Evaluation of the contribution of different groups of teeth to occlusion of patients with symptoms of temporomandibular disorders.

PURPOSE: The purpose of this study was to analyse the distribution of occlusal forces in the dental arches released during tooth clenching in patients with symptoms of temporomandibular disorders, and to analyse the age and gender structure of the patients in the study group and the control group. MATERIALS AND METHOD: The study was carried out on a group of 58 patients, of both genders, aged 18-40 years, with full dental arches, who presented for treatment at the Prosthodontics Clinic of the University Dental Clinic in Kraków due to symptoms of temporomandibular disorders. The patients were divided into two groups. The first group (study group) comprised 26 patients with painful temporomandibular disorders, while the second group (control group) comprised 32 patients without pain. The study only included patients over 18 years of age, with full dental arches with symptoms of temporomandibular disorders. All patients underwent a basic dental examination and a specialized functional examination of the masticatory organ. A T-Scan III-Novus instrument with electronic occlusal articulation paper was used to assess the distribution of occlusal contacts. RESULTS: In the study, women (43) were a larger group than men (15). Statistically significant values for the percentage distribution of occlusal contacts were obtained in group of women in the study group on the right and left side, in the area of molars and premolars. In the analysis of the percentage distribution of occlusal contacts in both the study and control groups, it can be seen that the first molars (teeth 16 and 26) showed a larger percentage range of values than the other teeth. The smallest values can be observed on the second incisal teeth and on the canines. CONCLUSIONS: The first molars are, in the majority of patients, the teeth on which the strongest occlusal contacts are generated. Excessive participation of incisal teeth in occlusion might influence the development of the pain form of TMD. In order to determine whether there is a correlation between an uneven distribution of occlusal contacts and TMD pain, studies on larger numbers of patients are needed. © 2024 Australian Dental Association.

Orthodontic treatment in patients with periodontitis - a narrative literature review.

Patients with periodontitis often require an inter-disciplinary approach, including orthodontic treatment, for effective rehabilitation of masticatory function, aesthetics and quality of life. The aim of this narrative review was to comprehensively discuss literature focusing on the biology, indications and inter-disciplinary connections related to the orthodontic approach in patients with periodontitis and to present clinical concepts in accordance with valid guidelines. The outcomes of the experimental studies indicate that orthodontic tooth movement (OTM) can be performed safely for teeth with reduced periodontium, provided infection and inflammation are controlled. Orthodontic treatment can correct pathological tooth migration, is not associated with deterioration of clinical periodontal parameters and improves aesthetics. Intrusion is safe when performed with light forces and under a strict oral hygiene regimen. Teeth can be moved either towards or away from the intrabony defect previously subjected to regenerative procedures, and research suggests that OTM has the potential to enhance bone formation after regenerative therapy. The data on orthodontic movement of teeth with furcation involvement are very scarce. The improvement in furcation involvement following either combined periodontal and orthodontic treatment was only documented in animal model studies. Due to bone and tooth loss, special consideration should be given to orthodontic treatment mechanics. © 2023 Australian Dental Association.

The Application of Radiofrequency Waves in Supportive Treatment of Temporomandibular Disorders.

In recent years, the number of patients applying for prosthetic treatment due to temporomandibular joint disorders (TMD) has been increasing. The main methods for treating disorders are the use of occlusal splints and physiotherapeutic rehabilitation as supportive treatment. Radio waves are electromagnetic waves with radiation frequency between 3 Hz and 3 THz, used for physiotherapeutic treatment of skeletal muscle relaxation in the range of 3 to 6 MHz. The rehabilitation effect of these waves is based on diathermy by means of high-voltage quick alternating current. Aim. The aim of the study was to evaluate the influence of radiofrequency waves on the pain of the masticatory muscles in the course of TMD and the usefulness of these procedures in the supporting treatment of these disorders. Materials and Methods. Patients aged 19 to 45 years, of both sexes, reported to the Consulting Room of TMD at the Institute of Dentistry in Krakow to undertake prosthetic treatment of TMD (I a-according to RDC/TMD). Study group (SG) consists of 20 patients who had 10 supportive treatments with radiofrequency currents. In the case of application of radiation to the muscle area, the energy was 20 J to the area of the masticatory muscles, the frequency was 3 MHz, bipolar technique, the duration of the procedure was 10 minutes, and the coupling substance was a gel for ultrasound examinations. The control group (CG) consisted of 20 patients who had 10 supportive treatments with sonophoresis procedures. For the area of masticatory muscles, 0.9 W/cm2 treatments were applied, the duty factor was 80%, the treatment time was 10 minutes, and the medical substance was 25% Voltaren gel. Results. Analysis of the results of the first clinical examinations (axis I) conducted in both groups shows a homogeneous clinical material and similar results. The second clinical examination revealed improved clinical parameters, but it showed a greater improvement in the SG. In the SG, the mean level of VAS was 6.25, and the extreme values were 5.9-0.14, the median was 2.15, and the standard deviation was 1.54. In the CG, the average value of VAS was 6.20 (peak of 5.2-0.7), the median was 2.4, and the standard deviation was 1.87. Summary. The search for new methods of supportive treatment of TMD is an important research direction due to the complex etiology of this disease and the lack of an explicit treatment algorithm. Conclusion. The results of our own research clearly indicate that the use of the radiofrequency waves brings pain relief and improvement of clinical parameters to a greater extent than in sonophoresis. It can be a very important new method in supportive treatment of TMD. Research needs to be continued.

