Cadiax Compact 2 and MODJAW comparative analysis of condylar inclination: Innovative digital approaches in dentistry.

STATEMENT OF PROBLEM: Artificial intelligence has been used to enhance the digitalized workflow, especially when undergoing complex oral rehabilitations. However, the reliability of real-time jaw motion registration devices is unclear, and no standard measurement method of the sagittal condylar inclination (SCI) and Bennett angle (BA) has been established. PURPOSE: The purpose of this clinical study was to compare and evaluate the reliability of the SCI and BA values recorded by using 2 different digital devices. MATERIAL AND METHODS: A total of 17 participants, aged between 20 and 30 years (10 women and 7 men) were included in the study. For each participant, the Cadiax Compact 2 and MODJAW tracking devices were used to measure the SCI and BA values at 3 mm and 5 mm of condylar displacement during 3 separate recording sessions. The intraclass correlation coefficient (ICC) was used to assess the reliability of the recordings. Comparisons between the devices were performed with the Wilcoxson rank-sum test (α=.05). The Bland-Altman plot was used to evaluate the quantitative agreement between the 2 devices. RESULTS: All ICC intrarater reliability values for Cadiax and MODJAW were higher than 0.90. Both at 3 and 5 mm, the SCI measurements were higher for MODJAW registrations than for those recorded by Cadiax. The Bland-Altman plot showed that the SCI values were higher for MODJAW than for Cadiax by 5.9 (95% CI 3.9 to 8.2) and that the BA differences between the MODJAW and the Cadiax were not consistent with the measured value. CONCLUSIONS: Excellent reliability was found with the MODJAW and Cadiax recordings. The SCI and BA values for MODJAW measurements were higher at 3 mm and 5 mm than those acquired with Cadiax. MODJAW showed higher values than Cadiax, and the discrepancies were more pronounced for 3 mm than for 5 mm of condylar displacement, highlighting the need for precision in measurements at lower ranges of motion.

Dental occlusion characteristics in subjects with bruxism.

Background and aims: Bruxism is associated with a variety of factors, some of which are oral (occlusion, joint, face shape) while others are of a systemic nature (respiratory, cardiac, neurotransmitters, stress). The relationship between bruxism and occlusion has received great attention, but it still has a lot of ambiguity. This study aimed at investigating the parameters that may affect bruxism: dental interferences or premature contacts, vicious habits, temporomandibular joint (TMJ) pain, TMJ noises, TMJ morning fatigue, snoring, obstructive sleep apnea, which may occur before bruxism, or because of chronic parafunction. Methods: We conducted an observational, analytical case-control study to determine the association between bruxism and oral cavity factors as well as general factors. Participants were chosen from a group of middle-aged Romanian population. An online questionnaire was used for data collection. A total of one hundred subjects were included in the sample. Fifty cases with bruxism were chosen as a study group, and another fifty persons of similar ages were chosen as a control group. Statistical analysis was performed using the MedCalc version 20.110 software. Results: The study comprised subjects between 18 and 42 years old. The most prevalent age range was between 20-25 years. The female-male ratio was almost similar; 62% of the participants had sleep bruxism, 10% had awake bruxism and 28% had a combined form. The arithmetic means of the daily stress levels for both research groups' scores were 3.0 for the bruxism group and 3.24 for the control group, while the work stress was 3.04 for the bruxism group and 3.41 for the control group. Dental interferences or premature contacts, vicious habits, TMJ pain, TMJ noises, TMJ morning fatigue, snoring, and obstructive sleep apnea were evaluated. The majority of subjects received an oral splint (n=26). Conclusions: Bruxism was associated with stress, occlusal parameters (premature contacts and occlusion interferences), and joint pathologies. Bruxism was not found to be positively correlated with obstructive sleep apnea syndrome. There was a moderately significant association between bruxism and snoring. There was no evidence of an association between bruxism and vicious habits, dental aesthetics, or obstructive sleep apnea. Treatment significantly improved the quality of life, the masticatory and joint functions.

