Assessment of occlusion and temporomandibular joint after placing preformed metal crowns on all primary molars in children

Abstract

Background Placing preformed metal crowns (PMCs) on all eight primary molars at one single clinical visit may disrupt a child's occlusion; the literature regarding the effects on occlusion and temporomandibular joint (TMJ) is scarce. Aim This study aimed to quantify the changes in occlusion using T‐Scan III and to investigate whether there was TMJ dysfunction after placing eight PMCs at the same time. Design In this study, we enrolled children with severe early childhood caries (S‐ECC) and dental phobia, who needed eight PMCs to be placed under general anesthesia. The participants underwent occlusal examinations with a computed occlusal analysis system. The vertical dimension of occlusion (VDO) was measured using a dental vertical dimension gauge, TMJ dysfunction signs were recorded by the clinical dysfunction index (Di), and TMJ dysfunction symptoms were recorded using a questionnaire. The data were collected before treatment (T0), 1 week after treatment (T1), and 1 month (T2) and 3 months (T3) after treatment during follow‐up visits. Repeated‐measures analysis of variance and Friedman's test were used for occlusal data analysis. In addition, the Di and symptoms were compared over time using McNemar's test. Results Forty patients (mean age = 4.25 ± 0.63 years, age range = 3–5 years, 21 boys and 19 girls) were followed up for 3 months. The occlusal contact area 3 months after treatment did not return to the pretreatment status (p = .03). The total of force at the 3‐month follow‐up visit increased significantly (p = .009) compared with that at the pretreatment. The asymmetric ratio of occlusal force at the 1‐month follow‐up visit was restored to pretreatment. Concerning the occlusion time, no significant changes were observed for any time intervals (p = .069). The VDO was recovered at the 1‐month follow‐up visit. The statistical analysis of TMJ dysfunction showed no significant differences in the Di and TMJ dysfunction symptoms before and after treatment (p > .05). Conclusion After undergoing eight PMC restorations under general anesthesia, occlusal re‐equilibration was attained approximately after 1 month. There were no significant signs and symptoms of TMJ dysfunction after treatment.

Outcomes of preformed metal crowns placed with the conventional and Hall techniques: A systematic review and meta‐analysis

“…There was increased muscle activity 29 and reduced bite force 30 immediately post‐treatment, but both measures returned to baseline levels by 1 month. Temporomandibular joint dysfunction was also not reported after PMC placement using the HT 31 up to 12 months and CT 32 up to 3‐month post‐treatment. Although there are no studies on masticatory difficulties in children after HT treatment, studies in adults have shown that masticatory function was unchanged following an increase in occlusal vertical dimension 33 .…”

“…Although there are no studies on masticatory difficulties in children after HT treatment, studies in adults have shown that masticatory function was unchanged following an increase in occlusal vertical dimension. 33 Although PMC placement in children results in increased occlusal vertical dimension, however, given the short timeframe during which occlusal equilibration occurs regardless of technique, 32,34 it is postulated that any masticatory difficulties that may occur immediately post-treatment would be expected to resolve fairly quickly, with minimal risk towards temporomandibular joint dysfunction and limited impact on OHRQoL. The study by Elamin et al 21 only measured the presence/ absence of occlusal contact between the teeth contralateral to PMC-treated side, but did not measure other above mentioned parameters (eg, changes in bite force and/or muscle activity), which may be necessary to provide further clarity on the impact of changes in occlusion and the masticatory ability of the child following PMC placement.…”

Does dental rehabilitation under general anaesthetic contribute to the development of temporomandibular disorders in children and adolescents? A scoping review

“…Forty‐one records were sought for retrieval, with four unavailable in hard copy version past the title and abstract, despite further attempts to contact the corresponding author. There were 37 articles which underwent full‐text evaluation of which only one met the eligibility criteria in full 17 . This study's characteristics are listed in Table 1.…”

“…15 As there is currently no research relating to the adolescent experience of TMD and with such a multifactorial aetiology, it is more important than ever to explore possible additional aetiologies of TMD in this cohort of patients. 16 A recent study by Shih et al, 17 which assessed occlusal changes and development of TMJ issues following dental rehabilitation under general anaesthetic in children, found that nearly a quarter of participants reported TMJ dysfunction during the follow-up period. Data also suggest the prevalence of TMD signs and symptoms increases with age 2 ; hence, with a rise in the amount of TMD reported in adolescents, alongside increasing numbers of dental general anaesthetics, it would be prudent to ascertain whether patients have previously undergone dental rehabilitation under general anaesthesia (henceforth referred to as paediatric dental general anaesthesia [pDGA]).…”

“…There were 37 articles which underwent full-text evaluation of which only one met the eligibility criteria in full. 17 This study's characteristics are listed in Table 1.…”