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      Craniomandibular Disorders and Mandibular Reference Position in Orthodontic Treatment

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          Abstract

          The aim of this paper is to bring into focus the literature on the choice of the mandibular reference position in orthodontic treatment; of a particular reference to this paper is intercuspal position, centric relation position, or therapeutic position. To give a comprehensive account of the literature review on craniomandibular disorders (CMD), we have relied on books and articles using both Google Scholar and PubMed. Selection criteria included a combination of Mesh and type of article. Article classification was made by two authors, using the following structure outline: prevalence of craniomandibular disorders, its etiology and pathophysiology, occlusion and craniomandibular disorders, orthodontic treatment and CMD, and the mandibular reference position in orthodontics. An important conclusion that emerged from the present literature review is that CMD do not seem to be directly related to orthodontic treatment, and their appearance cannot be predicted or prevented by any means. Therefore, orthodontists must adopt a mandibular reference suitable to their patients and which best respects the balance existing in the stomatognathic system.

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          Most cited references61

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          Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development.

          A sample of 4724 children (2353 girls and 2371 boys) (5-17 years old) were grouped not only by chronological age but also by stage of dental development (deciduous, early mixed, late mixed, and permanent dentition). The registrations included functional occlusion (anterior and lateral sliding, interferences), dental wear, mandibular mobility (maximal opening, deflection), and temporomandibular joint and muscular pain recorded by palpation. Headache was the only symptom of temporomandibular dysfunction (TMD) reported by the children. The results showed that one or more clinical signs were recorded in 25% of the subjects, most of them being mild in character. The prevalences increased during the developmental stages. Girls were in general more affected than boys. Significant associations were found between different signs, and TMD was associated with posterior crossbite, anterior open bite, Angle Class III malocclusion, and extreme maxillary overjet.
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            Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls.

            An epidemiologic study of clinical signs and symptoms of temporomandibular disorders (TMD) was conducted with a probability sample of adults enrolled in a major health maintenance organization (HMO). This report presents data from a first wave field examination and interview conducted by trained, calibrated dental hygienist field examiners. Significant gender differences for vertical jaw opening measures were observed but no significant age differences were found for the distribution of clinically relevant findings. Clinic cases showed smaller amounts of vertical range of jaw motion but did not differ from community cases or controls on extent of lateral, protrusive, or retrusive mandibular movements; on classification of occlusion; or on dentally related variables. Clinic cases had more pain during all jaw excursions as well as during muscle and joint palpation. Joint clicking sounds were also observed more frequently in clinic cases.
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              A longitudinal epidemiologic study of signs and symptoms of temporomandibular disorders from 15 to 35 years of age.

              To study the development over 20 years of signs and symptoms of temporomandibular disorders (TMD) in an epidemiologic sample and to analyze possible correlations between these signs and symptoms and some other variables. The original group comprised 135 randomly selected 15-year-old subjects who were examined clinically and by means of a questionnaire for signs and symptoms of TMD. The examination was repeated after 5, 10, and 20 years by the same methods. After 20 years, when the original group had reached the age of 35 years, 124 individuals (92%) could be traced, and they were sent a questionnaire and invited for a clinical examination. The response rate was high: 114 subjects (92%) completed and returned the questionnaire, and 100 subjects (81%) attended the clinical examination. There was a substantial fluctuation of both reported symptoms and clinically recorded signs over the 20-year period, but progression to severe pain and dysfunction of the masticatory system was rare. In both the 15-year-old and 35-year-old subjects, 13% reported 1 or more frequent TMD symptoms. At age 35, only 3 subjects (3%) were classified as having severe or moderate clinical signs of dysfunction according to the Helkimo Index, fewer than in previous investigations. Women reported TMD symptoms and headache and had muscle tenderness and joint sounds more often than men. Correlations between the studied variables were mainly weak. Among the highest correlations found (rs = 0.4) were those between reported clenching and bruxing habits and TMJ sounds and jaw fatigue. In this epidemiologic sample followed from age 15 to 35 years, a substantial fluctuation of TMD signs and symptoms was found over time. Progression to severe pain and dysfunction was extremely rare.
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                Author and article information

                Journal
                Int J Dent
                Int J Dent
                IJD
                International Journal of Dentistry
                Hindawi Publishing Corporation
                1687-8728
                1687-8736
                2013
                11 September 2013
                : 2013
                : 890942
                Affiliations
                1Department of Orthodontics, Faculty of Dentistry, Hassan II University, Casablanca 20360, Morocco
                2Faculty of Letters & Human Sciences, Chouaib Doukkali University, El Jadida 24000, Morocco
                Author notes

                Academic Editor: Chiarella Sforza

                Article
                10.1155/2013/890942
                3786527
                4661eeec-b61c-4940-ad9e-d977f84693b1
                Copyright © 2013 Farid Bourzgui et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 May 2013
                : 11 July 2013
                : 30 July 2013
                Categories
                Review Article

                Dentistry
                Dentistry

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