Size, shape, alignment, and arrangement-4 steps to optimize dentofacial composition in smile design by using the patient-centered concept: A dental technique.

A technique derived from patient-based outcomes is described for planning and determination of dental morphology in esthetic rehabilitation by direct evaluation in the mouth, with the help of the patient, and based on the definitive simulation results. The technique is focused on identification of a tooth arrangement to provide the most harmonious dentofacial composition based on size, shape, alignment, and arrangement, with input from the patient. A clinical treatment is presented to illustrate the use of the technique. Dental selection before smile design provided a comprehensive approach to the complex art of giving each patient's smile individuality and personality.

Sleep Disorders in Patients with Temporomandibular Disorders (TMD) in an Adult Population-Based Cross-Sectional Survey in Southern Brazil.

PURPOSE: To verify the prevalence of sleep disorders in temporomandibular disorders (TMD) subjects in a Brazilian population-based, cross-sectional survey (N = 1,643). MATERIALS AND METHODS: Patients were assessed with the Research Diagnostic Criteria for TMD (RDC/TMD) Axes I and II and the Sleep Assessment Questionnaire. Student t test and Pearson chi-square test were used for continuous and categorical data analyses, respectively. RESULTS: TMD subjects had significantly worse sleep disorders than controls (Graded Chronic Pain Severity categories I through IV vs 0, respectively) in RDC/TMD Axis II variables. Sleep disorders were also worse in the Axis I TMD groups (myofascial pain and arthralgia/osteoarthritis/osteoarthrosis), with the exception of disc displacements. CONCLUSION: TMD subjects had worse sleep disorders, mainly in Axis I TMD groups, with higher pain/disability levels.

General Health Quality of Life in Patients with Temporomandibular Disorders in a Population-Based Cross-Sectional Study in Southern Brazil.

PURPOSE: To assess the impact of temporomandibular disorders (TMD) on general health quality of life in a Brazilian population-based cross-sectional survey. MATERIALS AND METHODS: A total of 1,643 patients were assessed using the World Health Organization Quality of Life Bref (WHOQOL-Bref) and the Research Diagnostic Criteria for Temporomandibular Disorders Axes I and II (RDC/TMD). Cross-tabulation of the data was carried out to compare TMD subjects to controls in all domains of the WHOQOL-Bref and the RDC/TMD. RESULTS: TMD subjects had significantly worse quality of life than controls in Axes I and II of the RDC/TMD and in all WHOQOL-Bref domains except for disc displacement. Osteoarthrosis was significantly different only in the WHOQOL-Bref physical domain. CONCLUSION: TMD subjects had worse general health quality of life, particularly in Axis I groups with higher pain/disability levels (muscle disorders/arthralgia/arthritis).

Current Methods of Bruxism Diagnosis: A Short Communication.

PURPOSE: To assess the current diagnostic methods for sleep bruxism (SB). MATERIALS AND METHODS: This review of the literature evaluates all available instrumental and noninstrumental methods of bruxism/SB diagnosis. RESULTS: SB diagnosis can be performed using self-reports and clinical examination, but these methods have little agreement with polysomnography. Two portable electromyography/electrocardiography appliances have been validated against polysomnography (BiteStrip and Bruxoff), but they are indicated only for primary SB. Polysomnography is considered the gold standard and is indicated for secondary SB; however, it is expensive and time-consuming. CONCLUSION: No perfect method of SB diagnosis exists, and future research should concentrate on improving SB self-reports.

Depression and Somatization in Patients with Temporomandibular Disorders in a Population-Based Cross-Sectional Study in Southern Brazil.

PURPOSE: To assess the prevalence of depression and somatization in patients with temporomandibular disorders (TMD) in a Brazilian population-based cross-sectional survey. MATERIALS AND METHODS: A total of 1,643 subjects were assessed for TMD using the Research Diagnostic Criteria for Temporomandibular Disorders Axes I and II and were assessed for depression and somatization using the Graded Chronic Pain Scale. The data were cross-tabulated for comparison between TMD subjects and controls. RESULTS: TMD subjects had significantly worse depression and somatization levels than controls in the RDC/TMD Axis II. The levels were also worse in most Axis I TMD groups (muscle disorders and arthralgia/osteoarthritis/osteoarthrosis). CONCLUSION: TMD subjects had worse depression and somatization, particularly in diagnostic groups with higher pain/disability levels.

