Cranio: the journal of craniomandibular practice (CRANIO)

Publications in this journal

• Article: Application of a cephalometric method to the temporomandibular joint in patients with or without alteration in the orientation of the mandibular condyle axis.

  Jorge A Learreta, Esteban E Barrientos
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  ABSTRACT: In a prior study, the spatial relationship of the mandibular condyle was studied through a cephalogram based on laminographies of the temporomandibular joint (TMJ). The present method was developed with the aim of analyzing TMJ morphology and the spatial relationship of the mandibular head within the mandibular fossa, considering references far from these structures, as they may suffer shape alterations. This study was conducted in view of the importance of the study of morphology and the hard structures relationship, which constitutes the temporomandibular joint. Its purpose is to validate a new TMJ cephalogram method by analyzing joints with and without alterations in the orientation of the condylar axis growth. Sixty joints were studied through laminographies in maximal occlusion, examining those joints with and without alterations in the orientation of the axis during condylar growth for subsequent analysis. Results showed that those joints were in a posterior position and rotation of the mandibular head, and that they presented a greater inclination in the articular eminence compared to joints without alterations in the axis orientation. Moreover, a new cephalometric method could be validated, demonstrating that changes in the condylar axis orientation imply pathology; they could also be correlated with changes in the condylar position and in the glenoid fossa morphology.
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):46-55.
• Article: The influence of craniofacial morphology on Mandibular border movements.

  Tomoki Kataoka, Noriaki Kawanabe, Noriko Shiraga, Takashi Hashimoto, Toru Deguchi, Shouichi Miyawaki, Teruko Takano-Yamamoto, Takashi Yamashiro
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  ABSTRACT: Although they are widely used as diagnostic signs of temporomandibular disorders, mandibular border movements reflect not only condylar movement, but also other factors. In the present study, the authors investigated the effect of craniofacial morphology on three different mandibular border movements: maximum jaw opening, maximum jaw protrusion, and maximum jaw laterotrusion. One hundred female subjects were selected from outpatients visiting the orthodontic clinic of Okayama University Hospital. The mandibular border movements were measured using an optical recording system in three dimensions as six degrees of freedom. The craniofacial morphology was evaluated using lateral cephalograms. The results suggest that craniofacial morphology had different influences on each mandibular border movement. In particular, during maximum jaw laterotrusion, lower incisor movement strongly reflected condylar movement, and the influence of craniofacial morphology on mandibular border movement was minimal. Therefore, lower incisor movement during maximum jaw laterotrusion appears suitable to evaluate condylar movement.
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):14-22.
• Article: A possible case of eagle's syndrome from an Italian ossuary (Chiavari, GE).

  Demetra Fotis, Armando Mannucci, Giuseppe Vercellotti
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  ABSTRACT: Eagle's syndrome is a rare condition associated with the temporal styloid process hypertrophy (Eagle, 1937). It is in most cases asymptomatic, but may be accompanied by dysphagia, pharyngeal or head and neck pain due to neurovascular structure compression. The current study aims to present and discuss the etiology of a possible case of Eagle's syndrome from an Italian ossuary. Skull OC 002/08 shows a unilateral hypertrophic styloid process (48 mm long; 5-7 mm thick). Areas of remodel-ed periosteal swelling are visible at the stylohyoid and stylopharyngeus muscles' insertion, along with evidence of healed trauma to both nasal bones and a depressed fracture on the upper left portion of the frontal. Several factors have been proposed as possible causes of styloid elongation, including anatomical variation, aging and trauma. Evidence of unilateral styloid hypertrophy in association with healed cranial trauma in OC 002/08 suggests a traumatic etiology for the condition.
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):61-5.
• Article: Features of temporomandibular disorders in fibromyalgia syndrome.