Therapeutic effect of exogenous ghrelin in the healing of gingival ulcers is mediated by the release of endogenous growth hormone and insulin-like growth factor-1.

Ghrelin, an acylated 28-amino acid polypeptide, was primary isolated from the stomach, and the stomach is a main source of circulating ghrelin. Ghrelin strongly and dose-dependently stimulates release of growth hormone from the anterior pituitary, as well as increases food intake and fat deposition. Previous studies showed that ghrelin exhibits protective and therapeutic effect in different parts of the gastrointestinal system, including the oral cavity. The aim of present study was to examine the role of growth hormone and insulin-like growth factor-1 (IGF-1) in the healing of gingival ulcers. Studies were performed on rats with the intact pituitary gland and hypophysectomized rats. In anesthetized rats, chronic ulcers of the gum were induced by acetic acid. Rats were treated intraperitoneally twice a day with saline or ghrelin (4, 8 or 16 nmol/kg/dose) for six days. In pituitary-intact rats, administration of ghrelin significantly increased serum concentration of growth hormone and IGF-1 and this effect was associated with a significant increase in the healing rate of gingival ulcers. Moreover, treatment with ghrelin increased mucosal blood flow and DNA synthesis in the gum, while a local inflammation was decreased what was observed as a reduction in mucosal concentration of pro-inflammatory interleukin-1ß. Hypophysectomy decreased serum level of growth hormone below a detection limit; whereas serum concentration of IGF-1 was reduced by 90%. On the other hand, removal of the pituitary gland was without any significant effect on the healing rate of gingival ulcers or on the ulcer-induced increase in DNA synthesis and concentration of pro-inflammatory interleukin-1ß in gingival mucosa. Administration of ghrelin failed to affect serum level of growth hormone and IGF-1 in hypophysectomized rats, and was without any effect on the healing rate of gingival ulcers, mucosal blood flow, DNA synthesis or concentration of interleukin-1ß in gingival mucosa. Neither induction of gingival ulcers nor hypophysectomy nor administration of ghrelin significantly affected serum concentration of pro-inflammatory interleukin-1ß. We concluded that endogenous growth hormone and IGF-1 were involved in the therapeutic effect of exogenous ghrelin in the healing of gingival mucosa damage.

Evaluation of the saliva cortisol levels in patients under prosthetic treatment due to functional disorders of the masticatory organ.

