Procedimientos clínicos interdisciplinarios para un nuevo enfoque del bruxismo desde la integración médica en Cuba / Interdisciplinary clinical procedures for a new approach to bruxism from medical integration in Cuba

Fundamento: el enfoque científico del bruxismo resulta, en no pocas ocasiones, incongruente y obedece en lo particular a tres aspectos pendientes para la ciencia en el siglo XXI. Primero la ausencia de esquemas diagnósticos y terapéuticos definitivos, segundo la necesidad del empleo de específicos y depurados métodos de evaluación epidemiológica y clínica. Por último la integración tangente y activa de los profesionales de las Ciencias Médicas para desarrollar en un orden secuencial documentos científicos. Objetivo: diseñar un protocolo de procedimientos clínicos interdisciplinarios para un nuevo enfoque del bruxismo desde la integración médica en Cuba. Métodos: se realizó una investigación de desarrollo en el período de marzo de 2019 a marzo de 2020. Se conformó el universo del grupo de trabajo por nueve estomatólogos de alta especialización y el universo de investigaciones lo integraron 41, de ellas con una subsiguiente muestra de 19 investigaciones, destacadas por sus aportes y fortalezas con relación a la integración interdisciplinaria, seleccionadas por muestreo intencional. Se estructuró el documento en tres acápites que desglosan momentos, acciones específicas y condicionantes conformes a la valoración del grupo de trabajo; a través de la técnica de consenso del grupo nominal. Resultados:se establecieron consultas de evolución periódicas, valoración por etapas y procedimientos terapéuticos. Además procedimientos clínicos interdisciplinarios, según el momento de integración médica que se precisa. Se asumió el diagnóstico integral del bruxismo desde un concepto sistémico-neurológico. Conclusiones: se diseñó un documento científico que protocoliza procedimientos clínicos interdisciplinarios para un nuevo enfoque del bruxismo desde la integración médica en Cuba (AU)

Background: the scientific approach to bruxism is, on many occasions, incongruous and obeys in particular three pending aspects for science in the 21st century. Firstly, the absence of definitive diagnostic and therapeutic schemes, secondly, the need to use specific and refined epidemiological and clinical evaluation methods. Finally, the tangent and active integration of professionals in Medical Sciences to develop scientific documents in a sequential order. Objective: to design a protocol of interdisciplinary clinical procedures for a new approach to bruxism from medical integration in Cuba. Methods: a development research was carried out in the period from March 2019 to March 2020. The universe of the work group was formed by nine highly specialized dentists and the universe of investigations was made up of 41 of them with a subsequent sample of 19 researches, highlighted by its contributions and strengths in relation to interdisciplinary integration, selected by intentional sampling. The document was structured into three sections that break down moments, specific actions and conditioning factors in accordance with the assessment of the working group; through the nominal group consensus technique.Results: periodic evolution consultations were established, assessment by stages and therapeutic procedures. Besides interdisciplinary clinical procedures, according to the time of medical integration that is required. It was assumed the comprehensive diagnosis of bruxism from a systemic-neurological concept. Conclusions: a scientific document was designed that protocolizes interdisciplinary clinical procedures for a new approach to bruxism from medical integration in Cuba (AU)

SAT: Sistematización Adhesiva Temporaria. Integración estético-oclusal predecible en rehabilitación conservadora. Informe de caso y revisión bibliográfica / TAS: Temporary Adhesive Systematization. Predictable aesthetic-occlusal integration in conservative rehabilitation. Case report and bibliographic review