  Marcele Jardim Pimentel, Maisa Soares Gui, Luana Maria Martins de Aquino, Célia Marisa Rizzatti-Barbosa
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  ABSTRACT: This study aimed to investigate the prevalence of clinical features of temporomandibular disorders (TMD) in patients with fibromyalgia. The test group (FMG) consisted of 40 women with fibromyalgia (FM) compared to the control group of 40 healthy subjects using the research diagnostic criteria for temporomandibular disorders (RDC/TMD). The variables were compared using Fisher's exact test and a Mann-Whitney test. Facial pain was reported by 85% of the FM group, and 77.5% were diagnosed with myofascial TMD. Muscle pain during jaw movements, daytime bruxism/clenching, and limited mouth opening were significantly higher in the test group. There was no difference between groups in: (1) joint noises; (2) sleep bruxism/clenching; and (3) excursive or non-excursive movements. Classic signs of TMD, such as joint noise and self-reporting of clenching at night, are not associated with fibromyalgia syndrome as demonstrated in the current study. However, the self-reported daytime parafunctions, muscle pain in jaw movements, and limited mouth opening are features of the patients in the current study. This study revealed specific muscle involvement of TMD is also presence in FM.
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):40-5.
• Article: The "Minister of Defense" dies of obstructive sleep apnea.

  Riley H Lunn
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):3.
• Article: TMJ alias, The Great Imposter, has a co-conspirator: poor sleep.

  Ira L Shapira
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):1-2.
• Article: Special consideration regarding the assessment and management of patients being treated with mandibular advancement oral appliance therapy for snoring and obstructive sleep apnea.

  Jamison Spencer, Mayoor Patel, Noshir Mehta, H Clifton Simmons, Terry Bennett, Jeanne Kaye Bailey, Allen Moses
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  ABSTRACT: This position paper, as developed by a Task Force of the American Academy of Craniofacial Pain on Mandibular Advancement Oral Appliance Therapy for Snoring and Obstructive Sleep Apnea, contains recommendations for dentists engaged in the management of patients with snoring and obstructive sleep apnea utilizing mandibular advancement oral appliances. The recommendations are supported by current scientific evidence, published standards and guidelines, and expert panel consensus. Snoring and obstructive sleep apnea (OSA) affects millions of people. Oral appliance therapy (OAT) is recognized as an effective therapy for many with primary snoring and mild to moderate OSA, as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies. Dentists are playing a much larger role in the screening and management of patients with snoring and OSA as part of a multi-disciplinary team. It is also recognized that OAT has the potential to cause untoward side effects, including temporomandibular joint (TMJ) pain and dysfunction. The present paper highlights the need for dentists who manage patients using mandibular advancement OAT to be competent in the assessment, diagnosis and management of temporomandibular disorders (TMDs) and craniofacial pain disorders. The authors of this article are all clinically engaged in the management of patients with snoring and OSA, and reached consensus based on their review of the current evidence, published guidelines and clinical experience. It is the opinion of the authors that dentists experienced and knowledgeable in the assessment, diagnosis and management of TMD and craniofacial pain applying this knowledge to the management of patients with snoring and OSA using OAT will provide their patients with the best prognosis and most successful treatment outcomes.
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):10-3.
• Article: Evaluation of the effects of temporomandibular joint disc displacement and its progression on dentocraniofacial morphology in symptomatic patients using posteroanterior cephalometric analysis.

  Sakar O, Calişir F, Marşan G, Oztaş E
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):23-31.
• Article: Osteochondroma of the right coronoid process (Jacob disease): a case report.

  Nobuko Aoki, Kazuhiko Okamura, Daisuke Niino, Osamu Iwamoto, Jingo Kusukawa
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  ABSTRACT: Oscar Jacob was the first to describe osteochondroma of the coronoid process, naming it "Jacob disease." Jacob disease rarely occurs in the oral and maxillofacial regions. The tumor usually grows progressively, leading to a mushroom-shaped enlargement of the process, and a joint-like structure is found between the coronoid process and the inner aspect of the zygomatic arch. Most of these lesions grow like a mushroom on, and do not destroy, the coronoid process. The major symptoms include restricted mouth opening and morphological changes to the zygoma. The authors present a case report on an 18-year-old male patient with pain in the right zygoma. Interincisal maximum mouth opening was 51 mm. An intraoral coronoidectomy was performed.
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):66-9.
• Article: Reproducibility of condyle position and influence of splint therapy on different registration techniques in asymptomatic volunteers.

