Assessment of Orofacial Function After Mandibular Angle Harmonization with Hyaluronic Acid: A Longitudinal Observational Study.

BackgroundTo evaluate the EMG activity and thickness of right masseter (RM), left masseter (LM), right temporal (RT) and left temporal (LT) muscles and bite force in children with temporomandibular disorders (TMD).Material and MethodsForty five children (mean age 8.8 years; 22 boys and 23 girls) were examined on the basis of the RDC/TMD and the Faces Pain Scale-Revised (FPS-R) was used to determine the level of severity of the signs and symptoms of TMD, resulting in four groups: GI - without TMD (n=10); GII - with mild TMD (n=18), GIII: with moderate TMD (n=12) and GIV: with severe TMD (n=5). The data of electromyographic activity, maximum bite force and muscle thickness were tabulated and submitted to statistical analysis (ANOVA, P≤0.05).ResultsChildren with TMD signs and symptoms had lower EMG activity than children of the control group. There was significant difference among the groups for the LT at rest (P=0.01), right (P=0.03) and left (P=0.05) laterality, and for the LM (P=0.01) and LT (P=0.03) muscles in maximum voluntary contraction. There were no statistically significant differences among the groups regarding muscle thickness. The bite force was lower in the TMD groups than children of the control group, with significant statistical difference for the right region (P=0.03).ConclusionsThe severity of TMD signs and symptoms affected the EMG activity and the molar bite force in children. However, structural changes in the thickness of masticatory muscles are not perceptible in children with TMD signs and symptoms. Key words:Children, temporomandibular disorders electromyographic, bite force, ultrasound.

Objective: The purpose of this study was to examine the effects of continuous gum chewing exercise on perioral muscle strength. Methods: Thirty healthy adults (24.1 ± 2.0 years) with normal occlusion performed gum chewing exercise 3 times daily for 3 months. Each exercise session lasted 5 min and involved alternating of chewing 10 times using the left molars and then 10 times using the right molars, with the mouth closed. The effect of the exercise on oral function was evaluated by measuring tongue pressure (TP), cheek pressure (CP), and labial closure strength (LCS) immediately before starting exercise, at 2 weeks and 1, 2, and 3 months after starting exercise, and at 3 months after cessation of exercise. Changes in TP, CP, and LCS according to sex and duration of exercise were analyzed by repeated two-way ANOVA. Results: Measurements for all muscles were significantly greater in men than in women at all time points. After starting exercise, TP was markedly increased at 2 months in men and women, and both CP and LCS were markedly increased at 2 weeks in men and at 1 month in women. These effects persisted for 3 months. Three months after cessation of exercise, TP, CP, and LCS tended to decrease, but were not significantly attenuated as compared with 3 months after beginning of exercise in either sex. Conclusion: The results of this study revealed that gum chewing exercise contributed to an improvement in perioral muscle strength, and that this effect was maintained for at least 3 months after discontinuation of exercise.

Temporomandibular joint disorders (TMDs) are widely researched diseases in medical literature. They are associated with many symptoms, such as pain, limited mouth opening and joint sounds, resulting in decreased quality of life for the patient. Both the hyaluronic acid (HA) injection and the plateletrich plasma (PRP) injection have a remarkable efficacy in the treatment of TMDs. This study aimed to evaluate the participation of HA with PRP in the treatment of TMDs. The sample consisted of 24 patients with unilateral or bilateral TMDs. They were divided into 2 groups: HA+PRP was used in the test group (12 patients); and HA alone was used in the reference group (12 patients). The injection protocol for both groups was 4 times at 2-week intervals. Pain at mastication, masticatory efficiency, joint sounds, maximum mouth opening (MMO), and functional limitation in the mandibular movement were evaluated at 2 weeks, 1 month, 3 months, and 6 months after the last injection. The outcome variables were the visual analog scale (VAS) evaluations. The Likert-type scale was used to evaluate the functional limitation in the mandibular movement. The mean age was 30.58 years in the reference group, and 23.92 years in the test group. There was alleviation of symptoms in both groups through the follow-up periods. There were significant differences between the groups regarding pain at mastication, masticatory efficiency, MMO, and functional limitation at the end of the follow-up period (p < 0.05). The study results suggest that the HA and PRP injection provides greater improvement in patients with TMDs as compared to the HA injection alone; this may be due to taking advantage of the properties of both HA and PRP.

