title: The effect of a functional appliance in the management of temporomandibular joint disorders in patients with juvenile idiopathic arthritis.
abstract: BACKGROUND
  Patients affected by juvenile idiopathic arthritis (JIA) may have several craniofacial growth disturbances and involvements at the temporomandibular joint (TMJ). The objectives of the present study were to evaluate the clinical effectiveness of functional therapy used to reduce asymmetry of mandibular growth and TMJ disorder in patients with JIA.
  
  
  METHODS
  By a retrospective longitudinal design, a cohort of 54 patients with JIA (mean age, 13.2±3.7 years; range, 5-17.7 years) and with TMJ involvements was enrolled in the study. Each patient, following the collection of clinical parameters, was treated for 24 months with a functional appliance individually customized by acrylic resin and resilient stainless steel with posterior and anterior metallic bite planes preventing the teeth from intercuspal contact. To evaluate differences before (T0) and after therapy (T1) of the clinical TMJ parameters, the statistical analysis by the χ2 Test was performed.
  
  
  RESULTS
  All the patients completed successfully the study. In patients with JIA, the use of a functional appliance determined a statistically significant difference of the pain during jaw movement, maximal mouth opening, TMJ sounds and crepitations (P<0.001) and TMJ click, significantly reduced at T1 (P<0.05).
  
  
  CONCLUSIONS
  The use of an orthodontic functional appliance determined a significant improvement, at 24 months, in many TMJ signs and symptoms in patients affected by JIA and with TMJ disorders. This study suggests that children and adolescents with JIA which presented either unilateral or bilateral moderate to severe TMJ involvement, if not treated, should be develop severe disturbances during growing.
authors.affiliation: Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy - gisola@unime.it.|Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples &quot;Federico II&quot;, Naples, Italy - gisola@unime.it.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Isola
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples &quot;Federico II&quot;, Naples, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ramaglia
authors.affiliation: Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cordasco
authors.affiliation: Department of Orthodontics, Vita Salute San Raffaele University, Milan, Italy.|Unit of Dentistry, Division of Orthodontics, Research Area in Dentofacial Orthopedics and Orthodontics, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lucchese
authors.affiliation: Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Fiorillo
authors.affiliation: Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Messina, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Matarese
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D001171:Arthritis, Juvenile / Q000150:complications*; D001172:Arthritis, Rheumatoid / Q000150:complications; D002508:Cephalometry; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000254:growth & development; D009068:Movement; D016382:Orthodontic Appliance Design; D017289:Orthodontic Appliances, Functional; D012189:Retrospective Studies; D013705:Temporomandibular Joint Disorders / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome