Occlusal Changes with Clear Aligners and the Case Complexity Influence: A Longitudinal Cohort Clinical Study.

BACKGROUND: Clear aligners (CA) are used 22 h daily, creating a bite-block effect. This work aims to (i) analyze occlusal changes before the beginning of treatment, after the first set of CA and after the use of additional aligners; (ii) compare planned occlusal contacts with the ones obtained after the first set of CA; (iii) analyze the occlusal changes occurred after reaching the orthodontic goals after 3 months of using CA only at night; (iv) evaluate and characterize which tooth movements did not allow the treatment to be completed at the end of the first set of aligners, and finally (v) verify the possible relation between the changes in occlusal contact and areas and parameters such as case complexity and facial biotype. MATERIALS AND METHODS: A quantitative, comparative, and observational longitudinal cohort study design was implemented to evaluate the clinical data and the complexity levels of cases receiving CA. A non-probabilistic and convenience sample of 82 individuals was recruited. The orthodontic malocclusion traits were classified as simple, moderate, or complex corrections based on the basis of the Align® recommendations with the Invisalign® evaluation tool. According to the Invisalign® criteria, patients need only one complex problem for their case to be classified as complex. Meshlab® v. 2022.02, ClinCheck® version Pro 6.0, My-Itero® version 2.7.9.601 5d plus, and IBM® SPSS Statistics software (Statistical Program for Social Sciences), version 27.0 for Windows were the software® used. RESULTS: A statistically significant decrease in area and occlusal contacts number were observed from before the start of orthodontic treatment (T0) to the end of treatment (T1). The changes in the occlusal area (from T0 to T1) were statistically different between hyperdivergent (28.24 [15.51-40.91]) and hypodivergent (16.23 [8.11-24.97]) biotypes (p = 0.031). A significant difference between the hyperdivergent (4.0 [2.0-5.0]) and normodivergent (5.5 [4.0-8.0]) group was found in T1 for the anterior contacts (p = 0.044). Anterior contacts obtained were significantly higher than the planned (p = 0.037) Between T1 and T2 statistically significant increases of occlusal areas, posterior and total contacts were observed. CONCLUSIONS: Occlusal contact and area were decreased, either at the end of the first set or after the use of additional aligners. Anterior occlusal contacts obtained were higher than planned as opposed to posterior occlusal contacts obtained. The hardest tooth movements to achieve to complete the treatment were distalization, rotation, and posterior extrusion. After completing orthodontic treatment (T1) to 3 months after (T2) using additional aligners only at night, posterior occlusal contacts were significantly increased, which could be due to the natural settling of the teeth in this period.

Masticatory Function in Individuals with Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol in the PubMed, Cochrane Library, LILACS, EBSCO, Scielo, between 2012 and 2022. The methodological quality was assessed by using the Newcastle-Ottawa Study Quality Assessment Scale. Mean differences and 95% confidence intervals were calculated and combined in meta-analyses. A total of 1202 participants were included in this systematic review (690 with TMD; 512 without TMD), with 22 articles being included in the qualitative analysis. Only three studies enabled the comparative analysis of the results. Ten articles showed a high methodological quality and a low risk of bias, and twelve had a low methodological quality and an increased risk of bias. The meta-analysis showed that the differences between the intervention and control groups were not statistically significant for the percentage overlapping coefficient of the anterior temporal muscle, for the masseter, and for the torque coefficient. The parameters analyzed with the compound technique for chewing showed altered mandibular functions in individuals with TMD. With the EMG method, it was possible to suggest that TMD in adult individuals causes compensatory muscle behaviors, and several changes in the masticatory function were found.

The Role of Pain Inflexibility and Acceptance among Headache and Temporomandibular Disorders Patients.

