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Las fracturas condilares continúan siendo un desafío para los cirujanos maxilofaciales, debido a los múltiples tipos de fracturas que pueden ocurrir y los tratamientos disponibles. El tratamiento de este tipo de fractura podría dificultarse si el paciente presenta edentulismo. Así, entre las opciones de tratamiento, el uso de una férula o la prótesis dental preexistente como medio de fijación se muestra como una opción viable. Se presentan 02 casos clínicos de pacientes masculinos de 36 y 83 años de edad que presentan un maxilar edéntulo y fracturande cóndilo mandibular de lado derecho; para su tratamiento se utilizó una férula de Gunning superior con fijación intermaxilar mediante el uso de tornillos de fijación intermaxilar y elásticos intermaxilares durante 4 semanas. Después de 3 meses de evolución, ambos pacientes presentaron una adecuada apertura bucal, sin desviaciones o limitación a la apertura bucal. Las férulas de Gunning, a pesar que actualmente son poco usadas, continúan siendo una opción apropiada para los casos de fractura del cóndilo mandibular en pacientes edéntulos.
Condylar fractures continue to be a challenge for maxillofacial surgeons, due to the multiple types of fractures that can occur and the treatments available. Treatment of this type of fracture could be difficult if the patient has edentulism. Thus, among the treatment options, the use of a splint or the pre-existing dental prosthesis as a means of fixation appears to be a viable option. Two clinical cases are presented of male patients aged 36 and 83 years who present an edentulous maxilla and fracture of the mandibular condyle on the right side; For treatment, an upper Gunning splint with intermaxillary fixation was used through the use of intermaxillary fixation screws and intermaxillary elastics for 4 weeks. After 3 months of evolution, both patients presented adequate mouth opening, without deviations or limitations to mouth opening. Gunning splints, although they are currently rarely used, continue to be an appropriate option for cases of fracture of the mandibular condyle in edentulous patients.
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Objective@#To investigate the clinical efficacy of disc repositioning surgery combined with orthodontic treatment in patients with temporomandibular disorder and facial asymmetry.@*Methods@#One patient who underwent disc repositioning surgery combined with orthodontic treatment for temporomandibular joint disorder and facial asymmetry was reported. Preoperatively, the patient had a skewed shape of the opening, mild pressure pain in the right preauricular region with left mandibular deviation, and a mismatch between the width of the upper and lower dental arches. In the arthrosurgery department, bilateral temporomandibular disc replacement and anchorage were performed through a transauricular incision, and an auxiliary splint was worn to stabilize the jaw position for 6 months. In the orthopedic department, maxillary skeletal expansion was used in combination with the multiloop edgewise archwire technique to reconstruct the occlusion after 16 months of orthodontic treatment.@*Results@#The deviation was corrected by wearing an occlusal splint for six months after joint repositioning and anchoring; moreover, the pain symptoms disappeared, and the cone beam CT examination showed that the bilateral temporomandibular joint space was uniformly enlarged, the lower alveolar ridge midline deviated to the right, the posterior regions of the teeth were bilaterally inverted, and the anterior region and the posterior region of the left side were open. The orthodontic treatment matched the width of the upper and lower dental arches and established the cuspal molar neutrality relationship and the normal overjet coverage of the anterior teeth; additionally, the mandibular position was not obviously skewed. A review of the results of the related literature shows that abnormal occlusal relationships, such as mismatched arch width and skewed occlusal plane, can cause adaptive mandibular deviation, which can lead to the occurrence of TMD. Temporomandibular joint disc anchorage with splint treatment can effectively improve maxillofacial deformity in young TMD patients. After the establishment of a stable, physiologically functional disc-condylar relationship, orthodontic treatment is required to remove the interfering factors to rebuild the occlusion, and long-term postoperative review and follow-up are needed.@*Conclusion@#In patients with TMD and mandibular accommodative deviation due to occlusal anomalies, establishing a normal disc-condylar relationship and eliminating occlusal interference through disc repositioning surgery combined with orthodontic treatment can effectively improve facial shape and establish a stable jaw position.
