Ultrasound-Guided Single Puncture Technique to Simultaneously Reach the Upper and Lower Temporomandibular Joint Compartments for Arthrocentesis or Injections Purposes: A Technical Note.

Temporomandibular joint (TMJ) arthrocentesis is a widely described and effective technique that promotes lysis and lavage of TMJ compartments, improving pain and mandibular range of motion. Mostly, this technique has been used to reach the upper TMJ compartment, besides effusion may be present also in lower compartment, that, in the absence of disc perforation, may also need to be assessed. Here, we propose an adaptation of arthrocentesis technique aiming to access both upper and lower compartments of the TMJ with a single needle puncture and guided by ultrasound real-time images. The technique was initially established in fresh cadavers and later replicated in 2 patients. Technique modification proved to be efficient and reproducible, reducing the number of perforations and, consequently, possible adverse events. The proposed technique can be applied to arthrocentesis and/or intra-articular injections through the combination of two previously validated techniques, to improve its safety and efficacy.

Intra-articular injections in the TMJ inferior joint space: A scoping review.

OBJECTIVE: To perform a scoping review to identify the available evidence regarding intra-articular injections in the inferior joint space (IJS) of the temporomandibular joint (TMJ). METHODS: An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: "Arthrocentesis", "injection", "joint injection", "technique", "Temporomandibular joint", "Temporomandibular joint disorder". Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. Only articles with full-text access were included. RESULTS: Thirteen articles were included for analysis-one technical note, three cadavers studies, one animal study, two case reports, five randomised clinical trials and one retrospective study; studies were classified as 'patients-based studies' and 'non-patients-based studies'. Most 'patients-based studies' show moderate or high risk of bias. Techniques were categorised as 'anatomical technique' and 'image-guided technique'. Most 'patients-based studies' show favourable outcomes such as pain reduction, increase in maximum mouth opening, improvement in quality of life and improvement in TMJ dysfunction indexes for the treatment of arthrogenic TMDs. Comparisons between superior and IJS injections are scarce. On the other hand, 'non-patients-based' studies show that image-guided or ultrasound-checked injection techniques achieved a higher effectiveness for needle location than anatomical (or blind) techniques. CONCLUSION: The amount of available evidence is scarce, heterogeneous in design, and most 'patients-based studies' show moderate or high risk of bias, which demands the generation of new research to obtain definitive conclusions. The tendency observed suggests that intra-articular injections for the IJS of the TMJ are able to relieve TMJ pain, increase mouth opening and improve TMJ dysfunction, and image-guided injection techniques seem to be more effective than anatomical techniques to locate the needle in the IJS.

Unveiling MRI-based structural phenotypes in temporomandibular joint osteoarthritis: implications for clinical practice and research.

INTRODUCTION: Osteoarthritis (OA) is a progressive degenerative disease characterized by the gradual degradation of cartilage, remodeling of subchondral bone, synovitis, and chronic pain. This condition impacts various large and small joints, including the temporomandibular joint (TMJ). However, addressing OA, particularly in impeding or reducing disease progression, is challenging due to its clinical and imaging heterogeneity. Authors are increasingly suggesting that this heterogeneity involves different phenotypes or subpopulations, discernible by variations in the disease's pathophysiology and structural manifestations. Even within the TMJ, these phenotypes may display distinct clinical features, laboratory parameters, biochemical markers, and imaging criteria. Recent research has proposed MRI as a reference standard for TMJ OA, highlighting its substantial agreement with histopathological changes. MRI-based phenotypes offer a promising avenue for understanding disease progression and treatment response, potentially providing valuable insights for prognosis and treatment planning. OBJECTIVE: This article introduces the ROAMES-TMJ (Rapid OsteoArthritis MRI Eligibility Score for TMJ) to assess the structural eligibility of individuals for inclusion in TMJ OA clinical trials.

Nasal septum-derived chondroprogenitor cells control mandibular condylar resorption consequent to orthognathic surgery: a clinical trial.

