The current scientific knowledge of TMJ pathologies points to the importance of etiological research and the need for differential diagnosis using the most modem technological resources. Those include MRI, computed tomography, serologic studies, genetic mapping, and bioelectronic instruments which allow clinicians to study, understand, and measure respectively, the structural changes of soft and hard tissues, infections, genetic susceptibility for autoimmune diseases, and stomatognathic function. The purpose of this article is an overview of the current knowledge and related tools for the diagnosis of TMJ pathologies.

The clinical observation of the incisors overbite is the most common form used to evaluate the occlusal vertical dimension (OVD); however, this technique offers poor information about the compression state of the TMJ. In order to obtain such information, it is necessary to evaluate the electrical activity of the elevator muscles using surface electromyography (EMG). In case of a compressive irritation of the joint receptors, the trigeminal nucleus returns an inhibitory motor response of the elevator muscles that can be measured. The Learreta's EMG decompression test is done by measuring the EMG response of the masticatory muscles at maximal occlusion in four different OVD positions in such a way that the reduction of the TMJ pressure, and subsequently, relief of the inhibitory motor response can be studied. The aim of this study is to illustrate this technique, its clinical use and its limitations.

A contribuição da radiologia para o diagnóstico das alterações da articulação temporomandibular (ATM) baseia-se no desenvolvimento de técnicas para se obter uma visão mais detalhada das estruturas anatômicas e interpretação das imagens correspondentes aos espaços e posicionamentos condilares. A posição fisiológica mandibular de repouso e a avaliação dos espaços articulares são importantes no equilíbrio postural crânio-mandibular. O objetivo neste estudo foi avaliar, na posição de repouso, os espaços articulares em pacientes sintomáticos e assintomáticos de desordens temporomandibulares, utilizando a tomografia convencional corrgida na incidência frontal e sagital com cortes na porção central do côndilo. A posição da postura habitual do segmento superior foi um importante dado observado por ser considerado um fator modificador da posição de repouso mandibular. Foram selecionados 67 pacientes dos quais 29 eram assintomáticos e 38 clinicamente examinados como sintomáticos. Os dados obtidos foram analisados estatisticamente pelo teste t de Student e de Tukey. Pôde-se concluir que não houve diferença entre os lados do mesmo paciente e entre pacientes sintomáticos e assintomáticos, sendo somente estatisticamente significante a diferença entre os sexos, dos quais o masculino apresentou maiores dimensões. Estes resultados sugerem que, biologicamente o sexo masculino é possivelmente mais protegido dos comprometimentos articulares e demonstram que, com a metodologia aplicada, a posição de repouso mandibular é perfeitamente reproduzível e mensurável embora seja considerada uma posição intermediária e aparentemente instável.

OBJECTIVE To evaluate the efficacy patients treated based on the biopsychosocial model, with a Michigan-type myorelaxant/stabilization splint combined with alternative therapies, and Neurophysiological model with intermediate Occlusal Devices in patients with temporomandibular joint (TMJ) arthropathies based on two different treatment philosophies. PATIENTS AND METHODS: This was an interventional and longitudinal study of the randomized clinical trial with blinding. The survey was approved by the CEP under: CAAE 66446216.6.0000.5207. Statistical analyzes were performed based on the selection of 43 patients with diagnosis of temporomandibular arthropathies after examination of the Diagnostic Criteria for Temporomandibular Dysfunction (DC / TMD) and assistance with images such as CT scans and magnetic resonance imaging. The patients were divided into two groups: G1-Biopsychosocial group and G2-Neurophysiological group. The variables studied were pain, mandibular function, need for alternative therapies and physiological parameters of muscle recruitment and masticatory cycle, measured by electromyography and kinesiography, respectively. All patients were followed for a minimum period of 06 to 09 months. RESULTS The results were favorable to both treatment groups in relation to the decrease in pain symptomatology, but were more consistent and remained smaller at the end of the evaluation in the neurophysiological group. Also significant was the difference in muscle recruitment during treatment with the G2 and less use of alternative therapies for pain control compared to the Biopsychosocial group. CONCLUSIONS Even in the case of a preliminary and unpublished study, this research provides strong indications of the benefit of the treatment with the Neurophysiological model in patients with TMJ arthritis, as well as the improvement of the symptomatic aspects, there was a clear improvement in muscle recruitment patterns, masticatory cycle, bone marrow regeneration and joint disc recapture. Further research with anti-etiologic treatment model should be performed to confirm these results. CLINICAL RELEVANCE: This innovative research highlights a new model for diagnosing and treating TMJ pathologies beyond traditional palliative treatment measures, enabling a more assertive anti-etiological treatment.