Marginal Bone Loss in Implants Placed in the Maxillary Sinus Grafted With Anorganic Bovine Bone: A Prospective Clinical and Radiographic Study.

BACKGROUND: Sinus elevation is a reliable and often-used technique. Success of implants placed in such situations, even with bone substitutes alone, prompted the authors of this study to strive for bone loss close to zero and research variables that cause higher or lower rates of resorption. The objective of this study is to evaluate survival rates and marginal bone loss (MBL) around implants placed in sites treated with maxillary sinus augmentation using anorganic bovine bone (ABB), and identify surgical and prosthetic prognostic variables. METHODS: Fifty-five implants were placed in 30 grafted maxillary sinuses in 24 patients. Periapical radiographs were evaluated immediately after implant placement (baseline), 6 months, and at the most recent follow-up. MBL was calculated from the difference between initial and final measurements, taking into account a distortion rate for each radiograph compared with original implant measurements. RESULTS: Survival rate was 98.2%, with only one implant lost (100% survival rate after loading) over a mean follow-up time of 2.0 ± 0.9 years. MBL ranged from 0 to 2.85 mm: 75.9% of mesial sites and 83.4% of distal sites showed <1 mm of MBL, whereas 35.2% of mesial sites and 37% of distal sites exhibited no bone loss. MBL was significantly (P <0.05) greater in open-flap compared with flapless surgery. CONCLUSIONS: Within the limitations of the present study, it was concluded that maxillary sinus elevation with 100% ABB gives predictable results, and that flapless surgery results in less MBL compared with traditional open-flap surgery.

Effects of the bite splint 15-day treatment termination in patients with temporomandibular disorder with a clinical history of sleep bruxism: a longitudinal single-cohort study.

OBJECTIVE: The aim of this study was to assess the effects of bite splint (BS) treatment termination in patients treated for temporomandibular disorder (TMD) and sleep bruxism (SB). STUDY DESIGN: This longitudinal single-cohort study assessed 30 patients (29.5 ± 7.8 years old, 86.7% women) who were successfully treated with BS for SB and TMD for 30 days to 6 months prior to termination of the use of BS. The Research Diagnostic Criteria for TMD Axes I and II, Sleep Assessment Questionnaire, Beck Depression Inventory, and BiteStrip were used to assess TMD signs and symptoms, sleep disorders, depression, and SB at baseline and after 15 days of BS disuse. RESULTS: TMD symptoms, including the disability points, characteristic pain intensity, and present pain at rest, increased significantly (P < 0.05). After 15 days of BS termination, there were no significant differences in SB and depression levels, sleep quality, and TMD signs. CONCLUSIONS: In patients with TMD and SB, BS treatment cessation is not recommended.

Analysis of the influence of a mandibular advancement device on sleep and sleep bruxism scores by means of the BiteStrip and the Sleep Assessment Questionnaire.

PURPOSE: A before-and-after experimental clinical study was carried out with the objective of evaluating the effect of a mandibular advancement device (MAD; 75% advancement), made of a thermoplastic material, on sleep bruxism (SB) and sleep scores. MATERIALS AND METHODS: After a habituation period of 1 week, SB scores were taken at baseline and after use of the MAD for 30 days. Scores were compared using the newly developed BiteStrip, which registers the number of contractions of the unilateral masseter muscle after a 5-hour period, giving a severity score from 0 to 3 after the registrations. To assess sleep, the Sleep Assessment Questionnaire (SAQ), a screening tool with scores ranging from 0 to 68, was used before and after use of the MAD. Twenty-eight subjects (13 women, 15 men; mean age: 42.9 +/- 12.0 years) with a clinical history of SB and no spontaneous temporomandibular disorder (TMD) pain were selected. The clinical diagnosis of either moderate or severe SB was further confirmed through use of the BiteStrip (scores 2 or 3) at baseline. A 30-day follow-up period was used for evaluation. Both methods were validated against polysomnography. In addition, common signs and symptoms of TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders were also evaluated before and after use to assess the side effects of the MAD. RESULTS: There was a statistically significant improvement in both SB and sleep scores based on the BiteStrip and the SAQ (Wilcoxon signed rank and Student paired t test, P < .05). In the signs and symptoms of TMD, there was a significant reduction in temporomandibular joint sounds as well as in masseter and temporalis tenderness to palpation. None of the SB subjects experienced any breakage of the MAD. CONCLUSION: The MAD had a positive effect on SB and sleep scores, measured by the BiteStrip and the SAQ, respectively, and did not increase any traditional signs and symptoms of TMD in a 30-day evaluation period.

