Neuromodulator Finesse for Masseter Hypertrophy and Bruxism.

SUMMARY: A particularly prominent mandibular angle or a hypertrophied masseter muscle can result in an excessively wide facial appearance, which some individuals may find less aesthetically pleasing. Although normally a benign condition and strictly an aesthetic concern, a hypertrophied masseter can also cause pain, bruxism, and headaches. Neuromodulator for masseter reduction and treatment of bruxism has become first-line treatment. In this article, the authors present the senior author's (R.J.R.) anatomic approach to neuromodulator injection of the masseter, with a corresponding video of the injection technique.

Craniofacial and dental features in children aged 3-5 years with congenital Zika syndrome.

OBJECTIVE: Zika virus infection has been associated to congenital zika syndrome (CZS) in newborns and is characterized by microcephaly, central/axial motor and sensory dysfunction, dysphagia among other previously described severe health complications. CZS is usually diagnosed postpartum by evident/apparent neural development problems. Although there are some reports of craniofacial/dentition development in CZS, several clinical oral aspects are still unknown. This study describes some structural and functional characteristics of facial and cranial growth and deciduous dentition in CZS-affected children. MATERIAL AND METHODS: Some cranial, facial and dental characteristics were determined in 14 children with CZS aged 3-5 years and compared them against 12 apparently healthy children paired by age and gender. RESULTS: Fourteen CZS cases presented microcephaly, maxillary prognathism, altered facial thirds, asymmetric pupillary line, bruxism (p = 0.006), deep and anterior open bite and distal step decidual molar relationship (p = 0.031). CZS children cannot feed by themselves and most cannot walk and have not develop coordinated and intelligible language according to their chronological age. In contrast, controls presented normal skull features, have autonomous locomotion skills, speak intelligible language, feed by themselves, presented a harmonic intermaxillary relationship and have symmetrical facial thirds. CONCLUSION: Microcephaly, dysphagia, bruxism, mandibular retrognathia, altered facial proportions and malocclusion are the main craniofacial and oral features at CZS. CLINICAL RELEVANCE: The complications of CZS including those related with the face and the oral cavity are still being identified. This study revealed some cranial, facial and oral features in children affected by CSZ. Interdisciplinary rehabilitation protocols must address these syndromic features that could improve children and parents living conditions.

Postoperative pain after third molar extraction surgery in patients with and without bruxism: an observational study.

Third molar extraction surgery is a frequentprocedure in dentistry. Like any surgical procedure, it may lead to inflammatory responses, and postoperative pain is one of its main complications. Furthermore, temporomandibular disorder (TMD) is a collective termfor several clinicalproblems involving orofacial structures. Patients withparafunction are more sensitive to mechanical stimuli such as pressure during surgical procedures. Aim: To analyze postoperative pain in patients with and without bruxism subjected to third molar extraction surgery. Materials and Method: This was an observational study including four groups with a 1:1:1:! allocation ratio, conducted following ethical approval. Patients classified as ASA I with an indication for lower third molar extraction were recruited. Bruxism was self-reported. Two surgical techniques were used: one with only forceps and levers (ST1) and another with osteotomy and odontosection (ST2). Results: Four groups (bruxism and surgical techniques) were enrolled, each with a convenience sample (n=34). Postoperative pain levels were higher in patients with than without bruxism (p<0.05). The comparison between surgical techniques showed significantly higher pain levels only on the seventh day for ST2 groups (p<0.05). Oral mucosaflap incisions did not cause significantly higher persistence and pain levels. Conclusions: Bruxism, osteotomy, and odontosection may have increased postoperative pain levels, whereas performing an oral mucosa flap did not cause significant differences. Nevertheless, these preliminary data should be interpreted carefully. Randomized controlled trials are required to reinforce the findings of this study.