Condylar resorption is an aggressive and disability form of temporomandibular joint (TMJ) degenerative disease, usually non-respondent to conservative or minimally invasive therapies and often leading to surgical intervention and prostheses implantation. This condition is also one of the most dreaded postoperative complications of orthognathic surgery, with severe cartilage erosion and loss of subchondral bone volume and mineral density, associated with a painful or not inflammatory processes. Because regenerative medicine has emerged as an alternative for orthopedic cases with advanced degenerative joint disease, we conducted a phase I/IIa clinical trial (U1111-1194-6997) to evaluate the safety and efficacy of autologous nasal septal chondroprogenitor cells. Ten participants underwent biopsy of the nasal septum cartilage during their orthognathic surgery. The harvested cells were cultured in vitro and analyzed for viability, presence of phenotype markers for mesenchymal stem and/or chondroprogenitor cells, and the potential to differentiate into chondrocytes, adipocytes, and osteoblasts. After the intra-articular injection of the cell therapy, clinical follow-up was performed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and computed tomography (CT) images. No serious adverse events related to the cell therapy injection were observed during the 12-month follow-up period. It was found that autologous chondroprogenitors reduced arthralgia, promoted stabilization of mandibular function and condylar volume, and regeneration of condylar tissues. This study demonstrates that chondroprogenitor cells from the nasal septum may be a promise strategy for the treatment of temporomandibular degenerative joint disease that do not respond to other conservative therapies.

Advantages of ultrasound guidance for TMJ arthrocentesis and intra-articular injection: A narrative review.

Ultrasound (US) is a widely available, low-cost, non-invasive, and safe medical imaging method that enables real-time observation. Ultrasound offers several advantages for dentomaxillofacial images, such as portability, the possibility of dynamic and repeated examinations, patient comfort, and availability. It is a useful tool for recognizing the temporomandibular joint (TMJ) structures and their involvement during the course of different pathological processes, such as articular disk displacement, joint effusion and cortical erosion. In addition to its diagnostic use, US has been proposed as an auxiliary tool in minimally invasive procedures for arthrogenic temporomandibular disorders (TMD) to achieve an accurate puncture, recognize joint spaces and reduce surgical trauma. While US is widely used for large joints to visualize internal structures and guide the injection, this technique has only recently gained popularity for the TMJ procedures. Hence, the literature on this topic is scarce. The present review describes the potential advantages and the clinical technique of US guidance for TMJ arthrocentesis and intra-articular injection (IAI).

Effectiveness of dry needling on the local pressure pain threshold in patients with masticatory myofascial pain. Systematic review and preliminary clinical trial.

Objective: To systematically review the literature to identify controlled clinical trials evaluating the effectiveness of deep dry needling (DDN) in the treatment of patients with chronic masticatory myofascial pain (MMP).Methods: The sample size for a clinical trial was calculated and involved five patients who consecutively presented for treatment of MMP. The percentage of change in the means of three consecutive measurements of the pressure pain threshold (PPT) of myofascial trigger points (MTPs) was calculated and the statistical significance of this difference evaluated using the Wilcoxon test.Results: Twenty-five studies were considered for inclusion based on title and abstract. Only 2 studies met the inclusion criteria and were used to calculate the sample size. DDN significantly increased (p = 0.04) the PPT in MTP (44.6%) compared with sham procedure (-5.5%).Conclusion: Patients with chronic MMP treated with DDN of MTPs showed an increase in PPT measurements on the experimental side.Abbreviations: CGRP: calcitonin gene-related peptide; DC/TMD: diagnostic criteria for temporomandibular disorders; DDN: deep dry needling; DN: dry needling; LILACS: Latin American and Caribbean Health Sciences; MMP: masticatory myofascial pain; MTP: myofascial trigger point; MTPs: myofascial trigger points; PPT: pressure pain threshold; RCTs: randomized clinical trials; SciELO: Scientific Electronic Library Online; SP: Substance P; TMD: temporomandibular disorders.

COVID-19 and Painful Temporomandibular Disorders: what does the dentist need to know? / COVID-19 e Disfunções Temporomandibulares Dolorosas: o que o dentista precisa saber?

ABSTRACT COVID-19 outbreak may lead to major impacts in applied oral sciences. Remarkably, it could be expected that factors associated to pandemic may lead to a greater risk of developing, worsening and perpetuating TMD and its associated risk factors. This non systematic literature review aims to discuss how the COVID-19 pandemic can influence the emergence, maintenance or worsening of TMD worldwide. During epidemics: the number of people whose mental health is affected tends to be greater than the number affected by the infection, and fear increases anxiety and stress levels in healthy individuals; chronic pain patients probably not receipt important treatments; overuse of medications becomes frequent; there are manifestation of unconscious oral parafunctional habits and poor sleep quality. All these facts represent risk factors common to TMD. Dentists should be aware of these issues and adapt their practices to properly diagnose and treat these patients within a multifactorial approach, increasing the quality of life of these individuals.