Oral splints in the management of nociceptive pain and migraines: A scoping review.

Temporomandibular disorders (TMDs) are characterized by numerous pain manifestations. Their treatment often involves the use of an oral splint. Recent research has found a relationship between migraines, nociceptive pain and TMDs. The aim of the present study was to perform a scoping review of studies in order to evaluate the effectiveness of the various types of oral splint in the treatment of migraine or nociceptive pain. Publications were retrieved from seven databases (PubMed, Web of Science, EMBASE, Scopus, ProQuest, SpringerLink and Ovid). Out of the 15 included publications, three studies were before and after studies, with no control group, whereas the other twelve studies were clinical trials, among which two publications were crossover studies. A clear, single distinction of pain was difficult to describe. Therefore, numerous publications focused on a combination of various types of pains, including myofascial, temporomandibular joint, headaches and migraine-like symptoms, all of which mimicked TMD pain. Overall, six studies used the stabilization splint (SS), three explored the comparison between the SS and the nociceptive trigeminal inhibition splint (NTIS) and two the NTIS. The majority of publications reported a positive outcome of splint therapy. Regarding the type of oral splint usage, the most commonly used one was the SS, followed by the NTIS. The definition and assessment of pain were heterogenous in the identified articles. The findings of the current study showed that occlusal splints may help with pain management, and that effective treatment of TMD-related pain at an early stage can enhance the quality of life of patients.

Lateral Cephalometric Analytical Uses for Temporomandibular Joint Disorders: The Importance of Cervical Posture and Hyoid Position.

The temporomandibular joint disorder (TMD) is a syndrome that affects the masticatory muscles and temporomandibular joint (TMJ). Its pathophysiology is not yet fully known. Cephalometric analysis is used for routine evaluation regarding orthodontic treatment and other purposes. The aim of this study was to assess if using cephalometric analysis and TMJ conservative therapy to evaluate the hyoid bone position and the cervical posture reduced symptoms in adults with TMDs compared to no intervention. The authors conducted a systematic review of the literature (PubMed, Cochrane, Web of Science, Scopus, and Embase) for clinical studies of TMDs with conservative treatment and lateral cephalometric analysis of the hyoid and cervical posture. To assess the risk of bias for non-randomized clinical trials ROBINS-I tool was used. Out of 137 studies found, 6 remained to be included. Most of them found a link between TMD and lateral cephalometric analysis, but there was a high risk of bias. This review found a possible link between TMDs, the neck and cervical posture. There is a benefit reported regarding the use of the lateral cephalometry as a treatment, but more extensive prospective randomized clinical trials are necessary to be able to draw definitive conclusions.

An Unusual Case of Temporomandibular Joint Disorder Resembling Migraine.

This article presents the case of a 32-year-old woman with two distinct temporomandibular joint pathologies: right temporomandibular joint arthralgia, headache, disc displacement with reduction and intermittent locking, and limited opening, whereas the left temporomandibular joint was showing arthralgia and subluxation. A neurologist was regularly consulted and treated the patient for migraine. A detailed clinical assessment was used in the therapeutic approach. Cone beam computed tomography (CBCT) was used in the paraclinical assessment to evaluate the temporomandibular joint (TMJ); CBCT imaging revealed condylar bone changes that were not correlated with the clinical symptoms. To alleviate TMJ symptoms, the treatment plan included anti-inflammatory drugs, physiotherapy and an occlusal splint with lateral guiding ramps. After three months of anti-inflammatory medication, physiotherapy and splint wear, an improvement in the migraine symptoms and enhanced life quality was reported. The variation in pathology between the right and left joints and the extended history of temporomandibular disorder onset with no definitive diagnosis or therapy make this case unique.

Temporomandibular dysfunction diagnosis by means of computerized axiography.

