INSTRUMENTAL EVALUATION OF THE EFFECTIVENESS OF OCCLUSAL THERAPY IN TEMPOROMANDIBULAR JOINT DYSFUNCTIONS: RADIOLOGICAL AND ELECTROMYOGRAPHIC DATA

Abstract

Disorders of the temporomandibular joint (TMJ) are a common pathology, the frequency of which, according to most studies, reaches up to 40 %, and the most common clinical manifestation is pain in the masticatory muscles. At the same time, musculoskeletal disorders make up the main etiological group of TMJ dysfunctions and occur in at least 50% of cases. Purpose of the study. Evaluate the effectiveness of occlusal therapy in TMJ functional disorders using electromyographic and X-ray examinations. Research materials and methods. The study involved 40 patients with clinical signs of musculoskeletal dysfunction, including 32 (80 %) women and 8 (20 %) men aged 16 to 40 years. In order to assess the state of the masticatory muscles before and after occlusal therapy, an EMG study was performed with a Teethan device (manufacturer: Teethan S.p.A., Italy). The following indicators were determined: POC-indices for masticatory and temporal muscles-an indicator of contraction coordination; ASYMMETRY (% ) – symmetry of muscle contraction on both sides; TORSION ( % ) – the value of the torque indicating the presence of a lateral imbalance; BARYCENTER (% ) – localization of the center of muscle activity in the sagittal plane (anterially/posterially); IMPACT (% ) – integral value of the total activity of the masticatory complex. Research results. After eliminating the clinical manifestations of dysfunction and stabilizing occlusal ratios, patients underwent a control CPCT (Cone-Beam computed tomography) and EMG study. The results of the study show a pronounced positive dynamics of changes in EMG indicators of the masticatory muscles in patients with TMJ dysfunction before and after therapy. Conclusions. The obtained electromyographic and CPCT data demonstrate that the use of individually manufactured occlusal splints is an effective method for restoring the functional state of the TMJ and masticatory apparatus. The results obtained confirm the elimination of muscle discoordination, normalization of muscle load, optimization of masticatory function and balanced functioning of the masticatory muscles. Morphological changes identified according to the CPCT data, in particular stabilization or partial restoration of the integrity of the cortical plate, a decrease in the intensity of subchondral sclerosis, the absence of osteophyte progression and normalization of the width of the joint gap, indicate the cessation of degenerative processes and the restoration of biomechanical balance in the “joint – masticatory muscles”system. Thus, the results of the study confirm the high effectiveness of occlusive therapy as a key component of comprehensive rehabilitation of patients with TMJ dysfunction, as well as its ability to contribute to the restoration of structural and functional integrity of joint and muscle components.