Objective To compare effects of intra-articular injection of corticosteroid or viscoelastic agent alone or a combination of the two drugs for treatment of temporomandibular joint disorders. Methods A prospective quasirandomized controlled trial was conducted to compare 3 treatment protocols of intra-articular injections in the upper compartment of the joint immediately following arthrocentesis repeatedly every 10 days: ① triamcinolone 8 mg alone for 3 times, ② 1% hyaluronate 1 ml alone for 4 times, and ③ triamcinolone 8 mg for 2 times then 1% hyaluronate 1 ml for 2 times. Clinical examinations were done at baseline, 1, 12, and 24 months after end of the treatments. According to improvement of the symptoms and clinical signs, the effectiveness was graded in 3 classes: excellent, better, no change, or worse. The first two were classified as effective. Effective rates of the treatments and subgroups were compared statistically. Results Five hundred and sixty four patients with temporomandibular disorders were included and randomly allocated to 3 groups with 188 patients in each group. The rate of lost follow up at 24 months was 6.9% to 10.1%. At one month after treatment, the triamcinolone group had a better effective rate at 92.0%. At 12 and 24 months of follow up, effective rates of the hyaluronate group were better than those in the triamcinolone alone group (84.6% vs. 54.1% and 83.4% vs. 40.4%). Effective rates of combining triamcinolone and hyaluronate group at 12 and 24 months were 90.4% and 66.3% respectively. Conclusion Intra-articular injection of corticosteroid has better results in a short term and hyaluronate has better results in a long term in the treatment of temporomandibular joint disorders.
Objective To assess the evidence of Cochrane systematic reviews on the treatment of temporomandibular disorders (TMD) as well as the methodological quality of all randomized controlled trials (RCTs) of the included systematic reviews. Methods The Cochrane Library (Issue 3, 2008) was searched for systematic reviews on the treatment of temporomandibular disorders. The risk of bias was assessed independently by two authors. Results Three systematic reviews involving 25 RCTs were included. The methods of 23 studies were rated as of lower quality with high risk of various biases. Only 2 studies were of high quality. Conclusion There is insufficient or inconsistent evidence to support the use of hyaluronate, occlusal adjustment, and stabilization splint therapy for the treatment of TMD. The overall quality of RCTs about the treatment of TMD is generally low. Analysis of the included trials showed that some trials had no clear description of randomization methods, allocation concealment, sample size calculation, and intention-to-treat analysis. To improve the quality of the reporting of RCTs, clinical trial registration and the revised Consolidated Standards of Reporting Trials (CONSORT) statement should be introduced into the trial design and strictly followed.
目的 通过观察盐酸氨基葡萄糖、依托芬那酯凝胶治疗颞下颌关节紊乱病（TMD）的临床疗效，探寻治疗老年TMD的有效治疗方法。 方法 对2008年7月－2011年12月收治的 35例老年TMD患者，予口服盐酸氨基葡萄糖胶囊750 mg，2次/d，依托芬那酯凝胶5 cm局部外涂，3～4次/d，治疗时间为6周，并对治疗前、后颞下颌关节疼痛程度和活动度进行临床疗效评价。 结果 经治疗，35例患者颞下颌关节疼痛缓解，关节活动度亦明显改善；依据疗效评定标准，治愈10例，显效16例，好转7例，无效2例，总有效率达94.3%；治疗过程中，4例出现轻度胃胀、恶心等不适，2例出现局部皮肤轻度瘙痒现象，无1例中途退出或失访。 结论 盐酸氨基葡萄糖联合依托芬那酯凝胶治疗老年TMD，能缓解关节症状，改善关节活动度，副作用少，值得临床推广运用。
Objective To investigate the effect of hydrostatic pressure and insulin-like growth factor 1 (IGF-1) on the expression of filamentous actin (F-actin) of temporomandibular joint disc cells in goats, and to analyze the F-actin changes of temporomandibular joint disc cells in vitro under hydrostatic pressure and IGF-1 stimulation. Methods The bilateral temporomandibular joint discs were harvested from 4 1-month-old goats, and temporomandibular joint disc cells were isolated with collagenase. Immunohistochemical staining for collagen type I and collagen type II was performed for identification. The cells at passages 2-3 were used; the experiment was divided into 4 groups according to different interventions: the cells were cultivated with complete medium in group A as control; the cells were intervened by hydrostatic pressure (0.2 MPa and 1 Hz for 3 hours) in group B, by complete medium containing IGF-1 (10 ng/mL) in group C, and by a combination of hydrostatic pressure (0.2 MPa and 1 Hz for 3 hours) and complete medium containing IGF-1 (10 ng/mL) in group D. The changes of F-actin at 24 and 72 hours after cultivation were observed by immunofluorescence staining. The cell fluorescence intensity was measured. Results The cultivated cells were identified to be temporomandibular joint disc cells by morphological observation and