Evaluation of the effects of bruxism on oral health-related quality of life in adults.

OBJECTIVE: The aim of this study was to evaluate the effects of bruxism on oral health-related quality of life (OHRQoL) in adults in relation to temporomandibular disorders (TMD). METHODS: Three hundred-fifteen adults of both sexes were divided into two groups: bruxers (n = 172) and controls (n = 143). The participants with TMD were divided into three subgroups based on myofascial pain, disc displacement, or both. The Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL. RESULTS: Bruxers had poorer OHRQoL than controls, and the highest mean OHIP-14 domain scores were observed in physical pain. Bruxers with TMD had higher total OHIP-14 scores and individual domain scores than those without TMD. Bruxers without TMD demonstrated higher OHIP-14 scores than controls. CONCLUSION: Bruxism was associated with poor OHRQoL. Where bruxism was accompanied by TMD, OHRQoL could be more negatively affected. The presence of bruxism without TMD was also associated with poor OHRQoL.

Comparison of the Retention of Conventional and Polyvinyl Siloxane Matrix Materials with Different Patrices for Implant-Retained Overdentures: An In Vitro Study.

PURPOSE: To compare the retention forces of implant overdenture patrices (ball, bar, and TiSi.snap) to conventional (O-ring, metal housing, and clip) and polyvinyl siloxane (PVS)-based silicone (retention.sil 200, 400, and 600; Mucopren Soft; and GC Reline Soft) matrix materials. MATERIALS AND METHODS: Two implant analogs, in which the patrices were to be placed, were embedded parallel to each other in polyethylene blocks, and the matrices were placed in heatpolymerized acrylic blocks that were fabricated as overdentures. Ten samples were prepared for each attachment type, and 180 samples were obtained from 18 groups. All samples were placed in a chewing simulator for occlusal force application and for insertion and removal of the pieces. Retention measurements were performed with a universal testing device at the initial (10 cycles), simulated first-year (1,825 cycles), and simulated second-year (3,650 cycles) periods, assuming that the patients would insert and remove their overdenture five times daily. RESULTS: Loss of retention occurred in all the attachment systems at the end of 3,650 cycles (P < .05). The PVS matrix materials showed less retention than the O-ring and metal matrices when a ball patrix was used, while they had higher retention than bar clips when the Hader bar patrix was used (P < .05). Among the PVS matrix materials, retention.sil 200 produced the lowest retention values, whereas retention.sil 600 generated the highest. CONCLUSION: PVS matrix materials show higher retention than that achieved by yellow plastic bar matrices. However, these materials exhibit lower retention than with plastic and metal matrices of ball abutments.

The effect of the ischaemic compression technique on pain and functionality in temporomandibular disorders: A randomised clinical trial.

BACKGROUND: Interventions addressing pain and impaired functionality in individuals with temporomandibular disorders (TMDs) are needed. OBJECTIVE: To compare the effects of 4 weeks of exercise combined with ischaemic compression and exercise alone in patients with TMDs. METHODS: Fifty patients who were diagnosed with TMDs were randomised into Group 1 (exercise combined with ischaemic compression technique) (n = 25) or Group 2 (exercise alone) (n = 25). Both groups performed 4 weeks of Rocabado's exercise and 3 weeks of postural exercise, while Group 1 received ischaemic compression to the masseter muscle for a total of 3 sessions in addition to exercise. A ruler was used to assess range of motion (ROM) (painless mouth opening (PMO), maximum mouth opening, maximum assisted mouth opening (MAMO), left lateral movement and right lateral movement), the visual analogue scale and graded chronic pain scale were used to assess pain, an algometer was used to determine the pain pressure threshold (PPT), and the 8-item jaw functional limitation scale was used to assess, functionality. The assessments were performed at baseline, at week 1 and at week 4. RESULTS: The participants in Group 1 exhibited larger PMO (F = 5.26, P = .02) and MAMO values (F = 6.71, P = .01) than did the patients in Group 2 at week 1. The effect size was small for MAMO (ES = 0.27) and moderate for PMO (ES = 0.51). However, there were no significant differences in any other outcomes between groups at week 1 or 4. CONCLUSION: In summary, this randomised controlled trial indicates that exercise combined with ICT and exercise alone have similar effects on ROM, pain, the PPT and functionality in patients with TMDs.