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Objective@#To study the clinical effect of a polyetheretherketone (PEEK) bonding bridge on the loss of 3 internal incisors in patients with periodontitis.@*Methods@#This study was reviewed and approved by the ethics committee, and informed consent was obtained from the patients. Thirty-eight patients with periodontitis and 3 missing central or lateral teeth were selected to undergo restoration with a PEEK bonding bridge and then returned to the hospital 3, 6, 12, and 24 months after the restoration was completed. The survival rate of the restorations was assessed by the modified USPHS/Ryge criteria. The plaque index, gingival index, periodontal probing depth and attachment loss of the abutments were recorded, and the changes in periodontal tissues after restoration were observed and compared.@*Results@#Over 24 months of clinical follow-up observation of 38 patients, only 1 patient underwent secondary bonding after partial debonding (evaluated as grade B), while bonding was successful in the other 37 cases (evaluated as grade A). The plaque index, gingival index and periodontal probing depth were significantly lower after restoration than before (P<0.05). There was no significant change in attachment loss between before and after restoration (P>0.05).@*Conclusion@#For periodontitis patients missing 3 internal incisors, short-term PEEK bonding bridge repair has good clinical efficacy.
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Para el tratamiento de fracturas mandibulares existen protocolos cuyo propósito primordial es la función temprana. Existen diversos motivos por los cuales no se puede ejecutar ciertas técnicas en Venezuela, principalmente por problemas económicos para la adquisición de materiales de osteosíntesis especializados. Por esta razón, se ha recurrido a técnicas quirúrgicas antiguas. Se presenta un estudio con diseño longitudinal de tipo descriptivo, para el reporte de serie de 5 casos clínicos de fracturas de mandíbula, con los siguientes criterios de inclusión: presentar fractura mandibular en pacientes dentados parcialmente con imposibilidad al acceso al material de osteosíntesis del sistema de cargas soportadas. Tratados bajo procedimiento quirúrgico cerrado, la condición de edentulismo parcial confiere a la fractura de mandíbula inestabilidad, dificulta la reducción anatómica, pérdida de dimensión vertical y transversal, las que se recuperan a través de la elaboración de férulas tipo Gunning modificadas. Estas férulas se mantuvieron en posición con alambrados de suspensión ósea tipo circummandibulares y circumzigomáticos, como medios para establecer estabilidad en el tiempo. Se obtuvieron resultados satisfactorios, por lo que, aún hoy en día se pueden plantear como opciones de tratamiento.
For the treatment of mandibular fractures, there are protocols whose primary purpose is early function. However, several reasons prevent the execution of these techniques in Venezuela, mainly due to economic problems regarding the acquisition of specialized osteosynthesis materials. As a result, there is a necessity to resort to old surgical techniques. A study with a descriptive longitudinal design is presented, reporting 5 clinical cases of jaw fractures with the following inclusion criteria: presenting a mandibular fracture in partially dentate patients with impossibility of accessing the osteosynthesis material of the load-bearing system. The treatment conducted under closed surgical procedures. The condition of partial edentulism confers instability to the mandible fracture, hindering anatomical reduction and causing a loss of vertical and transverse dimension. These issues are addressed through the utilization of modified Gunning-type splints, which help in recovery. The splints were maintained in position with circum-mandibular and circum-zygomatic bone suspension wiring as a means to establish stability over time. Satisfactory results were obtained, indicating that these techniques can still be considered as treatment options today.
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Abstract Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgicallyinduced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep (Ovis aries). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.
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La osteomielitis es una inflamación ósea causada principalmente por bacterias. En los casos de osteomielitis del cuello del fémur y artritis séptica concomitante, las complicaciones pueden ocasionar, a largo plazo, acortamiento y deterioro articular considerables. Se describen los casos de dos pacientes neonatos, con manifestaciones de hipertermia como signo común; y solo en uno de ellos limitación del movimiento del miembro inferior derecho, contractura en flexión y aducción, dolorosa a la movilización. El diagnóstico se basó en criterios clínicos, imagenológicos y de laboratorio. El tratamiento consistió en el uso de la férula en abducción, lo cual garantizó la reducción concéntrica de la cabeza del fémur en la cavidad acetabular; esto pudo constatarse mediante seguimiento y control de la reducción, a través de radiografía simple de la pelvis en cada consulta. El diagnóstico precoz de la enfermedad determina el empleo de un tratamiento más conservador, además de minimizar la aparición de complicaciones.
