Férulas de Gunning. Una alternativa de tratamiento que sigue presente. Reporte de 02 casos / Gunning's splints. An alternative treatment that is still present. A report of 02 cases

Las fracturas condilares continúan siendo un desafío para los cirujanos maxilofaciales, debido a los múltiples tipos de fracturas que pueden ocurrir y los tratamientos disponibles. El tratamiento de este tipo de fractura podría dificultarse si el paciente presenta edentulismo. Así, entre las opciones de tratamiento, el uso de una férula o la prótesis dental preexistente como medio de fijación se muestra como una opción viable. Se presentan 02 casos clínicos de pacientes masculinos de 36 y 83 años de edad que presentan un maxilar edéntulo y fracturande cóndilo mandibular de lado derecho; para su tratamiento se utilizó una férula de Gunning superior con fijación intermaxilar mediante el uso de tornillos de fijación intermaxilar y elásticos intermaxilares durante 4 semanas. Después de 3 meses de evolución, ambos pacientes presentaron una adecuada apertura bucal, sin desviaciones o limitación a la apertura bucal. Las férulas de Gunning, a pesar que actualmente son poco usadas, continúan siendo una opción apropiada para los casos de fractura del cóndilo mandibular en pacientes edéntulos.

Condylar fractures continue to be a challenge for maxillofacial surgeons, due to the multiple types of fractures that can occur and the treatments available. Treatment of this type of fracture could be difficult if the patient has edentulism. Thus, among the treatment options, the use of a splint or the pre-existing dental prosthesis as a means of fixation appears to be a viable option. Two clinical cases are presented of male patients aged 36 and 83 years who present an edentulous maxilla and fracture of the mandibular condyle on the right side; For treatment, an upper Gunning splint with intermaxillary fixation was used through the use of intermaxillary fixation screws and intermaxillary elastics for 4 weeks. After 3 months of evolution, both patients presented adequate mouth opening, without deviations or limitations to mouth opening. Gunning splints, although they are currently rarely used, continue to be an appropriate option for cases of fracture of the mandibular condyle in edentulous patients.

Influence of occlusal appliances on the masticatory muscle function in individuals with sleep bruxism: A systematic review and meta-analysis.

This systematic review answers the question: "Does occlusal appliance use influence masticatory muscle function of dentate individuals with sleep bruxism?". The literature search included six databases, grey literature, and manual search for articles. Randomized and non-randomized clinical trials were included comparing muscle function of sleep bruxers before and after receiving occlusal appliances. Risk of bias was assessed with risk of bias assessment for randomized and non-randomized clinical trials tool. Twelve studies, three represent randomized clinical trials, were included. Risk of bias was considered low, moderate, or serious. Meta-analyses indicated that soft and hard appliances did not influence muscle activity and bite force of bruxers. Qualitative analysis showed that occlusal appliance use did not influence masticatory performance and muscle volume. However, it was effective in reducing tongue force. Certainty of evidence was considered very low for muscle activity when evaluated with hard appliances, and for bite force evaluated with both appliance materials. Low certainty of evidence was observed for muscle activity with soft appliances. Based on the findings of this meta-analysis, occlusal appliances do not affect masticatory muscle function of sleep bruxers. Regardless of appliance material, the activity of masseter and temporal, and bite force of sleep bruxers was not influenced.

Comparative Analysis between Conventional Acrylic, CAD/CAM Milled, and 3D CAD/CAM Printed Occlusal Splints.

The development of digital technologies has allowed for the fabrication of new materials; however, it makes it difficult to choose the best methods to obtain occlusal splints with optimal properties, so it is essential to evaluate the effectiveness of these materials. The aim of the study is to compare the fracture resistance of occlusal splints made of different materials after thermo-mechanical aging. METHODS: A total of 32 samples were made from 4 materials (two 3D printed polymeric materials, a PMMA disc for CAD/CAM, and a conventional heat-cured acrylic resin); subsequently, the fracture test was performed using the load compression mode applied occlusally on the splint surface. STATISTICAL ANALYSIS: Four statistical tests were used (Shapiro-Wilk, Levene's test, ANOVA, and Tukey's HSD test). RESULTS: The following study showed that there are differences in fracture strength among the four materials investigated, where the highest strength was observed in the milled splint, with a mean of 3051.2 N (newton) compared to the strength of the flexible splint with 1943.4 N, the printed splint with 1489.9 N, and the conventional acrylic splint with 1303.9 N. CONCLUSIONS: The milled splints were the most resistant to fracture. Of the printed splints, the splint made with flexural rigid resin withstood the applied forces in acceptable ranges, so its clinical indication may be viable. Although the results of this research indicated differences in the mechanical properties between the CAD/CAM and conventional fabrication methods, the selection may also be influenced by processing time and cost, since with a CAD/CAM system there is a significant reduction in the production time of the splint material.

