Efectividad de Férulas de Descarga Oclusivas como Tratamiento para la Disfunción Temporomandibular. Revisión Sistemática

El objetivo de este estudio de revisión sistemática consistió en la búsqueda de hallazgos clínicos en estudios de calidad sobre la efectividad de la terapia con férulas de descarga oclusales. Esta investigación bibliográfica se realizó en PubMed, Embase, SciELO, Science Direct, Scopus, Google Scholar y en el Registro Central de Ensayos clínicos Cochrane; delimitando la búsqueda desde el 1 de enero de 2011 al 1 de junio de 2022. Se incluyeron un total de 21 artículos, todos relacionados con la disfunción de la articulación temporomandibular y la eficacia de las férulas de descarga oclusales como tratamiento. Las férulas de descarga oclusales reducen eficazmente los síntomas dolorosos en pacientes con trastornos temporomandibulares, tanto en patologías musculares como articulares, aunque con mayor eficacia en casos de disfunción muscular, ya que se han observado desplazamientos recurrentes de disco en patologías articulares.

The objective of this systematic review study was to search for clinical findings in quality studies on the effectiveness of occlusal splint therapy. This literature search was conducted in PubMed, Embase, SciELO, Science Direct, Scopus, Google Scholar, and the Cochrane Central Register of Clinical Trials; delimiting the search from January 1, 2011 to June 1, 2022. A total of 21 articles were included, all related to temporomandibular joint dysfunction and the efficacy of occlusal splints as a treatment. Occlusal splints effectively reduce painful symptoms in patients with temporomandibular disorders, both in muscular and joint pathologies, although more effectively in cases of muscular dysfunction, since recurrent disc displacements have been observed in joint pathologies.

Relación entre oclusión, bruxismo y cefalea tensional en niños: Reporte de casos

La cefalea es uno de los motivos de consulta más frecuente en nuestros pacientes, presentando una alta prevalencia en niños en edades escolares y adolescentes. El objetivo de este reporte de casos es describir casos de niños entre 6 y 13 años, quienes presentan cefalea tensional crónica. Al examen clínico se observa maloclusión, dolor a la palpación de músculos masticatorios y bruxismo. Todos los pacientes tenían características comunes en su personalidad, siendo perfeccionistas, estudiosos y preocupados. La terapia que se les realizó fue la confección de una férula oclusal orgánica, construida en relación céntrica, y se controlaron cada 15 días. Luego de un mes de tratamiento los pacientes mostraron una remisión total de las cefaleas y de la contractura muscular, llegando a la conclusión de que los planos de relajación sirven para aliviar la cefalea tensional en niños con bruxismo y maloclusión, siempre realizando un correcto diagnóstico previo.

Headache is one of the most frequent reasons for consultation in our patients, with a high prevalence in school-age children of and adolescents. The objective of this case report is to present cases of children between 6 and 13 years old, who have chronic tension headache. On clinical examination, malocclusion, palpation of masticatory muscles and bruxism were observed. All the patients had common characteristics in their personality, being perfectionists, studious and concerned. The therapy consisted of the preparation of an occlusal splint, with partial or total coverage depending on the case, and they were monitored every 15 days. After one month of treatment, the patients showed a total remission of headaches and muscle contracture, concluding that occlusal splints can relieve tension headache in children with bruxism and malocclusion, always with a correct previous diagnosis.

Placas oclusais termoplásticas para o tratamento da dor muscular mastigatória: um ensaio clínico / Thermoformed occlusal splints for the treatment of masticatory muscle pain: a clinical trial

Objective: Compare the clinical effectiveness of custom thermoformed occlusal splints (OS) alongside behavioral and self-care therapy (BST) in the management of myalgia of the masticatory muscles. Material and methods:A controlled clinical trial was conducted with a total of 46 subjects with a diagnosis of myalgia according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). All subjects were treated with BST at the beginning of the study and were then randomized into four groups: behavioral and self-care control group; Thermoformed Tough-elastic splint group; Thermoformed Soft-elastic splint group, and non-occlusive splint group. Follow-ups were carried out at 2, 6, and 10 weeks, where it was evaluated: pain in the masticatory muscles, mandibular range of motion, mandibular functional limitation, and occlusal discomfort. Data were analyzed with Doornik and Hansen, Shapiro­Wilk, and ANOVA at p=0.05. Results: All the variables showed significant improvement (p<0.05) from the first follow-up and were maintained later. BST control group, as well as groups with BST associated with OS, were able to reduce pain and increase the mandibular range of motion without significant differences between them (p>0.05), while the Thermoformed Tough-elastic splint was the most efficient in terms of the mandibular functional limitation. The occlusal discomfort decreased over time, but without statistically significant differences in terms of time and design of OS. Conclusion: The addition of thermoformed OS to behavioral and self-care therapy does not have a significant impact on myalgia of the masticatory muscles. (AU)

