Measuring orthodontic treatment impact: Description or judgment, challenge or result.

INTRODUCTION: Determination of improvement in orthodontic treatment may depend on the measurement method used and the purpose. METHODS: Improvement after orthodontic treatment (from T1 to T2 [beginning to end of treatment]) was assessed 3 ways from a set of 98 patient records: (1) calculated by subtracting judges' assessments at T2 from T1 for records presented in random order, (2) judged as a holistic impression viewing T1 and T2 records side by side, and (3) determined from proxies (American Board of Orthodontics Discrepancy Index, the American Board of Orthodontics Objective Grading System, and the Peer Assessment Rating index). RESULTS: High levels of intramethod consistency were observed, with intraclass correlation coefficient clustering around an intraclass correlation coefficient of 0.900, and distributions were normal. Calculated and judged improvements correlated at r = 0.606. Calculated or judged improvements were correlated at a lower level with proxies. Calculated improvement was significantly associated with "challenge" (T1) scores and judged improvement associated with "results" (T2) scores. Common method bias was observed, with higher correlations among similar indexes than among indexes at the same time that used various methods. Relative to differences in Peer Assessment Rating scores, calculated improvement overestimated low scores and underestimated high ones. The same effect, but statistically greater, was observed using direct judgment of improvement. CONCLUSIONS: These findings are consistent with decision science and measurement theory. In some circumstances, such as third-party reimbursement and research, operationally defined measures of occlusion are appropriate. In practice, the determination of occlusion and improvement are best performed by judgment that naturally corrects for biases in proxies and incorporates background information.

[Methods of medical rehabilitation in the complex program therapy for patients with cervicobrachialgia caused by pathological dental occlusion]. / Metody meditsinskoi reabilitatsii v programme kompleksnoi terapii patsientov s tservikobrakhialgiei, obuslovlennoi patologicheskoi dental'noi okklyuziei.

Chronic pain syndromes in the neck and shoulder girdle are one of the important clinical problems due to their high prevalence. In addition, it's of great interest to study the mutual influence of the musculoskeletal system pathology, balance organs and dentoalveolar system due to the possible negative impact of these structures on each other which surely affects the treatment timing and its results. OBJECTIVE: To develop a diagnostic algorithm and a comprehensive program for the treatment and rehabilitation of patients with cervicobrachialgia combined with pathological dental occlusion. MATERIAL AND METHODS: The study involved 90 persons of both genders aged 18 to 55 years consisted of 3 clinical study groups (25 patients) and one control group (15 healthy persons). The clinical groups included 75 patients with chronic myofascial pain syndrome in the neck and shoulder girdle resistant to drug therapy, with temporomandibular joint (TMJ) dysfunction and/or pathological dental occlusion (PDO). The groups were formed depending on the chosen treatment methods: manual therapy was used in the 1st group; in the 2nd group - dental treatment aimed at correcting PDO; in the 3rd group the manual therapy was used together with the correction of the jaws' occlusal relationship. RESULTS: In the study course the most effective algorithm for the diagnosis and rehabilitation of patients with cervicobrachialgia caused by pathological dental occlusion was determined. Positive clinical results were noted in patients of all three groups; however, in the 3- group where manual therapy and complex dental treatment were carried out the results are not differing significantly from the controls. The study showed that in patients with myofascial pain syndrome at the cervical and shoulder levels caused by TMJ dysfunction and pathological dental occlusion it's advisable to include manual and osteopathic diagnostics in the algorithm. Manual muscle testing, posture tests in combination with 3D X-ray imaging and computerized functional studying the maxillofacial region should be used to identify etiology-pathogenesis links between these conditions. These methods are also applicable for quality control of treatment. CONCLUSION: Thus, as a study result the diagnostic algorithm was developed; it allows to determine the relationship of pharmacoresistant pain syndrome of the cervicobrachial region with dental pathology at high degree of accuracy; and a comprehensive interdisciplinary approach to the therapy and rehabilitation of this combined pathology was proposed.

