A comparative study based on the mandibular movement track and the movement parameters of the virtual articulator in simulating occlusal adjustment / 华西口腔医学杂志

OBJECTIVES@#This study aimed to compare the effects of virtual adjustment on occlusal interferences in mandibular posterior single crown and three-unit bridge restorations by using the mandibular movement track and the movement parameters of a virtual articulator.@*METHODS@#Twenty-two participants were recruited. Digital casts of the maxillary and mandibular arches were obtained using an intraoral scanner, and the jaw registration system was used to record the data of the mandibular movement track and the movement parameters of the articulator. Four kinds of restorations with 0.3 mm occlusal interferences were designed with dental design software. In particular, single crowns were designed for teeth 44 and 46, whereas three-unit bridges were designed for teeth 44-46 and 45-47, and the corresponding natural teeth were virtually extracted. Virtual adjustment of the restorations was performed using two dynamic occlusal recordings, namely, the mandibular movement track and the movement parameters of the virtual articulator. A reverse-engineering software was used to measure the root-mean-square of the three-dimensional deviation of the occlusal surfaces between natural teeth and the adjusted restorations. The differences between the two methods of virtual-occlusion adjustment were compared and analyzed.@*RESULTS@#For the same group of restorations, the three-dimensional deviation of the mandibular movement track group were lower than those of the virtual articulator group, and the differences were statistically significant (P<0.05). For the four groups of restorations adjusted by the same method, the three-dimensional deviation of the 46-tooth single crown was the largest and the smallest three-dimensional deviation was that of the 44-tooth single crown. Statistical differences existed between the 44-tooth single crown and the other groups (P<0.05).@*CONCLUSIONS@#For the occlusal design of posterior single crown and three-unit bridge, the mandibular movement track could be a more effective approach to virtual occlusal adjustment than the movement parameters of the virtual articulator.

Characteristics of Chewing: An Update of the Literature

ABSTRACT: Chewing is the first step in the digestion process in mammals. It is a highly coordinated process with a complex sensorimotor activity, the aim of which is to prepare foods for the formation of the alimentary bolus and then swallowing. It is a process with defined stages and patterns of movement that adapt to changes derived from the environment or the individual. Here, we review the main characteristics of chewing, including aspects of the physiology and characteristics of the mechanics of mandibular movement. We highlight the latest advances reported and the new methodologies used for a chewing analysis, which has made it possible to collect more precise and reliable data. Thus, we will see how the new technologies have provided a better understanding of this function and its relation to aspects of an individual's general healt h such as nutrition or the appearance of neurodegenerative diseases. Also, in this review we emphasize the close relation that exists between chewing and a person's quality of life.

RESUMEN: La masticación es el primer paso en el proceso de digestión en los mamíferos, es un proceso altamente coordinado y con una compleja actividad sensoriomotora, cuyo objetivo es preparar los alimentos para la formación del bolo alimenticio y luego la deglución, es un proceso con etapas definidas y patrones de movimiento que se adaptan a los cambios derivados del entorno o del individuo, aquí se revisan las principales características de la masticación, incluyendo aspectos de la fisiología y características de la mecánica del movimiento mandibular, se destacan los últimos avances reportados y las nuevas metodologías utilizado para un análisis de la masticación, lo que ha permitido recolectar datos más precisos y confiables, así, veremos cómo las nuevas tecnologías han permitido comprender mejor esta función y su relación con aspectos de la salud general de un individuo como la nutrición o la aparición de enfermedades neurodegenerativas; además, en esta revisión destacamos la estrecha relación que existe entre la masticación y la calidad de vida.

Method and accuracy of determining the jaw position of repositioning splint with the aid of digital technique / 北京大学学报(医学版)

