Effectiveness of a new method for positioning the lower jaw in patients with partial tooth loss and temporomandibular joint dysfunction

Abstract

BACKGROUND: Temporomandibular joint (TMJ) dysfunction and partial tooth loss are common conditions among the population. The progression of these conditions and the insufficient effectiveness of diagnostic and treatment methods pose several challenges for modern dentistry. Numerous methods for determining the position of the lower jaw can be employed; however, comprehensive diagnostics are required for patients with these issues. Some diagnostic algorithms and treatment methods are unreliable. Studies have indicated that most treatment errors occur during the determination of the optimal lower jaw position.

AIM: To investigate the effectiveness of the developed method for lower jaw positioning in patients with partial tooth loss and TMJ dysfunction.

MATERIALS AND METHODS: This randomized controlled study enrolled 108 patients diagnosed with partial tooth loss and TMJ dysfunction. Patients were divided into three groups: group 1 underwent lower jaw positioning using transcutaneous electrical nerve stimulation, group 2 using a hydrostatic cap, and group 3 using the developed method. After establishing the lower jaw position, a stabilizing cap was fabricated for the patient to maintain the identified position for 60 days. Subsequently, the examination was repeated using the initial diagnostic algorithm, which included the same investigation methods.

RESULTS: Statistically significant changes were found in the morphofunctional state of the stomatognathic system in patients with partial tooth loss and TMJ dysfunction after applying various methods of lower jaw positioning, i.e., transcutaneous electrical nerve stimulation, hydrostatic cap, and the proposed method (p < 0.05). The symptoms diminished in all groups, and the greatest changes were observed in group 3. The analysis of cephalometric data showed a significant reduction in the displacement of the dental midline and sagittal dental distance and an increase in the vertical dental distance after lower jaw positioning. Electromyographic analysis revealed an increase in the symmetry of the temporal and masticatory muscles, torsion index, and masseteric center, particularly in group 3. The obtained data confirm the effectiveness of the proposed method for lower jaw positioning in improving the condition of the stomatognathic system in patients with partial tooth loss and TMJ dysfunction.

CONCLUSION: In comparison with existing methods, the proposed method of mandibular positioning improves the symmetry indices of temporal and masseter muscles, torsion index, and masseteric center to a greater extent, which contributes to the normalization of the TMJ articular gap parameters.

Keywords

temporomandibular joint / partial tooth loss / occlusal disorders / determination of central jaw relationship

References

[1] Bulycheva EA. Differential approach to the development of pathogenetic therapy of patients with temporomandibular joint dysfunction complicated by hypertonia of masticatory muscles [dissertation abstract]. Saint Petersburg, 2010. 331 p. (In Russ.)

[2] Булычева Е.А. Дифференцированный подход к разработке патогенетической терапии больных с дисфункцией височно-нижнечелюстного сустава, осложненной гипертонией жевательных мышц: автореф. дис. … д-ра мед. наук. Санкт-Петербург, 2010. 331 с.

[3] Vyazmin AY, Podkorytov YM, Klushnikov OV. Temporomandibular joint dysfunction and its treatment. Innovation science. 2015;1(1–2):247–251. (In Russ.) EDN: TMVQID

[4] Вязьмин А.Я., Подкорытов Ю.М., Клюшников О.В. Дисфункция височно-нижнечелюстного сустава и его лечение // Инновационная наука. 2015. Т. 1, № 1–2. С. 247–251. EDN: TMVQID

[5] Onopa EN, Evdokimov SN. The changing of the relative optical density of bone tissue of head of mandible in patients with partial teeth missing, the decrease of the lower facial height and distal occlusion in case of the presence or absence of temporomandibular joint dysfunction. The dental institute. 2013;(1):72–75. EDN: SQJRDL

[6] Онопа Е.Н., Евдокимов С.Н. Изменение относительной оптической плотности костной ткани головки нижней челюсти у больных с частичным отсутствием зубов, снижением высоты нижнего отдела лица и дистальной окклюзией при наличии и отсутствии дисфункции височно-нижнечелюстного сустава // Институт стоматологии. 2013. № 1. С. 72–75. EDN: SQJRDL

[7] Fadeev RA, Ovsiannikov KA. Etiology and pathogenesis of diseases of temporomandibular joint and masticatory muscles. Vestnik NovSU. 2020;(4):50–59. EDN: QOQWXI doi: 10.34680/2076-8052.2020.4(120).50-59

[8] Фадеев Р.А., Овсянников К.А. Этиология и патогенез заболеваний височнонижнечелюстного сустава и жевательных мышц // Вестник Новгородского государственного университета им. Ярослава Мудрого. 2020. № 4. С. 50–59. EDN: QOQWXI doi: 10.34680/2076-8052.2020.4(120).50–59

[9] Redinov IS, Pylaeva YeA, Strakh OO, Lysenko BA. Signs of temporomandibular joint dysfunction in individuals with different dentition defects and unequal preservation of antagonist pairs of teeth. International Dental Review. 2021;(2):52–58. EDN: VECPJD doi: 10.35556/idr-2021-2(95)52-58

[10] Рединов И.С., Пылаева Е.А., Страх О.О., Лысенко Б.А. Признаки дисфункции височно-нижнечелюстного сустава у лиц с различными дефектами зубных рядов и неодинаковой сохранностью пар зубовантагонистов // Стоматология для всех. 2021. № 2. С. 52–58. EDN: VECPJD doi: 10.35556/idr-2021-2(95)52-58

[11] Hughes GA, Regli CP. What is centric relation? J Prosthet Dent. 1961;11(2):16–22. doi: 10.1016/0022-3913(61)90104-4

[12] Hughes G.A., Regli C.P. What is centric relation? // J Prosthet Dent. 1961. Vol. 11, N. 2. P. 16–22. doi: 10.1016/0022–3913(61)90104-4

[13] Losev KV, Losev AV, Verendeeva MA, et al. Methods of deprogramming the masticatory muscles: literature review. Acta Medica Eurasica. 2021;(4):91–99. EDN: TMNFGN doi: 10.47026/2413-4864-2021-4-91-99

[14] Лосев К.В., Лосев А.В., Верендеева М.А., и др. Методы депрограммирования жевательных мышц: обзор литературы // Acta Medica Eurasica. 2021. № 4. С. 91–99. EDN: TMNFGN doi: 10.47026/2413-4864-2021-4-91-99

[15] Fadeev RA, Parshin VV. To the question of determining the central position of the lower jaw. The dental institute. 2023;(1):70–71. EDN: ISWXTM

[16] Фадеев Р.А., Паршин В.В. К вопросу определения центрального положения нижней челюсти // Институт стоматологии. 2023. № 1. С. 70–71. EDN: ISWXTM

[17] Manfredini D, Segù M, Arveda N, et al. Disorders in patients with different facial morphology. A systematic review of the literature. J Oral Maxillofac Surg. 2016;74(1):29–46.

[18] Manfredini D., Segù M., Arveda N., et al. Disorders in patients with different facial morphology. A systematic review of the literature // J Oral Maxillofac Surg. 2016. Vol. 74, N. 1. P. 29–46.

RIGHTS & PERMISSIONS

Eco-Vector