Method of early diagnostics and correction of temporomandibular joint dysfunctions

 

The invention relates to medicine, namely to the dentist.

In the literature there are no data on the regularities of the influence of occlusion on the function of the masticatory muscles and temporomandibular joints (TMJ). Little also highlighted the issues of diagnosing disorders of the TMJ in prosthetic dentistry. These issues are described in monographs and articles Vahatalo and her students, in the works Day. However, the complexity of the diagnosis of functional disorders of the TMJ in the initial stages is the absence of pain. The proportion of persons with complaints from TMJ attending PSC bgmu for consultation, amounted to 4.1% of the total number of patients, and the examination of the dysfunction of the TMJ were detected in 38% of patients.

The problem of diagnostics and correction of functional disorders of the TMJ remains relevant due to the lack of consensus about the origin of these disorders, there is no single treatment methods, difficult diagnosis similar clinical picture of various forms of pathology of the TMJ. Especially important early diagnosis and treatment in pre-clinical forms of violation

Known methods of diagnostics of diseases of the TMJ:

- Conventional radiography (planar x-rays, including panoramic) is a fast, painless, and relatively inexpensive technique. But it shows you what are the bone structure of the joint and therefore its use is mainly limited exception obvious pathological changes and disease processes (E. Bulychev The study of radiographic changes in the dysfunctions of the temporomandibular joints, complicated Paratunka masticatory muscles of the Text. / Eaaea // Institute of dentistry. - 2008. No. 1. - 44-47).

Imaging shows "slices" through the joint. When it is done properly and accurately interpreted, then tomograms provide a clearer picture than a simple x-rays. The main disadvantages of rentgenoterapii: the higher the cost, the time and the fact that conventional radiograph, roentgenogram shows only the bone tissue, the higher the irradiation of the patient x-rays compared with the sighting radiograph (Polarus NF Improvement techniques layered shooting temporomandibular joints. / Nppears, Ophthacare, Liapunov. // Actual. questions dentistry: Metall nauch.-practical use. proc. - Samara - 1998. - S-143).

- X-ray computer tomography (CT or CAT Scan) provides greater detail of the bone tissue, gives images in many directions with the least amount of training. These images are rather expensive and provide some limited view of the disc and soft tissue. Dysfunctional disorders is not always accompanied with morphological abnormalities (Pautov, YOU Computed tomography in the diagnosis of internal breaches of n is genecluster joint Text.: abstract. dis. (Kida. the honey. Sciences / Yourauto. - M., 1996. - 15 S.).

Magnetic resonance imaging (MRI study) gives a very detailed and accurate images as bone and soft tissue. MRI is widely recognized as the best way to learn TMJ. No radiation is not used; however, since the need for complex equipment, the cost of MRI high compared with other methods (badanin, V.V. Magnetic resonance imaging in dentistry Text./ V.ya.yakovleva, Apergillus // Russian dental journal. - 2001. No. 5. - 40-44).

- Artrografia allows to study the position and function of the joint, including the disk. In this method, in the joint injected contrast. Then do normal radiographs, roentgenogram, video, or combinations thereof. For this method, you need a qualified researcher. The procedure can be very unpleasant for the patient, but if it is done properly, arthrography can be extremely accurate diagnostic tool for advanced severe forms of joint pathology. All of these methods characterize morphological disorders of the TMJ, without affecting the functional impairment that is of great importance in the development of the pathological process (Kurland, V.Y. Methods of research in prosthodontics Text./ Voukourestiou, etc.): Tashkent, 1973. - 231 S.).