Osteomyelitis is a bone inflammation caused mainly by bacteria. In cases of the femur's neck osteomyelitis and concomitant septic arthritis, complications can lead to considerable joint shortening and deterioration in the long term. The cases of two neonatal patients are described, with hyperthermia manifestations as a common sign; and only in one of them limited movement of the right lower limb, flexion and adduction contracture, painful on movement. The diagnosis was based on clinical, imaging and laboratory criteria. The treatment consisted in the use of the abduction splint, which guaranteed the concentric reduction of the femoral head in the acetabular cavity; this could be verified by monitoring and control of the reduction, through simple radiography of the pelvis in each consultation. The early diagnosis of the disease determines the use of a more conservative treatment, in addition to minimizing complications.
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This paper reported a case of neonatal radial nerve palsy that was successfully treated by conservative therapy. The patient with 39 weeks of gestational age was born vaginally. On the 2nd day after birth, right wrist drop, decreased muscle strength in the right upper limb, the erythema patch, and the subcutaneous nodule on the upper arm were observed. Electromyography revealed acute denervation of the radial nerve. Based on the electromyography results combined with clinical evaluations, neonatal radial nerve palsy was diagnosed. The patient was treated with self-made simple splint fixation along with comprehensive treatment. At 15 days of age, the family members removed the splint fixation themselves (13 days of fixation). At the age of 20 days, the symptoms of right wrist drop had disappeared, and the grasp reflex and Moro reflex of both hands returned to normal. A follow-up electromyography conducted at six months after discharge showed no obvious abnormalities.
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Objective To explore the short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures, and explore the quantification of traditional Chinese medicine manual reduction and personalized improvement of splinting. Methods The clinical data of 50 patients with AO type-A distal radius fractures, who received treatment at the outpatient department of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province, were retrospective analyzed. The patient cohort included 22 females and 28 males, with ages ranging from 25 to 75 years old. Among them, 27 cases presented with distal radius fractures on the left side, and 24 cases on the right side. The patients were categorized into two groups: treatment group (n=25) and control group(n=25). There were 13 males and 12 females in the treatment group, with an average age of (56.2±5.5) years old. Treatment approach for this group involved several steps. Initially, Mimics Research software was used to conduct comprehensive analysis of complete CT data from the affected limb, resulting in the creation of a three-dimensional model. Subsequently, 3D models of the bones and skin contours, stored as STL format files, were imported into the Materialise Magics 23.0 software for model processing and repair. This facilitated the simulation of reduction and recording of displacement data, effectively generating a "digital prescription" to guide and quantify traditional Chinese medicine manipulation procedures. Finally, a personalized 3D printed splint was applied for fixation treatment. There were 15 males and 10 females in the control group, with an average age of (53.32±5.28) years old. These patients were treated with manualreduction combined with traditional splinting. The clinical efficacy of the two groups was assessed in terms of fracture reduction quality, fracture healing time, Gartland-Werley wrist joint score and X-ray parameters (palminclination angle, ulnar deviation angle, radius height) at 6 weeks post-operatively. Results The treatment group exhibited a shorter duration for achieving clinical healing compared to the control group (P<0.05). Six weeks post-operatively, the treatment group demonstrated higher wrist joint function scores, and a higher proportion of excellent and good outcomes than the control group(P<0.05). The treatment group was superior to the control group in terms of imaging parameters 6 weeks post-operatively (P<0.05). Conclusion By quantifying skin contours through digital simulation prescription reduction, a personalized 3D printed splint is developed to effectively stabilize fractures, enhancing localized fixation while ensuring greater adherence, stability, and comfort. This innovative approach offers personalized treatment for AO type-A distal radius fractures and presents a novel, precise treatment strategy for consideration.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População do Leste Asiático , Impressão Tridimensional , Estudos Retrospectivos , Contenções , Fraturas do Punho/terapia , Medicina Tradicional Chinesa/métodos , Terapia Assistida por Computador/métodos , Manipulação Ortopédica/métodos , Tomografia Computadorizada por Raios X , Medicina de Precisão/métodosRESUMO
Post-injury rotation contractures of the forearm significantly interfere with various activities of daily living, such as washing the face, receiving change, or wiping a desk, and cause distress to patients. The Colello-Abraham dynamic pronation-supination splint is useful for rotation contractures of the forearm;however, the device includes several small parts and a complicated structure, and assembling the appliance requires technical expertise. Here, we report a case of rotation contracture of the forearm that improved following the use of a simple dynamic splint.
