Avaliação da eficácia do acessório mamilo na remoção dos hábitos deletérios / Evaluation of the effectiveness of the nipple accessory in the removal of the deletery habits

Objetivo: avaliar a eficácia do acessório mamilo aplicado a aparelhos ortopédicos/ ortodônticos no tratamento de hábitos deletérios de sucção de chupeta, língua, lábio e dedo, e onicofagia em pacientes tratados nos últimos 20 anos com o aparelho. Métodos: Trata-se de um estudo clínico observacional, retrospectivo, no qual a amostra foi composta de prontuários de pacientes de ambos os gêneros, atendidos por profissionais habilitados pelo aparelho mamilo, que os utilizaram em crianças de 03 a 16 anos portadoras de hábitos deletérios. Os prontuários utilizados, correspondem a pacientes tratados entre os anos 2000 a 2020. Todas as análises foram realizadas no programa R, com nível de significância de 5%. Resultados: Foram analisados 142 prontuários, nos quais 122 foram incluídos, por estarem dentro dos critérios de inclusão propostos no estudo e 20 foram excluídos da pesquisa por apresentarem informações incompletas e/ou não preenchidas corretamente. O hábito com maior incidência foi o de sucção digital, em 71,3% dos pacientes, 91,8% dos pacientes deixaram o hábito, destacando que nos casos de sucção de chupeta e onicofagia, o sucesso na remoção do hábito foi de 100%, em ambos os casos. O tempo médio de uso do aparelho foi de 4,8 meses, variando de 0,6 a 14 meses. O tempo médio para a remoção do hábito após a instalação do aparelho foi de 1,6 meses, variando de 0 a 12 meses. Conclusão: O aparelho mamilo, mostra-se como uma alternativa de alta eficácia na remoção de hábitos deletérios de sução de chupeta, dedo, língua e onicofagia.(AU)

Objective: Evaluate the effectiveness of the nipple accessory applied to orthopedic/orthodontic appliances in the treatment of harmful pacifier, tongue, lip and finger sucking habits, and onychophagia in patients treated in the last 20 years with the device. Methods: This is an observational, retrospective clinical study, in which the sample consisted of medical records of patients of both genders, assisted by professionals qualified by the nipple device, who used them in children aged 03 to 16 years with deleterious habits. The medical records used correspond to patients treated between the years 2000 and 2020. All analyzes were performed in the R program, with a significance level of 5%. Results: 142 medical records were analyzed, in which 122 were included, as they were within the inclusion criteria proposed in the study and 20 were excluded from the research because they presented incomplete information and/or not filled in correctly. The habit with the highest incidence was digital sucking, in 71.3% of patients, 91.8% of patients quit the habit, noting that in cases of pacifier sucking and onychophagia, success in removing the habit was 100%, in both cases. The average time of use of the device was 4.8 months, ranging from 0.6 to 14 months. The mean time to remove the habit after installing the device was 1.6 months, ranging from 0 to 12 months. Conclusion: The nipple device is a highly efficient alternative for removing harmful habits of pacifier, finger, tongue and onychophagy sucking.(AU)

Comparison between Simple Planas Indirect Tracks and occlusal splints for treatment of temporomandibular disorder-related headache: a randomized controlled clinical trial / Comparação entre Pistas Indiretas Planas Simples e placas miorrelaxantes para tratamento de dor de cabeça relacionada à disfunção temporomandibular: ensaio clínico randomizado

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder-related headache (TMDH) is a very common clinical condition which manifests as pain around the temples. The treatment recommended in dentistry is occlusal splint. However, there is a device generally used in functional jaw orthopedics, called simple Planas indirect tracks (SPIT), which has been shown to be efficient in managing these headaches. This clinical trial aimed to compare SPIT and occlusal splints in the treatment of TMDH patients. METHODS: This randomized clinical trial included thirty-seven women who had TMDH for more than one year into three groups: GPIT treated with SPIT, GSPLINT treated with a Michigan splint, and a control group (CG) submitted to no treatment. The randomization was paired, that is, each new individual was assigned to a group sequentially. The number of headache days per month, average pain intensity, pain response to masseter and temporalis palpation, and days of pain drug use were collected and analyzed. The follow-up lasted for 3 months. RESULTS: Thirty-seven patients were included but 4 dropped out during treatment and 33 underwent intervention. Patients in GPIT exhibited superior results compared to GSPLINT and CG, with significant differences between groups for almost all variables. In GPIT, the number of headache days was reduced by 87.43%, pain intensity by 66.67%, and days of drug use by 88.42%, with significant improvement in all parameters compared to CG. In GSPLINT, the number of headache days decreased by 44.46% and days of drug use by 36.63%, while pain intensity increased by 46.67%; however, there was no significant difference in any of the parameters compared to CG. CONCLUSION: SPIT may be a good treatment option for patients with TMDH since these appliances have shown much more consistent results than occlusal splints. Further studies and with more individuals will be needed to confirm these findings.

