Functional orthodontics after arthroscopic disk repositioning in adolescent anterior disk displacement with mandibular retrusion

The effect of anterior disc displacement with polycystic ovarian syndrome on adolescent condylar bone remodeling

BACKGROUND

Adolescent females have a high prevalence of temporomandibular joint (TMJ) anterior disc displacement (ADD), which can lead to condylar resorption and dentofacial deformity. Polycystic ovarian syndrome (PCOS) is a common endocrine disorder that disrupts bone metabolism. However, the effects of PCOS on bone remodeling especially after disc repositioning (DR) surgery are not well understood.

MATERIALS AND METHODS

This was a retrospective study. Patients aged 12 to 20 years diagnosed with ADD were reviewed and matched into 3 groups: A (ADD without PCOS), B (ADD with untreated PCOS), and C (ADD with treated PCOS). Each group was divided into 2 subgroups according to ADD observation (A1, B1, C1) and DR (A2, B2, C2). Condylar height (CH) was measured by MRI at the start (T0) and after more than 6 months follow-up (T1). ∆CH (T1-T0) were compared within and between groups.

RESULTS

93 patients (157 joints) with an average age of 15.17 ± 2.35 years and follow-up period of 14.04 ± 9.11 months were selected in the study. ∆CH in Group B1 was significantly larger than that in Groups A1 and C1 (p = 0.048, p = 0.018). While in Group B2, it was significant smaller than Groups A2 and C2 (p < 0.001, p = 0.023). There was no significant difference of ∆CH between Groups C2 and A2. DR acquired larger ∆CH than observation within each A, B, C Groups (p < 0.05). Multiple linear regression analysis showed that ∆CH was related to the presence of PCOS (p = 0.003), PCOS treatment (p < 0.001), and DR (p < 0.001).

CONCLUSIONS

Adolescent ADD with untreated PCOS can aggravate condylar degeneration and affect bone remodeling after DR. PCOS treatment can improve bone remodeling.

Physical therapy and non-surgical manual disc reduction combined with anterior repositioning splint for acute disc displacement without reduction of the temporomandibular joint in adolescents

OBJECTIVES

Current studies on the treatment of adolescent patients with disc displacement without reduction (DDWOR) are limited by short follow-up periods and small sample sizes, and there are few comparative studies on the efficacy of conservative treatment with and without disc reduction for acute DDWOR. This study compared the therapeutic effects of two conservative treatment methods: physical therapy alone and physical therapy combined with non-surgical manual disc reduction and anterior repositioning splints (ARS), in adolescent patients with acute DDWOR.

MATERIALS AND METHODS

This retrospective study included adolescent patients with DDWOR who underwent physical therapy at the Temporomandibular Joint Rehabilitation Department of the Shanghai Ninth People's Hospital from January 2018 to December 2021. Patient assessment data were collected before and after treatment. Patients were followed up through telephone and online questionnaires from March to August 2023.

RESULTS

The results indicate that compared to physical therapy alone, the combination of physical therapy and non-surgical manual disc reduction with ARS showed better short-term efficacy, improved mouth opening, and better long-term pain control. Also, it may be effective in preventing degenerative joint disease.

CONCLUSIONS

This combination therapy is recommended for clinical application in adolescent patients with acute DDWOR.

CLINICAL RELEVANCE

The present research demonstrates the superior efficacy of physical therapy and non-surgical manual disc reduction combined with anterior repositioning splint in adolescent patients with acute DDWOR.

Feasibility of simultaneous TMJ arthroscopy in ADDwoR patients undergoing orthognathic surgery for jaw deformity

This study evaluated the feasibility of simultaneous temporomandibular joint (TMJ) arthroscopy and orthognathic surgery as a new treatment strategy for anterior disc displacement without reduction (ADDwoR) patients with severe jaw deformities. Twelve ADDwoR patients with facial deformities who underwent arthroscopy and orthognathic surgery between September 2015 and December 2019 were retrospectively evaluated. Pre- and postoperative maximum incisal opening (MIO) and joint pain were recorded. Computed tomography (CT) and three-dimensional cephalometric analysis were performed at 3 (T1) and ≥6 (T2) months postoperatively. Magnetic resonance imaging (MRI) of the TMJ was performed before, ≤7 days after and ≥6 months after surgery. The lateral profile radiological findings, the symmetry of the maxilla and mandible, and the MRI measurements were compared. Anterior disc displacement did not recur, and the maximum incisal opening (MIO) increased from 27.4 mm to 32.7 mm after surgery (p < 0.05). No significant differences were found in the lateral profile, symmetry indices or condylar height via MRI between T1 and T2. Joint morphology and the position of both the maxilla and mandible remained stable during postoperative follow-up, while joint symptoms were markedly relieved and facial appearance was noticeably improved. Combined arthroscopy and orthognathic surgery is effective and recommended for ADDwoR patients with jaw deformities.