Objetivos: Realizar una revisión de la literatura sobre métodos de rehabilitación mínimamente invasivos, y presentar un caso clínico acerca de un nuevo procedimiento denominado sistematización adhesiva temporaria (SAT), destinado a pacientes que presentan pérdida de sustancia dentaria y que se caracteriza como un abordaje terapéutico predecible para transferir el proyecto rehabilitador (encerado) a la boca del paciente mediante 3 pasos bien definidos y con objetivos específicos. Caso clínico: Un paciente adulto joven de sexo masculino con desgastes severos por bruxismo es rehabilitado temporalmente con resinas compuestas (SAT) para devolver la anatomía perdida en forma adhesiva y conservadora, siguiendo un protocolo de abordaje terapéutico predecible denominado EGOP (estéticamente guiado y oclusalmente protegido). Este procedimiento, que es considerado muchas veces de transición previo a las restauraciones finales, nos permite evaluar la estética, la oclusión y mejorar la comunicación entre el equipo de trabajo para poder realizar el cambio por restauraciones cerámicas en forma gradual. En aquellos pacientes que necesitan rehabilitaciones totales producto del desgaste dentario severo, la SAT puede ser una herramienta que facilite al odontólogo la posibilidad de restablecer los patrones oclusales y estéticos perdidos sin la necesidad de realizar desgastes dentarios y provisionales como se hacía clásicamente (AU)

Aims: To carry out a literature review on minimally-invasive rehabilitation methods and to present a clinical case on a new procedure called Temporary Adhesive Systemization (TAS), intended for patients that show a considerable loss of dental substance, characterized by a predictable therapeutic approach to transfer the rehabilitation diagnosis wax-up through 3 well defined steps and with specific objectives to the patient´s dentition. Clinical case: A young adult male patient with severe wear due to bruxism is temporarily rehabilitated with composite resins (TAS) to return the lost anatomy in a conservative way, following a predictable therapeutic approach protocol called EGOP (aesthetically guided and occlusally protected). This procedure, which is often considered transitional prior to final restorations, allows us to evaluate aesthetics, occlusion, improve communication between the working team and to be able to gradually change for ceramic restorations. In patients that need full rehabilitation due to severe dental erosion, TAS is a predictable procedure that helps the dentist to re-establish the loss of aesthetical and occlusal patterns, without the need of preparing the teeth for the classic provisional restorations (AU)

Rehabilitación oral adhesiva: diagnóstico y tratamiento. Caso clínico / Adhesive oral rehabilitation: diagnosis and treatment. A clinical case

El objetivo de este reporte de caso clínico es presentar una rehabilitación integral adhesiva resuelta por alumnos de grado de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), bajo un protocolo de abordaje terapéutico que simplifica su realización. Esta sistematización hace foco en un abordaje completamente aditivo con la finalidad de devolver la salud, la función y la estética de manera predecible. Un paciente de 55 años concurrió a la consulta por motivos estéticos. En el diagnóstico se evidenciaron desgastes severos producto de la parafunción. Se realizó una rehabilitación oral adhesiva seleccionando a la cerámica vítrea como material restaurador. El diagnóstico y la comprensión de su etiología son fundamentales para realizar un tratamiento conservador con restauraciones adheridas y con alto grado de predictibilidad, que se prolongará en el tiempo, gracias a la utilización de una placa orgánica y a los controles de mantenimiento correspondientes (AU)

Sobredentadura parcial en adulto mayor con bruxismo / Partial overdenture in older adult with bruxism

Introducción: el bruxismo es un trastorno que causa daños graves al sistema estomatognático, particularmente a la dentadura. La extracción dentaria provoca reabsorciones óseas progresivas de los rebordes alveolares residuales, y ello causa pérdida de la retención y desajustes de las prótesis dentales. Sin embargo, existen tratamientos más conservadores, que permiten mantener en boca las raíces y dientes remanentes, y garantizar la adaptación del paciente a las prótesis.Objetivo: presentar el caso de un paciente adulto mayor diagnosticado de bruxismo excéntrico, con gran pérdida de sustancia dentaria, rehabilitado mediante el empleo de sobredentadura parcial como opción válida de rehabilitación oral.Presentación del caso: paciente masculino de 70 años de edad, con antecedentes de hipertensión arterial, cardiopatía isquémica y diabetes mellitus tipo 2. Fue remitido desde los servicios básicos estomatológicos a la consulta multidisciplinaria de prótesis de la Clínica Estomatológica Docente de Ciego de Ávila, para definir el tratamiento rehabilitador adecuado a su caso. Ante los riesgos quirúrgicos que presentó, se optó por preservar todos los dientes en boca y la realización de tratamientos pulporradiculares para soportar una sobredentadura parcial removible. Actualmente porta sus prótesis de forma satisfactoria y su calidad de vida ha mejorado.Conclusiones: debido a la pérdida considerable de sustancia dentaria provocada por el bruxismo la mejor opción en el caso de este paciente fue el tratamiento conservador y el empleo de una sobredentadura parcial removible. Esto permitió mejorar la calidad de vida del afectado y se demostró que es una opción válida de rehabilitación oral en estos casos(AU)

