A new aid in temporomandibular joint disorders' therapy: the universal neuromuscular immediate relaxing appliance.

Among the various treatment options currently indicated to deal with temporomandibular joint disorders (TMD) an important role is played by occlusal devices, which can be used in an individualized or universal manner. A new universal occlusal appliance device was designed and patented at the Clinical Gnathology Service of the Sapienza University of Rome. To assess its validity and efficacy a preliminary study on a sample of 50 patients was carried out. Patients were selected from a cohort of 158 according to the RDC-TMD (SPEC) criteria and randomly assigned to two groups, the patient group (PG), treated with the device, and a control group (CG) without any treatment. The two groups were evaluated by comparing four VAS pain scores: muscular, migraine, cervical and temporomandibular joint (TMJ). On the whole, all VAS pain scores in the PG showed a marked and statistically significant improvement after treatment, decreasing to about 50-80 percent, while the control group remained stable. The best improvement was achieved in muscular pain. Age did not affect neither the initial scores, nor the pain response to the treatment. The pain scores tended to slightly increase with time of application (one, two or three months), but this trend was significant only for cervical pain. Overall the results are favourable to the application of this new occlusion device. However, the data should be considered preliminary and require further verification in time and on a higher sample of patients of both sexes.

A new aid in TMD Therapy: the Universal Neuromuscular Immediate Relaxing appliance "UNIRA".

Among the various treatment options currently indicated for the temporomandibular joint disorders (TMD) tackle an important role is played by occlusal devices which can be used in an individualized and or universal.At the Service of Clinical Gnathology of the Head-Neck Department of the Umberto I Polyclinic at the Sapienza University of Rome, has been tested a new universal occlusal appliance, invented and patented by dott. Rampello.To assess the applicability and efficacy was carried out a preliminary study on a sample of 50 patients selected according to the criteria RDC-TMD and divided in random into two groups, the patient group (PG), treated with the device, and a control group (CG) does not undergo any treatment.The two groups were evaluated according to an analysis of segmentation by comparing the clinical data. Were considered some aspects of the application of the device using a self-evaluation questionnaire administered to the PG.CONSIDERATIONS DERIVED FROM THIS INITIAL APPLICATION ARE: none of the 25 patients in the sample PG has worsened the initial situation. 6 patients (24%) were healed and were included in a protocol of regular six-monthly visits. 16 patients (64%) have improved and incorporated into treatment to complete the treatment cycle. 3 patients (12%) were stationary and subjected to a diagnostic reassessment.The patients in the CG have all been included in the multidisciplinary treatment program.The findings of our preliminary study are favorable to this new device occlusion, however, requires further verification in time and on a sample of patients numeroso.

TMD in migraneurs: a static stabilometric study.

OBJECTIVE: Aims of the study were to assess the stabilometric pattern in a TMD population with migraine and to evaluate the role of static stabilometry as an important tool in the clinical practice to quantify postural analysis in TMD and migraine patients. MATERIALS AND METHODS: We recruited 3 samples. The first one with TMD and headache symptom; the second one consisted in a migraneurs population and the third one was a healthy group. All subjects submitted to a stomathognatic visit for diagnosis of TMD in according to international RDC/TMD criteria, a neurological visit to make diagnosis of primary headache (IHS criteria, 2004) and stabilometric tests (1.open eyes, 2.closed eyes, 3. hyperextended head, 4.with cotton rolls). RESULTS: We found that TMD patients showed an high percentage of migraine diagnosis (90%) and that TMD patients with migraine presented a muscular involvement in the neck district, more than healthy controls. CONCLUSIONS: We showed that there is a strong association between TMD and migraine and an increase of myogenous tension in the neck area is frequent in TMDs, particularly when they are associated with migraine. We suggest that stabilometry could represent a valid tool in the postural approach of TMD and migraine patients.

The condyle-fossa relationship in temporomandibular disorders. Considerations on the pathogenetic role of the disc.

AIM: The purpose of this study is to evaluate the condylar position and its variation in patients with temporomandibular joint (TMJ) disorders before and after therapy with occlusal gnathologic devices. METHODS: Twenty-five TMJ of 25 patients with temporomandibular joint disorder were examined by linear measurement of the anterior, posterior and superior joint space between the condyle and glenoid fossa through cephalometric analysis on X-ray tomography of the TMJ and by calculating the condylar position with the Pullinger and Hollender method. RESULTS: The average condylar position in the TMJ with DTM was posterior with a mean value of 22.2% and a range from 14.3% to 36%. The condylar position of 25 TMJs was: anterior 0(0%); centric 8(32%) and posterior 17(68%). After therapy with occlusal gnathologic devices the average condylar position was centric with a mean value of 0.6% and a range from 5.3% to 6.6%. The condylar position of 25 TMJs was: anterior 2(8%); centric 22(88%) and posterior 1 (14%). CONCLUSIONS: The hypothesis can be advanced that joint pathology is the consequence of the alteration of the condyle position and therefore of the mandibular movement and vice versa. Therapy with occlusal devices makes it possible to modify the condylar position by increasing the condylar capability to recapture the joint disc.

