Objetivo: Apresentar as modalidades de tratamentos conservadoras e minimamente invasivas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTM). Revisão da literatura: Os objetivos do tratamento invariavelmente incluem redução da dor, diminuição das atividades parafuncionais e restauração da função. Dentre as alternativas conservadoras e minimamente invasivas, podemos citar os dispositivos interoclusais, exercícios terapêuticos, eletrofototermoterapia, agulhamento seco e infiltração de anestésicos locais em pontos gatilho, injeção de sangue autógeno para controle da luxação mandibular, terapia cognitivo comportamental, toxina botulínica, viscossuplementação, controle farmacológico da dor aguda e crônica. As DTMs afetam uma proporção significativa da população. Somente após o fracasso das opções não invasivas é que devem ser iniciados tratamentos mais invasivos e irreversíveis. No entanto, algumas condições, como a anquilose e neoplasias, por exemplo, são essencialmente tratadas cirurgicamente e tentativas de tratamentos conservadores podem trazer piora na qualidade de vida ou risco de morte. Considerações finais: Uma abordagem de equipe multidisciplinar para o manejo é essencial no cuidado fundamental de todos os pacientes com DTM, para que o tratamento possa ser especificamente adaptado às necessidades individuais do paciente.
Aim: To present the most widely used conservative and minimally invasive treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: Treatment goals invariably include pain reduction, reduction of parafunctional activities and restoration of function. Among the conservative and minimally invasive alternatives, we can mention interocclusal devices, therapeutic exercises, electrophototherapy, dry needling and infiltration of local anesthetics in trigger points, autogenous blood injection to control mandibular dislocation, cognitive behavioral therapy, botulinum toxin, viscosupplementation, pharmacological control of acute and chronic pain. TMD affects a considerable proportion of the population. Only after non-invasive options have failed should more invasive and irreversible treatments be initiated. However, some conditions, such as ankylosis and neoplasms, for example, are treated surgically and attempts at conservative treatments can lead to worsening quality of life or risk of death. Conclusions: A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, so that treatment can be specifically tailored to the patient's individual needs.
Humans , Facial Pain/therapy , Temporomandibular Joint Disorders/therapy , Temporomandibular Joint Disorders/physiopathology , Occlusal Splints , Viscosupplementation/methods , Conservative Treatment/methods , Dry Needling/methods
Objetivo: Apresentar as modalidades de tratamentos cirúrgicas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTMs). Revisão da literatura: As DTMs são muito frequentes e são responsáveis ââpor dor e desconforto em um número importante de pacientes. A avaliação e o diagnóstico são as chaves para determinar um plano de manejo adequado dessas doenças. Embora o tratamento conservador seja bem-sucedido na maioria dos pacientes, os tratamentos cirúrgicos podem ser a única opção para aqueles que não respondem ao tratamento conservador ou para casos com indicação cirúrgica inicial como, por exemplo, algumas neoplasias articulares. Dentre as alternativas cirúrgicas, podemos citar a artrocentese, artroscopia, reposicionamento do disco articular por cirurgia aberta, discectomia e tratamentos cirúrgicos para hipermobilidade e anquilose da articulação temporomandibular. Considerações finais: A seleção adequada dos casos é requisito obrigatório para uma intervenção cirúrgica bem-sucedida, a fim de alcançar o resultado desejado do tratamento, como alívio dos sintomas e melhora da função.
Aim: To present the most commonly used surgical treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: TMD is very common and is responsible for pain and dysfunction in a significant number of patients. Assessment and diagnosis are key to determining a management plan for these diseases. Although conservative treatment is successful in most patients, surgical treatments may be the only option for those who do not respond to conservative treatment or for some cases with an initial surgical indication, such as some joint neoplasms. Surgical alternatives include arthrocentesis, arthroscopy, repositioning of the articular disc by open surgery, discectomy and surgical treatments for temporomandibular joint hypermobility and ankylosis. Conclusions: Proper case selection is the mandatory requirement for successful surgical intervention in order to achieve the desired treatment outcome, such as symptom relief and improved function.