Unusual case of prolonged breastfeeding in an orthodontic patient: clinical and psychosocial implications / Amamentação prolongada em paciente ortodôntico: implicações clínicas e psicossociais

Case report: This article presents the case of an 11-year-old patient who sought orthodontic treatment, complaining of crooked teeth. In anamnesis, an emotional and physical dependence was reported regarding the act of breastfeeding. Considerations on the diagnosis, psychological implications, and clinical approach in this rare case were addressed. An orthodontic treatment and myofunctional therapy were performed to resolve the occlusal and functional aspects of the patient. Psychological therapy for the child and her mother was required to handle emotional sequelae. Conclusion: Multidisciplinary treatment was prescribed. Dentists should be aware of this need in cases of patients with special characteristics for treatment beyond oral problems. In orthodontics, this may be the difference between effective treatment outcomes or not.

Relato de caso: Este artigo apresenta o caso de uma paciente de 11 anos que procurou tratamento ortodôntico com queixa de "dentes tortos". Na anamnese, foi relatada dependência emocional e física da criança em relação ao ato de amamentar. Considerações sobre diagnóstico, implicações psicológicas, abordagem clínica neste raro caso foram abordadas. Foi realizado tratamento ortodôntico e terapia miofuncional para resolução dos aspectos oclusais e funcionais do paciente. Um acompanhamento psicológico para crianças e sua mãe foi necessária para abordar sequelas emocionais inerentes. Conclusão: Um tratamento multiprofissional foi instituído e o dentista deve estar atento a essa necessidade nos casos de pacientes com características especiais, visando uma abordagem além dos problemas bucais. Na Ortodontia, essa pode ser a diferença entre os resultados eficazes do tratamento ou não.

Factores morfofuncionales de interés en prostodoncia que dependen de los biotipos craneofaciales / Morphofunctional factors of interest in prosthodontics depending on the craniofacial biotypes

El presente es un trabajo de investigación bibliográfica que busca establecer la posibilidad de utilizar las cefalometrías como elementos de diagnóstico pronóstico y elaboración de prótesis. Centra su objeto de estudio en encontrar y clasificar los factores morfológicos y funcionales que varían con los biotipos craneofaciales y que son de interés en la prostodoncia. La metodología empleada fue la revisión de la literatura histórica hasta la actualidad en la que se relacionan temas de prostodoncia a los biotipos craneofaciales. Si bien solo dos autores relacionaron la prostodoncia con los biotipos cráneo faciales, sí se encontraron varios temas de interés asociados directamente a la prostodoncia. Se clasificaron en temas de oclusión: Curva de Spee, plano de oclusión, movimientos mandibulares, dimensión vertical oclusiva y de especio libre interoclusal. Tema de maloclusiones. Tema de fuerza muscular. Tema variaciones morfológicas de procesos alveolares, corticales ósea y de la forma dentaría. Encontrándose para cada uno de ellos alguna correlación positiva con los distintos tipos faciales. De este estudio, se concluye que es necesario sistematizar el estudio de los conocimientos que puede aportar la cefalometría como una importante herramienta de diagnóstico al prostodoncista a partir de haberse encontrado variaciones muy importantes en los aspectos mencionados que hacen al interés de la rehabilitación prostodóncica (AU)

This Work is a bibliographic research that seeks to establish the use of cephalometries as elements of diagnosis prognostic and prosthesis elaboration. Its focus is to find and classify morphological and functional factors that vary with facial types which are of interest in prosthodontics. This was a review of the historical literature to date, in which prosthodontics are related to facial types. Although only two authors related prosthodontics to facial ypes, they did find several topics of interest directly associated with prosthodontics. They were classified into occlusion themes: Spee curve, occlusion plane, mandibular movements, occlusive vertical dimension and interocclusal free space. Malocclusion issue. Muscle strength theme. Morphological variations of alveolar processes, cortical bone and dental morphology. They found some positive correlation with the different facial types for each of them. From this study, it is concluded that it is necessary to systematize the study of cephalometries because they can provide to be an important diagnostic tool to the prosthodontist because there were found very important variations in the mentioned aspects that are of interest in prosthodontic rehabilitation (AU)

Malocclusion from the prehistoric to the medieval times in Serbian population: Dentoalveolar and skeletal relationship comparisons in samples.