RESUMO O surto de COVID-19 pode causar grandes impactos nas ciências relacionadas a odontologia. Notavelmente, pode-se esperar que os fatores associados à pandemia possam levar a um maior risco de desenvolver, agravar e perpetuar a DTM e seus fatores associados. Esta revisão não sistemática da literatura tem como objetivo discutir como a pandemia de COVID-19 pode influenciar no surgimento, manutenção ou agravamento da DTM em todo o mundo. Durante as epidemias: o número de pessoas cuja saúde mental é afetada tende a ser maior do que o número afetado pela infecção, e o medo aumenta os níveis de ansiedade e estresse em indivíduos saudáveis; pacientes com dor crônica provavelmente não recebem tratamentos importantes; o uso excessivo de medicamentos torna-se frequente; há manifestação de hábitos parafuncionais orais inconscientes e má qualidade do sono. Todos esses fatos representam fatores de risco comuns à DTM. O dentista deve estar atento a essas questões e adaptar sua prática para diagnosticar e tratar adequadamente esses pacientes dentro de uma abordagem multifatorial, aumentando a qualidade de vida desses indivíduos.

Early cephalometric characteristics in Class III malocclusion

OBJECTIVE: Early identification of craniofacial morphological characteristics allows orthopedic segmented interventions to attenuate dentoskeletal discrepancies, which may be partially disguised by natural dental compensation. To investigate the morphological characteristics of Brazilian children with Class III malocclusion, in stages I and II of cervical vertebrae maturation and compare them with the characteristics of Class I control patients. METHODS: Pre-orthodontic treatment records of 20 patients with Class III malocclusion and 20 control Class I patients, matched by the same skeletal maturity index and sex, were selected. The craniofacial structures and their relationships were divided into different categories for analysis. Angular and linear measures were adopted from the analyses previously described by Downs, Jarabak, Jacobson and McNamara. The differences found between the groups of Class III patients and Class I control group, both subdivided according to the stage of cervical vertebrae maturation (I or II), were assessed by analysis of variance (ANOVA), complemented by Bonferroni's multiple mean comparisons test. RESULTS: The analysis of variance showed statistically significant differences in the different studied groups, between the mean values found for some angular (SNA, SNB, ANB) and linear variables (Co - Gn, N - Perp Pog, Go - Me, Wits, S - Go, Ar - Go). CONCLUSION: Assessed children displaying Class III malocclusion show normal anterior base of skull and maxilla, and anterior positioning of the mandible partially related to increased posterior facial height with consequent mandibular counterclockwise rotation.

Cephalometric deviations present in children and adolescents with temporomandibular joint disorders

INTRODUCTION: Temporomandibular disorders (TMD) have proved to be a risk factor for developing hyperdivergent facial growth patterns. OBJECTIVE: The aims of this study were: (1) Assess differences between the cephalometric measurements in children with articular TMD and a control group, before and after mandibular growth peak according to cervical vertebral maturation; and (2) Identify a predictive model capable of differentiating patients with TMD and control group patients based on early cephalometric characteristics. METHOD: The study included children and adolescents with maximum age of 17 years, divided into experimental group (n=30) diagnosed with articular TMD-according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for children and adolescents-subdivided according to growth stage, called pre-peak (n=17) and post-peak (n=13) and control group (n = 30), matched by gender, skeletal maturity stage of the cervical vertebrae and classification of malocclusion. Lateral cephalometric and craniofacial structures were traced and their relations divided into: Cranial base, maxilla, mandible, intermaxillary relations, vertical skeletal relations and dental relations. Differences between the means for each variable were evaluated by applying the statistical Student t test for independent samples. RESULTS: The means of the variables analyzed in the pre-peak showed no statistically significant differences. However, analysis of post-peak showed that the experimental group displayed decreased SNA and SNB and increased SN.Gn and 1.NB (p<0.05). CONCLUSION: It was possible to identify a predictive model able to differentiate patients with TMD and asymptomatic controls from early cephalometric characteristics.

