published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

A dissertation presented to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, 2009 / Introduction: The aetiology of Temporomandibular Joint Dysfunction (TMJD) is not fully understood and the treatment of TMJD is controversial. Most treatment plans are based on postulated aetiology. Treatment plans currently range from pharmacological to surgical and occasionally physical therapy is also used for any myofascial component. Myofacial Trigger Points (MFTP’s) in the head and neck region have similar pain referral patterns as TMJD and there is overlap in aetiology and epidemiology. If correlation can be proved to exist between the severities of TMJD and MFTP’s then the treatment of MFTP’s can potentially decrease the severity of TMJD and then the more radical treatments can be avoided. Objectives: To determine whether TMJD was present and establish severity. To locate any MFTP’s in the Sternocleidomastiod (SCM), Temporalis, Masseter, Posterior Cervical (PC), Lateral and Medial Pterygoid muscles and determine their severity. Methods: A random sample of 25 participants were evaluated. A p value <0.05 was considered as statistically significant. Quantitative variables were summarized using median, inter-quartile range and range due to skewness of distribution, while categorical variables were described using frequency distributions and bar charts. Spearman’s nonparametric correlation analysis, and curve estimation were used to determine the existence of a relationship between TMJ severity and MFTP severity. A scatterplot was used to graphically assess the relationship. Conclusion: The results suggested that the participants were actually chronic neck pain suffers that developed TMJD over the long term as a result of chronic neck pain changing the kinematic biomechanics or as a result of a completely different and independent event as suggested by Foreman and Croft (1995).

Made available in DSpace on 2015-06-17T19:34:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-11. Added 1 bitstream(s) on 2015-06-18T12:47:29Z : No. of bitstreams: 1 000830144.pdf: 673220 bytes, checksum: 918dda784fc3b54454589caeb53e1090 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: A obesidade é uma doença crônica, prevalente e comórbida com condições dolorosas como as musculoesqueléticas. A Disfunção Temporomandibular (DTM) é uma dor musculoesquelética altamente prevalente. O objetivo desse estudo foi avaliar a relação entre obesidade com a presença e gravidade de DTM dolorosa. Métodos: A amostra foi estratificada de acordo com a presença e grau de DTM dolorosa de acordo com o Research Diagnostic Criteria para Temporomandibular Disorders-Eixo I e II (RDC/TMD). A composição corporal foi determinada pelo Índice de Massa Corporal (IMC) e pelo exame de bioimpedância (BIA). As cefaleias primárias (CP) foram classificadas segundo critérios da Classificação Internacional de Cefaléia II (CIC-II). Análises uni e multivariadas avaliaram associação entre DTM dolorosa e obesidade. Resultados: A amostra foi constituída por 245 indivíduos (35,89 ± 12,61 anos), sendo 183 (74,7%) mulheres. Do total, 130 (53,25%) apresentaram DTM dolorosa. Houve associação significativa entre a presença de DTM dolorosa e sobrepeso/obesidade avaliada por BIA (RP = 1,44, IC 95% = 1,09-1,91). Associação se manteve em análise multivariada corrigido por gênero e presença de cefaleias crônicas diárias (CCD) (OR= 2,02, IC95%: 1,16-3,54). Não houve associação significativa entre a gravidade de DTM e a composição corporal segundo IMC (p= 0,06) ou BIA (p= 0,08). Conclusão: Obesidade está associada a presença de DTM dolorosa, mas não com a gravidade, após o ajuste para CCD e gênero. / Objectives: Obesity is a chronic and prevalent disorder, comorbid with painful conditions such as musculoskeletal disease. Temporomandibular disorders (TMD) are a high prevalent musculoskeletal pain. The aim of this study was to evaluate the relationship between obesity and the presence and degree of painful TMD. Methods: The sample was stratified according to the presence of painful TMD following the Research Diagnostic Criteria for Temporomandibular Disorders- Axis I and II (RDC/TMD) criteria. The body composition was assessed through Body Mass Index (BMI) and bioimpedance (BIA) analysis. The primary headaches (PH) were classified according to the International Classification for Headache Disorders II (ICHD-II). Uni and multivariate analysis assessed the association between painful TMD and obesity. Results: The sample consisted of 245 individuals (35.89 ± 12.61 years), 183 (74.70%) of them were women. Of the total, 130 (53.25%) presented painful TMD. In contrast with normal weighted individuals, those presenting overweight/obesity according to BIA were more likely to present painful TMD (PR= 1.44, 95%CI= 1.09 to 1.91). Association persisted in multivariate analysis correcting for gender and presence of chronic daily headache (CDH) (OR = 2.02, 95%CI: 1.16 to 3.54). There was no significant association between the grade of the TMD pain and body composition assessed through BMI (p= 0.06) or BIA (p= 0.08). Conclusion: Obesity is associated with the presence of painful TMD, but not with the grade of TMD pain, after adjustment for the CDH and gender. / FAPESP: 2012/10935-4

