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Quintessence Publishing: Journals: ORTHODONTICS
ORTHODONTICS
The Art and Practice of Dentofacial Enhancement

Formerly World Journal of Orthodontics

Edited by
Rafi Romano, DMD, MSc (Editor-in-Chief)

ISSN 2160-2999 (print) / ISSN 2160-3006 (online)

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Publication:
Winter 2002
Volume 3 , Issue 4

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Cervical Spine Problems in Patients with Temporomandibular Disorder Symptoms: An Investigation of the Orthodontic Treatment Effects for Growing and Nongrowing Patients

Etsuko Kondo, DDS, DDSc, Rizako Nakahara, DDS, PhD, Miyoko Ono, DDS, Shiho Arai, DDS, Kumiko Kuboniwa, DDS5/Etsuko Kanematsu, DDS, DDSc, Yoko Toyomura, DDS, T.M. Graber, DMD, MSD, PhD, OdontDr hc, DSc, ScD, MD, FRCS, T.J. Aoba, DMD, DDS

Pages: 295-312

Aim:To determine the relationship of morphologic abnormality of the cervical spine with the position of the apex of the dens (odontoid process of C2 vertebra) to the McGregor line (the line between posterior nasal spine and basi occiput) and the incidence of morphologic abnormality of the mandibular condyle and ramus as well as asymmetric activities of sternocleido mastoid and masticatory muscles in growing and nongrowing patients with clicking only and those with trismus. Subjects and Method: Seventy-six growing patients (42 patients with clicking only and 34 patients with trismus) and 61 nongrowing patients (19 patients with clicking only and 42 patients with trismus) were selected from 1050 patients treated by the authors during the past decade (study sample). The authors also included 50 control subjects (20 with normal occlusion and 30 with long-term occlusal stability without clicking or trismus at 5 or more years out of treatment). Pretreatment, posttreatment, and out-of-treatment cephalograms, panoramic and joint radiographs, facial and intraoral photographs, dental casts, and electromyographic findings for these patients were analyzed. Results and Conclusions:The results were statistically analyzed for any correlations between these parameters and to find significant differences in the incidence of these parameters between the control group and the study sample, between growing and nongrowing patients, and between patients with clicking only and those with trismus. The findings indicated that when the dens of the axis protruded 6.0 mm or more above the McGregor line into the cranial base, there was a major impact on the development of morphologic abnormality of the cervical spine in the clicking only group. Trismus and asymmetric activities of the sternocleido mastoid and masticatory muscles were closely related with morphologic abnormalities of the condyle and ramus. The study sample of growing patients showed a higher improvement rate of morphologic abnormality in the C2-C3 area and asymmetry of the condyle and ramus than the study sample of nongrowing patients. These results suggest that orthodontic patients with clicking or trismus will benefit from early comprehensive treatment, consisting of occlusal treatment and orthopedic correction of morphologic abnormalities of the cervical spine and muscles, during active growth of the temporomandibular joints.

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