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Post-injury rotation contractures of the forearm significantly interfere with various activities of daily living, such as washing the face, receiving change, or wiping a desk, and cause distress to patients. The Colello-Abraham dynamic pronation-supination splint is useful for rotation contractures of the forearm;however, the device includes several small parts and a complicated structure, and assembling the appliance requires technical expertise. Here, we report a case of rotation contracture of the forearm that improved following the use of a simple dynamic splint.
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Introduction: with the technological advance in dentistry, light-polymerized three-dimensional (3D) printing resins had become an alternative for the manufacture of occlusal splint splints. Objective: the present study aimed to analyze the flexural strength of a resin for 3D printing compared to conventional acrylic resins (chemically activated and thermally activated), under the influence of thermocycling. Material and method: 60 specimens were made, which were distributed in six experimental groups (n = 10), according to the resin employed (chemically activated acrylic resin, thermally activated acrylic resin and 3D printing resin) and the treatment received (control and thermocycling). The specimens were submitted to flexural strength by the three-point flexural test. Result: data analysis showed that the material factor (<0.0001) and the thermocycling factor (p = 0.0096) influenced flexural strength, however, the interaction between the two factors did not (p = 0.9728). Conclusion: it was concluded that 3D printing resins presented the lowest flexural resistance to acrylic resins, especially when submitted to thermocycling.
Introdução: com o avanço tecnológico dentro da odontologia, as resinas fotopolimerizáveis para impressão tridimensional (3D) se tornaram uma alternativa para a fabricação de dispositivos interoclusais. Objetivo: o presente trabalho teve como objetivo analisar a resistência flexural de uma resina para impressão tridimensional comparada com resinas acrílicas convencionais (quimicamente ativada e termicamente ativada), sob a influência da termociclagem. Material e método: foram confeccionados 60 corpos de prova, que foram distribuídos aleatoriamente em seis grupos experimentais (n=10), de acordo com a resina utilizada (resina acrílica ativada quimicamente, resina acrílica ativada termicamente e resina para impressão 3D) e com o tratamento recebido (controle e termociclagem). Os corpos de prova foram submetidos ao ensaio de flexão de três pontos para determinação da resistência flexural. Resultado: a análise dos dados demonstrou que o fator material (<0.0001) e o fator termociclagem (p=0.0096) influenciaram a resistência flexural, entretanto, a interação entre os dois fatores não (p=0.9728). Conclusão: deste modo podemos concluir que a resina para impressão 3D apresentou desempenho inferior às resinas acrílicas, especialmente quando submetida a termociclagem.