Temporomandibular disorders (TMD) and headache are complex. This study aims to assess the association between TMD, headache, and psychological dimensions such as psychological inflexibility and pain acceptance. The sample consisted of 120 participants following a non-probabilistic convenience sampling strategy through a direct invitation to the patients attending our facilities and their relatives (n = 61 diagnosed with headache, n = 34 diagnosed with TMD-headache, n = 25 control group). Diagnostic Criteria for Temporomandibular Disorders (DC-TMD), International Classification of Headache Disorders (ICHD-3 beta version), Chronic Pain Acceptance Questionnaire (CPAQ-8), and Psychological Inflexibility in Pain Scale (PIPS) were used as assessment tools. One-way ANOVA, multiple regression analysis (MRA), and the Johnson-Neyman approach were run by IBM SPSS, version 27 (IBM® Company, Chicago, IL, USA). The significance level was 0.05. One third of our sample presented with headache with TMD. Females were predominant. Males with headache, no systemic disease, less pain severity but higher frequency, living longer with the disease and having sensitive changes, showed higher pain acceptance. When headache occurs with TMD, women with higher education, no headache family history, less pain, and no motor changes showed higher pain acceptance. Patients with both conditions are more liable to have chronic pain and pain inflexibility. Pain intensity and willingness explain 50% of the psychological inflexibility in the headache group. In our sample, individuals suffering from both conditions show greater pain inflexibility, implicating more vivid suffering experiences, leading to altered daily decisions and actions. However, further studies are needed to highlight this possible association.

Genetic overlap between temporomandibular disorders and primary headaches: A systematic review.

Primary headache disorders (PHD), specifically migraine, are strongly associated with temporomandibular disorders (TMD), sharing some patterns of orofacial pain. Both disorders have significant genetic contributions already studied. PRISMA guidelines were followed to conduct this systematic review, which comprehensively summarize and discuss the genetic overlap between TMD and PHD to aid future research in potential therapy targets. This review included eight original articles published between 2015 and 2020, written in English and related to either TMD and/or PHD. The genes simultaneously assessed in PHD and TMD studies were COMT, MTHFR, and ESR1. COMT was proved to play a critical role in TMD pathogenesis, as all studies have concluded about its impact on the occurrence of the disease, although no association with PHD was found. No proof on the impact of MTHFR gene regulation on either TMD or PHD was found. The most robust results are concerning the ESR1 gene, which is present in the genetic profile of both clinical conditions. This novel systematic review highlights not only the need for a clear understanding of the role of ESR1 and COMT genes in pain pathogenesis, but it also evaluates their potential as a promising therapeutic target to treat both pathologies.

Orthodontic Treatment and Craniocervical Posture in Patients with Temporomandibular Disorders: An Observational Study.

Orthodontic treatment acts through the application of forces and/or by stimulating and redirecting the functional forces within the craniofacial complex. Considering the interrelationship between craniomandibular and craniocervical systems, this intervention may alter craniocervical posture. Thus, our aim is to (a) compare craniocervical posture, hyoid bone position, and craniofacial morphology before, after, and also in the contention phase at least one year after the orthodontic treatment, in patients with temporomandibular disorders and (b) to verify whether the presence of condylar displacement, the skeletal class, or the facial biotype interferes with the abovementioned outcomes. To do so an observational, analytical, longitudinal, and retrospective design study was carried out. A non-probabilistic convenience sampling method was applied. The sample consisted of clinical records of patients diagnosed with temporomandibular disorders in order to compare pre-orthodontic treatment with post-orthodontic treatment (n = 42) and contention phase data (n = 26). A cephalometric analysis of several variables was performed. The p-value was set as 0.05. When the pre- and post-orthodontic treatment data were analyzed, there were statistically significant changes in variables concerning craniocervical posture (CV angle, C0-C1, and AA-PNS) and also concerning hyoid bone position (C3-Rgn). When pre- and post-orthodontic treatment and contention phase data were analyzed the variables concerning craniocervical posture (C0-C1, CVT/Ver, NSL/OPT, NSL/CVT, NSL/Ver; OPT/CVT, OPT/Ver) and facial biotype had statistically significant changes. This allowed us to conclude that in the sample studied, there were significant differences regarding hyoid bone position (pre- versus post-orthodontic treatment) and craniocervical posture (pre- versus post-orthodontic versus contention), with the craniocervical posture being prone to return to basal values. The presence of condylar displacement was found to significantly increase the H-H1 distance in the three moments of evaluation. Facial biotype was found to significantly increase the NSL/Ver angle on hypodivergent compared to hyperdivergent in the contention phase.

