This Clinical and radiographic study will be designed to evaluate the temporomandibular joint condition post longstanding mouth opening during dental procedure using rubber dam. primary outcome : preoperative and postoperative assessment of interincisal distance , occlusal biting force , visual analogue scale , lateral excursion movement and Magnetic resonance imaging (MRI).
Secondary outcome: investigator will try to answer the question of what is the best duration of time could the dentist use rubber dam isolation in dental procedures without harmful effect on TMJ and its supporting structures?
Patients aged from 18 - 40 years old of both sexes.
No evidence of bad habits that affect occlusion like bruxism or clenching.
Patient with normal occlusion.
Patient free of any signs and symptoms of TMD and myofascial pain.
Patient with systemic or local diseases that can affect TMJ like osteoarthritis, rheumatoid arthritis, or systemic lupus erythema.
Patient with trismus.
Patient with Recurrent dislocation of TMJ.
Swelling affects mouth opening.
Parallel
Application of a rubber dam during dental treatments for varying durations.
Procedure/SurgeryPatients in each group will undergo dental procedures (either operative or endodontic treatment) with rubber dam isolation. The rubber dam will be applied for the specific durations mentioned in each group to evaluate the impact of mouth opening on the temporomandibular joint (TMJ).
Interincisal Distance
Measurement of the distance from the incisal edge of upper incisors to the incisal edge of lower incisors when the mouth is opened maximally in mm.
Occlusal Biting Force
measurement of the biting force exerted by the patient's occlusion. This will be measured using a bite force gauge or similar instrument at the specified time points.
Visual Analogue Scale (VAS)
A subjective measure of pain intensity experienced by the patient. Patients will mark their pain level on a scale from 0 (no pain) to 10 (worst pain imaginable).
Magnetic Resonance Imaging (MRI)
MRI scans will be done for patients who exhibit signs and symptoms of TMD postoperatively.
Optimal Duration for Rubber Dam Use
measure the duration of time for rubber dam application from the beginning of rubber dam application till the dentist remove rubber dam from the mouth of patient .
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