Association between constitution, medical history, axiography and postural control in women aged between 21 to 30 years.

The aim of this study was to determine association between constitutional, medical history and axiographic parameters with postural control parameters. Overall, 106 healthy female subjects aged between 21 and 30 years were measured. Data collection was carried out by completing a questionnaire on constitutional parameters, illnesses, accidents and medical/orthodontic therapies, as well as by axio- and posturographic measurements. Data were analyzed using correlations, pair comparisons and group comparisons. The significance level was set at p ≤ 0.05. The statistical evaluation showed significant correlations between sporting exercise and body sway in the sagittal direction (p ≤ 0.03), the BMI and the load on the forefoot/rear foot (p ≤ 0.01), the mouth opening and the load on the forefoot/rearfoot (p ≤ 0.01) and the presence of a deviation with the load on the left/right foot (p ≤ 0.01). The physical condition as well as the temporo-mandibular system are associated with the postural control in young women. Therefore, a holistic diagnosis and therapy will be supported by the present outcomes.

Ultra-low frequency transcutaneous electric nerve stimulation does not affect the centric relation registration.

OBJECTIVE: To evaluate the influence of ULF-TENS on the displacement of the mandibular condyle and on the repeatability of centric relation (CR) registration of three different techniques: bimanual manipulation (BM), long strip technique, and harmonic centric occlusal relationship (R.O.C.A. wires). METHODS: Twenty-five participants without temporomandibular disorder (TMD) underwent two study stages conducted via electronic position analysis: (1) three CR records were made, one for each manipulation technique; (2) the ULF-TENS was applied for 30 min, and after that the same CR records were repeated. STATISTICAL ANALYSES: Mann-Whitney, ICC, and one-tailed F test. RESULTS: The ULF-TENS did not influence the condyle total displacement, regardless of CR recording technique used (p > 0.05). BM showed an improvement in repeatability after ULF-TENS. DISCUSSION: Concerning the variance, BM showed less variation at the X-axis. Long strip technique and R.O.C.A. wires varied less at the Y-axis. Long strip technique was again less variable at the Z-axis.

Long-term results of ORIF of condylar head fractures of the mandible: A prospective 5-year follow-up study of small-fragment positional-screw osteosynthesis (SFPSO).

BACKGROUND: Optimum treatment of condylar head fractures (CHF) remains subject to controversy. There are currently a variety of alternative techniques applied, data in literature are often inconsistent and especially systematic long-term data on results after treatment by open reduction and internal fixation (ORIF) have so far not been available. This study in hand is the first long-term prospective study of ORIF after CHF based on osteosynthesis with 1.7 mm small-fragment positional screws (SFPSO)via a retroauricular transmeatal approach (RA). METHODS: The study made use of radiologic, anatomic and objective functional parameters (axiography and MRI) to assess vertical height, disk mobility, protrusive and translatory movement as well as potential physical complaints. Included were surgical long-term sequelae after RA, such as incidence of stenosis of the auditory canal, the facial nerve and resulting disturbance of facial skin sensitivity. Retroauricular scars were evaluated according to the Vancouver Scar Scale. Helkimo and RDC/TMD indices were applied for patient's self-assessment of quality of life aspects after ORIF via RA. The sample in the first follow-up trial (FFT) in the years 2003-2004 comprised 26 patients (36 CHF). 22 patients (31 CHF) were re-evaluated in a second follow-up trial (SFT) between 2006 and 2008. A reference collective (43 patients, 56 CHF) treated with ORIF from 1993 to 2000 mainly by mini- or microplates (MMP) served as a surgical control group. RESULTS: Five years after ORIF all fractured condyles (FC) continued to show stable anatomic restoration of the pre-trauma vertical height. FC treated with SFPSO exhibited a significantly superior range of motion (p < 0.05) of disk and condyle during mouth opening and protrusion compared to a previous MMP reference collective. Also, no difference was found between condylar mobility of FC five years after surgery and non-fractured condyles (NFC). SFPSO had thus successfully achieved a sustainable, stable physiological restoration of protrusive mobility of the articular disk and condyle. Remarkably, these long-term results were even slightly better in SFT vs. FFT (p < 0.05). Except for sporadically occurring minor complaints, the patients' subjective overall long-term perception of the success of the treatment was equally positive to the surgeons' objective assessment. CONCLUSIONS: This first long-term prospective follow-up study, based on objective assessment tools, demonstrates that in all cases the major goals of ORIF in CHF could be fully achieved. These goals are: restoration of vertical height viz. prevention of occlusal disorders, physiological function of disk and condyle as well as of the lateral pterygoid muscle. Accordingly, ORIF of CHF e.g. with SFPSO and via the RA secures both a long-term functionally and anatomically stable result and as best as possible pain-free result for the patient, a central prerequisite of optimum perceived HRQoL. The paper has been amended by an extensive review part that covers the current knowledge of the major surgical aspects regarding the treatment of condylar head fractures.

