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1.
Rev Med Suisse ; 16(709): 1865-1869, 2020 Oct 07.
Artículo en Francés | MEDLINE | ID: mdl-33026729

RESUMEN

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder affecting up to 49 % and 23 % of middle to older aged men and women respectively. CPAP (continuous positive airway pressure) is the gold-standard treatment for severe apneas. In mild and moderate forms of OSAS, mandibular advancement devices (MAD) are equally a first line of treatment. Both CPAP and MAD have their advantages and side effects. Patient tolerance to these two therapies varies according to different patient-parameters. In order to guide physicians and patients in choosing between these two treatments, we present a description of both treatment modalities.


Asunto(s)
Toma de Decisiones Clínicas , Presión de las Vías Aéreas Positiva Contínua , Avance Mandibular , Apnea Obstructiva del Sueño/terapia , Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Humanos , Avance Mandibular/efectos adversos , Ferulas Oclusales/efectos adversos
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4079-4084, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33018895

RESUMEN

We propose a smart mandibular advancement device (MAD) that can monitor cardiorespiratory parameters intraorally. The device comprises a flexible hybrid wireless monitoring platform integrated with a MAD. This monitoring platform is based on acquiring the intraoral photoplethysmography (PPG) signals. It is designed on a double-sided flexible polyimide substrate. Our experimental measurements show that the PPG signals captured intraorally are highly correlated with the conventional PPG signals received from the fingertip. Intraoral PPG signals have vital information as well as adequate quality to be utilized for estimation of multiple-physiological parameters, such as heart-rate (HR), respiration rate (RR), respiration pattern (RP) and blood oxygen saturation (SpO2). The estimated values of HR, RR, and SpO2 from the intraoral PPG signals recorded by our smart MAD show an accuracy of over 96% with reference to the conventional monitoring techniques.


Asunto(s)
Ferulas Oclusales , Procesamiento de Señales Asistido por Computador , Oximetría , Fotopletismografía , Frecuencia Respiratoria
3.
Rev. ADM ; 77(5): 261-266, sept.-oct. 2020. ilus
Artículo en Español | LILACS | ID: biblio-1147137

RESUMEN

Una de las consecuencias de la desprogramación neuromuscular es la rotación mandibular en sentido horario, evidenciando el punto prematuro de contacto y aumentando la dimensión vertical del paciente. En pacientes clase II con componente vertical, es un problema realizar este tipo de tratamiento, ya que por lo general este efecto de posterorrotación mandibular hace el perfil más convexo, y en algunos casos genera mordida abierta anterior, la cual se debe corregir posteriormente con el tratamiento de ortodoncia, cirugía o prótesis, lo que alarga el tiempo total de tratamiento por la necesidad de control vertical. El presente caso se trata de una mujer de 45 años de edad, dolicofacial, con tendencia a mordida abierta, mordida dual, sobremordida vertical y horizontal disminuidas, motivo de consulta dolor articular, el cual no le permite continuar con sus labores diarias, el tratamiento realizado fue desprogramación neuromuscular con un guarda oclusal inferior con el propósito de aliviar sintomatología articular y control vertical con microtornillos palatinos previo a tratamiento ortodóncico (AU)


One of the effects of the neuromuscular deprogramming treatment is the mandibular clockwise rotation, making the light premature occlusal contact more evident and increasing the patient vertical dimension. In Class II patients with vertical component is difficult to treat them due to profile worsening as an effect of the clockwise rotation creating in some patient's anterior open bite, this has to be corrected later in treatment with orthodontic intrusion, surgery or prosthodontic treatment, increasing the total time of treatment with the vertical control necessity. This case report is a 45 years old patient, dolichofacial, with anterior open bite tendency, dual bite, decreased overjet and overbite, her chief complaint was temporomandibular joint dysfunction which dont allow her to do her daily duties, the treatment for her was neuromuscular deprogramming splint for the temporomandibular joint pain, and vertical control with temporary anchorage devices (miniscrews) before the orthodontic treatment (AU)


Asunto(s)
Humanos , Persona de Mediana Edad , Dimensión Vertical , Síndrome de la Disfunción de Articulación Temporomandibular/terapia , Implantes Dentales , Mordida Abierta/terapia , Rotación , Ferulas Oclusales , Manifestaciones Neuromusculares , Sobremordida/terapia , Mandíbula/fisiología , México
5.
Oral Health Prev Dent ; 18(1): 719-729, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32895655