BACKGROUND AND AIMS: The objective of this study was to evaluate the accuracy of the CADIAX Compact 2 axiograph in confirming the presumptive clinical diagnosis of temporomandibular dysfunction, established according to the muscular-articular clinical examination. METHODS: A retrospective analytical study was carried out on 50 patients, aged between 21 and 62 years, 31 women and 19 men. A clinical diagnosis was established after masticatory muscles, temporomandibular joints and mandibular border limit movements were assessed. During the same day a computerized axiography (Cadiax Compact 2, Gamma, Vienna, Austria) was performed in order to confirm the diagnosis. RESULTS: The study had a sensitivity of 100%, which means that the CADIAX device detected all clinically positive patients. On the other hand, the specificity of the study was 74%, representing the percentage of patients negatively diagnosed by CADIAX device out of the total number of patients clinically diagnosed as negative. The 88% accuracy shows the proportion in which the CADIAX device provides a diagnosis equal to the clinical one. CONCLUSIONS: Of all the methods for investigating temporomandibular joint dysfunction, axiography is less invasive, does not irradiate the patient, it is relatively easy to use and it offers functional information about the TMJ function.

Clinical occlusion analysis versus semi-adjustable articulator and virtual articulator occlusion analysis.

BACKGROUND AND AIMS: Identifying the optimal method for occlusion analysis by comparing examination sensitivity of the static and dynamic occlusion using three systems: clinical occlusion analysis, semi-adjustable articulator and virtual articulator (3Shape, Denmark) occlusion analysis. METHODS: The occlusion analysis of sixteen patients was performed using the three systems. In order to analyze the number of concordant and discordant points and trajectories, the clinical method was compared to the semi-adjustable articulator and to the computerized method. RESULTS: The greatest correspondence was obtained by comparing the clinical and the articulator methods, having a success rate of 85.25%, versus the clinical and the computerized method with a success rate of 73.25%. The propulsion registered the highest discrepancies: 35% in case of the semi-adjustable articulator comparison and 62% in case of the virtual articulator comparison. CONCLUSIONS: The semi-adjustable articulator was superior in static and dynamic occlusion analysis compared to the virtual articulator. The analysis of the dynamic occlusion is the most problematic due to its dependency on the individual anatomy of the glenoid fossa which cannot be exactly reproduced by any articulator.

Irradiation provided by dental radiological procedures in a pediatric population.

BACKGROUND: Children are more sensitive to ionizing radiation effects due to their high radiosensitivity. PURPOSE: To estimate doses and risks for dental radiological examinations in children. MATERIAL AND METHODS: A pediatric population consisting of 7150 children and young adults which underwent 12252 dental radiological examinations (4220 intraoral, 1324 cephalometric, 5284 panoramic radiographs and 1424 CBCTs) within two years were included. Two groups were studied: CBCT group (exposed to CBCT ±â€¯conventional radiographs) and 2D group (exposed only to 2D radiological examinations). The effective doses were corrected according to age at exposure and settings parameters (mA;FOV) by using logarithmic fit equations for dose interpolation. The individual cumulative dose, per-caput collective dose and radiation risk were calculated for each group. RESULTS: The median effective and cumulative doses for conventional radiographs were lower than 20 µSv and did not vary with age. Children exposed to CBCT had a higher median effective dose (127.2 µSv) and cumulative dose (156.5 µSv) with a significant increased cumulative dose between 11 and 14 years. The CBCT contributed with 70% to the collective dose and per caput collective dose was 184 µSv for CBCT exposures. The Life Attributable Risk (LAR) and Relative Radiation Level (RRL) were significantly higher for children exposed to CBCT under the age of 18. The highest radiation dose for CBCT was equivalent with 34.1 days of natural background radiation and it was found for ages between 11 and 15. CONCLUSION: The CBCT doses and radiation risk vary but remain in the lower levels of the relative risk of medical exposures.