Joint disorders significantly affect quality of life and present unique challenges for tissue engineering. In the craniofacial space, and especially for the temporomandibular joint (TMJ), there is an unmet need for anatomically precise and mechanically robust cartilage and bone tissues to recapitulate native function. Current surgical reconstruction methods, whether using autologous or synthetic options, suffer from imprecision, comorbidities, complications, and frequently require subsequent operations. Furthermore, many craniofacial graft efforts have focused on improving bone without addressing cartilage, which is essential to proper TMJ function. Thus, there is a compelling need to engineer a human-sized, biologically and anatomically matched cartilage-bone TMJ replacement. This dissertation demonstrates the ability to generate such a graft with native-like properties in a human-sized large animal model by focusing on two aims: (i) establish methods to fabricate and culture anatomically specific, autologous cartilage-bone grafts (Aim 1), and (ii) show improvement of graft performance after six months implantation in vivo compared to previous methods, controls, and native tissue (Aim 2). Using Yucatan mini-pigs as a human-sized model, the ramus-condyle unit (RCU), a geometrically intricate portion of the mandible and primary load bearing section of the TMJ, was targeted for reconstruction. Scaffolds were created using computer tomography (CT) image-guided micromilling of decellularized bone matrix, then infused with autologous adipose-derived chondrogenic and osteogenic progenitors. These biological constructs were then cultured in vitro in a novel dual-perfusion bioreactor before in vivo implantation. Similar in vitro culture of representative constructs done in parallel demonstrated cell attachment and some differentiation. After six months implantation, the dual cartilage-bone RCU grafts maintained their predefined anatomical structure and regenerated full-thickness, stratified, and mechanically robust cartilage over the underlying bone, to a significantly greater extent than either bone-only grafts or acellular scaffolds, and showed remarkable similarity to native tissue. Furthermore, tracking of implanted cells enabled additional insights into the progression of cartilage and bone regeneration. The methods and results established in this dissertation form a promising basis for the next evolution in engineering full-sized, patient-specific, and biologically and mechanically robust TMJ replacements.

published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

M.Tech. (Chiropractic) / Headache is the most common type of pain and is one of the most frequent reasons for medical consultation (Rasmussen, 1995). Tension-type headaches cause substantial levels of disability for the patient as well as the global society because of its high prevalence in the general population (Stovner, Hagen, Jensen, 2007). Tension-Type headache is a primary headache commonly found in three forms: infrequent episodic, frequent episodic and chronic with or without pericranial tenderness (International Headache Society, 2009). The aim of this study was to determine the effectiveness of chiropractic manipulation of the temporomandibular joint in conjunction with ischemic compression of the lateral pterygoid muscle as a treatment protocol for tension-type headache. Method: This study consisted of three groups of sixteen participants each with tension-type headaches. The participants were between the ages of 18 and 25 years of age. Potential participants were examined and selected based on the inclusion and exclusion criteria. Group one received chiropractic manipulation of the temporomandibular joint. Group two received ischemic compression of the lateral pterygoid muscle. Group three received a combination treatment of chiropractic manipulation of the temporomandibular joint and ischemic compression of the lateral pterygoid muscle. Objective and subjective finding were based on the treatment sessions. Procedure: All participants received a total of six treatments over two weeks followed by a seventh visit which consisted of data gathering only. The subjective data collected was in the form of a TMJ symptom questionnaire completed at visit one and seven and a Headache Disability Index (HDI) completed at visits one, three and seven. TMJ motion was measured by means of a vernier caliper.