<> A known way to determine pathological changes in the temporomandibular joints, which consists in the fact that you are doing the scan in axial projection with a computer or magnetic resonance tomography (MRT), presents the images determine the width and density, and for MRI intensity and uniformity of the signal of the lateral pterygoid, medial pterygoid and masseter muscles, and then determine the magnitude of the angles formed by the intersection of the transverse axis of the articular heads to the longitudinal axes of the branches of the lower jaw on both sides, and the location of the proposed point of intersection of the transverse axis of the articular heads (patent RU 2198599, 2003). When the extension of the lateral pterygoid muscle on one side, chewing and (or) the medial pterygoid muscle on the other, in combination with the displacement of the point of intersection of the transverse axis of the articular heads towards the thickened lateral pterygoid muscle to 0.3 cm, when compared with the two sides of the performance of condylo-kolonodale angles define muscle and joint dysfunction. With the increase of the lateral pterygoid muscle on one side, chewing and (or) the medial pterygoid on the other side, reducing condylo-kolonodale angle on the side of the thickened lateral pterygoid muscle and the offset of the intended point of intersection of the cross the s axis of the articular heads from the midline to the side, the opposite hypertrophied lateral pterygoid muscle, 0.3 or more cm determine the initial manifestations of osteoarthritis of the TMJ (I-II stage). This method provides enhanced diagnostic capabilities by detecting changes in spatial-topographical orientation of the articular heads of the mandible.

A known method for the diagnosis of dysfunction of the temporomandibular joint, characterized by the fact that determine the functional status of the masticatory muscles by measuring characteristics of blood flow in the vessels of the external carotid artery and in the area of the maxillary artery on the right and left sides. When the values of the linear blood flow velocity in the region of the external carotid artery, corresponding to the age norm, and asymmetry of the testimony of the linear velocity of blood flows in the area of the maxillary artery on the right and left sides of at least 30% of diagnosed dysfunction of the temporomandibular joint. Measurement of blood flows made with the help of Doppler ultrasound (patent RU 2322182, 2008). This method simplifies the process of diagnosing and increases the reliability of diagnostic results.

For the prototype accepted methods of examination of patients with diseases of the TMJ on Waitrose (Petrosov, Y.A. Diagnosis and orthopedic treatment of diseases of the temporomandibular joint Tex is./ Waitrose. - Krasnodar: Soviet Kuban, 2007. - 304 S.), including the collection and examination of complaints, the collection and analysis of medical history, physical examination of the face, palpation and auscultation of the joint during movement of the mandible, measuring the distance between the cutting edges of the Central incisors at the maximum open mouth, palpation of lymph nodes and salivary glands, the use of functional-diagnostic tests, x-ray and laboratory tests. This method is time-consuming, does not imply identification to clinical symptoms of TMJ.

The objective of the invention was to improve the diagnosis and treatment of TMJ dysfunction in the early stages.

The technical result when using the invention - early detection and correction of TMJ dysfunction before the onset of clinical symptoms of joint pathology.

This technical result is achieved in that in the method for the diagnosis of dysfunction of the temporomandibular joint (TMJ), including inspection, orthopantomography, anthropometry of the face with the determination of the proportions of its parts vertically, according to the invention additionally spend onclusory in habitual occlusion to determine displacement of the mandible in the sagittal and transverse directions, conduct sample Esler-Bitner to determine distal movement of the lower jaw, when the definition of a secondary offsets the lower is her jaw in the sagittal and/or transverse and/or distal directions, the presence of joint gaps of different sizes on the orthopantomogram and change the height of the lower third of persons diagnosed with TMJ dysfunction, then install the lower jaw in a neutral position in Central occlusion, made a splint with nakonechnyi grounds for fixing the lower jaw in this position, re-produce onclusory in Central occlusion together with a cotter pin, determine the difference of initial and blocking contacts, and when the advancing contact conduct of the electoral presledovanie, about the elimination dysfunction judged by subjective sensations of the patient, anthropometric measurements, and hold the lower jaw in position without displacement in the sagittal and transverse planes, conduct a final correction of the cotter pin in the Central occlusion under control Optg at the Central position of the TMJ head in the glenoid fossa, after which the cotter pin from silicone to replace the plastic, I appoint myotherapy and witnesses carry out orthodontic treatment and/or dentures after reaching adaptation.