The aims of this study were to reconstruct and analyze dental occlusion and skeletal jaw relationship in samples from Mesolithic-Neolithic, Bronze Age, Roman and Medieval times in Serbia, to compare results and to determine possible direction of the occlusal changes. Anatomically preserved skulls with mandibles and most of the posterior teeth were included in the investigation. Dental occlusion was reconstructed using the position of centric occlusion and centric relation and analyzed according to Angle's classification. Lateral cephalometric radiographs were traced manually. Site differences were tested by one-way ANOVA, while sex, age and site impacts were analyzed by UNIANOVA. Most of the individuals in all groups had Class I occlusion. Half-cusp distal occlusion was also present in all groups, but there were no significant differences between the groups. Cephalometric analysis showed no differences in the sagittal measurements, almost all individuals had skeletal Class I jaw relationship. Vertical traits analysis revealed markedly decreased basal plane angle and also decreased posterior facial height and sum of the posterior angles in the oldest group in comparison to the later groups. These results indicate that in the Serbian skeletal sample from the Mesolithic-Neolithic to the Medieval times, malocclusions were present in the form of dentoalveolar Class II occlusion. Skeletal deep bite was found in the oldest group, while horizontal growth pattern decreased from prehistoric to the Medieval times. Samples were too small to confirm environmental impact on the vertical skeletal discrepancies.

Brain activation patterns during unilateral premolar occlusion.

OBJECTIVE: To observe the characteristics of brain activation during unilateral premolar occlusion. METHODS: Functional magnetic resonance imaging was collected from 10 healthy volunteers during occlusion of the left first premolar (L1), left second premolar (L2), and right first premolar (R1). The brain activation patterns were analyzed, and the primary sensorimotor cortex, supplementary motor area, insula, thalamus, and prefrontal cortex were chosen as regions of interest. RESULTS: Single premolar occlusion activated the precentral gyrus, postcentral gyrus, cerebellum, thalamus, frontal lobe, hippocampus, cingulate gyrus, and parietal lobe. The brain areas showing activation during single premolar occlusion were similar to those activated by chewing. The activation pattern of L1 was more similar to that of L2 than R1. No significant left and right hemisphere differences in signal intensity were detected within the regions of interest. CONCLUSION: Brain activation patterns from two ipsilateral premolars were more similar than the pattern from a contralateral premolar.

The results of cephalometric analysis in the dynamics of orthodontic treatment of patients with transversal anomalies of occlusion.

OBJECTIVE: Introduction: This article discusses the problems of the current issue of modern orthodontics aimed at increasing the effectiveness of diagnosis and treatment of transversal anomalies of occlusion in patients in periods of alternating and permanent bites by using standard orthodontic equipment in combination with orthopedic treatment by physical rehabilitation methods. In this work, the features of cephalometric indices in patients with transversal anomalies of occlusion have been studied, which make it possible to approach the choice of orthodontic treatment method in a comprehensive way. The aim was to prove the efficiency of the combination of standard orthodontic equipment with orthopedic treatment by physical rehabilitation methods. PATIENTS AND METHODS: Materials and methods: In order to study the characteristics of cephalometric indices in 9-15 years old patients with transversal anomalies of occlusion and to determine the criteria for the treatment effectiveness. Depending on the method of treatment, the patients were further divided into 2 subgroups: A and B. The method of treatment of subgroup A consisted of orthodontic treatment, which was carried out simultaneously with osteopathic correction of postural muscle imbalance by physical rehabilitation methods. Patients of subgroup B were treated exclusively by orthodontic treatment. The analysis of teleradiograms in the frontal projection was carried out using Dolphin software. RESULTS: Results: The effectiveness of the proposed regimens was carried out with the help of clinical and cephalometric indices which were studied before and after the orthodontic intervention. Clinical effectiveness of the performed orthodontic treatment was established in the absence of aesthetic disorders of facial features, normalisation and synchronization of the sizes of the upper and lower dentition, physiological positioning of the mandible, restoration of nasal breathing, disappearance of difficulties while chewing. CONCLUSION: Conclusions: When using proposed method (complex orthodontic treatment combined with physical rehabilitation methods) of orthodontic treatment, cephalometric analysis indices showed better dynamics, especially with unilateral cross-bite.

