Férula multifunción en paciente adulto / Multifunction splint in an adult patient

RESUMEN Introducción: El bruxismo del sueño es una parafunción que afecta a más del 20 por ciento de la población en general, produce trastornos en el aparato estomatognático y el resto del organismo. Su multicausalidad dificulta su diagnóstico, control y tratamiento, sobre todo cuando está asociado con el hábito de respiración bucal. Existen aditamentos que son utilizados como coadyuvantes del tratamiento en ambas entidades por separado, pero se torna aún más difícil cuando están combinadas. Objetivo: Comprobar la efectividad de una férula multifunción en el bruxismo del sueño asociado al hábito de respiración bucal. Caso clínico: Paciente masculino de 42 años de edad, con antecedentes de faringitis a repetición y de hipertrofia de adenoides, que acude a la consulta de Trastornos Témporo Mandibulares de la Facultad de Estomatología "Raúl González Sánchez", quien refiere apretamiento de las mandíbulas cuando duerme y dolores en músculos de la cara al despertar. A través de la anamnesis, el examen clínico intrabucal y extrabucal y de diferentes maniobras clínicas, se observó sintomatología relacionada con bruxismo del sueño céntrico combinado con hábito de respiración bucal. Conclusiones: Con la colocación de la férula multifunción se logró disminuir la sintomatología por la cual asistió a consulta el paciente(AU)

ABSTRACT Introduction: Sleep bruxism, a parafunctional habit affecting more than 20 percent of the general population, causes disorders in the stomatognathic system and the rest of the body. Its multicausality makes its diagnosis, control and treatment difficult, particularly when it is associated with mouth breathing. Devices have been created which may be used for the treatment of either condition separately, but therapy becomes more complicated when the two are present. Objective: Verify the effectiveness of a multifunction splint for the treatment of sleep bruxism associated with mouth breathing. Clinical case: A male 42-year-old patient with a history of recurrent pharyngitis and adenoid hypertrophy presents at the temporomandibular disorders service of Raúl González Sánchez Dental School and reports tightening of his jaws during sleep and facial muscle pain upon awakening. Anamnesis, intraoral and extraoral clinical examination, and various clinical maneuvers reveal symptoms of centric sleep bruxism combined with mouth breathing. Conclusions: Placement of a multifunction splint reduced the symptoms that had prompted the patient to attend consultation(AU)

Heat-moulded versus custom-made mandibular advancement devices for obstructive sleep apnoea: a randomised non-inferiority trial.

RATIONALE: Custom-made mandibular advancement devices (MADs) are reported as providing higher efficacy rates compared with thermoplastic heat-moulded MADs but at the price of higher costs and treatment delays. OBJECTIVE: To determine whether a thermoplastic heat-moulded titratable MAD (ONIRIS; ONIRIS SAS, Rueil Malmaison, France) is non-inferior to a custom-made acrylic titratable MAD (TALI; ONIRIS SAS, Rueil Malmaison, France) for obstructive sleep apnoea (OSA). METHODS: We conducted a multicentre, open, randomised controlled trial of patients with OSA refusing or not tolerating continuous positive airway pressure (CPAP). Participants were randomly assigned to a thermoplastic heat-moulded titratable device or a custom-made acrylic device for 2 months with stratification by centre and OSA severity. The non-inferiority primary outcome was a ≥50% reduction in apnoea-hypopnoea index (AHI) or achieving AHI <10 events/hour at 2 months. The non-inferiority margin was preset as a difference between groups of 20% for the primary outcome in the per-protocol analysis. MAIN RESULTS: Of 198 patients (mean age 51 [SD, 12] years; 138 [72.6%] men; mean body mass index 26 [SD, 2.7] kg/m2; mean AHI 26.6/hour [SD, 10.4]), 100 received TALI and 98 ONIRIS. In per-protocol analysis, the response rate was 51.7% in the TALI group versus 53.6% in the ONIRIS group (absolute difference 1.9%; 90% CI: 11% to 15%, within the non-inferiority margin). Effectiveness was the same for severity, symptoms, quality of life and blood pressure reduction. Patients in ONIRIS group reported more side effects and adherence was slightly better with TALI. CONCLUSION: In patients with OSA refusing or not tolerating CPAP, the thermoplastic heat-moulded titratable MAD was non-inferior in the short-term to the custom-made acrylic MAD. TRIAL REGISTRATION NUMBER: NCT02348970.

