divers are, overall, at a higher risk of oral pathoses than non-divers. This may be related to the characteristics and intensity of their military service.

ObjectiveTreatment of temporomandibular disc displacement with reduction is controversial. This study assesses the use of an anterior positioning splint with botulinum toxin in the lateral pterygoid muscle (BTX) for such cases.MethodsTwelve joints were included; groups I and II received BTX injection while group II also received an anterior positioning splint. Pain scores and clicking status were recorded at regular intervals then a postoperative MRI was done after 4 months.ResultsClinical improvement was noted in both groups. Mean pain scores dropped significantly and clicks in the twelve joints disappeared in 83% of group I and 33% of group II. MRIs showed significant disc position improvement with the higher mean change (1.33 ± 0.76) in group I.Group I showed better improvement of discal position and only one joint regained a click. Patients of group II reported discomfort from the splint which may have caused psychological distress and so worst pain scores.ConclusionsGroup I showed slightly better results but the cost of BTX injections and the complications of the splint should be kept in mind and the decision of treatment selection made according to each condition.

Objective. To characterize the closed-mouth temporomandibular joint (TMJ) disc-condyle relationship in a population of individuals who sought hospital services for temporomandibular disorders (TMD). Methods. Two hundred and twenty-four TMJ magnetic resonance images (MRIs) of 112 patients were assessed in all spatial planes to classify disc position with respect to the condyle in a closed-mouth position. Results. Disc displacement (DD) was present in 62.1% and superior disc position in 29.9% of the patients. Position could not be determined in 8% of the cases. Among DD, pure anteriorized position was the most common condition (34.4%), with different combined translational and rotational displacements in all the other joints (27.7%). Conclusion. There is a wide biological variability in disc position in closed mouth among patients seeking for TMD advice. Getting deeper into the correlation with clinical symptoms is recommended to refine the potential relevance of any diagnostic and management strategies based on the imaging evaluation of TMJ disc position.

Background Static MRI was used as an effective tool for diagnosis of temporomandibular joint dysfunction instead of invasive techniques such as arthroscopy and arthrography. The purpose of this study was to detect whether dynamic MRI can be used instead of static MRI in diagnosis of TMJ dysfunction or not. Results According to disc displacement, anterior disc displacement was detected in 29 joints (36.25%) by both static and dynamic MRIs, and medial and lateral disc displacements were detected only by static MRI. Regarding disc mobility, dynamic MRI detects stuck disc in 4 joints versus 2 joints detected by static MRI (p value 0.008). Condylar translation was abnormal in 18 joints (22.5%) by static MRI and in 26 joints (32.5%) by dynamic MRI (p value < 0.001). The detection rate of articular disc for dynamic MRI was 87.5% versus static MRI 92.5% (p value 0.038), and the detection rate of condylar head for dynamic MRI was 97.5% versus static MRI 100% (p value 0.012). Conclusion Dynamic MRI cannot replace static MRI in evaluation of TMJ dysfunction; both of them support each other for accurate diagnosis and better image quality.

espanolLos danos a los tejidos blandos intrarticulares de la articulacion temporomandibular (ATM) durante una fractura condilar han sido tradicionalmente relegados y escasamente estudiados. La artroscopia es un procedimiento quirurgico minimamente invasivo que puede combinarse con el abordaje abierto de las fracturas condilares con el fin de diagnosticar los danos intrarticulares y tratarlos si se precisa. Tras realizar una revision bibliografica, tan solo se han publicado 4 articulos sobre los hallazgos artroscopicos en estos casos y revelan una patologia mayor de la esperada, que si no se soluciona puede llevar a secuelas importantes a largo plazo. Se presenta un caso clinico de una fractura subcondilar derecha desplazada en el que se combina una artroscopia de la ATM con un abordaje abierto y reduccion de la fractura en el mismo acto. Los hallazgos artroscopicos mas comunes son la hemartrosis, los coagulos, el desplazamiento discal, la sinovitis hiperplasica, los danos sobre el fibrocartilago y las perforaciones discales. La presente revision concluye que es necesario evaluar y diagnosticar los danos intrarticulares en fracturas condilares mandibulares y que la artroscopia es un metodo adecuado que permite ademas tratar la patologia articular asociada. EnglishDamage to the intra-articular soft tissues of the temporomandibular joint (TMJ) during a condylar fracture has traditionally been neglected and poorly studied. Arthroscopy is a minimally invasive surgical procedure that can be combined with the open approach for condylar fractures, in order to diagnose intra-articular damage and treat it if necessary. After conducting a literature review, only 4 articles have been published on arthroscopic findings and they reveal a pathology greater than expected which, if not resolved, can lead to significant long-term sequelae. A clinical case of a displaced right subcondylar fracture is presented in which an arthroscopy of the TMJ is combined with an open approach and reduction of the fracture in the same act. The most common arthroscopic findings are hemarthrosis, clots, disc displacement, hyperplastic synovitis, fibrocartilage damage, and disc perforations. The present review concludes that it is necessary to evaluate and diagnose intra-articular damage in mandibular condylar fractures and that arthroscopy is an adequate method that also allows treating associated joint pathology.