Thirty-year follow-up of a TMD case treated based on the neuromuscular concept.

AIM: Occlusal therapy is employed to alleviate the symptoms of a temporomandibular disorder (TMD) at times. However, the long-term effect of occlusal therapy in the masticatory system is not well understood. This case study aims to present a 30-year follow-up of a TMD case. METHODOLOGY: The patient developed TMD with intermittent closed lock of the left temporomandibular joint (TMJ). Chief complaints included trismus, pain, and noise of the left TMJ during function. The patient's occlusal disharmony was assessed with use of electronic instruments and corrected based on the neuromuscular concept. A minimum-invasive and reversible approach using adhesive occlusal restorations was used. RESULTS: The jaw movement and masticatory muscle activity assessed at the 7- and 23-year follow-ups revealed that the established occlusion was well adapted, and re-established the patient's functional occlusion system. The patient has been free from TMD symptoms with the corrected occlusion for 30 years. CONCLUSIONS: Occlusal reconstruction based on the neuromuscular concept can be stably integrated into the patient's functional occlusion system.

The effects of ULF-TENS stimulation on gnathology: the state of the art.

AIMS: The aim of this study was to evaluate the state of the art in the current literature regarding the effect of ultra low frequency-transcutaneous electrical nerve stimulation (ULF-TENS) on patients with temporomandibular disorders (TMD). METHODOLOGY: The authors reviewed the literature through a thorough manual and electronic research on PubMed database (using the Medical Subject Headings thesaurus) and subsequent analysis of all the found papers regarding the effect of TENS on TMD patients. No randomized controlled trials on the investigated topic were found. Only eight papers regarding controlled clinical trials (CCT) were selected according to the search strategy selection criteria. RESULTS: According to the available literature and the authors' experience, ULF-TENS seems to be a valid support in the management of TMD patients, but also a 'provocative' tool, so its application should always be monitored by electromyographic and electrognathographic analysis (before and after TENS). CONCLUSIONS: Further clinical studies (mainly randomized controlled trials) on ULF-TENS application in neuromuscular gnathology are needed.

Clinical and electromyographic follow-up of myofascial pain patients treated with two types of oral splint: a randomized controlled pilot study.

Increased resting electromyographic activity (EMG), reduced EMG during maximum voluntary clenching, and a shift to lower frequencies of the mean/median power frequency (MPF) of the EMG power spectrum have been reported for patients with temporomandibular disorder pain. It is unclear, however, whether these electrophysiological phenomena can be correlated with symptom improvement during the follow-up of myofascial pain patients in treatment. The objective of this study was to monitor the therapeutic effects of two different splint concepts (standard method and a complex splint procedure assisted by transcutaneous electrical nerve stimulation, TENS) for a period of 12 weeks, by use of clinical outcome criteria and EMG recordings. We tested the hypotheses that both measures evaluated will change in parallel during treatment and that the different splint concepts will result in no outcome differences between the variables studied. For two randomly selected groups, each containing 20 non-chronic myofascial pain patients, the clinical course after splint insertion was documented over a period of 12 weeks on the basis of pain and pain on palpation ratings, in parallel with EMG recording. Baseline values were monitored for matched healthy subjects. Although there was no correlation between the course of symptom improvement and significant changes in EMG data, MPF differed significantly (p < 0.05) between healthy subjects and patients. The therapeutic effects of splints of different clinical complexity differed significantly (p < 0.05) between the patient groups, in favor of the complex oral appliances, and substantial (p < 0.001) but temporary pain relief was achieved by additional TENS. For non-chronic myofascial TMD pain patients treated with splints, the course of symptom improvement is not paralleled by significant changes in EMG data. MPF can, however, be used to distinguish between healthy subjects and patients. Splints of different clinical complexity differ in their therapeutic effects in non-chronic myofascial TMD patients, and substantial temporarily limited pain relief can be achieved by additional muscle stimulation by TENS.