Long term follow-up of patients affected by temporomandibular joint dysfunction treated with orthodontic and/or prosthetic occlusal therapy.

AIM: Clinical evidences about therapeutic effectiveness of splint therapy and modern concept concerning the etiopathogenesis of temporomandibular disorders (TMD) lead to a review of the therapeutic approach accepted until the middle 90s for the solution of this derangement of the stomathognatic system. Aim of this study is to produce a long term follow-up of a sample of TMD patients, to estimate the validity and utility of the present therapeutic procedures. METHODS: After diagnostical classification of the patients observed, they have been included in a therapeutic protocol. The outcomes obtained (46 patients at the 1st control in 1994 and 38 patients at the last control in 2001) are re-examined with an average follow-up of 10 years. RESULTS: The results obtained showed the efficacy of the therapeutic procedures carried out (36 healed, 9 improved and 1 worsened at the 1994 check-up: on the whole, a successful result in 98% of cases; 17 healed, 21 improved and 8 lost at the 2001 check-up: on the whole, a successful result in 100% of cases), but at present their application has to be reviewed according to a more conservative and careful therapeutic approach, based on the evaluation of some fundamental parameters. CONCLUSION: The rehabilitative occlusal therapy, in its various aspects, is successful in the long term treatment of TDMs, as long as it is used only when it is possible to determine a correct indication.

[Posterior vertical dimension and condylo-discal non-coordination of the temporomandibular joint. Hypothesis on correlation]. / Dimensione verticale posteriore e incoordinazione condilo-discale dell'ATM. Ipotesi di correlazione.

BACKGROUND: On the basis of clinical evidence, an analytic study has been carried out to verify the hypothetic correlation between reduction of the posterior vertical overlap and internal derangements. METHODS: 58 patients with temporomandibular disorders have been observed; they presented clinically a reduction of the posterior vertical dimension (RPVD) due either to the loss of molar teeth or to the molar occlusal surface abrasion or to a wrong prosthetic rehabilitation. A cephalometric exam showed a significative correspondence between the RPVD and the retruded condylar position in the glenoidae fossa with a reduction of posterior joint space in comparison with the standard values purposed by Farrar. RESULTS: The results obtained showed a possible relation between occlusal alterations and the TMJ pathology. CONCLUSIONS: The conclusion is drawn that the clinical evaluation brings to consider occlusal factors, and in particular the reduction of posterior vertical dimension may be considered as possible etiologic factors of TMJ disorders.

[Retrospective study on the application of occlusal splints in 312 patients with temporomandibular disorders]. / Studio retrospettivo sull'applicazione di splint occlusali di 312 pazienti affetti da disordini temporo-mandibolari.

BACKGROUND: Temporo-mandibular disorders are classified into disorders involving TMJ components (articular disk displacement, deviation in form) and masticatory muscle disorders. METHODS: In this study the authors describe their experience of the non-surgical treatment of these pathologies. They review a total of 312 patients suffering from TMJ disorders treated with occlusal splint therapy applied for any TMJ dysfunction. The sample was monitored before and after occlusal therapy with an average follow-up of 30 months. RESULTS AND CONCLUSIONS: The results were evaluated by comparing the authors' method of assessment with the parameters put forward by Levitt in 1993. Both methods of evaluation gave comparable results with a percentage of long-term success in excess of 87%.

[A longitudinal analysis of dysfunctional TMJ pathology: an assessment of a sample of patients undergoing nonsurgical therapy]. / Analisi longitudinale della patologia disfunzionale dell'ATM: valutazione di un campione di pazienti sottoposti a terapia non chirurgica.

One the different interpretation of the pathological and clinical evolution of TMJ dysfunctions, the most-common of these pathologies is the condyle-disk uncoordination. This study analyzes the evolution of the treatment on the sample of patients affected by TMJ dysfunction and examined at the maxillo-facial department of the University of Rome "La Sapienza". After the TMJ dysfunction has been diagnosed the patients were informed of the individual therapeutic program which consisted of a temporary and definitive occlusal therapy. The aim of this scientific work is to control the efficiency within this therapeutic program in relation to the uncoordination of TMJ. In order to validate this approach the study was compared with another that considered the evolution of TMJ pathology in patients examined at the first diagnostic, visit but who had not undergone any treatment.

[A longitudinal analysis of dysfunctional pathology of the TMJ: an assessment of a sample of patients not undergoing therapy]. / Analisi longitudinale della patologia disfunzionale dell'ATM: valutazione di un campione di pazienti non sottoposti a terapia.

Concerning the different interpretation on the pathological and clinical evolution of the TMJ dysfunctions, the most common of these pathology is the condyle-disk incoordination. This study analyzed the evolution of TMJ dysfunctions examined at the maxillo-facial department of the University of Rome "La Sapienza". The non therapeutic approach does not consider an addition al control-sample of the non treated being itself a control-sample of a parallel work whose aim was to analyze patients who had undergone a complete therapeutic cycle.