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Resinas Acrílicas , Placas Oclusais , Resinas , Impressão Tridimensional , Resistência à FlexãoRESUMO
Objective: The present study aimed to evaluate the quality of life in TMD patients with the use of Stabilization Splints (SSs) and Home Therapeutic Exercises (HTEs) guidance. Material and Methods: The study was a clinical, randomized, controlled, prospective, and interventional trial. The screening included dentate patients of both genders, diagnosed with TMD through the RDC/TMD questionnaire with no TMJ osteoarthritis and/or osteoarthrosis. To assess the quality of life, the Short-Form Health Survey (SF-36) questionnaire was applied to all patients (n=70), randomized into a test group with SS and a control group with HTE. The evaluations of both questionnaires were performed before and after the intervention of 12 weeks. Results: The comparisons between pre- and post-intervention intragroups were performed by the non-parametric Wilcoxon test with a 5% significance level. There was a frequency distribution of the responses to the 36 items of the SF-36 questionnaire and comparisons between times. In the test group, 49 patients received a SS and did HTEs. In the control group, 21 patients performed HTEs. In the statistical analysis, among the eight domains, three were identified with significant scores: pain, mental health, and vitality. Conclusion: It was found that there was an improvement in pain and quality of life after the treatment of TMD with a SS and HTE (AU)
Objetivo: O presente estudo teve como objetivo avaliar a qualidade de vida em pacientes com DTM com o uso de placas de estabilização (SSs) e orientação de exercícios terapêuticos domiciliares (HTEs). Material e Métodos: O estudo foi um ensaio clínico, randomizado, controlado, prospectivo e intervencionista. A triagem incluiu pacientes dentados de ambos os sexos, diagnosticados com DTM através do questionário RDC/TMD sem osteoartrite e/ou osteoartrose da ATM. Para avaliar a qualidade de vida, o questionário Short-Form Health Survey (SF-36) foi aplicado a todos os pacientes (n=70), randomizados em grupo teste com SS e grupo controle com HTE. As avaliações de ambos os questionários foram realizadas antes e após a intervenção de 12 semanas. Resultados:As comparações intragrupos pré e pós-intervenção foram realizadas pelo teste não paramétrico de Wilcoxon com nível de significância de 5%. Houve distribuição de frequência das respostas aos 36 itens do questionário SF-36 e comparações entre os tempos. No grupo controle, 21 pacientes realizaram HTEs. Na análise estatística, dentre os oito domínios, três foram identificados com escores significativos: dor, saúde mental e vitalidade. Conclusão: Verificou-se que houve melhora da dor e da qualidade de vida após o tratamento da DTM com SS e HTE.(AU)
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Humanos , Masculino , Feminino , Qualidade de Vida , Transtornos da Articulação Temporomandibular , Ensaio Clínico , Placa DentáriaRESUMO
Objective: This study aimed to evaluate the efficacy and sustainability of using low level LASER therapy and CAD/CAM Michigan splint on improving the range of mandibular movements, muscle activity and reducing the pain. Material and Methods: 56 female patients were randomly divided into two groups. Group A: Patients received applications of low-level LASER therapy using semiconductor InGaAsp diode LASER type 940 nm with continuous mode of operation, applied for 180 sec per session for 12 sessions. Group B: Patients received Michigan splint of 2 mm thickness constructed on their upper teeth, the splint was 3D digitally printed. Electromyography was used to evaluate muscle activity, visual analogue scale was used to evaluate the pain intensity, ARCUS digma facebow was used to evaluate range of mandibular movements, and maximum mouth opening was taken using a millimeter ruler. They were measured before the beginning of the treatment, and at three and six month follow-up periods. Results: The results revealed that both low-level LASER therapy and Michigan splint reduce the myofascial pain, improved the range of the mandibular movements, and the muscles activity, but the effect of the low-level LASER therapy was more profound and sustainable. After 6 months from the beginning of the treatment, changes in masseter muscle activity (P= 0.001; effect size= 1.757), pain intensity (P= 0.003; effect size= 3), and range of mandibular movement (P= 0.001, effect size= 1.729) differed significantly between the two groups. Conclusions: Low-level LASER therapy had a better and more sustainable effect on reducing the pain intensity and improving the muscle activity as well as the mandibular movement when compared to Michigan splint (AU)