Registro de mordida neuromuscular para ortopedia con Tens / Neuromuscular bite recording for orthopedics with Tens

El propósito de este artículo es difundir la odontología neuromuscular, su fundamento, filosofía y en esta oportunidad, aplicarla a la toma del registro de mordida para la confección de aparatología de ortopedia funcional.

Registro de mordida neuromuscular para ortopedia con Tens / Neuromuscular bite recording for orthopedics with Tens

El propósito de este artículo es difundir la odontología neuromuscular, su fundamento, filosofía y en esta oportunidad, aplicarla a la toma del registro de mordida para la confección de aparatología de ortopedia funcional.(AU)

The muscle engram: the reflex that limits conventional occlusal treatment.

The engram (the masticatory "muscle memory") is shown to be a conditionable reflex whose muscle conditioning lasts less than two minutes, far shorter than previously thought. This reflex, reinforced and stored in the masticatory muscles at every swallow, adjusts masticatory muscle activity to guide the lower arch unerringly into its ICP. These muscle adjustments compensate for the continually changing intemal and external factors that affect the mandible's entry into the ICP. A simple quick experiment described in this article isolates the engram, enabling the reader to see its action clearly for the first time. It is urged that every reader perform this experiment. This experiment shows how the engram, by hiding the masticatory muscles' reaction (the hit-and-slide), limits the success of the therapist in achieving occlusion-muscle compatibility. This finding has major clinical implications. It means that, as regards the muscle aspect of treating occlusion, the dentist treating occlusion conventionally is working blind, a situation the neuromuscular school of occlusal thought seeks to correct. The controversy over occlusion continues.

Complete denture services: clinical technique, lab costs, manpower, and reimbursement. One-year review.

Complete denture services at comprehensive care public health clinics are not common in part because of clinician concerns regarding outcomes. Educational debt forgiveness has attracted recent dental graduates to public health dentistry; however, not all recent graduates receive denture education experiences necessary to attain proficiency. While fundamental patient assessment and denture construction are taught, psychological assessment and communication with denture patients requires experience. A thorough understanding of occlusion, phonetics, esthetics and laboratory steps is also necessary. Expecting recent dental graduates to become proficient providing complete dentures at minimal reimbursement levels, with no mentorship or on-site laboratory support, is unrealistic. Public health dental clinics operate at full capacity performing emergency, preventive and restorative procedures. Complete dentures come with a laboratory fee approximately one-half the total reimbursement, meaning a remake drops clinic revenue to zero while doubling expenses. It is understandable that full schedules, marginal reimbursement, unpredictability and the risk of an occasional failure block clinician interest in providing denture services. This one-year report of services describes a three-appointment complete denture technique offering improved patient and laboratory communication, reduced chair time and controlled cost, resulting in high-quality complete dentures.

The FTB (Flores Twin Block): a new fixed functional appliance.

Functional Orthopaedics, Functionalism and their appliances have as their objective to correct the skeletal dysplasia that underlies many malocclusions, taking advantage of the potential of the stomatognathic system's strength. The range of functional appliances is very extensive and there is a great variety thereof. Basically, functional appliances can be: removable functional appliances and fixed functional appliances. In this article, we are going to present a new design for fixed functional appliances for the treatment of Class II, basing ourselves on the biomechanical principles of the Twin Block. We believe this new design, compared with other fixed functional appliances currently in use, improves patient comfort, providing a more effective response and helps us to treat our Class II cases with total success.

Comparative study of intermaxillary relationships of manual and swallowing methods.

This study compared the mandibular displacement from three methods of centric relation record using an anterior jig associated with (A) chin point guidance, (B) swallowing (control group) and (C) bimanual manipulation. Ten patients aged 25-39 years were selected if they met the following inclusion criteria: complete dentition (up to the second molars), Angle class I and absence of signs and symptoms of temporomandibular disorders and diagnostic casts showing stability in the maximum intercuspation (MI) position. Impressions of maxillary and mandibular arches were made with an irreversible hydrocolloid impression material. Master casts of each patient were obtained, mounted on a microscope table in MI as a reference position and 5 records of each method were made per patient. The mandibular casts were then repositioned with records interposed and new measurements were obtained. The difference between the two readings allowed measuring the displacement of the mandible in the anteroposterior and lateral axes. Data were analyzed statistically by ANOVA and Tukey's test at 5% significance level. There was no statistically significant differences (p>0.05) among the three methods for measuring lateral displacement (A=0.38 +/- 0.26, B=0.32 +/- 0.25 and C=0.32 +/- 0.23). For the anteroposterior displacement (A=2.76 +/- 1.43, B=2.46 +/- 1.48 and C=2.97 +/- 1.51), the swallowing method (B) differed significantly from the others (p<0.05), but no significant difference (p>0.05) was found between chin point guidance (A) and bimanual manipulation (C). In conclusion, the swallowing method produced smaller mandibular posterior displacement than the other methods.

