BACKGROUND: Juvenile Idiopathic Arthritis (JIA) is one of the most common chronic diseases in childhood. In these patients, the temporomandibular joint (TMJ) involvement is a frequent, with a prevalence that varies between 38% and 72% depending on the JIA subtype, the diagnostic method used and the population studied. The aim of this study was to assess possible correlations between the clinical parameters of temporomandibular joint arthritis and pathologic MRI findings of the TMJ in patients affected by JIA, and the effect of a functional orthodontic therapy with a Class II activator. METHODS: Fifty-three patients (41 girls and 12 boys, age ranging from 7 to 17 years) were selected for this study. Each patient had JIA based on the ILAR criteria with a median age of 5.5 years at disease onset and a median disease duration of 2 years. Clinical examination included facial evaluation and dynamic examination of the TMJ. A questionnaire was devised to evaluate the presence orofacial pain considering pain characteristics and location. Each patient with TMJ involvement was treated for 24 months with an Andresen activator, with a central screw and a vestibular arch. Magnetic resonance imaging included T1 (pre-treatment) and T2 (posttreatment) sequences in order to assess the TMJ involvement. RESULTS: In the sample selected for the study, only 15 patients (10 girls, 2 boys) showed TMJ involvement; 7 patients were affected by oligoarthritis JIA, 8 patients by a polyarthritis JIA. Among the 15 patients with TMJ involvement the pathologic findings observed were: bilateral TMJ click (25); bilateral functional limitation (12); monolateral TMJ click (7); monolateral chewing pain (7); monolateral chewing pain + monolateral TMJ click (7); bilateral chewing pain + monolateral functional limitation (7); bilateral functional limitation + monolateral click (7); monolateral swelling + bilateral click + deviation (6); bilateral functional limitation + deviation (7); bilateral chewing pain + functional limitation + deviation (7); deviation (7). Comparing pretreatment and post-treatment with Andresen activator for 24 months, clinical signs, a significant improvement of TMJ symptoms was observed; TMJ pain, jaw deviation and mouth opening limitation were considerably improved in almost all patients. An improvement in facial profile with a reduced skeletal discrepancy and an increased function was observed, as the signicant regression of orofacial pain. CONCLUSIONS: The results of this study showed that a Class II activator could prevent severe problems of the TMJ in JIA patients with TMJ involvement. Moreover, an early treatment of patients with TMJ involvement with a Class II activator could prevent severe TMJ disorders caused by hypoplasic condyles and growth alterations of the mandible. Increasing of posterior vertical facial height and the consequent mandibular counterclockwise rotation can improve occlusion, masticatory function and facial profile. A regular clinical examination, together with progressive monitoring of the craniofacial development, in cooperation with paediatric rheumatologists, should be trained to early recognize TMJ disorders in patients affected by JIA.

Efficacy and effect induced by functional orthodontic appliance in a cohort of patients with juvenile idiopathic arthritis with a temporomandibular joint involvement

G. Isola
Writing – Original Draft Preparation
;
2016

Abstract

BACKGROUND: Juvenile Idiopathic Arthritis (JIA) is one of the most common chronic diseases in childhood. In these patients, the temporomandibular joint (TMJ) involvement is a frequent, with a prevalence that varies between 38% and 72% depending on the JIA subtype, the diagnostic method used and the population studied. The aim of this study was to assess possible correlations between the clinical parameters of temporomandibular joint arthritis and pathologic MRI findings of the TMJ in patients affected by JIA, and the effect of a functional orthodontic therapy with a Class II activator. METHODS: Fifty-three patients (41 girls and 12 boys, age ranging from 7 to 17 years) were selected for this study. Each patient had JIA based on the ILAR criteria with a median age of 5.5 years at disease onset and a median disease duration of 2 years. Clinical examination included facial evaluation and dynamic examination of the TMJ. A questionnaire was devised to evaluate the presence orofacial pain considering pain characteristics and location. Each patient with TMJ involvement was treated for 24 months with an Andresen activator, with a central screw and a vestibular arch. Magnetic resonance imaging included T1 (pre-treatment) and T2 (posttreatment) sequences in order to assess the TMJ involvement. RESULTS: In the sample selected for the study, only 15 patients (10 girls, 2 boys) showed TMJ involvement; 7 patients were affected by oligoarthritis JIA, 8 patients by a polyarthritis JIA. Among the 15 patients with TMJ involvement the pathologic findings observed were: bilateral TMJ click (25); bilateral functional limitation (12); monolateral TMJ click (7); monolateral chewing pain (7); monolateral chewing pain + monolateral TMJ click (7); bilateral chewing pain + monolateral functional limitation (7); bilateral functional limitation + monolateral click (7); monolateral swelling + bilateral click + deviation (6); bilateral functional limitation + deviation (7); bilateral chewing pain + functional limitation + deviation (7); deviation (7). Comparing pretreatment and post-treatment with Andresen activator for 24 months, clinical signs, a significant improvement of TMJ symptoms was observed; TMJ pain, jaw deviation and mouth opening limitation were considerably improved in almost all patients. An improvement in facial profile with a reduced skeletal discrepancy and an increased function was observed, as the signicant regression of orofacial pain. CONCLUSIONS: The results of this study showed that a Class II activator could prevent severe problems of the TMJ in JIA patients with TMJ involvement. Moreover, an early treatment of patients with TMJ involvement with a Class II activator could prevent severe TMJ disorders caused by hypoplasic condyles and growth alterations of the mandible. Increasing of posterior vertical facial height and the consequent mandibular counterclockwise rotation can improve occlusion, masticatory function and facial profile. A regular clinical examination, together with progressive monitoring of the craniofacial development, in cooperation with paediatric rheumatologists, should be trained to early recognize TMJ disorders in patients affected by JIA.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/360822
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