The invention is illustrated by the following figures: figure 1 presents a photograph of the patient K. before treatment, in full face when your teeth are occluded in the position of habitual occlusion, where α is the offset angle (15°) of the lower jaw to the left, the length of the offset - 4 mm (lower ka is et); figure 2 - the same, the mouth if your teeth are occluded in habitual occlusion; figure 3 is the same, the mouth of the patient when the mouth is open: the displacement of the mandible increases to the width of the cutter (7 mm); figure 4 - results of research on the machine T-Scan at the maximum your teeth are occluded in habitual occlusion; figure 5 - orthopantomogram of the patient K.; figure 6 is a photograph of a patient Century to the treatment profile when your teeth are occluded in the position of habitual occlusion; 7, 8, and 9 are the same, the mouth if your teeth are occluded in habitual occlusion; figure 10 - results of research on the T-Scan at the maximum your teeth are occluded in habitual occlusion; figure 11 - orthopantomogram patient Century; Fig is a photograph of the patient P. before treatment, in full face when your teeth are occluded in the position of habitual occlusion; Fig, 14, and 15 are the same, the mouth if your teeth are occluded in habitual occlusion; Fig - research results on the T-Scan at the maximum your teeth are occluded in habitual occlusion; Fig - orthopantomogram of the patient P.

The proposed method consists in the following: after taking a history and examining complaints, inspection of the face and oral cavity, setting the preliminary diagnosis is carried out anthropometry of the face to determine the displacement of the lower jaw and the change in height of the lower third of the face, which can lead to TMJ dysfunction. Define offset lower Chol is ti in the sagittal, transversal and distal directions. To determine the distal movement of the lower jaw used a sample of Asclera-Bitner. To determine the lateral displacements are onclusory in habitual occlusion - get results with the help of a computer program T-Scan. Spend orthopantomography and determine the amount of joint cracks. When determining the secondary displacement of the mandible in the sagittal and/or transverse and/or distal directions, the presence of joint gaps of different sizes on the orthopantomogram and change the height of the lower third of persons diagnosed with TMJ dysfunction. For early treatment of TMJ dysfunction after determining the secondary displacement of the lower jaw by means of anthropometry and TMJ study on orthopantomogram (optg) occlusion train the patient to shift the lower jaw to the center neutral position, controlling for anthropometric facial features. Determine the Central occlusion, made mouthguard with nakonechnyi grounds for fixing the lower jaw in this position using a special Registrar of occlusion, for example: "Occlufast" by Zhermack.

Scan occlusal contacts in Central occlusion with Kappa T-Scan. Determine the difference of initial and blocking contacts (super contacts in case)when anticipating contact conduct of the election sewn ifbyphone. About the end of the preparatory period and the elimination dysfunction judged by subjective sensations of the patient, appearance (anthropometric data) and quiet to hold the lower jaw in a new position without displacement in the sagittal and transversal directions).

Final correction of the mouthguard in the Central occlusion produced under the control optg at the Central position of the TMJ head in the glenoid fossa, then the Kappa of silicone to replace the plastic.

Then proceed to medical activities under the control of optg or CT, is made mouthguard in a constructive occlusion in the new position of the lower jaw without displacement in the sagittal and transversal planes (i.e. the lower jaw is set in a neutral position using a custom mouthguard), designate myotherapy and give recommendations on the use of therapeutic Kappa, control occlusion of the T-Scan in the dynamics of treatment.

If necessary, according to the testimony spend orthodontic preparation or manufacture dentures, restoring existing defects in the new position of the lower jaw, made in the course of treatment using Invisalign and other methods of correction of occlusion used in the retention period of myotherapy.

The advantages of the proposed method.

1. Early diagnosis and correction of secondary displacements and is isfunction TMJ allows to detect and prevent disease TMJ until pronounced pathological articular symptoms.

2. In the early stages define the great displacement of the mandible and disorders of occlusion, the timely establishment of its neutral position in space of the skull, training, myotherapy under the control objective data.

3. Objectification obtain Central occlusion according to the scan occlusion.

4. Scan occlusal contacts on computer program T-Scan before treatment, in the dynamics of active treatment achieved an objective evaluation of the results.

5. A comparative analysis of the initial and blocking contacts the teeth of the upper and lower jaws allows you to precisely define "super contacts in case" and eliminate them, to achieve efficiency electoral presledovaniya.

6. Restores normal occlusion and smooth uniform movement of the lower jaw, which contributes to the normal functioning of the TMJ.

7. Restored full chewing. The restructuring of the myotatic reflex.

8. Does not require high material costs.

9. Ensures the preservation of emotional social stability of the patient, achieving positive outcomes, improve quality of life.