Deep Friction Massage in the Management of Patellar Tendinopathy in Athletes: Short-Term Clinical Outcomes.

CONTEXT: Deep friction massage (DFM) is often used in the treatment of tendinopathies; however, the pressure applied may vary and interfere with the obtained results. OBJECTIVE: To assess whether the immediate effects of DFM on pain (pain intensity and time to onset of analgesia) and muscle strength are dependent on the pressure applied during the DFM application in athletes with patellar tendinopathy. DESIGN: Randomized, controlled, cross-over trial. SETTING: University research laboratory (institutional). PARTICIPANTS: Ten athletes with diagnosis of unilateral patellar tendinopathy (age 27.90 [5.24] y). INTERVENTIONS: All participants attended 4 sessions, 3 treatment sessions with DFM applied with different pressures (the mean pressure-previously determined for each participant-and the mean pressure ± 25%) and a control session, each of which was separated by 48 hours. MAIN OUTCOME MEASURES: Pain (intensity upon palpation and time to onset of analgesia), and muscle strength of knee extensors were assessed before and immediately after each session. RESULTS: Pain intensity changed significantly over time (F1,9 = 52.364; P < .001; ηp2=.853) and among sessions (F3,27 = 82.588; P < .001; ηp2=.902), with a significant interaction for group × time (F3,27 = 19.841; P < .001; ηp2=.688). The knee extensors strength did not change significantly over time (F1,9 = 2.240; P = .17; ηp2=.199), nor a significant interaction for session × time was observed (F3,27 = 3.276; P = .07; ηp2=.267). Regardless of the pressure applied, the time to onset of analgesia was not significantly different (F2,18 = 1.026; P > .05; ηp2=.102). CONCLUSION: It was shown that DFM induces an immediate reduction in pain intensity upon palpation, regardless of the pressure performed. Notwithstanding, the reader should take into account the small sample size and the caution needed in the results' interpretation.

Perception of facial esthetics by different observer groups of Class II malocclusion with mandibular retrusion.

AIM: To compare the esthetic perception of different observer groups of 14 photos of two patients with Class II, division 1 malocclusion with severe mandibular retrusion. MATERIALS AND METHODS: A sample of 441 participants, of which 191 were laypeople, was obtained through a snowball sampling method. Fourteen photos of two children with Class II, division 1 malocclusion with severe mandibular retrusion were used, before and after orthodontic treatment (OT), with advance genioplasty simulation. For the evaluation of esthetic perception, the photos were rated using a numerical scale from 0 (very unesthetic) to 10 (extremely esthetic). RESULTS: Despite a parallelism of opinions, there were statistically significant differences (P < 0.05) in the assessments made by the different observer groups. Laypeople tended to attribute higher values (statistically significant difference of P < 0.05) compared to the other observer groups, with the exception of the girl's lateral profile and smile photos before OT (P > 0.05). Although they did not agree on all the photos, the other groups expressed similar scores between them. Pretreatment photos obtained the lowest scores, and those with advance genioplasty simulation obtained the highest. CONCLUSIONS: Mandibular retrusion has a strong impact on the perception of facial attractiveness. The esthetics of the lateral profile in children with severe mandibular retrusion is improved by OT. As a rule, laypeople tend to assign higher ratings.

Common symptoms of temporomandibular disorders do not mean same treatment plans: A case series.