This case report evaluated electromyographic activity of the masseter and temporalis muscles and molar bite force, before and after with functional orthopedic. A 65 years woman presenting with orofacial pain symptoms, cervical tension, condyle subluxation and osteoarthrosis. The patient was diagnosed with temporomandibular dysfunction and treated with use of a Simoes Network 9 modified type functional maxillary orthopedics appliance. The Myosystem BR1 apparatus was used to analyze the electromyographic activity of the masseter and temporalis muscles. The maximum molar bite force was measured with the digital dynamometer (Kratus). This study showed increased EMG activity of the masseter and temporalis muscles in postural conditions of mandible and molar bite force after 12 months of treatment. After twelve months of treatment, the patient had lack of pain symptoms as well as an improvement in the balance of the mastication muscles, as demonstrated by EMG activity and maximum molar bite force.

Bite forcehas been studied as representative of functional indices of mastication and its value may have diagnostic significance in disorders of the musculoskeletal system of facial bones. This study aimed to evaluate bite force in adolescents with and without orthodontic needs considering presence of temporomandibular disorders (TMD) as well as anthropometry: craniofacial dimensions and body mass index (BMI). A total of 80 subjects were screened (61 females, 19 males; 18±3years old). Unilateral molar bite force was measured using a digital dynamometer with a fork thickness of 12mm. Direct anthropometry was used to quantify craniofacial measurements. Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were used to classify samples according to malocclusion and to TMD, respectively. Data were analyzed using normality tests, Mann-Whitney U test, and multiple linear regression analyses with stepwise backward elimination, controlling for the presence of malocclusion and TMD (p≤0.05). The cephalic index was greater in females with malocclusion and the longitudinal cranial diameter was reduced in females with malocclusion. BMI was not different between normal and malocclusion groups for either gender. Bite force was negatively related with vertical dimension of the face, and positively related with facial width and facial index. The model explained 32% of bite force variability, considering the sample size (coefficient of determination R 2=0.324). Even when orthodontic needs and TMD signs and symptoms are present, stronger bite force is still observed in males and in subjects with smaller anterior facial heights and wider facial widths.

Objetive: To investigate the maximum molar bite force in women with chronic neck pain after treatment with acupuncture. Materials and Methods: Twenty-three women with chronic neck pain participated. Dynamometer was used to measure the right and left maximum molar bite force. Dong Bang acupuncture needles - 0.25 mm x 30 mm was inserted into the integumentary tissue. Treatment was 10 sessions, each 30 minutes long and twice a week. Results: The right (p = 0.01) and left (p = 0.004) molar bite force was assessed after treatment with acupuncture, and showed increased occlusal strength. Conclusions: This study suggests a functional improvement in the stomatognathic system in women with chronic cervical pain after treatment with acupuncture. However, it is important to note that further research is needed to fully elucidate the long-term effects and potential clinical implications of these findings in the field of pain management and rehabilitation. Keywords: Acupuncture; Bite force; Neck pain; Women; Neck; Chronic pain

BACKGROUND: Sleep bruxism (SB) changes the functionality patterns of the stomatognathic system. However, its severity can be an aggravating factor in the function of this complex system. AIM: The purpose of the study was to investigate the stomatognathic system of healthy subjects with different severity of SB, as determined by BiteStrip. METHODS: Thirty-four subjects were divided into two groups: Mild SB (n = 15) and severe SB (n = 19). Electromyograph was used to evaluate the electromyographic activity of the right masseter (RM), left masseter (LM), right temporal (RT), and left temporal (LT) muscles at mandibular rest, right and left laterality, protrusion, and maximum voluntary contraction. Molar bite force was measured by the dynamometer. The data were tabulated and submitted for statistical analysis (p &lt; 0.05). RESULTS: Molar bite force was significantly lower in the severe SB group. There was a significant increase in electromyographic activity in the severe SB group for the mandibular rest tasks (RM, RT, and LT), protrusion (RM, LM, RT, and LT), and right and left laterality in the temporalis muscles. There was a significant decrease in electromyographic activity in the severe SB group in maximum voluntary contraction for the masseter and temporalis muscles. CONCLUSION: Subjects with severe SB demonstrated greater functional impairment of the stomatognathic system, mainly affecting the electromyographic activity and molar bite force.

