COMPARATIVE EVALUATION OF THE EFFICACY OF OCCLUSAL SPLINTS FABRICATED IN CENTRIC RELATION OR MAXIMUM INTERCUSPATION IN TEMPOROMANDIBULAR DISORDERS PATIENTS

Fabrication of occlusal splints in centric relation for temporomandibular disorders (TMD) patients is arguable, since this position has been defined for asymptomatic stomatognathic system. Thus, maximum intercuspation might be employed in patients with occlusal stability, eliminating the need for interocclusal records. This study compared occlusal splints fabricated in centric relation and maximum intercuspation in muscle pain reduction of TMD patients. Twenty patients with TMD of myogenous origin and bruxism were divided into 2 groups treated with splints in maximum intercuspation (I) or centric relation (II). Clinical, electrognathographic and electromyographic examinations were performed before and 3 months after therapy. Data were analyzed by the Student''s t test. Differences at 5% level of probability were considered statistically significant. There was a remarkable reduction in pain symptomatology, without statistically significant differences (p>0.05) between the groups. There was mandibular repositioning during therapy, as demonstrated by the change in occlusal contacts on the splints. Electrognathographic examination demonstrated a significant increase in maximum left lateral movement for group I and right lateral movement for group II (p<0.05). There were no significant differences (p>0.05) in the electromyographic activities at rest after utilization of both splints. In conclusion, both occlusal splints were effective for pain control and presented similar action. The results suggest that maximum intercuspation may be used for fabrication of occlusal splints in patients with occlusal stability without large discrepancies between centric relation and maximum intercuspation. Moreover, this technique is simpler and less expensive.     

POSTURAL EVALUATION OF PATIENTS WITH TEMPOROMANDIBULAR DISORDERS UNDER USE OF OCCLUSAL SPLINTS

Objectives:

Alterations in the temporomandibular complex can reflect in adaptations of the individual''s entire muscular system, intervening with the head position and scapular waist, developing postural alterations and modifying all corporal biomechanics. The aim of this study was to evaluate the head position (HP) and head postural alterations before and after installation of occlusal splints.

Material and Methods:

Twenty patients with temporomandibular disorders (TMD) underwent clinical and postural examination, before the installation of an occlusal splint, and after 1 week and 1 month of use.

Results:

There were statistically differences for HP, between the initial values and after 1 week of use of the occlusal device (p= 0.048) and also between 1 week and 1 month of evaluation (p= 0.001). Decrease of the painful symptomatology and maintenance of the rectification were also observed.

Conclusions:

The individual''s postural position can suffer biomechanical alterations due to stomatognathic alterations, causing clinically visible changes in dysfunctional individuals and affecting the performance of the involved structures.     

TENS AND LOW-LEVEL LASER THERAPY IN THE MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS

Pain relief and reestablishment of normal jaw function are the main goals of conservative management of Temporomandibular Disorders (TMD). Transcutaneous electrical nerve stimulation (TENS) and laser therapy are part of these modalities, although little is known about their real efficacy in controlled studies. This research compared these two treatments in a sample of 18 patients with chronic TMD of muscular origin, divided into two groups (LASER and TENS). Treatment consisted of ten sessions, in a period of 30 days. Active range of motion (AROM), visual analogue scale (VAS) of pain and muscle (masseter and anterior temporalis) palpation were used for follow-up analysis. Data were analyzed by Friedman test and ANOVA for repeated measurements. Results showed decrease in pain and increase in AROM for both groups (p<0.05), and improvement in muscle tenderness for the LASER group. Authors concluded that both therapies are effective as part of TMD management and a cumulative effect may be responsible for the improvement. Caution is suggested when analyzing these results because of the self-limiting feature of musculoskeletal conditions like TMD.     

EXAMINATION OF TEMPOROMANDIBULAR DISORDERS IN THE ORTHODONTIC PATIENT: A CLINICAL GUIDE

The possible association between orthodontic treatment and temporomandibular disorders (TMD) is a topic of great interest in the current literature. The true role of orthodontic therapy on the etiology of TMD, however, is still uncertain. From the clinical prospective, a thorough examination of the stomatognathic system is always necessary in order to detect possible TMD signs and symptoms prior to the beginning of the orthodontic therapy. Caution should be exercised when planning, performing and finalizing orthodontics, especially in patients who with history of signs and symptoms of TMD. The clinician must always eliminate patient’s pain and dysfunction before initiating any type of orthodontic mechanics. Muscle incoordination, unstable disc-condyle relationship and bone alterations are usual TMD conditions that can interfere with the presenting occlusal relationship. This article reviews these aspects and presents a detailed clinical guide for the examination of the orthodontic patient, considering aspects related to facial pain and dysfunction.     