Fractura de mandíbula en pacientes parcialmente edéntulos. Alternativa de tratamiento cerrado. Serie de casos / Mandibular fractures in partially edentulous patients. Closed treatment alternatives. A Cases series

Para el tratamiento de fracturas mandibulares existen protocolos cuyo propósito primordial es la función temprana. Existen diversos motivos por los cuales no se puede ejecutar ciertas técnicas en Venezuela, principalmente por problemas económicos para la adquisición de materiales de osteosíntesis especializados. Por esta razón, se ha recurrido a técnicas quirúrgicas antiguas. Se presenta un estudio con diseño longitudinal de tipo descriptivo, para el reporte de serie de 5 casos clínicos de fracturas de mandíbula, con los siguientes criterios de inclusión: presentar fractura mandibular en pacientes dentados parcialmente con imposibilidad al acceso al material de osteosíntesis del sistema de cargas soportadas. Tratados bajo procedimiento quirúrgico cerrado, la condición de edentulismo parcial confiere a la fractura de mandíbula inestabilidad, dificulta la reducción anatómica, pérdida de dimensión vertical y transversal, las que se recuperan a través de la elaboración de férulas tipo Gunning modificadas. Estas férulas se mantuvieron en posición con alambrados de suspensión ósea tipo circummandibulares y circumzigomáticos, como medios para establecer estabilidad en el tiempo. Se obtuvieron resultados satisfactorios, por lo que, aún hoy en día se pueden plantear como opciones de tratamiento.

For the treatment of mandibular fractures, there are protocols whose primary purpose is early function. However, several reasons prevent the execution of these techniques in Venezuela, mainly due to economic problems regarding the acquisition of specialized osteosynthesis materials. As a result, there is a necessity to resort to old surgical techniques. A study with a descriptive longitudinal design is presented, reporting 5 clinical cases of jaw fractures with the following inclusion criteria: presenting a mandibular fracture in partially dentate patients with impossibility of accessing the osteosynthesis material of the load-bearing system. The treatment conducted under closed surgical procedures. The condition of partial edentulism confers instability to the mandible fracture, hindering anatomical reduction and causing a loss of vertical and transverse dimension. These issues are addressed through the utilization of modified Gunning-type splints, which help in recovery. The splints were maintained in position with circum-mandibular and circum-zygomatic bone suspension wiring as a means to establish stability over time. Satisfactory results were obtained, indicating that these techniques can still be considered as treatment options today.

Advantages of FDM and gamma irradiation to manufacture personalized medical devices for airway obstructions.

In the early childhood population, congenital airway conditions like bronchomalacia (BM) can pose a life-threatening threat. A breakthrough technology called additive manufacturing, or 3D printing, makes it feasible to create a biomedical device that aids in the treatment of airway obstruction. This article describes how a polycaprolactone (PCL) splint for the upper airways can be created using the fusion deposition technique (FDM) and sterilized using gamma radiation. It is presented as a simple, accessible, and cost-reduced alternative that complements other techniques using more expensive and sophisticated printing methods. Thermomechanical and morphological analysis proved that FDM and sterilizing by gamma irradiation are both appropriate methods for producing splints to treat life-threatening airway blockages. Additionally, the 3D-printed splints' effectiveness in treating a young patient with BM that was life-threatening was assessed by medical professionals. In this regard, the case report of a patient with 34 months of follow-up is presented. Splints manufactured by this affordable 3D printing method successfully surpass breathing arrest in life-threatening airway obstruction in pediatric patients. The success of this procedure represents a fundamental contribution to the treatment of the population in countries where access to expensive and complex technologies is not available.