Objetivo: Comparar a eficácia clínica das Placas Oclusais (PO) termoplásticas personalizadas associadas à Terapia Cognitiva Comportamental (TCC) na condução da mialgia dos músculos mastigatórios. Material e Métodos: Foi realizado um ensaio clínico controlado randomizado com um total de 46 participantes com um diagnóstico de mialgia de acordo com os Critérios de Diagnóstico das Desordens Temporomandibulares (DC/TMD). Todos os participantes foram tratados com a TCC, no início do estudo, e foram, depois, randomizados em quatro grupos: grupo controle Terapia Congnitivo Comportamental; grupo de placa termoplástica dura-soft, grupo de placa termoplástica soft, e grupo de placa sem cobertura oclusal. Foram realizados controles com 2, 6, e 10 semanas, onde foi avaliado: dor nos músculos mastigatórios, amplitude de movimento mandibular, limitação funcional mandibular, e desconforto oclusal. Os dados foram analisados com Doornik e Hansen, Shapiro-Wilk, e ANOVA a p=0,05. Resultados: Todas as variáveis mostraram melhora significativa (p<0,05) desde o primeiro controle e se mantiveram posteriormente. O grupo de controlo da TCC, bem como os grupos com TCC associada a PO, foram capazes de reduzir a dor e aumentar a amplitude de movimento mandibular sem diferenças significativas entre eles (p>0,05), enquanto que, a placa termoplástica dura-soft, foi a mais eficiente em termos da limitação mandibular funcional. O desconforto oclusal diminuiu ao longo do tempo, mas, sem diferenças estatisticamente significativas em termos de tempo e design da PO. Conclusão: A inclusão da Terapia Cognitivo Comportamental à PO termoplástica não tem um impacto significativo na mialgia dos músculos mastigatórios.(AU)

Avaliação eletromiográfica da musculatura mastigatória e da coluna cervical com uso de placa oclusal: relato de caso / Electromyographic evaluation of masticatory and cervical musculature with occlusal splint: case report

Objetivo: Avaliar a atividade elétrica de músculos mastigatórios e cervicais e sua inter-relação na estabilização da cadeia crânio cervico umeral com uso da placa oclusal, por meio da avaliação eletromiográfica. Relato de caso: Paciente sexo feminino, 39 anos, queixando-se de dores na cabeça, faciais e cervicais, com prejuízo em suas atividades diárias. Relatou apertar os dentes durante o dia e a noite e ser uma pessoa muito ansiosa. Pratica exercício físico de 5 a 6 vezes por semana. Foi submetida ao tratamento com placa oclusal estabilizadora. O exame eletromiográfico foi realizado nos músculos masseter e trapézio, bilateralmente. A coleta de dados foi realizada antes da instalação da placa e passados 90 dias de uso. Considerações finais: Após o tempo de tratamento, foi relatado redução do comportamento de apertamento noturno e diurno dos dentes, redução do nódulo muscular antes visível na região supraescapular, eliminação das dores e melhor rendimento muscular durante a prática de atividade física.(AU)

Objective: To evaluate the electrical activity of masticatory and cervical muscles and their relationship in the stabilization of the craniocervicohumeral chain using a occlusal splint, through electromyographic evaluation. Case report: Female patient, 39 years old, complaining of headaches, facial and cervical pain, with impairment in her daily activities. She reported teeth clenching during the day and night, and being a very anxious person. She practices physical exercise 5 to 6 times a week. She underwent treatment with a stabilizing occlusal splint. The electromyographic examination was performed on the masseter and trapezius muscles, bilaterally. Data was collected before occlusal splint installation and after 90 days of use. Final considerations: After the treatment period, it was reported a reduction in the behavior of nocturnal and daytime teeth clenching, reduction of the muscle nodule previously visible in the suprascapular region, elimination of pain and better muscle performance during the practice of physical activities.(AU)

Occlusal Splint: A Vital Adjunct in Full Mouth Rehabilitation for Cases of Severely Worn Dentition

Introduction: Excessive wear of dentition results infunctional disharmony, loss of esthetics, pulpal injuries andcompromises longevity of dentition adversely. The etiologicalfactors of tooth wear may be abrasion, attrition, or erosionacting individually or in combination.Case Report: The present case report emphasizes the use ofa ‘sectional occlusal verticalization splint’, as a guide for fullmouth rehabilitation. As the treatment plan envisaged wasocclusal rehabilitation using reorganized approach, sectionalsplint offered the advantage of restoring the exact amount ofvertical dimension to which patient had got programmed. Thevertical dimension was maintained during various phases ofsegmental technique using sectional splint.Conclusion: Although there are plethora of philosophiesand techniques available for full mouth rehabilitation thereis a limited evidence-based literature on a particular methodfor exact restoration of vertical dimension. Also, due topresence of many hard and soft tissues variables in humanstomatognathic system, making various occlusal records andrepeated transfer to mechanical articulator may introduceerrors. Therefore, an occlusal ‘verticalization splint’, wellaccepted by patients stomathognathic dynamics, may act asthe best guide to restore vertical dimension with an addedadvantage of reduction in errors due to omission of varioussteps of occlusal recordings, transfers and use of mechanicaldevices.

Freely available or over-the-counter occlusal splints obtainable in commercial outlets: a reality dentists should know

Aim and objective: bruxism is defined by The american sleep disorders association as "tooth grinding during sleep plus tooth wear, sounds or jaw muscle discomfort in absence of medical disorder. people are obtaining over the counter splints (OTC) as a possible alternative to manage bruxism without the need for dental assessment. the aim of this study is survey OTC bruxism splints available in Chile through the internet or other commercial outlets, categorize their characteristics, claims, safety warnings and contrast it with scientific evidence. materials and methods: an internet search was made for OTC bruxism splints available in Chile. only chilean domains were evaluated. information recorded was manufacture, name of the device, splint design, material, adjustability, price, claims and safety warnings. results: five devices were found in our search. only one is from a chilean laboratory, being the most accessible. all devices have a full coverage splint design. the material made of is only described in one and their prices in the market are very dissimilar. the most usual advertising was "eliminate bruxism. stop night-time Grinding & Clenching". two manufactures suggest that the device will help to sleep better. no manufacture provided a guide for how long each day the splint must be worn. conclusion: dentists should be aware to keep this market in mind when reviewing patients if there have been unexplained occlusal changes or other problems. bruxism is often a long-term problem and with any type of bruxism appliance the importance of regular review by a professional is critical.