Possíveis fatores etiológicos para desordens temporomandibulares de origem articular com implicações para diagnóstico e tratamento / Possible etiological factors in temporomandibular disorders of articular origin with implications for diagnosis and treatment

Os fatores envolvidos na etiologia, diagnóstico e tratamento das desordens temporomandibulares (DTM) de origem articular foram revisados. Critérios específicos de inclusão e exclusão para o diagnóstico de DTM são essenciais, mas apresentam utilidade limitada. Atualmente, os Critérios Diagnósticos de Pesquisa para Desordem Temporomandibular (RDC/TMD) oferecem a melhor classificação baseada em evidências para os subgrupos mais comuns de DTM. O RDC/TMD inclui não apenas métodos para a classificação diagnóstica física, presentes em seu Eixo I, mas ao mesmo tempo métodos para avaliar a intensidade e a severidade da dor crônica e os níveis de sintomas depressivos e físicos não-específicos, presentes em seu Eixo II. Embora historicamente as más oclusões tenham sido consideradas como fatores de risco para o desenvolvimento das DTM, incluindo as predominantemente articulares, em muitos casos a associação estabelecida entre essas variáveis parece ter tomado direção oposta. No que diz respeito aos desarranjos internos da ATM, os resultados de estudos prévios sobre a redução induzida do ramo mandibular, secundária ao deslocamento anterior do disco articular, indicam que o reposicionamento do disco deslocado em crianças ou adolescentes jovens pode fazer mais sentido do que previamente imaginado. O uso terapêutico de suplementos alimentares, como o sulfato de glicosamina, parece uma alternativa segura ao uso dos medicamentos anti-inflamatórios normalmente utilizados para controlar a dor relacionada à osteoartrite da articulação temporomandibular (ATM), embora a evidência em torno de sua eficácia para a maioria dos pacientes de DTM não tenha sido completamente estabelecida.

The authors reviewed the factors involved in the etiology, diagnosis and treatment of temporomandibular joint disorders (TMD). Although essential, specific criteria for inclusion and exclusion in TMD diagnosis have shown limited usefulness. Currently, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) offer the best evidence-based classification for the most common TMD subgroups. The RDC/TMD includes not only methods for physical diagnostic classification, comprised in Axis I, but also methods to assess the intensity and severity of chronic pain and the levels of non-specific depressive and physical symptoms, in Axis II. Although historically malocclusions have been identified as risk factors for the development of TMD-including those predominantly joint-related-in many cases the association established between these variables seems to have taken opposite directions. Regarding internal TMJ derangements, the results of studies on the induced shortening of the mandibular ramus, secondary to anterior articular disk displacement, indicate that repositioning the displaced disk in children or young adolescents may make more sense than previously imagined. The therapeutic use of dietary supplements, such as glucosamine sulfate, seems to be a safe alternative to the anti-inflammatory drugs commonly used to control pain associated with TMJ osteoarthritis, although evidence of its effectiveness for most TMD patients has yet to be fully established.

Reabsorções condilares em pacientes cirúrgicos: alternativas terapêuticas conservadoras e minimamente invasivas / Condylar reabsortion in surgical patients: conservative and minimally invasive therapeutic alternatives

Resumo / O processo degenerativo articular é caracterizado pela presença de crepitação, que pode estar acompanhada ou não de artralgia, com dor espontânea ou provocada pela palpação e/ou função. Esse diagnóstico é confirmado por meio de imagens tomográficas. A prevalência de lesões degenerativas da ATM é extremamente alta em pacientes candidatos a procedimentos de Cirurgia Ortognática, e esse pode aumentar o risco de agravamento dos quadros preexistentes, inclusive com a possibilidade de grandes recidivas pós-cirúrgicas da deformidade dentofacial. Estratégias terapêuticas envolvem protocolos capazes de produzir efeitos sobre a dor e a incapacidade funcional, mas também na interrupção da progressão e no reparo dos defeitos da cartilagem articular. A abordagem terapêutica inicial utiliza de terapias não cirúrgicas ou minimamente invasivas, baseadas na supressão da carga articular parafuncional por meio da utilização de placas estabilizadoras e na administração de suplementos ou infiltração de materiais biológicos, como as glicosaminas e ácido hialurônico. Procedimentos cirúrgicos mais invasivos, como as cirurgias abertas da ATM, são reservados para casos isolados refratários à terapia conservadora. Entre os procedimentos da medicina regenerativa, o transplante autólogo de condrócitos parece ser o mais promissor como alternativa terapêutica eficaz e segura para casos de reabsorções condilares.