A cirurgia de extragao de terceiros molares é um procedimento frequente na odontologia. Como em qualquer procedimento cirúrgico, pode levar a respostas inflamatorias. A dor pós-operatória é uma das principais complicagoes após a cirurgia de extragao de terceiros molares. Além disso, disfungao temporomandibular (DTM) é um termo coletivo para vários problemas clínicos envolvendo estruturas orofaciais. Pacientes com parafungao sao mais sensíveis a estímulos mecánicos como pressao durante procedimentos cirúrgicos. Objetivo: Analisar a dor pós-operatória em pacientes com e sem bruxismo submetidos á cirurgia de extragao de terceiros molares. Material e Método: Um estudo observacional incluindo quatro grupos com uma proporgao de alocagao de 1:1:1:1 foi realizado após aprovagao ética. Foram recrutados pacientes classificados como ASA I com indicagao de exodontia de terceiros molares inferiores. O bruxismo foi autorreferido e foram realizadas duas técnicas cirúrgicas: uma com apenas fórceps e alavancas (ST1) e outra com osteotomia e odontosecgao (ST2). Resultados: Foram incluidos quatro grupos (bruxismo e técnicas cirúrgicas), cada um com uma amostra de conveniencia (n=34). Os níveis de dor pós-operatória foram maiores em pacientes com bruxismo (p<0,05). A comparagao entre as técnicas cirúrgicas mostrou níveis de dor significativamente maiores apenas no sétimo diapara os grupos ST2 (p<0,05). Incisoes de retalhos de mucosa oral nao mostraram níveis de dor significativamente maiores. Conclusoes: Bruxismo, osteotomia e odontosecgaopodem aumentar os níveis de dor pós-operatória, enquanto a realizagao de retalho de mucosa oral nao apresenta diferengas significativas. No entanto, a interpretagao cuidadosa desses dados preliminares é recomendada, e ensaios clínicos randomizados sao necessários para fortalecer os achados deste estudo.

Clinical investigation of botulinum toxin (prabotulinumtoxin A) for bruxism related to masseter muscle hypertrophy: A prospective study.

This study aims to confirm the effectiveness and safety of a prabotulinumtoxin type A (praBTX-A) injection in patients with bruxism and masseter hypertrophy. The study included patients who ground or clenched their teeth while sleeping and had computed tomography (CT) scans that showed a maximum thickness of the masseter muscle of 15 mm or more. The praBTX-A was administered bilaterally into the masseter muscles; 15 U/side for group 1, 25 U/side for group 2, and 35 U/side for group 3. CT scans and bruxism questionnaires were conducted before and eight weeks after the injection. Thirty-seven patients were enrolled, but three dropped out due to loss of follow-up. After injection, masseter thickness decreased to 15.1 ± 2.0 mm for group 1, 14.3 ± 2.9 mm for group 2, and 13.4 ± 1.8 mm for group 3 (p = 0.043). Group 3 showed a statistically significant lower masseter thickness compared to group 1 (p = 0.039). Both subjective and objective frequencies of bruxism decreased for all groups, but there were no significant differences in either subjective (p = 0.396) or objective frequencies (p = 0.87) between the groups after the injection. The results of this study suggest that praBTX-A injection is a safe and effective treatment for bruxism and masseter hypertrophy. A dosage of 35 IU/side can effectively decrease masseter thickness and relieve bruxism symptoms. Even the minimum dosage of 15 IU/side can contribute to improvements in bruxism symptoms. This investigation provides valuable information for managing bruxism that is associated with hypertrophic masseter muscles.

Implant survival rate and marginal bone loss with the all-on-4 immediate-loading strategy: A clinical retrospective study with 1 to 4 years of follow-up.