Tratamiento ortésico de luxación de cadera derivada de osteomielitis del cuello del fémur. Presentación de dos casos

La osteomielitis es una inflamación ósea causada principalmente por bacterias. En los casos de osteomielitis del cuello del fémur y artritis séptica concomitante, las complicaciones pueden ocasionar, a largo plazo, acortamiento y deterioro articular considerables. Se describen los casos de dos pacientes neonatos, con manifestaciones de hipertermia como signo común; y solo en uno de ellos limitación del movimiento del miembro inferior derecho, contractura en flexión y aducción, dolorosa a la movilización. El diagnóstico se basó en criterios clínicos, imagenológicos y de laboratorio. El tratamiento consistió en el uso de la férula en abducción, lo cual garantizó la reducción concéntrica de la cabeza del fémur en la cavidad acetabular; esto pudo constatarse mediante seguimiento y control de la reducción, a través de radiografía simple de la pelvis en cada consulta. El diagnóstico precoz de la enfermedad determina el empleo de un tratamiento más conservador, además de minimizar la aparición de complicaciones.

Osteomyelitis is a bone inflammation caused mainly by bacteria. In cases of the femur's neck osteomyelitis and concomitant septic arthritis, complications can lead to considerable joint shortening and deterioration in the long term. The cases of two neonatal patients are described, with hyperthermia manifestations as a common sign; and only in one of them limited movement of the right lower limb, flexion and adduction contracture, painful on movement. The diagnosis was based on clinical, imaging and laboratory criteria. The treatment consisted in the use of the abduction splint, which guaranteed the concentric reduction of the femoral head in the acetabular cavity; this could be verified by monitoring and control of the reduction, through simple radiography of the pelvis in each consultation. The early diagnosis of the disease determines the use of a more conservative treatment, in addition to minimizing complications.

Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes

Abstract Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgicallyinduced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep (Ovis aries). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.

Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes.

Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgically-induced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep ( Ovis aries ). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.

Two Types of Management for the Noninvasive Treatment of Pectus Excavatum in Neonatal Puppies-Case Reports.

Pectus excavatum is a deformity of the thorax characterized by ventrodorsal narrowing of the sternum bone and costal cartilages, which can lead to compression and cardiopulmonary alterations in dogs, presenting a high prevalence in brachycephalic breeds. The aim of this report was to describe two types of management for the noninvasive treatment of pectus excavatum in newborn puppies of the breeds French Bulldog and American Bully. The puppies presented dyspnea, cyanosis and substernal retraction during inspiration. The diagnosis was performed by physical examination and confirmed by chest X-ray. Two types of splints were performed (a circular splint with plastic pipe and a paper box splint on the chest), aiming at thoracic lateral compression and frontal chest remodeling. The management was effective for the conservative treatment of mild-grade pectus excavatum, resulting in the repositioning of the thorax and improvement of the respiratory pattern.

Resistência flexural de uma resina para impressão 3D comparada a resinas acrílicas convencionais empregadas para confecção de placas estabilizadoras de mordida / Flexural resistance of 3D printing resin compared to conventional acrylic resins employed to build occlusal bite splints

Introduction: with the technological advance in dentistry, light-polymerized three-dimensional (3D) printing resins had become an alternative for the manufacture of occlusal splint splints. Objective: the present study aimed to analyze the flexural strength of a resin for 3D printing compared to conventional acrylic resins (chemically activated and thermally activated), under the influence of thermocycling. Material and method: 60 specimens were made, which were distributed in six experimental groups (n = 10), according to the resin employed (chemically activated acrylic resin, thermally activated acrylic resin and 3D printing resin) and the treatment received (control and thermocycling). The specimens were submitted to flexural strength by the three-point flexural test. Result: data analysis showed that the material factor (<0.0001) and the thermocycling factor (p = 0.0096) influenced flexural strength, however, the interaction between the two factors did not (p = 0.9728). Conclusion: it was concluded that 3D printing resins presented the lowest flexural resistance to acrylic resins, especially when submitted to thermocycling.

Introdução: com o avanço tecnológico dentro da odontologia, as resinas fotopolimerizáveis para impressão tridimensional (3D) se tornaram uma alternativa para a fabricação de dispositivos interoclusais. Objetivo: o presente trabalho teve como objetivo analisar a resistência flexural de uma resina para impressão tridimensional comparada com resinas acrílicas convencionais (quimicamente ativada e termicamente ativada), sob a influência da termociclagem. Material e método: foram confeccionados 60 corpos de prova, que foram distribuídos aleatoriamente em seis grupos experimentais (n=10), de acordo com a resina utilizada (resina acrílica ativada quimicamente, resina acrílica ativada termicamente e resina para impressão 3D) e com o tratamento recebido (controle e termociclagem). Os corpos de prova foram submetidos ao ensaio de flexão de três pontos para determinação da resistência flexural. Resultado: a análise dos dados demonstrou que o fator material (<0.0001) e o fator termociclagem (p=0.0096) influenciaram a resistência flexural, entretanto, a interação entre os dois fatores não (p=0.9728). Conclusão: deste modo podemos concluir que a resina para impressão 3D apresentou desempenho inferior às resinas acrílicas, especialmente quando submetida a termociclagem.

