Physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: A randomised controlled trial.

BACKGROUND: Myogenic temporomandibular disorders (M-TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT). OBJECTIVES: To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M-TMD patients. METHODS: In this double-blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post-treatment (T1) and 3 months post-treatment (T2). RESULTS: Intention-to-treat analysis revealed significant improvements favouring EG (VAS rest = -1.50 cm [CI95%: -2.67, -0.32], p = .04; VAS open = -2.00 cm [CI95%: -3.23, -0.75], p < .01; VAS chew = -1.71 cm [CI95%: -2.90, -0.52], p = .01; ROM = 4.61 [CI95%: 0.93, 8.30], p = .04). Additionally, VAS measures were influenced by follow-up times (VAS rest = -0.73 cm [CI95%: -1.30, -0.17], p = 0.03; VAS open = -0.97 cm [CI95%: -1.57, -0.37], p < .01; VAS chew = -1.15 cm [CI95%: -1.73, -0.58], p < .01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ2(1) = 4.39, p = .04) and VAS chew (χ2(1) = 11.58, p < .01). CONCLUSION: Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M-TMD. TRIAL REGISTRATION NUMBER: NCT03726060.

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate.

BACKGROUND: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. OBJECTIVE: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. METHODS: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). RESULTS: Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. CONCLUSION: In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

Effectiveness of physical therapy in addition to occlusal splint in myogenic temporomandibular disorders: protocol of a randomised controlled trial.

INTRODUCTION: Temporomandibular disorders (TMDs) are considered a collection of musculoskeletal conditions involving the masticatory muscles, the temporomandibular joint and associated structures. The myogenous group appears to represent the most frequently diagnosed category. In the context of a multimodal approach, splint therapy and musculoskeletal physiotherapy are often considered as a preferred therapy. The purpose of this study will be to investigate the effects of musculoskeletal physiotherapy combined with occlusal splint and education versus occlusal splint and education alone in the treatment of chronic myogenous TMD on pain and mandibular range of motion. METHODS AND ANALYSIS: All consecutive adults complaining of TMDs presented to the Department of Biomedical and Neuromotor Sciences of the University of Bologna will be considered eligible. Inclusion criteria shall be based on the presence of myogenous TMDs, as diagnosed through clinical examination in reference to the international diagnostic criteria of TMDs. Randomisation, concealed allocation, blinded assessment and intention-to-treat analysis will be employed. The splint therapy will consist of the use of the splint every night and concurrent delivery of an educational programme; the protocol shall have a duration of three consecutive months. The combined musculoskeletal physiotherapy, splint therapy and education will additionally consist of manual therapy techniques and exercise; such protocol shall consist of a duration of three consecutive months, inclusive of 10 sessions for the enhanced elements. All outcome measures will be collected at baseline, after treatment and at a 6 months follow-up. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Independent Ethic Committee in Clinical Research of AUSL Bologna-Italy (47/2018/SPER/AUSLBO). Pursuant to applicable rules,we will obtain informed consent from each participant and collect data anonymously to maintain privacy. Results will be disseminated to clinicians and researchers through peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER: NCT03726060.

"Safe zones": a guide for miniscrew positioning in the maxillary and mandibular arch.

The aim of this study was to provide an anatomical map to assist the clinician in miniscrew placement in a safe location between dental roots. Volumetric tomographic images of 25 maxillae and 25 mandibles taken with the NewTom System were examined. For each interradicular space, the mesiodistal and the buccolingual distances were measured at two, five, eight, and 11 mm from the alveolar crest. In this article, measurements distal to the canines are presented. In the maxilla, the greatest amount of mesiodistal bone was on the palatal side between the second premolar and the first molar. The least amount of bone was in the tuberosity. The greatest thickness of bone in the buccopalatal dimension was between the first and second molars, whereas the least was found in the tuberosity. In the mandible, the greatest amount of mesiodistal dimension was between first and second premolar. The least amount of bone was between the first premolar and the canine. In the buccolingual dimension, the greatest thickness was between first and second molars. The least amount of bone was between first premolar and the canine. Clinical indications for a safe application of the miniscrews are provided, as well as the ideal miniscrew features.