Prevalence and impact of infant oral mutilation on dental occlusion and oral health-related quality of life among Kenyan adolescents from Maasai Mara.

BACKGROUND: Infant Oral Mutilation (IOM) includes germectomy and early extraction of primary and permanent incisors and canines, primarily in the lower jaw. The aim of the present study was to examine the prevalence and impact of IOM, involving the removal of mandibular permanent incisors and/or canines, on dental occlusion and Oral Health-Related Quality of Life (OHRQoL) among Kenyan adolescents from Maasai Mara. METHODS: In a cross-sectional study, 284 adolescents (14-18 yrs. of age) participated in an oral examination and an interview, using a structured questionnaire on age, gender, medical history, and IOM practice. For the analysis of the dental occlusion, participants with IOM, in terms of absence of two or more permanent teeth in the mandibular incisor and/or canine tooth segments (IOM group), were compared to participants who had all six incisors and canines present in the oral cavity (control group). OHRQoL was assessed using child perception questionnaire (CPQ11-14). RESULTS: The majority of the participants (61%) had been exposed to IOM, among whom 164 (95%) had absence of two mandibular central incisors. More individuals in the IOM group had maxillary overjet exceeding 5 mm than in the control group (50.9% vs. 20%, p <  0.001). Nineteen (11%) subjects in the IOM group had mesial occlusion in contrast to none in the control group (p <  0.001). The mean and median total CPQ scores and the mean and median CPQ domain scores were low in both groups with no significant differences between the groups. CONCLUSIONS: Approximately two-thirds of the study population presented with IOM, with the majority of them missing two mandibular permanent central incisors. Although some participants with IOM had substantial maxillary overjet and mesial occlusion, only few of them showed substantial effect on their OHRQoL.

Influência das terapias conservadoras sobre a qualidade do sono, intensidade de dor e níveis de depressão em pacientes portadores de disfunção temporomandibular: ensaio clínico randomizado / Influence of conservative therapies on sleep quality, pain intensity and depression levels in patients with temporomandibular disorders: a randomized clinical trial

