Abstract
Objectives
The aim of this prospective study was to evaluate the short-term effects of full-time and night-time wear of functional appliances on the temporomandibular joint (TMJ) and masticatory muscles and to compare the differences in craniofacial structures, TMJ, and masticatory muscles with magnetic resonance imaging (MRI).
Methods
The study was carried out using cephalometric radiographs and MRI of 20 Class II patients who were treated with monoblock/twin-block appliances. The patients were divided into 2 groups: ten patients in Group 1 used their appliances all day, while ten patients in Group 2 were instructed to wear the appliances during sleep. After at least 6 months of uninterrupted treatment, post-treatment cephalograms and MRI were obtained for patients whose molar relationship improved by at least a half cusp width. Signal intensity ratios (SIR) of TMJ structures and morphological evaluations of masticatory muscles were done for all patients.
Results
It was found a significant increase in SIR values of the condylar process, articular disc, retrodiscal tissue, and masticatory muscles for all treatment groups. Length of the masseter and medial pterygoid muscles increased to varying degrees which left side of Group 2 was significantly increased (P < 0.05). The volume of all muscles also increased to varying degrees.
Conclusions
The cephalometric and MRI findings of this study show that the treatment effects were similar for both wear schedules.
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References
Woodside DG, Metaxas A, Altuna G. The influence of functional appliance therapy on glenoid fossa remodelling. Am J Orthod Dentofac Orthop. 1987;92(3):181–98.
McNamara JA Jr., Bryan FA. Long-term mandibular adaptations to protrusive function: an experimental study in macaca mulatta. Am J Orthod Dentofac Orthop. 1987;92:98–108.
Williams S, Melsen B. Condylar development and mandibular rotation and displacement during activator treatment. An implant study. Am J Orthod. 1982;81:322–6.
Fränkel R, Fränkel C. Clinical implication of Roux’s concept in orofacial orthopedics. J Orofac Orthop. 2001;62:1–21.
Orhan K, Nishiyama H, Tadashi S, Murakami S, Furukawa S. Comparison of altered signal intensity, position, and morphology of the TMJ disc in MR images corrected for variations in surface coil sensitivity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(4):515–22.
Ruf S, Pancherz H. Temporomandibular joint growth adaptation in Herbst treatment: a prospective magnetic resonance imaging and cephalometric roentgenographic study. Eur J Orthod. 1998;20:375–88.
Pancherz H, Ruf S, Thomalske-Faubert C. Mandibular articular disc position changes during herbst treatment: a prospective longitudinal MRI study. Am J Orthod Dentofac Orthop. 1999;116:207–14.
Wadhawan N, Kumar S, Kharbanda O, Duggal R, Sharma R. Temporomandibular joint adaptations following two-phase therapy: an MRI study. Orthod Craniofac Res. 2008;11:235–50.
Orhan K, Ucok O, Delilbası C, Paksoy C, Doğan N, Karakurumer K, et al. Prevalence of temporomandibular joint sideways disc displacement in symptom-free volunteers and comparison of signal intensity ratios of masticator muscles on magnetic resonance images. Oral Health Dent Manag In Black Sea Ctries. 2005;4:14–8.
Boom HPW, Van Spronsen PH, Van Ginkel FC, Van Schijndel RA, Castelijns JA, Tuinzing DB. A comparison of human jaw muscle cross-sectional area and volume in long- and short-face subjects, using MRI. Arch Oral Biol. 2008;53:273–81.
Ahlgren J. Early and late electromyographic response to treatment with activators. Am J Orthod. 1978;74:88–93.
Sander FG. Mouth opening and its influencing through the SII appliance during the night. J Orofac Orthop. 2001;62:133–45.
Sander FG. Function al processes when wearing the SII appliance during the day. J Orofac Orthop. 2001;62:264–75.
Greulich WW, Pyle SI. Radiographic atlas of skeletal development of hand and wrist. 2nd ed. Stanford: Stanford University Press; 1959.
Clark WJ. The twin block tecnique. In: Graber TM, Rakosi T, Petrovic AG, editors. Dentofacial orthopedics with functional appliances. St. Louis: Mosby Co.; 1997. pp. 268–98.
Björk A, Skieller V. Growth of the maxilla in three dimensions as revealed radiographically by the implant method. Br J Orthod. 1977;4:53–64.