Guarda oclusal gnatológica: técnica de elaboración, procesado y polimerizado por microondas / Gnathological occlusal guard: technique of elaboration, processing and polymerization by microwaves

Los trastornos temporomandibulares (TTM) constituyen un problema en la población en general cuyos signos y síntomas tienen un carácter multifactorial que debe ser abordado de manera interdisciplinaria para poder brindar una mejor oportunidad de éxito y estética en los tratamientos. Las guardas oclusales forman parte del tratamiento en los TTM, se deben conocer sus indicaciones, contraindicaciones, ventajas y desventajas, debido a que las guardas oclusales cumplen ciertas funciones y objetivos. La guarda oclusal elaborada por la técnica de polimerización en microondas (GOTMI) reduce signifi cativamente el tiempo de elaboración en el laboratorio, proporciona un aparato de alta calidad y baja porosidad. La GOTMI es un aparato que proporciona un método indirecto y no invasivo modifi cando la oclusión, recuperando el tejido u órganos dentales perdidos, reorganiza la actividad refl eja neuromuscular, relaja la musculatura, promueve el reposicionamiento del disco articular, protege los dientes, oclusión y estructuras de sostén periodontal, además de mejorar la estética y la autoestima del paciente. La GOTMI disminuye el dolor en la ATM y la neuromusculatura, proporciona alivio a las cefaleas tensionales, elimina las interferencias oclusales, es un distribuidor de fuerzas oclusales, además de provocar un mayor número de contactos de igual intensidad de fuerza contra la superfi cie oclusal en todos los dientes. Existen varios métodos para la confección de las guardas oclusales, en el presente trabajo se describe la elaboración de una guarda oclusal programada con los principios de oclusión orgánica. La técnica de polimerización por microondas es innovadora debido a que este proceso consiste en la generación de calor dentro de la resina mediante ondas electromagnéticas producidas por un generador llamado magnetrón. Las moléculas de metilmetacrilato son capaces de orientarse por el campo electromagnético a una frecuencia de 2,450 MHz, y cambian su dirección cinco billones de veces por segundo aproximadamente, lo que implica numerosas colisiones intermoleculares y causa una rápida polimerización (AU)

Temporomandibular disorders (TMD) are a problem in the general population whose signs and symptoms have a multifactorial character that must be addressed by an interdisciplinary team to provide a better chance of success and aesthetic treatments. Occlusal guards are part of TMD treatment, you should know the indications, contraindications, advantages, and disadvantages, because the occlusal guards perform certain functions and objectives. The occlusal guard by Iztacala modifi cation provides an indirect and noninvasive method modifying occlusion, recovering the lost dental tissue or organs, reorganizes the neuromuscular refl ex activity, relaxes the muscles, promotes articular disc repositioning, protecting the teeth and supporting occlusion structures, it also improves aesthetics and self-esteem. The occlusal guard Iztacala modifi cation has the advantage of decreasing TMJ pain, provides relief to tension headaches, elimination of occlusal interferences, is a distributor of occlusal forces as well as causing a greater number of contacts equal intensity of force against the occlusal surface of all teeth. There are several methods for the fabrication of occlusal guards, in this paper the development of an occlusal guard programmed with the principles of organic occlusion is described, using as a basis a rigid acetate and acrylic for programming, in addition to providing your cosmetic use and function. The acquisition or denial of treatment with an occlusal splint depends on the choice, preparation, occlusal guard adjustment and patient cooperation (AU)

Influence of dental occlusion on the athletic performance of young elite rowers: a pilot study

OBJECTIVES: The present study aimed to assess the influence of dental occlusion on body posture and the competitive performance of young elite rowers. METHOD: Dental occlusion disturbance devices were used to simulate dental malocclusions. We assessed the influence of malocclusion on the body balance, paravertebral muscle contraction symmetry, and muscular power of young elite rowers. A nonparametric permutation test for repeated measures ANOVA, a Cochran's Q test for paired data and a paired Student's t-test were used in order to statistically evaluate the influence of artificial occlusal disturbance on each factor. A force platform and a Dyno Concept 2 machine were used as measuring instruments. RESULTS: A total of 7 members of the "Pôle France Aviron" (age range of 15-17 years) were enrolled in the study. None of the body balance parameters was significantly influenced by the artificial occlusal disturbance. The interposition of an occlusal silicone splint significantly increased the proportion of athletes presenting asymmetric muscular contractions from 14.3% to 85.7% (p=0.025) and induced a significant 17.7% decrease in the athletes' muscular power (p=0.030). CONCLUSIONS: This study shows the negative impacts of an occlusal disturbance on the athletic performance of young elite rowers. The detection of malocclusion traits by regular occlusal monitoring would be of great interest in this population.