Rehabilitation of Occlusal Vertical Dimension in a Patient with Acromegaly: A Clinical Report.

Acromegaly is a rare acquired disorder caused by excessive growth hormone production. Dentists play an important role in the diagnosis of this disorder because of intraoral and extraoral symptoms such as extreme growth of the mandible, enlargement of the maxilla, diastema between teeth, a tendency toward malocclusion, a wide and thick nose, a marked malar bone, and thick lips. The prosthetic treatment of these patients is challenging because growth in the condyles and rami can lead to the development of a severe class III jaw relationship. This case report describes the prosthetic treatment of a patient with acromegaly. A decreased occlusal vertical dimension and class III jaw relationship were determined by intraoral and extraoral examinations and cephalometric radiography. The occlusal vertical dimension was reestablished by increasing it approximately 10 mm, as per the esthetic and functional needs of the patient. Four years after treatment, the patient was functioning well, and neither occlusal disharmony nor temporomandibular disorder was observed.

The hemodynamic effects of occlusal splint therapy on the masseter muscle of patients with myofascial pain accompanied by bruxism.

Objective: The aim of this study was to investigate the hemodynamic effects of occlusal splint therapy on masseter muscles of patients with myofascial pain accompanied by bruxism with near-infrared spectroscopy (NIRS). Methods: Twenty-four patients were randomly divided into two groups, where the study group (n = 12) received occlusal splint therapy and the control group (n = 12) underwent no therapy. Measurements were categorized into four subgroups: painful or painless control and painful or painless splint. Percent changes in deoxyhemoglobin (Hb), oxyhemoglobin (HbO2), and OXY (HbO2-Hb) values were calculated during a 1-month period. Results: Statistically significant inter-session differences between painful-splint and painful-control groups were detected for NIRS oxygenation parameters, whereas inter-session differences between painless groups were statistically insignificant. Conclusion: The results suggest that occlusal splint usage causes a decrease in hyperemic response, which is indicative of a decrease in masseter muscle contraction strength.

Multidisciplinary management of a partially edentulous patient with oromandibular dystonia: A clinical report.

Oromandibular dystonia (OMD) is defined as a subset of movement disorders characterized by involuntary muscle contraction in different parts of the oromandibular region. This clinical report presents a multidisciplinary approach to the management of a patient with OMD. The involuntary movement of her mandible and tongue was improved with a mandibular custom occlusal device and maxillary modified removable complete denture together with botulinum toxin A injections.

Distraction of the temporomandibular joint condyle in patients with unilateral non-reducing disc displacement: Fact or fiction?

OBJECTIVES: This study investigated the distractive effect of a unilateral pivot splint on patients with unilateral disc displacement without reduction. METHODS: The study group was comprised of 18 patients who had no history of treatment with removable prosthetic restorations of molars, premolars, or canine teeth, and no previous treatment for temporomandibular disorder. Joint spaces measurements made on magnetic resonance images indicated the affected side to be narrower than the healthy side. Unilateral distraction splints were made for all patients. An ultrasonic motion analyzer was used to measure the vertical shift occurring on the affected side as patients closed their mouths with maximal force with the splint in their mouths. RESULTS: Closing with maximal force on the unilateral distraction splint led to a noticeable downward movement of the affected condyle. DISCUSSION: The findings of this study indicate that the TMJ condyle of patients with unilateral disc displacement without reduction may be unilaterally distracted if the articular space is narrowed.

Familial gigantiform cementoma with Ehlers - Danlos syndrome: A report of 2 cases.

Ehlers-Danlos syndrome is an autosomal dominant hereditary disorder of connective tissue, while familial gigantiform cementoma is a condition that usually manifests as multiple radiopaque cementum-like masses throughout the jaws. This case report discusses the oral management and prosthetic rehabilitation of two patients presenting familial gigantiform cementoma with Ehlers-Danlos Syndrome.