Quality of life assessment in patients with temporomandibular disorder with stabilization splints and home therapeutic exercises: a randomized clinical trial / Avaliação da qualidade de vida em pacientes com desordem temporomandibular com uso da placa estabilizadora e exercícios terapêuticos caseiros: um ensaio clínico randomizado

Objective: The present study aimed to evaluate the quality of life in TMD patients with the use of Stabilization Splints (SSs) and Home Therapeutic Exercises (HTEs) guidance. Material and Methods: The study was a clinical, randomized, controlled, prospective, and interventional trial. The screening included dentate patients of both genders, diagnosed with TMD through the RDC/TMD questionnaire with no TMJ osteoarthritis and/or osteoarthrosis. To assess the quality of life, the Short-Form Health Survey (SF-36) questionnaire was applied to all patients (n=70), randomized into a test group with SS and a control group with HTE. The evaluations of both questionnaires were performed before and after the intervention of 12 weeks. Results: The comparisons between pre- and post-intervention intragroups were performed by the non-parametric Wilcoxon test with a 5% significance level. There was a frequency distribution of the responses to the 36 items of the SF-36 questionnaire and comparisons between times. In the test group, 49 patients received a SS and did HTEs. In the control group, 21 patients performed HTEs. In the statistical analysis, among the eight domains, three were identified with significant scores: pain, mental health, and vitality. Conclusion: It was found that there was an improvement in pain and quality of life after the treatment of TMD with a SS and HTE (AU)

Objetivo: O presente estudo teve como objetivo avaliar a qualidade de vida em pacientes com DTM com o uso de placas de estabilização (SSs) e orientação de exercícios terapêuticos domiciliares (HTEs). Material e Métodos: O estudo foi um ensaio clínico, randomizado, controlado, prospectivo e intervencionista. A triagem incluiu pacientes dentados de ambos os sexos, diagnosticados com DTM através do questionário RDC/TMD sem osteoartrite e/ou osteoartrose da ATM. Para avaliar a qualidade de vida, o questionário Short-Form Health Survey (SF-36) foi aplicado a todos os pacientes (n=70), randomizados em grupo teste com SS e grupo controle com HTE. As avaliações de ambos os questionários foram realizadas antes e após a intervenção de 12 semanas. Resultados:As comparações intragrupos pré e pós-intervenção foram realizadas pelo teste não paramétrico de Wilcoxon com nível de significância de 5%. Houve distribuição de frequência das respostas aos 36 itens do questionário SF-36 e comparações entre os tempos. No grupo controle, 21 pacientes realizaram HTEs. Na análise estatística, dentre os oito domínios, três foram identificados com escores significativos: dor, saúde mental e vitalidade. Conclusão: Verificou-se que houve melhora da dor e da qualidade de vida após o tratamento da DTM com SS e HTE.(AU)

Effect of low-level LASER therapy versus CAD/CAM Michigan splint on patients with Temporomandibular Muscle Disorders: a randomized clinical trial / Efeito da terapia LASER de baixa potência versus placa de Michigan CAD/CAM em pacientes com Distúrbios Temporomandibulares musculares: um ensaio clínico randomizado