Comparação dos dispositivos interoclusais rígido e resiliente no tratamento do bruxismo: revisão de literatura / Comparison of hard and soft interoclusal splints in the treatment for bruxism: literature review

O bruxismo é definido pelo ranger e/ou apertar dos dentes, que pode provocar sinais e sintomas orofaciais como desgaste dental e dor. O dispositivo interoclusal tem sido a primeira escolha para controle do bruxismo, por ser reversível e de baixo custo, entretanto questiona-se sobre qual o material de fabricação dos dispositivos seja mais eficaz. O objetivo deste trabalho foi revisar sobre os tipos de dispositivo interoclusal, rígido ou resiliente, no tratamento desse hábito parafuncional. Foi realizada uma pesquisa bibliográfica através de uma busca computadorizada nas bases de dados Pubmed, Medline, Lilacs e Cochrane com os descritores "treatment bruxism", "splint occlusal", "hard", "soft" que foram cruzados nos mecanismos de busca. Para a inclusão no estudo, os artigos selecionados foram submetidos a uma revisão e como critérios de inclusão deveriam discorrer sobre o bruxismo e/ou terapêuticas com dispositivos oclusais rígidos e/ou resilientes e redigidos na língua inglesa ou portuguesa. Foram analisados artigos publicados de 1984 até a atualidade, sendo que apenas 9 artigos comparavam a utilização dos diferentes materiais. Com base nas evidencias científicas pesquisadas, investigou-se a ação dos dispositivos rígidos e resilientes sobre atividade muscular, força oclusal, distribuição de tensões sobre as superfícies dentais, e sinais e sintomas associados ao bruxismo. Finalmente, notou-se que ambos os dispositivos são eficazes na redução dos sinais e sintomas associados ao bruxismo, entretanto o dispositivo rígido apresenta melhores resultados na redução da atividade muscular, e o dispositivo interoclusal resiliente mostra-se mais eficaz na redução da força oclusal, e distribuição das tensões sobre as estruturas dentais(AU)

Bruxism is defined as grinding and / or tightening of teeth, which can cause orofacial signs and symptoms such as tooth wear and pain. The interocclusal splint has been a first choice to control bruxism, because it is reversible and inexpensive, but it's not clear about the quality of the material of manufacture of the splint. The objective of this work was to review the types of interocclusal splint, hard or soft, to treat the parafunctional habits. A bibliographic search was realized through a computerized search in the databases Pubmed, Medline, Lilacs and Cochrane with the descriptions "bruxism of treatment", "occlusal splint", "hard", "soft". For this study, the articles selected was reviewed and the inclusion criteria was bruxism and / or therapeutics with hard and / or soft occlusal splints written in English or Portuguese. We had analyzed articles published from 1984 until now, and only 9 articles compared a use of different materials. Based on the scientific evidences researched, it was investigated the action of the hard and soft splint on the muscular activity, occlusal force, distribution of tensions on dental surfaces and signs and synonym of association with bruxism. Finally, it was observed that both splints are effective in reducing the signs and symptoms of bruxism; however, the hard splint has better results in reducing muscle activity, and the soft splint is more effective in reducing occlusal strength, and stresses distribution on dental structures(AU)

Counseling and oral splint for conservative treatment of temporomandibular dysfunction: preliminary study / Aconselhamento e dispositivo interoclusal para tratamento conservador da disfunção temporomandibular: estudo preliminar

Introduction: Temporomandibular Disorders (TMD) involve the masticatory muscles, temporomandibular joint (TMJ) or both. The most common symptom is pain, which is usually located in the muscles of mastication, pre-auricular region, and / or ATM, especially during mandibular function. The main treatment for TMD is related to pain relief. Objective: The purpose of this case report was to evaluate the reduction of pain symptoms using Visual Analogue Scale (VAS) of patients with TMD treated with counseling and use of occlusal splint (OS). Material and method: 16 subjects had participated in this study, that was composed by 4 appointment with 7-day interval between each (CEP FOP / Unicamp - 137/2009). In the first, an examiner used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) to diagnose each patient and delivered a VAS to register the intensity of daily pain. In the second, counseling, molding of both dental arcs to fabricate the OS and the delivery of new VAS were performed. In the third, there was the installation and adjustment of the OS and the delivery of another scale, and in the last, possible adjustments on the OS were done. Data were analyzed by ANOVA two way and Tukey post-test at 5% significance level. Result: There was significant difference when comparing the intensity of pain of individuals after installation of splint with the baseline data and after counseling (p = 0.05). Conclusion: According to the result of this study, the treatment of TMD associating counseling occlusal splint is effective in reducing pain intensity.

Introdução: As desordens temporomandibulares (DTM) envolvem a musculatura mastigatória, as articulações temporomandibulares (ATM) ou ambas. O sintoma mais frequente é a dor, geralmente localizada nos músculos da mastigação, na região pré-auricular, e/ou na ATM, principalmente durante as funções mandibulares. O tratamento principal para pacientes com DTM consiste no alívio da dor. Objetivo: O objetivo deste estudo de relato de casos foi avaliar a redução da sintomatologia dolorosa, utilizando Escala Visual Analógica (EVA), de pacientes com DTM por meio do aconselhamento e utilização de dispositivos interoclusais (DI). Material e método: Um total de 16 indivíduos participaram deste estudo, composto de 4 consultas com intervalo de 7 dias entre cada uma delas (CEP FOP/Unicamp - 137/2009). Na primeira consulta, foi realizado o diagnóstico através do questionário para diagnóstico de DTM, o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) e entregue a EVA para registrar a intensidade de dor diária. Na segunda consulta, foi realizado o aconselhamento, moldagem para confecção dos DI e a entrega de nova EVA. Na terceira, houve a instalação e ajuste dos DI e a entrega de outra escala, e na última, realização de possíveis ajustes dos DI. Os dados foram analisados por meio do ANOVA a 2 critérios e utilizado o pós-teste de Tukey, com nível de significância de 5%. Resultado: Observou-se diferença significante quando se comparou a intensidade de dor dos indivíduos após instalação dos DI com as informações inicias da pesquisa e após o aconselhamento (p=0,05). Conclusão: A partir dos dados obtidos, pode-se concluir que o tratamento de DTM por meio do DI, seguido do aconselhamento, é eficaz na redução da intensidade da dor.

