The purpose of the thesis was to develop methods of computed tomography (CT) for examining the temporomandibular joint (TMJ) (I). AN attempt was made to compare the densities of the caput mandibulae obtained by CT with clinical findings related to TMJ dysfunction (II). The CT examinations were performed at the Department of Diagnostic Radiology, Oulu University Central Hospital. In an experimental comparison of acupuncture versus stomatognathic treatment, the aim was to reassess the profile of TMJ dysfunction and to investigate the potential of acupuncture for treating the patients with TMJ dysfunction (III, IV, V). The acupuncture treatment was performed at he Department of Physical Medicine and Rehabilitation. Oulu University Central Hospital. Direct sagittal CT scanning of TMJs was performed on 28 patients (53 TMJs) using Toshiba TCT-80 A equipment and an accessory stretcher especially developed for this purpose. The TMJs were scanned from medical to lateral side using contiguous 2 mm thick sections. The optimal scan was reproduced with the mouth in the closed, semi-open and maximally open positions, and prior to and after clicking. Both TMJs could be examined in the same situation if needed. The anatomical view obtained of the TMJ was good. The position and function of the disc, the structure and shape of the caput mandibulae and mandibular fossa, the movement of the mandibular fossa condyle and its position relative to the mandibular fossa were well demonstrated. In the study on the density of the caput mandibulae the 25 patients and 29 controls were scanned in the axial and coronial planes in supine position with a Somatom 2-scanner. The slice thickness was 4 mm and slices were obtained at 2 mm intervals with a 2 mm overlap. The density of the caput mandibulae was measured anteriorly and posteriorly in axial slices and superiorly in coronal slices. Clinical examinations of the stomatognathic system were performed in the same way in both groups using the clinical dysfunction index of Helkimo. The densities of the caput mandibulae were higher among the patients than among the controls. They were significantly higher (p < 0.01) anteriorly in both joints and significantly higher (p < 0.01) posteriorly in the right joint. Superiorly the densities revealed no significant difference (p > 0.05) in either joint. The densities of the caput mandibulae seemed to correlate with the clinical symptoms and signs, especially with regard to muscle pain and deviation on mouth opening. The treatment comparison was performed using a series of 50 patients with TMJ dysfunction having a virtually complete dentition. The patients were divided randomly into two groups of 25, one being treated by acupuncture and the other receiving standard stomatognathic treatment. All the patients were evaluated before treatment, within one week of treatment and 3 months after treatment using the clinical dysfunction index of Helkimo. Both groups showed a significant reduction in subjective and clinical symptoms and signs of TMJ dysfunction, and further analysis of the individual components of the index revealed no significant difference except in indicators of the range of mandibular movement. No significant difference (p > 0.05) could be detected in painful movement of the mandible except in retrusion movement, where stomatognathic treatment was clearly superior immediately after treatment. Acupuncture seems to be useful as a complementary treatment especially in cases of TMJ disorders with evidence of psychophysiological or neuromuscular disturbances but not so clearly where marked occlusal disturbances or joint damage are involved.

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