OBJECTIVE@#To establish the workflow of determining the jaw position of repositioning splint with the aid of digital technique, and to evaluate the accuracy of this workflow and compare the accuracy of raising different vertical dimensions in vitro.@*METHODS@#A volunteer was recruited. The data of full-arch scans, cone beam computed tomography (CBCT) image and ultrasonic jaw motion tracking of the volunteer were acquired. The full-arch scans were merged with the CBCT image, which were then matched to the jaw motion tracking reference system. The jaw position of repositioning splint was determined when the anterior teeth opening was 3 mm and the condyle was in centric relation of the fossa in the sagittal plane. A digital repositioning splint was designed in the software based on virtual articulator and fabricated with additive manufacturing technique. After the splint was tried in, another CBCT image was taken and a qualitative analysis was conducted to compare the position of condyle between these two CBCT images. In the in vitro study, standard dental plaster casts with resin ball markers attached to the base were mounted onto a fully adjustable articulator in the intercuspal position. The dental casts were scanned by an extraoral scanner to establish digital models. The ultrasonic jaw motion tracking device was used to obtain simulated jaw movements on the articulator, which was repeated for three times. The digital models and data of jaw movements were merged in one coordination with the aid of bite forks. The jaw position of repositioning splint was determined by adjusting data of jaw movements, each of which was used to determine three vertical jaw positions 4 mm, 5 mm, and 6 mm with the horizontal jaw position of protrusion 2 mm. The virtual articulators with differently adjusted jaw movements were applied in designing repositioning splints, and the final repositioning splints and virtual jaw relationships were exported in STL format. Then the repositioning splints were fabricated with additive manufacturing technique and tried in plaster casts on the mechanical articulator, which were scanned and the jaw relationships on the mechanical articulator were exported later. The virtual jaw relationships and scanned jaw relationships were registered according to lower models and displacement of upper models was calculated. Ball markers were fit to acquire the coordinates of centers and absolute difference values of centers along three coordinating axes X, Y, and Z were calculated. One-way analysis of variance was conducted using SPSS 18.0 software to compare deviations of the three different vertical jaw relationships in two-side test and the significance level was 0.05.@*RESULTS@#With the aid of multi-source data fusion and individualized jaw motion, the clinical workflow of determining jaw position of repositioning splint was preliminarily established. The designed jaw position was realized on the right and the condyle was more inferior than the designed position on the left. Both displacement of the upper models and absolute difference values of centers showed no significant differences (P>0.05) in different vertical jaw dimensions. The displacement of the upper models was (0.25±0.04) mm. The absolute difference values of centers along the three coordinating axes X, Y, and Z were respectively (0.08±0.01) mm, (0.30±0.02) mm, and (0.21±0.04) mm.@*CONCLUSION@#A novel method of determining the jaw position of repositioning splint with the aid of digital technique is established. It is proved to be feasible by try-in after multi-data fusion, computer-aided design and computer-aided manufacturing. As is shown in vitro, it is accurate to apply this method in adjusting jaw position. Further clinical trial will be designed to evaluate its clinical effect.

Gradient sequential treatment of temporomandibular joint disorders / 口腔疾病防治

@#Temporomandibular joint disorder (TMD) is a common clinical disease in stomatology that occurs fre⁃ quently in young people, mostly in women, with an incidence of approximately 30%; its clinical manifestations include mandibular dysfunction, regional pain, and clicking noises around the temporomandibular joint (TMJ). Some patients have tinnitus, headache and other symptoms. With regard to the treatment procedures of TMD, a gradient sequential treatment model is currently preferred, each of which has strict indications. Generally, conservative treatment or nonin⁃ vasive treatment is preferred and is suitable for patients with dysfunction or mild organic disease. The second⁃choice minimally invasive treatment is suitable for patients who have failed conservative treatment or patients with mild organic disease. Finally, open surgery, which is suitable for patients who are not responsive to the first two treatments and show severe organic lesions, can be considered. The formulation of an open surgery treatment diagnosis and treatment plan should be personalized, led by doctors, and completed with the cooperation of patients. This article describes the“gradi⁃ ent sequential treatment”of temporomandibular joint disorders.