Irritable bowel syndrome patients versus responding and nonresponding temporomandibular disorder patients: a neuropsychologic profile comparative study.

PURPOSE: This study aimed to assess the use of neuropsychologic tests as a tool to differentiate, or not, between a nonresponding chronic pain condition of nonmuscular origin, irritable bowel syndrome (IBS) (n = 20), versus 2 pain conditions of muscular origin, responding (n = 36) and nonresponding (n = 24) temporomandibular disorders. MATERIALS AND METHODS: The neuropsychologic tests used were the simple and multiple-choice reaction-time tests, California Verbal Learning Tests, the Brown-Peterson Consonant Trigram Auditory Memory Test, Sleep Assessment Questionnaire, and Beck Depression Inventory, as well as fatigue and energy level assessments (100-mm visual analog scale). RESULTS: Most of the tests used were capable of significantly differentiating between responding TMD versus IBS patients. Conversely, no statistically significant difference was found between nonresponding TMD versus IBS patients. Overall, the nonresponding TMD and IBS groups did worse in the neuropsychologic assessment than the responding TMD group, with higher memory deficits, levels of depression and fatigue, more sleep disturbances, and lower energy levels. CONCLUSIONS: These data suggested that 2 nonresponding chronic pain conditions of different origins may share similar neuropsychologic test results compared to a responding condition. These findings are consistent with the hypothesis that nonresponding chronic pain disorders, irrespective of peripheral location, may be regulated centrally and have similar neuropsychologic impacts.

Occlusal risk factors for temporomandibular disorders.

OBJECTIVE: To determine the role of occlusal variables (overbite; overjet; number of anterior and posterior teeth; bilateral canine guidance on lateral and protrusive movements; anterior centric slide; Angle Classes I, II, and III malocclusion) as risk indicators for the development of temporomandibular disorders (TMDs). MATERIALS AND METHODS: Seventy-two TMD patients with myofascial pain, with or without limited opening and arthralgia, as well as 30 age- and gender-matched pain-free concurrent controls were included. The association (critical odds ratio [OR] = 2.0) between the significant occlusal variables and TMD was calculated. Confounders were controlled in the inclusion-exclusion criteria as well as in the analysis stage (unconditional logistic regression) by variation in the OR (15%). RESULTS: Angle Class II malocclusion (crude OR = 8.0, confidence interval [CI] = 2.2 to 29.3) and the absence of bilateral canine guidance on lateral excursion (crude OR = 3.9, CI = 1.6 to 9.7) were statistically more common in patients than in controls. Spontaneous pain as well as pain on palpation (Class II or higher) were also statistically worse in TMD patients. Significant confounders (ie, employment, age, cigarette and alcohol consumption) acted as effect modifiers not changing the critical OR (adjusted OR Angle Class II and bilateral canine guidance = 8.3 to 12.4 and 2.2 to 4.1, respectively). CONCLUSIONS: Absence of bilateral canine guidance on lateral excursion and particularly Angle Class II malocclusion were considered important risk indicators for the development of TMD in this investigation, even when some sociodemographic factors were considered as effect modifiers.

Maximum occlusal force and medial mandibular flexure in relation to vertical facial pattern: a cross-sectional study.