Skeletal pattern in subjects with temporomandibular joint disorders.

INTRODUCTION: To establish the skeletal pattern in subjects with malocclusions and temporomandibular disorders (TMD); to assess the relationship between craniofacial skeletal structures and TMD in subjects with malocclusions. MATERIAL AND METHODS: Sixty-four subjects with malocclusions, over 18 years of age, were included in the study. Temporomandibular disorders were clinically assessed according to the Helkimo Anamnestic Index. Subjects underwent a lateral cephalogram. Subjects were grouped according to the sagittal skeletal pattern (ANB angle) into class I, II and III. Parametric Student tests with equal or unequal variations were used (variations were previously tested with Levene test). RESULTS: Twenty-four patients with TMD (experimental sample); 40 patients without TMD (control group); interincisal angle was higher in class I and II (p < 0.05) experimental subjects; overjet was larger in experimental subjects; midline shift and Wits appraisal were broader in the experimental group in all three classes. In class III subjects, the SNB angle was higher in the experimental group (p = 0.01). Joint noises followed by reduced mandible mobility, muscular pain and temporomandibular joint (TMJ) pain were the most frequent symptoms in subjects with TMD and malocclusions. CONCLUSIONS: Temporomandibular joint status is an important factor to consider when planning orthodontic treatment in patients with severe malocclusions; midline shift, large overjet and deep overbite have been associated with signs and symptoms of TMD.

Disk and joint morphology variations on coronal and sagittal MRI in temporomandibular joint disorders.

OBJECTIVES: This study aims to assess the disk morphology and the condyle position in subjects with temporomandibular (TMJ) disk displacements on sagittal and coronal magnetic resonance imaging (MRI). MATERIALS AND METHODS: Seventy-four TMJs (from 37 patients) with positive clinical TMD symptoms according to the RDC/TMD axis I protocol were evaluated by 1.5 T MRI. Disk position, disk morphology, sagittal and coronal condyle position, joint effusion, joint space, and coronal condyle angulation were evaluated. Multivariate logistic regression was used to explore the relationship between disk displacement and MRI variables. RESULTS: Disk displacement with reduction (DDR) was found in 36.48 % and without reduction (DDwR), in 21.62 % of the joints. Disk displacement was anterior in 35.1 %, anterior-medial in 13.5 %, and anterior-lateral in 9.45 % of cases. The thickened posterior band (94.48 OR, p = 0.001) and the posterior condyle position (4.57 OR, p = 0.03) were more likely found on sagittal MRI in disk displacements. On coronal slices, the disk displacement was significantly associated with the distance from the most medial condyle point to the midplane (p < 0.05). CONCLUSIONS: Disk displacement is associated with changes of disk shape, disk dimension, and condyle position on sagittal MRI. A significant variation of the distance from the most medial condyle point to the midplane in disk displacement was found on coronal MRI. CLINICAL RELEVANCE: Our study highlights the existence of changes on coronal MRI in TMD patients which should be assessed for better understanding of the clinical evolution of temporomandibular disorders.

Osteonecrosis of the jaws associated with the use of bisphosphonates. Discussion over 52 cases.

BACKGROUND: Osteonecrosis of the jaws is increasing worldwide in patients treated with bisphosphonates. STUDY DESIGN: A retrospective review of 52 patients who were treated during 2007-2010 for bisphosphonate related maxillofacial symptoms of the jaws was conducted. Patient characteristics and other factors that influenced the disease process were studied. RESULTS: Thirteen patients received bisphosphonates for the prevention or treatment of osteoporosis; 39 for preventing bone metastases from malignant tumors. Thirty-six patients were females (age range 32-87 years, median 64 years); 16 were males (age range 30-81 years, median 73.5 years). Bisphosphonate used was ibandronic acid in four cases, alendronate sodium in 14 cases, and zoledronic acid in 34 cases. Mean bisphosphonate treatment period was 22.44 months (95%CI 19.33-25.55). Thirty patients received intravenous, 22 received oral bisphosphonate. The average period until occurrence of maxillofacial symptoms was 6 months (range 0.5-24 months) in subjects with intravenous bisphosphonate and 12.26 months (range 0.25-36 months) in subjects with oral bisphosphonates (p=0.011). CONCLUSIONS: The risk of bisphosphonate related osteonecrosis of the jaws is very high twelve months after oral administration and six months after intravenous administration in patients who have a trigger point in the jaws area. A proper monitoring of patients receiving bisphosphonates can reduce the risk of osteonecrosis and can prevent complications.