RESUMO JUSTIFICATIVA E OBJETIVOS: A cefaleia secundária à disfunção temporomandibular (CDTM), é uma condição clínica muito comum, com dores nas têmporas. O tratamento padrão na odontologia são as placas miorrelaxantes, entretanto um aparelho da ortopedia funcional dos maxilares, chamado de Pistas Indiretas Planas Simples (PIPS), tem se demonstrado eficiente no controle dessas cefaleias. Este estudo clínico visou comparar as PIPS com as placas miorrelaxantes, no quadro álgico de CDTM. MÉTODOS: Este ensaio clínico randomizado incluiu 37 mulheres portadoras de CDTM há mais de um ano, que foram distribuídas aleatoriamente em três grupos: o GPIPS, no qual as pacientes foram tratadas com PIPS, o GPLACA, com uso de placas miorrelaxantes de Michigan e o grupo controle (GC), sem qualquer tratamento. A aleatorização foi pareada, sendo que cada participante era consecutivamente alocada em um grupo diferente. Foram coletados e analisados dias de cefaleia por mês, intensidade de dores, resposta álgica à palpação de masseter e temporal, bem como os dias de uso de fármacos. O acompanhamento foi de três meses. RESULTADOS: Das 37 pacientes iniciais, 4 desistiram do tratamento e apenas 33 foram submetidos a alguma intervenção. As pacientes do GPIPS apresentaram resultados muito superiores às do GPLACA e do GC, com diferenças significativas entre os grupos em quase todas as variáveis. No GPIPS, os dias de dor diminuíram 87,43%, a intensidade 66,67% e os dias de uso de fármacos analgésicos 88,42%, sendo estatisticamente significante a melhora em todos os parâmetros em relação ao GC. Já no GPLACA, os dias de dor diminuíram 44,46% e os dias de uso de fármacos 36,63%, mas a intensidade da dor aumentou 46,67%, porém sem diferença estatisticamente significante em nenhum parâmetro quando comparado ao GC. CONCLUSÃO: O uso do PIPS pode ser uma boa escolha de tratamento da CDTM, tendo apresentado resultados mais consistentes do que as placas miorrelaxantes. Mais estudos e com mais participantes são necessários para confirmar estes achados.

Impact of counterclockwise rotation of the occlusal plane on the mandibular advancement, pharynx morphology, and polysomnography results in maxillomandibular advancement surgery for the treatment of obstructive sleep apnea patients.

PURPOSE: Evaluate the impact of counterclockwise rotation of the occlusal plane (CCWROP) on pharynx morphology and polysomnography in maxillomandibular advancement (MMA) surgery to treat obstructive sleep apnea (OSA) patients. METHODS: Prospective clinical trial of patients with OSA treated by MMA. Computed tomography and polysomnography were performed pre- and postoperatively and the parameters were compared. The surgery classified the patients into two groups: with (R) and without (NR) CCWROP. RESULTS: The study sample comprised 38 individuals: R (n = 19) and NR (n = 19). An anterior mandible advancement of 0.71 mm was identified for each degree of CCWROP (p < 0.001). As for polysomnography, the apnea-hypopnea index was reduced by 80% and 62% in R and NR, showing final values of 6.8 and 13.0, respectively. The apnea index changed equally in both groups. Reduction of 68 and 26% in the hypopnea index was observed for R and NR, respectively, with no statistically significant difference. Total volume increased by 45% in R and 30% in NR. Retropalatal and retrolingual volumes increased by 49% and 4% in R and 43% and 15% in NR, respectively. The minimum axial area increased by 92% in the retropalatal region and 97% in the retrolingual region in R, whereas these increases were of 76% and 31% in NR, respectively. CONCLUSION: Anterior mandibular advancement of 0.71 mm for each degree of CCWROP is of great importance for surgical planning. As a result of this resource, individuals in R presented better results than those in NR in all parameters assessed, especially regarding the retrolingual region.

Effects of surgically assisted rapid maxillary expansion on the modification of the pharynx and hard palate and on obstructive sleep apnea, and their correlations.

