Headache Attributed to Masticatory Myofascial Pain: Clinical Features and Management Outcomes.

AIMS: To describe the characteristics of headaches attributed to temporomandibular disorders (TMD) and assess the effects of two management strategies used for the management of TMD on headache intensity and frequency. METHODS: The initial sample (n=60) of this randomized controlled trial comprised patients with masticatory myofascial pain according to the Research Diagnostic Criteria for TMD (RDC/TMD), and headache. The patients were divided into two groups: group 1 received only counseling for behavioral changes, and group 2 received counseling and an occlusal appliance. A 5-month follow-up period included three assessments. TMD-related headache characteristics, eg, headache intensity (scored on a visual analog scale [VAS]) and frequency were measured by a questionnaire. Two-way analysis of variance, chi-square, Friedman, and Mann-Whitney tests were used to test for differences considering a 5% significance level. RESULTS: The main clinical features of headache attributed to masticatory myofascial pain were the long duration (≥4 hours), frontotemporal bilateral location, and a pressing/tightening quality. Forty-one subjects (group 1, 17 subjects; group 2, 24 subjects) were included in the final analysis. There was a reduction in headache intensity and frequency, with no significant differences between groups (P>.05). The mean (±SD) baseline VAS was 7.6 (±2.2) for group 1 and 6.5 (±1.6) for group 2; final values were 3.1 (±2.2) (P<.001) and 2.5 (±2.3) (P<.001), respectively. CONCLUSION: Headache attributed to masticatory myofascial pain was mainly characterized by long duration, frontotemporal bilateral location, and a pressing/tightening quality. Also, counseling and behavioral management of masticatory myofascial pain improved headache, regardless of the use of an occlusal appliance.

Occlusion on oral implants: current clinical guidelines.

Proper implant occlusion is essential for adequate oral function and the prevention of adverse consequences, such as implant overloading. Dental implants are thought to be more prone to occlusal overloading than natural teeth because of the loss of the periodontal ligament, which provides shock absorption and periodontal mechanoreceptors, which provide tactile sensitivity and proprioceptive motion feedback. Although many guidelines and theories on implant occlusion have been proposed, few have provided strong supportive evidence. Thus, we performed a narrative literature review to ascertain the influence of implant occlusion on the occurrence of complications of implant treatment and discuss the clinical considerations focused on the overloading factors at present. The search terms were 'dental implant', 'dental implantation', 'dental occlusion' and 'dental prosthesis'. The inclusion criteria were literature published in English up to September 2013. Randomised controlled trials (RCTs), prospective cohort studies and case-control studies with at least 20 cases and 12 months follow-up interval were included. Based on the selected literature, this review explores factors related to the implant prosthesis (cantilever, crown/implant ratio, premature contact, occlusal scheme, implant-abutment connection, splinting implants and tooth-implant connection) and other considerations, such as the number, diameter, length and angulation of implants. Over 700 abstracts were reviewed, from which more than 30 manuscripts were included. We found insufficient evidence to establish firm clinical guidelines for implant occlusion. To discuss the ideal occlusion for implants, further well-designed RCTs are required in the future.

Extreme root resorption associated with induced tooth movement: A protocol for clinical management

Cases in which teeth have only the cervical third remaining from orthodontically induced external root resorption, cast the following doubts: 1) What care should be taken to keep these teeth in mouth with the least risk possible? 2) What care should be taken with regards to reading of imaging exams, particularly in terms of accurately determining cervical root and bone loss? 3) Why is not endodontic treatment recommended in these cases? The present study aims at shedding light on the aforementioned topics so as to induce new insights into the theme.

Nos casos em que os dentes têm apenas o terço cervical remanescente de uma reabsorção radicular externa induzida ortodonticamente: 1) Quais seriam os cuidados para que permaneçam na boca, com o menor risco possível de perda? 2) Quais seriam os cuidados na interpretação imaginológica desses casos, quanto à determinação precisa da perda radicular e óssea cervical? 3) Por que o tratamento endodôntico não estaria indicado? No presente trabalho, procura-se esclarecer esses pontos e respondendo os questionamentos, para induzir novos insights sobre o assunto.

Aetiology of a diagnosis: the key to success in treatment planning.

Aetiology is the cause of a diagnosis. The essential key for the determination ofaetiology is a thorough examination: the history of the problems, the crucial elements in function, and habits. Our case report involves progression of a malocclusion and aggravation of the gum recessions which resolved following root planing and fixed orthodontic correction for the underlying cause, malocclusion, without any gum graft procedures.