  Sabine S Linsen, Helmut Stark, Miriam Klitzschmüller
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  ABSTRACT: The current study aims to analyze and quantify the effects of different registration techniques on the reproducibility of condyle position and the influence of stabilization splint therapy on the technique's reproducibility. Three-dimensional electronic-condylar-position analysis (EPA) with an ultrasound-based jaw-tracking system was recorded during intermaxillary registration of manually guided centric relation (CR), maximal intercuspation (MI), and clenching-force-dependent Gothic arch tracing guided centric relation (DIR method) before (T0) and after (T1) splint therapy. Patients were supplied with a stabilization splint for three months on the basis of the DIR registration. Participants were 26 asymptomatic volunteers with a mean age of 30.6 +/- 9.5 years. The registration technique was found to have a significant (p = 0.001) effect on condylar displacement in all axes before, and in X- and Y-axes after splint therapy. Condyles during DIR were found to be in a more anterior-inferior position compared with CR and MI, with the condyles in the latter position being likewise more anterior than in CR. There were significant (p < 0.03) differences in reproducibility of the condyle position dependent on the technique, both at T0 and T1. The DIR method showed the highest reproducibility, followed by MI and CR. There was no significant effect of time of investigation on the technique's reproducibility.
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):32-9.
• Article: Eagle's syndrome: signs and symptoms.

  Fulvia Costantinides, Gabriele Vidoni, Christiane Bodin, Roberto Di Lenarda
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  ABSTRACT: Eagle's syndrome, an uncommon sequela of an elongated styloid process, can manifest itself as a sensation of a foreign body in the throat and a retrogoniac or anterolateral neck pain often referred to the TMJ and the ear. When treating patients affected by temporomandibular disorders (TMD), complaining of atypical orofacial pain, and with a concomitant radiographic finding of a bilaterally elongated styloid, the possible coexistence of Eagle's syndrome should always be considered. The aim of this review is to present an overview of the epidemiology, pathophysiology, diagnosis, and therapy for Eagle's syndrome and to help the clinician in differential diagnosis with other conditions that can provide similar signs and symptoms.
  Cranio: the journal of craniomandibular practice 01/2013; 31(1):56-60.
• Article: Masseter and temporalis excursive hyperactivity decreased by measured anterior guidance development.

  Robert B Kerstein, John Radke
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  ABSTRACT: The purpose of this study was to determine if a statistically significant reduction in muscle activity (p<0.05) occurs when prolonged disclusion time (>0.4 sec/excursion) is shortened to <0.4 sec/excursion with the Immediate Complete Anterior Guidance Development (ICAGD) enameloplasty. Forty-five symptomatic, fully informed subjects (29 female, 16 male) had their right and left disclusion times recorded with T-Scan III, while simultaneously, the bilateral masseter and anterior temporalis muscle activity was recorded electromyographically with BioEMG III (n=180 muscles). This recording was done twice, once pretreatment and again posttreatment (same day) after undergoing the ICAGD enameloplasty on the same day without changing electrodes. The Student's paired t-test was utilized to detect any significant change in the muscle activity levels between the pre- and posttreatment lateral excursive muscle contractions. Highly significant reductions were found in all four muscles' activities after shortening the pretreatment prolonged disclusion time to less than 0.4 seconds (p<0.0014); after Bonferroni correction (p<0.006). When properly performed, such that the posttreatment disclusion time is <0.4 sec/excursion, the ICAGD enameloplasty predictably reduces excursive muscle activity levels in the bilateral anterior temporalis and masseter muscles. Excursive muscle hyperactivity can be a source of lactic acid accumulation, muscular ischemia, and chronic myalgic temporomandibular joint dysfunction (TMD) symptoms. The ICAGD enameloplasty significantly reduces excursive muscle contractions after completion of the first ICAGD treatment session.
  Cranio: the journal of craniomandibular practice 10/2012; 30(4):243-54.
• Article: Low level laser therapy for the treatment of temporomandibular disorders: a systematic review of the literature.