Efecto de los dispositivos oclusales sobre la vía aérea en pacientes con bruxismo / Effects of occlusal splints on upper airway in bruxism therapy

Objetivo Para el manejo de los trastornos temporomandibulares y del bruxismo de sueño (BS) se ha recurrido durante años a los dispositivos oclusales rígidos superiores (DORS). Estos dispositivos podrían modificar la posición de la mandíbula induciendo una posición más posterior de la lengua y del hueso hioides, comprometiendo la permeabilidad de la vía aérea superior y agravando los trastornos respiratorios del sueño. Este trabajo tiene como objetivo evaluar el cambio de las dimensiones lineales y de área de la luz de la vía aérea faríngea en pacientes diagnosticados con BS que estén usando un DORS, mediante una telerradiografía lateral. Metodología Se reclutaron 20 pacientes del Hospital de Carabineros, de ambos sexos, diagnosticados con BS probable manejados con un DORS, a los cuales se les tomó una telerradiografía lateral sin DORS y otra con DORS sin modificar la postura para evitar distorsiones por posición craneocervical. Se analizó el área y profundidad faríngea por medio de cefalometría para medir el espacio faríngeo. Resultados Se observaron diferencias estadísticamente significativas en la disminución del área de la orofaringe (promedio: 41,2 mm2, p = 0,035) y la profundidad al nivel del gonion (promedio: 0,38 mm, p = 0,019) y la úvula (promedio: 1,38 mm, p = 0,009). No se encontró correlación entre el aumento de la dimensión vertical y las diferencias dimensionales. Conclusión Bajo las condiciones de este estudio el uso de un DORS produce una tendencia a la disminución del área y profundidad orofaríngea.

Objective The use of the superior rigid occlusal splint (SROS) has been used to management temporomandibular disorders and sleep bruxism for many years. These SROS could change the mandibular position leading to a more posterior position of the tongue and hyoids bone, and compromising the upper airway flow permeability and make sleep-breathing disorders worse. The aim of this study is to evaluate the linear and area changes of lumen in patients with sleep bruxism who are using a SROS, measured by lateral teleradiograph. Methodology The study included 20 patients, of both sexes, from the Hospital de Carabineros, Chile, who were diagnosed with probable sleep bruxism due to using and SROS. The cephalometric analysis was performed of the area and pharyngeal depth in order to measure the pharyngeal space, by obtaining a lateral teleradiograph without SROS and a second teleradiograph using SROS, at the same time, to avoid dimensional variation due to possible craniocervical positional changes. Results A statistical significance was found for oropharynx reduction (mean: 41.2 mm2, P = .035), for the gonion linear depth (mean: 0.38 mm, P = .019), and at uvula level (mean: 1.83 mm, P = .009). No correlations were found between the increasing vertical dimensions using SROS and pharyngeal spaces. Conclusion The using of a superior occlusal splint (SROS) could reduce the oropharyngeal depth and space.

Influence of the interocclusal splint in condylar position of patientswith tmd: a cone beam computed tomography study / Influência da placa interoclusal na posição condilar de indivíduos com dtm: um estudo por tomografia de feixe cônico

Objective: The aim of this study was to evaluate the condylar position in patients with intra-articular temporomandibular disorders (TMD) before, during and after treatment with interocclusal stabilization splint (ISS) through cone beam computed tomography (CBCT). Material and Methods: Twenty-two patients diagnosed with intra-articular TMD (Research Diagnostic Criteria for Temporomandibular Disorders - Group II) were submitted to the therapy with ISS during 90 days. Three CTCB exams were performed in three moments: T1 (initial moment, before the ISS therapy, with the patient in dental occlusion), T2 (after 90 days of treatment, in occlusion on the ISS) and T3 (after 90 days of treatment, with the patient in dental occlusion). Afterwards the anterior (AS), superior (SS) and posterior articular spaces (PS) in sagittal sections were then measured and the data were statistically analyzed using the t-test. Results: There was a statistically significant increase in the comparison between T1 and T2 for the AS and PS (p < 0.0001), between T3 and T2 for AS (p = 0.0008) and PS (p < 0.0001). In comparison T1 /T3 there was a significant increase in AS (p = 0.01) and SS (p = 0.04), and non-significant in PS (p = 0.89). Conclusion: The interocclusal splint provides temporary changes in condylar position, with a tendency to increase the joint space, varying in accordance with individual characteristics. Therefore, it should not be used as a single therapy, but combined with other strategies that include the TMD multidimensionality. The interocclusal splint has proved to be reversible and conservative therapeutic modality, as it does not generate permanent changes in joint tissues.