STATEMENT OF PROBLEM: Assessing peri-implant marginal bone loss (MBL) and its risk factors with cone beam computed tomography (CBCT) may clarify the risk factors for the all-on-4 (5 or 6) strategy and further improve its survival rate. PURPOSE: The purpose of this retrospective clinical study was to evaluate the implant survival rate, MBL, and associated risk factors of all-on-4 (5 or 6) prostheses after 1 to 4 years of follow-up with CBCT. MATERIAL AND METHODS: A total of 56 participants rehabilitated with 325 implants by using the all-on-4 (5 or 6) concept between October 2015 and December 2019 were included. Outcome measures were cumulative implant survival (life-table analysis) and MBL. Four CBCT scans, a scan immediately after surgery (T0), a scan 1 year after surgery (T1), a scan 2 years after surgery (T2), and a scan 3 to 4 years after treatment (T3), were obtained to evaluate the MBL. The Pearson correlation coefficient analysis and linear mixed models were performed to assess the potential risk factors for MBL (α=.05). RESULTS: The implant survival rate was 99.38%, and the prosthesis survival rate was 100%. The reductions in the vertical buccal bone height (△VBBH) were 0.74 ±0.10 mm (T0-T1), 0.37 ±0.12 mm (T1-T2), and 0.15 ±0.14 mm (T2-T3). Except for T2-T3, the △VBBH showed a significant difference at T0-T1 and T1-T2 (P≤.05). The alterations in vertical mesial bone height (VMBH), vertical distal bone height (VDBH), and vertical lingual bone height (VLBH) were similar to the trend observed in VBBH. The △VBBH (T0-T3) was negatively correlated with the horizontal buccal bone thickness (HBBT) (T0) (r=-.394, P<.001). Linear mixed models revealed that factors such as smoking (P=.001), mandible implant site (P<.001), immediate implant (P=.026), tilted implant (P<.001), female sex (P=.003), systemic disease (P=.025), and bruxism (P=.022) negatively affected MBL. The cantilever length (CL) also had a negative effect on MBL around the implants at the distal extension (P<.001). CONCLUSIONS: The high implant and prosthesis survival rates and low MBL confirmed the predictability of the all-on-4 (5 or 6) concept. Smoking, mandible implant site, systemic disease, bruxism, female sex, immediate implant, tilted implant, and CL were identified as potential risk factors for MBL.

Comparison of 4- or 6-implant supported immediate full-arch fixed prostheses: A retrospective cohort study of 217 patients followed up for 3-13 years.

PURPOSE: Choosing four or six implants to support immediate full-arch fixed prostheses (FAFPs) is still controversial worldwide. This study aims to analyze and compare the long-term results of All-on-4 and All-on-6. MATERIALS AND METHODS: This retrospective cohort study enrolled 217 patients rehabilitated with 1222 implants supporting 271 FAFPs, including 202 prostheses supported by 4 implants (All-on-4 group) and 69 prostheses supported by 6 implants (All-on-6 group), and followed up for 3-13 years. Implant survival, prosthesis survival, complications, and implant marginal bone loss (MBL) were evaluated and compared between two groups. Patient characteristics including age, gender, jaw, opposite dentition condition, smoking habit, bruxism, bone quantity and quality, cantilever length (CL), prosthesis material, and oral hygiene were analyzed to assess their influence on the clinical results of the two groups. Six surgeons and three prosthodontists who performed FAFPs more than 5 years were invited for questionnaires, to assess patient- and clinician-related influences on implant number. RESULT: In general, All-on-4 group indicated no significant difference with All-on-6 group in the implant survival (implant-level: hazard ratio [HR] = 1.0 [95% confidence interval (CI): 0.8-1.2], P = 0.96; prosthesis-level: HR = 0.8 [95% CI: 0.3-1.8], P = 0.54), prosthesis survival (odds ratio [OR] = 0.8 [95% CI: 0.3-2.8], P = 0.56), biological complications (OR = 0.9 [95% CI: 0.5-1.8], P = 0.78), technical complications of provisional prosthesis (OR = 1.3 [95% CI: 0.7-2.3], P = 0.42), technical complications of definitive prosthesis (OR = 1.1 [95% CI: 0.6-2.2], P = 0.33) and the 1st, 5th, and 10th year MBL (P = 0.65, P = 0.28, P = 0.14). However, for specific covariates, including elderly patients, opposing natural/fixed dentition, smoking, bruxism, long CL, low bone density, and all acrylic provisional prostheses, All-on-6 was more predictable in some clinical measurements than All-on-4. The implant prosthodontists and the medium-experienced clinicians showed significant preference for All-on-6 (P < 0.05). CONCLUSION: Based on this study, the long-term clinical results showed no significant difference between All-on-4 and All-on-6 groups in general. However, for some specific characteristics, All-on-6 seemed to be more predictable in some clinical measurements than All-on-4. For the clinicians' decision-making, medium-experienced clinicians and the implant prosthodontists showed significant preference for All-on-6.