Introduction: bruxism is a disorder that causes serious damage to the stomatognathic system, particularly the denture. Dental extraction causes progressive bony reabsorption of the residual alveolar rims, and this causes loss of retention and mismatches of dental prostheses. However, there are more conservative treatments that allow to keep the roots in the mouth and remaining teeth and guarantee the patient's adaptation to prostheses.Objective: to present the case of an older adult patient diagnosed with eccentric bruxism, with great loss of dental substance, rehabilitated by using partial overlay denture as a valid option for oral rehabilitation.Case presentation: a 70-year-old male patient with a history of hypertension, ischemic heart disease and type 2 diabetes mellitus. He was remitted from the basic stomatological services to the multidisciplinary prosthesis consultation of the Teaching Stomatological Clinic of Ciego de Ávila, to define the rehabilitation treatment appropriate to his case. Given the surgical risks presented, it was decided to preserve all the teeth in the mouth and perform pulporradicular treatments to support a removable partial overlay denture. Currently he carries his prosthesis in a satisfactory way and his quality of life has improved.Conclusions: due to the considerable loss of dental substance caused by bruxism, the best option for this patient was conservative treatment and the use of a removable partial overlay denture. This allowed the patient to improve the quality of life and it was demonstrated that it is a valid option of oral rehabilitation in these cases(AU)

Bruxismo ­ a doença do século / Bruxism ­ the disease of the century

O termo bruxismo vem do grego "bruchein" e significa apertamento, fricção ou atrito dos dentes. Pode ser definido como uma atividade involuntária e hábito parafuncional, sendo caracterizado pelo ato de ranger (bruxismo excêntrico) ou apertar os dentes (bruxismo cêntrico) que resulta em desgastes da superfície dentárias, causando consequências irreversíveis ao sistema mastigatório, onde sua etiologia é complexa e multifatorial. (AU)

The term bruxism comes from the Greek "Bruchein" and means squeezing, friction or friction of the teeth. It can be defined as an involuntary activity and parafunctional habit, characterized by the act of creaking (eccentric bruxism) or tightening the teeth (bruxism centric), which results in dental surface abrasions, causing irreversible consequences for The chewing system, where its etiology is complex and multifactoric. The bruxism is a phenomenon that has become more and more frequent within the dental office, causing a great concern for patients. (AU)

Bruxism: Is There an Indication for Muscle-Stretching Exercises?

Bruxism is a common phenomenon involving repetitive activation of the masticatory muscles. Muscle-stretching exercises are a recommended part of several international guidelines for musculoskeletal disorders and may be effective in management of the jaw muscle activity that gives rise to bruxism. However, most studies of muscle-stretching exercises have mainly focused on their influence on performance (eg, range of motion, coordination, and muscle strength) of the limb or trunk muscles of healthy individuals or individuals with sports-related injuries. Very few have investigated stretching of the human masticatory muscles and none muscle-stretching exercises in the management of (sleep) bruxism. This article reviews the literature on muscle-stretching exercises and their potential role in the management of sleep bruxism or its consequences in the musculoskeletal system.