  Marcello Melis, Massimiliano Di Giosia, Khalid H Zawawi
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  ABSTRACT: The authors performed a review of the literature to evaluate the efficacy of low level laser therapy (LLLT) for the treatment of temporomandibular disorders (TMD). Selection criteria included: 1) human subjects, 2) articles written in English, and 3) randomized placebo-controlled trials. Evaluation was performed according to the CONSORT 2010 criteria. A total of 14 articles were included in the review. Studies varied considerably in terms of methodological design, particularly regarding the site of application of the laser beam, the number of applications performed, their duration, the laser beam features (wavelength, frequency, output, dosage), and outcome measures. The outcome of the trials was controversial and not particularly related to any features of the laser beam, to the number of laser applications, and their duration. Based on the results of this review no definitive conclusions can be drawn on the efficacy of LLLT for the treatment of TMD. Many methodological differences among the studies, especially regarding the number and duration of laser applications and characteristics of the laser beam (wavelength, frequency, output), do not allow for standardized guidelines for effective treatment with LLLT. The only indication seems to be that LLLT is probably more effective for the treatment of TMJ disorders, and less effective for the treatment of masticatory muscle disorders.
  Cranio: the journal of craniomandibular practice 10/2012; 30(4):304-12.
• Article: Orofacial myofunctional therapy: why now?

  Joy L Moeller
  Cranio: the journal of craniomandibular practice 10/2012; 30(4):235-6.
• Article: Degenerative changes in rat condylar cartilage induced by non-matching occlusion created by scattered orthodontic teeth-moving.

  Meiqing Wang, Lei Sun, Shi-Bin Yu, Xiaodong Liu, Kai Jiao, Guo-Wei Wang, Lei Liu, Jian-Jun He
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  ABSTRACT: The effect of occlusion on the temporomandibular joint (TMJ) is debated. By inserting rubber-bands that were replaced by self-curing resin one week later, the left maxillary and the right mandibular first-molars were moved and kept mesially in Sprague-Dawley (SD) rats in both experimental I (EXP-I) and II (EXP-II) groups, aiming to establish a non-matching cusp-to-fossa occlusal relation. Four weeks later, the left maxillary and the right mandibular third-molars were moved and kept distally in the EXP-II group. Degenerative changes, typically as a cell-free area, were observed in TMJs of the EXP groups. Binary logistical analysis indicated that the odds ratio of EXP group, EXP-II vs. EXP-I, on the incidence of a cell-free area, was 2.8 (p=.036). Time point, gender, and side did not have such effects (p>0.05). The results indicate that the persistence of more scattered non-matching cusp-to-fossa occlusion is more harmful to the condylar cartilage in terms of the incidence of degenerative changes.
  Cranio: the journal of craniomandibular practice 10/2012; 30(4):286-92.
• Article: Sequential analysis of head movement during mandibular open-close movements in TMD patients with disc displacement with reduction.

  Haruka Kon, Naoki Sakurai, Mikako Tanaka, Hiroshi Kobayashi, Naoko Sato, Saori Makita, Rumi Yoshida, Asako Kai, Shuichi Nomura
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  ABSTRACT: This study examined relationships between starting points of head and mandibular movements in 11 female control subjects and 10 TMD patients showing disc displacement with reduction during consecutive open-close movements, using a six-degree-of-freedom measuring device. During the first mandibular opening cycle, in the TMD group, head movement was significantly preceded in relation to mandibular movement when compared with the control group, and major differences in onset were seen between maximum and minimal values at the beginning of mandibular movements. After the second cycle, significant differences in starting points were not evident. In TMD patients showing disc displacement with reduction, in the first cycle, at the commencement of opening movements, it is proposed that the head precedes the mandible in order to compensate for irregular condylar movements, and the degree of the condylar movement irregularity might affect the onset relation between the head and the mandible.
  Cranio: the journal of craniomandibular practice 10/2012; 30(4):272-9.
• Article: Technology is here to stay.