INTRODUCTION: Temporomandibular disorders (TMDs) present several risks and different contributing factors with consequently diverse treatment approaches. It is important to recognize what patients' characteristics may benefit from orthodontics, from physiotherapy, from other treatment modalities or even from a combined approach. CASES PRESENTATION: We present three cases of patients with common TMDs signs and/or symptoms and different treatment approaches and outcomes, and our aim is to understand what might explain the different outcomes observed and also provide a rationale about the skeletal, muscular, facial and occlusal characteristics that may be indicative of a particular intervention benefit. CONCLUSION: It has been shown that orthodontics plays an important role solving occlusal problems as well as changes in the vertical dimension. On the other hand, physiotherapy was effective in pain management and range improvement, when musculoskeletal changes were clearly found. Finally, it has also been shown that a multidisciplinary approach may be crucial, and the clinician should be aware of a comprehensive assessment, valuing all the contributing factors, namely the psychological ones.

Deep Friction Massage and the Minimum Skin Pressure Required to Promote a Macroscopic Deformation of the Patellar Tendon.

OBJECTIVE: The purpose of this study was to determine the skin pressure needed to promote the macroscopic deformation of the asymptomatic patellar tendon and to verify if the pressure is associated with the individual's characteristics. METHODS: A descriptive laboratory study was performed with a convenience sample of 18 young, voluntary, and asymptomatic individuals of both sexes. A progressively increasing pressure was applied on the skin over the patellar tendon, through an instrument designed to perform and control the pressure upon an ultrasound probe; data were recorded and analyzed by 2 blind investigators. All statistical analyses were conducted considering α = 0.05. RESULTS: The average pressure needed to promote a macroscopic deformation of the patellar tendon was 1.12 ± 0.37 kg/cm2. Female sex and age were inversely but not significantly associated with the pressure performed. Sports practice, weight, height, body mass index, muscle mass, and subcutaneous thickness were positively but not significantly associated with the pressure executed. CONCLUSION: The average pressure needed to promote the macroscopic deformation of the patellar tendon was 1.12 ± 0.37 kg/cm2, which was not influenced by the characteristics of the participants.

Comparison between the Visual Analog Scale and the Numerical Rating Scale in the perception of esthetics and pain.

BACKGROUND: Pain is an unpleasant, emotional, and sensorial experience. Esthetics and pain express perceptions or sensations that are subjective and personal, but non-consensual, between professionals and patients. The Visual Analog Scale (VAS) and the Numerical Rating Scale (NRS) are simple methods to evaluate such subjective phenomena. OBJECTIVE: To verify whether a concordance exists between VAS and NS in the perception of esthetics and pain. MATERIAL AND METHODS: Regarding esthetics, an on-line questionnaire was prepared with extra- and intra-oral images (adapted). The order of the scales was alternated between interwoven and sequential. Regarding perception of pain, respondents personally classified its intensity at the present moment, or over the past 30 days. RESULTS: A statistically significant concordance (P<0.001) - positive and moderate - was found between the scales, for the evaluation of both the extra- and intra-oral images, r=0.678 and 0.638, respectively. Regarding pain perception, taking formal education into account, no concordance was found between the two scales for participants who had "no formal education" (P>0.05). The concordance between the scales increased proportionally with the level of education. CONCLUSION: There was a concordance between the scales with regard to esthetical perception and the evaluation of pain. When assessing esthetics, the order in which the two scales are applied does not affect the concordance between them. However, the strength of the concordance is influenced. Esthetic perception is not influenced by the differences between the panels of evaluators. The concordance between the two scales, for the evaluation of pain, increases proportionally with the level of formal education.

Cyriax's deep friction massage application parameters: Evidence from a cross-sectional study with physiotherapists.