Resultados de tratamiento estomatológico en niños con bruxismo / Results of the dental treatment in children with bruxism

Fundamento: el bruxismo es un hábito asociado al estrés y a las interferencias oclusales, las cuales pueden resolverse aplicando tratamiento estomatológico.Objetivo: evaluar la efectividad del tratamiento estomatológico en escolares de 5 a 11 años de edad con bruxismo. Métodos: se realizó un estudio con diseño de intervención cuasiexperimental del tipo antes y después, en todos los niños con bruxismo (52), con edades de 5 a 11 años, pertenecientes al Área de Salud II del municipio Cienfuegos. Para el diagnóstico de bruxismo se realizó examen bucal a cada niño, así como entrevistas a padres y maestros. Las variables estudiadas fueron: edad, sexo, grado de afectación del bruxismo, diagnóstico psicológico y síntomas y signos del bruxismo. Los resultados se presentan en tablas de números y porcentajes. Resultados: predominó la afectación mayor en las féminas de 6 a 11 años de edad y el diagnóstico psicológico de trastornos severos. Al analizar los signos y síntomas del bruxismo antes de la intervención, los más frecuentes fueron el rechinamiento dentario y el apretamiento dentario. Después de aplicado el tratamiento, más de la mitad de los niños afectados mejoraron su sintomatología en relación al estado inicial, lográndose una mejoría de más del 70 por ciento en el caso del dolor muscular. Conclusiones: se demostró la efectividad del tratamiento estomatológico en el mejoramiento de los signos y síntomas del bruxismo(AU)

Background: bruxism is a habit associated to stress and to occlusal disturbances which can be solved applying an odontological treatment.Objective: to evaluate the effectiveness of the odotological treatment in students from 5 to 11 years with bruxism.Methods: a study of cuasiexperimental intervention design of type before and after in all the children with bruxim (52), with ages of 5 to 11 elderly years, belonging to Health Area II. Cienfuegos. An oral exam to each child was made; parents and teachers were interviewed as well. Studied variables were: Age, sex, the bruxism's grade of affectation, psychological diagnosis and symptoms and the bruxism's signs. The results present itself in draw of numbers and percentages.Results: the bigger affectation predominated in the female sex from 6 to 11 elderly years and the psychological diagnosis of severe disorders. When examining the signs and symptoms of bruxism before the intervention, the more frequent were the dental squeaking and the dental squeezing. After applying the treatment, more than the half of the children improved his symptomatology in relation to the initial status, and an improvement of over the 70 percent in the event of the muscular pain was achieved. Conclusion: the effectiveness of the dental treatment in the improvement of the signs and symptoms of the bruxism was demonstrated(AU)

Implant rehabilitation in bruxism patient.

A white female patient presented to the university clinic to obtain implant retained prostheses. She had an edentulous maxillary jaw and presented three teeth with poor prognosis (33, 34 and 43). The alveolar bone and the surrounding tissues were healthy. The patient did not report any relevant medical history contraindicating routine dental treatment or implant surgery, but self-reported a dental history of asymptomatic nocturnal bruxism. The treatment plan was set and two Branemark protocols supported by six implants in each arch were installed after a 6-month healing period. A soft occlusal splint was made due to the patient's history of bruxism, and the lack of its use by the patient resulted in an acrylic fracture. The prosthesis was repaired and the importance of using the occlusal splint was restated. In the 4-year follow-up no fractures were reported.

Functional analysis and treatment of the diurnal bruxism of a 16-year-old girl with autism.

Bruxism is defined as the clenching and grinding of teeth. This study used a functional analysis to examine whether the bruxism of a 16-year-old girl with autism was maintained by automatic reinforcement or social consequences. A subsequent component analysis of the intervention package described by Barnoy, Najdowski, Tarbox, Wilke, and Nollet (2009) showed that a vocal reprimand (e.g., "stop grinding") effectively reduced the participant's bruxism. Results were maintained across time, and effects extended to novel staff members.