Clinical example 1. Patient K., 22, turned in the direction of the stomatologist-therapist because of the difficulties in carrying out restorations of teeth, namely a sharp painful owoseni is in the area of TMJ, especially when you have a long time to be with widely open mouth. When taking a history and complaints, the patient noted the emergence of pain in the TMJ area with prolonged mouth opening (dentist), clicking when opening the mouth, periodic headaches. Complained of nighttime teeth grinding. From the anamnesis it was found that injuries of the maxillofacial region was not.

Was applied the proposed method for the examination. The first stage preliminary diagnosis after taking a history, explanation of the complaints and clinical examination of the oral cavity was the anthropometry of the face (figure 1), then the determination of the displacement of the lower jaw and the results write a computer program T-Scan position habitual occlusion, training the patient to shift the lower jaw to the center for facial anthropometric characteristics, receipt of Central occlusion, manufacturing Nakonechnyj sites for its fixation (Kappa), scan occlusal contacts in Central occlusion, determining the difference of the initial and blocking contacts (super contacts in case), x - ray control optg provisions of TMJ head in the glenoid fossa during R-graphy occlusion (figure 5) and using them in the position of Central occlusion for comparison. Next, the patient was referred for CT.

During the inspection revealed the following signs we is echno-articular TMJ dysfunction: painless, limited mouth opening, clicking in the TMJ on the left with a wide mouth opening, symptom deviation, difficulty displacement of the lower jaw to the right. The tone of the masseter muscle is increased on the left. Bite - 1 class Anglo, deep cutting overlap, the offset of the center line of the lower jaw to the left by 4 mm. Defined severe traumatic occlusion and periodontitis separate groups of teeth, especially in the frontal area.

During examination of the patient was used articulator, to identify the true centric relation of the jaws, on the basis of what was the conclusion about the need to shift the lower jaw in a neutral position and fixation of this provision for subsequent treatment at the rented equipment with side inclined plane for revamping the muscles.

The first stage of treatment was conducted selective grinding of the enamel, in the field of super contacts in case for the blocking of sites.

Next was manufactured plastic removable Kappa with an inclined plane in the position of Central occlusion. The patient was recommended constant use of the Kappa and myotherapy.

According to the patient, in the first day using the Kappa has been a significant pain in the area of the front teeth of the upper and lower jaws, which is presumably related to the nature of the bite of the patient.

3 weeks after the start of treatment by this method has been adapting to the new position of the lower jaw and the Kappa determined that the patient freely holds the lower jaw in a neutral position after removing the mouthguard. Then the treatment continued aguis technique for final leveling of the teeth and the normalization of the occlusion.

Clinical example 2. Patient C., 26 years old, came with complaints of malocclusion, ugly smile. Anomaly dentition and bite marks 13 years. A study of the relation of the elements of the TMJ in position habitual occlusion and centric relation position on wax template.

Was applied the proposed method for the examination. The first stage of the preliminary diagnosis was anthropometry of the face: the face is symmetrical, proportional, the facial profile is concave, marked underdevelopment of the midface (6), then the determination of the displacement of the lower jaw and the results write a computer program T-Scan position habitual occlusion (figure 10), training the patient to shift the lower jaw to the center for facial anthropometric characteristics, receipt of Central occlusion, manufacturing Nakonechnyj sites for its fixation (Kappa), scan occlusal contacts in Central occlusion, determining the difference of the original is blocking contacts (super contacts in case), x-ray control optg provisions of TMJ head in the glenoid fossa at R-graphy occlusion (11) and using them in the position of Central occlusion for comparison. Next, the patient was referred for CT.

During the inspection revealed the following signs of muscular-articular TMJ dysfunction: difficulty displacement of the lower jaw back. The tone of the masticatory muscles is increased. The mouth opening is not limited to, the anomaly dentitions: retrose 12, 11, 21, 22, Treme between 42 and 43, between 32 and 33. The ratio of dentition: 1 class Anglo right, 3 class Anglo left. Reverse blade disocclusion. Slight displacement of the middle line (Fig.7, 8, 9).

Defined severe traumatic occlusion and periodontitis separate groups of teeth, especially in the frontal area.

During examination of the patient was used articulator, to identify the true centric relation of the jaws, on the basis of what was the conclusion about the need to shift the lower jaw in a neutral position and fixation of this provision for adjustment of the working muscles.

