Franco Mongini

Anatomic and clinical evaluation of the relationship between the temporomandibular joint and occlusion.

An anatomic and clinical investigation of condylar remodeling; the position of the condyle in centric occlusion; and the relationships of these two factors to each other and to the features of the dentition are reported. Two groups of 100 adult crania were examined. The first group had complete or partially edentulous arches. In the second group, the dentition was complete and there were various degrees of abrasion. In addition, clinical and tomographic data were obtained from 70 patients with temporomandibular joint pain-dysfunction syndrome. Occlusion was also studied by intraoral registration of the gothic arch and by mounting the casts on an articulator in 40 patients. Comparison of the data made it clear that occlusal conditions determine the course of condylar remodeling and lead to marked changes in shape of the joints. Occlusal disorders are also responsible for condylar displacement (noted in 51.4 per cent of patients), which, in turn, may be the cause of typical reshaping of the joint. These findings cast doubt on the proposition that the gnathologic determinants (particularly centric relation) are never changed in the course of time.

The importance of radiography in the diagnosis of TMJ dysfunctions: A comparative evaluation of transcranial radiographs and serial tomography

Eight men and 22 women with TMJ pain-dysfunction syndrome were selected. After clinical examination, TR and serial tomography were performed in 5 to 7 different planes. In 27 patients, TR showed a condylar displacement. This was confirmed by serial tomography, which also showed that the apparent position may vary from the medial to the lateral aspects due to rotation in some patients. Changes in shape were a common feature and did not necessarily occur in the same manner on each side or in the different sections of the same condyle. In these patients, the TR shape was generally more similar to that of the middle and lateral tomographic planes. The relationship between remodeling pattern and condylar position was confirmed. Degenerative lesions were present in some patients but could only be clearly detected by serial tomography. This study confirms the important role of the TMJ in dysfunctions and the validity of radiography in diagnosis.

Dental abrasion as a factor in remodeling of the mandibular condyle.

Skulls of 100 male and female subjects of various ages and with unimpaired dental arches were examined with respect to the morphological features of the mandibular condyle. A certain number of typical shapes were distinguished. Dental abrasion was also assessed and three parameters were calculated: (1) total abrasion index; (2) working:balancing abrasion ratio, and (3) frontal abrasion index. These data were then related to condylar shape and subject age. The results show that abrasion influences changes in condyle shape due to bone remodeling. The forces applied on this bone segment are distributed over functional areas that vary both in extent and in their different characteristics.

Condylar remodeling after occlusal therapy

Seven men and 15 women with TMJ pain dysfunction syndrome were selected. After clinical examination, polytomography of the TMJ was performed in centric occlusion in different planes. Open-mouth projections were also made in three patients, frontal tomography in one patient, and transcranial radiographs in 16 patients. Occlusal analysis was performed on the articulator. Twenty patients showed various patterns of condylar displacement with flattening of the anterior, superior, or posterior condylar walls in 11 patients, including three with arthritic lesions. Therapy included occlusal splints (21 patients), selective grinding (seven patients), prosthodontic rehabilitation (10 patients), and orthodontic treatment (two patients). After therapy, tomographic examination was repeated at intervals of 9 to 44 months. A distinct reshaping of the condyle was seen in seven patients. The new shape tended to be rounded. The three patients with degenerative changes before treatment showed regression of the lesions. No change was seen in condyles which were rounded before therapy.

Muscle tenderness in different headache types and its relation to anxiety and depression.

Abstract To assess in patients with migraine and tension type headache, both episodic and chronic, the extent to which muscle tenderness may relate to anxiety and depression, 459 patients with Episodic Migraine (EM, 125), Chronic Migraine (CM, 97), Episodic Tension Type Headache (ETTH, 82), Chronic Tension Type Headache (CTTH, 83), and EM+ETTH (72) were enrolled. For each patient, a psychological assessment on the Axis 1 of the DSM‐IV and muscle palpation of pericranial and cervical muscles were carried out. A Pericranial Muscle Tenderness Score (PTS) and a Cervical Muscle Tenderness Score (CTS) were calculated (range 0–3). Logistic and linear regression analyses were employed to assess relations between muscle tenderness, the demographic variables and psychiatric disorders in the different patient groups. Odds ratio for ‘male gender’ was higher in groups with tension type headache. Only EM patients showed a positive association with increasing age. Anxiety and depression were significantly associated to CM. A significant negative correlation of PTS and CTS was observed in EM patients. In relation to male gender, the PTS was significantly lower in EM, ETTH and CTTH; CTS was significantly lower in EM, CM, and CTTH. Anxiety and, even more, anxiety and depression combined were positively associated to higher PTS and CTS in EM patients. Anxiety and depression were also positively associated to higher CTS in patients with EM+ETTH. In CTTH patients, PTS only was positively associated to anxiety and depression. We conclude that in patients with EM, the presence of anxiety or anxiety and depression combined considerably increases the level of muscle tenderness in the head and, even more, in the neck, and might facilitate the evolution into CM.