[Minimally invasive method for the restoration of localized anterior tooth wear. A case report]. / Minimál invazív módszer alkalmazása frontfogak területére korlátozott fogkopás helyreállításakor. Esetismertetés.

Wear localized on front teeth is quite common; the restoration of the lost tissue is generally difficult due to the lack of vertical space between the upper and lower teeth. The traditional prosthetic method would include further tooth preparation for complete crowns and for increasing the occlusal vertical dimension. By applying the Dahl concept the necessary vertical space can be created with the preservation of the tooth tissue in a relatively short period of time. Definitive restoration can be made for the replacement of lost enamel and dentine with a direct or indirect method. Due to the Dahl concept the preparation of the teeth and its potentially harmful consequences can be avoided, the treatment is non- or minimally invasive. In the presented case the lost palatal and incisal tooth tissue was replaced with palatal E.max Press ceramic laminate. After cementing the laminate the patient was advised to wear a night guard, because of bruxism, to counteract the extreme load on the laminates.

Resistencia de dientes restaurados con postes prefabricados ante cargas de máxima intercuspidación, masticación y bruxismo / Resistance of teeth restored with prefabricated posts to maximum intercuspidation loads, mastication and bruxism

Objetivo: determinar por el método de los elementos finitos la resistencia de dientes restaurados con postes prefabricados ante cargas estáticas de máxima intercuspidación y cargas cíclicas de masticación y bruxismo y analizar el efecto de la pérdida periodontal en la resistencia de las restauraciones. Métodos: se realizó una investigación in vitro mediante el método de los elementos finitos de dientes con pérdida periodontal, rehabilitados con postes prefabricados en fibra de vidrio, carbono y titanio. Los dientes fueron reconstruidos a partir de imágenes tomográficas de un paciente periodontalmente sano. Resultados: se muestra que ante cargas estáticas las rehabilitaciones no presentan tendencia a la falla, independientemente del material del poste o del grado de pérdida periodontal. En el caso de bruxismo y pérdida periodontal de 4 mm, la dentina presenta una durabilidad de 60 000 ciclos independiente del material del poste. Para cargas de masticación y periodonto sano, la falla en la dentina ocurre a los 100 000 ciclos con poste en titanio, 200 000 ciclos con poste en fibra de carbono y 1 100 000 ciclos con poste en fibra de vidrio. Para una pérdida periodontal de 2 mm la durabilidad de la dentina se reduce a 4 000 ciclos con poste en titanio, 5 000 ciclos con poste en fibra de carbono y 7 000 ciclos con poste en fibra de vidrio. Para pérdida periodontal de 4 mm, la durabilidad de la dentina se estima en 1 000 ciclos, independientemente del material del poste utilizado. Conclusiones: ante carga estática de máxima intercuspidación las rehabilitaciones con postes prefabricados en fibra de vidrio, carbono y titanio no presentan tendencia a la falla, independientemente del grado de pérdida periodontal. Ante cargas cíclicas, los postes prefabricados presentan una vida útil infinita, y es la dentina la estructura más afectada ante dichos eventos(AU)

Objective: using the finite element method, determine the resistance of teeth restored with prefabricated posts to maximum static intercuspidation loads, cyclical mastication loads and bruxism, and analyze the effect of periodontal loss on resistance by restorations. Methods: using the finite element method, an in vitro study was conducted of teeth with periodontal loss rehabilitated with prefabricated glass fiber, carbon and titanium posts. Reconstruction of the teeth was based on tomographic images from a periodontically healthy patient. Results: it was shown that rehabilitations did not tend to yield to static loads, irrespective of post material or the degree of periodontal loss. For bruxism and 4 mm periodontal loss, dentin durability was 60 000 cycles, irrespective of post material. For mastication loads and a healthy periodont, dentin failure occurs at 100 000 cycles with titanium posts, 200 000 cycles with carbon fiber posts, and 1 100 000 cycles with glass fiber posts. For 2 mm periodontal loss, dentin durability decreased to 4 000 cycles with titanium posts, 5 000 cycles with carbon fiber posts, and 7 000 cycles with glass fiber posts. For 4 mm periodontal loss, dentin durability is estimated at 1 000 cycles, irrespective of post material. Conclusions: restorations with glass fiber, carbon and titanium prefabricated posts do not yield to maximum static intercuspidation loads, irrespective of the degree of periodontal loss. Prefabricated posts exhibit endless resistance to cyclic loads. Dentin is the structure most severely affected by such events(AU)

Elements of implant-supported rehabilitation planning in patients with bruxism.