Extreme root resorption associated with induced tooth movement: a protocol for clinical management.

Cases in which teeth have only the cervical third remaining from orthodontically induced external root resorption, cast the following doubts: 1) What care should be taken to keep these teeth in mouth with the least risk possible? 2) What care should be taken with regards to reading of imaging exams, particularly in terms of accurately determining cervical root and bone loss? 3) Why is not endodontic treatment recommended in these cases? The present study aims at shedding light on the aforementioned topics so as to induce new insights into the theme.

Longitudinal supportive periodontal therapy for severe chronic periodontitis with furcation involvement: a 12-year follow-up report.

We report a case involving a 12-year follow-up after treatment for chronic periodontitis with furcation involvement. A 54-year-old woman presented with the chief complaint of hypersensitivity. Clinical examination at the first visit revealed 15% of sites with a probing depth ≥4 mm and 35% of sites with bleeding on probing. Initial periodontal therapy was implemented based on a clinical diagnosis of severe chronic periodontitis. Surgical periodontal therapy was subsequently performed at selected sites. For #44, regenerative periodontal therapy using enamel matrix derivative (Emdogain(®)) was selected. For #16, which exhibited a 2- to 3-wall vertical bony defect and class III (mesio-distal) furcation involvement, bone graft was scheduled. Other sites with residual periodontal pockets were treated by open flap debridement. For #37, with a gutter-shaped root, odontoplasty was performed. After reevaluation, the patient was placed on supportive periodontal therapy (SPT). During 12 years of SPT, the periodontal condition remained uneventful in most of the teeth. However, bone resorption was observed in the distal aspect of #37, making the prognosis poor. This indicates the need to continuously monitor risk factors, including inflammation and traumatic occlusion, during SPT. Although some problems still remain, severe periodontitis with furcation involvement was successfully maintained longitudinally with an adequate level of patient compliance and careful SPT.

Influence of different metal flask systems on tooth displacement in complete upper dentures.

OBJECTIVE: To verify the occurrence of tooth displacement in dentures processed by moist hot-polymerisation using traditional and experimental metal flask systems. MATERIALS AND METHODS: Waxed complete dentures were randomly assigned to three groups (n = 10), including traditional (TF) and experimental flasks (DF and HHF). Metal pins were placed at the incisal edge of maxillary central incisors (I), buccal cusp of first premolars (P) and mesiobuccal cusp of second molars (M). Transversal (I-I, P-P and M-M) and anteroposterior (LI-LM and RI-RM) distances were measured before and after denture processing using an optical microscope. The dentures were processed by hot water curing cycle (9 h/74 °C). Collected data were analysed by anova, Paired Student's t-test and Holm-Sidak method (p < 0.05). RESULTS: All measured distances demonstrated contraction after polymerisation, except for LI-LM in TF and RI-RM in DF and HHF. Statistically significant differences were found between the distances P-P for DF and HHF, and M-M for all groups. Comparison among flask systems revealed statistically significant difference in the P-P distance for the TF and HHF. CONCLUSION: Different flask systems did not cause variation in tooth displacement during denture processing, with the exception of P-P distances for the TF and HHF. There is no evidence that different metal flask systems would promote tooth displacement of clinical significance.

Occlusal considerations in implantology: good occlusal practice in implantology.

UNLABELLED: This article is concerned with implants that are being used for fixed crown and bridgework rather than removable prostheses. The huge increase in the provision of implants over the past two decades is set to continue. Most of the research is related to avoiding failures in implants. This research, in the main, has concentrated on the essential interface between the artificial implant and living bone: osseointegration. The other interface, which is worthy of our full attention, is the one between the implant-supported crown and the antagonist tooth: the occlusion. CLINICAL RELEVANCE: This article aims to provide the basis for guidelines for good occlusal practice in implantology. It will consider these under two headings: those which could be considered as basic occlusal principles; and those occlusal considerations that are specific to implants.

How long should a shortened dental arch be?

UNLABELLED: Increasing numbers of older adults are retaining teeth into old age. Many of these patients refuse to wear removable partial dentures, and have a high prevalence of dental disease and heavily restored teeth. The shortened dental arch (SDA) concept is a potentially cost-effective way of managing older, partially dentate adults. However, case selection is critical and long term preservation of a functional dentition may not be possible in certain patients. This paper highlights the critical treatment planning issues and outlines treatment strategies aimed at avoiding occlusal instability in patients with shortened dental arches. CLINICAL RELEVANCE: Appropriate application of the shortened dental arch concept will provide satisfactory oral function in the long term for partially dentate adults.