Prevalence and Risk Factors of Bruxism in a Selected Population of Iranian Children

ABSTRACT Objective: To investigate the prevalence of bruxism in Iranian children aged 6 to 12 years. Material and Methods: This cross-sectional study was conducted on 600 schoolchildren aged 6-12 years. The questionnaire consisted of two sections: the first section included demographic information, while the second evaluated the occurrence of bruxism. Kruskal-Wallis, Chi-Square, Fisher and Multinomial logistic regression were used. A level of p<0.05 was considered statistically significant. Results: 698 questionnaires were distributed, of which 600 participants were returned. According to Multinomial logistic regression, awake bruxism was associated significantly with the following variables: age, sequence of birth, recurrent headache, gastrointestinal disease, nasal obstruction, neurological disorder, easy child crying, sleep disorders, talking in a dream and snoring and jaw disorder. Sleep bruxism was associated significantly with age, premature birth, allergy, gastrointestinal disease, drooling, mouth breathing, nasal obstruction, oral habit, nail biting, sleep disorder, jaw disorders, and family history. Conclusion: Pre-birth and post-birth factors play an important role in the prevalence of bruxism in society. It is possible to prevent complications of bruxism by informing parents and making a timely diagnosis. Parents should be aware of this occurrence to reduce possible related factors to teeth and the masticatory system.

Fratura de implante dentário: relato de caso / Dental implant fracture: case report / Fractura de implante dental: informe de un caso

Com o aumento da população brasileira e consequentemente o número de edêntulos realizando tratamentos reabilitadores com implantes dentários, se tornou frequente aparições de complicações como, por exemplo, sua fratura. O presente trabalho tem por objetivo apresentar as causas prováveis relacionadas a fratura de implante dentário, através de um relato de caso clínico onde pode-se avaliar a condição da fratura apresentada e como foi solucionada. Após a analise do caso clínico, foi constatado que o principal fator que levou a sua fratura foram as sobrecargas oclusais associadas ao mal posicionamento e a qualidade do implante antigo. A partir disso, conclui-se que é de extrema importância o cirurgião dentista estar ciente de todas as possíveis complicações acerca do implante dentário, afim de realizar um bom planejamento cirúrgico diminuindo a taxa de insucesso levando a um bom prognóstico.

With the increase of the Brazilian population and, consequently, the number of edentulous individuals undergoing rehabilitation treatmentes with dental implants, the appearance of complications such as, for example, their fracture has become frequent. The present work aims to presente the probable causes related to dental implant fracture, trough a clinical case report where the condition of the fracture presented and how it was resolved can be evaluated. After analyzing the clinical case, it was found that de main factor that led to its fracture were the occlusal overloads associated with poor positioning and the quality of the old implant. From this , it is concluded that it is extremely important for the dental surgeon to be aware of all possible complications regarding the dental implant, in order to carry out a good surgical planning, reducing the failure rate, leading to a good prognosis.

Con el aumento de la población brasileña y, en consecuencia, del número de personas edéntulas que se someten a tratamientos de rehabilitación con implantes dentales, las complicaciones, como las fracturas, se han vuelto comunes. El presente trabajo tiene como objetivo presentar las probables causas relacionadas con la fractura de implantes dentales, a través del reporte de un caso clínico, donde se puede evaluar la condición de la fractura presentada y la forma en que fue resuelta. Tras analizar el caso clínico, se comprobó que el principal factor que condujo a la fractura fue la sobrecarga oclusal asociada a una mala colocación y a la calidad del implante antiguo. Esto lleva a la conclusión de que es muy importante que el cirujano dental conozca todas las posibles complicaciones de los implantes dentales, para realizar una buena planificación quirúrgica, reduciendo así la tasa de fracasos y consiguiendo un buen pronóstico.

Assessment of Electromyographic Changes in a Patient with Masseter Hypertrophy and Muscle Pain after Botulinum Injections: A Case Report and 5 Months Follow-up.