A disfunção temporomandibular (DTM) constitui um importante problema de saúde pública, já que é uma das causas mais relatadas de dor orofacial crônica que interfere nas atividades diárias. Aspectos biológicos e comportamentais como depressão e qualidade do sono, podem desempenhar um papel importante na adaptação à dor e recuperação desses pacientes. Objetivo: avaliar a influência das terapias conservadoras, placa, aconselhamento e terapia manual, sobre a intensidade de dor, nível depressão e qualidade do sono em pacientes portadores de DTM. Métodos: 85 pacientes diagnosticados com DTM através do RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders) foram incluídos nesse ensaio clinico randomizado. Aleatoriamente eles foram distribuídos em 4 grupos de tratamento distintos: placa oclusal-PO (n= 24), placa oclusal associada ao aconselhamento-PAC (n=24), terapia manual-TM (n=19) e aconselhamento-AC (n=18). Os pacientes foram avaliados quanto a intensidade de dor por meio da Escala Visual Analógica (EVA), nível de depressão pelo Inventário de Depressão de Beck (BDI) e pela Escala Hospitalar de Ansiedade e Depressão (HADSd) e qualidade do sono através do Índice de Qualidade de Sono de Pittsburgh (PSQI) no baseline e também nos períodos de um e três meses após realização do tratamento. Os dados foram analisados utilizando o teste Split Plot ANOVA, com o intuito de observar a diferença ao longo do tempo e entre grupos, com nível de confiança de 95%. Resultados: Ao analisar as variáveis ao longo do tempo todas as terapias se mostraram positivas, com redução da intensidade de dor (p=0,000), diminuição dos escores do nível de depressão avaliado pelo BDI (p=0,001) e também de qualidade do sono avaliada pelo PSQI (p=0,005). Exceto nos níveis de depressão avaliado pela HADSd não foi encontrada diferença significativa ao longo do tempo (p=0,106) e entre grupos (p=0,890). Diferença significativa também não foi evidenciada entre os grupos de tratamento, em nenhuma variável durante o período da pesquisa. Conclusão: As terapias PO, PAC, AC e TM possuem resultados positivos, quanto a intensidade de dor, níveis de depressão e qualidade do sono em pacientes portadores de DTM a curto prazo (1 e 3 meses), sem diferenças entre elas (AU).

Temporomandibular disorders (TMDs) is a major public health problem, as they are the most commonly reported causes of pain that interfere with daily activities. Biological and behavioral aspects such as depression and sleep quality may play an important role in adapting to pain and canceling out patients. Objective: to evaluate the therapy of conservative therapies, occlusal splint, counseling and manual therapy on the intensity of pain, anxiety level and sleep quality in patients with temporomandibular disorders. Methods: 85 patients diagnosed with TMD through RDC / TMD (Diagnostic Criteria for Research in Temporomandibular Disorders) were included in this randomized clinical trial. They were randomly assigned to 4 different treatment groups: oclusal splint (n = 24), occlusal splint associated with counseling (n = 24), manual therapy (n = 19) and counseling (n = 18). The patients were evaluated for pain intensity by means of the Visual Analogue Scale (VAS), pressure level by the Beck Intelligence Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADSd) and the quality of sleep through Pittsburgh Sleep Quality Index (PSQI) there is no baseline and also the last two weeks after the treatment. The data were used in the Split Plot ANOVA test, in order to observe the difference between time and groups, with a confidence level of 95%. Results: When analyzing how variables over time all therapies differ positively, with reduction of pain intensity (p = 0.000), decrease in depression levels by BDI (p = 0.001) and also sleep quality evaluated by PSQI (p = 0.005). Except for confidence levels at the same time that HADSd was not different over time (p = 0.106) and between groups (p = 0.890). Significant difference was not found between treatment groups in any of the variables during the study period. Conclusion: As therapy of occlusal splint, counseling therapy and manual terapy, have positive results regarding pain intensity, depression levels and sleep quality in patients with short-term MS (1 and 3 months) with no differences between them (AU).

[Occlusion: current situation and prospect in view of holistic integrative medicine].

The rise of holistic integrative medicine (HIM) is an inevitable consequence of modern medical development which emphasizes the change from specialization to integration of the most advanced medical knowledge. It does not mean a simple collection of the medical theories, but means the digestion of those theories for the clinical practical application. Because occlusal therapy is characterized as not only a high level of individualization, but also a relation to many stomatology and other disciplines, such as plastic surgery, orthopedics, neurosciences and psychology. It needs the HIM to guide the clinical practice. With undertaking occlusal therapy, to avoid the limitation due to the excessive specialized disciplines, and to provide effective treatment plans for abnormal occlusion induced diseases, it is necessary to develop the discipline of the holistic integrative stomatology.

Dental occlusion analysis in the Mesolithic-Neolithic Age, Bronze Age, and Roman to Medieval times in Serbia: Tooth size comparison in skeletal samples.