immunohistochemical staining. At 24 hours, fluorescence intensity of groups A and C was b and clear, with normal morphology of temporomandibular joint disc cells; F-actin arranged in disorder in group B, and F-actin was thinner with arrangement disorder in group D. At 72 hours, the F-actin arranged regularly in groups A and C; however, some F-actin became blurry with irregular arrangement, breakage, and pseudopodia in group B; and F-actin was thinner and ruptured formed in group D. With time passing, the fluorescence intensity of F-actin in groups A, B, and D had an increasing trend, showing significant differences between 24 hours and 72 hours (P lt; 0.05); but there was no significant difference between 24 and 72 hours in group C (t=0.284, P=0.781). At 24 hours, fluorescence intensity of F-actin was highest in group C and was lowest in group B, showing significant difference when compared with groups A and D (P lt; 0.05). At 72 hours, fluorescence intensity in groups B and D was significantly lower than that in groups A and C (P lt; 0.05), but there was no significant difference between groups B and D, and between groups A and C (P gt; 0.05). Conclusion Hydrostatic pressure may cause the F-actin breakage and rearrangement of temporomandibular joint disc cells, and IGF-1 can up-regulate the F-actin expression. Such effects may be correlated with the biological behavior of the temporomandibular joint disc cells.
【Abstract】 Objective To assess the feasibility and clinical outcomes of artificial condylar process in reconstruction of the temporomandibular joint. Methods Between January 2005 and January 2010, the reconstructions of the temporomandibular joints with artificial condylar process were performed in 10 cases (11 sides, including 7 left sides and 4 right sides). There were 7 males and 3 females with an average age of 50 years (range, 40-68 years). Mandibular condyle defects were caused by mandible tumor in 7 patients with a mean disease duration of 15 months (range, 9-24 months) and by bilateral condylar fractures in 3 patients with the disease duration of 2, 3, and 2 days respectively. According to Neff classification, there were type M and A in 1 case, type M and B in 1 case, and type M in one side and subcondylar fracture in the other side in 1 case. Results Incisions in all patients healed by first intention, and no complication occurred. All cases were followed up 1 to 4 years, showed facial symmetry and good occluding relation, and the mouth opening was 22-38 mm (mean, 30 mm). No temporomandibular joint clicking or pain and no recurrence of tumor were observed. Most of the artificial condylar process were in good position except 1 deviated from the correct angle slightly. All the patients could have diet normally. Conclusion The results of temporomandibular joint reconstruction after tumor resection with artificial condylar process are good, but the clinical outcome for intracapsular condylar fracture is expected to be further verified.
Objective To discuss the stabil ity and practical ity of temporomandibular joint replacement by establ ishing goats artificial temporomandibular joint replacement model. Methods Six healthy mature goats were selected, the male and female being half and weighing 35.3-37.0 kg. According to the parameters from X-ray films of goat’ s temporomandibular joint and the shape of the same kind goat’s skull, the total temporomandibular joint prosthesis was prepared. The one side temporomandibular joints of six goats were replaced by prosthesis randomly as the experimental group (n=6, fossa and condyle according to replacement location) and the other side by titanium plate as the control group (n=6). At 4,8, and 12 weeks, the histological observation, scanning electron microscope (SEM) observation were carried out for observing structural changes in the interface. The mechanical test and histochemistry test were used for observing the combination degree of interface and the alkal ine phosphatase (ALP) activity. Results All animals were al ive to the end of experiment with normal open mouth, good recovery of masticatory function, and normal eating. At 4, 8, and 12 weeks, implants were stable in 2 groups without loosening. The histological observation and SEM observation showed the amount of osteoblasts in interface increased over times. There were significant differences in the shearing force and the ALP activity between fossa in experimental group and control group at 4 weeks (P lt; 0.05), but there was no significant difference between other groups (P gt; 0.05). Conclusion The total temporomandibular prosthesis has good stabil ity in temporomandibular joint reconstruction of goat after replacement.