PURPOSE: To investigate the changes induced by surgically assisted rapid maxillary expansion (SARME) on palate and pharynx morphology as well as the correlation of these changes with the improvement of obstructive sleep apnea (OSA). MATERIALS AND METHODS: The study was conducted in 16 patients, seven women and nine men, aged on average 40.23 ± 10.23 years, all of them with OSA confirmed by polysomnography (PSG) and with posterior crossbite. All participants underwent computed tomography (CT) and PSG before and after SARME. The CT scans were used to determine the dimensions of the palate and pharynx before and after surgery. Data were analyzed statistically by the paired t-test, Wilcoxon test and Pearson correlation, with the level of significance set at P < 0.05. RESULTS: A 56.24% reduction in apnea and hypopnea index was detected (from 33.23 ± 39.54 to 14.54 ± 19.48: P = 0.001). The total airway area increased on average by 23.99% (P = 0.016), although in a more expressive manner in its lower half (28.63%, P = 0.008). A 24% transverse bone increase was observed in the palate in the region of the first premolars and an 18% increase in the region of the first molars (from 2.42 ± 0.31 to 2.99 ± 0.26. P < 0.001, and from 3.11 ± 0.32 to 3.70 ± 0.41, P < 0.001, respectively), and a mean 15% reduction of its depth (from 1.07 ± 0.33 to 0.89 ± 0.18, P = 0.014). A moderate correlation was detected between palate depth and width and OSA severity, as well as a correlation of the reduction of palate depth and its transverse increase with the improvement of OSA, especially among patients with severe OSA. CONCLUSION: It appears that narrowing of the palate, especially in the premolar region, and its greater depth may be related to the severity of OSA. SARME promotes transverse maxillary widening and lowering of palate depth, thus reducing OSA among adults and expanding the airway, especially in its lower half.

Effects of transverse maxillomandibular distraction osteogenesis on obstructive sleep apnea syndrome and on the pharynx.

PURPOSE: To assess the effects of transverse maxillomandibular distraction osteogenesis (TMDO) on the treatment of obstructive sleep apnea (OSA) and on the morphology of the pharynx. METHODS: A clinical trial was conducted with seven patients with OSA and with transverse maxillomandibular deficiency, two women and five men aged on average 41.16 ± 10.9 years on the day of surgery. All participants were submitted to computed tomography (CT) and full-night polysomnography (PSG) before and approximately 9 months after surgery. A 95% confidence interval was defined. RESULTS: The AHI and RDI of the participants were reduced by about 62% (from 27.65 ± 36.65 to 10.73 ± 11.78, p = 0.031 and from 41.21 ± 32.73 to 15.30 ± 13.87, p = 0.015, respectively). The airway showed a surprising mean reduction in volume of 10% (from 5.78 ± 2.53 to 4.71 ± 1.42, p = 0.437, for the upper pharynx; from 6.98 ± 2.23 to 6.23 ± 2.05, p = 0.437, for the lower pharynx; and from 12.76 ± 1.56 to 10.94 ± 2.42, p = 0.625, for the total pharynx). However, the site of the smallest area of the pharynx was considerably increased both in the anteroposterior and transverse direction and in its total area (from 0.88 ± 7.11 to 0.99 ± 0.39, p = 0.625; from 1.78 ± 0.81 to 2.05 ± 0.61, p = 0.812; and from 0.99 ± 0.74 to 1.40 ± 0.51, p = 0.180, respectively). CONCLUSION: TMDO proved to be efficient in reducing or curing OSA, producing modifications of upper pharynx morphology with an increase of the smallest area of the pharynx.

Effects of surgically assisted rapid maxillary expansion on obstructive sleep apnea and daytime sleepiness.

PURPOSE: The aim of the study was to evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on obstructive sleep events and daytime sleepiness in adults with obstructive sleep apnea syndrome (OSAS). METHODS: Sixteen individuals (7 women/9 men) aged 40.2 ± 10.2 (range, 24.4 to 62.2 years) with maxillary transverse deficiency and OSAS (respiratory disturbance index [RDI] greater than 5) confirmed with full-night polysomnography (PSG) underwent SARME to evaluate its efficiency for OSAS treatment. RESULTS: Several PSG parameters and the Epworth Sleepiness Scale (ESS) results were compared in selected individuals before and after they underwent SARME. An RDI reduction from 35.4 ± 38.5 to 16.0 ± 19.7 was found, corresponding to a mean decrease of 54.6 % (p = 0.0013). A 56.2 % (33.23 ± 39.5 to 14.5 ± 19.4, p = 0.001) decrease was found in the apnea-hypopnea index (AHI), in addition to decreases in the desaturation and microarousal rates, among other parameters. The ESS scores improved from 12.5 ± 5.3 to 7.2 ± 3.5 (p < 0.001). CONCLUSIONS: SARME promotes an improvement in OSAS symptoms; decreases the rates of respiratory disturbances; microarousal, and desaturation; and reduces daytime sleepiness.

Enlargement of the Pharynx Resulting From Surgically Assisted Rapid Maxillary Expansion.