The Evaluation of the Reliability of Periotest for Implant Stability Measurements: An In Vitro Study.

Periotest (Medizintechnik Gulden, Modautal, Germany) is a widely accepted implant stability measurement method, although the reliability is not well known. The aim of this in vitro study was to investigate the reliability of the Periotest in implant stability measurements. Thirty implants were placed in 3 cow ribs. The stability of each implant was measured by insertion torque, resonance frequency analyses, and Periotest and then compared. The Periotest values (PTVs) were measured by 4 different examiners. The measurements were repeated twice in both the buccal and mesial directions, for each implant at 2-hour intervals and the intra- and interobserver reliability of Periotest was measured. Results showed that the intraobserver reliability of the Periotest was excellent for the buccal PTVs but fair to poor for the mesial PTVs. The interobserver reliability of the Periotest was excellent for the buccal PTVs but poor for the mesial PTVs. No significance was found between the PTVs and IT values (P = .803) and PTVs and ISQ values, whereas a 47.1% significant correlation was detected between the IT values and ISQ values (P = .009). The present study indicates that only Periotest measurements from buccal result in excellent intra- and interobserver reliability for the quantification of the implant stability.

Evaluation of the closest speaking space in different dental and skeletal occlusions.

STATEMENT OF PROBLEM: The closest speaking space (CSS) together with the vertical overlap of anterior teeth during the production of the /s/ sound have not been previously investigated with respect to differences in dental and skeletal orthodontic classifications. PURPOSE: The purpose of this study was to investigate the CSS in dental and skeletal occlusions and to analyze the cause and effect relationship of the CSS and the amount of the vertical overlap of anterior teeth. MATERIAL AND METHODS: Poly vinylsiloxane interocclusal registration material was placed bilaterally onto the occlusal surfaces of premolar and molar teeth of 155 native Turkish speaking adolescent and young adult dentate participants, who were then asked to pronounce the word seyis. The thinnest point between the maxillary and mandibular teeth was recorded in millimeters as the CSS. The occlusion of each participant was classified according to the Angle dental and Steiner skeletal classifications. The differences in CSS values within each classification were statistically analyzed with the Kruskal-Wallis test, and the correlation between the CSS and the vertical overlap was statistically analyzed with the Spearman Rho Correlation tests (P<.05). RESULTS: The differences in the CSS were only significant between Angle Class II division 2 and Class III groups (P=.034), while the differences in the CSS between skeletal classes were not significant. The correlation between the amount of CSS and the amount of vertical overlap was not significant. CONCLUSIONS: The results showed that regardless of dental and skeletal occlusions, average CSS values could be used to determine the occlusal vertical dimension of prosthetic restorations.

Evaluation of the effects of temporomandibular joint disc displacement and its progression on dentocraniofacial morphology in symptomatic patients using posteroanterior cephalometric analysis.

The aim of this study was to evaluate the effects of disc displacement (DD) and its progression on dentocraniofacial morphology in symptomatic patients, and to compare the results with asymptomatic volunteers. Female patients with DD, diagnosed with magnetic resonance imaging (MRI) and posteroanterior cephalometric analysis, were included in this study. Subjects were grouped as follows: control group with bilateral normal disc position (group 1, n=20), unilateral DD with reduction (group 2, n=17), bilateral DD with reduction (group 3, n=32), unilateral DD without reduction (group 4, n=16), and bilateral DD without reduction (group 5, n=19). Thirteen cephalometric variables were measured. A significant increase in the ANS (Anterior nasal spine)-Me (Menton)-MSP (Midsagittal plane) angle in unilateral DD groups and decreases in the Ag (Antegonial notch)-Me dimension on the affected side in all DD groups were observed. Also, the maximum values of the Me-MSP dimension and ANS-Me-MSP angle were observed in group 4. The results of this study showed that the deviation of the menton point toward the disc displacement side causes a mandibular asymmetry. It can be concluded from these results that the presence of DD in female patients affects facial morphology, and its progression makes the differences more significant and remarkable. These results emphasize the importance of early diagnosis and treatment in the management of DD.