Mechanical properties of three different commercially available miniscrews for skeletal anchorage.

BACKGROUND: During the last 5 years, anchorage control with self-tapping miniscrews has become an important part of the clinical management of orthodontic patients. Yet, no studies have been performed for measuring mechanical properties of the currently available systems. OBJECTIVES: The purpose of this study is the evaluation of mechanical properties of three commercially available self-tapping screw systems used in orthodontic treatment. MATERIALS: three systems with a 1.5 mm diameter and 11 mm length screw (Leone, Firenze, Italy; M.A.S. Micerium, Avegno, Italy; Dentos, Korea) were examined. The results compared the resistance to bending, torque, pullout of each screw and the insertion moments needed to screw down each sample. CONCLUSIONS: All three miniscrews have mechanical properties that contribute to their safe use as skeletal anchorage in orthodontics. Although stainless steel has demonstrated to be more resistant to failure than titanium, its overall performance as material for miniscrews could be inferior to titanium. In order to facilitate the insertion, the asymmetric profile of the thread should be preferred to the symmetric cut. The ratio between the diameter of the drill and the diameter of the corresponding miniscrew is pivotal for the successful implantation and resistance of the miniscrews. Looking at the mechanical properties evaluated in this study, a cylindric shape of the screw is better than a conic one. The conic shape could be preferred in case the site of insertion is iterradicular and therefore limited to 2.5-3.5 millimetres.

Clinical applications of the Mini-Screw-Anchorage-System (M.A.S.) in the maxillary alveolar bone.

AIMS: anchorage control with self-tapping screws has become an important part of the clinical management of the orthodontic patients. Mechanical resistance and sites of insertion of miniscrews as orthodontic anchorage are critical to ensure successful outcomes. Aim of this clinical study was threefold: 1) to measure the mechanical resistance of the M.A.S., 2) to evaluate if the alveolar areas usually selected for mini-screws placement are adequate, 3) to illustrate the most frequent clinical application on the maxillary alveolar bone. METHODS: two methods were chosen to test these screws mechanically, representing two potential modes of failure during insertion or removal: torsional strenght and bending strenght. Three-dimension images of fifty maxillas have been retrieved from a group of 200 patients, age range between 20 and 40 years with a new type of tomogram called Newtom System. For each area mesio-distal and labio-lingual measurements from four horizontal cuts made at 2-5-8-11 mm below the bone-crest have been evaluated. RESULTS: the mean value of resistance to breakage in torsion is of 48.7 N.cm (around 5 Kg) for the miniscrew of 1.5 diameter, while the mean value of resistance to breakage in torsion is of 23.4 N.cm (around 2 Kg) for the miniscrew of 1.3 diameter.. The mean value of resistance to breakage in flexion is of 120.4 N (around 12 Kg) for the miniscrew of 1.5 diameter, while the mean value of resistance to the flexion is of 63.7 N (around 6 Kg) for the miniscrew of 1.3 diameter. On the maxillary alveolar bone the highest amount of bone was in mesio-distal dimension between 6 and 5 on the palatal side (minimum 1.9 mm at -11 mm cut; maximum 5.5 mm at -5 mm cut). The smallest amount of bone was in the tuber (minimum 0.2 mm; maximum 1.3 mm). Examination of the labio-palatal dimension demonstrated similar high thickness between 5-6 and 6-7 (minimum 3.7 mm at -11 mm cut; maximum 13.2 mm at -2 mm cut). The smallest amount of bone was recorded on the tuber (minimum 0.6 mm; maximum 4.1 mm). The following clinical applications are described: Closure of the extractions space, Symmetric intrusion of the incisors, Correction of the cant of the plane of occlusion and of the dental midline, Molar intrusion of one or two teeth, Molar distalization with the Distal Jet and miniscrews, Molar mesialization, Intermaxillary anchorage. CONCLUSIONS: the mechanical resistance of the miniscrews M.A.S. is suitable for their use in orthodontics. The best anatomical zones for their implantation are the interradicular spaces mesial to the first maxillary molars. From our experience to date, the miniscrews are a reliable and convenient system for skeletal anchorage when compared with other more invasive osseo-integrated systems.