Objetivo: O objetivo deste estudo foi avaliar a posição condilar em pacientes com disfunção temporomandibular (DTM) articular antes e após tratamento com placa oclusal estabilizadora (POE) por meio de tomografia computadorizada de feixes cônicos (TCFC). Material e Métodos: Vinte e dois pacientes diagnosticados com DTM articular (Research Diagnostic Criteria for Temporomandibular Disorders – Grupo II) foram submetidos à terapia com POE durante 90 dias. Foram realizados três exames de TCFC: T1 (momento inicial, antes da terapia com POE, na posição de oclusão dental), T2 (após 90 dias de tratamento em oclusão na POE) e T3 (após 90 dias de tratamento, em oclusão dental). Foram então mensurados o espaço articular anterior (EAA), superior (EAS) e posterior (EAP) em cortes sagitais. Os dados foram analisados estatisticamente por meio do teste t. Resultados: Houve aumento estatisticamente significante na comparação entre T1 e T2 para o EAS e EAP (p < 0,0001), entre T3 e T2 para EAS (p = 0,0008) e EAP (p < 0,0001). Na comparação entre T1 e T3 houve aumento significante no EAA (p = 0,01) e EAS (p = 0,04), e não significante no EAP (p = 0,89). Conclusão: A placa interoclusal promove alterações temporárias na posição condilar, com tendência de aumentar o espaço articular, variando de acordo com características individuais. Portanto, ela não deve ser utilizada como terapia única, e sim combinada com outras estratégias que abordem a multidimensionalidade da DTM. A placa interoclusal provou ser uma terapia reversível e conservadora, já que não gera alterações permanentes nos tecidos articulares.

Occlusion changes of the young subjects with bruxism before and after treatment by elastic occlusal splint / 实用口腔医学杂志

Objective:To study the occlusion characteristics of the young subjects with bruxism before and after treatment by elastic occlusal splint. Methods:10 patients with bruxism and aged 22-27 years(n=10) were treated by elastic occlusal splint, before and 6 months after treatment they were examined by T-Scan occlusion detector. The occlusion time( OT) , disclusion time( DT) , oc-clusion force( OF) , the perentage of occlusion force( POF) , the changes of the position of center occlusal force( COF) and the asym-metry index of occlusion force(AOF) were observed and compared with those of the healthy controls(n=10). Results: ① In the case group there was significant difference in the OT and DT between left and right anterior teeth before treatment (P0. 05). There was significant difference in the momevent of COF of left and right side, the POF of right side and the AOF between the 2 groups before treatment, but not after the treatment(P>0. 05). ② In the case group after treatment the OT and DT of left and right anterior teeth were shortened(P0. 05). Conclusion:The occlusal factors such as early contact, lateral teeth synthetic interference, occlusal force center excursion have close relationship with bruxism. Elastic occlusal splint can effectively correct muscle dysfunction and make occlusal relationship more coordinated and stable, and therefore is effective in the treatment of bruxism.

A Systematic Approach for Splint Fabrication in Orthognathic Surgery: Case Series.

Orthognathic surgery involves the surgical manipulation of the facial skeleton to correct anatomical and functional deformities. Model surgery is an integral part of orthognathic surgery. It gives the three-dimensional understanding of the post-operative relationship of the jaws. Orthognathic model surgery has been used to assist the surgeon in repositioning the upper and lower jaws into a predicted position. Model surgery planning has generally been carried out using one of two techniques - The lock wood key spacer technique or Eastman Dental Hospital anatomically orientated model surgery technique. This work presents our experiences in model surgery using modified Eastman’s technique.

Variations in soft facial tissue by using the interocclusal stabilization splint: 3D stereophotogrammetry / Variações de tecido mole facial com o uso de placa interoclusal: estereofotogrametria 3D

To analyze variations in soft facial tissue by using the interocclusal stabilization splint(ISS) through the 3D stereophotogrammetry technique in a group of young women with temporomandibular disorder (TMD). Material and Methods: 20 females between 20 and 60 years of age (39.3 ± 12.5) and TMD diagnosis based on the criteria of the RDC/TMD, received treatment with ISS. Reference points were marked on the face and photos were performedt wice using the Vectra (M3–Canfield®): with and without ISS. In the 3D images the following variables were measured: area of the cheeks and lips (cm3), linear labial distances (Ls-Cph, Cph-Ch,Li-Ch, Ls-Li, Ch-Ch), lower third of the face (Sn-Me), height of the upper lip (Sn-Ls)/lower (Li-Me) and the angles C-Sn-Ls, N-Sn-Pg and Li-Sl-Pg. The data were analyzed in a descriptive manner, the times with and without ISS were comparedusing the t-test and the Pearson’s correlation was employed in order to correlate the ISS thick nesswith the facial measurements (5% significance). Results: A statistically significant difference was found only for the variables of the lip area (p =0.01) and Ls-Li (p = 0.006) in comparison with/without ISS. No correlation was found between the ISS thickness and the lip area for both facesides, right (p = 0.7; r = 0.07) and left (p = 0.9;r = -0.001). Conclusion: The use of inter occlusal stabilization splint does not provide large changesin facial morphology, with the exception of the liparea and height...