Application of a digital articulator based on virtual reality technique in oral repair / 中国组织工程研究

BACKGROUND: The development of digital technology has changed the diagnosis and treatment process in traditional oral clinic. The digital workflow can improve patient’s comfort, and save time. Virtual articulator as the new development section has been used in most of the dental design software, which is to replicate the function of mechanical articulator and simulate static and dynamic occlusion. It makes treatment more convenient, accuract and efficient. OBJECTIVE: To review the recent progress in the field of operation and clinical application of multiple virtual articulators at home and abroad. METHODS: The first author searched the related literature, clinical cases and books by computer in domestic and foreign databases, and the related contents and opinions were summarized. RESULTS AND CONCLUSION: (1) Although it has been studied for about 20 years, virtual articulator has not been widely applied because of technical sensitivity and high cost. (2) The transfer of articulator needs to scan the mandible model and record the mandibular movement relation. To define mandibular movement relation, average mandible parameters can be used, the ultrasonic sensor, photoelectric sensor, digital face bow or cone beam computed tomography for individualized records can also be used. (3) At present, virtual articulator has been used in fields of orthognathic surgery, temporomandibular joint disease, implant, and aesthetic repair. Comparative studies have shown that accuracy can meet clinical requirements and save time. However, differences between occlusal systems need to be detected. (4) Virtual articulator can save clinical operation time, improve accuracy, make up for the limitations of mechanical articulator, and has a wide range of application prospects.

Relación entre Síntomas de Trastornos Témporomandibulares Auto-Reportados y el Movimiento Mandibular de Sujetos Adultos Jóvenes / Relationship Between Symptoms of Self-Reported Temporomandibular Disorders and Mandibular Movement of Young Adult Subjects

RESUMEN: Tanto la limitación del movimiento mandibular como el auto reporte de síntomas de trastornos témporomandibulares (TTM) son utilizados como elementos para el diagnóstico de pacientes en la clínica. Sin embargo, la relación entre la presencia de síntomas y el movimiento mandibular no está del todo clara. Por ello, el objetivo de este estudio fue relacionar la presencia de síntomas asociados a TTM con el movimiento mandibular en una muestra de sujetos adultos jóvenes y sanos. En este estudio exploratorio participaron 40 estudiantes de Odontología, médicamente sanos, con arco dentario maxilar y mandibular continuo y completo (hasta el primer molar). A cada uno se les solicitó responder un cuestionario de auto-reporte de síntomas asociados a TTM recomendado por la American Academy of Orofacial Pain (AAOP). También se realizó un registro y análisis de sus movimientos mandibulares utilizando articulografía electromagnética 3D, con el objetivo de correlacionar la presencia de síntomas con el rango y trayectoria de apertura, y el área comprendida en lo que se describe como polígono de Posselt en el plano frontal y sagital. No se encontraron diferencias significativas entre las respuestas a cada pregunta entre hombres y mujeres. De acuerdo a las respuestas y según Delcanho (1994), 12 participantes resultaron necesitar una evaluación más exhaustiva. En este grupo se encontró que el área del polígono de Posselt en el plano frontal, fue significativamente menor que el de aquellos participantes que no requieren una evaluación más exhaustiva (p=0,003). Los valores de la trayectoria de apertura mandibular varían según de que síntoma se trate. Los principales síntomas que afectarían los valores de los movimientos bordeantes son la "dificultad para abrir la boca" y el "ruido en las articulaciones mandibulares". Con este estudio, hemos puesto de manifiesto que la limitación del movimiento mandibular como signo de TTM debe evaluarse con cautela, debido a que según la presencia de determinados síntomas y otras características de los sujetos (como el sexo), su valor podría variar.

ABSTRACT: Both the limitation of mandibular movement and the self-report of symptoms of temporomandibular disorders (TMD) are used for the diagnosis of patients in clinical diagnosis. However, the relationship between the symptoms and mandibular movement is not entirely clear. Therefore, the objective of this study was to relate the presence of symptoms associated with TMD with mandibular movement in a sample of young and healthy adult subjects. This exploratory study involved 40 medically healthy dentistry students with a continuous and complete maxillary and mandibular arch (up to the first molar). Each subject was asked to answer a self-report questionnaire for symptoms associated with TTM recommended by the American Academy of Orofacial Pain (AAOP). We also recorded and analyzed their mandibular movements using 3D electromagnetic articulography, with the aim of correlating the presence of symptoms with the range and trajectory of opening, and the area included in what is described as a polygon of Posselt in the frontal and sagittal plane. No significant differences were found between the answers to each question between men and women. According to the responses and to Delcanho, 12 participants turned out to need a more exhaustive evaluation. In this group it was found that the area of the Posselt polygon in the frontal plane was significantly smaller than that of those participants who did not require a more extensive evaluation (p = 0.003). The values of the mandibular opening path vary depending on the symptom involved. The main symptoms that would affect the values of the bordering movements are the "difficulty to open the mouth" and "noise in the mandibular joints". With this study, we have shown that the limitation of mandibular movement as a sign of TMD should be assessed with caution, as, according to the presence of certain symptoms and other characteristics of subjects (such as sex), its value may vary.