Serum changes induced by intramedullar experimental administration of bisphosphonates.

Bisphosphonates, stable analogues of pyrophosphate, have the ability to bind to bone molecules, possessing anti-resorbtion properties influenced by the radicals linked to the carbon group of their structure. Bisphosphonates link to the hydroxyapatite of the mineral surfaces and are selectively internalized by osteoclasts, whose activity they inhibit, jeopardizing the osteoblastic activity. The purpose of this study is to determine the influence of intramedular administration (at the hip bone) of bisphosphonates on the serum values of alkaline phosphatase, total Ca, Ca2+, proteins and serum osteocalcin in a lot of experience Wistar rats. Fifteen Wistar rats of experience, five in the control group and 10 in the experimental group. All rats underwent surgery to create a bone defect with a 1.5 mm diameter bone-bur at the right femur transcortical through the medullar canal. Rats from experimental group were divided into two groups: group A, who received Zometa 1 mL single dose intramedular, intraoperative and group B, who received Zometa 1 mL in divided doses daily, 0.1 mL for 10 days. 3 mL of blood from the frontal sinus were collected from each subject at 24 hours, 14 days and 21 days postoperatively. From the blood samples were determined: alkaline phosphatase [U/L], seric proteins [g/dL], total Ca [mmol/L, mg/dL], osteocalcin [mmol/L]. The data were statistically analyzed using the ANOVA test. We found an increase in alkaline phosphatase [U/L] in all groups studied. In group B there was a significant decrease in total Ca levels [mg/dL] throughout the experiment compared with controls (11.82→10.36→9.25 mg/dL; 2.95→2.59→2.31 mmol/L; p=0.001). Ca2+ has changed significantly both in group A (1.18→1.25→1.25 mmol/L; p=0.01) and group B (1.21→1.24→1.13 mmol/L; p=0.02). Serum proteins were significantly reduced both in the control group (9.4→8.5→8.1 g/dL; p=0.03) and the experimental groups A (9.3→8.5→8.3 g/dL; p=0.01) and B (9.9→7.6→7.3 g/dL; p=0.0008). At each stage of bone development, multiple factors act in a coordinated manner that leads to increased local metabolic processes, acting both on the process of bone resorption and bone repair. Healing processes are initiated within 24 hours in both studied groups and the control group; at 14 and 21 days the bone healing processes are compromised directly proportional to the administration manner and dose of bisphosphonates.

[Mesialization of upper second molars using skeletal anchorage]. / Mezializarea molarilor doi superiori cu ajutorul miniimplantelor ortodontice.

UNLABELLED: Anchorage represents a great issue that challenged orthodontists all over the years. Nowadays, with the use of microimplants, it has become possible even to induce complex teeth movements. AIM: To present a clinical case in which mesialisation of upper second molars was performed by the means of using miniimplants. RESULTS: The present case shows how a bilateral mesialization of upper second molars using skeletal anchorage was performed by orthodontic treatment using fixed appliances and miniimplants. CONCLUSION: The placing site of the miniimplants plays a huge role in the moments of force produced and delivered to the teeth, thus influencing tooth movement. Miniimplants increase tooth movement control, by the use of skeletal anchorage. The success of their usage depends upon its good primary stabilization and a judicious loading.