Alterações cefalométricas presentes em crianças e adolescentes com desordens da ATM nas diferentes classificações sagitais de má oclusão / Cephalometric changes present in children and adolescents with TMJ disorders with different classes of malocclusions

INTRODUÇÃO: o acometimento da ATM por alterações degenerativas e deslocamentos do disco articular demonstrou ser um fator de risco para a identificação de indivíduos com padrões hiperdivergentes de crescimento facial. OBJETIVOS: avaliar diferenças entre as médias encontradas para as variáveis cefalométricas em crianças com DTM articular e grupo controle, nas diferentes classificações sagitais de má oclusão (Classe I, II e III de Angle). MÉTODO: foram incluídos crianças e adolescentes com idade máxima de 17 anos, divididos em grupo experimental (n = 30) com diagnóstico de DTM articular, segundo o eixo I do RDC/TMD para crianças e adolescentes, igualmente divididos em 3 sub-grupos (n= 10) de acordo com a classificação da má oclusão presente e grupo controle (n = 30) sem DTM, pareados por gênero, índice de maturidade esquelética vertebral cervical e classificação da má oclusão. Foram traçadas telerradiografias laterais e as estruturas craniofaciais e suas relações foram divididas em: base do crânio, maxila, mandíbula, relações intermaxilares, relações esqueléticas verticais e relações dentárias. As diferenças encontradas entre as médias, para cada uma das variáveis, foram avaliadas pela aplicação do teste estatístico t de Student para amostra independentes. RESULTADOS: o grupo experimental Classe I apresentou S.N.Ar (p = 0,05) aumentado, o grupo experimental Classe II apresentou S.N.Ar (p = 0,006) e NperpA (p = 0,037) diminuídos e S.Ar.Go (p = 0,045) aumentado e o grupo experimental Classe III apresentou N.A.P (p = 0,045), 1.NB (p = 0,001) e 1-NB (p = 0,017) aumentados e 1.1 (p = 0,004) diminuído, todos em relação aos seus respectivos controles CONCLUSÃO: as diferenças foram mais significantes nos pacientes com má oclusão de Classe II e de Classe III.

INTRODUCTION: the involvement of TMJ through degenerative changes and displacements of the articular disc proved to be an important risk factor when identifying individuals with vertical facial growth patterns. PURPOSES: to evaluate differences between cephalometric variables in children with articular TMD and a control group, checking the variations in relation to the different patterns of malocclusion (Class I, II and III). METHOD: the study included children and adolescents of up to a maximum age of 17, who were divided up into an experimental group (n=30) diagnosed with articular TMD, diagnosed in accordance with the RDC/TMD axis I for children and adolescents, and a control group (n=30) without TMD, further paired by gender, stage of cervical vertebral skeletal maturity and class of malocclusion. Lateral cephalogram was carried out and both the craniofacial structures and their relations were separated into: the cranial base, maxillary, mandible, intermaxillary relations, vertical skeletal relations and dental relations. The differences found between the means, for each of the variables, were evaluated through the application of the Student t statistical test for independent samples. RESULTS: the Class I experimental group presented increased S.N.Ar (p=0.05). The Class II experimental group presented reduced S.N.Ar (p=0.006) and NperpA (p=0.037) and increased S.Ar.Go (p=0.045). The Class III experimental group presented increased N.A.P (p=0.045), 1.NB (p=0.001) and 1-NB (p=0.017) and reduced 1.1 (p=0.004). CONCLUSION: differences were more significant in those patients who presented Class II and III malocclusions.