Temporomandibular joint (TMJ) disorder (TMD) is a broad term encompassing many diseases affecting the TMJ and the surrounding structures and includes internal derangement or disc displacement disorders. Our understanding of internal derangement, its causation, and treatments have evolved over the years, and we are now able to offer effective nonsurgical and surgical management strategies. This chapter will discuss the evolution of our understanding of TMJ internal derangement, diagnosis, causation, and management strategies.

espanolObjetivos: Describir y analizar la posible relacion entre las caracteristicas clinicas y radiologicas de los pacientes intervenidos de una disfuncion temporomandibular (DTM) y la presencia asociada de las principales comorbilidades vinculadas al dolor cronico orofacial segun la literatura; el trastorno de ansiedad, la depresion mayor, la migrana y la fibromialgia. Material y metodos: Se realizo un estudio retrospectivo y descriptivo de pacientes diagnosticados e intervenidos mediante artroscopia de una DTM de predominio articular entre los anos 2006-2016. Distribuidos en dos grupos en funcion de la presencia de las comorbilidades descritas. Se realizo un analisis y descripcion de las principales variables de exploracion clinicas y radiologicas como el dolor (EVA), la apertura oral y la presencia de ruidos articulares, asi como del desplazamiento discal, la presencia de cambios degenerativos, el componente miofascial y los estadios de Wilkes. Estas variables fueron evaluadas de forma preoperatoria. Resultados: Un total de 280 pacientes fueron incluidos en el estudio distribuidos en 2 grupos, formados mayoritariamente por mujeres (92,14 %) con una media de edad de 38,6 anos. Las comorbilidades mas frecuentemente observadas fueron el trastorno de ansiedad (42 %), la asociacion entre ansiedad y depresion (22,7 %) y la depresion (11,4 %). Se describio una peor situacion clinica en el grupo de pacientes con comorbilidades asociadas, con significacion estadistica en las variables sexo, dolor, ruidos articulares y estadios de Wilkes Avanzados (IV-V). Conclusiones: Segun nuestro trabajo la mayoria de los pacientes intervenidos de una DTM cronica mediante artroscopia presentaban alguna comorbilidad vinculada al dolor cronico, destacando el trastorno de ansiedad. En este grupo de pacientes se observo ademas una peor situacion clinica y funcional especialmente significativa en cuanto al dolor. EnglishObjectives: Describe and analyze the possible relationship between the clinical and radiological characteristics of patients on temporomandibular dysfunction (TMD) artroscopy and the associated presence of the main comorbidities related to chronic orofacial pain according to the literature; anxiety disorder, major depression, migraine, and fibromyalgia. Material and methods: A retrospective and descriptive study of patients diagnosed and operated by artroscopy on a predominantly joint TMD between the years 2006-2016 was carried out. Distributed into two groups based on the presence of the comorbidities described. An analysis and description of the main clinical and radiological examination variables such as pain (VAS), oral opening and the presence of joint noises, as well as disc displacement, the presence of degenerative changes, the myofascial component and the stages of Wilkes were performed. These variables were evaluated preoperatively. Results: A total of 280 patients were included in the study distributed in 2 groups, formed mainly by women (92.14 %) with a mean age of 38.6 years. The most frequently observed comorbidities were anxiety disorder (42 %), association between anxiety and depression (22.7 %) and depression (11.4 %). A worse clinical situation was described in the group of patients with associated comorbidities, with statistical significance in the variables sex, pain, joint noises, and advanced Wilkes stages (IV-V). Conclusions: According to our study, most of the patients operated on chronic TMD by arthroscopy had some comorbidity related to chronic pain, highlighting the anxiety disorder. In this group of patients, a particularly significant worse clinical and functional situation was observed in terms of pain.

Non-specific Chronic sialadenitis of the Parotid gland is an inflammatory disorder that leads to several anatomical and functional changes within the glandular structure. The exact etiopathogenesis of this disorder is unknown due to its relatively rare occurrence. Primary sarcoidosis of the Parotid gland masquerading the peripheral changes of Chronic sialadenitis has never been reported in literature. We report such a case of Primary Sarcoidosis of the Parotid gland presenting with non-specific chronic sialadenitis along with ipsilateral non-reducing disc displacement of the Temporomandibular joint along with its management.