Objective: This study aimed to evaluate the efficacy and sustainability of using low level LASER therapy and CAD/CAM Michigan splint on improving the range of mandibular movements, muscle activity and reducing the pain. Material and Methods: 56 female patients were randomly divided into two groups. Group A: Patients received applications of low-level LASER therapy using semiconductor InGaAsp diode LASER type 940 nm with continuous mode of operation, applied for 180 sec per session for 12 sessions. Group B: Patients received Michigan splint of 2 mm thickness constructed on their upper teeth, the splint was 3D digitally printed. Electromyography was used to evaluate muscle activity, visual analogue scale was used to evaluate the pain intensity, ARCUS digma facebow was used to evaluate range of mandibular movements, and maximum mouth opening was taken using a millimeter ruler. They were measured before the beginning of the treatment, and at three and six month follow-up periods. Results: The results revealed that both low-level LASER therapy and Michigan splint reduce the myofascial pain, improved the range of the mandibular movements, and the muscles activity, but the effect of the low-level LASER therapy was more profound and sustainable. After 6 months from the beginning of the treatment, changes in masseter muscle activity (P= 0.001; effect size= 1.757), pain intensity (P= 0.003; effect size= 3), and range of mandibular movement (P= 0.001, effect size= 1.729) differed significantly between the two groups. Conclusions: Low-level LASER therapy had a better and more sustainable effect on reducing the pain intensity and improving the muscle activity as well as the mandibular movement when compared to Michigan splint (AU)

Objetivo: Este estudo teve como objetivo avaliar a eficácia e a durabilidade do uso da terapia LASER de baixa potência e da placa de Michigan CAD/CAM na melhora da amplitude dos movimentos mandibulares, atividade muscular e redução da dor. Material e Métodos: 56 pacientes do sexo feminino foram divididos aleatoriamente em dois grupos. Grupo A: os pacientes receberam aplicações de terapia LASER de baixa potência utilizando diodo semicondutor InGaAsp LASER tipo 940 nm em modo contínuo de operação, aplicado por 180 segundos por sessão durante 12 sessões. Grupo B: os pacientes receberam a placa de Michigan com uma espessura de 2 mm confeccionada sobre a arcada superior, a placa foi impressa digitalmente em 3D. A eletromiografia foi utilizada para avaliar a atividade muscular, a escala visual analógica foi utilizada para avaliar a intensidade da dor, o arco facial ARCUS digma foi utilizado para determinar a amplitude dos movimentos mandibulares e a abertura máxima da boca foi medida com uma régua milimétrica. Todas as medidas foram realizadas antes do início do tratamento e nos períodos de acompanhamento de três e seis meses. Resultados: Os resultados revelaram que tanto a terapia LASER de baixa potência como a placa de Michigan reduziram a dor miofascial, aumentaram a amplitude dos movimentos mandibulares e melhoraram a atividade muscular, mas o efeito da terapia LASER de baixa potência foi mais profundo e duradouro. Após 6 meses do início do tratamento, as alterações na atividade do músculo masseter (P= 0. 001; tamanho do efeito= 1,757), intensidade da dor (P= 0,003; tamanho do efeito= 3), e amplitude de movimento mandibular (P= 0,001, tamanho do efeito= 1,729) diferiram significativamente entre os dois grupos. Conclusão: A terapia com LASER de baixa potência teve um efeito melhor e mais duradouro na redução da intensidade da dor e na melhora da atividade muscular, bem como do movimento mandibular, quando comparada à placa de Michigan(AU)

Efectividad de Férulas de Descarga Oclusivas como Tratamiento para la Disfunción Temporomandibular. Revisión Sistemática

El objetivo de este estudio de revisión sistemática consistió en la búsqueda de hallazgos clínicos en estudios de calidad sobre la efectividad de la terapia con férulas de descarga oclusales. Esta investigación bibliográfica se realizó en PubMed, Embase, SciELO, Science Direct, Scopus, Google Scholar y en el Registro Central de Ensayos clínicos Cochrane; delimitando la búsqueda desde el 1 de enero de 2011 al 1 de junio de 2022. Se incluyeron un total de 21 artículos, todos relacionados con la disfunción de la articulación temporomandibular y la eficacia de las férulas de descarga oclusales como tratamiento. Las férulas de descarga oclusales reducen eficazmente los síntomas dolorosos en pacientes con trastornos temporomandibulares, tanto en patologías musculares como articulares, aunque con mayor eficacia en casos de disfunción muscular, ya que se han observado desplazamientos recurrentes de disco en patologías articulares.

The objective of this systematic review study was to search for clinical findings in quality studies on the effectiveness of occlusal splint therapy. This literature search was conducted in PubMed, Embase, SciELO, Science Direct, Scopus, Google Scholar, and the Cochrane Central Register of Clinical Trials; delimiting the search from January 1, 2011 to June 1, 2022. A total of 21 articles were included, all related to temporomandibular joint dysfunction and the efficacy of occlusal splints as a treatment. Occlusal splints effectively reduce painful symptoms in patients with temporomandibular disorders, both in muscular and joint pathologies, although more effectively in cases of muscular dysfunction, since recurrent disc displacements have been observed in joint pathologies.

