Department of Orthodontics and Paediatric Dentistry, Dental School, University of Messina, Italy.
Department of Orthodontics, Dental School, Vita Salute University, San Raffaele Hospital, Milan, Italy.
Eur J Paediatr Dent. 2014 Mar;15(1):63-6.
The aim of the study was to assess possible correlations between the clinical parameters of temporomandibular joint (TMJ) arthritis and pathologic MRI findings of the TMJ in patients affected by juvenile idiopathic arthritis (JIA), and the effect of a functional orthodontic therapy on the evolution of TMJ disorders.
A prospective clinical and nuclear magnetic resonance (NMR) investigation was conducted on a sample of 53 patients (41 female, 12 male) with JIA, treated for 24 months with an Andresen appliance. The involvement of TMJ was defined by clinical and radiological signs. NMR assessments were performed in closed and maximum opening mouth position before (T0) and at the end of functional orthodontic therapy (T1).
Fifteen patients showed physical and radiologic TMJ abnormalities. Changes were not uniformly distributed among the different JIA subtypes. Patients with poliarticular JIA (≥5 peripheral joints affected) showed more destructive bony changes. No correlation existed between clinical symptoms and NMR alterations. Approximately one half of the patients experienced significant improvement of the TMJ and muscular pain using the Andresen appliance.
The prevalence of TMJ involvement in patients suffering of JIA, and the improvement of TMJ and muscular pain associated with the use of functional appliance found in the present study, suggest an alert for TMJ dysfunction in patients with JIA and demonstrate the utility of functional orthodontic therapy in preventing the morbidities associated with TMJ arthritis in JIA.
本研究旨在评估青少年特发性关节炎（JIA）患者颞下颌关节（TMJ）关节炎的临床参数与 TMJ 病理 MRI 表现之间的可能相关性，以及功能正畸治疗对 TMJ 疾病演变的影响。
对 53 例（41 名女性，12 名男性）接受 Andresen 矫治器治疗 24 个月的 JIA 患者进行前瞻性临床和磁共振（NMR）研究。TMJ 的受累情况通过临床和影像学征象确定。NMR 评估在闭口和最大开口位进行，分别在功能正畸治疗前（T0）和结束时（T1）进行。
15 例患者出现 TMJ 物理和影像学异常。变化在不同 JIA 亚型之间分布不均。多关节炎型 JIA（≥5 个外周关节受累）患者显示出更多的破坏性骨改变。临床症状与 NMR 改变之间无相关性。大约一半的患者使用 Andresen 矫治器后 TMJ 和肌肉疼痛显著改善。
本研究发现 JIA 患者 TMJ 受累的患病率以及使用功能矫治器后 TMJ 和肌肉疼痛的改善，提示 JIA 患者 TMJ 功能障碍应引起警惕，并证明功能正畸治疗在预防 JIA 相关 TMJ 关节炎的并发症方面具有实用性。