Category: Ankle, Arthroscopy Introduction/Purpose: Non-operative treatment options with symptomatic OLT after failed primary arthroscopic treatment may be treated by various methods such as analgesics, anti-inflammatory drug, steroid injection, Platelet rich plasma (PRP) injection and hyaluronic acid (HA) injection. HA injection could be treated OLT besides osteoarthritis on knee or ankle joint. Effect of HA is viscoelastic and lubricating properties primarily, and other biomechanical effect can be considered. Purpose of this study is to evaluate the clinical outcomes of intra-articular HA injection in the patients with recurrent pain after the arthroscopic microfracture for OLT Methods: This study included 20 patients who received three weekly injections of intra-articular HA after arthroscopic microfracture for OLT between June 2014 and August 2016. All patients had persistent pain for more than 3 months after the index surgery. The patients were followed for 16.7 months (range: 4.6-30.9). At each visit, the efficacy of HA injection in reducing pain was evaluated by a Visual Analog Scale (VAS). In addition, subjective satisfactions were assessed by the Alexander scale. Results: The mean period from the arthroscopic microfracture to the intra-articular HA injection was 26.5 months (range: 6.0- 87.0). Mean VAS scores decreased from 6.7 ± 1.1 at a pre-injection to 3.8 ± 2.3 at post-injection six months (p = 0.02). According to the Alexander scale, there were 65.0% (13/20) good, 25.0% (5/20) fair, and 10.0% (2/20) poor results at post-injection six months. There was no severe adverse effect. Conclusion: The HA injection may be a useful treatment option after failed arthroscopic microfracture in OLT. Further studies will be needed to evaluate long-term results.

Maximum voluntary isometric bite force was recorded at the incisors and at the molars in 29 healthy females aged 19–23 years. The relationships between the variations in bite force and dimensions of the facial skeleton were studied by means of linear simple and multiple regression analyses.There was a high correlation between incisor and molar bite force. Bite force was mainly associated with a long mandible and a small gonion angle. 49% of the variation in incisor bite force could be explained by variations in the length of the mandible, the gonion angle and the length of the anterior cranial base. 56% of the variation in molar bite force could be explained by variations in the length of the mandible, the gonion angle and a long maxilla.

Objectives: Chewing discomfort (CD) is a predictor of poor oral and general health. Herein, we report a case in which we evaluated the effects of multi-oral muscle function improvement training (MoMFIT) for tongue pressure and masticatory function (bite force) conducted via home visits in an older adult. Methods: For 12 weeks, two trained dental hygienists visited the home of a denture-wearing older adult who complained of severe CD to conducted weekly MoMFIT sessions. MoMFIT comprises oral muscle massage, oral stretching exercises, tongue strength and pressure improvement training, and gum chewing exercises. Tongue pressure and bite force were measured at baseline (pre-intervention) and during the 9th and 12th MoMFIT sessions. Tongue pressure was determined as the maximum value after three measurements, and bite force was measured using a Prescale Film. Results: Tongue pressure increased by 58.6% in the 9th session (20.3 kPa) compared with the baseline (12.8 kPa) and by 72.7% in the 12th session (22.1 kPa). Compared with their pre-intervention values, the maximum and average bite forces increased by 58.9% and 12.7%, respectively, in the 12th session. Conclusions: Our data suggest that MoMFIT conducted via home visits can be a useful oral function rehabilitation program for denture-wearing older adults with CD.