Guidelines for occlusion strategy in implant-borne prostheses. A review.

Medium- or long-term failure of endosseous dental implants after osseointegration, when it has occurred, has been associated in the great majority of cases with occlusal overload. Overload depends ultimately on the number and location of occlusal contacts, which to a great extent are under the clinician's control. Much of our current understanding of occlusal contacts in this context is based on concepts derived from non-implant-borne prosthetics and has not been rigorously tested. The present article reviews occlussal contact designs and offers occlusion strategy guidelines for the main types of implant-borne prostheses.

The effect of remount procedures on patient comfort for complete denture treatment.

STATEMENT OF PROBLEM: Occlusal disharmony due to processing can cause discomfort to the patient. PURPOSE: The purpose of this investigation was to identify whether refinement in occlusion was correlated with patient comfort and the number of postinsertion visits. MATERIAL AND METHODS: Maxillary and mandibular complete dentures were fabricated for 30 subjects who were randomly divided into 3 groups of 10 subjects using a lottery: Group LCRO, the control group, received both laboratory and clinical remount procedures along with occlusal corrections; Group LRO subjects received only laboratory remount with occlusal corrections; and Group OOC subjects underwent routine procedures in complete denture construction without remount corrections and only occlusal corrections where required, intraorally. A pilot study was conducted to identify the feasibility of a close-ended questionnaire designed by the investigator and containing 5 questions regarding the comfort, pain, masticatory ability, swallowing, and occlusal contacts of maxillary and mandibular complete dentures. The evaluation was performed following the subject's use of the dentures for 7 days. All 30 subjects were examined for tissue irritation at this time. The evaluation was conducted by a single examiner who was unaware of the groups to which the subjects belonged. An analysis of statistical difference between the treatment groups for the number of postinsertion visits, comfort, pain during mastication, swallowing, and areas of tissue irritation during use of complete dentures was assessed using the chi-square test and Kruskal-Wallis test (alpha =.05). RESULTS: The results indicated that remount procedures and occlusal corrections significantly reduced the number of postinsertion visits (Kruskal-Wallis test, P<.001). There was less pain during mastication in group LCRO compared to the other groups (Kruskal-Wallis test, P=.0399). Group LCRO subjects also reported less incidence of tissue irritation compared to group LRO and group OOC (chi2=18.26, P<.001) CONCLUSIONS: The combination of laboratory and clinical remount procedures with occlusal corrections enhanced patient comfort, compared to the other groups in which either one or both of the procedures were not performed.

Effect of virtual articulator settings on occlusal morphology of CAD/CAM restorations.

PURPOSE: Determinants of mandibular movements, like condylar inclination and incisal guidance, should be considered in the fabrication of restorations in occlusion to prevent posterior excursive occlusal interferences. The aim of this study was to investigate differences in the occlusal morphology of the right mandibular molar resulting from high, average, and low values of settings for determinants of anteroposterior and transverse mandibular movement using a virtual articulation model. MATERIAL AND METHODS: The articulation functionalities of computer integrated restorative technology by imaging and new acquisition (CYRTINA, Oratio B.V., Zwaag, The Netherlands) were used as a tool to examine the potential effect of determinants of mandibular movement on occlusal molar design. High, average, and low values for condylar guide inclination, incisal guide angle, and intercuspal contact area (antero-posterior determinants) and laterotrusion, mandibular lateral translation and intercuspal contact area (transverse determinants) were introduced and differences in molar morphology studied. The latter was done by comparing mesiodistal and buccolingual sections of the occlusal designs. These interocclusal differences were quantified as differences in frequency of occlusal distance intervals in an interocclusal range of 1 mm, measured from the occlusal surface of the molar model. The vertical distance with which a standard crown in occlusion had to be corrected to avoid interferences was calculated. RESULTS: Among all parameters, the ipsilateral and contralateral mandibular lateral translation, sagittal condylar guide inclination, the ipsilateral laterotrusion and the incisal guide angle give substantial occlusal surface corrections. The high setting for the ipsilateral mandibular lateral translation required most correction. CONCLUSION: High and low setting values of mandibular movement determinants require considerable adaptation of the occlusal surface of a crown to prevent occlusal disturbances.