Background/purpose There is a paucity of comprehensive information about posterior open bite (POB) in patients with temporomandibular disorders (TMD) because of its rare prevalence. The purpose of this study was to investigate the etiologies, clinical characteristics, and treatment outcomes of patients with TMD presenting POB. Materials and methods This study includes a careful review of medical records and imaging findings of 12 patients with TMD (seven men and five women, 50.9 ± 19.2 years, 15–72 years) complaining of POB. Results In total, 11 had unilateral POB, whereas 1 had bilateral POB. In 11 patients, POB was caused by inflammatory disorders of temporomandibular joint (TMJ). In the remaining one patient, TMJ medial disc displacement (MDD) was responsible for POB. Of 11 patients with inflammatory conditions of TMJ, four patients had unilateral TMJ internal derangement (ID), two had bilateral TMJ ID, and one had rheumatism. POB was resolved in 10 of 11 patients with TMJ inflammation following the administration of non-steroidal anti-inflammatory drugs and self-management instructions. Prosthodontic treatment was needed in one patient to resolve POB. POB was resolved in the patient with TMJ MDD after stabilization splint therapy. Conclusion POB in patients with TMD was mostly caused by inflammatory disorders of TMJ. TMJ MDD could also be a reason. Although almost all POB was resolved by conservative treatments including medications, the possibility of prosthodontic, orthodontic, or surgical treatments also must be considered.

Purpose Temporomandibular joint disc repositioning surgery is 1 of the treatment modalities used for treating anterior disc displacement of the temporomandibular joint. The procedure can be arthroscopic disc repositioning or open disc repositioning. This systematic review measured and compared the efficacy of arthroscopic and open disc repositioning procedures. Materials and Methods The authors conducted a systematic review without meta-analysis by performing a literature search electronically and manually covering arthroscopic and open disc repositioning studies published up to July 2020 in Pubmed, Embase, and Cochrane databases. Surgical outcomes such as changes in maximal incisal opening (MIO) and pain scores, temporomandibular joint noises, diet consistency, malocclusion, and postoperative complications were extracted and analyzed. Results A total of 28 studies were included in the review and split into those assessing open disc repositioning (n = 13) and those assessing arthroscopic disc repositioning (n = 15). The average age of the study patients in the included studies was 31.5 ± 6.8 years, and women represented 83.3% of the study population. Both arthroscopic and open disc repositioning showed to be efficacious in reducing pain and increasing MIO. Due to heterogeneity in study designs and data reporting between the studies, no quantitative analysis was performed, and the groups were not directly compared. Conclusions Both arthroscopic and open disc repositioning led to significant improvements in clinical outcomes based on pain scores and MIO. This study highlights the need for comparative studies of the 2 techniques with well-documented case selection including standardized diagnosis based on Wilkes stages and rigorous outcomes assessment including patient reported outcomes.

Surface Electromyography of masticatory muscles (sEMG) is used as a tool to support diagnosis and treatment of Temporomandibular disorders (TMDs). The study aimed at examining jaw muscles pattern in individuals with temporomandibular joint disc displacement with reduction (TMJ/DDR). This sort of subjects was supposed to have a different muscular pattern compared to the control group.Sixty-four women with unilateral TMJ/DDR and forty TMD-free women underwent a sEMG assessment of masticatory muscles. Descriptive statistics were performed. Student T-Test assessed differences between the two groups. Statistical significance was set at ρ0.05.The t-test showed statistically significant results only in BAR and SMI scores (ρ value0,0001). The other measurements did not differ between the two groups. BAR index values of all healthy subjects were within the reference range. Almost the entire TMJ/DDR group had BAR index out of reference range and anteriorly placed.Women with TMJ/DDR showed an altered recruitment of the jaw muscles, with significant difference between the activity of the couple of temporalis and the one of masseters, compared to the control group. A lower chewing efficiency was found in the DDR group compared to the control one.

A normal disc–condyle relationship is crucial to the health and function of the temporomandibular joint. We herein introduce a novel technique that can precisely and rapidly restore the disc–condyle relationship. An initial bite rim was made, and the patient was instructed to wear this bite rim during magnetic resonance imaging (MRI) scanning. A quick MRI scan was performed, and the disc–condyle relationship and direction and vector of the displacement was measured. Adjustments to the mandible position were made on an articulator based on the measurements, after which a second bite rim was made. A second quick preview MRI scan was immediately performed, and the images were evaluated and measured again. Additional adjustments were made as needed, and the preview scan was repeated until an ideal disc–condyle relationship was achieved. Once a good disc–condyle relationship was acquired, the mandible position was recorded as the treatment mandible position, and a splint was fabricated. MRI visualization enabled precise and very fine adjustment of the disc–condyle relationship by articulating. This technique might help to simplify the clinical process and improve treatment effectiveness.