The role of mandibular repositioning splint in the orthodontic treatment of patients with TMJ dysfunction.

OBJECTIVES: to evaluate the effectiveness of mandibular repositioning splints in the young and adult patients with TMJ dysfunction. SUBJECTS AND METHODS: 23 adult and 14 adolescent patients with TMJ dysfunction selected by Helkimo's index and the criteria of the American Academy of Craniomandibular disorders. RESULTS: upon anamnestic follow up, almost a total disappearance of the functional pain was reported by all patients, while for the headache, a cyclic onset was present, but with an uncertain etiology. Patients had a complete control of the mandibular movements with some articular sounds. But a modicum of muscular tenderness remained possibly due to the psyche of the patient. DISCUSSION: the prevalence of dysfunction in the growing patients was an intriguing observation. Not Angle's classification, but the presence of open bite, deep bite, or unilateral cross was the significant etiological factors.

[Operative and diagnostic set-up for dysfunctional patients]. / Il set-up operativo e diagnostico nel paziente disfunzionale.

The application of the set-up for treatment planning and prognosis can be extended to the stimulation of the orthodontic teeth movements in the patients with TMJ dysfunctions, already repositioned, and with very severe dentoalveolar discrepancy in order to decide the indication for extractions and selection of the teeth to be extracted. The limits of this simulation always remain the function of the masticatory system. The sequences of the procedures on the articulator and the different steps on the upper and lower models are described. A patient with TMJ disorders and dento-alveolar discrepancy is presented with the different procedures of treatment as for the dysfunction as for the orthodontic problems.

[New methods for splint construction for dysfunctional patients]. / Nuovi metodi per la costruzione dei bite nei pazienti disfunzionali.

The use of the splint is a very important step in the treatment of the dysfunctional patient. Considering the construction of the bite, beside the two usual procedures: a direct and indirect method with the different steps of the laboratory, we can realize a mixed one which all the advantages without the defects of both. That is made possible by the use of the new photopolimerizing resins, and by using the articulator with rapidity in the manufacturing and high quality of the splint, avoiding the steps of the laboratory. The methods are described in the different aspects until the final preparation of a repositioning splint.

[New directions in cranio-cervico-mandibular cephalometry]. / Nuovi orientamenti nella cefalometria cranio-cervico-mandibolare.

A pilot survey has been conducted on a sample of 22 adolescents in order to correlate the cranio-facial morphology and the condylar position with the mandibular posture, cranio-cervical posture and airway adequacy. Cephalograms extended to the cervical column and oblique lateral trans-cranial X-Rays with the standard projection has been adopted. The use of specific cephalometrics parameters allowed to separate the sample in sub-groups with similar variables and to obtain diagnostic indications. The utility of an analysis not only cranio-basal but extended to the cranio-cervical, intercervical, cervico-mandibular and hyoid parameters has been demonstrated.

[Radiographic screening of asymmetry and postural changes in orthodontic patients]. / Screening radiologico delle asimmetrie e delle alterazioni posutrali nel paziente ortodontico.

The role of OPM and of the teleradiography in the diagnosis of the asymmetries and of the postural problems of the orthodontic patients, is pointed out from this analysis on the group of 204 patients from mixed dentition to the adult age with different types of malocclusion. The evidence of a significant amount of patients with asymmetries and incorrected posture shows the utility of this radiological screening and gives advises for a therapeutic approach more corrected.

[Orthodontics and prosthetics: finishing dysfunctional cases]. / Ortodonzia e protesi: finalizzazione dei casi disfunzionali.

The Authors present the pathogenetic factors involved in the dysfunction of TMJ following the agenesia of permanent teeth. In these cases is very important to find and to maintain the therapeutic position by a repositioning splint. After this first stage it is necessary to correct the position and the relationship of the teeth in order to rearrange the space for the prosthetic reconstruction.

[Role of posture in the etiopathogenesis of asymmetry and flexibility of therapeutic approach]. / Ruolo della postura nell'eziopatogenesi delle asimmetrie e flessibilita dell'approccio terapeutico.

In the orthodontic evaluation of the cranio-cervical region, the relation between the form and the function is very important, specially if we consider the most frequent component of the modification of the armony of the system, the asymmetries, that we can classify as skeletal, functional and mixed. In this regards, the cervico-cranio-mandibular posture is a very important factor very often associated with the proper function of the respiratory system. The different factors, as cervical, nasal, temporo-mandibular and dento-alveolar are considered. On this basic approach, a diagnostic procedure is presented, in order to obtain a complete evaluation of the patient by considering the dental and skeletal age, the amount of compensation, the presence of the signs and symptoms of the dysfunction. We obtain a therapeutic procedure that must be individualized: the most important times of the treatment are the interceptive approach, followed by the orthodontics steps and finally, the reevaluation of the results. The guide line of these steps are mostly a continuous monitoring of the symptoms, the priority of the sequences of the treatment, the use of a repositioning splint and a selective biomechanics. Four cases are presented at different ages, with asymmetries, on which the posture play an important role. The treatment procedures and the satisfactory results show the possibility of an interceptive approach of the asymmetries, at least of the postural component in the adult patient, and the important role of the orthodontist in the treatment of these malocclusions.

[Joint locking in the orthodontic patient: etiopathology, diagnosis and therapy]. / Il locking articolare nel paziente ortodontico: eziopatogenesi, diagnosi e terapia.

The role of the orthodontist in the diagnosis and specially in the active treatment of the patients with locking is very important. In the present study, after the analysis of the most frequent etiologic factors, are presented the diagnostic fundamental components of the dysfunction. Furthermore, are illustrated, with some consequent, the therapeutic steps of the orthopedic approach, the occlusal emergency splint, the orthodontic treatment, in order to obtain the occlusal stability in the new interarches relationship.

[Cephalometric postural parameters and dental malocclusion]. / Parametri posturali cefalometrici e malocclusioni dentarie.

The role of the cephalometric analysis in the diagnosis of the posture in the orthodontic patient results from the analysis on 204 cases with different types of malocclusion. Four parameters cranio-cervicals are used and the results are a very large frequency of anterior posture of the head and neck, especially in Class II skeletal and in the dolicofacial type. The importance of this analysis is evident for the treatment approach.

[Dysfunctional pathology from "true" and "de facto" mutilation of the dental arches]. / Patologia disfunzionale da mutilazione "vera" e "di fatto" delle arcate dentali.

The mutilations of the dental arches for agenesia, extractions or trauma and because of ankylosis, caries can be the cause of the disorders of the stomatognatic system. These problems are in relation with the time of the disfunction, the skeletal type and the interarches relationship. The pathogenetic factors are secondary to the amount and the direction of the dislocations or the entrapment of the lower jaw. The treatment planning can provide the closure of the spaces or the reopening. These procedures are demonstrated by two treated cases with TMJ disorders.