Estudo imaginológico da posição condilar na cavidade da articulação temporomandibular em diferentes situações clínicas: revisão sistemática da literatura e ensaio clínico tipo caso-controle

Abstract

The position of the mandibular condyle in the temporomandibular joint (TMJ) cavity is a subject that generates divergences between researchers, due to its relation with temporomandibular disorders (TMD), dental occlusion and centric relation. The main goal of this study, which has two chapters, is to make a bibliographic review of clinical case studies concerned the condilar position, by using analysis of the imagens and also carry out a control-case clinical test, in order to evaluate the tomographic images of the condylar position symptomatic and non-symptomatic patients for temporomandibular disorders (TMD), in maximum regular intercuspation (MRI) and using inter-occlusal devices with anterior and horizontal guidance. Using the descriptors “mandibular condyle” and “position”, a search was accomplished on the databases of MEDLINE/Pubmed, Scielo, LILACS, Science Direct, CINAHL and Web of Science, from 2012 to 2017. The first chapter addresses about this bibliographic review. Twenty papers, that evaluated condyle position by computed tomography and /or magnetic ressonance, were investigated. All the eligibility criteria were obeyed. In the most of the studies, the majority of the samples were represented by women. It was observed that the larger part of asymptomatic patients have centralized condyles in the joint cavity, while the symptomatic patients were inclined to have more posterior condyles. Regarding the interference of the occlusal and skeletal pattern, in the condylar position, controversies were found out. Just few works about the influence of the interoclusal devices have been found; however, they have shown a tendency to move the condyle to a lower and anterior position. In the second chapter, the clinical investigation was proceded in a final 52 symptomatic and 10 asymptomatic patients, who received two metallic-acrylic devices, the first one with anterior guide (DII) and the second one with horizontal guide (DIH). Then, they were submitted to a conical beam CT scan of temporomandibular joint (TMJ). The images were evaluated in terms of anterior (A), superior (S) and posterior (P) spaces (mm) between condyle extremity and temporal bone. Data had been analyzed intergroup and intragroup by Student t test, ANOVA/Bonferroni and Pearson correlation. (α=0,05). It was not possible to attest that examination of the condylar position could determine presence or absence of TMD. Symptomatic patients with TMD had condyles positioned more posteriorly in MIH and using DII, with DIH promoting centralization; while asymptomatic patients presented centralized condyles, regardless of whether they were in MRI or using one of the devices. In general, it was concluded that changes in the position of the condyle can occur within the joint cavity, through different factors, such as gender, presence of TMDs, occlusal patterns and use of interoclusal devices. The data obtained in the research were consistent with the literature.