OBJECTIVE: Anthropological studies have reported that tooth size decreases in the context of diet changes. Some investigations have found a reverse trend in tooth size from the prehistoric to the modern times. The aims of this study were to analyze tooth size in skeletal samples from Mesolithic-Neolithic Age, Bronze Age, and Roman to Medieval times to determine sex differences and establish a temporal trend in tooth size in the aforementioned periods. DESIGN: Well-preserved permanent teeth were included in the investigation. The mesiodistal (MD) diameter of all teeth and buccolingual (BL) diameter of the molars were measured. Effects of sex and site were tested by one-way ANOVA, and the combined effect of these factors was analyzed by UNIANOVA. RESULTS: Sexual dimorphism was present in the BL diameters of all molars and MD diameters of the upper first and the lower third molar. The lower canine was the most dimorphic tooth in the anterior region. The MD diameter of most teeth showed no significant difference between the groups, (sample from: Mesolithic-Neolithic Age-group 1; Bronze Age-group 2; Roman times-group 3; Medieval times-group 4), whereas the BL diameters of the upper second and the lower first molar were the largest in the first group. Multiple comparisons revealed a decrease in the BL diameter of the upper second and the lower first molar from the first to the later groups. Lower canine MD diameter exhibited an increase in the fourth group compared to the second group. CONCLUSION: On the basis of the MD diameter, a temporal trend could not be observed for most of the teeth. The lower canine exhibited an increase in the MD diameter from the prehistoric to the Medieval times. Changes of BL diameter were more homogeneous, suggesting that the temporal trend of molar size decreased from the Mesolithic-Neolithic to Medieval times in Serbia.

Optimal duration of ultra low frequency-transcutaneous electrical nerve stimulation (ULF-TENS) therapy for muscular relaxation in neuromuscular occlusion: A preliminary clinical study.

OBJECTIVES: The primary aim of this work was to determine the duration of ultra-low-frequency transcutaneous electrical nerve stimulation (ULF-TENS) application necessary to achieve sufficient relaxation of the masticatory muscles. A secondary aim was to analyze the influence of stimulation on muscle relaxation in pathological subjects and determine whether ULF-TENS has a noteworthy impact on muscle relaxation. METHODS: Sixteen adult subjects with temporomandibular disorders (TMD) and muscle pain and a group of four control subjects were included in this study. ULF-TENS was applied, and muscular activities of the masseter, temporal, and sternocleidomastoid muscles (SCM) were recorded for 60 min. RESULTS: Significant relaxation was achieved in the TMD group from 20, 40, and 60 min for the temporal, masseter, and SCM muscles (p < 0.05), respectively. Maximum relaxation was achieved in 12.5% of the subjects after 20 min, in a further 12.5% after 40 min, and in the remaining 75% after 60 min. Significant relaxation was achieved in the control group from 20 to 40 min for the masseter and temporal muscles, respectively (p < 0.05). DISCUSSION: Taken together, the results suggest that an ideal ULF-TENS application would last 40 min to obtain sufficient muscle relaxation both in patients with masticatory system disorders and healthy subjects, a time constraint that is consistent with everyday clinical practice.

Effect of Water-Cooled Nd:YAG Laser on Dentinal Tubule Occlusion In Vitro.

OBJECTIVE: The objective of this study was to investigate the effect of a new water-cooled Nd:YAG laser on dentinal tubule occlusion. BACKGROUND DATA: The effect of water-cooled Nd:YAG laser on dentinal tubule occlusion has not been reported. METHODS: Acid-etched dentin samples were randomly divided into three groups: (1) dentin control, (2) dentin treated by Nd:YAG laser, (3) dentin treated by water-cooled Nd:YAG laser. After laser irradiation, half of the samples were immersed in a 6 wt% citric acid (pH 1.5) solution for 1 min to evaluate the acid resistance. The morphologies of dentin surfaces were characterized by scanning electron microscopy. The number and diameters of the open dentinal tubules were analyzed by one-way and two-way analyses of variance. RESULTS: Both the Nd:YAG laser and water-cooled Nd:YAG laser melted the superficial layer of dentin, which caused dentinal tubule occlusion in most areas and diameter reduction of the rest open tubules. Microcracks on the dentin surface were only observed in the Nd:YAG laser group. The tubule occlusion induced by the two lasers showed a good acid resistance. CONCLUSIONS: The effect of water-cooled Nd:YAG laser on dentinal tubule occlusion is similar to that of the Nd:YAG laser. The dentinal tubule occlusion induced by the two lasers could resist acid challenge to some extent.