Freqüência de relatos de parafunções nos subgrupos diagnósticos de DTM de acordo com os critérios diagnósticos para pesquisa em disfunções temporomandibulares (RDC/TMD) / Frequency of relates of parafunctions in the diagnostic subgroups of TMD according to research diagnostic criteria for temporomandibular disorders (RDC/TMD)

INTRODUÇÃO: as disfunções temporomandibulares (DTM) podem ser definidas como um conjunto de condições dolorosas e/ou disfuncionais, que envolvem os músculos da mastigação e/ou as articulações temporomandibulares (ATM). Um dos meios usados para o diagnóstico é o "Critério Diagnóstico para Pesquisa em Disfunções Temporomandibulares" (RDC/TMD). Hábitos parafuncionais são aqueles não relacionados à execução das funções normais do sistema estomatognático. O bruxismo é caracterizado por atividade parafuncional noturna involuntária dos músculos mastigatórios, enquanto o apertamento dentário é considerado uma parafunção diurna envolvendo esta musculatura, embora possa ocorrer também à noite. OBJETIVOS: o objetivo do presente estudo foi avaliar a freqüência do relato de parafunções orais diurna e/ou noturna em pacientes com DTM nos diferentes subgrupos diagnósticos do RDC/TMD. METODOLOGIA: foram utilizados dados provenientes de 217 pacientes que procuraram tratamento na Clínica de DTM e Dor Orofacial da Faculdade de Medicina de Petrópolis, sendo avaliados através do questionário e exame físico que compõem o RDC/TMD. RESULTADOS: dos 182 pacientes com DTM estudados, 76,9 por cento relataram algum tipo de parafunção, podendo ser diurna, noturna ou a associação de ambas. A parafunção diurna foi a mais freqüentemente relatada entre os subgrupos de DTM, sendo encontrada em 64,8 por cento dos casos contra 55,5 por cento dos casos com relato de bruxismo. O relato de ambas as parafunções foi constatado em 43,4 por cento dos pacientes com DTM. CONCLUSÕES: considerando cada subgrupo diagnóstico, os relatos de parafunções diurna e noturna foram mais freqüentes nos pacientes com dor miofascial.

INTRODUCTION: temporomandibular disorders (TMD) can be defined as a group of painful and/or dysfunctional conditions that involve masticatory muscles and/or the temporomandibular joints (TMJ). One of the methods used to the diagnostic is the "Research Diagnostic Criteria for Temporomandibular Disorders" (RDC/TMD). Parafunctional habits are those not related to the execution of normal functions of stomatognatic system. Bruxism is characterized by nocturnal involuntary parafunctional activity of masticatory muscles, while clenching is considered as a diurnal parafunction involving this musculature, although this may also occur at night. OBJECTIVE: the goal of the present study was to evaluate the frequency of relates of diurnal and/or nocturnal oral parafunctions in patients with TMD in different diagnostic subgroups of RDC/TMD. METHODOLOGY: it has been used data from 217 patients that seek for treatment at TMD and Orofacial Pain Clinic of Petropolis Medicine School, being evaluated through questionnaire and physical examination that compose RDC/TMD. RESULTS: from 182 TMD patients studied, 76.9 percent has related some kind of parafunction, that could be diurnal, nocturnal or both. Diurnal parafunction was the most frequent related among TMD subgroups, present in 64.8 percent of cases against 55.5 percent of cases with relates of bruxism. Relate of both parafunctions was verified in 43.4 percent of TMD patients. CONCLUSION: regarding each diagnostic subgroup, relates of diurnal and nocturnal parafunctions has been more frequent in patients of miofascial pain group.

Diagnóstico e planejamento do tratamento 3D: o futuro da cirurgia ortognática / Diagnosis and treatment planning in 3D: the future of orthognathic surgery

Desde o início da documentação de registros, ortodontistas e cirurgiões perceberam que a melhor maneira de representação da condição de um paciente seria em três dimensões (3D). A tomografia computadorizada de feixe cônico introduziu um novo conceito para o diagnóstico e planejamento clínico das deformidades dentofaciais e registro documental desses processos em 3D. Combinando a tomografia computadorizada com fotografias 3D e modelos 3D digitais, temos pela primeira vez, todas as informações diagnósticas reunidas em um único software com medidas livres de distorção ou ampliação. Nesse ambiente virtual, diferentes opções de tratamento podem ser simuladas e guias podem ser prototipadas para transportar o planejamento para a clínica com grande precisão. Contudo, como acontece com qualquer nova prática, a familiarização com seus princípios e técnicas é necessária para permitir a utilização eficaz e eficiente

