In modern orthodontics, the main condition to achieve effective and, above all, stable morphological results of treatment is abolishing of etiological factors, restoration of myodynamic balance of maxillofacial area, normalization of breathing, swallowing, chewing, speech, lip-seal functions and elimination of temporomandibular joint disorders. The aim of the study is to optimize treatment of TMJ muscular dysfunction in patients with orthodontic pathology by integration of removable appliances (braces) along with myogymnastics and differential massage of temporal, masticatory muscles and orbicular muscle of mouth. Object and methods. The results of treatment of 16 people aged from 15 to 25 years old were analyzed (women – 12 (75%), men – 4 (25%), who were diagnosed malocclusion with severe dental crowding (DC) (III-IV according to N.G. Snagina), which were combined with TMJ muscular dysfunction. The function of TMJ was studied using static and dynamic clinical studies. Comparative palpation of dorsal muscles, shoulders, atlantooccipital area muscles, m.masseter, m.temporalis, m.pterygoideus medialis, m.mylohyoideus, m.digastricus, infrahyoidale mm., m.sternocleidomastoideus, m.omohyoideus was carried out. Change of lower jaw movement trajectory, anamnestic Helkimo’s index (Ai) and indices of clinical dysfunction (Di) were evaluated. Additional studies included morphometric analysis of control and diagnostic models of jaws, orthopanotomography (OPG), X-ray of temporomandibular joint with closed teeth and open mouth, electromyography (EMG) of temporal, masticatory muscles and orbicular muscle (OM) mouth. Braces were used as removable appliance technic. Differentiated massage and myogymnastics were indicated as proposed complex. Results. There was pronounced asymmetry in the length of rami of lower jaw in the examined patients. Significant asymmetry in the length of rami of mandible, from 3 mm to 9 mm, was observed on OPTG images. In 80% of patients, TMJ dysfunction was observed on the side of long mandibular ramus. Most patients had a harmonious (neutral) type of jaw growth (58.82%). The horizontal type of mandible was marked in 41.18%. Vertical type of jaw growth was not registered in examined patients. Significant morphological changes in the bony elements of temporomandibular joint were not found on temporomandibular radiographs. After administration of the proposed complex of massage and myogymnastics exercises, positive clinical dynamics was observed after only from seven to ten days at 100%, and above all, the results of treatment remained stable after a year of observation. Conclusion. Use of weak, biologically adapted forces in malocclusion treatment and achievement of physiological functions of oral cavity and TMJ guarantee stability of the obtained morphological results. Analysis of the research results allowed to recommend the developed complex of myogymnastics and differentiated massage of temporal, masticatory muscles and orbicular muscle of mouth for clinical application in patients with muscular dysfunction of TMJ.
muscular dysfunction of temporomandibular joint, massage, myogymnastics, orthodontic treatment, malocclusion, dental crowding.
«Bulletin of problems biology and medicine» Issue 2 Part 1 (150), 2019 year, 304-307 pages, index UDK 616.314-089:616.724-08
