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Informationen aus Orthodontie & Kieferorthopädie 2013; 45(03): 161-172
DOI: 10.1055/s-0033-1353150
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Spezifische CMD-Befunde nach klinischer Funktionsanalyse und manueller Strukturanalyse bei Patienten mit juveniler idiopathischer Arthritis

Specific TMJ Findings after Clinical Functional Analysis and Manual Structural Analysis in Patients with Juvenile Idiopathic Arthritis
D. Heekeren
1   Kieferorthopädische Fachpraxis, Berlin
,
R. Beyer
1   Kieferorthopädische Fachpraxis, Berlin
,
A. Bumann
1   Kieferorthopädische Fachpraxis, Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
19 September 2013 (online)

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Zusammenfassung

In dieser Studie wurden 155 Patienten mit juveniler idiopathischer Arthritis (JIA) hinsichtlich spezifischer Kiefergelenkbefunde untersucht. Bei allen Patienten wurde eine klinische Funktionsanalyse und eine manuelle Strukturanalyse durchgeführt. Zusätzlich lagen von allen Patienten Panoramaschichtaufnahmen vor.

Die klinische Funktionsanalyse ergab bei 11,6% der Patienten Schmerzbefunde, bei 5,2% Bewegungseinschränkungen und bei 12,9% Gelenkgeräusche. Mithilfe der manuellen Strukturanalyse wurden bei 47,1% der Patienten Schmerzen, bei 20,6% Bewegungseinschränkungen und bei 39,3% Gelenkgeräusche festgestellt. Bei passiven Bewegungen wurden vermehrt „zu harte“ Endgefühle als Zeichen einer Kapselverkürzung ­gefunden.

Röntgenologisch bestanden bei 28,7% der Patienten Abflachungen der Kondylen. Die mittlere Mundöffnung war bei Patienten mit Abflachungen signifikant geringer als bei Patienten ohne morphologische Veränderungen der Kondylen. Der Kjellberg-Index und damit die Länge des Proc. condylaris korrelierte mit „zu harten“ Endgefühlen bei ventraler Translation und Traktion.

Die Ergebnisse der vorliegenden Studie erlauben 2 Konklusionen: Erstens ist eine manuelle Strukturanalyse der klinischen Funktionsanalyse deutlich überlegen, da tatsächlich vorhandene Befunde in deutlich höherem Maße erfasst werden. Bildgebende Befunde aus Panoramaschichtaufnahmen (PSA) korrelieren mit den manuell erhobenen Befunden, obwohl zahlreiche neuere Studien zeigen, dass digitale Volumentomografien (DVT) der PSA in der röntgenologischen Bildgebung signifikant überlegen ist. Manuelle Strukturanalyse und DVT sind daher aktuell die Methoden der Wahl für eine spezifische Untersuchung von Patienten mit JIA.

Abstract

In this study, 155 patients with juvenile idiopathic arthritis (JIA) have been investigated with regard to specific TMJ findings. Clinical functional analysis and manual structural analysis were performed in all patients. In addition, panoramic radiographs were available for each patient.

The clinical functional analysis revealed pain in 11.6% of the patients, movement restrictions in 5.2% and joint sounds were found in 12.9% of the patients. By manual structure analysis pain was found in 47.1% of patients, 20.6% showed movement restrictions and in 39.3% of the cases joint sounds could be detected. In cases of limited passive movements the end feeling „too hard“ was found as a sign of capsule shortening.

Flattening of the condyles could be found radiographically in 28.7% of patients. The average mouth opening was significantly lower in pa­tients with flattening than in patients with no morphological changes of the condyles. The Kjellberg index and thus the length of the condylar process correlated with „too hard“ end feelings in anterior translation and traction.

The results of this study allow 2 conclusions: First, a manual structural analysis is definitely superior compared to a regular clinical functional analysis as existing findings are detected in a significantly higher degree. Radiological condylar findings from a panoramic radiograph show correlations with the manually collected findings, although several recent studies show that the cone beam computed tomography (CBCT) is significantly superior to the panoramic x-ray regarding the radiographic imaging. Manual structural analysis (MSA) for clinical assessment and radiographic imaging with a CBCT are therefore currently the methods of choice for a specific examination of patients with JIA.

Schlüsselwörter

juvenile idiopathische ­Arthritis (JIA) - Kiefergelenk - manuelle Strukturanalyse

Key words

juvenile idiopathic arthritis (JIA) - temporomandibular joint - manual structural analysis
 

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