Freely available or over-the-counter occlusal splints obtainable in commercial outlets: a reality dentists should know

Aim and objective: bruxism is defined by The american sleep disorders association as "tooth grinding during sleep plus tooth wear, sounds or jaw muscle discomfort in absence of medical disorder. people are obtaining over the counter splints (OTC) as a possible alternative to manage bruxism without the need for dental assessment. the aim of this study is survey OTC bruxism splints available in Chile through the internet or other commercial outlets, categorize their characteristics, claims, safety warnings and contrast it with scientific evidence. materials and methods: an internet search was made for OTC bruxism splints available in Chile. only chilean domains were evaluated. information recorded was manufacture, name of the device, splint design, material, adjustability, price, claims and safety warnings. results: five devices were found in our search. only one is from a chilean laboratory, being the most accessible. all devices have a full coverage splint design. the material made of is only described in one and their prices in the market are very dissimilar. the most usual advertising was "eliminate bruxism. stop night-time Grinding & Clenching". two manufactures suggest that the device will help to sleep better. no manufacture provided a guide for how long each day the splint must be worn. conclusion: dentists should be aware to keep this market in mind when reviewing patients if there have been unexplained occlusal changes or other problems. bruxism is often a long-term problem and with any type of bruxism appliance the importance of regular review by a professional is critical.

Disminución de la permeabilidad de la vía aérea con el uso de dispositivos intraorales estabilizadores en pacientes con trastornos respiratorios del sueño: una revisión de la literatura / Decreased airway permeability with the use of occlusal stabilization splints in patients with sleep-disordered breathing: a literature review

RESUMEN: Introducción: Los dispositivos intraorales o planos estabilizadores son actualmente indicados indiscriminadamente por el dentista, aun cuando su valor terapéutico es controversial y poco se sabe de sus posibles efectos secundarios. Materiales y métodos: Se revisaron publicaciones que incluyeran pacientes con diagnóstico polisomnográfico de Apnea Obstructiva del Sueño que hayan sido tratados con un dispositivo estabilizador controlado mediante polisomnografía, o bien, que hayan sido usados como sujeto control con un dispositivo sin avance mandibular en estudios que evaluaran la eficacia de los dispositivos de avance mandibular. Resultados: Se encontraron 6 artículos que cumplían los criterios de inclusión. Cuando los resultados se consideraban de manera grupal, el cambio en el Índice de Apnea/Hipopnea o Índice de Eventos Respiratorios no era significativo estadísticamente, pero si se analizaba caso a caso, existían pacientes en los que estos valores aumentaban de manera violenta. Conclusión: Aunque un empeoramiento de los índices no es un efecto secundario en todos los pacientes con apnea del sueño, el riesgo en aquellos que lo sufren puede determinar un empeoramiento importante de su condición médica. Es posible que el uso de dispositivos de estabilización esté contraindicado en pacientes que presenten trastornos respiratorios del sueño.

ABSTRACT: Introduction: Frequently, the oral devices or stabilization splints are indiscriminately indicated by the dentist, even when its therapeutic value is controversial and there is poor knowledge about its possible side effects. Material and Method : We reviewed in Pubmed and Ebsco-Host all the publications that included patients with polysomnographic diagnosis of Obstructive Sleep Apnea (OSA) who were being treated with stabilization splints and controlled by polysomnography, or patients who were used as control subjects with stabilization splints in studies evaluating mandibular advancement devices (MAD) effectiveness. Results: Six publications met the inclusion criteria. They all describe that when the results of the study were considered as a group, the changes in the Apnea/Hypopnea Index or in the Respiratory Disturbance Index were considered as not statistically significant, but if each case was studied individually some patients experimented a violent increase of these values. Conclusion: Although the increase of index is not a side effect in all patients, the risk in those who experimented it can determinate an important aggravation of a medic condition. It´s possible that there´s There may be a contraindication in the use of stabilization splints in patients with sleep respiratory disorders.

