Effect of Shortened Dental Arch on Temporomandibular Joint Intra-articular Disorders

Aims: To investigate whether a shortened dental arch (SDA), as identified by reduced posterior occlusal contacts, is a risk factor for the progression of temporomandibular joint (TMJ) intra-articular disorders (ID), as identified using imaging techniques. Methods: This multisite, prospective observational study with a mean follow-up period of 7.9 years had a sample of 345 participants with at least 1 temporomandibular disorder (TMD) diagnosis at baseline. SDA was defined as reduced occlusal posterior support due to lack of occlusal intercuspal contacts in the molar region on the left and/or right side. SDA was assessed at baseline and at follow-up with metalized Mylar Tape. The presence or absence of a TMJ ID and the specific TMJ ID diagnoses for baseline and follow-up images were established by a calibrated, blinded radiologist at each of three sites by using bilateral magnetic resonance imaging for soft tissue imaging for disc displacement and by bilateral multidetector computed tomography or cone beam computed tomography for hard tissue imaging for degenerative joint diseases. Wilcoxon rank sum test and linear regression analyses were used to test for an impact of SDA on TMJ ID status. Results: At baseline, TMJ ID status of either side was not significantly affected by the presence of SDA on the ipsilateral or contralateral side of the jaw (all P > .05). Furthermore, the presence or absence of SDA at baseline was also not a significant predictor for progression of the TMJ ID status between baseline and follow-up (all P > .05). Conclusion: The findings of this study suggest that there is no significant effect of SDA on progression of TMJ ID.

intra-articular disorders, observational study, risk factor, shortened dental arch, temporomandibular joint

1.Okeson JP. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. Chicago: Quintessence, 1996.

2.Suvinen TI, Reade PC, Kemppainen P, Könönen M, Dworkin SF. Review of aetiological concepts of temporomandibular pain disorders: Towards a biopsychosocial model for integra-tion of physical disorder factors with psychological and psy-chosocial illness impact factors. Eur J Pain 2005;9:613–633.

3.Rasmussen OC. Description of population and progress of symptoms in a longitudinal study of temporomandibular ar-thropathy. Scand J Dent Res 1981;89:196–203.

4.Wilkes CH. Internal derangements of the temporomandibular joint. Pathological variations. Arch Otolaryngol Head Neck Surg 1989;115:469–477.

5.de Leeuw R, Boering G, Stegenga B, de Bont LG. Radiographic signs of temporomandibular joint osteoarthrosis and internal derangement 30 years after nonsurgical treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:382–392.

6.Ahmad M, Schiffman EL. Temporomandibular joint disorders and orofacial pain. Dent Clin North Am 2016;60:105–124.

7.Schiffman EL, Ahmad M, Hollender L, et al. Longitudinal stability of common TMJ structural disorders. J Dent Res 2017;96:270–276.

8.Becker IM. Occlusion as a causative factor in TMD. Scientific basis to occlusal therapy. N Y State Dent J 1995;61:54–57.

9.Pullinger AG, Seligman DA, Gornbein JA. A multiple logistic regression analysis of the risk and relative odds of temporo-mandibular disorders as a function of common occlusal fea-tures. J Dent Res 1993;72:968–979.

10.Cooper BC, International College of Cranio-Mandibular Orthopedics. Temporomandibular disorders: A position paper of the International College of Cranio-Mandibular Orthopedics (ICCMO). Cranio 2011;29:237–244.

11.Velly AM, Schiffman EL, Rindal DB, et al. The feasibility of a clin-ical trial of pain related to temporomandibular muscle and joint disorders: The results of a survey from the Collaboration on Networked Dental and Oral Research dental practice-based research networks. J Am Dent Assoc 2013;144:e1–e10.

12.Kakudate N, Yokoyama Y, Sumida F, et al. Dentist prac-tice patterns and therapeutic confidence in the treatment of pain related to temporomandibular disorders in a dental practice-based research network. J Oral Facial Pain Headache 2017;31:152–158.

13.Costen JB. A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. Ann Otol Rhinol Laryngol 1934;43:1–15.

14.Käyser AF. Shortened dental arches and oral function. J Oral Rehabil 1981;8:457–462.

15.Dulcic´ N, Panduric´ J, Kraljevic´ S, Badel T, Celi R. Incidence of temporomandibular disorders at tooth loss in the supporting zones. Coll Antropol 2003;27(suppl):s61–s67.