PURPOSE: Given that transverse maxillary deficiency is an etiologic factor of obstructive sleep apnea and is intimately connected to pharyngeal size, the objective of this study was to determine whether surgically assisted rapid maxillary expansion (SARME) would promote pharyngeal enlargement in adults. MATERIALS AND METHODS: This prospective study was conducted in patients with uni- or bilateral posterior crossbite who underwent SARME. Participants were recruited from the Integrated Center for the Study of Face Defects, School of Medicine of Ribeirão Preto, University of São Paulo (São Paulo, Brazil). All patients underwent computed tomography of the pharynx before and after surgery (171.5 days on average), and the sagittal and transverse planes and the total area across 3 levels of the pharynx, including the upper (posterior nasal spine), middle (first cervical vertebra), and lower (second cervical vertebra) levels, were measured on the images. A paired-samples t test was used to evaluate changes in the pharynx before and after surgery. RESULTS: The studied sample consisted of 18 adult patients (10 women and 8 men) with an average age of 37.11 years (standard deviation, 11.73 yr); all patients resided in the region of Ribeirão Preto, São Paulo, Brazil. No statistical changes were observed in the upper level. An enlargement of 17.82% (P = .0107) was observed in the sagittal plane of the middle level. The cross-sectional and area values of this same portion were enlarged (16.96 and 37.38%, respectively), with a trend toward statistical significance (P = .067 and .051, respectively). The airway enlargements in the lower level were 26.41, 24.87, and 53.87% in the sagittal and transverse planes and total area, respectively; these differences were statistically significant (P = .0003, .0033, and .0016, respectively) for all 3 measurements. CONCLUSIONS: SARME promotes pharyngeal enlargement, especially in the lower levels of the pharynx.

Ronco e apneia do sono: apresentação de novo dispositivo intra-oral e protocolo de tratamento / Snoring and sleep apnea: presentation of a new oral device and treatment protocol

O ronco e a apneia do sono vêm despertando a atenção da área da saúde graças às inúmeras comorbidades associadas, além de problemas sociais, comportamentais e socioeconômicos. Cada vez mais, esta área da odontologia vem necessitando de cirurgiões-dentistas capacitados e que se adéquem as necessidades da odontologia do sono para o correto manejo, compreensão e tratamento destas doenças. O objetivo deste artigo é apresentar um novo dispositivo intraoral simples e altamente eficiente para o tratamento do ronco e da apneia obstrutiva do sono e suas variações (hipopneia e a síndrome da resistência das vias aéreas superiores), além de um protocolo seguro para o seu manejo. Este aparelho apresenta algumas vantagens sobre seus antecessores, sendo confortável para os pacientes e simples de instalar e operar pelos profissionais, com sistema de avanço fácil e mensurável além de ter um protocolo objetivo e claro, sem por em risco o paciente e deixando os dentistas seguros para trabalhar com a Odontologia do Sono.

Snoring and sleep apnea have been drawing interest from the health sector due to numerous associated comorbidities, as well as to the social, behavioral and economic problems they cause. This new area in dentistry increasingly demands dental surgeons to be skilled in sleep dentistry so that they can handle, understand and treat these diseases correctly. The objective of this article is to present a new, simple and highly efficient intraoral device for treating snoring and obstructive sleep apnea and its variations (hypopnea and upper airway resistance syndrome), and a protocol for handling it properly. This device has some advantages over its predecessors: it is comfortable for the patient, easy to assemble and handle by professionals and has an easy and measurable advance system. It also has a clear and objective protocol that does not put the patient at risk, allowing dental surgeons to treat these conditions confidently.

Comparaçäo da eficácia de três técnicas de limpeza de brocas / Comparative eficience of three cleaning techniques for dental burs

Três técnicas de limpeza de brocas odontológicas foram testadas, comparativamente quanto as suas eficácias, com brocas se removeu dentina cariada, cimento de oxido de zinco-eugenol e cimento fosfato de zinco de cavidades de dentes extraidos. Em seguida foram limpas com ultra-som e água, escovaçäo com escova de metal e escovaçäo com escova de plástico. Foram depois, examinadas em microscópio metalográfico e determinadas as porcentagens de resíduos por instrumento. O método apresentado determinou que o ultra-som propiciou brocas mais limpas

O uso do fio dental junto ao público / The use of dental floss among the population

Empregando-se um questionário, entrevistou-se 1016 indivíduos das classes sociais média e média-alta, de ambos os sexos, do grupo etário 20-50 anos de idade, com o objetivo de conhecer a opinião da população sobre a utilização do fio dental. Conclui-se que há uma grande diferença entre o que a população julga saber e o que realmente deveria saber quanto ao seu uso; que 55 por cento dos entrevistados não usam ou usam esporadicamente o fio dental; 44,88 por cento utilizam-no regularmente, porém apenas para tirar alguma coisa que ficou entre os dentes; 79,13 por cento dos indivíduos compram-no regularmente mas adquirem os produtos mais veiculados pela propaganda