One of the main etiological factors of the stomatognathic system dysfunction is stress and psychoemotional disorders. During stressful situations, there is an increase in the level of cortisol, the so-called stress hormone. Literature data indicate the existence of a correlation between blood cortisol levels and its amount in the saliva. This spurred an inspiration to undertake open, non-randomised studies, the objective of which was to conduct a comparative assessment of the saliva cortisol levels in patients with functional disorders of the masticatory system and in healthy volunteers, as well as to compare the results of cortisol levels with the results of survey-based tests with the use of Endler and Parker's CISS survey. Cortisol level was assessed due to its association with stress present in the body as one of the primary etiological factors of the stomatognathic system dysfunction, and hence the association of elevated cortisol levels assessed in the morning with the occurrence of dysfunctions of the stomatognathic system. The subject of the study is a group of 30 patients, of both sexes, aged between 20 and 46, who reported to the Dental Prosthetic Out-Patient Clinic of the Institute of Dentistry, Jagiellonian University in Cracow, for prosthetic treatment due to the painful form of functional masticatory organ disorders. The control group consisted of 30 subjects, aged between 19 and 41, in whom dysfunctions of the stomatognathic system were excluded. Collection of saliva for testing was performed at a fixed hour (9 am) into plastic test tubes with a stopper. Immediately after collection, the saliva was frozen at the temperature of -18 °C. The assessment of the cortisol levels was conducted by the high performance liquid chromatography (HPLC) with UV detection at the Department of Analytical Chemistry, Faculty of Pharmacy, Department of Laboratory Medicine of the Gdansk Medical University. Moreover, a 20-minute psychological test was conducted with the use of the CISS (coping inventory for stressful situations) survey in order to assess the patients in terms of their abilities to cope with stressful situations. The results obtained were submitted to a statistical analysis based on the conventional calculation procedures. The test group revealed significantly higher cortisol levels compared with the results obtained by the control group. The findings of the CISS survey confirmed the predominance of the emotion-focused strategy of coping with stressful situations in the test group. The results support the view that the psychoemotional factor is, to a considerable extent, conducive to the development of functional disorders. The elevated cortisol levels in patients with psychological disorders concur with the findings by other authors. The results obtained confirm that psychoemotional disorders may be one of the etiological factors of the stomatognathic system dysfunctions. The CISS survey, which was not used in similar studies before, makes it possible to obtain information on the subject's method of coping with stress, thus allowing for the initiation of a relevant psychological therapy aiding the prosthetic treatment.

Evaluation of pain regression in patients with temporomandibular dysfunction treated by intra-articular platelet-rich plasma injections: a preliminary report.

OBJECTIVE: The objective of this study was to evaluate the regression of temporomandibular pain as a result of intra-articular injections of platelet-rich plasma (PRP) to patients with temporomandibular joint dysfunction previously subjected to prosthetic treatment. MATERIALS AND METHODS: The baseline study material consisted of 10 patients, both males and females, aged 28 to 53 years, previously treated due to painful temporomandibular joint dysfunction using occlusal splints. All patients were carried out to a specialist functional assessment of the dysfunction using the Polish version of the RDC/TMD questionnaire axis I and II. Intra-articular injections were preceded by a preparation of PRP. The injection sites were determined by the method used during arthroscopic surgical procedures. Following aspiration, 0.5 mL of plasma was injected into each temporomandibular joint. RESULTS: The comparison of the intensity of pain during all examinations suggests a beneficial effect of the procedure being performed as the mean VAS score was 6.5 at examination I, 2.8 at examination II, and 0.6 at examination III. CONCLUSION: Application of the intra-articular injections of platelet-rich plasma into the temporomandibular joints has a positive impact on the reduction of the intensity of pain experienced by patients treated for temporomandibular joint dysfunction.

Incidence of otolaryngological symptoms in patients with temporomandibular joint dysfunctions.

UNLABELLED: The functional disorders of the masticatory organ are the third stomatological disease to be considered a populational disease due to its chronicity and widespread prevalence. Otolaryngological symptoms are a less common group of dysfunction symptoms, including sudden hearing impairment or loss, ear plugging sensation and earache, sore and burning throat, difficulties in swallowing, tinnitus, and vertigo. The diagnostic and therapeutic problems encountered in patients with the functional disorders of the masticatory organ triggered our interest in conducting retrospective studies with the objective of assessing the incidence of otolaryngological symptoms in patients subjected to prosthetic treatment of the functional disorders of masticatory organ on the basis of the analysis of medical documentation containing data collected in medical interviews. MATERIAL AND METHODS: Retrospective study was conducted by analyzing the results of medical interviews of 1208 patients, who had reported for prosthetic treatment at the Functional Disorders Clinic of the Department of Dental Prosthetics of Jagiellonian University Medical College in Cracow between 2008 and March 14, 2014. RESULTS: Otolaryngological symptoms were observed in 141 patients. The most common symptoms in the study group were earache and sudden hearing impairment; no cases of sudden hearing loss were experienced.

Differential diagnostics of pain in the course of trigeminal neuralgia and temporomandibular joint dysfunction.

Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.

Psychoeducation program on strategies for coping with stress in patients with temporomandibular joint dysfunction.

Lack of educational projects in the available literature was an inspiration to develop a psychoeducational program. The objective was to provide patients with basic information on the contribution of stressors in the occurrence of temporomandibular joint dysfunction and educate on methods for coping with stress most commonly used in psychology. In the course of three meetings, patients are familiarised with the issue of experienced stress as a potential source of psychosomatic illnesses (in particular, temporomandibular joint dysfunction). Preliminary patients' opinions, expressed through self-report methods, indicate significant usefulness of the developed psychoeducational program for the process of treatment and the quality of patients' lives.