Laser Therapy and Occlusal Stabilization Splint for Temporomandibular Disorders in Patients With Fibromyalgia Syndrome: A Randomized, Clinical Trial.

Context • Patients with fibromyalgia syndrome (FMS) report frequent and severe symptoms from temporomandibular disorders (TMDs). The appropriate treatment of TMDs remains controversial. No studies have occurred on the efficacy of therapy with a laser or an occlusal stabilization splint in the treatment of TMDs in patients with FMS. Objective • The study intended to investigate the therapeutic effects of laser therapy and of an occlusal stabilization splint for reducing pain and dysfunction and improving the quality of sleep in patients with TMDs and FMS. Design • The research team designed a single-blinded, randomized clinical trial. Setting • The study took place in the research laboratory at the University of Granada (Granada, Spain). Participants • Participants were 58 women and men who had been diagnosed with FMS and TMDs and who were referred from the clinical setting. Intervention • Participants were randomly assigned to the occlusal-splint or the laser group. The laser group received a treatment protocol in which laser therapy was applied to the participant's tender points, and the occlusal-splint group underwent a treatment protocol in which an occlusal stabilization splint was used. Both groups underwent treatment for 12 wk. Outcomes Measures • Pain intensity, widespread pain, quality of sleep, severity of symptoms, active and passive mouth opening, and joint sounds were assessed in both groups at baseline and after the last intervention. The measurements used were (1) a visual analogue scale (VAS), (2) the Widespread Pain Index (WPI), (3) the Symptom Severity Scale (SSS), (4) the Patient's Global Impression of Change (PGIC), (5) the Pittsburgh Quality of Sleep Questionnaire Index (PSQI), (6) an assessment of the number of tender points, (7) a measurement of the active mouth opening, (8) a measurement of the vertical overlap of the incisors, and (9) the measurement of joint sounds during mouth opening and closing. Results • The group X time interaction for the 2 × 2 mixed analysis of variance found no statistically significant differences between the 2 treatment groups: (1) VAS, P = .591; (2) WPI, P = .112; (3) SSS, P = .227; (4) PGIC, P = .329; (5) number of tender points, P = .107; (6) right and left clicking sounds in the jaw joint during palpation at mouth opening, P = .723 and P = .121, respectively; and (7) right and left clicking sounds in the jaw joint during palpation at mouth closing, P = .743 and P = .698, respectively. Compared with baseline, the laser treatment showed significant improvements on several outcomes, including the VAS, P < .001; WPI, P = .003; and SSS, P = .001. Overall, the study found an average improvement in symptoms from baseline of 21% , P < .001, based on the PGIC. Conclusions • Laser therapy or an occlusal stabilization splint can be an alternative therapeutic treatment for reducing pain symptoms and the clicking sound for TMDs in patients with FMS.

Efecto de los dispositivos oclusales sobre la vía aérea en pacientes con bruxismo / Effects of occlusal splints on upper airway in bruxism therapy

Objetivo Para el manejo de los trastornos temporomandibulares y del bruxismo de sueño (BS) se ha recurrido durante años a los dispositivos oclusales rígidos superiores (DORS). Estos dispositivos podrían modificar la posición de la mandíbula induciendo una posición más posterior de la lengua y del hueso hioides, comprometiendo la permeabilidad de la vía aérea superior y agravando los trastornos respiratorios del sueño. Este trabajo tiene como objetivo evaluar el cambio de las dimensiones lineales y de área de la luz de la vía aérea faríngea en pacientes diagnosticados con BS que estén usando un DORS, mediante una telerradiografía lateral. Metodología Se reclutaron 20 pacientes del Hospital de Carabineros, de ambos sexos, diagnosticados con BS probable manejados con un DORS, a los cuales se les tomó una telerradiografía lateral sin DORS y otra con DORS sin modificar la postura para evitar distorsiones por posición craneocervical. Se analizó el área y profundidad faríngea por medio de cefalometría para medir el espacio faríngeo. Resultados Se observaron diferencias estadísticamente significativas en la disminución del área de la orofaringe (promedio: 41,2 mm2, p = 0,035) y la profundidad al nivel del gonion (promedio: 0,38 mm, p = 0,019) y la úvula (promedio: 1,38 mm, p = 0,009). No se encontró correlación entre el aumento de la dimensión vertical y las diferencias dimensionales. Conclusión Bajo las condiciones de este estudio el uso de un DORS produce una tendencia a la disminución del área y profundidad orofaríngea.