Maxillary anterior implant restoration with appropriate anterior guidance using T-Scan in a patient with full fixed prostheses / 대한치과보철학회지

In implant restorations, it is difficult for the patient to percept any symptoms. In addition, they are absent of shock absorbers, which can lead to mechanical failure if stress distribution is not considered. Since maxillary anterior multiple-implant restorations play a significant role in guiding the functional movement of the mandible by distributing lateral force, it is crucial to form appropriate occlusion. The use of the T-scan system is more advantageous in assessing ‘dynamic occlusion’, such as the change of occlusion over time, the amount of tooth contact during functional movement, and assessing the occlusion in the less-visible posterior teeth. The case is reported as it has satisfactory results in harmonious anterior guidance of a maxillary anterior multiple-implant restoration using T-scan analysis.

Rango de movimientos mandibulares en niños de seis años de edad con dentición mixta temprana / Range of mandibular movement in six-year old children with early mixed dentition

La medición y examen del rango de movimientos mandibulares están considerados dentro del diagnóstico clínico. El reporte de dichos rangos es extenso en adultos pero se ha escrito poco sobre el tema en cuanto a niños. El objetivo de este estudio fue determinar el rango de movimientos mandibulares en escolares de seis años de edad en México. Se recolectaron los datos de 52 niños de seis años de edad; el 52% correspondió al sexo femenino y el 48% al sexo masculino; con la prueba χ² de bondad de ajuste a la distribución uniforme o proporciones iguales, se analizó diferencias entre las categorías de: patrón de apertura, desviación de la línea media y desviación en apertura y cierre. Cabe señalar que para dicha prueba, en el patrón de apertura se excluyó la categoría con frecuencia cero. Debido al incumplimiento del supuesto de normalidad se utilizó la prueba de Wilcoxon para muestras dependientes en la comparación de la máxima apertura sin asistir y asistida, y con la prueba de t para muestras dependientes, se comparó la lateralidad derecha e izquierda. El patrón de apertura difirió significativamente (χ² = 60.9231, p < 0.0001, gL = 3): Recto 71.1%, desviación lateral derecha no corregida 0%, desviación «S¼ corregida derecha 13.5%; desviación lateral izquierda no corregida 1.9% y desviación «S¼ corregida izquierda 13.5%. El promedio de la máxima apertura no asistida fue de 35.00 mm en comparación con la máxima apertura asistida que fue de 39.11 mm (T = 0, p < 0.0001). Conclusión: El rango de movimientos mandibulares hallados en la población infantil mexicana de seis años de edad en dentición mixta primaria difiere de los encontrados en los niños de la misma edad en otras regiones. Este hecho es debido probablemente a que dichos rangos se ven influenciados por las características craneofaciales, peso, talla de cada población.

Measurement and examination of mandibular movements are procedures considered within any clinical diagnosis. Reports on these ranges are quite widespread for adult patients, but little has been written on the subject when dealing with children. The aim of the present study was to determine range of mandibular movements in six year old schoolchildren in Mexico. Data were collected on 52 six year old children. In this sample, 52% were female and 48% male. With the χ2 goodness of fit test to uniform distribution or equal proportions, differences between the following categories were examined: opening pattern, midline deviation and deviation in opening and closing. It should be noted that for the present test zero frequency category was excluded from the opening pattern. Due to the breach of normality assumption, Wilcoxon test was used for dependent samples in the comparison of unassisted and assisted maximum opening, t test for dependent samples was used to compare left and right laterality. Opening patterns differed significantly (χ2 = 60.9231, p < 0.0001, gL = 3) straight 71.1%. Uncorrected right lateral deviation 0%, right corrected «S¼ deviation 13.5%; uncorrected left lateral deviation 1.9%, and corrected left «S¼ deviation 13.5%. Average of non assisted maximum opening was 35.00 mm when compared to maximum assisted opening which was 39.11 mm (T = 0, p < 0.0001). Conclusion: Range of observed mandibular movements in Mexican six year old children with primary mixed dentition was different from same- age children in other regions. This was probably due to the fact that ranks were under the influence of craniofacial, weight, height and size characteristics of each different population.