AIM: To determine if botulinum injections in masseters could be an option to avoid surgery and prolonged treatment with occlusal splints and/or drugs to care for both painful bruxism and cosmetic improvement in a patient with a square jaw, bruxism, and orofacial pain. BACKGROUND: Masseter muscle hypertrophy (MMH) is a benign, unilateral, or bilateral, painless enlargement in the lower face. It presents as a symmetrical or asymmetrical increase in the masseter muscle. Masseter muscle hypertrophy (MMH) sometimes can be related to bruxism symptoms like muscle and/or temporomandibular joint (TMJ) pain. CASE DESCRIPTION: A 38-year-old woman complained of bilateral pain at palpation in the masseter body. She also complained about esthetics because of the prominent masseter muscle in the face and square face shape. A diagnosis of bruxism-related myalgia was performed, and treatment with botulinum injections into the masseter muscles was opted for. An oral electromyography was performed to detect the electrical muscular activity of masseter muscles over time. CONCLUSION: After a drastic reduction in the mean electrical activity immediately after the botulinum injections, a progressive increase in strength over time was noted, testifying about the decrease in the effect of botulinum over time. The pain disappeared for 5 months after the injections of botulinum. The reduction of the masseter muscle mass led to a softening of the face shape. CLINICAL SIGNIFICANCE: This case report shows that treatment with botulinum can lead, in the short term, to a reduction in orofacial pain due to a decrease in muscle electrical activity.

Efficacy of botulinum-A for nocturnal bruxism pain and the occurrence of bruxism events: a meta-analysis and systematic review.

The purpose of this study was to explore the treatment efficacy of botulinum-A (BTX-A) in nocturnal bruxism. Five electronic databases (PubMed, Web of Science, Cochrane, Embase and Clinical Trials) were searched to identify related randomised controlled trials up to September 1, 2020. Five evaluation indices were extracted, namely, the pain at rest and at chewing (PR and PC), the number of bruxism events (NBE) and the self-assessment by patients (SA), to assess the treatment efficacy of BTX-A in bruxism. All data analyses were conducted using Review Manager (Version 5.3; The Cochrane Collaboration, London, United Kingdom). Six studies were included in this review. The sample was composed of 148 participants. Compared with the placebo group, the BTX-A group showed the significantly improved the PR index scores (MD, 1.16 cm; 95%CI, 0.65 to 1.67 cm; p < 0.00001), slightly improved the PC index scores (SMD, 0.25; 95%CI -0.14 to 0.64; p = 0.21), and the NBEs were significantly decreased in the before-injection group compared with that in the after-injection group (MD, 1.72; 95%CI, 0.60 to 2.85; p = 0.003). The results of this study suggest that BTX-A possesses significant therapeutic efficiency for the relief of pain and events of bruxism. However, whether the events of bruxism would recur or rebound after botulinum toxin injection needs more follow-up clinical evidence.

El Estrés y Bruxismo por COVID-19 como Factores de Riesgo en la Enfermedad Periodontal / Stress and Bruxism Due to COVID-19 as Risk Factors in Periodontal Disease

Por la pandemia de COVID-19 que inició año 2020 se ha venido desarrollando problemas de gran consecuencia afectando a la salud general, incluyendo a la salud mental y bucodental. El estrés, y angustia ha generado manifestaciones clínicas psicosociales como la ansiedad, depresión entre otros. Problemas orales como el bruxismo definido como el rechinamiento de dientes inconscientemente y parafunción mandibular persistente trae como consecuencias problemas patológicos en la articulación temporomandibular, los músculos asociados, ligamento periodontal y la fractura de dientes. El estrés siendo un factor psicosocial que aumentó por esta pandemia es un factor de riesgo para desarrollar enfermedad periodontal. Ha sido estudiado una persona con estrés libera moléculas en el organismo que llevan a depresión, y este metabolismo puede llevar a un desánimo repercutido en poca disposición para realizar los hábitos de higiene oral o buscar en el tabaco para liber ar el estrés, por eso estas son condiciones que van en círculo vicioso que afectan la salud periodontal. El estrés crónico es noci vo ya que se mantiene a lo largo del tiempo estimulando al hipotálamo en una serie de hormonas desencadenando liberación de glucocorticoides como el cortisol demostrado en estudios relacionado a una baja de defensas del organismo y este va hacer un factor de riesgo a desarrollar la enfermedad periodontal. Sumado a todo esto el bruxismo con lleva a una parafuncion donde se va a producir un trauma oclusal afectando el ligamento periodontal y al hueso. Se han reportado muchos casos de fracturas dentales a causa del estrés que genera el bruxismo. Existen muchos métodos para prevenir y eliminar el estrés como, actividad física, comida saludable entre otras que pueden tener un impacto positivo y ayudar en las afecciones psicosociales en esta pandemia de COVID 19.