The rehabilitation of partial or completely edentulous patients with implant-supported prostheses has been widely used, achieving high success rates. However, many studies consider the presence of bruxism as a contraindication for this treatment modality. The purpose of this study was to revise the literature and identify risk factors in implant-supported rehabilitation planning in subjects with bruxism. Available literature was searched through Medline, with no time limit, including only studies in English. Topics discussed were etiology of bruxism and its implications on dental implants, biomechanical considerations regarding the overload on dental implants, and methods to prevent the occurrence of overloads in implant-supported prostheses. The rehabilitation of bruxers using implant-supported prostheses, using implants with adequate length and diameter, as well as proper positioning seems to be a reliable treatment, with reduced risks of failure. Bruxism control through the use of a nightguard by rigid occlusal stabilization appliance relieved in the region of implants is highly indicated. Although it is clear that implant-supported rehabilitation of patients with bruxism requires adequate planning and follow-up, well-designed randomized controlled trials are needed to provide reliable evidence on the long-term success of this treatment modality.

Rehabilitación ocluso-articular en un paciente bruxópata / Occlusal-articular rehabilitation in a patient with bruxism

Se realizó la presentación del caso de un paciente masculino de 68 años de edad que acudió a la Consulta de Trastornos Temporomandibulares de la Facultad de Estomatología de La Habana, por presentar problemas estéticos y dificultades masticatorias. Durante la anamnesis y el examen físico se observaron facetas de desgastes oclusales, disminución de la dimensión vertical y prominencias óseas asociadas al bruxismo. Se realizó la discusión del caso y el tratamiento seguido para su rehabilitación ocluso-articular. El resultado final fue la restauración de la estética y la función(AU)

This is the presentation of the case of a male patient aged 68 came to our consultation of temporomandibular disorders of the Stomatology Faculty of Ciudad de La Habana due to esthetic problems and mastication difficulty. During anamnesis and physical examination it was possible to note occlusal wear facets, decrease of vertical dimension and bone prominences associated with bruxism. Case was discussed and treatment was followed for its occlusal-articular rehabilitation. Final result was the restoration of esthetics and function(AU)

Rehabilitación ocluso-articular en un paciente bruxópata / Occlusal-articular rehabilitation in a patient with bruxism

Se realizó la presentación del caso de un paciente masculino de 68 años de edad que acudió a la Consulta de Trastornos Temporomandibulares de la Facultad de Estomatología de La Habana, por presentar problemas estéticos y dificultades masticatorias. Durante la anamnesis y el examen físico se observaron facetas de desgastes oclusales, disminución de la dimensión vertical y prominencias óseas asociadas al bruxismo. Se realizó la discusión del caso y el tratamiento seguido para su rehabilitación ocluso-articular. El resultado final fue la restauración de la estética y la función(AU)

This is the presentation of the case of a male patient aged 68 came to our consultation of temporomandibular disorders of the Stomatology Faculty of Ciudad de La Habana due to esthetic problems and mastication difficulty. During anamnesis and physical examination it was possible to note occlusal wear facets, decrease of vertical dimension and bone prominences associated with bruxism. Case was discussed and treatment was followed for its occlusal-articular rehabilitation. Final result was the restoration of esthetics and function(AU)

Prosthetic rehabilitation and treatment outcome of partially edentulous patients with severe tooth wear: 3-years results.