Does the presence of anterior mandibular teeth increase the incidence of denture stomatitis?

PURPOSE: To compare the frequency of denture stomatitis (DS) under maxillary complete dentures (CDs) in patients with opposing mandibular distal extension removable partial dentures (RPDs) and CDs. MATERIALS AND METHODS: Participants included 365 maxillary CD wearers (241 women, mean age 70.5 ± 13.2 years; 124 men, mean age 71.5 ± 10.4 years) from 7 rest homes in Istanbul. A total of 268 had mandibular CDs; 97 had mandibular distal extension RPDs. Two independent, calibrated examiners performed oral examinations. Presence of maxillary denture-related stomatitis and the effect of risk factors on DS were evaluated and recorded. RESULTS: The frequency of palatal DS (Newton I-III) was 45.1% (n = 121) in the mandibular CD group and 49.5% (n = 48) in the mandibular distal extension RPD group, a statistically insignificant difference (p= 0.4). Factors significantly associated with palatal DS were maxillary denture age (p= 0.02), reduced occlusal vertical dimension (p= 0.04), and nocturnal denture wear (p= 0.03). CONCLUSION: In this study, DS beneath maxillary CDs did not differ between mandibular distal extension RPD and CD wearers. The presence of mandibular anterior teeth did not influence the occurrence of palatal DS.

The effect of mandibular anterior teeth on the hypermobile tissue in the anterior part of the maxilla.

The absence of posterior occlusal contacts may result in increased anterior occlusal contacts and forces between natural mandibular dentition and artificial maxillary dentition. The impact of natural mandibular anterior teeth on the development of hypermobile tissues in the anterior part of the edentulous maxillary alveolar ridge was investigated in this study. The study group consisted of 410 patients with maxillary complete dentures and various mandibular dentitions from seven rest homes in Istanbul. The data; including hypermobile tissue in the anterior part of the maxilla, occlusal relationship, nocturnal wear, denture age, and duration of the maxillary full edentulism period were recorded. A chi-square test was performed to analyze the effects of following data: Existence of mandibular anterior teeth, poor adaptation of the dentures, nocturnal wear, types of occlusal contacts, and gender, on the resorption of the anterior part of the maxilla. To examine the effects of the presence of anterior mandibular teeth and early maxillary edentulism on bone resorption in the anterior part of the maxilla, a logistic regression analysis was performed. The results reveal that patients with edentulous maxilla and natural mandibular anterior teeth are approximately twice more likely to show risk of hypermobile tissue in the anterior part of the maxilla than are full edentulous patients. Further, edentulous periods exceeding 30 years in maxilla seem to increase this risk approximately 4 times.

Precision of implant placement with stereolithographic templates: a pilot in vitro study.

This pilot study assesses the accuracy of 2 bone-supported stereolithographic surgical templates with respect to placement of implants in originally planned positions, and it tests the precision of dental volumetric tomography planning. Two mandibles retrieved from formalin-fixed human cadavers were scanned by dental volumetric tomography for planning of the implant positions, leading to stereolithographic models and fabrication of surgical guides. The situation immediately following drilling and implant insertion by an experienced surgeon was scanned and the outcome compared with the initial planning. The 3-dimensional discrepancies were then analyzed and determined. The results show deviations of the placed implants from the original planning, especially in the vertical direction, making the seating of a prefabricated denture impossible. At present, the flapless surgery technique based on stereolithographic surgical templates appears unsafe; further improvement is required.

Multidisciplinary management of limited interocclusal space: a clinical report.

