Graduate Program in Medicine (Clinical Radiology), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Department of Orthodontics, Universidade Santa Cecília, Santos, Brazil.
Orthod Craniofac Res. 2024 Aug;27(4):615-625. doi: 10.1111/ocr.12777. Epub 2024 Mar 8.
The objective of this prospective study was to assess possible changes in the position and shape of the temporomandibular joint (TMJ) articular disc in patients treated with two protocols of rapid maxillary expansion (RME) and face mask (FM) therapy.
A sample of 88 patients with Class III or Class III subdivision malocclusions, aged between 6 and 13 years, were consecutively selected and divided into three groups (G): G1-34 patients were treated with RME, followed by FM therapy; G2-34 patients were treated using RME according to modified alternate rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by FM therapy. These treated groups were randomly (1:1 allocation ratio) distributed according to the two treatment protocols. G3 - Control Group - 20 untreated patients were followed. Magnetic resonance imaging (MRI) TMJs were obtained before (T1) and after (T2) a treatment period or follow-up. McNemar test, Fisher's exact test and intra- and inter-observer concordance (K) were performed (p ≤ .05).
There were no statistically significant differences in the baseline cephalometric variables at T1 between the groups. There were statistically significant differences between the groups (p < .001) in relation to the disc shape in T1, since G1 (8 TMJs -11.76%) presented higher occurrences of altered forms in comparison with G2 (no changes). No significant differences were observed in disc position CM and OM (G1 - p > .999; G2 - p = .063; G3 - p = .500) and shape (G1 - p > 0.999; G2 - p = .250; G3 - not calculable), between T1 × T2, in any of the groups studied.
The two treatment protocols did not have adverse effects on the position and shape of the TMJ disc, in a short-term evaluation.
本前瞻性研究旨在评估两种快速上颌扩张（RME）和面部矫正器（FM）治疗方案治疗的患者颞下颌关节（TMJ）关节盘位置和形状的可能变化。
连续选择了 88 名患有 III 类或 III 类亚类错牙合畸形的 6 至 13 岁患者，将其分为三组（G）：G1-34 例患者接受 RME 治疗，然后接受 FM 治疗；G2-34 例患者接受改良交替快速上颌扩张和收缩（ALT-RAMEC）方案治疗 RME，然后接受 FM 治疗。这些治疗组根据两种治疗方案以 1:1 的分配比例随机分布。G3-对照组-20 例未接受治疗的患者进行随访。在治疗期间或随访前（T1）和后（T2）获得 TMJ 的磁共振成像（MRI）。采用 McNemar 检验、Fisher 确切检验和观察者内和观察者间一致性（K）（p≤0.05）。
在 T1 时，各组的基线头影测量变量无统计学差异。在 T1 时，各组在关节盘形状方面存在统计学差异（p<0.001），因为 G1（8 个 TMJ-11.76%）的改变形式发生率高于 G2（无变化）。在关节盘位置 CM 和 OM（G1-p>0.999；G2-p=0.063；G3-p=0.500）和形状（G1-p>0.999；G2-p=0.250；G3-不可计算）方面，三组在 T1 和 T2 之间均无显著差异。
在短期评估中，两种治疗方案对 TMJ 盘的位置和形状均无不良影响。