Objetive To investigate the effect of elastic pivot stable biteplate on treating irredueible temporal bone displacement of the temporomandibular joint. Methods Twenty-eight cases of irredueible temporal bone displacement of the temporomandibular joint treated with the elasticpivot stable biteplate from 2000 to 2004 were summarized. The ages of the patients ranged from 15 to 58 yeras includding 11 men and 17 women.Results All the patients were treated for 1 month and followed up for 3 to 6 months. The effective rate was 87.51%. The patients who had shorter course of diseases obtained better effect than the patients who had longer courses of diseases. Conclusion Elastic pivot stable biteplate is an effective alternative for treating irredueible temporal bone displacement of the temporomandibular joint and it exerts better effect on the patients that have short courses of diseases.
Objective To assess the effectiveness of intraarticular injection of hyaluronate (HA) on temporomandibular disorders (TMD). Methods Searching various databases available, handsearching 15 Chinese dental journals to find articles, abstracts and unpublished literature with randomized or quasi-randomized design on the effects of intraarticular injection of HA on TMD.Data extraction, appraisal, and the methods for Meta-analysis were conducted based on the Cochrane guidelines. Results 12 RCTs and 2 CCT on TMD and 1 RCT on rheumatoid arthritis involving temporomandibular joints (TMJ) were located, 10 of them fulfilled inclusion criteria in which 561 patients were reported.Except 71 cases with only qualitative data, 490 cases could be calculated in Meta-analysis: 277 on HA, 113 on placebo or non-treatment (PL) and 100 on corticosteroids (CO). In comparison with PL, HA injection showed no statistically significant effect on short and long term improvement of symptoms, and short term improvement of VAS as well. But it presented significant better effects than PL in short and long term improvement of clinical signs, especially mouth opening. When sensitivity analysis was conducted for improvement of short term signs, the conclusion was not stable. Comparison of the effect between HA and CO showed the same efficacy levels. Adverse reactions of HA were mild and transient. Conclusions HA may improve short and long term clinical signs of TMD and have only mild and transient adverse reactions. However, more RCTs are needed to confirm its therapeutic effect.
目的 探讨伴颞下颌关节紊乱病（TMD）的成人正畸患者的心理社会因素。 方法 2009年5月－2011年12月伴TMD的成人正畸患者42例为观察组，无矫正要求、伴TMD的错牙合患者50例为对照组。采用九十项症状清单（SCL-90）、艾森克人格问卷（EPQ）进行测试，同时进行TMD调查。 结果 观察组与对照组相比，得分较高的有强迫、焦虑、抑郁、人际关系敏感等因素，差异有统计学意义（P＜0.05）；观察组患者P量表、N量表得分高于对照组，差异有统计学意义（P＜0.05）。 结论 伴TMD的成人正畸患者心理健康问题普遍存在,倾向于神经质和精神质的人格特征。
ObjectiveTo discuss the fixed restoration for severe dental attrition with partial dentition defect. MethodsWe selected 15 patients who had received treatments in Hebei Ophthalmology Hospital due to dental allergy, chewing weakness and temporomandibular joint dysfuction caused by severe attrition from February 2007 to October 2012. Among them, there were 9 males and 6 females, aged from 22 to 58 years old averaging 33. We performed occlusal reconstruction by fixed restoration for these patients, recovered their vertical dimension, and then carried out the follow-up. ResultsIn the two-year follow-up, two patients had porcelain cracking, one patient's metal-ceramic crown dropped; no gingiva swelling occurred, periodontal tissues were healthy, occlusal functions recovered well, temporomandibular joint dysfunction and masticatory muscles were not discomfortable, subfacial 1/3 was normal, and patients were satisfied with their appearance and facial contour. ConclusionUsing the fixed restoration to reconstruct occlusions can effectively recover patients' masticatory functions, add height for subfacial 1/3, and improve the symptoms of temporomandibular joint.