Prosthetic management of partial edentulism can be challenging with the presence of limited interocclusal space. The extrusion of opposing teeth combined with the alveolar extrusion of the edentulous areas reduces the space needed for fabricating a removable or fixed prosthesis when edentulous areas are present in the maxilla. This clinical report describes the treatment provided to a patient who presented with a limited interocclusal space on the posterior right quadrant. Before prosthetic rehabilitation, mandibular right posterior teeth were intruded, and the maxillary right posterior alveolar crest was reduced by alveoloplasty. After gaining adequate space, prosthetic rehabilitation was completed with a maxillary removable partial denture. During the 2-year follow-up period, the patient's chewing functions and physical appearance improved, and no complications occurred.

Reliability and comparison of two facial measurements to detect changes of occlusal vertical dimension in complete denture wearers.

BACKGROUND: Facial measurements are frequently used to determine OVD. However, the reliability of neither the method nor the chosen landmarks has been cleared yet. OBJECTIVE: This study compares the reliability of two facial measurements, subnasal (SN) to chin (C) and tip of the nose (TN) to C, for determining occlusal vertical dimension (OVD). MATERIALS AND METHODS: Thirty edentulous subjects with adequate neuromuscular co-ordination, without signs and symptoms of temporomandibular disorders and who had been wearing complete dentures for at least 5years were enrolled. A modified central bearing device was used to alter the OVD and facial measurements were made with a digital caliper. Student's t-test was used to compare the two measurements. Interobserver and intraobserver reliability were evaluated with Spearman's rho correlation test. RESULTS: TN-C distance had an improved correlation with the changes in intraoral alterations than SN-C distance. While the means of the changes in facial measurements were in good agreement with the intraoral alterations, the ranges were wide. Both interobserver and intraobserver reliability of the measurements were high. CONCLUSION: While facial measurement is not a good predictor of OVD, TN-C distance appears to be more reliable than SN-C distance.

Evaluation of the effects of temporomandibular joint disk displacement and its progression on dentocraniofacial morphology in symptomatic patients using lateral cephalometric analysis.

The aim of this study was to evaluate the effects of disk displacement (DD) and its progression on dentocraniofacial morphology in symptomatic patients and compare the results with asymptomatic volunteers. Skeletal and dental Class I female patients with DD, diagnosed using magnetic resonance imaging (MRI) and lateral cephalometric analysis were included in the study. Subjects were grouped as follows: control group with bilateral normal disk position (group 1, n=12), unilateral DD with reduction (group 2, n=16), bilateral DD with reduction (group 3, n=26), unilateral DD without reduction (group 4, n=12), and bilateral DD without reduction (group 5, n=8). Thirty-two (32) cephalometric variables were measured, and statistically significant differences were found in 11. Dental and soft tissue measurements did not reveal any differences, but variables related to the mandible showed statistically significant differences. Progression of DD was associated with an increase in all angular measurements related to vertical skeletal relationships and articular angle and a decrease in the ratio of posterior face height to anterior face height indicating clockwise rotation of the mandible. Similarly, the height of ramus was decreased with the progression of DD. The results of this study demonstrated that the presence of DD in skeletal Class I female patients effects facial morphology, and its progression makes the differences more significant and remarkable. These results emphasize the importance of early diagnosis and treatment in the management of DD.

Prosthodontic treatment of a patient with hemimandibular elongation: a clinical report.

This clinical report describes prosthodontic treatment of a patient with hemimandibular elongation that resulted in significant dentofacial asymmetry. A maxillary metal-ceramic fixed dental prosthesis and crowns were fabricated. To eliminate the negative horizontal overlap, 3 mandibular teeth were reduced to the gingival level. The mandibular prosthetic restoration was completed with metal and composite resin using an electroforming technique.

Combined prosthodontic and orthodontic treatment of a patient with a Class III skeletal malocclusion: a clinical report.

This clinical report describes a multidisciplinary approach for the treatment of a patient with Angle Class III skeletal malocclusion and decreased occlusal vertical dimension. An overlay removable partial denture (ORPD) was used to reestablish the occlusal vertical dimension (OVD). After the trial and adjustment period, the reduced lower anterior dentofacial height was orthodontically increased and the negative horizontal overlap was corrected. A maxillary precision attachment RPD and a mandibular fixed partial denture and metal ceramic crowns were fabricated to satisfy esthetic and functional requirements.