The purpose of this study was to compare the chondroprotective effects of chondroitin sulfate (CS)-hyaluronic acid (HA) (CS-HA) injection and HA injection in an experimental model of osteoarthritis. After induction of osteoarthritis in rabbits, 28 rabbits were randomized into four groups: control group, 'HA' group, 'CS' group, and 'CS-HA' group. After 7 days, rabbits in the control group, 'HA' group, 'CS' group and 'CS-HA' group were respectively treated with normal saline, HA, CS, or CS-HA injection in the knees. All animals were treated once weekly. The animals were treated continuously for 5 weeks. Histological and biochemical evaluations were performed. As shown by histological observation, CS-HA injection treatment showed a chondroprotective effect on osteoarthritis. However, the histological scores of 'HA' group and 'CS-HA' group were not significantly different (p > 0.05). The results of biochemical evaluation showed that the expression levels of IL-1β, TNF-α, TIMP-1 and NO in synovial fluid of treated groups were all different from the control group (p < 0.05). However, the expression levels of these biochemical molecules in three treated groups were not significantly different (p > 0.05). In conclusion, CS-HA injection showed no obvious advantage over HA injection in osteoarthritis treatment.

Hyaluronic acid (HA) injection is an effective method to correct tear trough deformity. Nevertheless, the quantitative data of cosmetic results and complications of HA injection in tear troughs remained unemployed. The purpose of this meta-analysis was to synthesize the current quantitative data on the aesthetic outcomes and adverse effects of tear trough deformity correction with HA injection. This meta-analysis consulted PubMed, Embase, Web of Science, Scopus and Cochrane databases based on the search terms published before September 2022. Data extracted was analyzed to evaluate the satisfaction rates and complications of HA injection. Meta-analysis was performed using the random-effect model for overall and subgroup analysis. This meta-analysis comprised 31 reports involving 2556 participants. The pooled overall satisfaction rate was 91.0% (95% CI 84.9-95.7%). The pooled rates of swelling/edema and bruising/ecchymosis were 19.2% (95% CI 10.4-29.9%) and 18.4% (95% CI 10.1-28.4%), respectively. The pooled rates of redness/erythema, contour irregularity/lump and blue discoloration/Tyndall effect were 7.1% (95% CI 1.5-15.6%), 5.3% (95% CI 1.8-10.2%) and 0.9% (95% CI 0.0-2.5%), respectively. The present meta-analysis manifested a low risk of complication rate and a high satisfaction rate in tear trough rejuvenation with HA injection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Intra-articular hyaluronic acid (HA) injections are widely used in the therapy of patients with knee osteoarthritis (OA). Contradictory data on its effectiveness, lack of clear recommendations on the regimens of HA administration, predictors of positive/negative response to intra-articular HA injections make us think about the necessity of choosing this method of OA treatment. This review provides information on the functions of HA in the joint environment, its metabolism in patients with OA. The differences among the existing types of HA for intra-articular injection are briefly described. The positive effects of intraarticular HA injections are described, such as reducing pain and the need for nonsteroidal anti-inflammatory drugs and analgesics, improving knee joint function, reducing cartilage degradation and periarticular fibrosis, delaying knee replacement, and economic feasibility. Data on the most significant predictors of clinical response to intra-articular HA injections are presented.

Traditionally, hyaluronidase (HYAL) is used after hyaluronic acid (HA) injection to dissolve the undesired migration of product. To describe a novel lip augmentation technique that uses HA and HYAL simultaneously in patients who previously had HA migration. Nine hundred twenty female patients were included. In the first group ( n = 793), HA injections were performed in subcutaneous plane of the lips. In the second group who had previous product migration ( n = 127), 7.5 units of HYAL is injected in 4 points in ergotrid area before proceeding with HA injection. The medicis lip fullness scale scores after 2 weeks improved in all patients, while 92% of patients perceived the results as "very much improved" with Global Aesthetic Improvement Scale ( p ˂ .001). There was no difference between 2 groups regarding the patient satisfaction rates ( p ˃.05), while filler migration was seen in 0.2% ( n : 15) of patients in the first group during the follow-up period. The new vertical injection approach provided an increased vertical height, optimal eversion, and an incisor display on the lips. The simultaneous use of HYAL before HA injection seems to be a safe and effective practice in 1-stage treatment of the previously injected lips with filler migration into ergotrid area.

Bite forces in patients treated for mandibular angle fractures: Implications for fixation recommendations