Retrospective analysis of the treatment of internal disorders of the temporomandibular joint and myofascial pain disorders in the conditions of adult orthodontic reception

BACKGROUND: Internal disorders of the temporomandibular joint (VN TMJ) occur at orthodontic reception no less often than with other types of dental treatment. The main clinical manifestations of VN TMJ are caused by variants of anterior displacement of the articular disc, pathology of the capsular ligamentous apparatus, hypermobility of the mandibular head, and dysfunction of the masticatory muscles. The main symptom of VN TMJ is joint pain (arthralgia) and muscle pain (myalgia). VN TMJ occupies a special place in orthodontic treatment. They can be detected at the initial treatment, and their symptoms can appear at any stage of orthodontic treatment and be a complete surprise for the doctor and the patient, arise after orthodontics, and be associated with it. Since VN TMJ significantly affects the therapeutic process, its outcomes, prognoses, and treatment problems are under the close influence of orthodontists.

AIM: To examine the effectiveness of the treatment of VN TMJ and myofascial pain disorders in patients with dental anomalies.

MATERIAL AND METHODS: The study retrospectively analyzed case histories of 300 adult patients with dental anomalies in need of orthodontics who underwent examination and treatment in a multidisciplinary dental clinic between 2014 and 2016. The prevalence and structure of VN TMJ were assessed, and myofascial pain disorders (MFDB) and results of their correction were analyzed.

RESULTS: A total of 146 (71.5%) patients with myofascial pain and 58 (28.3%) with myofascial facial pain syndrome needed orthodontic treatment more often. In these patients, VN TMJ and maxillary anomalies belonging to class II according to Engle of unilateral distal occlusion, deep bite, and class I with crowding of teeth are more often detected. Internal TMJ disorders with concomitant MFDB in the form of myofascial pain were observed in 168 (82.4%) patients. Myofascial pain disorders without VN TMJ were registered in 36 (17.4%) patients. The overall effectiveness of the treatment of VN TMJ and MFBSD was 46.4% (n=78 patients). No lasting improvement was observed in 35.7% (n=60). Deterioration was registered in 17.8% (n=30). Relapses were noted in 60.7% (n=124). In the treatment of MFDB without VN TMJ, the overall effectiveness of treatment was 5.5% (n=2), stabilization in 50.0% (n=18), and deterioration in 44.4% (n=16).

CONCLUSION: Myofascial facial pain is very difficult to treat. In combination with VN, TMJ creates significant and sometimes insurmountable difficulties in adult orthodontics. All this forces specialists to look for new approaches and develop effective ways to optimize orthodontic treatment in the case of TMJ pathology and myofascial pain disorders.