Relationship between dental occlusion and brain activity: A narrative review.

Objectives: Occlusal function stimulates different areas of the cerebral cortex. The purpose of this narrative review was to identify the relationship between occlusion and brain activity so as to provide theoretical support to enable future studies on the subject. Study selection data and sources: Relevant case-control studies, clinical trials, and systematic reviews available in English were retrieved from the following databases: MEDLINE, PubMed, ScienceDirect, Wiley Online Library, and Biblioteca Virtual en Salud (BVS). Of the 53 articles obtained, 12 were included. Conclusion: The sensorimotor cortex is affected by changes in occlusion. It is speculated that occlusion could play an important role in the development of diseases, from anxiety and stress to Alzheimer's disease and senile dementia. Further investigations into the interactions between occlusion and brain function are needed to elucidate the parts of the brain that are affected when occlusion is disturbed and to determine whether brain function is altered. Clinical significance: Dentists must consider that alterations in the occlusal pattern during mastication can lead to changes in the activation of different brain regions related to memory, learning, anticipatory pain, and anxiety. This suggests that mastication maintains the integrity of certain brain areas and that it may be a key factor in the onset of neurodegenerative diseases.

Relación entre oclusión, bruxismo y cefalea tensional en niños: Reporte de casos / Relation between occlusion, bruxism and tension headache in children: Case report

La cefalea es uno de los motivos de consulta más frecuente en nuestros pacientes, presentando una alta prevalencia en niños en edades escolares y adolescentes. El objetivo de este reporte de casos es describir casos de niños entre 6 y 13 años, quienes presentan cefalea tensional crónica. Al examen clínico se observa maloclusión, dolor a la palpación de músculos masticatorios y bruxismo. Todos los pacientes tenían características comunes en su personalidad, siendo perfeccionistas, estudiosos y preocupados. La terapia que se les realizó fue la confección de una férula oclusal orgánica, construida en relación céntrica, y se controlaron cada 15 días. Luego de un mes de tratamiento los pacientes mostraron una remisión total de las cefaleas y de la contractura muscular, llegando a la conclusión de que los planos de relajación sirven para aliviar la cefalea tensional en niños con bruxismo y maloclusión, siempre realizando un correcto diagnóstico previo.

Headache is one of the most frequent reasons for consultation in our patients, with a high prevalence in school-age children of and adolescents. The objective of this case report is to present cases of children between 6 and 13 years old, who have chronic tension headache. On clinical examination, malocclusion, palpation of masticatory muscles and bruxism were observed. All the patients had common characteristics in their personality, being perfectionists, studious and concerned. The therapy consisted of the preparation of an occlusal splint, with partial or total coverage depending on the case, and they were monitored every 15 days. After one month of treatment, the patients showed a total remission of headaches and muscle contracture, concluding that occlusal splints can relieve tension headache in children with bruxism and malocclusion, always with a correct previous diagnosis.

Dental trauma splints for the mixed dentition - A finite element analysis of splint material, splint extension, missing teeth, and PDL representation.

BACKGROUND/AIMS: Dental traumatic injuries are common in children during the mixed dentition stage. These injuries usually require splinting for stabilization, which is complicated by the various stages of the permanent tooth development and primary tooth exfoliation. The aim of this study was to evaluate the effect on mobility of splint materials and extensions for an avulsed central incisor, stabilized with and without the adjacent incisor under intrusive and extrusive loading with different periodontal ligament (PDL) conditions. MATERIALS AND METHODS: Seventeen 3D model variations were created from a CBCT scan of a 7-year-old patient without erupted permanent upper lateral incisors. A 1000 N palatal load on the right central incisor simulated the avulsion injury and created an increased alveolus and bone deformation, resulting in an increased PDL thickness of 0.45 mm. Wire-resin composite splints with 0.9 mm cross-section (WCS) or 1.0 mm diameter nylon-resin composite splints (NCS) were created. The models simulated conditions with and without the adjacent upper central incisor. Two PDL conditions were investigated, simulating detached PDL or PDL with polyether impression material-like properties. Mobility was calculated under simulated biting loads in horizontal and vertical (intrusive and extrusive) directions. RESULTS: The NCS allowed greater tooth mobility of the avulsed incisor than the WCS, irrespective of splint extension, PDL condition, or load application. During horizontal loading, polyether-like properties for the PDL allowed around 0.2 mm mobility of the avulsed tooth with the WCS, similar to the intact tooth, whereas a simulated detached PDL allowed 25% more mobility with a WCS than with a NCS. CONCLUSIONS: Based on the FEA analysis, a 1.0 mm NCS may be suitable for splinting avulsion injuries during the mixed dentition stage compared to the considerably more rigid WCS. The NCS models provided flexibility for PDL healing while maintaining stability, even when missing adjacent teeth increased span widths. Extensions beyond directly adjacent teeth did not alter the mobility with the NCS but should still be considered an extra protection in case of bond failure or exfoliation.