Björk A, Skieller V. Normal and abnormal growth of the mandible. A synthesis of longitudinal cephalometric implant studies over a period of 25 years. Eur J Orthod. 1983;5:1–46.
Komada T, Naganawa S, Ogawa H, Matsushima M, Kubota S, Kawai H, et al. Contrast-enhanced MR imaging of metastatic brain tumor at 3 T: utility of T1-weighted space compared with 2D spin echo and gradient echo sequence. Magn Reson Med Sci. 2008;7:13–21.
Tümer N, Gültan AS. Comparison of the effects of monoblock and twin-block appliances on the skeletal and dentoalveolar structures. Am J Orthod Dentofac Orthop. 1999;116:460–8.
Aggarwal P, Kharbanda O, Mathur R, Duggal R, Parkash H. Muscle response to the twin-block appliance: an electromyographic study of the masseter and anterior temporal muscles. Am J Orthod Dentofac Orthop. 1999;116:405–14.
Franchi L, Pavoni IC, Faltin K Jr., McNamara JA Jr., Cozza P. Long-term skeletal and dental effects and treatment timing for functional appliances in Class II malocclusion. Angle Orthod. 2013;83:334–40.
Mills CM, McCulloch KJ. Posttreatment changes after successful correction of class II malocclusions with the twin block appliance. Am J Orthod Dentofac Orthop. 2000;118:24–33.
Rabie ABM, Zhao Z, Shen G, Hagg E, Robinson W. Osteogenesis in the glenoid fossa in response to mandibular advancement. Am J Orthod Dentofac Orthop. 2001;119:390–400.
Elgoyhen JC, Moyers RE, McNamara JA Jr, Riolo Ml. Craniofacial adaptation of protrusive function in young rhesus monkeys. Am J Orthod. 1972;62:469–80.
Kannus P, Jozsa L, Renström P, Järvinen M, Kvist M, Lehto M. The effects of training, immobilization, and remobilization on musculoskeletal tissue. Scand J Med Sci Sports. 1992;2:100–18.
Andersen P, Henriksson J. Capillary supply of the quadriceps femoris muscle of man: adaptive response to exercise. J Physiol. 1977;270(3):677–90.
Oudeman J, Nederveen AJ, Strijkers GJ, Maas M, Luijten PR, Froeling M. Techniques and applications of skeletal muscle diffusion tensor imaging: a review. J Magn Reson Imaging. 2016;43:773–88.
Froeling M, Oudeman J, Strijkers GJ, Maas M, Drost MR, Nicolay K, et al. Muscle changes detected with diffusion-tensor imaging after long-distance running. Radiology. 2015;274:548–62.
Akima H. Evaluation of functional properties of skeletal muscle using functional magnetic resonance imaging (fMRI). J Phys Fitness Sports Med. 2012;1(4):621–30.
Budzik JF, Balbi V, Verclytte S, Pansini V, Le Thuc V, Cotten A. Diffusion tensor imaging in musculoskeletal disorders. Radiographics. 2014;34(3):56–72.
Bryant ND, Li K, Does MD, Barnes S, Gochberg DF, Yankeelov TE, et al. Multi-parametric MRI characterization of inflammation in murine skeletal muscle. NMR Biomed. 2014;27(6):716–25.
Acknowledgements
We would like to express our gratitude to Dr. Oktay Algın, all the officials and staff members of UMRAM, especially MRI technicians Mustafa Delikanlı and Alp Eren Kılıç for their help and patience in taking the MRI. We also thank Prof. Dr. Ensar Başpınar and Dr. Rabia Albayrak for their guidance in completing statistical analysis of this study. This work was supported by the Ankara University, Scientific Research Projects Center (BAP) with Project Number 15B0234003.
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Emre Cesur declares that he has no conflict of interest. Orhan Özdiler declares that he has no conflict of interest. Ayşegül Köklü declares that she has no conflict of interest. Kaan Orhan declares that he has no conflict of interest. Umut Seki declares that he has no conflict of interest.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.
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Cesur, E., Özdiler, O., Köklü, A. et al. Effects of wear time differences of removable functional appliances in class II patients: prospective MRI study of TMJ and masticatory muscle changes. Oral Radiol 36, 47–59 (2020). https://doi.org/10.1007/s11282-019-00379-0
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DOI: https://doi.org/10.1007/s11282-019-00379-0