Objetivo: Este estudo teve como objetivo avaliar a eficácia e a durabilidade do uso da terapia LASER de baixa potência e da placa de Michigan CAD/CAM na melhora da amplitude dos movimentos mandibulares, atividade muscular e redução da dor. Material e Métodos: 56 pacientes do sexo feminino foram divididos aleatoriamente em dois grupos. Grupo A: os pacientes receberam aplicações de terapia LASER de baixa potência utilizando diodo semicondutor InGaAsp LASER tipo 940 nm em modo contínuo de operação, aplicado por 180 segundos por sessão durante 12 sessões. Grupo B: os pacientes receberam a placa de Michigan com uma espessura de 2 mm confeccionada sobre a arcada superior, a placa foi impressa digitalmente em 3D. A eletromiografia foi utilizada para avaliar a atividade muscular, a escala visual analógica foi utilizada para avaliar a intensidade da dor, o arco facial ARCUS digma foi utilizado para determinar a amplitude dos movimentos mandibulares e a abertura máxima da boca foi medida com uma régua milimétrica. Todas as medidas foram realizadas antes do início do tratamento e nos períodos de acompanhamento de três e seis meses. Resultados: Os resultados revelaram que tanto a terapia LASER de baixa potência como a placa de Michigan reduziram a dor miofascial, aumentaram a amplitude dos movimentos mandibulares e melhoraram a atividade muscular, mas o efeito da terapia LASER de baixa potência foi mais profundo e duradouro. Após 6 meses do início do tratamento, as alterações na atividade do músculo masseter (P= 0. 001; tamanho do efeito= 1,757), intensidade da dor (P= 0,003; tamanho do efeito= 3), e amplitude de movimento mandibular (P= 0,001, tamanho do efeito= 1,729) diferiram significativamente entre os dois grupos. Conclusão: A terapia com LASER de baixa potência teve um efeito melhor e mais duradouro na redução da intensidade da dor e na melhora da atividade muscular, bem como do movimento mandibular, quando comparada à placa de Michigan(AU)
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Dor Facial/radioterapia , Transtornos da Articulação Temporomandibular/radioterapia , Placas Oclusais , Terapia com Luz de Baixa Intensidade , Medição da Dor , Amplitude de Movimento Articular , Eletromiografia , Músculos da Mastigação/fisiopatologiaRESUMO
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.
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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.
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Humanos , Masculino , Feminino , Criança , Adolescente , Bruxismo , Cefaleia do Tipo Tensional , Oclusão Dentária , Músculos da MastigaçãoRESUMO
SUMMARY OBJECTIVE: Finger splints are used as a treatment option in tendon, bone, and soft tissue injuries. For immobilization, custom-made splints and prefabricated finger splints are used. In splints made for immobilization, it is aimed to limit joint movement. The aim of our study is to reveal how much custom-made splints and prefabricated finger splints limit joint motion (flexion angle in proximal interphalangeal and distal interphalangeal joints). METHODS: Custom-made splints and prefabricated finger splints were applied to the second fingers of the dominant side in a total of 40 individuals, 20 women and 20 men, not having any health problems. Individuals were asked to flex and joint motion was measured with the iPhone compass application. RESULTS: The mean distal interphalangeal joint angle values of the participants measured by prefabricated finger splints were found to be 24.27±8.29, and the mean distal interphalangeal joint angle values measured by custom-made splints was 0.52±1.50. There was a difference between the participants' distal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splint. The mean of the participants' proximal interphalangeal joint angle values measured by prefabricated finger splints was 16.55±7.90, and the proximal interphalangeal joint angle values measured by custom-made splints was "0" for all participants. There was a difference between the participants' proximal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). Distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splints. CONCLUSION: According to our study, custom-made splints can significantly reduce the flexion of the finger interphalangeal joints compared to prefabricated finger splints.
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Objective To compare the stress distributions in temporomandibular joint (TMJ) for patients with bilateral anterior disc displacement with reduction (ADDwR) after wearing stabilization splints with two different thicknesses during prolonged clenching by using three-dimensional (3D) finite element methods. Methods The 3D TMJ finite element models were constructed based on CT and MRI image data when the patient was biting in maximum intercuspation (working condition 1), on 3 mm thickness splint (working condition 2) and on 5 mm thickness splint (working condition 3), respectively. The von Mises stresses in the articular cartilages ,the TMJ disc and bilaminar zone under 3 working conditions were evaluated after the maximum jaw-closing forces were applied to the mandible for 60 s. Results The von Mises stress of left TMJ was bigger than that of right TMJ under each working condition. After wearing the 3 mm thickness splint, the disc was not recaptured, the stress was concentrated at the posterior band and bilaminar zone of the disc, and the stress on bilateral TMJ was significantly increased. After wearing the 5 mm thickness splint, the right disc was recaptured, the maximum stress was located at intermediate zone of the disc, and the von Mises stresses of articular cartilages and bilaminar zone were decreased by about 40%. However, the left disc was not recaptured, and the von Mises stresses of glenoid fossa cartilage and bilaminar zone were only slightly decreased by about 6%. Conclusions Different thicknesses of occlusal splints lead to different stresses and stress distribution patterns in TMJ of patients with ADDwR. The 5 mm thickness stabilization splint can reduce the stress of glenoid fossa cartilage and bilaminar zone in ADDwR patients. Disc recapture is helpful for ADDwR patients to relieve TMJ stress. When using stabilization splints for the treatment of ADDwR patients, on the premise of comfort wearing, a thicker splint can achieve more favorable stress distributions.