BACKGROUND: Vertical facial pattern may be related to the direction of pull of the masticatory muscles, yet its effect on occlusal force and elastic deformation of the mandible still is unclear. This study tested whether the variation in vertical facial pattern is related to the variation in maximum occlusal force (MOF) and medial mandibular flexure (MMF) in 51 fully-dentate adults. METHODS: Data from cephalometric analysis according to the method of Ricketts were used to divide the subjects into three groups: Dolichofacial (n = 6), Mesofacial (n = 10) and Brachyfacial (n = 35). Bilateral MOF was measured using a cross-arch force transducer placed in the first molar region. For MMF, impressions of the mandibular occlusal surface were made in rest (R) and in maximum opening (O) positions. The impressions were scanned, and reference points were selected on the occlusal surface of the contralateral first molars. MMF was calculated by subtracting the intermolar distance in O from the intermolar distance in R. Data were analysed by ANCOVA (fixed factors: facial pattern, sex; covariate: body mass index (BMI); alpha = 0.05). RESULTS: No significant difference of MOF or MMF was found among the three facial patterns (P = 0.62 and P = 0.72, respectively). BMI was not a significant covariate for MOF or MMF (P > 0.05). Sex was a significant factor only for MOF (P = 0.007); males had higher MOF values than females. CONCLUSION: These results suggest that MOF and MMF did not vary as a function of vertical facial pattern in this Brazilian sample.

Sleep and depression as risk indicators for temporomandibular disorders in a cross-cultural perspective: a case-control study.

PURPOSE: We conducted this case-control study to determine the role of 2 neuropsychologic variables (sleep and depression) as possible risk indicators for the development of temporomandibular disorders (TMD). MATERIALS AND METHODS: Neuropsychologic tests, traditional signs and symptoms of TMD, and social and economic variables were analyzed. Seventy-two predominantly muscle-related TMD patients (Research Diagnostic Criteria for TMD groups Ia, Ib, and IIIa) and 30 age- and sex-matched pain-free controls were included in the population. RESULTS: Overall, TMD patients had statistically significantly higher sleep and depression scores on the Sleep Assessment Questionnaire and on the Brazilian Portuguese version of the Beck Depression Inventory, with odds ratios of 5 and 1.6, respectively. These results remained unchanged even after controlling for 8 confounders in the logistic regression analysis. Spontaneous pain and pain on palpation (grade 2 or higher) were also statistically significantly worse in TMD patients. In the forward-step logistic regression analysis, we also found that the combination of our best TMD predictors (ie, sleep, cigarettes, alcohol) had a better predictive value (percent agreement = 78.69%) than when the variables were analyzed alone. CONCLUSION: Sleep and depression are considered important risk indicators for the development of TMD.

Vestibular schwannoma (acoustic neuroma) mimicking temporomandibular disorders: a case report.

Approximately 6 to 16% of patients with trigeminal neuralgia symptoms present intracranial tumors, the most common being the vestibular schwannoma (acoustic neuroma). Some symptoms reported by patients include hearing loss, tinnitus, headaches, vertigo and trigeminal disturbances. An increased muscle response in the surrounding head and neck musculature may also be observed, which mimics signs and symptoms of temporomandibular disorders. In these cases, magnetic resonance imaging (MRI) has proved to be a useful tool in tumor diagnosis. The differential diagnosis between myofascial and neuralgic pain is important, as both may present similar characteristics, while being of different origin, and demanding special treatment approaches. The purpose of this paper is to demonstrate the relationship among trigeminal neuralgia symptoms, intracranial tumors and temporomandibular dysfunction by presenting a clinical case.

Associação entre a pressão sangüínea com sinais e sintomas de dor orofacial e disfunção temporomandibular / Relationship between blood pressure with signs and symptons of orofacial pain and temporomandibular disorders

O objetivo deste estudo é o de determinar a função da pressão sangüínea como possível fator diagnóstico em pacientes com desordens temporomandibulares (DTM). Foram examinadas as pressões sangüíneas de mulheres entre 17 e 40 anos de idade, com sinais e sintomas de desordens temporomandibulares (DTM), versus grupo controle (sem DTM), usando o aparelho "Digital Blood Pressure Meter" da A&D Engineering, Inc. Sendo assim, observou-se uma tendência à hipotensão nos pacientes com DTM em relação ao grupo controle