Humans , Facial Pain/surgery , Temporomandibular Joint Disorders/surgery , Arthroscopy/methods , Temporomandibular Joint/surgery , Diskectomy/methods , Arthrocentesis/methods
AIM: To describe different modalities to record and transfer natural head position (NHP) to 3D facial imaging by using the virtual surgical planning software in three facial asymmetry patients. CASE REPORTS: Three patients with facial asymmetries (A, B, and C) were evaluated by means of dental and facial analysis, photographs, cone-beam computed tomography (CBCT) and digitized dental arches. Before starting the VSP workflow with Dolphin Imaging, NHP was recorded by three modalities and transferred to three-dimensional (3D) facial images as follows: (a) facial photographs taken with digital camera and the estimated NHP was transferred to 3D images by comparing lines and planes from both images; (b) cross-line level laser was used to place radiopaque markers on the face skin for recording the estimated NHP, which was transferred to 3D images by alignment of planes and markers in the software; and (c) photographs of the face were processed to generate facial surface mesh by using the Agisoft PhotoScan software, which maintained the same position of the estimated NHP in 3D for aligning the images of the soft tissue with the facial surface mesh by using superimposition. All the three patients underwent bi-maxillary orthognathic surgery. CONCLUSION: There are different modalities using simple and available technologies in the clinical routine, but whose reproducibility, reliability and validation could not be assessed nor compared to each other. There was no trend for better predictability, feasibility and efficiency because the postoperative outcomes were adequate regarding the patients' satisfaction and facial symmetry.
Dentofacial deformities (DFD) presenting mainly as Class III malocclusions that require orthognathic surgery as a part of definitive treatment. Class III patients can have obvious signs such as increasing the chin projection and chin throat length, nasolabial folds, reverse overjet, and lack of upper lip support. However, Class III patients can present different facial patterns depending on the angulation of occlusal plane (OP), and only bite correction does not always lead to the improvement of the facial esthetic. We described two Class III patients with different clinical features and inclination of OP and had undergone different treatment planning based on 6 clinical features: (I) facial type; (II) upper incisor display at rest; (III) dental and gingival display on smile; (IV) soft tissue support; (V) chin projection; and (VI) lower lip projection. These patients were submitted to orthognathic surgery with different treatment plannings: a clockwise rotation and counterclockwise rotation of OP according to their facial features. The clinical features and OP inclination helped to define treatment planning by clockwise and counterclockwise rotations of the maxillomandibular complex, and two patients undergone to bimaxillary orthognathic surgery showed harmonic outcomes and stables after 2 years of follow-up.
Introdução: A movimentação ortodôntica é limitada por forças recíprocas de ação e reação. Tendo em vista esses aspectos, a utilização dos mini-implantes surge como um novo conceito de ancoragem em Ortodontia. Objetivo: Avaliar a resistência à remoção de mini-implantes para ancoragem ortodôntica. Metodologia: Usou-se costela de porco onde foram fixados 20 mini-implantes de titânio da marca SIN de 1,6mm de diâmetro e 8mm de comprimento e seccionados em 20 blocos (osso/mini-implante) de 6X10 mm e inseridos em tubos de PVC de 10X16 mm e divididos em dois grupos (n=10), grupo I: autoperfurantes; grupo II: autorrosqueantes. Foi avaliada a força de remoção (Tira Test 2420). Resultado: Os resultados em Newton (N) foram analisados estatisticamente pelo teste de Fisher, com significância de 5%. A força média para remoção de todos os mini-implantes foi de 87,0 N ± 26,6, sendo para os autoperfurantes de 92,4 N ± 33,0 e 82,2 N ± 19,6 para os autorrosqueantes. O teste de Fischer mostrou não haver diferença estatisticamente significante entre os grupos (p=0.575). Conclusão: Os mini-implantes analisados apresentam resistência à tração suficientemente superior àquela necessária para as aplicações clínicas; Não houve diferença significante entre os dois tipos de mini-implantes analisados.
Introduction: Orthodontic movement is limited by reciprocal forces of action and reaction. In view of this, the use of mini-implants has emerged as a new concept in orthodontic anchorge. Objective: To evaluate resistance to the removal of mini-implants for orthodontic anchorage. Methods: We used pork ribs onto which 20 titanium mini-implants titanium of the SIN brand, 1.6 mm in diameter and 8 mm in length, were fixed, sectioned into 20 blocks (bone/mini-implant), 6x10 mm, and inserted into PVC tubes, 10x16 mm, and divided into two groups (n= 10) as follows: group I: self-perforating screws; group II: self-threaded screws. An evaluation was made of the removal force (Strip Test 2420) Result: The results obtained in Newton (N) were statistically analyzed by Fisher's test with a significance of 5%. The mean force found for removal of all the mini-implants evaluated was 87.0 N ± 26.6, being 92.4 N ± 33.0 for the self-perforating screws and 82.2 N ± 19.6 for the self-threaded ones. Fischer's test showed no statistically significant differences between the groups (p=0.575). Conclusion: The mini-implants analyzed exhibit a resistance to traction higher than that required for clinical applications; there were no significant differences between the two types of mini-implants analyzed.