BACKGROUND: Deep friction massage is one of several physiotherapy interventions suggested for the management of tendinopathy. OBJECTIVES: To determine the prevalence of deep friction massage use in clinical practice, to characterize the application parameters used by physiotherapists, and to identify empirical model-based patterns of deep friction massage application in degenerative tendinopathy. DESIGN: observational, analytical, cross-sectional and national web-based survey. METHODS: 478 physiotherapists were selected through snow-ball sampling method. The participants completed an online questionnaire about personal and professional characteristics as well as specific questions regarding the use of deep friction massage. Characterization of deep friction massage parameters used by physiotherapists were presented as counts and proportions. Latent class analysis was used to identify the empirical model-based patterns. Crude and adjusted odds ratios and 95% confidence intervals were computed. RESULTS: The use of deep friction massage was reported by 88.1% of the participants; tendinopathy was the clinical condition where it was most frequently used (84.9%) and, from these, 55.9% reported its use in degenerative tendinopathy. The "duration of application" parameters in chronic phase and "frequency of application" in acute and chronic phases are those that diverge most from those recommended by the author of deep friction massage. CONCLUSION: We found a high prevalence of deep friction massage use, namely in degenerative tendinopathy. Our results have shown that the application parameters are heterogeneous and diverse. This is reflected by the identification of two application patterns, although none is in complete agreement with Cyriax's description.

The Effectiveness of Physiotherapy in the Management of Temporomandibular Disorders: A Systematic Review and Meta-analysis.

AIMS: To analyze the methodologic quality, summarize the findings, and perform a meta-analysis of the results from randomized controlled trials that assessed the effects of physiotherapy management of temporomandibular disorders. METHODS: A literature review was performed using the electronic databases PubMed, Science Direct, and EBSCO. Each article was independently assessed by two investigators using the Physiotherapy Evidence Database (PEDro), Jadad scales, and the Cochrane Risk of Bias tool. A meta-analysis was conducted by using the DerSimonian-Laird random-effects method to obtain summary estimates of the standardized mean differences (SMD) and the corresponding 95% confidence intervals (95% CI). Between-study heterogeneity was computed and publication bias was assessed. RESULTS: Seven articles met the inclusion criteria and were used in the analysis, corresponding to nine estimates of SMD. The meta-analysis showed that for pain reduction, the summary SMD favored physiotherapy (SMD = -0.63; 95% CI: -0.95 to -0.31; number of studies = 8; I² = 0.0%), while for active range of movement (ROM) the differences between the intervention and control groups were not statistically significant (SMD = 0.33; 95% CI: -0.07 to 0.72; number of studies = 9; I² = 61.9%). CONCLUSION: Physiotherapy seems to lead to decreased pain and may improve active ROM. However, the results are not definitive and further studies and meta-analyses are needed before these results can be considered fully generalizable.

Avaliação do impacto da saúde oral em utentes diabéticos com idade superior ou igual a 65 anos / Assessment of the impact of oral health on diabetic users aged 65 years or over