  Riley H Lunn
  Cranio: the journal of craniomandibular practice 10/2012; 30(4):237.
• Article: The use of electrognathography in jaw movement research: a literature review.

  Paulo Fernandes Pinheiro, Daniele Andrade da Cunha, Mário Genuíno Dourado Filho, Ada Salvetti Cavalcanti Caldas, Thais Myriam Aragão Melo, Hilton Justino da Silva
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  ABSTRACT: The measurement of mandibular movements is a complex task that can be simplified through the use of electrognathography (EGN), an examination that can be applied as an auxiliary method for the diagnosis or follow-up of the evolution of specific therapeutics applied to the stomatognathic system. The aim of the present study was to review the literature pertaining to the use of EGN as a method for monitoring jaw movements in the research and treatments related to the stomathognathic system. A literature review was made by searching for articles in PubMED, MEDLINE (1997-2010), MEDLINE (1966-1996), LILACS, Ovid, BBO and SciELO databases. In this systematic review, 373 articles were found, of these, 23 articles were selected. The study concluded that EGN can be used with advantages in varied clinical situations, although it is a technique still not widely applied.
  Cranio: the journal of craniomandibular practice 10/2012; 30(4):293-303.
• Article: Assessment of the reliability and repeatability of landmarks using 3-D cephalometric software.

  Gianluigi Frongia, Maria Grazia Piancino, Andrea Adriano Bracco, Vito Crincoli, Cesare Lorenzo Debernardi, Pietro Bracco
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  ABSTRACT: The aim of this study was to analyze the reliability and repeatability of identification landmarks using 3-D cephalometric software. Ten orthognathic patients were selected for this study and underwent the following protocol: 1. radiographic evaluation (CBCT technique); 2. stone casts; 3. photos; and 4. 3-D cephalometric evaluation. Twenty-one hard tissue landmarks and 14 cephalometric measurements were taken three times (T1, T2, and T3) on each patient, with an interval of one week by two experts in orthodontics (A, B). Standard deviation and Pearson's correlation coefficient were calculated to evaluate intra- and inter-observer repeatability. The results showed a strong correlation for both intra- and inter-observer Pearson's correlation coefficient (>0.7). The current preliminary study showed that the reliability and repeatability of the identification landmarks were very high if the 3-D cephalometric landmarks are defined correctly in the three planes of the space. Further evaluation is necessary to better define the 3-D cephalometric system.
  Cranio: the journal of craniomandibular practice 10/2012; 30(4):255-63.
• Article: Low level laser therapy as an adjunctive technique in the management of temporomandibular disorders.

  Marco Antônio Moreira Rodrigues da Silva, André Luís Botelho, Carolina Vogt Turim, Ana Maria Bettoni Rodrigues da Silva
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  ABSTRACT: The purpose of this study was to assess the effect of low level laser therapy on subjects with intra-articular temporomandibular disorders (IA-TMD), and to quantify and compare severity of signs and symptoms before, during, and after the laser applications. The sample consisted of 45 subjects randomly divided into three groups (G) of 15 subjects each: G-I: 15 individuals with IA-TMD submitted to an energy dose of 52.5 J/cm2; G-II: dose of 105.0 J/cm2; and G-III: placebo group (0 J/cm2). In all groups, the applications were performed on condylar points on the masseter and anterior temporalis muscles. Two weekly sessions were held for five weeks, totaling 10 applications. The assessed variables were: mandibular movements and painful symptoms evoked by muscle palpation. These variables were measured before starting the study, then immediately after the first, fifth, and tenth laser application, and finally, 32 days after completing the applications. The results showed that there were statistically significant differences for G-I and G-II at the level of 1% between the doses, as well as between assessments. Therefore, it was concluded that the use of low level laser increased the mean mandibular range of motion and reduced painful symptoms in the groups that received effective treatment, which did not occur in the placebo group.
  Cranio: the journal of craniomandibular practice 10/2012; 30(4):264-71.