Francesco Cocilovo

Surface electromyography of jaw muscles and kinesiographic recordings: diagnostic accuracy for myofascial pain

The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty-six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnosis of myofascial pain and an age- and sex-matched group of 36 TMD-free asymptomatic subjects underwent sEMG and KG assessments to compare EMG parameters of the masseter and temporalis muscles as well as the jaw range of motion and the interarch freeway space. EMG data at rest were not significantly different between myofascial pain patients and asymptomatic subjects, while the latter achieved significantly higher levels of EMG activity during clenching tasks. Symmetry of muscle activity at rest and during clenching tasks, KG parameters of jaw range of motion and the measurement of the interarch vertical freeway did not differ between groups. Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and KG measures did not reach acceptable levels of sensitivity and specificity, with a 30·6-88·9% percentage of false-positive results. Therefore, clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand-alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage.

Natural course of temporomandibular disorders with low pain‐related impairment: a 2‐to‐3‐year follow‐up study

To describe the natural course of temporomandibular disorders (TMD) in patients with low levels of pain-related impairment, independently by the physical diagnoses they received. Amongst all patients who attended the TMD Clinic, University of Padova, Italy, during the year 2009, those who: (i) had Research Diagnostic Criteria for TMD (RDC/TMD) axis II Graded Chronic Pain Scale (GCPS) grade 0 or 1 scores, (ii) received counselling on their signs and symptoms at the time of their first visit and suggestions on how to self-manage their symptoms, (iii) did not attend the Clinic since the time of their last visit and (iv) were visited by the same resident, were recalled for a follow-up assessment during the period from September to December 2011. Sixty-nine patients (79% females; mean age 47.4 ± 11.3 years; range 26-77) of 86 who were potentially eligible accepted to enter the study. The time span since the first visit ranged from 23 to 36 months. At the follow-up assessment, the percentage of patients with muscle disorders decreased from 68.1% to 23.1%; disc displacement with reduction remained unchanged (52.1%), whilst the 5.7% of patients who had disc displacement without reduction with limited opening then showed absence of limitation; diagnoses related to other joint disorders decreased from 30.4% to 14.4% for arthralgia and from 27.5% to 24.6% for osteoarthritis/osteoarthrosis. In a sample of patients TMD with low pain-related impairment followed up with a single recall assessment at 2-to-3 years, the natural course of disease was generally favourable.

Surface Electromyography Findings in Unilateral Myofascial Pain Patients: Comparison of Painful vs Non Painful Sides

OBJECTIVES To answer the clinical research question: in patients with myofascial pain, are there any differences in the surface electromyography (sEMG) activity of muscles of the painful and nonpainful sides that can be detected by commercially available devices? METHODS The study sample (N = 39; 64% F, mean age 35.7 ± 15 years) consisted of patients seeking for temporomandibular disorders Temporomandibular Disorders (TMD) treatment and meeting Research Diagnostic Criteria for TMD (RDC/TMD) diagnosis of myofascial pain, with pain referred only in muscles on one side. They underwent sEMG of jaw muscles to record levels of standardized sEMG activity at rest, as well as during maximum clenching on teeth for the four investigated muscles, viz., bilateral masseter and temporalis. The existence of differences between sEMG values of muscles of the painful and nonpainful sides during the standardization test (i.e., clenching on cotton rolls) at rest and during clenching on teeth was assessed. RESULTS At the study population level, differences between the sEMG values of muscles of the painful and nonpainful sides were not significant in any conditions, viz., either at rest or during clenching tasks. At the individual level, the difference between the sEMG activity of painful and nonpainful sides was very variable. CONCLUSIONS The above findings were not supportive of the existence of any detectable difference in sEMG activity between jaw muscles of the painful and nonpainful sides in patients with unilateral myofascial pain. Centrally mediated mechanism for pain adaptation may explain these findings, and the role of sEMG as a diagnostic tool for muscle pain needs to be carefully reconceptualized.

Kinesiographic recordings of jaw movements are not accurate to detect magnetic resonance–diagnosed temporomandibular joint (TMJ) effusion and disk displacement: findings from a validation study

OBJECTIVE The aim of this study was to perform a validation study assessing the correlation between magnetic resonance (MR) findings of temporomandibular joint (TMJ) disk displacement and effusion and some parameters drawn from kinesiographic (KG) recordings of jaw motion, i.e., deflection, deviations, incisures. STUDY DESIGN Thirty-one patients with TMJ disorders underwent a kinesiographic recording in the same day in which the MR was performed. Regression analysis was performed to assess the correlation between the MR and KG findings. RESULTS MR findings were not correlated with KG parameters (P > .05). The accuracy of all KG variables for diagnosing MR-detected signs was low. KG deflection ranged from 38.7% to 54.8%, KG deviation from 42% to 54.8%, and KG incisures from 9.6% to 71%. Specificity and positive predictive values were far from acceptable levels for all KG variables. CONCLUSIONS The findings do not support the usefulness of jaw-tracking devices in dental practices that diagnose and manage temporomandibular disorders.

Multidisciplinary correction of anterior open bite relapse and upper airway obstruction

A 27-year-old man presented an anterior open bite relapse. He had low tongue posture positioned anteriorly at rest and during swallowing and reported chronic difficulty in nose breathing. Head cone-beam computed tomography revealed nasal septum deviation, right turbinate hypertrophy, and left maxillary sinus congestion, which were thought to contribute to the breathing problem, encourage the improper tongue posture, and thereby cause the relapse. Multidisciplinary treatment involving an otorhinolaryngologist, an orthodontist, and a periodontist resolved the upper airway obstruction and corrected the malocclusion. The follow-up examination after 3 years 5 months demonstrated stable results.

A comparison trial between three treatment modalities for the management of myofascial pain of jaw muscles: A preliminary study

Abstract Objectives: To compare three treatment modalities for the management of myofascial pain of jaw muscles. Methods: Thirty (N = 30) patients with low pain-related impairment were randomly assigned to receive laser therapy (LST), oral appliance therapy (OA), or counseling (CSL). Visual Analog Scale (VAS) pain levels and the Muscular Index (MI) of the Craniomandibular Index were the outcome variables, which were assessed at baseline, at three weeks, three months, and six months. Results: At six months, improvement in the MI was maintained both in the LST (p = .025) and OA groups (p < .001). As for VAS values, positive changes were still shown for LST (p = .001), and were also shown for the OA (p = .002) and CSL groups (p = .048). Conclusions: Despite differences in the short-term effectiveness of LST and OA, with respect to CSL alone, all three treatment groups improved at six months. This suggests that active treatments should be directed to maximize the positive changes in the short-term period.

A conservative surgical approach to temporomandibular joint ankylosis.

AbstractThe current article describes a case of a patient with temporomandibular joint (TMJ) ankylosis undergoing surgery performed with a tailored technique for condylar reshaping. A patient with posttraumatic bilateral TMJ ankylosis underwent interpositional arthroplasty with temporalis fascia, and focus was put on the need to maintain the vertical height of the mandible. The postoperative course was uneventful, and positive outcomes were kept during a 1-year follow-up span. The adoption of surgical strategies aiming at restoring a condylar shape as similar as possible to the natural one may be important in the light of the search for surgeries providing and/or recreating normal function of the TMJ.