A patologia oral afeta a capacidade de comer, falar e socializar, influenciando negativamente as atividades de vida diária (AVD) no idoso e está exacerbada na presença de doenças crónicas, como a diabetes. Objetivos: Avaliar o impacto da saúde oral em idosos diabéticos e residentes no concelho de Alfândega da Fé, utilizando os índices OHIP-14 e GOHAI e correlacionar estes índices com as condições orais avaliadas clinicamente. Metodologia: Estudo quantitativo e transversal em 250 idosos diabéticos, orientados e residentes no concelho de Alfândega da Fé. Aplicaram-se formulários com questões sobre as caraterísticas sócio-demográficas, autoperceção da condição oral direta e através dos índices OHIP-14 e GOHAI, complementando com exame clínico à cavidade oral. A correlação de Spearman (rs) foi utilizada para avaliar a associação entre dados clínicos e os índices OHIP-14 e GOHAI. Resultados: Dos 250 idosos diabéticos, 53,6% são mulheres e 91,2% têm baixa escolaridade. As mulheres têm menor número de dentes naturais (p=0,004), maior percentagem de dentes com mobilidade (p=0,006) e com perda óssea (p=0,002) do que os homens. Os índices OHIP-14 e GOHAI revelam pior situação oral na mulher do que no homem (p<0,001 para ambos os índices). Das 8 condições orais avaliadas, 6 estão correlacionadas com os índices OHIP-14 e GOHAI no homem, mas apenas 3 na mulher. Das condições orais, a perda óssea e a percentagem de dentes cariados são as que estão mais fortemente correlacionadas quer com o GOHAI (na mulher: rs=-0,212, p<0,05 para a perda óssea e rs=-0,197, p<0,05 para a percentagem de dentes cariados; no homem: rs=-0,475, p<0,01 para a perda óssea e rs=-0,472, p<0,01 para a percentagem de dentes cariados), quer com o OHIP (na mulher: rs=0,222, p<0,05 para a perda óssea e rs=0,267, p<0,01 para a percentagem de dentes cariados; no homem: rs=0,505, p<0,01 para a perda óssea e rs=0,502, p<0,01 para a percentagem de dentes cariados). Das dimensões do índice GOHAI e do índice OHIP-14 a mais afetada foi a dimensão física. Conclusões: A correlação entre dados clínicos e índices OHIP-14 e GOHAI mostra padrão diferente entre homens e mulheres o que pode colocar restrições na aplicabilidade destes índices. Os resultados sugerem que perda óssea e a cárie são as patologias com maior interferência nos idosos diabéticos, por conseguinte deve-se investir na sua prevenção.

Oral pathology affects the ability to eat, speak and socialize, negatively influencing the activities of daily living (ADL) in the elderly and is exacerbated in the presence of chronic diseases such as diabetes. Objectives: Evaluate the impact of oral health in elderly diabetics and residents in Alfândega da Fé, using the OHIP-14 and GOHAI indexes and correlate these indexes with oral conditions evaluated clinically. Methodology: A cross-sectional nature study with a quantitative approach was made in a sample of 250 elderly diabetics, oriented / able to answer the questionnaire, and residents in Alfândega da Fé. Questionnaires with questions about socio-demographic characteristics, self-perception oral condition directly and through OHIP - 14 and GOHAI indexes, complementing with clinical examination of the oral cavity, were applied. The Spearman correlation (rs) was used to evaluate the association between clinical data and the OHIP-14 and GOHAI indexes. Results: Of the 250 elderly diabetics, 53.6% are women and 91.2% had low education. Women have fewer natural teeth (p = 0.004), higher percentage of teeth with mobility (p = 0.006) and bone loss (p = 0.002) than men. The OHIP-14 and GOHAI indexes reveal worse oral situation in women than in men (p <0.001 for both indexes). From the 8 oral conditions evaluated, 6 are correlated with OHIP-14 and GOHAI indices in man, but only 3 in women. From oral conditions, bone loss and the percentage of carious teeth are those that are most strongly correlated with either GOHAI (in women: rs = -0.212, p <0.05 for bone loss and rs = -0.197, p <0 05 to the percentage of carious teeth, in men: rs = -0.475, p <0.01 for bone loss and rs = -0.472, p <0.01 for the percentage of carious teeth), with either OHIP (in women: rs = 0.222, p <0.05 for bone loss and rs = 0.267, p <0.01 for the percentage of decayed teeth, in men: rs = 0.505, p <0.01 for bone loss and rs = 0.502, p <0.01 for the percentage of carious teeth). From the dimensions of GOHAI and OHIP-14 indexes the most affected was the physical dimension. Conclusions: The correlation between clinical data and OHIP-14 and GOHAI indexes show different between men and women which may put restrictions on the applicability of these indices. The results suggest that bone loss and dental caries are pathologies with higher interference in elderly diabetics therefore investment in their prevention should be made.