Relationship between craniocervical orientation and center of force of occlusion in adults.

OBJECTIVE: Clinical observation and anecdotal reports suggest changes can occur to dental occlusion following intervention with the National Upper Cervical Chiropractic Association (NUCCA) procedure. This case controlled study discerned if occlusion changes are measurable using a dental force plate (T-Scan®) following an adjustment to the craniocervical junction (CCJ). METHODS: A degree of case control was established by active patients being assessed twice prior to and following intervention. Before-after intervention assessment included posture evaluation and dental occlusion (T-Scan®). RESULTS: Findings suggest that changes in posture and occlusion can be observed after the NUCCA chiropractic procedure. Not all patients demonstrated a more balanced contact pattern following the adjustment, indicating a need for further investigation. DISCUSSION: These findings may suggest interconnectivity between the CCJ and an individual's occlusal contacts and support the need for further integration between chiropractors and dentists seeking to co-manage temporomandibular joint disorders.

Recuperación de la postura en pacientes con DTM tratados con ortodoncia neuromuscular / Restoration of posture in patients with TMD treated with neuromuscular orthodontics

En este artículo se plantea la importancia queejerce la oclusión habitual en la postura corporaly la necesidad de llegar a una oclusión neuromuscularpara recuperar el equilibrio postural.Es imprescindible realizar un diagnóstico de laATM antes de iniciar nuestros tratamientos deortodoncia. Una mala oclusión va a estar viciadade anómalos procesos musculares y articularesadaptativos, que son el camino a la disfunciónde la articulación temporomandibular (DTM) ya las alteraciones posturales. Por esto es que laoclusión habitual no es confiable como punto departida de nuestro diagnóstico.La filosofía neuromuscular nos proporciona instrumentaciónbioelectrónica como la electromiografíade superficie (SEMG), la sonografía, la kinesiografíay la estimulación neural transcutánea (T.E.N.S.)para ser aplicadas en el diagnóstico, control de laevolución y resultado final de nuestros tratamientos,incorporando una visión totalmente objetiva.Recordemos que los recursos tecnológicos están anuestra disposición en la odontología actual.

In this article it was shown the importance of the habitual occlusion on the body posture and the need to get to a neuromuscular occlusion to regain postural equilibrium. It is a needto perform a differential diagnosis before starting our orthodontics treatments. A bad occlusion will be based on abnormal adaptative muscular and articulatory processes that leadto the temporomandibular disorders (TMD)and postural alterations. This is why habitualocclusion is not reliable as a starting point forour diagnosis.The neuromuscular philosophy provides uswith bioelectronic instrumentation such as Surface Electromyography (SEMG), Sonography,Kinesiography and Transcutaneous NeuralStimulation (T.E.N.S.) to be applied in diagnosis,progression control and final result of ourtreatments, bringing in an objective pointof view. Let’s remember that technologicalresources are available in the current dentistry.

An Alternative Method of Intermaxillary Fixation for Simple Pediatric Mandible Fractures.