Comparison of disc position stability and condylar bone remodeling between two open disc repositioning surgeries: a retrospective single-center cohort study

BACKGROUND AND OBJECTIVE

Open suturing (OSu) and Mini-screw Anchor (MsA) are two commonly used open disc repositioning surgeries for anterior disc displacement (ADD) of the temporomandibular joint (TMJ). This study assesses the differences in disc position stability (DPS) and condylar bone remodeling (CBR) between these two surgical procedures in a single center.

METHODS

A retrospective cohort study using magnetic resonance imaging (MRI) scans (preoperation, 1 week and 12 mo postoperation) of all patients who had open TMJ disc repositioning surgery from January 2016 to June 2021 at one center through two surgical techniques (OSu and MsA) was performed. The predictor variable was technique (OSu and MsA). Outcome variables were DPS and CBR. During follow-up, DPS was rated as good, acceptable and poor, and CBR was graded as improved, unchanged, and degenerated. Multivariate analysis was used to compare the DPS and CBR at 12 months after adjusting 5 factors including age, sex, Wilkes stage, preoperative bone status (normal, mild/moderate abnormal) and the degree of disc repositioning (normal, overcorrected, and posteriorly repositioned). Relative risk (RR) for DPS and CBR was calculated by multivariate logistic regression.

RESULTS

385 patients with 583 joints were included in the study. MRIs at 12 months showed that 514 joints (93.5%) had good DPS, and 344 joints (62.5%) had improved CBR. Multivariate analysis revealed that OSu had higher DPS (RR=2.95; 95% confidence interval [CI], 1.27 to 6.85) and better CBR (RR=1.58; 95%CI, 1.02 to 2.46) than MsA. Among the factors affecting DPS, females had better results than males (RR=2.63; 95%CI, 1.11 to 6.26) and overcorrected or posteriorly repositioned discs were more stable than normally-repositioned discs (RR=5.84; 95%CI, 2.58 to 13.20). The improvement in CBR decreased with age increasing (RR=0.91; 95%CI, 0.89 to 0.93). Preoperative mild/moderate abnormal bone status had a higher probability of improved CBR compared to normal preoperative bone status (RR=2.60; 95%CI, 1.76 to 3.83).

CONCLUSION

OSu had better DPS and CBR than MsA. Sex and the degree of disc repositioning impacted DPS, while age and preoperative bone status affected CBR.

Temporomandibular joint disc repositioning and occlusal splint for adolescents with skeletal class II malocclusion: a single-center, randomized, open-label trial

BACKGROUND

Temporomandibular joint (TMJ) disc repositioning through open suturing (OSu) is a new disc repositioning method. Its result for adolescents with condylar resorption and dentofacial deformities combined with and without postoperative occlusal splints (POS) has not been well studied.

OBJECTIVE

This study was to evaluate and compare the effects of OSu with and without POS in the treatment of TMJ anterior disc displacement without reduction (ADDwoR) in adolescent skeletal Class II malocclusion.

METHODS

A total of 60 adolescents with bilateral ADDwoR were enrolled in this study. They were randomly allocated into two groups: OSu with and without POS. Magnetic resonance imaging (MRI) and lateral cephalometric radiographs were used to measure changes in condylar height and the degree of skeletal Class II malocclusion from before operation and at 12 months postoperatively. Changes in these indicators were compared within and between the two groups.

RESULTS

After OSu, both groups exhibited significant improvements in condylar height and occlusion at the end of 12 months follow-up (P < 0.05). The group of OSu with POS had significantly more new bone formation (2.83 ± 0.75 mm vs. 1.42 ± 0.81 mm, P < 0.001) and improvement in dentofacial deformity than the group of OSu only (P < 0.05). The new bone height was significantly correlated with POS (P < 0.001), the changes of SNB (P = 0.018), overjet (P = 0.012), and Wits appraisal (P < 0.001).

CONCLUSION

These findings indicated that OSu can effectively stimulate condylar regeneration and improve skeletal Class II malocclusion in adolescents with bilateral ADDwoR. The results are better when combined with POS.

