Dentofacial changes of non-orthodontically treated female patients with TMJ disk displacement: a longitudinal cephalometric study

Jung-Woo Han; Tae-Woo Kim

doi:10.4041/kjod.2010.40.6.398

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Han and Kim: Dentofacial changes of non-orthodontically treated female patients with TMJ disk displacement: a longitudinal cephalometric study

Original Article

Korean Journal of Orthodontics

Korean Journal of Orthodontics 2010; 40(6): 398-410.

Published online: 31 December 2010

DOI: https://doi.org/10.4041/kjod.2010.40.6.398

Dentofacial changes of non-orthodontically treated female patients with TMJ disk displacement: a longitudinal cephalometric study

Jung-Woo Han, DDS, MSD^a, Tae-Woo Kim, DDS, MSD, PhD^b

^aDental Officer, ROK Army.

^bProfessor, Department of Orthodontics, School of Dentistry, Seoul National University, Korea.

Corresponding author: Tae-Woo Kim. Department of Orthodontics, School of Dentistry, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. +82 2 2072 3317; taewoo@snu.ac.kr.

Received 16 July 2010 Revised 9 October 2010 Accepted 12 October 2010

Abstract

Objective

The purpose of this study was to investigate the changes in dentofacial morphology of non-orthodontically treated female patients with TMJ disk displacement.

Methods

The sample consisted of 25 Korean female patients with bilateral TMJ disk displacement who visited the Department of Orthodontics, Seoul National University Dental Hospital from 1996 to 2006. Disk displacements were diagnosed using the magnetic resonance imaging (MRI) of both TMJs. Baseline (T1) and follow-up (T2) lateral cephalograms were analyzed. The mean age of samples at T1 was 18.1 ± 3.5 years (range 14.2 - 25.8 years) and at T2, 21.1 ± 3.5 years (range 16.2 - 28.0 years). The mean observation period was 3.0 ± 1.9 years. Descriptive statistics for each variable were calculated at baseline (T1) and follow-up (T2) stages, and during the observation period (T2-T1).

Results

Skeletal changes were found in 64% of the non-orthodontically treated female patients with TMJ disk displacement during the observation period. The L1 to Mandibular plane distance (mm) increased significantly by 0.8 mm (p < 0.01). But there were no significant differences in the other dental relationship variables (overjet, overbite, U1 to palatal plane) during the observation period. Most patients with skeletal changes showed a backward rotation of the mandible. The ratio of the rotation was a decrease of SNB by 0.43° for every 1° increase of FMA (Spearman rho = -0.660, p < 0.01). A few patients showed a distal shift of the mandible without rotation or significant changes in the vertical dimension.

Conclusions

During observation periods without orthodontic treatment, non-growing patients with TMJ disk displacement showed dentoskeletal changes, mainly backward rotation of the mandible.

Keywords: Temporomandibular disorder, Longitudinal study, Dentofacial change, MRI

Figures and Tables

Fig. 1

Hard tissue landmarks. 1, Nasion; 2, sella; 3, orbitale; 4, porion; 5, ANS; 6, PNS; 7, articulare; 8, A point; 9, incisor superius; 10, incisor inferius; 11, B point; 12, pogonion; 13, menton; 14, gonion; 15, occlusal point.

Fig. 2

Maxillomandibular relation measurements. measurements. 1, SNA; 2, SNB; 3, N perpendicular to A point; 4, N perpendicular to pogonioon; 5, facial convexity (N-A-Pog); 6, ANB.

Fig. 3

Vertical skeletal pattern measurements. 7, SN to mandibular plane; 8, FMA; 9, maxillomandibular plane angle; 10, totoal anterior facial height; 11, total posterior facial height; 12, lower anterior facial height.

Fig. 4

Mandibular form and size measurements. 15, Ramus height; 16, ramus inclination; 17, effective mandibular length; 18, gonial angle; 19, articular angle.

Fig. 5

Denture pattern measurements. 20, Overjet; 21, overbite; 22, U1 to palatal plane; 23, L1 to mandibular plane.

Fig. 6

Distribution of samples according to change in FMA and SNB (T2 - T1).

Fig. 7

Clockwise rotation of the mandible. Fifty-two percent of the sample showed clockwise rotation of the mandible (solid line, initial; dashed line, recall).

Fig. 8

Skeletal and soft tissue change during observation. A, Distal shifting of the mandible. Twelve percent of the sample (3 cases) showed distal shifting of the mandible without clockwise rotation (solid line, initial; dashed line, recall); B, no or negligible dentofacial change. Thirty-six percent of the sample showed no significant changes (solid line, initial; dashed line, recall).

Table 1

Method error (n = 25)

LAFH, Lower anterior facial height; Mn, mandibular; OJ, overjet; OB, overbite. *by Dahlberg's formula,

errors of measurements = \sqrt{\sum d^{2} / 2 N}

Table 2

Cephalometric measurements at T1 (Initial stage) (n = 25)

SD, Standard deviation; LAFH, lower anterior facial height; Mn, mandibular; OJ, overjet; OB, overbite.

Table 3

Cephalometric measurements at T2 (follow-up) (n = 25)

SD, Standard deviation; LAFH, lower anterior facial height; Mn, mandibular; OJ, overjet; OB, overbite.

Table 4

Change in cephalometric measurements between T1 and T2 (T2 - T1) (n = 25)

SD, Standard deviation; LAFH, lower anterior facial height; Mn, mandibular; OJ, overjet; OB, overbite; NS, non-significant. ^*p < 0.05; ^†p < 0.01.

Table 5

Distribution of samples according to change in FMA and SNB (T2 - T1)

FMA, Frankfort mandibular angle.

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