PURPOSE: Mandibular fractures represent a substantial portion of facial fractures in the pediatric population. Pediatric mandibles differ from their adult counterparts in the presence of mixed dentition. Avoidance of injury to developing tooth follicles is critical. Simple mandibular fractures can be treated with intermaxillary fixation (IMF) using arch bars or bone screws. This report describes an alternative to these methods using silk sutures and an algorithm to assist in treating simple mandibular fractures in the pediatric population. PATIENTS AND METHODS: A retrospective chart review was performed and the records of 1 surgeon were examined. Pediatric patients who underwent treatment for a mandibular fracture in the operating room from 2011 to 2015 were identified using Common Procedural Terminology codes. Data collected included age, gender, type of fracture, type of treatment used, duration of fixation, and presence of complications. RESULTS: Five patients with a mean age of 6.8 years at presentation were identified. Fracture types were unilateral fractures of the condylar neck (n = 3), bilateral fractures of the condylar head (n = 1), and a unilateral fracture of the condylar head with an associated parasymphyseal fracture (n = 1). IMF was performed in 4 patients using silk sutures, and bone screw fixation was performed in the other patient. No post-treatment complications or malocclusion were reported. Average duration of IMF was 18.5 days. CONCLUSIONS: An algorithm is presented to assist in the treatment of pediatric mandibular fractures. Silk suture fixation is a viable and safe alternative to arch bars or bone screws for routine mandibular fractures.

Success rates of the first inferior alveolar nerve block administered by dental practitioners

BACKGROUND: Inferior alveolar nerve block (IANB) of the mandible is commonly used in the oral cavity as an anesthetic technique for dental procedures. This study evaluated the success rate of the first IANB administered by dental practitioners. METHODS: Volunteer dental practitioners at Mahidol University who had never performed an INAB carried out 106 INAB procedures. The practitioners were divided into 12 groups with their advisors by randomized control trials. We recorded the success rate via pain visual analog scale (VAS) scores. RESULTS: A large percentage of the dental practitioners (85.26%) used the standard method to locate the anatomical landmarks, injecting the local anesthetic at the correct position, with the barrel of the syringe parallel to the occlusal plane of the mandibular teeth. Further, 68.42% of the dental practitioners injected the local anesthetic on the right side by using the left index finger for retraction. The onset time was approximately 0-5 mins for nearly half of the dental practitioners (47.37% for subjective onset and 43.16% for objective onset), while the duration of the IANB was approximately 240-300 minutes (36.84%) after the initiation of numbness. Moreover, the VAS pain scores were 2.5 ± 1.85 and 2.1 ± 1.8 while injecting and delivering local anesthesia, respectively. CONCLUSIONS: The only recorded factor that affected the success of the local anesthetic was the administering practitioner. This reinforces the notion that local anesthesia administration is a technique-sensitive procedure.

Success rates of the first inferior alveolar nerve block administered by dental practitioners

BACKGROUND: Inferior alveolar nerve block (IANB) of the mandible is commonly used in the oral cavity as an anesthetic technique for dental procedures. This study evaluated the success rate of the first IANB administered by dental practitioners. METHODS: Volunteer dental practitioners at Mahidol University who had never performed an INAB carried out 106 INAB procedures. The practitioners were divided into 12 groups with their advisors by randomized control trials. We recorded the success rate via pain visual analog scale (VAS) scores. RESULTS: A large percentage of the dental practitioners (85.26%) used the standard method to locate the anatomical landmarks, injecting the local anesthetic at the correct position, with the barrel of the syringe parallel to the occlusal plane of the mandibular teeth. Further, 68.42% of the dental practitioners injected the local anesthetic on the right side by using the left index finger for retraction. The onset time was approximately 0-5 mins for nearly half of the dental practitioners (47.37% for subjective onset and 43.16% for objective onset), while the duration of the IANB was approximately 240-300 minutes (36.84%) after the initiation of numbness. Moreover, the VAS pain scores were 2.5 ± 1.85 and 2.1 ± 1.8 while injecting and delivering local anesthesia, respectively. CONCLUSIONS: The only recorded factor that affected the success of the local anesthetic was the administering practitioner. This reinforces the notion that local anesthesia administration is a technique-sensitive procedure.