Due to the COVID-19 pandemic of this year 2020, problems of great consequence have been developing in consequences in general health, including mental and oral health. Stress and anguish have generated psychosocial clinical manifestations such as anxiety, depression, among others. Oral problems such as bruxism defined as unconscious grinding of teeth and persistent mandibular parafunction results in pathological problems in the temporomandibular joint, associated muscles, periodontal ligament and tooth fracture. Stress, being a psychosocial factor that increased by this pandemic, is a risk factor for developing periodontal disease. A person with stress has been studied to release molecules in the body that lead to depression, and this metabolism can lead to discouragement, impaired in a reluctance to perform oral hygiene habits or to look at tobacco to release stress, so these are conditions that go vicious circle that affect periodontal health. Chronic stress is harmful since it is maintained over time by stimulating the hypothalamus in a series of hormones, triggering the release of glucocorticoids such as cortisol, shown in studies related to a decrease in the body's defenses and this will become a risk factor to develop periodontal disease. In addition to all this, bruxism leads to a parafunction where an occlusal trauma will occur affecting the periodontal ligament and the bone. Many cases of dental fractures have been reported due to the stress generated by bruxism. There are many methods to prevent and eliminate stress such as physical activity, healthy food among others that can have a positive impact and help in psychosocial conditions in this COVID 19 pandemic.

Case Report: Digital analysis of occlusion with T-Scan Novus in occlusal splint treatment for a patient with bruxism.

Bruxism is a disease with a multifactorial etiology. Its clinical manifestations are most often an unaesthetic smile with abraded tooth surfaces, temporomandibular disorders and muscle hyperactivity. Here we present a case of bruxism where proper articulation of the occlusal splint was performed using the T-scan Novus system. A patient with bruxism underwent treatment with stabilization splint made by 3D printer technology. Intraoral scanning was performed using Trios Color (3Shape, 2014), and the digital design was achieved using the 3Shape Dental system design - splint studio. Formlabs Form 2 printer with biocompatible resin Dental LT Clear Resin was used for printing. The T-Scan Novus system with software attached to it, version 9.1, was used for digital examination of the occlusion. A 2.7 mm thick occlusal splint was developed, and the software adapted the occlusion with antagonists. After adjustment with T-Scan Novus, a reduction in disocclusion time of the patient was achieved, which is a desired result in the treatment of bruxism. The position of the joint components was proven radiologically. The treatment of bruxism with splint therapy continues to be the main method of treatment. Using digital technology allows for more accurate constructions and precise balancing of occlusal relationships.

A new biofeedback approach for the control of awake bruxism and chronic migraine headache: utilization of an awake posterior interocclusal device / Uma nova abordagem via biofeedback para o controle do bruxismo de vigília e de enxaqueca crônica: utilização de um dispositivo interoclusal posterior em vigília

ABSTRACT Background: The relationship of bidirectional comorbidity between chronic migraine and pain in the cephalic segment led us to evaluate the improvement in reducing the pain in patients diagnosed with chronic migraine headache and awake bruxism, when undergoing treatment with a partial posterior interocclusal device designed for the management and control of awake bruxism through biofeedback. Methods: Seventy-four patients were evaluated during the following periods: pretreatment, seven, thirty, ninety, one hundred and eighty days, and one year. The evaluation was carried out by measuring the pain in the pretreatment period and pain reduction after awake bruxism treatment, using clinical evaluation and numerical scales for pain. Results: Most of the patients who complained of headache migraine pain, masticatory myofascial pain, temporomandibular joint and neck pain experienced a significant reduction in overall pain, including headaches, between t0 and t30 (p<0.0001). After 30 days of using the device, it was observed that the improvement remained at the same level without any recurrence of pain up to t90. At t180 and t360, it was observed that even with the device withdrawal (at t90) the improvement remained at the same level. Conclusion: The utilization of a posterior interocclusal device designed for the management and control of awake bruxism through biofeedback seems to contribute to the reduction of pain (including migraine headache) in the majority of patients, and, even with the device withdrawal (at t90), the improvement remained at the same level, suggesting the patients succeeded in controlling their awake bruxism and consequently the pains.