TRIAL REGISTRATION

This trial was prospectively registered on the chictr.org.cn registry with ID: ChiCTR1900021821 on 11/03/2019.

Comparison of two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease

OBJECTIVES

To compare two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease.

MATERIALS AND METHODS

A total of 47 patients were included in this study. Group anterior repositioning splint (ARS) was treated with temporomandibular joint (TMJ) disc surgery followed by an ARS and camouflage orthodontic treatment. Group stabilization splint (SS) was treated with an SS followed by orthodontic treatment combined with orthognathic surgery. Cephalometric analysis of lateral radiographs and measurements of condylar height were evaluated before and after splints.

RESULTS

In group ARS, mandibular advancement was observed after treatment in 21 of 24 patients (87.5%). The SNB angle increased by an average of 1.40 ± 1.01°. The ANB angle, overjet, Wits, and convexity decreased. Facial angle and soft tissue N Vert to pogonion increased. Vertically, MP-FH, MP-SN, y-axis, and vertical ratio decreased and ANS-Me/N-Me and S-Go/N-Me increased, suggesting a counterclockwise rotation of the mandible. In group SS, 18 of 23 patients (78.3%) showed a backward change tendency. The SNB angle reduced by 0.90 ± 0.93°. The ANB angle, overjet, Wits, convexity, and y-axis increased. The facial angle and soft tissue N Vert to soft tissue pogonion (ST N Vert to ST pogonion) decreased. Magnetic resonance imaging showed condylar height increased by 1.45 ± 3.05 mm (P = .002) in group ARS. In group SS, condylar height change was not consistent.

CONCLUSIONS

TMJ disc surgery followed by ARS promoted condylar bone remodeling and regeneration. The SNB angle increased, and the severity of skeletal Class II was improved. The SS enabled the mandible to withdraw backward and revealed a retrognathic but true mandible position.

Review of the studies on the relationship and treatment of anterior disc displacement and dentofacial deformity in adolescents

Anterior disk displacement (ADD) is a common type of temporomandibular joint (TMJ) internal derangement. In adolescents, the relationship between ADD and dentofacial deformities are brought into focus. Whether treatment is needed, or what kind of treatment are effective are still without a consensus. From the literature review, the consequences of ADD without treatment and the effect on disk repositioning were summarized. The results showed that after ADD, condylar height was prone to reduce that may lead to or aggravate dentofacial deformities in adolescents. Disk repositioning could promote the regeneration of condylar bone, thus improving the development of dentofacial deformities.

The Effect of Condylar Regeneration After Different Disc Repositioning Surgeries in Adolescents with Skeletal Class II Malocclusion

PURPOSE

To evaluate the effect of different temporomandibular joint (TMJ) disc repositioning surgeries for the treatment of anterior disc displacement (ADD) in juvenile patients with skeletal Class II malocclusion.

PATIENTS AND METHODS

Patients (< 20 years, cervical vertebral maturation stage, IV-V) who had bilateral TMJ ADD with skeletal Class II malocclusion were treated by disc repositioning surgery (mini-screw anchor, [MsA]; or opening suturing, [OSu]). Magnetic resonance imaging (MRI) and lateral cephalometric films before and more than 12 months after surgery were collected from all patients. Changes of SNA, SNB, ANB, incisor overjet, pogonion position (pg'-G'), and condylar height were measured before and after surgery in different disc reposition surgeries and compared by statistical analysis.

RESULTS

Eighty-four patients with an average age of 16.44 years and follow-up time of 14.60 months (12 to 33 months) were included in the study. Among them, 16 patients had a mean follow-up of 14.8 months without treatment before disc repositioning. Their condylar height was significantly decreased (P = .004) by MRI measurement. Six patients who had cephalometric films showed significantly decreased SNB (P = .042) and increased overjet (P = .037). After disc repositioning by either OSu (54 cases) or MsA (30 cases), condylar height, SNB were significantly increased and overjet, Pg'-G', ANB were decreased in both groups (P < 0.001). There was more new bone height in OSu than MsA (P = .004), but no significant differences in SNB, ANB, overjet and Pg'-G' between the 2 groups (P > .05). The new bone height was significantly correlated with the surgical method (P = .029), age (P = .015), SNB (P = .008), overjet (P = .048) and pg'-G' (P = .001).

CONCLUSIONS

Both types of disc repositioning method can effectively promote condylar regeneration and improve skeletal Class II malocclusion in adolescents with ADD. Disc repositioning by OSu obtained more new bone height than MsA.