OBJECTIVES: The purpose of this study was to report on the management and treatment outcomes of partially edentulous elderly patients with severe tooth wear. METHODS: Partially edentulous patients with severe tooth wear who underwent the same protocols for full prosthodontic rehabilitation were eligible for this observational study. Their clinical diagnoses were based on a complete oral examination, photos, functional and cast analysis, general health conditions and behavioural aspects, such as acidic diets and bruxism. A 6-month preliminary phase with splints and provisional prostheses was maintained prior to the final fabrication of fixed and removable prostheses. All patients completed a follow-up period of ≥3years. The outcomes were technical and biological complications with the prosthesis (wear or fracture of anchorage, abutment, prosthesis core or veneering, and implants, plaque index, caries, endodontic and periodontal lesions, tooth fractures and periimplantitis) and oral health-related quality of life (using the oral health impact profile questionnaire, German version of OHIP G-14). RESULTS: Data from 42 patients (33 men, 9 women) with a mean age of 62±8years were available. The probability that a first, second or third technical complication occurred was 49%, 38% and 21%, respectively. About 50% of the patients remained without any complication. The average OHIP-value was 5±7, which represents high oral health-related quality of life. No statistically significant correlations between the OHIP values and the type of prostheses or the occurrence of complications were observed. CONCLUSIONS: From multiple perspectives, the rehabilitation of partially edentulous patients with severe tooth wear is a complex task, and more information regarding treatment protocols, prosthetic indications and treatment outcome is needed.

Effect of awareness through movement on the head posture of bruxist children.

The aim of this study was to evaluate the effectiveness of physiotherapy to improve the head posture and reduce the signs of bruxism in a group of bruxist children. A single-blind randomized clinical trial was performed. All the subjects were 3- to 6-year old, had complete primary dentition, dental and skeletal class I occlusion and were classified as bruxist according to the minimal criteria of the ICSD for bruxism. For each child, a clinical, photographic and radiographic evaluation of the head and cervical posture were realized with standardized techniques. The children were randomized in an experimental (n = 13) and a control (n = 13) group. A physiotherapeutic intervention was applied to the children of the experimental group once a week, until 10 sessions were completed. Afterwards, the cephalogram and the clinical and photographic evaluation of the head posture were measured again. The data were analysed with the t-test and Mann-Whitney test. The subjects of the experimental group showed statistically significant improvement in the natural head posture. The physiotherapeutic intervention showed to be efficient to improve the head posture at the moment of measurement in the studied children. The relationship between bruxism and head posture, if exists, seems to be worthwhile to examine.

Effect of incisal tooth wear and restoration on interocclusal distance during Brazilian Portuguese language speech.

AIM: The aim of this study was to investigate changes in interocclusal distance (IOD) during pronunciation of /m/ and /s/ sounds in Brazilian Portuguese, in patients presenting dental wear due to bruxism, before and after placement of a stabilization appliance and restorative treatment. METHODS: Subjects were divided into a control group of 19 patients with no dental wear and an experimental group of 18 patients presenting dental wear on anterior teeth due to bruxism. A stabilization appliance was placed in each patient in the experimental group and anterior teeth were restored. A magnetic jaw-tracking device measured the interocclusal distance during pronunciation of /m/ and /s/ phonemes. Interocclusal distance for the experimental group was evaluated one week before and again immediately before the appliance was inserted and 24 hours, 7 days, 1 month and 2 months after appliance insertion. The same evaluation was performed 7 days and 1 month after restorative treatment. In the control group, the measurements were carried out at the same intervals. RESULTS: Comparison between groups revealed a significant difference (P<0.05) in interocclusal distance for the /m/ sound at all evaluation intervals. No differences were found before and after appliance insertion and restorative treatment with either phoneme. CONCLUSION: Stabilization appliance therapy and restorative treatment of subjects with dental wear did not change the interocclusal distance during speech of /m/ and /s/ sounds in the Brazilian Portuguese language, however, when compared with normal subjects, the IOD values were higher for the dental wear group during pronunciation of the /m/ sound.