Personality traits, depression and migraine in women: a longitudinal study

Our purpose was to examine the association between personality traits, depression and migraine in the long term. In 56 women with migraine a psychological assessment was carried out to assess the presence of major depression, and the Minnesota Multiphasic Personality Inventory (MMPI) and the State and Trait Anxiety Inventory (STAI) were administered at baseline (T0) and after 6-7 years (T2). Frequency, severity and duration of migraine were recorded at T0, after treatment (T1) and at T2, and their relation to the prevalence of depression and to the MMPI and STAI data was examined (ANOVA, Students t-test, X 2 analysis, and multiple regression analysis). Pain parameters improved in all patients in T0-T1, but at T2 were higher in patients with depression at T0. The patients whose migraine improved at T2 had, at T0 and T2, significantly lower MMPI and STAI scores. Multiple regression analysis showed a correlation of the MMPI depression score and STAI 1,2 scores at T0 with headache frequency at T2. We conclude that the co-occurrence of migraine, personality changes and depression in women does not appear to influence the results of treatment at short-term, but it seems to be influential on headache history in the long term.

Habitual mastication in dysfunction: A computer-based analysis

To study the different parameters of habitual mastication in stomatognathic dysfunction, mandibular movements and electromyographic activity of the elevator muscles were recorded during three chewing sequences in 86 dysfunctional subjects. The Dysfunction Index system was used to treat two subgroups, patients with severe temporomandibular joint impairment and patients with severe muscle dysfunction. Data on the different parameters of mastication from the single patients, the whole group, and the two subgroups were statistically assessed and compared with those from 12 normal individuals. The following conclusions were drawn. (1) In dysfunctional patients the normal symmetrical and balanced distribution of the chewing cycles is lost and movements are more restricted. (2) The electromyographic data show marked alterations with a tendency to reduce or suppress the isometric phase of contraction during closing in the temporomandibular joint patients. This can be viewed as a defensive mechanism of the impaired system. (3) The data at hand are helpful in explaining some of the mechanisms that lead to muscle pain in dysfunctional patients.

Muscle tenderness in different types of facial pain and its relation to anxiety and depression: A cross-sectional study on 649 patients.

Abstract To evaluate in patients with different types of facial pain the association between muscle tenderness and a set of characteristics, 649 consecutive outpatients with facial myogenous pain (MP), TMJ disorder, neuropathic pain (NP) and facial pain disorder (FPD) (DSM‐IV) were enrolled. For each patient a psychological assessment on the Axis 1 of the DSM‐IV and standardized palpation of pericranial and cervical muscles were carried out. A pericranial muscle tenderness score (PTS), a cervical muscle tenderness score (CTS) and a cumulative tenderness score (CUM, range 0–6) were calculated. Univariate analyses (one‐way analysis of variance or χ2 test) indicated that both age‐ and sex‐distribution, tenderness scores and prevalence of psychiatric disorders markedly differed between groups. The prevalence of depression was highest in FPD patients (44.9%). Both muscle tenderness scores (either PTS or CTS) and prevalence of anxiety were higher in patients with MP than in those with TMJ or NP. To assess associations between CUM score and patients’ demographic and clinical characteristics an ordered logit model was fit and interactions between psychiatric disorders and diagnostic groups were tested. The analysis showed that, regardless of the diagnostic group, anxiety and depression independently increase the likelihood of having one point higher muscle tenderness score (OR = 1.55, 95% CI: 1.13–2.12 and OR = 1.56, 95% CI: 1.10–2.21, respectively). A careful screening for the presence of an underlying psychiatric disorder, either anxiety or depression, should be part of the clinical evaluation in patients suffering from facial pain.

Chronic Daily Headache. A Clinical and Psychological Profile Before and After Treatment

To assess the clinical and personality characteristics of patients with chronic daily headache before and after treatment, 20 patients were examined and the Minnesota Multiphasic Personality Inventory (MMPI [Italian 356‐item abbreviated version]) and the Stait and Trait Anxiety Index 1,2 (STAI) administered. There were two groups: group 1 (n=6), with a “conversion V” configuration (with elevation of hypochondria and hysteria scales, the depression scale being somewhat lower); and group 2 (n=13) with elevation of depression and of other MMPI scales. One patient had no scale elevation. STAI 1,2 scores were high in both groups. Several psychosomatic symptoms and some migraine features were present in almost all patients. Occurrence, severity, and duration of headache were recorded regularly and the MMPI and the STAI administered again after treatment. Improvement of headaches and a decrease of several MMPI and STAI 2 scores were observed. However, 12 of 20 patients showed a conversion V configuration after treatment. It is concluded that chronic daily headache was transformed migraine in most cases and was accompanied by high anxiety levels in all patients and hysteric traits in some. With time, these patients may develop a depressive disorder. After treatment, hysterical traits are still present at a lower level in those showing these traits before treatment and may be unmasked in those that had depression.

Relationship Between Structure and the Stress Pattern in the Human Mandible

The internal bony structure of ten dentate human mandibles was examined on lateral radiograms, and the condylar shape measured with a digital electronic machine. The external surface was coated with photoelastic material. Each mandible was then placed in centric occlusion with brass replicas of the upper arch and the glenoid fossae and set in a supporting frame. Occlusal loads were simulated and the isoclinics recorded in plane-polarized light. The isostatic flow lines were constructed for each mandible. A relation was found between the mandibular structure and the distribution pattern of these lines.