Objective The use of the superior rigid occlusal splint (SROS) has been used to management temporomandibular disorders and sleep bruxism for many years. These SROS could change the mandibular position leading to a more posterior position of the tongue and hyoids bone, and compromising the upper airway flow permeability and make sleep-breathing disorders worse. The aim of this study is to evaluate the linear and area changes of lumen in patients with sleep bruxism who are using a SROS, measured by lateral teleradiograph. Methodology The study included 20 patients, of both sexes, from the Hospital de Carabineros, Chile, who were diagnosed with probable sleep bruxism due to using and SROS. The cephalometric analysis was performed of the area and pharyngeal depth in order to measure the pharyngeal space, by obtaining a lateral teleradiograph without SROS and a second teleradiograph using SROS, at the same time, to avoid dimensional variation due to possible craniocervical positional changes. Results A statistical significance was found for oropharynx reduction (mean: 41.2 mm2, P = .035), for the gonion linear depth (mean: 0.38 mm, P = .019), and at uvula level (mean: 1.83 mm, P = .009). No correlations were found between the increasing vertical dimensions using SROS and pharyngeal spaces. Conclusion The using of a superior occlusal splint (SROS) could reduce the oropharyngeal depth and space.

Orthodontic occlusal reconstruction after conservative treatment of unicystic ameloblastoma in an adolescent patient: 10-year follow-up.

Conservative treatment of an ameloblastoma often requires an occlusal reconstruction. In this article, we report the successful interdisciplinary treatment of a 14-year-old girl with a unicystic ameloblastoma in the mandible. One year after the marsupialization, enucleation with bone curettage was performed with extraction of the impacted third molar, but the proximal second molar could be maintained. The conservative treatment required long-term use of an obturator, and it caused a total open bite. Additionally, the patient genetically had a Class II malocclusion with severe crowding. Consequently, orthodontic treatment was performed after 4 premolar extractions. There was no recurrence of the ameloblastoma 10 years after the enucleation.

Efeitos do uso da placa oclusal sobre equilíbrio postural em indivíduos dentados, não reprogramados, com sinais e sintomas de desordem temporomandibular diagnosticados pelo RDC/TMD e ressonância magnética / Effects of using occlusal splint on postural equilibrium in dentate, non-reprogrammed, individual with signs and symptoms of temporomandibular disorder diagnosed via RDC/TMD and magnetic-resonance imaging

A desordem temporomandibular (DTM) de origem multifatorial pode estar associada a fatores oclusais e também a alterações posturais. O objetivo desse estudo foi investigar os efeitos do uso da placa sobre o equilíbrio postural em indivíduos dentados, não reprogramados, com sinais e sintomas de desordem temporomandibular (DTM). Colaboraram com a pesquisa 70 pacientes (59 placa e 21 controle), entre 18e 84 anos, de ambos os gêneros, diagnosticados com DTM por meio do questionário do RDC/TMD além de ressonância magnética da articulação temporomandibular. O estudo foi de ensaio clínico, randomizado, controlado, prospectivo e de intervenção. Foram respondidos os questionários de risco de quedas - FES-I e de qualidade de vida - SF-36 antes que fosse realizada a avaliação do equilíbrio postural por meio da plataforma de força. Cumprida estas etapas eram feita a randomização: o grupo da amostra recebia placa oclusal com critérios de estabilidade oclusal além de orientação para que fizesse exercícios terapêuticos, enquanto o grupo controle era orientado para fazer apenas exercícios terapêuticos. Após 12 semanas, os dois grupos eram reavaliados. A análise estatística foi feita por frequências, avaliação da associação entre grupos por teste de Fisher; medidas quantitativas considerando por média, mediana, desvio padrão, percentis 25 e 75 além de valores máximo e mínimo; as comparações entre os tempos fez uso de teste não paramétrico de Wilcoxon enquanto a entre grupos usou o teste de Mann-Whitney, com nível de significância de 5%.