Since the beginning of documental records, orthodontists and surgeons realized that the best way to represent the condition of a patient would be in three dimensional (3D). The cone beam computed tomography unfolded a new landscape for clinical diagnosis and treatment planning of dentofacial deformities and documental record of these processes in 3D. Combining CT with 3D photos and 3D digital models, we have for the first time, all the diagnostic information gathered in a single software with measures free of distortion or magnification. In this virtual environment, different treatment options can be simulated and guides can be prototyped to transport planning for the clinic with great precision. However, as with any new practice, familiarity with its principles and techniques is necessary to enable their efficient and effective use

Bases epidemiológicas para análise das más oclusões morfológicas como fatores de risco no desenvolvimento das desordens temporomandibulares de origem articular / Epidemiological basis for the analysis of morphologic malocclusion as a risk factor for the development of temporomandibular joint disorders

Dentre as pesquisas empreendidas no campo da epidemiologia, um grupo específico aborda patologias de etiologia deconhecida ou não totalmente compreendidas. É dentro deste grupo que estão situadas as desordens temporomandibulares (DTM). Três estratégias observacionais básicas têm sido utilizadas para abordar o papel etiológico da má oclusão no desenvolvimento das DTM, dentro do repertório epidemiológico. São elas: estudos do tipo transversal, estudos de caso controle e estudos de coorte. Alguns experimentos clínicos são realizados com base na remoção do fator etiológico suspeito. Com base em uma revisão estruturada na literatura, a partir da metodologia empregada nos estudos selecionados, podemos concluir que a definição dos possíveis fatores etiológicos relacionados a subgrupos específicos de DTM é fundamental para que o papel das más oclusões no desenvolvimento destas desordens, embora pareça pequeno quando baseado nas evidências disponíveis, não seja subestimado. Pode ser útil a caracterização de uma oclusão normal como aquela associada como o menor risco para o desenvolvimento de problemas de DTM, mas é provavelmente inapropriada a aplicação destes parâmetros para reverter um problema intra-capsular já estabelecido. O conceito de uma oclusão de baixo fator de risco implicaria em um pequeno desvio entre RC e MIH, pequeno transpasse horizontal, transpasse vertical positivo e ausência de mordida cruzada posterior. Este conceito é compatível com o conceito de oclusão normal defendido por décadas, embora uma variação do normal ao invés de um critério absoluto deva ser permitida. Embora provavelmente seja prudente estabelecer metas morfológicas terapêuticas que busquem o que é observado em oclusões não tratadas julgadas normais ou ideais, o estabelecimento de uma oclusão que alcance todos os critérios gnatológicos, por meio de tratamento ortodôntico, talvez seja impossível e provavelmente desnecessário

Níveis de depressão em portadores de câncer de cabeça e pescoço / Depression level in patients with head and neck cancer

Objetivos: avaliar os níveis de sintomas depressivos em pacientes com dor orofacial crönica por câncer de cabeça e pescoço e verificar a associação destes com a gravidade da dor crônica. Método: o protocolo seguido foi observacional transversal. A casuística foi composta de sessenta pacientes com diagnóstico de câncer na região da cabeça e pescoço, divididos igualmente em portadores ou não de dor orofacial crônica realcionada ao processo de câncer. Os níveis de sintomas depressivos e a intensidade e severidade da dor foram avaliados pelo eixo II do RDC/TMD. Resultados: não foram encontradas diferenças estatisticamente significantes entre os níveis de sintomas depressivos presentes nos dois grupos de pacientes com câncer de cabeça e pescoço, havendo uma moderada correlação estatisticamente significante entre os níveis de sintomas depressivos e a severidade da dor crônica sentida nso pacientes com dor. Conclusões: podemos concluir que esiste uma correlação positiva moderada entre os níveis de severidade da dor e de sintomas depressivos

Objective: to assess the levels of depression symptoms in head and neck cancer patients with chronic orofacial pain and to verify the association between them and the chronic pain severity. Methods: it was an observational and sectional protocol. The sample consisted of sixty patients, uniformly divided in having chronic orofacial pain related to cancer process or not. Depression levels, pain intensity and severity were assessed with RDC/TMD axis II. Results: the study did not demstrate statiscally significant difference in depression levels in both head and neck cancer paind groups, with the occurrence of moderate statiscally significant correlation between depression levels and chronic pain intensity felt in pain patients. The study demonstrated a moderate statiscally sifnificant correlation between chronic pain severity and depression levels presented by pain patients. Conclusion: there is a positive moderate correlation between chronic pain severity graduation and derpession levels