Custom-made finger splint versus prefabricated finger splint: finger flexion stabilization

SUMMARY OBJECTIVE: Finger splints are used as a treatment option in tendon, bone, and soft tissue injuries. For immobilization, custom-made splints and prefabricated finger splints are used. In splints made for immobilization, it is aimed to limit joint movement. The aim of our study is to reveal how much custom-made splints and prefabricated finger splints limit joint motion (flexion angle in proximal interphalangeal and distal interphalangeal joints). METHODS: Custom-made splints and prefabricated finger splints were applied to the second fingers of the dominant side in a total of 40 individuals, 20 women and 20 men, not having any health problems. Individuals were asked to flex and joint motion was measured with the iPhone compass application. RESULTS: The mean distal interphalangeal joint angle values of the participants measured by prefabricated finger splints were found to be 24.27±8.29, and the mean distal interphalangeal joint angle values measured by custom-made splints was 0.52±1.50. There was a difference between the participants' distal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splint. The mean of the participants' proximal interphalangeal joint angle values measured by prefabricated finger splints was 16.55±7.90, and the proximal interphalangeal joint angle values measured by custom-made splints was "0" for all participants. There was a difference between the participants' proximal interphalangeal joint angle values measured by prefabricated finger splints and custom-made splints (p<0.001). Distal interphalangeal joint angle values measured with custom-made splints were significantly smaller than those measured with prefabricated finger splints. CONCLUSION: According to our study, custom-made splints can significantly reduce the flexion of the finger interphalangeal joints compared to prefabricated finger splints.

Stack Splinting Versus Kirschner Wire Treatment in Acute Closed Mallet Finger Doyle I.

Introduction: Mallet injuries are common and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding the best management, and it is still unclear. Objective: To evaluate the treatment efficacy of Stack Splinting compared to a Kirschner wire immobilization of acute closed mallet finger Doyle I. Methods: From March 2019 to February 2020, 41 patients with acute close mallet finger Doyle I were treated; 19 patients were treated with Kirschner wire and 22 with Stack splinting for a mean of 6 weeks. The average patient age at the time of the injury was 43 years. Results: Twenty-eight males and 13 females were in this study. Among them, 17 patients were injured in the little finger, 15 in the middle finger, and 9 in the ring finger. Twenty-seven of injuries suffered an aggression, 11 from falling, and 3 from sports injuries. All the fingers had typical mallet malformation. Seventeen patients treated with Kirschner wire completed the treatment with full recovery, only 7 patients treated with Stack splint completed the treatment and 15 treated with Stack splint had relapse on mallet injury. Conclusion: Kirschner wire treatment is a simple procedure, and proves in this study that has better results in patients with acute closed mallet finger Doyle I compared to Stack splint.

Introduction: Les doigts à gâchette (ou à ressaut) sont courants et généralement traités avec prudence. Diverses analyses systématiques ont constaté un manque de données probantes sur la prise en charge optimale, qui n'est pas toujours claire. Objectif: Évaluer l'efficacité du traitement par attelle de Stack par rapport à l'immobilisation par broches de Kirschner en cas de doigt à gâchette fermé en phase aiguë correspondant à la classification 1 de Doyle. Méthodologie: Entre mars 2019 et février 2020, 41 patients d'un âge moyen de 43 ans au moment de la lésion ont présenté un doigt à gâchette fermé en phase aiguë correspondant à la classification 1 de Doyle et ont été traités. Ainsi, 19 ont été traités par une broche de Kirschner et 22, par une attelle de Stack, pendant une période moyenne de six semaines. Résultats: Au total, 28 hommes et 13 femmes ont participé à cette étude. De ce nombre, 17 patients ont subi une blessure de l'auriculaire, 15, du majeur, et neuf, de l'annulaire. Une agression avait causé 27 des blessures, une chute en avait causé 11 et des blessures sportives, trois. Tous les doigts présentaient la malformation à gâchette classique. Au total, 17 patients traités par une broche de Kirschner ont terminé le traitement et se sont pleinement rétablis, mais seulement sept patients ayant eu une attelle de Stack ont terminé le traitement, et 15 d'entre eux ont vécu une rechute. Conclusion: Le traitement par broche de Kirschner est une intervention simple, et la présente étude démontre qu'il donne de meilleurs résultats que l'attelle de Stack chez les patients ayant un doigt à gâchette fermé en phase aiguë correspondant à la classification 1 de Doyle.