Analisar as variações de tecido mole facial durante o uso de placa inter oclusal estabilizadora(POE) por meio da técnica de estereofotogrametria 3D em um grupo de mulheres jovens com disfunção temporomandibular (DTM). Material e Métodos: 20 pacientes do gênero feminino, com idade entre 20 e 60 anos (39,3 ± 12,5) e diagnóstico de DTM com base nos critérios do RDC/TMD, receberam tratamento com POE. Foram então demarcados pontos de referência na face e realizada tomada fotográfica por meio do aparelho Vectra (M3–Canfield®) em dois momentos:com e sem placa. Nas imagens 3D foram mensuradas as seguintes variáveis: área das bochechas e dos lábios(cm3), distâncias labiais lineares (Ls-Cph, Cph-Ch,Li-Ch, Ls-Li, Ch-Ch), terço inferior da face (Sn-Me),altura do lábio superior (Sn-Ls) e inferior (Li-Me); e os ângulos C-Sn-Ls, N-Sn-Pg e Li-Sl-Pg. Os dados foram analisados de forma descritiva, os momentos com e sem placa foram comparados por meio do Teste T-Student, foi também empregado o Teste de Correlação de Pearson, a fim de correlacionar a espessura da placa com as medidas faciais obtidas (significância 5%). Resultados: Foi encontrada diferença estatística apenas para as variáveis área do lábio (p = 0,01) e Ls-Li (p = 0,006) na comparação com/sem placa. Não foi encontrada correlação entre a espessura da placa e a área do lábio para ambos os lados da face, direito(p = 0,7; r = 0,07) e esquerdo (p = 0,9; r = -0,001).Conclusão: A utilização da placa oclusal não gera grandes alterações na morfologia facial, com exceção da área e altura de lábios...

Evaluation of stabilizing plate therapeutic effects on different types of temporomandibular disorders - painful evolution of patients treated in a reference center / Avaliação dos efeitos terapêuticos da placa estabilizadora nos diferentes tipos de desordens temporomandibulares – evolução sintomatológica de pacientes atendidos em um centro de referência

Objective: Evaluation of the symptomatic outcome of patients of various types of TMD treated exclusively with stabilizing plate for a period of three months patients comparing painful muscle and joint symptoms , and clinical aspects , both before and after treatment periods. Material and methods: A retrospective study of medical records of 628 rescue the last ten years (2004 – 2013) of subjects treated at the Serviço de Diagnóstico e Orientação a pacientes com Desordem Temporomandibular (Serviço ATM), Faculty of Dentistry/UFJF. The sample was divided into subgroups distinct diagnoses, in which the evaluation of symptomatic progression of patients through the analysis of pain scores, measuring the amplitude of mouth opening and the presence of joint sounds was performed. Data were obtained in early stages and after treatment with stabilizing plate. Results: The group of individuals diagnosed with muscular disorder (47.45 %) and those with multiple diagnoses (3.34 %) had a higher prevalence of chronic orofacial pain (90.26 % and 95.23 %). The remission of painful symptoms was visible in groups accompanied by increased amplitude of mouth opening. Additional way, we obtained reduction joint sounds in patients with intracapsular and degenerative disorders, respectively. Conclusion: The stabilizing plate has shown efficacy in various types of temporomandibular disorders evaluated. However, in an attempt to encompass all etiological factors in therapy, emphasizes the importance of multidisciplinary therapies for the treatment of temporomandibular disorders...

Objetivo: Avaliação da evolução sintomatológica de pacientes com diagnósticos de DTM, tratados exclusivamente com a placa estabilizadora durante um período de 3 meses, comparando a sintomatologia dolorosa muscular e articular, assim como aspectos clínicos, nos períodos anterior e posterior ao tratamento. Material e métodos: Foi realizado um estudo retrospectivo com avaliação de 628 prontuários dos últimos dez anos (2004 – 2013) de pacientes atendidos no Serviço de Diagnóstico e Orientação a pacientes com Desordem Temporomandibular (Serviço ATM) da Faculdade de Odontologia/UFJF. A amostra foi dividida em subgrupos diagnósticos distintos, nos quais foi realizada a avaliação da evolução sintomatológica dos pacientes por meio da análise de escores de dor, mensuração de amplitude da abertura bucal e presença de ruídos articulares. Os dados foram obtidos em momentos iniciais e após o tratamento com placa estabilizadora. Resultados: O grupo dos indivíduos diagnosticados com desordem muscular (47,45%) e aqueles com diagnósticos múltiplos (3,34 %) apresentaram maior prevalência de dor crônica orofacial (90,26 % e 95,23 %). A remissão da sintomatologia dolorosa foi visível nos grupos estudados acompanhada de aumento de amplitude de abertura bucal. De modo adicional, obteve-se redução ruídos articulares em pacientes com DTM intracapsulares e degenerativas, respectivamente. Conclusão: A placa estabilizadora mostrou eficácia nos variados tipos de desordens temporomandibulares avaliadas. Contudo, na tentativa de englobar todos os fatores etiológicos na terapêutica, ressalta-se a importância de terapias multidisciplinares para tratamento das desordens temporomandibulares...

Evaluation of the effect of two different occlusal splints on maximum occlusal force in patients with sleep bruxism: a pilot study

PURPOSE: The occlusal splint has been used for many years as an effective treatment of sleep bruxism. Several methods have been used to evaluate efficiency of the occlusal splints. However, the effect of the occlusal splints on occlusal force has not been clarified sufficiently. The purpose of this study was to evaluate the effect of occlusal splints on maximum occlusal force in patients with sleep bruxism and compare two type of splints that are Bruxogard-soft splint and canine protected hard stabilization splint. MATERIALS AND METHODS: Twelve students with sleep bruxism were participated in the present study. All participants used two different occlusal splints during sleep for 6 weeks. Maximum occlusal force was measured with two miniature strain-gage transducers before, 3 and 6 weeks after insertion of occlusal splints. Clinical examination of temporomandibular disorders was performed for all individuals according to the Craniomandibular Index (CMI) before and 6 weeks after the insertion of splints. The changes in mean occlusal force before, 3 and 6 weeks after insertion of both splints were analysed with paired sample t-test. The Wilcoxon test was used for the comparison of the CMI values before and 6 weeks after the insertion of splints. RESULTS: Participants using stabilization splints showed no statistically significant changes in occlusal force before, 3, and 6 weeks after insertion of splint (P>.05) and participants using Bruxogard-soft splint had statistically significant decreased occlusal force 6 weeks after insertion of splint (P<.05). There was statistically significant improvement in the CMI value of the participants in both of the splint groups (P<.05). CONCLUSION: Participants who used Bruxogard-soft splint showed decreases in occlusal force 6 weeks after insertion of splint. The use of both splints led to a significant reduction in the clinical symptoms.