No description available.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / The relationship between TMD and dysfunction in the cervical spine has been reported in the literature and there are many case studies which have shown favourable results when treatment was aimed at the TMJ, cervical spine relationship. However, the numerous TMD treatment protocols described in the literature concerning this relationship, and the effectiveness of these treatments have not been well established. In spite of this many chiropractors treat TMD. TMD is a multifactoral condition and conservative treatment options need to be further investigated in order to determine if manual interventions directed at the cercival spine in the treatment of TMD are beneficial. Objectives: The purpose of this study was to compare myofascial trigger point therapy and manipulative therapy of either the TMJ, cervical spine or a combination of the two in order to determine their effectiveness for the TMD. Method: Thirty participants with TMD were randomly assigned to one of three treatment groups. Participants in each group received two treatments per week for two weeks with a follow up consultation in the third week. Data were collected before the commencement of the first, second, and fourth treatments and at the follow up consultation. Outcome measures included algometer readings, CROM, Mouth opening readings, NRS and a disability questionnaire. SPSS version 15.0 was used for analysis of the data. A p value <0.05 was considered as statistically significant. Multivariate testing was used for intra- and inter-group comparisons. Profile plots were generated to assess the direction and trend of the effect and to visually compare the trends in the different treatment groups. Results: Inter-group comparisons did not reveal any statistically significant different improvements between the three treatment groups. Conclusion: All groups responded favourably to treatment and showed trends towards improvement. However, statistically analysis revealed that no one treatment protocol was superior to the other. Although no definitive inferences may be drawn regarding the effectiveness of each treatment approach, within group trends indicated that the combination of the two treatment approaches may be preferred.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / The relationship between TMD and dysfunction in the cervical spine has been reported in the literature and there are many case studies which have shown favourable results when treatment was aimed at the TMJ, cervical spine relationship. However, the numerous TMD treatment protocols described in the literature concerning this relationship, and the effectiveness of these treatments have not been well established. In spite of this many chiropractors treat TMD. TMD is a multifactoral condition and conservative treatment options need to be further investigated in order to determine if manual interventions directed at the cercival spine in the treatment of TMD are beneficial. Objectives: The purpose of this study was to compare myofascial trigger point therapy and manipulative therapy of either the TMJ, cervical spine or a combination of the two in order to determine their effectiveness for the TMD. Method: Thirty participants with TMD were randomly assigned to one of three treatment groups. Participants in each group received two treatments per week for two weeks with a follow up consultation in the third week. Data were collected before the commencement of the first, second, and fourth treatments and at the follow up consultation. Outcome measures included algometer readings, CROM, Mouth opening readings, NRS and a disability questionnaire. SPSS version 15.0 was used for analysis of the data. A p value <0.05 was considered as statistically significant. Multivariate testing was used for intra- and inter-group comparisons. Profile plots were generated to assess the direction and trend of the effect and to visually compare the trends in the different treatment groups. Results: Inter-group comparisons did not reveal any statistically significant different improvements between the three treatment groups. Conclusion: All groups responded favourably to treatment and showed trends towards improvement. However, statistically analysis revealed that no one treatment protocol was superior to the other. Although no definitive inferences may be drawn regarding the effectiveness of each treatment approach, within group trends indicated that the combination of the two treatment approaches may be preferred. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / BACKGROUND: Temporomandibular disorders (TMDs) affect up to fifteen percent of adults. It produces craniofacial pain of musculoskeletal structures within the head and neck. One particular cause of TMDs is said to be myofascial pain syndrome (MFPS), which according to various research papers, if not considered and/or assessed, the general cause of a patient’s pain could be disregarded and incorrect treatment offered. Numerous studies conducted internationally on dental management of temporomandibular joint disorder (TMJD) concluded that there is a significant gap in dentists’ education and training regarding the identification and management of MFPS. Upon reviewing the current literature available in South Africa, very little research existed on dentists’ knowledge and the management strategies that they utilised regarding MFPS in TMJD patients. OBJECTIVES: To determine the dentists’ knowledge regarding MFPS of the temporomandibular joint (TMJ). What assessment and treatment/management strategies they use, and whether they make use of referral networks and if the respondents’ demographics influence their knowledge, utilisation, perception and referral patterns. METHODOLOGY: The researcher developed a research questionnaire, which was validated by both an expert and a pilot study group. This questionnaire was then used as a research tool in this cross-sectional study. General dental practitioners from the Greater eThekwini Region received an invitation to participate. The questionnaire-based survey consisted of five sections: biographical profile of respondents; topic background; perception; knowledge; utilisation and management (including referral patterns) of MFPS. RESULTS: The majority of respondents did receive basic education in MFPS, with 76.9% reporting that they received undergraduate education and 57.7% indicating that they had attended post-graduate courses/talks on MFPS. There was a 100% response from dentists indicating their willingness to attend post-graduate courses/talks on MFPS. The results indicated that the respondents, who felt that their curriculum regarding MFPS was sufficient, were more knowledgeable and more competent in diagnosing and managing MFPS. Overall, the average score for knowledge was 65.17%. Clinical features (78.85%) and the perpetuating and relieving factors (72.11%) scored the highest while causes (58.06%) and differential diagnoses (51.16%) scored the lowest knowledge levels. Respondents mostly made use of allopathic medical fields, and not of alternative medical fields, however a high number of respondents (73.1%) indicated that they would consider chiropractic co–management of patients with MFPS. CONCLUSION: This study adds new information in the South African context regarding dentists’ understanding of the myofascial component of TMDs. It also provides the dental profession with information about the knowledge and practices related to MFPS as well as information regarding the strengths and weaknesses on its educational component. It is recommended that dentists receive additional training on differential diagnoses and causes. It is also recommended that the chiropractic profession take this opportunity to offer courses/talks on MFPS and join forces with the dentistry profession on how they can assist in managing patients with MFPS. / M