Auriculo-vestibular symptoms related to structural and functional disorders of stomatognatic system.

Auriculo-vestibular symptoms are otolaryngological complaints which frequently co-occur with functional disorders of masticatory organ. These symptoms include: earache, plugged ears sensation, sudden hearing impairment, burning pain of the throat, tinnitus, and dizziness. The aim of the study was assessment of co-occurrence of functional disorders of masticatory organ and auriculo-vestibular symptoms, in patients referred for otolaryngological treatment. Forty-two patients aged 24-46 years of both sexes referred for otolaryngological treatment, because of auriculo-vestibular symptoms, were qualified to our study within the framework of research project. After otolaryngological diagnostics (Department of Otolaryngology), these patients were referred for prosthetic consultation to the Department of Dental Prosthetics of Jagiellonian University Medical College. In Otolaryngology Clinic the following specialist examinations were carried out: basic clinical examinations, including otoscopy, tuning fork trials, tonal and verbal audiometry, and tympanometry. These examinations were supplemented with electronystagmometry. On prosthetic consultation, specialist functional investigations of masticatory organ, and electromyographic assessment of the activity of masseter muscles and the anterior part of the temporal muscle, were carried out. Results of the investigation revealed otolarygological causes of the reported symptoms in 30 patients, whereas in 12 patients (out of 42 patients referred for prosthetic consultation), numerous functional disorders of the stomatognathic system were observed. The investigation confirmed the occurrence of functional disorders in patients with auriculo-vestibular symptoms and appropriateness of treatment by a multi-specialist team.

Measurement of occlusal forces in the therapy of functional disorders with the use of botulinum toxin type A.

Functional disorders of the stomatognathic system include dysfunctions leading to pathological increase of the occlusal forces generated by mandibular adductors. High values of these forces are the cause of numerous disorders within the masticatory organ such as pathological abrasion of the teeth, tension headaches and pain in the region of the temporomandibular joints. The aim of this study was assessment of occlusal forces in the course of the therapy of painful types of functional disorders with the use of botulinum toxin type A - the drug causing muscle relaxation. The material for the study comprised adult patients aged 24-42 years who presented with a painful type of functional disorders in the University Hospital, Institute of Dentistry Jagiellonian University Medical College in Cracow. The patients were qualified to the study on the basis of the results of specialist functional examination of the masticatory organ in which additionally the VAS (Visual Analogue Scale) was used for pain assessment of the masseters and temporomandibular joints. The measurement of maximal occlusal forces in the examined patients was carried out in all patients in the region of the central incisors and first molars on the both side with the use of a special measuring instrument for dental examination, specially constructed (patent number P 334933). The examinations were performed before the beginning of the treatment, 10 days and 16 weeks after intramuscular administration of botulinum toxin type A at a dosage of 21 mouse units - U for one masseter. The results of the examination of maximal occlusal forces obtained in the first examination, that is, before the beginning of the treatment, markedly exceeded the physiological values. In the control examinations, significant, persistent decrease of the studied forces has been noted.

Experimental research on the possibilities of maintaining thermal conditions within the limits of the physiological conditions during intraoral preparation of dental implants.

The objective of the study was to evaluate the degree of temperature change in the bone, directly adjacent to the implant site during the abutment part of one-piece implants, during procedures involving different cutting techniques. Three different one-piece implants: Osteoplant, Nobel Direct, Q-implant were cut with air-turbine burs after insertion in fresh pig ribs. Tests were performed with a variety of cooling techniques including air and air-liquid coolant. Implants were cut on the occlusal and axial surfaces of the abutment part. The temperature changes were evaluated using thermocouple type K during and after cutting procedures. It was found that regardless of the cutting technique, the temperature of the bone always increased during the cutting procedure. The critical temperature threshold Delta T=10 degrees C (47 degrees C) was always exceeded, when only the air coolant was used, although when the air-water spray coolant was utilized during the cutting procedure, it prevented the temperature to exceed this critical level. The extent of thermal changes in the bone depends on the cutting technique. Constant air-water cooling during the cutting procedure is a recommended technique in order to avoid overheating the implant-bone interface. The dry cutting technique, using only an air coolant, should be avoided as it can induce sufficiently high thermal damage in the bone adjacent to the implant, which leads to compromise of the osteointegration process.