El arco facial en la elaboración de las férulas oclusales tipo Míchigan / Face bows in the production of Michigan occlusal splints

Introducción: la férula oclusal tipo Míchigan (FOM) es un dispositivo usado frecuentemente para el manejo de pacientes con bruxismo. La literatura menciona el uso del arco facial para el montaje de modelos en el articulador semiajustable, sin embargo el beneficio de este en la elaboración de las FOM aún es controvertido. Por lo tanto el objetivo de esta investigación fue comparar el registro de número de puntos de contacto y el tiempo de ajuste entre las FOM elaboradas con y sin el uso del arco facial en pacientes con diagnóstico de bruxismo. Métodos: se elaboraron 90 férulas entregadas a 45 pacientes de la Clínica de Rehabilitación Benemérita Universidad Autónoma de Puebla (BUAP), previo diagnóstico de bruxismo. Las dos férulas elaboradas (una con modelos montados con arco facial y otra sin él), se compararon en el articulador y clínicamente. Se registró el número de puntos de contacto obtenidos en ambas férulas y el tiempo de ajuste requerido. Las comparaciones se hicieron con la prueba estadística de Wilcoxon y significancia menor a 0,05. Resultados: la media de puntos de contacto en boca de las férulas con el uso del arco fue superior (11,67) a la de sin uso del arco (11,58) sin diferencias significativas (p = 0,799). El tiempo de ajuste fue superior en las férulas elaboradas sin arco (51 s) que con arco (33 s), sin diferencias significativas (p = 0,332). Conclusión: no existen diferencias significativas con el uso del arco facial o sin él para la elaboración de las FOM en pacientes bruxómanos.

Introduction: Michigan occlusal splints (MOS) are frequently used for the management of patients with bruxism. The literature mentions the use of face bows for mounting models in semi-adjustable articulators, but its benefit in the production of MOS is still controversial. Therefore, the objective of this study was to compare the record of number of contact points and mounting time between MOS made with and without face bows in patients diagnosed with bruxism. Methods: a total of 90 splints were made and distributed among 45 patients diagnosed with bruxism at the Oral Rehabilitation Clinic of Benemérita Universidad Autónoma de Puebla (BUAP). The two splints (one made with a face bow mounted model and the other one without it) were compared at the articulator and clinically. The number of obtained contact points was recorded in both splints as well as the time needed for mounting. The comparisons were made with Wilcoxon statistical test and a significance level lower than 0.05. Results: the splints with face bows showed a greater average of contact points in the mouth (11.67) compared with the ones without face bows (11.58), with no significant difference (p = 0.799). Mounting time was higher in the splints made without face bows (51 s) compared with the ones with face bows (33 s), with no significant difference (p = 0.332). Conclusion: there are no significant differences in using face bows for developing MOS in bruxism patients.

Evaluation of the correlation between dental occlusion and posture using a force platform

OBJECTIVES: Force platforms are widely used to evaluate the relationship between posture and dental occlusion. This study evaluated whether force platforms are able to detect eventual postural modifications resulting from dental occlusion. METHOD: A total of 44 healthy volunteers who were given no information on the aim of the study underwent six postural stabilometric exams under different mandibular and visual conditions. Four parameters were considered: sway area, sway velocity, X axis displacement of the center of the foot pressure and Y axis displacement of the center of the foot pressure. RESULTS: An analysis of variance (ANOVA) revealed the relative influence of each factor; specifically, the ocular afference significantly influenced the sway area and sway velocity parameters, and the mandibular position had only aweakinfluence on theswayareaparameter. CONCLUSIONS: Vision was shown to influence body posture, and a weak correlation was observed between mandibular position and body posture in healthy subjects. However, the force platform is most likely not able to clearly detect this relationship. Gnathologists must use caution when using force platform analysis to modify a therapeutic plan. The sway area seems to be the most sensitive parameter for evaluating the effect of occlusion on body posture.

Effect of simultaneous therapy of arthrocentesis and occlusal splints on temporomandibular disorders: anterior disc displacement without reduction

OBJECTIVES: This study sought to evaluate the effect of simultaneous application of arthrocentesis and occlusal splint. MATERIALS AND METHODS: A retrospective study of 43 patients (3 males, 40 females) whose symptoms had improved was conducted at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital between 2008 and 2010. Subjects were divided into three groups: Group A (17 patients with arthrocentesis and occlusal splints simultaneously applied), Group B (13 patients whose symptoms did not improve with occlusal splints, undergoing arthrocentesis after occlusal splint use for 8 weeks), and Group C (13 patients that only used occlusal splints). We compared these groups in maximum comfortable opening (MCO) and the visual analogue scale of pain and noise. Follow-up was performed at 1 week, 1 month, 3 months, and 6 months. RESULTS: The improvement of symptoms was noted in all three groups, but Group A had a quicker improvement than the other groups, in terms of pain reduction and MCO increases. CONCLUSION: The simultaneous application of arthrocentesis and occlusal splints can reduce patient discomfort more quickly.