Función anterior durante el movimiento de propulsión / Prior-during function in propulsion movement

Se realizó un estudio observacional descriptivo transversal en una muestra de 36 estudiantes de tercer año de la Facultad de Estomatología de Ciudad de La Habana, Cuba, en el periodo comprendido entre enero de 2006 y junio de 2009. Tuvo como objetivo determinar, durante el movimiento de propulsión, cuáles son las relaciones dentarias funcionales (función anterior) que se establecen y predominan en la población, y cuáles son las que permiten un mejor funcionamiento del sistema estomatognático (SE). Para analizar la oclusión, los modelos de las arcadas dentarias fueron relacionados en un articulador semiajustable marca Dentatus. El 83,3 por ciento de los estudiantes presentó una función anterior guiada por el grupo incisivo. Al disminuir la relación incisivo-canino fue mayor la participación de los caninos en el logro de la desoclusión posterior, por lo que pudieron influir en el tipo de función anterior que presentaba el paciente(AU)

A cross-sectional, descriptive and observational study was conducted in 36 third year students of the Stomatology Faculty of La Habana, Cuba from January, 2006 to June, 2009. The aim of present study was to determine during the propulsion movement which were the functional dental function (prior function) established and prevailed in the population and which are those allowing a better funcioning of Stomatognatic System (SS). To analyze the occlusion the models of the dental arcades were related using a semiadjusted articulator type Dentatus. The 83,3 percent of students had a prior function guided by the incisives. With decrease, the incisive-canine relationship the participation of the canines was greater to achieve the posterior non-occlusion with a potential influence in the type of prior funcion present in patient(AU)

Mandibular movement characteristics in patients with skeletal class Ⅲ malocclusion during chewing movement / 实用口腔医学杂志

Objective: To investigate mandibular movement characteristics in patients with skeletal class Ⅲ malocclusion during chewing different foods. Methods: 14 skeletal class Ⅲ adult patients with mandibular asymmetry, 10 patients without mandibular asymmetry and 10 normal control cases were chosen to find out the different condylar and incisor movement area ratio based on the aid of ARCUSdigma mandibular moving track analysis system. Results: First,during chewing soft food, the condylar tracing length of skeletal class Ⅲ adult patients with mandibular asymmetry were significant different in sagittal and horizontal plane compared with the other two groups(P<0.05), while the incisor point trajectory difference was not statistically significant. Second, the condylar and incisor movement characteristic showed much more different among three samples during chewing brittle food(P<0.05). Third, in sagittal plane, the deflective condylar movement area ratio was significantly higher than that of the other two groups during chewing hand food(P<0.01). Conclusion: The mandibular movement in skeletal class Ⅲ adult patients are affected obviously by the shape and texture of food. Asymmetric lower mandible patients have a greater preponderance of this phenomenon.

Quantitative analysis of the TMJ movement with a new mandibular movement tracking and simulation system / 대한구강악안면방사선학회지

PURPOSE: The purpose of this study was to develop a system for the measurement and simulation of the TMJ movement and to analyze the mandibular movement quantitatively. MATERIALS AND METHODS: We devised patient-specific splints and a registration body for the TMJ movement tracking. The mandibular movements of the 12 subjects with facial deformity and 3 controls were obtained by using an optical tracking system and the patient-specific splints. The mandibular part was manually segmented from the CT volume data of a patient. Three-dimensional surface models of the maxilla and the mandible were constructed using the segmented data. The continuous movement of the mandible with respect to the maxilla could be simulated by applying the recorded positions sequentially. Trajectories of the selected reference points were calculated during simulation and analyzed. RESULTS: The selected points were the most superior point of bilateral condyle, lower incisor point, and pogonion. There were significant differences (P<0.05) between control group and pre-surgical group in the maximum displacement of left superior condyle, lower incisor, and pogonion in vertical direction. Differences in the maximum lengths of the right and the left condyle were 0.59+/-0.30 mm in pre-surgical group and 2.69+/-2.63 mm in control group, which showed a significant difference (P<0.005). The maximum of differences between lengths of the right and the left calculated during one cycle also showed a significant difference between two groups (P<0.05). CONCLUSION: Significant differences in mandibular movements between the groups implies that facial deformity have an effect on the movement asymmetry of the mandible.