RESUMO Introdução: A relação de comorbidade bidirecional entre enxaqueca crônica e dor no segmento cefálico nos levou a avaliar a melhora na redução da dor em pacientes diagnosticados com cefaleia crônica de enxaqueca e bruxismo de vigília, quando submetidos a tratamento com dispositivo interoclusal posterior parcial projetado para o manejo e o controle do bruxismo acordado através de biorretroalimentação (biofeedback). Métodos: Setenta e quatro pacientes foram avaliados durante os seguintes períodos: pré-tratamento, sete, trinta, noventa e cento e oitenta dias, e um ano. A avaliação foi realizada por meio da avaliação da dor no período pré-tratamento e redução da dor após o tratamento do bruxismo de vigília, através de avaliação clínica e escalas numéricas de dor. Resultados: A maioria dos pacientes que se queixou de dor de cabeça com enxaqueca, dor miofascial mastigatória, articulação temporomandibular e dor no pescoço sofreu uma redução significativa na dor geral, incluindo dores de cabeça, entre t0 e t30 (p<0,0001). Após 30 dias de uso do dispositivo, observou-se que a melhora permaneceu no mesmo nível, sem recorrência da dor até t90. Em t180 e t360, observou-se que, mesmo com a retirada do dispositivo (em t90), a melhoria permaneceu no mesmo nível. Conclusão: A utilização de um dispositivo interoclusal posterior projetado para o controle do bruxismo de vigília através de biofeedback parece contribuir para a redução da dor (incluindo enxaqueca) na maioria dos pacientes, e, mesmo com a retirada do dispositivo (t90), a melhora manteve-se no mesmo nível, sugerindo que os pacientes conseguiram controlar o seu bruxismo de vigília e a dor associada a esse hábito.

Association of bruxism and anxiety symptoms among military firefighters with frequent episodic tension type headache and temporomandibular disorders / Associação de bruxismo e sintomas de ansiedade em bombeiros militares com cefaleia do tipo tensional episódica frequente e desordens temporomandibulares

ABSTRACT Objective To assess the presence of bruxism and anxiety among military firefighters with frequent episodic tension-type headache and painful temporomandibular disorders (TMDs). Methods The sample consisted of 162 individuals aged 18 to 55 years divided into four groups. Headache was diagnosed in accordance with the International Classification of Headache Disorders-III. The Research Diagnostic Criteria for Temporomandibular Disorders questionnaire was used to classify TMDs and awake bruxism; sleep bruxism was diagnosed in accordance with the International Classification of Sleep Disorders-3; and anxiety was classified using the Beck Anxiety Inventory. In statistical models, a significance level of 95% was used. The chi-square test was used to assess anxiety. Results Associations were found among frequent episodic tension-type headache, painful TMDs, awake bruxism and anxiety (p < 0.0005). Sleep bruxism was not a risk factor (p = 0.119) except when associated with awake bruxism (p = 0.011). Conclusion Anxiety and awake bruxism were independent risk factors for developing frequent episodic tension-type headache associated with painful TMDs; only awake bruxism was a risk factor for frequent episodic tension-type headache with non-painful TMDs.

RESUMO Objetivo Avaliar a presença de bruxismo e sintomas de ansiedade entre bombeiros militares com cefaleia do tipo tensional episódica frequente (CTTEF) e desordens temporomandibulares Dolorosas (DTMs). Métodos A amostra foi composta por 162 indivíduos com idade entre 18 e 55 anos divididos em quatro grupos. A CTTEF foi diagnosticada de acordo com o ICHD-III. O RDC / TMD foi usado para classificar as DTMs e o bruxismo acordado; o bruxismo do sono foi diagnosticado de acordo com o ICSD-3; e a ansiedade foi classificada usando o Inventário de Ansiedade de Beck. Nos modelos estatísticos, utilizou-se um nível de significância de 95%. O teste Qui-quadrado avaliou a ansiedade. Resultados Associações foram encontradas entre CTTEF, DTMs dolorosas, bruxismo diurno e ansiedade (p < 0,0005). O bruxismo do sono não foi fator de risco (p = 0,119), mas quando associado à atividade diurna (p = 0,011). Conclusão Ansiedade e bruxismo diurno foram fatores de risco independentes para o desenvolvimento de CTTEF associado a DTMs dolorosas. Apenas o bruxismo diurno foi fator de risco para CTTEF com DTMs não dolorosas.

