| Temperomandibular disorders (TMD) is a common kind of disease in oral and maxillofacial region which includes many types. The clinical symptoms of TMD are often similar between different types, which make it difficult to diagnose and differentiate TMD only depending on the clinical symptoms, nowadays the clinicians have to make the diagnosis and differential diagnosis of TMD with radiological examination. Because of many disadvantages of these examinations, they are not commonly used in clinic, which decreased the accuracy of diagnosis and the therapeautic effects.The common symptoms of TMD include abnormal jaw tracking, joint pain and joint sounds. Because the sounds and jaw tracking can be measured objectively, they have great value in diagnosing TMD, however the value was decreased in clinic because of obvious error or inconvenience for using.K6-I evaluation system is a kind of equipment for evaluating temperomandibular joint function through recording the electromyography of masticatory muscle, jaw tracking and joint sounds. The mechanism of recording jaw tracking was through detecting the magnetic field alteration with sensors and calculating with a computer, this method is helpful to observe and can compare the jaw tracking objectively. Joint sounds was recorded and analyzed through Fast-Fourier Translation (FFT), then the sounds were observed in waveform,. frequency and amplitude field, and the results were more objective. In this study, we tried to use this system to record and analyze the jaw tracking and joint sounds of asymptom individuals, temporomandibular joints with anterior disc displacement with reduction and without reduction, joints with disc displacement, in order to investigate the jaw tracking and joint sounds characters of normal and diseased temporomandibular joint, the purpose is to investigate the value of jaw tracking, joint sounds analysis and K6-I evaluation system in TMD diagnosis.This study included three parts.Part one. The study of jaw tracking of TMD patients.Purpose: To investigate and compare the jaw tracking characters of asymptom individuals and TMD patients, in order to find the alteration of jaw tracking in TMD patients.Methods: The jaw tracking of 21 asymptom individuals and TMD patients with unilateral anterior disc displacement with reduction (31 patients), without reduction (35 patients), disc perforation (18 patients) were recorded with K6-I Evaluation System, the jaw tracking and movement range of maximal opening and closing, lateral border movement, maximal lateral movement were studied.Results:1. In 18 objects of the 21 asymptom individuals, the jaw tracking of opening and closing were smooth and superposition, about 70% jaw tracking deviated to the left side during opening the mouth, the range of lateral border movement and maximal lateral movement did not show significant difference between right and left side.2. In the group of unilateral anterior disc displacement with reduction (ADDWR), obvious bounce was found in the jaw tracking of 20 patients. The mandible deviated to the left side in 80% patients during opening the mouth, the mean maximal mouth opening did not show significant difference between asymptom individuals and ADDWR patients, and the range of lateral border movement and maximal lateral movement did not show significant difference between both sides.3. In the group of anterior disc displacement without reduction (ADDWoR), the jaw tracking of 25 patients were superposition, 72% jaw tracking deviated to the left side during mouth opening. The maximal mouth opening of ADDWoR was less than control group significantly, the range of lateral border movement did not show significant difference between both sides, but the range of maximal lateral movement to diseased side was higher than to the contrary side significantly.4. Most of the jaw tracking of patients with unilateral disc perforation were coarse, about 2/3 tracking was almost superposition, 82% jaw tracking deviated to the left side during mouth opening. The maximal mouth opening of patients with unilateral disc perforation was less than control group, the range of lateral border movement did not show significant difference between both sides, but the range of maximal lateralmovement to diseased side was higher than to the contrary side significantly.Conclusion: There existed some difference in jaw tracking between asymptom individuals and TMD patients.Part two: The research of joint sounds from TMD patientsPurpose: fp study the characters of joint sounds from asymptom individuals and TMD patients, in order to investigate joint sounds characters in TMD patients.Methods: The joint sounds from temporomandibular joints of asymptom individuals (22 individuals 42 joints) and TMD patients with anterior disc displacement with reduction (30 patients 30 joints), without reduction (36 patients 45 joints), disc perforation (38 patients 45 joints) were recorded with K6-I Evaluation System, then the sounds were analyzed with K6-I software through computer, and the characters were observed in the field of waveform, frequency and amplitude.Results:1. Joint sounds were detected in about 60% asymptom temporomandibular joints, after analyzed through Fast-Fourier Translation with K6 I software, 4 mainly kinds of waveform were found in the electrosonography of TMJ sounds, the frequency and amplitude of these waveforms were different.2. A special kind of waveform appeared in most joints with ADDWR (29/30), which was more often than in other kinds of TMD. The frequency of the waveform is low.3. The waveform of "wave" and "irregular" were more often appeared in the sounds from group of ADDWoR, but difference of appearance odds was not significant when compared with control group. When observed in the field of frequency, more of the sounds showed lower frequency.4. In the electrosonography of sounds from disc perforation, the form of "tussock" and "irregular" were more often appeared than other forms, the appearance of "tussock" was significant more than in the control group. When observed in the field of frequency, more of the sounds showed higher frequency.Conclusion:1. Joint sounds were detected in 60% asymptom TMJ.2. According the waveform, 4 types of joint sounds were found in TMJ, the frequency and amplitude were different among the 4 types.3. The appearance odds of every type waveform in different types of TMD were different.4. The sounds from joints of anterior disc displacement with reduction, without reduction mainly showed lower frequency, the sounds from joints with disc perforation mainly showed higher frequency.Part three: The study of application joint sounds for assisting diagnosis of TMD in clinicPurpose: To investigate the value of joint sounds in assisting diagnosis of TMD and K6-I Evaluation System in clinic.Methods:1. Joint sounds were recorded and analyzed with K6-I Evaluation System from total 308 TMD joints, then the electrosonographic diagnoses were made according to the characters found in part two.2. The clinical diagnoses were made according to clinical symptom and radiological evidence.3. The clinical diagnoses were regarded as "gold standard" , the sensitivity and specificity of electrosongraphic diagnoses were detected when compared with the clinical diagnoses.Results: The sensitivity and specificity of electrosongraphic diagnosis were 77.2% and 93.3% for ADDWR, 81.6% and 64.7% for ADDWoR, 75.7% and 78.4% for disc perforation respectively.Conclusion: The sounds analysis with K6-I Evaluation System for TMD diagnosis is useful in clinic.
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