O total de pacientes, que completou o estudo de risco de queda e qualidade de vida, era composto por 77% de mulheres, com média de idade de 42,5 anos. Os itens significantes do risco de queda contribuíram para reduzir a preocupação em cair da mesma forma que os de qualidade de vida auxiliaram o aumento dos domínios saúde mental, dor e vitalidade. Dos setenta pacientes, 64 completaram o RDC/TMD (47 placa e 17 controle), com diferenças significativas no que diz respeito ao diagnóstico de dor miofascial, deslocamento do disco, artralgia direita e esquerda, grau de dor crônica, depressão esomatização relacionada a placa. Dentre os mesmos 70 pacientes, 49 completaram o estudo sobre o equilíbrio postural (36 placa e 13 controle), que apresentou aumento significante na velocidade anteroposterior do CP nas condições olhos abertos e fechados (VAPoa e VAPof), durante a postura em pé no grupo placa. Concluiu-seque o uso da placa foi eficaz no tratamento da DTM sendo que seu efeito pode ser observado no equilíbrio postural a ponto de diminuir a preocupação em cair além de melhorar os domínios de saúde mental e dor, com consequente repercussão sobre a qualidade de vida.

Temporomandibular disorder (TMD) of multifactorial origin may be associated with occlusal factors but also with changes in posture. The objective of this study was to investigate the effects of the use of the occlusal splint on the postural equilibrium of non-reprogrammed, dentate individual with signs and symptoms of temporomandibular disorder. The research group consisted of 70 patients (59 with occlusal splints, 21 in the control group) between 18 and 84 years of age, of both genders, diagnosed with TMD by way of the RDC/TMD questionnaire and magnetic-resonance imaging of the temporomandibular joint. The research was performed via a randomized, controlled, prospective clinical study and intervention. The questionnaires regarding risk of falls - FES-I and quality of life - SF-36 were filled out before evaluating postural equilibrium by way of a force platform. In the randomization, the sample group received occlusal splint, occlusal-stability criteria, and advice about therapeutic exercises; the control group only received advice about therapeutic exercises. After 12 weeks, the groups were re-evaluated qualitatively by frequency, evaluation of the association between the group via Fisher testing; quantitatively via average, median, standard deviation, 25 and 75 percentiles, and minimum and maximum values; comparison between the times via non-parametric Wilcoxon testing and between the groups via Mann-Whitney testing with a threshold of significance of 5%. Of the universe of the patients patients who completed the risk-of-fall and quality-of-life study, 77% were women with an average of 42.2 years.

Migration of aluminum silicate from the oral cavity to the submandibular region, with foreign body granuloma formation: report of a case.

We present the first case of foreign body granuloma in the cervical (submandibular) region as a result of migration of noninjected aluminium silicate particles from the oral mucosa. This migration can be explained by macrophage phagocytosis and transport through the local lymphatic network and surgical disruption of fascial layers. The appearance of foreign body granulomas in distant sites may appear several weeks after the local event in a specific disposition according with the migration route. This entity must be born in mind in differential diagnosis of multiple nodules, pigmentation, or persistent swelling in the cervical-orofacial region.

Alterações das atividades eletromiográficas dos músculos masseter e temporal anterior após a desprogramação neuromuscular da mandíbula de acordo com a filosofia de Roth / Changes of the electromyographics activities of the masseter and anterior temporal muscles after the mandibular neuromuscular deprogramming according to Roth’s philosophy