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A 53-year-old woman with rheumatoid arthritis had been suffering from right thumb deformity for a couple of months. Due to this, she was unable to perform the pinch movement. There were surgical options to treat the deformity, but the patient declined surgery. We therefore surmised whether we could correct the deformity with a splint. In 2012, we then proposed the use of a finger splint. The patient's finger function improved, and as of 2021, she was still using the finger splint without any problems. Thus, it is recommended to use a finger splint for thumb deformity because it is easier and less invasive than surgery.
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OBJECTIVE@#According to 73 patients with middle clavicle fracture treated conservatively, a new classification of middle clavicle fracture was proposed, and the clinical effect of plastic splint in the treatment of middle clavicle fracture was observed.@*METHODS@#Total 73 patients with middle clavicle fracture treated with plastic splint from September 2018 to August 2020 were analyzed retrospectively. All the patients were divided into 4 types according to the degree of fracture displacement. There were 16 cases of typeⅠ, including 7 males and 9 females, ranging in age from 18 to 37 years old, with a mean of (28.6±7.8) years old;12 cases of mild disease, 3 cases of moderate disease and 1 case of severe disease. There were 16 cases of type Ⅱ, including 6 males and 10 females, ranging in age from 25 to 49 years old, with a mean of (37.3±9.4) years old;5 cases of mild disease, 8 cases of moderate disease and 3 cases of severe disease. There were 7 cases of type Ⅲ, including 4 males and 3 females, ranging in age from 33 to 57 years old;2 cases of mild disease, 3 cases of moderate disease and 2 cases of severe disease. There were 34 cases of type Ⅳ, including 16 males and 18 females, ranging in age from 48 to 82 years old, with a mean of(66.4±14.9) years old;7 cases of mild disease, 17 cases of moderate disease and 10 cases of severe disease. All patients received plastic splint external fixation for 4 weeks. Visual analgue scale (VAS) and Constant-Murley shoulder scores before treatment and 1, 3 and 9 months after treatment were observed and recorded to evaluate the change of pain degree and shoulder function recovery before and after treatment. The patients' satisfaction with the appearance after treatment was recorded at the latest follow-up. The X-ray findings at the latest follow-up were used to judge whether the patient had fracture nonunion. And according to the fracture healing time and imaging findings, the excellent and good rate of clinical curative effect in patients with different types was obtained.@*RESULTS@#All patients were followed up, and the duration ranged from 9 to 11 months, with a mean of (9.8±0.7) months. The VAS scores of typeⅠ, typeⅡand type Ⅳ before treatment were 2.88±0.83, 3.67±0.80 and 6.92±1.71 respectively, which were decreased to 0.54±0.19, 0.77±0.25 and 1.18±0.17 respectively after 9 months of treatment. The Constant-Murley shoulder scores of typeⅠ, typeⅡand type Ⅳ were 65.81±2.09, 63.50±2.22 and 47.93±2.91 respectively before treatment, and increased to 88.56±2.11, 85.12±2.23 and 71.25±2.16 respectively after 9 months of treatment. Five patients were not satisfied with the appearance after treatment;6 patients had no obvious continuous callus passing through after 9 months of treatment, which was fracture nonunion.@*CONCLUSION@#The classification of middle clavicle fracture is more appropriate to the clinic, which has a certain clinical guiding significance for the selection of treatment methods and prognosis of middle clavicle fracture. Plastic splint is effective in the treatment of middle clavicle fracture without obvious displacement and overlapping displacement, and the incidence of complications is low. It can be popularized in clinic.
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Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Placas Ósseas , Clavícula/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Plásticos , Estudos Retrospectivos , ContençõesRESUMO
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)