Auricular acupuncture in TMD - A sham-controlled, randomized, clinical trial.

This study evaluated the effect of auricular acupuncture (AA) on physical (PA) and emotional (EA) aspects of patients with temporomandibular disorders (TMDs) and compared the effect of AA with those of Sham and occlusal splints (OS). In accordance with the CONSORT guidelines, patients with TMDs were evaluated by axes I and II of the RDC-TMD. The patients were allocated among three groups: OS, Sham and AA; and followed for 8 weeks. Both intragroup and intergroup evaluation for quantitative variables were analyzed with ANOVA, one-way, followed by the Tukey test. Qualitative variables were analyzed with the Kruskal-Wallis, and Dunn tests (intergroup evaluation) and for intragroup analyses, the Friedman and Wilcoxon tests were applied. At the end of the experiment, the chi-squared test was applied to compare the three groups with respect to the number of variables that had shown improved scores. The adopted level of significance for all tests was α = 5%. Intragroup analysis showed that, in the Sham group, no improvement in performance was seen in either EA and significant was improvements in 5 variables for 9 for PA, while in the AA group, significant improvements were observed in 2 variables for EA and in 9 for PA. In the OS group at the end of this study, significant improvements were observed in 8 and 8 variables for EA and PA, respectively. The analysis of therapies used revealed that the number of variables exhibiting significantly improved outcomes after treatment was similar between the AA and OS groups, whereas the sham group showed statistically significant differences when compared with the other two groups. In conclusion, this study demonstrated that AA applied at a specific TMJ ear point was able to bring about improvements in patients with TMDs, with outcomes similar to those in patients treated with an OS. CLINICAL TRIAL REGISTRATION: RBR-69ynnw (Brazilian Registry of Clinical Trials).

Splint stiffness and extension effects on a simulated avulsed permanent incisor-A patient-specific finite element analysis.

BACKGROUND/AIM: Splinting is an important procedure after avulsion. However, the role of splint stiffness and extension is not fully understood. The aim of this study was to evaluate the effect of splint stiffness and extensions on the mobility and stress on an injured tooth under physiological biting load. MATERIALS AND METHODS: Three-dimensional (3D) finite element models were created from a cone beam computer tomogram of a patient with normal occlusion. An avulsion injury of the right central incisor was created with a 1000 N load application on the palatal of the injured tooth, causing increased socket width. Splints made from four materials were tested: 0.9 mm diameter wire-composite splint (WCS1), 0.4 mm diameter wire-composite splint (WCS2), 1.0 mm diameter nylon-composite splint (NCS), and a 2 mm high by 0.2 mm thick plastic strip composite splint (PSS). Three splint extensions (involving 6, 5, and 3 teeth) were evaluated. Mobility of the avulsed tooth and the maximum principal stress distributions in the adjacent teeth were calculated. RESULTS: The injured incisor tooth mobility was not affected by the splint extensions. The NCS and PSS stabilized the avulsed incisor but allowed, respectively, 10 and 20 times more mobility under horizontal loading than the WCS1, which inhibited most mobility, while the WCS2 allowed double the mobility compared with WCS1. The NCS and PSS allowed more tooth mobility, mainly in the extrusion direction. Splints were 2-3 times more effective in limiting mobility under intrusive loads than extrusive loads. High levels of stress were found at the base of the composite attachments in the adjacent incisors. CONCLUSION: Splinting an avulsed tooth to one or two teeth bilaterally using a nylon splint or a plastic strip is appropriate for tooth stabilization and should be recommended over the 0.4mm wire-composite splint, while the 0.9 mm orthodontic wire is too rigid and not recommended.