Pre-operative parafunctional or dysfunctional oral habits are associated with the temporomandibular disorders after orthognathic surgery: An observational cohort study.

BACKGROUND: Temporomandibular disorders (TMDs) are frequent and disabling, and hence, preventing them is an important health issue. Combining orthodontic and surgical treatments for malocclusions has been shown to affect temporomandibular joint (TMJ) health. However, publications regarding the risk factors that predict negative TMJ outcomes after orthognathic surgery are scarce. OBJECTIVE: Present prospective cohort study was conducted to identify an association between pre-operative dysfunctional/parafunctional oral habits and the presence of TMD symptoms after orthognathic surgery. METHOD: We included 237 patients undergoing orthodontics and surgical treatment for malocclusions associated with dentofacial deformities within the Department of Oral and Maxillofacial Surgery of the University of Lille. Their parafunctional and dysfunctional oral habits were recorded through clinical examination along with the presence of TMD symptoms before and after the surgery. According to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) classification, the TMD symptoms studied were myalgia, arthralgia, disc displacement with or without reduction. RESULTS: Multivariate analysis revealed significant associations among bruxism (odds ratio [OR] 3.17 [1.066; 9.432]), lingual interposition (OR 4.241 [1.351; 13.313]), as well as primary swallowing (OR 3.54 [1.225; 10.234]) and the presence of postoperative symptoms of myalgia. Moreover, a significant association was observed between the presence of any dysfunctional oral habit and postoperative disc displacement with reduction (OR 4.611 [1.249; 17.021]). CONCLUSION: Bruxism and dysfunctional oral habits were shown to be risk factors for the presence of TMD symptoms also after combined orthodontic and surgical treatment. Treating such habits before orthognathic surgery should help prevent TMD.

Does traumatic occlusal forces lead to peri-implant bone loss? A systematic review

Abstract Observational studies have indicated that crestal bone level changes at implants are typically associated with clinical signs of inflammation, but still mechanical overload has been described as possible factor leading to hard-tissue deficiencies at implant sites without mucosal inflammation. The aim of this paper was systematically review the literature regarding the possible effect of traumatic occlusal forces on the peri-implant bone levels. Literature search was conducted using PubMed, Scielo and Lilacs, including the following terms: oral OR dental AND implant$ AND (load OR overload OR excessive load OR force$ OR bruxism) AND (bone loss OR bone resorption OR implant failure$). Databases were searched for the past 10 years of publications, including: clinical human studies, either randomized or not, cohort studies, case control studies, case series and animal research. Exclusion criteria were review articles, guidelines and in vitro and in silico (finite element analysis) research, as well as retrospective studies. The PICO questions formulated was: "does traumatic occlusal forces lead to peri-implant bone loss?" The database searches as well as additional hand searching, resulted in 807 potentially relevant titles. After inclusion/exclusion criteria assessment 2 clinical and 4 animal studies were considered relevant to the topic. The included animal studies did not reveal an association between overload and peri-implant bone loss when lower overloads were applied, whereas in the presence of excessive overload it seemed to generate peri-implant bone loss, even in the absence of inflammation. The effect of traumatic occlusal forces in peri-implant bone loss is poorly reported and provides little evidence to support a cause-and-effect relationship in humans, considering the strength of a clinically relevant traumatic occlusal force.

Occlusal Palliation of a Hematopoietic Stem Cell Transplant Patient.

Dental providers are integral to patients preparing for hematopoietic stem cell transplantation (HSCT) and for survivorship care. Following successful treatment, HSCT patients eventually return to the care of a general dentist, who must understand the importance of assessing and managing these individuals in collaboration with medical colleagues. This case report describes the dental therapy of a patient diagnosed with multiple myeloma who was experiencing teeth chipping in the anterior, clenching, and myofascial tension. The three-phase treatment plan was aimed at creating a relaxed, comfortable bite position, preventing further functional damage, and optimizing the patient's dental/medical health for her survival prognosis of 2 to 4 years.