16.Tallents RH, Macher DJ, Kyrkanides S, Katzberg RW, Moss ME. Prevalence of missing posterior teeth and intraarticular tem-poromandibular disorders. J Prosthet Dent 2002;87:45–50.

17.Barghi N, dos Santos Júnior J, Narendran S. Effects of poste-rior teeth replacement on temporomandibular joint sounds: A preliminary report. J Prosthet Dent 1992;68:132–136.

18.Seedorf H, Seetzen F, Scholz A, Sadat-Khonsari MR, Kirsch I, Jüde HD. Impact of posterior occlusal support on the condylar position. J Oral Rehabil 2004;31:759–763.

19.Takayama Y, Miura E, Yuasa M, Kobayashi K, Hosoi T. Comparison of occlusal condition and prevalence of bone change in the condyle of patients with and without temporo-mandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:104–112.

20.Ciancaglini R, Gherlone EF, Radaelli G. Association be-tween loss of occlusal support and symptoms of function-al disturbances of the masticatory system. J Oral Rehabil 1999;26:248–253.

21.Roberts CA, Tallents RH, Katzberg RW, Sanchez-Woodworth RE, Espeland MA, Handelman SL. Comparison of internal de-rangements of the TMJ with occlusal findings. Oral Surg Oral Med Oral Pathol 1987;63:645–650.

22.Witter DJ, Kreulen CM, Mulder J, Creugers NH. Signs and symptoms related to temporomandibular disorders—Follow-up of subjects with shortened and complete dental arches. J Dent 2007;35:521–527.

23.Ikebe K, Hazeyama T, Iwase K, et al. Association of symptom-less TMJ sounds with occlusal force and masticatory perfor-mance in older adults. J Oral Rehabil 2008;35:317–323.

24.Hattori Y, Satoh C, Seki S, Watanabe Y, Ogino Y, Watanabe M. Occlusal and TMJ loads in subjects with experimentally shortened dental arches. J Dent Res 2003;82:532–536.

25.Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28:6–27.

26.von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Int J Surg 2014;12:1495–1499.

27.Schiffman EL, Truelove EL, Ohrbach R, et al. The Research Diagnostic Criteria for Temporomandibular Disorders. I: Overview and methodology for assessment of validity. J Orofac Pain 2010;24:7–24.

28.Derogatis LR. SCL-90-R: Administration, Scoring and Procedures Manual-II for the Revised Version. Towson, MD: Clinical Psychometric Research, 1992.

29.Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the sever-ity of chronic pain. Pain 1992;50:133–149.

30.Cole SR. Assessment of differential item functioning in the Perceived Stress Scale-10. J Epidemiol Community Health 1999;53:319–320.

31.Markiewicz MR, Ohrbach R, McCall WD Jr. Oral behaviors checklist: Reliability of performance in targeted waking-state behaviors. J Orofac Pain 2006;20:306–316.

32.Anderson GC, Schulte JK, Aeppli DM. Reliability of the evalua-tion of occlusal contacts in the intercuspal position. J Prosthet Dent 1993;70:320–323.

33.Ahmad M, Hollender L, Anderson Q, et al. Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD): Development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:844–860.

34.De Vos W, Casselman J, Swennen GR. Cone-beam comput-erized tomography (CBCT) imaging of the oral and maxillo-facial region: A systematic review of the literature. Int J Oral Maxillofac Surg 2009;38:609–625.

35.Hussain AM, Packota G, Major PW, Flores-Mir C. Role of different imaging modalities in assessment of temporoman-dibular joint erosions and osteophytes: A systematic review. Dentomaxillofac Radiol 2008;37:63–71.

36.Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examina-tions and specifications, critique. J Craniomandib Disord 1992;6:301–355.

37. Cohen J. Statistical Power Analysis for the Behavioral Sciences, ed 2. Hillsdale, NJ: Lawrence Earlbaum Associates, 1988.

38.Chantaracherd P, John MT, Hodges JS, Schiffman EL. Temporomandibular joint disorders’ impact on pain, function, and disability. J Dent Res 2015;94(suppl):s79–s86.

39.Reissmann DR, Heydecke G, Schierz O, et al. The random-ized shortened dental arch study: Temporomandibular disorder pain. Clin Oral Investig 2014;18:2159–2169.