The first stage of treatment was conducted selective grinding of the enamel, in the field of super contacts in case for the blocking of sites.

Next was manufactured plastic removable Kappa with an inclined plane in the position of Central occlusion. The patient was recommended DC Paul who Finance the Kappa and myotherapy.

According to the patient, at the beginning of the use of the Kappa was discomfort in the anterior teeth of the upper and lower jaws, which is presumably related to the nature of the bite of the patient.

6 weeks after the start of treatment by this method has been adapting to the new position of the lower jaw and the Kappa determined that the patient freely holds the lower jaw in a neutral position after removing the mouthguard. Started orthodontic treatment aguis technique for the final normalization of the occlusion.

Clinical example 3. Patient R., 20 years old, came with complaints of facial asymmetry. Transferred and associated diseases: otitis denies.

Was applied the proposed method for the examination. The first stage preliminary diagnosis after taking a history, explanation of the complaints and clinical examination of the oral cavity was the anthropometry of the face: facial asymmetry, displacement of the mandible to the left (11), then the determination of the displacement of the lower jaw and the results write a computer program T-Scan position habitual occlusion (Fig), training the patient to shift the lower jaw to the center for facial anthropometric characteristics, receipt of Central occlusion, manufacturing Nakonechnyj sites for its fixation (Kappa), scan occlusal contacts in Central occlusion, is the distribution of the difference of the initial and blocking contacts (super contacts in case), x-ray control optg provisions of TMJ head in the glenoid fossa at R-graphy occlusion (Fig) and using them in the position of Central occlusion for comparison. Next, the patient was sent for a CT scan.

During the inspection revealed the following signs of muscular-articular TMJ dysfunction: painless, unrestricted mouth opening, clicking in the TMJ on the left and right wide opening of the mouth, difficulty displacement of the lower jaw to the left and to the right. The tone of the masticatory muscles is increased. Examination of the oral cavity (habitual occlusion): 3 class Anglo right, 1 class Anglo left. Overlapping on sagittal=0 mm Overlap vertically=0 mm Displacement of the middle line of the lower jaw to the left by 4 mm, narrowing of the upper dentition. Local gingivitis in region 11 (Fig, 14, 15).

During examination of the patient was used articulator, to identify the true centric relation of the jaws, on the basis of what was the conclusion about the need to shift the lower jaw in a neutral position and fixation of this provision for subsequent treatment to removable drop side inclined plane for revamping the muscles.

The first stage of treatment was conducted selective grinding of the enamel in the field of super contacts in case for the blocking of sites.

Next was manufactured plastic removable Kappa with an inclined plane is the position of Central occlusion. The patient was recommended constant use of the Kappa and myotherapy.

5 weeks after the start of treatment by this method has been adapting to the new position of the lower jaw and the Kappa determined that the patient freely holds the lower jaw in a neutral position after removing the mouthguard. Started orthodontic treatment aguis technique for the final normalization of the occlusion.

The correction method identified early diagnosis of dysfunctions of the temporomandibular joint (TMJ), including inspection, orthopantomography, anthropometry of the face with the determination of the proportions of its parts vertically, characterized in that it further conduct onclusory in habitual occlusion to determine displacement of the mandible in the sagittal and transverse directions, conduct sample Esler-Bitner to determine distal movement of the lower jaw, when the determination of the secondary displacement of the mandible in the sagittal and/or transverse and/or distal directions, the presence of joint gaps of different sizes on the orthopantomogram and change the height of the lower third of persons diagnosed with TMJ dysfunction after then establish the lower jaw in a neutral position in Central occlusion, made mouthguard with nakonechnyi grounds for fixing the lower jaw in this position, proizvodyostvo onclusory in Central occlusion with Kappa, determine the difference of initial and blocking contacts, and when the advancing contact conduct of the electoral presledovanie, about the elimination dysfunction judged by subjective sensations of the patient, anthropometric measurements, and hold the lower jaw in position without displacement in the sagittal and transverse planes, conduct a final correction of the mouthguard in the Central occlusion under control optg at the Central position of the TMJ head in the glenoid fossa, then the Kappa of silicone to replace the plastic, on the testimony designate myotherapy and carry out orthodontic treatment and/or dentures after achieving adaptation.