As atividades eletromiográficas dos músculos masseter e temporal anterior foram avaliadas em amostra constituída por 37 indivíduos assintomáticos, com maloclusão de Classe I divididos em dois grupos - Experimental e Controle. O grupo Experimental foi composto por 23 indivíduos, sendo 14 do gênero masculino e 9, do feminino, com média de idade de 23 anos e 7 meses, e foi submetido à desprogramação neuromuscular, com o uso de placa oclusal, pelo período médio de 6 meses e 3 dias. O grupo Controle foi formado por 14 indivíduos, sendo 11 do gênero feminino e 3, do masculino, com média de idade de 25 anos e 11 meses, e não fez uso de placa oclusal, nem foi submetido a qualquer intervenção oclusal, no período médio de observação de 8 meses e 10 dias. Os registros eletromiográficos foram realizados por meio de eletrodos bipolares de superfície durante o repouso mandibular e o apertamento oclusal máximo, em dois momentos – T1 e T2. Os valores obtidos foram mensurados pelo cálculo do “Root Mean Square” (RMS) e expressos em microvolts (μV). Os índices de assimetria e atividade foram calculados em porcentagem ( por cento). Os dados foram analisados estatisticamente por meio dos testes ANOVA e Bonferroni, considerando-se o nível de significância de 5 por cento. Os resultados mostraram que no grupo Experimental, após o uso da placa oclusal, ocorreu redução significante das atividades eletromiográficas de repouso, assim como aumento significante da atividade eletromiográfica em apertamento oclusal máximo. O grupo controle não mostrou qualquer diferença estatisticamente significante entre os momentos. Os índices de assimetria mostraram que, no repouso mandibular, os músculos do lado esquerdo foram mais ativos. Os índices de atividade mostraram que o músculo temporal anterior apresenta maior contribuição relativa, quando comparado ao masseter, no repouso mandibular. Ambos os índices não sofreram alterações significantes entre os momentos estudados, nos dois grupos.

Effect of alteration in organic material of the occlusal caries on DIAGNOdent readings

DIAGNOdent é um aparelho de fluorescência a laser usado para o diagnóstico de lesões de cárie dentária em superfícies oclusais e lisas. Apesar dos resultados preliminares promissores, as moléculas envolvidas no aumento da fluorescência em lesões de cárie permanecem sem explicação. O objetivo deste estudo foi comparar as leituras com o aparelho de fluorescência a laser antes e depois de alterações no conteúdo orgânico de lesões de cárie oclusal em dentes decíduos. Vinte e quatro molares decíduos armazenados em soro fisiológico com pelo menos um sítio com lesão de cárie oclusal foram divididos em dois grupos. O grupo controle foi composto de 17 sítios com cárie, e o grupo experimental, 16 sítios. As lesões de cárie foram medidas com o aparelho de fluorescência a laser. As amostras do grupo experimental foram então removidas da solução de armazenamento e imersas em uma solução de hipoclorito de sódio a 2% por 24 horas. Depois da lavagem com água, os dentes foram medidos novamente com o aparelho de fluorescência a laser. Os dentes do grupo controle foram submetidos aos mesmos procedimentos, mas soro fisiológico foi usado em vez de hipoclorito de sódio. Uma redução estatisticamente significante na média das leituras depois da imersão nas duas soluções testadas comparadas às primeiras leituras de ambos os grupos foi observada, mas a porcentagem de redução foi estatisticamente maior no grupo experimental (p < 0,0001). Neste estudo, os dados indicam que alterações na fluorescência de lesões de cárie medidas pelo aparelho de fluorescência a laser ocorrem principalmente devido a alterações no conteúdo orgânico ao invés da perda mineral.

A mandibular protruding device in obstructive sleep apnea and snoring.