A Clinical Study on Mandibular Movement after Orthognathic Surgery

The purpose of this study is to evaluate the relationship of the factors which could be influenced by orthognathic surgery especillay SSRO. We measured the amounts of the maximum opening, lateral movements, maximum velocity and pattern of mandibular path during the opening and closing of mandible at the following times ; preoperative, 1 month after operation, 6 months after operation respectively using MKG. And the results were compared according to the categorized subgroups. Following results were obtained : 1. The change of the amounts of mandibular lateral movement and maximum opening velocity were statistically different between male and female (p0.05). 3. According to the amounts of mandibular movement, the recovery of left lateral movement of the group of 6~10mm was better than the other groups (p0.05). 6. There was not a statistical difference in the change of the mandibular movement between repositioning device applied group and non-applied group (p>0.05). 7. Sixty three percents of the patients who had preoperative TMJ symptoms were improved after surgery and preoperative TMJ symptoms were more improved after operation in the repositioning device non-applied group statistically (p<0.05).

A study on the mandibular movement changes after orthognathic surgery in skeletal Class III patients / 대한치과교정학회지

The purpose of this study was to evaluate changes in mandibular movement patterns after orthognathic surgery in skeletal Class III patients. The sample consisted of 20 Class III malocclusion patients(9 males, 11 females). Just before and after(2-7months) surgery, maximum opening & closing movement, mandibi3 ar border movement on sagittal, frontal and horizontal planes were recorded using Sirognathograph & BioPak EGN. On each record, 21 items were measured and statistically analyzed. The results were as follows 1. Angle of protrusive movement on sagittal plane showed greatest change after surgery. Also, as the incisal guidance was established by surgery, straight path of protrusive movement became curved line. 2. Maximum opening distance and maximum antero-posterior distance on maximum opening & closing movement, maximum opening distance on sagittal plane, angle of left lateral excursion on frontal plane were statistically significant after snrgery(p<0.01). 3. Maximum width of lateral excursion on frontal plane, distane of right lateral excursion and angle of maximum left lateral excursion on horizontal plane were statistiraily significant after surgery(p<0.05). 4. Maximum opening distance and maximum antero-posterior distance on maximum opening & closing movement showed significant differences according to post-surgical time(p<0.05). More recovery of range of movement occured in 5-7month group than in 2-3month group. 5. As the occlusal interferences were removed by orthognathic surgery, irregular opening & closing path became smooth curve.

Electromyography activities of the facial and neck muscles in children with high-angle / 实用口腔医学杂志

Objective:To investigate the electromyography activities of the facial and neck muscles during mandibular movement in children with high-angle.Methods:A computer-integrated BioEMG Ⅱ diagnostic system was used to synchronously record the electromyography activities of temporal anterior(TA), masseter muscle(MM), sternocleidomastoid(SCM) and digastric anterior(DA) muscles during mandibular movement in 14 children with high-angle and 16 children with normal-angle.Results:Muscular activity of TA, DA and SCM in children with high-angle was significantly weaker than that in those with normal-angle in the rest position(P

Investigation on the traces of mandibular movement with severe tooth wear / 实用口腔医学杂志

Objective:To study the mandibular movement characteristics of subjects with severe tooth wear (TW).Methods:30 TW patients (24 men, 6 women, mean age 51 years) were served as TW group and 10 subjects with individual normal occlusion were served as control group (7 men, 3 women, mean age 40.5 years). All cases were examined by means of K6-1 Evaluation System manufactured by Myotronics US. The traces of the mandibular opening-closing movement and border movement were recorded.Results:During the movement from mandible posture position(MPP) to intercuspal position(ICP), the TW patients showed unstable characteristic. The velocity showed no significant difference between the two groups during opening and closing, but the congruence and smoothness of traces during the mandibular opening-closing and border movements in the TW patients were a little worse than the controls; and the TW patients had less mandibular movement index(MMI) than the controls(P