Comparative study of intermaxillary relationships of manual and swallowing methods

This study compared the mandibular displacement from three methods of centric relation record using an anterior jig associated with (A) chin point guidance, (B) swallowing (control group) and (C) bimanual manipulation. Ten patients aged 25-39 years were selected if they met the following inclusion criteria: complete dentition (up to the second molars), Angle class I and absence of signs and symptoms of temporomandibular disorders and diagnostic casts showing stability in the maximum intercuspation (MI) position. Impressions of maxillary and mandibular arches were made with an irreversible hydrocolloid impression material. Master casts of each patient were obtained, mounted on a microscope table in MI as a reference position and 5 records of each method were made per patient. The mandibular casts were then repositioned with records interposed and new measurements were obtained. The difference between the two readings allowed measuring the displacement of the mandible in the anteroposterior and lateral axes. Data were analyzed statistically by ANOVA and Tukey's test at 5 percent significance level. There was no statistically significant differences (p>0.05) among the three methods for measuring lateral displacement (A=0.38 ± 0.26, B=0.32 ± 0.25 and C=0.32 ± 0.23). For the anteroposterior displacement (A=2.76 ± 1.43, B=2.46 ± 1.48 and C=2.97 ± 1.51), the swallowing method (B) differed significantly from the others (p<0.05), but no significant difference (p>0.05) was found between chin point guidance (A) and bimanual manipulation (C). In conclusion, the swallowing method produced smaller mandibular posterior displacement than the other methods.

Este estudo comparou o deslocamento mandibular a partir de 3 métodos de registro da relação cêntrica usando um jig anterior associado com: (A) guia da ponta do mento; (B) deglutição grupo controle (C) manipulação bimanual. As moldagens dos arcos maxilares e mandibulares foram feitas com hidrocolóide irreversível. Os modelos de estudo de cada paciente foram obtidos e montados em máxima intercuspidação como uma posição de referência no microscópio. Foram obtidos 5 registros de cada método em 10 pacientes. Os modelos mandibulares foram reposicionados com os registros interpostos e novas medidas foram obtidas. A diferença entre as duas leituras permitiu a medida do deslocamento mandibular nos eixos ântero-posterior e laterais. ANOVA não demonstrou diferença estatisticamente significativa entre os 3 métodos em relação ao registro do deslocamento lateral (A = 0,38 ± 0,26, B = 0,32 ± 0,25 e C = 0,32 ± 0,23). Quanto ao deslocamento anteroposterior, ANOVA e o teste de Tukey (a=0,05) indicaram diferença estatisticamente significante entre os três métodos (A=2,76 ± 1,43, B=2,46 ± 1,48 e C=2,97 ± 1,51). Não houve diferença estatisticamente significante entre A e C. A deglutição propiciou menor deslocamento mandibular posterior que os outros métodos.

Neuromuscular diagnosis in orthodontics: effects of TENS on the sagittal maxillo-mandibular relationship.

AIM: This study was conducted in order to assess the changes in the occlusal position of the mandible after ULF (Ultra Low Frequency)-TENS relaxing procedure in subjects in pubertal growth phase with diagnosed Angle Class II division 1 and mandibular dentoalveolar retrusion. MATERIALS AND METHODS: This study was performed on 19 patients (13 females, 6 males) with an Angle Class II division 1, aged between 10 and 15 years old (mean age 12.26, SD 1.32), characterised by mandible dentoalveolar retrusion and optimal vertical facial dimension, diagnosed by clinical and cephalometric evaluation. Diagnostic neuromuscular registrations were made for all subjects. The casts were mounted on articulator in habitual intercuspal position with a tooth-guided wax bite registration. Reference points were chosen at molar level. Subsequently the same casts were mounted in myocentric position and compared to the habitual intercuspal position, assessing the sagittal shift after TENS procedure. STATISTICS: Mean and standard deviation were calculated on the amount of shifting at the left molar reference point after TENS procedure. Analysis of variance (ANOVA), using STATA statistics package, was carried out in order to evaluate the influence of sex and age on the amount of molar shift. RESULTS: Nine subjects showed, in the sagittal plane, a forward mandibular shift in neuromuscular myocentric position compared to habitual intercuspal position. Six subjects showed no differences between habitual and myocentric position in the sagittal plane. Four individuals showed a backward mandible shift after TENS indicating worsening of the II molar class in the sagittal plane. CONCLUSION: This study suggests that TENS recorded occlusion in subjects with Class II division 1 with mandible dentoalveolar retrusion allows to visualise an unusual trend of growth. The advancements of the mandible were not taken into account. These results could offer new diagnosis and prognosis methods for Class II malocclusions.

Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients.

The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.

Neuromuscular diagnosis in orthodontics: effects of TENS on maxillo-mandibular relationship.

AIM: This study was conducted in order to assess the changes in the occlusal position of the mandible after Ultra Low Frequency (ULF)-TENS relaxing procedure in children with diagnosed functional mandibular lateral deviation. METHODS: This study was performed on 20 children, aged between 8 and 12 years, with a mean age of 10 years (SD 0.79) with functional mandibular lateral deviation, diagnosed by clinical and cephalometric evaluation, referred to the Dental Clinic for paediatric dental care. Diagnostic neuromuscular registrations were made for all children, and their casts mounted on articulator Galetti at the myocentric position and compared to casts provided of a wax bite registration in intercuspal position. RESULTS: The alignment of the midline after TENS was not punctual (p >0.05). Compared with the existing intercuspal position, neuromuscular registration showed improvement in 10 (50%) patients, 6 patients (30%) showed no changes, while worsening of the tooth-midline discrepancy was assessed in the remaining 4 (20%). The molar relationship did not follow the same trend of the midline because of the three-dimensional changes in the maxillo-mandibular relationship induced by TENS. After TENS there was a significant correlation between midline and right side deviation (r >0.65), there was no correlation between midline and the left side (r <0.65). Furthermore, right molar movement showed no correlation with the contralateral molar (r <0.65). The posterior areas of the arch were moving in a very unpredictable way, resulting in the diagnosis and prognosis of mandibular lateral deviation as absolutely individual and unpredictable. Conclusion This study suggests that TENS recorded occlusion is an interesting diagnostic approach in orthodontics since it allows visualising the trends of the neuromuscular system.

Parameters of an optimal physiological state of the masticatory system: the results of a survey of practitioners using computerized measurement devices.

While bioelectronic instruments have been available for nearly 30 years to assist dentists in day-to-day evaluations of patients' masticatory systems, little guidance has been published to support physiological norms or ideals. An electronic questionnaire was developed and administered to an international group of dentists familiar with the use of bioelectronic instrumentation. Respondents were asked to provide feedback on the norms or ideal parameters of jaw movement, masticatory muscle function with electromyography, and joint sounds through electrosonography that they use in guiding evaluation and treatment of patients with temporomandibular disorders, neuromuscular occlusion, and orthodontics. Surveys were collated to determine areas of consensus. Out of 150 surveys, 55 responses were received from dentists representing nine different countries. Sixty percent of the respondents reported treating more than 150 cases in the past five years using bioelectronic testing. While experience ranged from 2-30 years with different types of devices, average experience was longer with mandibular/jaw tracking (mean 15.3 years) and electromyography (mean 14.1 years) than with electrosonography (mean 7.0 years). Parameters proposed as norms or ideals for electromyographic rest and clench values, and mandibular tracking (velocity, freeway space, and trajectory to closure) were very consistent. Although a smaller number of respondents reported utilization of electrosonography, their criteria for data significance and tissue-type genesis of joint sounds were consistent. While the intra-patient variability may limit the diagnostic use of bioelectronic instruments, the current study demonstrates that through decades of experience, dentists have independently arrived at very consistent definitions of an ideal physiology that can be used to guide treatment.

Assessment of treatment for functional posterior cross-bites in patients at the deciduous dentition phase.

The aim of this study was to clinically assess the results of treatment for functional posterior cross-bites by means of selective grinding in individuals at the deciduous dentition phase over a period of 12 months. From a total of 1,011 children examined in the 2-to-6-year age bracket, 26 with functional posterior cross-bites were selected. The sample was divided into 2 groups of 13 children each, group 1 receiving the treatment proposed and group 2 serving as the control group. Treatment was followed up by exercises designed to alter the children's muscular memory. The results showed that correction of functional posterior cross-bite was achieved for all the children treated, the correction remaining stable 12 months later. No self-correction of malocclusion occurred among the control group.