UNLABELLED: The overall purpose behind treatment in sleep-breathing disorders is to ease breathing and thereby reduce the risk of morbidity. The mandibular protruding device (MPD) is one method of treating both obstructive sleep apnea (OSA) and snoring. The aims of the studies were to study MPD users after 2 years and evaluate the following aspects of the MPD: subjective and objective effects on sleep, influences on airway passages and hard tissues, and the incidence and types of adverse events of the masticatory system including temporomandibular disorders. Further aims were to evaluate the impact of body posture and the effects of the MPD on pharyngeal width and to validate two methods for measuring mandibular protrusion and MPD advancement. MATERIALS AND METHODS: Seventy-seven subjects with OSA or snorers without OSA. were admitted to the study after a medical examination, which included a somnographic registration. The patients completed questionnaires regarding sleep quality and symptoms from the masticatory system, and underwent a clinical jaw function examination, were given an MPD, and were subjected to lateral cephalometric examination. Two follow-ups, 6 months and 2 years after MPD treatment were conducted. The study population comprised 65 patients at the 2-year follow-up. RESULTS: At the 2-year follow-up, a significant reduction of the subjective complaints was noted by 90% of the MPD users. In the objective evaluation, the oxygen desaturation index (ODI) of the OSA group (n = 39) decreased significantly from a mean of 14.7 to 3.1 and the mean arterial oxygen saturation (SaO2) increased significantly from 78% to 89%. The snorers maintained their initial values. In the total group, MPD treatment significantly increased most pharyngeal measures and lifted the hyoid bone. The pharyngeal area decreased significantly--by more than 50%--when the patient was supine, and the velum area increased significantly. At the 2-year follow-up, on upright cephalogram without MPD, the pharyngeal area had significantly increased and the velum area had significantly decreased. The mandible was posteriorly rotated (P < 0.01) as well as the lower incisors were proclined (P < 0.05). Mandibular advancement and vertical opening with an MPD, as measured with a ruler, compared well with measurements taken from a cephalogram. At the 2-year follow-up significant changes in the mean mandibular range of protrusion (+0.6 mm), overjet (-0.5 mm), and overbite (-0.8 mm) were registered. Nine of the 65 patients had developed a lateral open bite, and 2 were aware of the change. The reported frequency of headache was significantly reduced. At the 2-year follow-up there was a significant reduction in pain during mandibular movements. CONCLUSIONS: MPD treatment significantly reduced subjective complaints of sleep disturbances and significantly reduced ODI values among OSA patients. A high MPD compliance rate after 2 years (84%) indicated a well-tolerated treatment and a low rate of side effects were noted. The key factor in OSA and snoring is the obstruction of pharynx. The MPD treatment significantly increased the pharyngeal passages and significantly reduced the size of velum and thereby facilitated the breathing.

[Dental device (sleep splint)].

Sleep splint, which is a dental device made of regin, is now widely used for the treatment of obstructive sleep apnea in our country. This device is worn in the mouth at night and makes the upper airway opened during sleep. It enlarges the velopharyngeal space as well as the space at the tongue base and prevents the collapse of the upper airway. This device is a treatment of choice for the patients with mild or moderate types of obstructive sleep apnea who are not treated ordinarily by nasal CPAP. When the patients have nasal obstruction, adenoid hypertrophy, enlarged tonsils, or improper conditions of the teeth, sleep splint is not indicated for those patients. At first, nasal obstruction should be treated, and the adenoids and enlarged tonsils should be removed surgically. The compliance of this treatment is better than that of nasal CPAP, and the major complication of this treatment is almost none.

Irreversible alteration in occlusion caused by a mandibular advancement appliance: an unexpected complication of sleep apnea treatment.

A 56-year-old woman who had suffered from socially disturbing snoring, daytime tiredness, and panic-like apnea episodes showed mild obstructive apnea in somnography. She was examined in the Oral and Maxillofacial Unit of Vaasa Central Hospital, Finland. She did not wish to have her malocclusion and lower airway obstruction corrected with orthognathic surgery, but instead chose to be treated with a mandibular advancement appliance. After having used the appliance nightly for more than 3 years, an irreversible alteration in her occlusion was noticed. The case is presented and possible reasons for this change are discussed.

Placa interceptora iatrogênica: relato de um caso clínico / Iatrogenic occlusal platform: a clinical report

A cada dia uma quantidade maior de pacientes que apresentam Disfunçöes Temporo-Mandibulares é diagnosticada. Foi observado, neste caso clínico, que um tratamento realizado com a indicaçäo de uma placa miorrelaxante subestendida nas oclusais dos dentes naturais, acabou prejudicando funçöes orais normais do paciente, com o passar de alguns meses. Após a realizaçäo de um diagnóstico clínico e radiográfico, foi executado o tratamento, devolvendo ao paciente a funçäo mastigatória, estética e principalmente a eliminaçäo da sintomatologia dolorosa localizada na regiäo pré-auricular