合创伤对家兔颞下颌关节的影响－X线及病理观察

对１１只创伤家兔和６只对照组家兔颞下颌关节的Ｘ线和病理组织学观察，发现创伤后家兔颞下颌关节出现了早期退行性改变，如：髁状突表层胶原纤维变性、松解、与关节盘粘连；增殖带和肥大带变薄；钙化软骨带消失。创伤５月的髁状突Ｘ线也出现明显的变化。表明，创伤可以导致颞下颌关节的退行性改变，从而支持因素为颞下颌关节紊乱综合症诸多致病因素之一的观点。     

正颌外科患者术前的颞下颌关节功能评价

目的　了解正颌患者颞下颌关节 (TMJ)的功能状况 ,探讨牙颌面畸形与颞下颌关节之间的关系。方法正颌外科发育性牙颌面畸形 12 3例患者 ,平均年龄 2 3.8岁 ,男性 45例 ,女性 78例。颞下颌关节功能的检查方法采取问诊与检查相结合 ,颞下颌关节功能记分采取 Helkim o指数记分方法。结果　 (1)牙颌面畸形患者颞下颌关节紊乱病 (TMD)各种症状发生率明显高于对照组人群。(2 )男性患者弹响症状发生率高于女性 ,而女性患者关节触诊疼发生率高。(3) 16～ 2 5岁患者张口受限发生率较高 ,但大多数为轻度张口受限。(4 )不对称畸形 (下颌前突偏斜 )者弹响症状发生率较高 ,而且相应偏斜侧最大侧向移动度小。而下颌后缩组开口度明显小于其他各组 ,提示其关节功能受损较严重。结论　牙颌面畸形患者的颞下颌关节功能不同于正常人 ,部分下颌偏斜与后缩患者关节功能受损     

ASSESSMENT OF TEMPOROMANDIBULAR DISORDER AND OCCLUSION IN TREATED CLASS III MALOCCLUSION PATIENTS

Objective:

The aims of this study were to compare the prevalence of temporomandibular disorders (TMD) in individuals submitted to either orthodontic or ortho-surgical Class III malocclusion treatment and to assess the influence of occlusal aspects on TMD severity.

Material and methods:

The sample consisted of 50 individuals divided into two groups, according to the type of treatment (orthodontic or orthodontic with orthognathic surgery). The presence of signs and symptoms of TMD was evaluated by an anamnestic questionnaire and a clinical examination, including TMJ and muscle palpation, active mandibular range of motion, joint noises and occlusal examination.

Results:

Based on the anamnestic questionnaire, 48% had no TMD, 42% had mild TMD and 10% had moderate TMD. The presence and severity of TMD did not show any relationship with the type of orthodontic treatment (p>0.05). The chi-square test showed a positive association (p<0.05) between TMD and non-working side occlusal interferences.

Conclusion:

Based on the methodology used and the results obtained, it may be concluded that Class III orthodontic treatment was not associated with the presence of TMD signs and symptoms and the non-working side contacts can be occlusal factors of risk. There was no significant difference in TMD prevalence between the studied groups (orthodontically treated patients and patients treated with orthodontics followed by orthognathic surgery).     

VESTIBULAR SCHWANNOMA (ACOUSTIC NEUROMA) MIMICKING TEMPOROMANDIBULAR DISORDERS: A CASE REPORT

Approximately 6 to 16% of patients with trigeminal neuralgia symptoms present intracranial tumors, the most common being the vestibular schwannoma (acoustic neuroma). Some symptoms reported by patients include hearing loss, tinnitus, headaches, vertigo and trigeminal disturbances. An increased muscle response in the surrounding head and neck musculature may also be observed, which mimics signs and symptoms of temporomandibular disorders. In these cases, magnetic resonance imaging (MRI) has proved to be a useful tool in tumor diagnosis. The differential diagnosis between myofascial and neuralgic pain is important, as both may present similar characteristics, while being of different origin, and demanding special treatment approaches. The purpose of this paper is to demonstrate the relationship among trigeminal neuralgia symptoms, intracranial tumors and temporomandibular dysfunction by presenting a clinical case.     

EVALUATION OF THE REPRODUCIBILITY OF TWO TECHNIQUES USED TO DETERMINE AND RECORD CENTRIC RELATION IN ANGLE’S CLASS I PATIENTS

The centric relation is a mandibular position that determines a balance relation among the temporomandibular joints, the chew muscles and the occlusion. This position makes possible to the dentist to plan and to execute oral rehabilitation respecting the physiological principles of the stomatognathic system. The aim of this study was to investigate the reproducibility of centric relation records obtained using two techniques: Dawson’s Bilateral Manipulation and Gysi’s Gothic Arch Tracing. Twenty volunteers (14 females and 6 males) with no dental loss, presenting occlusal contacts according to those described in Angle’s I classification and without signs and symptoms of temporomandibular disorders were selected. All volunteers were submitted five times with a 1-week interval, always in the same schedule, to the Dawson’s Bilateral Manipulation and to the Gysi’s Gothic Arch Tracing with aid of an intraoral apparatus. The average standard error of each technique was calculated (Bilateral Manipulation 0.94 and Gothic Arch Tracing 0.27). Shapiro-Wilk test was applied and the results allowed application of Student’s t-test (sampling error of 5%). The techniques showed different degrees of variability. The Gysi’s Gothic Arch Tracing was found to be more accurate than the Bilateral Manipulation in reproducing the centric relation records.