RESUMEN

PURPOSE: This study investigated the progression of incisal tooth wear clinically for 4-years, using various diagnostic methods. Effectiveness of occlusal splints (night guards) for patients with nocturnal bruxism was also evaluated. MATERIALS AND METHODS: Forty maxillary incisors from 10 patients with nocturnal bruxism were selected. Group 1 (n=5) wore occlusal splints for 6 months, whereas group 2 (n=5) didn't. Ultrasound, cast-model analysis (control), digital radiography, FluoreCam and colorimeter were used for measurements. Clinical progression of incisal wear monitored at baseline, 3, 6, 12, 24 and 48 months, respectively. RESULTS: Ultrasound, cast-model analysis and FluoreCam readings gradually and statistically significantly decreased during the overall evaluation period for both groups (p<0.001). Regarding colorimeter, statistically significant differences in periodical measurements were observed from 24 months and 12 months, for group 1 and group 2, respectively (p<0.001). There were no statistically significant differences in readings at evaluation periods, between the groups, for ultrasound, digital radiography and cast-model analysis (p≥0.05); however, statistically significant differences were observed for colorimeter at 24 months (p=0.010) and 48 months (p<0.001), and for FluoreCam at 12, 24, 48 months (p<0.001). Annual decrease in mean crown length was determined as 20-30 µm for group 1 and 40-50 µm for group 2. The decreases in mean crown length were statistically significantly lower for group 1 compared to group 2, regarding the assessments for 1 year, 2 years and 4 years (p<0.001). Positive and good correlations were observed between ultrasound, cast-model analysis and FluoreCam measurements (p<0.001). CONCLUSIONS: Ultrasound, FluoreCam and colorimeter showed promising results for monitoring any change and progression of incisal tooth wear clinically. Ultrasound might be considered as a quantitative, reliable and repeatable method. Precision of the measurements varied among the diagnostic methods used. Occlusal splints may have a potential preventive effect for progressive tooth wear.


Asunto(s)
Radiografía Dental Digital , Desgaste de los Dientes , Humanos , Incisivo , Estudios Longitudinales , Ferulas Oclusales
6.
Quintessence Int ; 51(9): 753-762, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32901236

RESUMEN

OBJECTIVE: Conservative treatment modalities are recommended for managing masticatory myalgia in individuals with temporomandibular disorders. The aim of this study was to retrospectively review and compare the effectiveness of four conservative treatments: counseling and occlusal splint therapy, counseling and manipulation integrated with electrophysiotherapy, the combination of the two treatments, and counseling only. METHOD AND MATERIALS: One hundred and sixty-eight patients who had myalgia with limited jaw movement were retrospectively observed in this study. Between January 2015 and December 2017, 63 patients received counseling and stabilization occlusal splint therapy (Group 1), 35 patients received counseling and manipulation integrated with electrophysiotherapy (Group 2), 33 patients received the combination of counseling, splint therapy, and manipulation integrated with electrophysiotherapy (Group 3), and 37 patients received counseling only (Group 4). All subjects were followed up for 12 weeks. The intensity of spontaneous pain, palpation pain, chewing pain in the masticatory muscles, and range of pain-free maximal mouth opening were recorded in the clinical assessments. Intragroup and intergroup differences were examined by using analysis of variance (ANOVA) and the Kruskal-Wallis test. RESULTS: Spontaneous pain in the masticatory muscles was relieved significantly in all groups at the 6-week visit (P < .05), and no significant difference was found among the groups (P > .05). Palpation pain was relieved significantly at the 9-week visit in the counseling + occlusal splint therapy group, counseling + manipulation + electrophysiotherapy group, and counseling + occlusal splint + manipulation + electrophysiotherapy group (P < .05). In the treatment group with counseling alone, significant palpation pain relief occurred at 12 weeks. Chewing pain was relieved significantly at the 6-week visit in the counseling + occlusal splint therapy group, counseling + manipulation + electrophysiotherapy group, and counseling + occlusal splint + manipulation + electrophysiotherapy group (P < .05), yet no significant difference compared to the baseline was observed in the counseling-only group (P > .05). A significant increase in the maximal range of pain-free mouth opening was observed at the 9-week visit in the counseling + occlusal splint therapy group, and at the 3-week visit in the counseling + manipulation + electrophysiotherapy group and counseling + occlusal splint + manipulation + electrophysiotherapy group (P < .05). Nevertheless, no significant change in the range of mouth opening was found throughout the follow-up period in the counseling-only group (P > .05). CONCLUSION: Each of the included treatment modalities relieved spontaneous pain and tenderness to palpation of the masticatory muscles during the follow-up intervals. Counseling alone did not help patients with chewing pain and limited mouth opening in the short term. Treatment protocols including counseling, occlusal splint therapy, and manipulation, integrated with electrophysiotherapy showed the best short-term outcomes for symptomatic improvement.


Asunto(s)
Tratamiento Conservador , Mialgia , Humanos , Mandíbula , Ferulas Oclusales , Estudios Retrospectivos
7.
J Oral Rehabil ; 47(12): 1530-1537, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32841412

RESUMEN

OBJECTIVE: To compare the manual time and preliminary clinical effects between the digital manufactured occlusal splints for sleep bruxism patients with those of traditional hard splints. METHODS: Sixteen individuals (18 to 44 y/o) with clinically diagnosed sleep bruxism were selected based on the inclusion criteria. All patients were divided into two groups, and a random control method was applied. Digital splints (test group) were designed and milled using CAD/CAM. Hard splints (control group) were made of transparent acrylic resin in laboratory office. The manual time spent including impression obtaining, splint production and clinical occlusal adjustment was recorded. A visual analog scale was used to report the subjective evaluations. The maximum depth loss and volumetric loss of the occlusal surface of splints in posterior tooth were measured. SPSS software was used for statistical analysis (P = .05). RESULTS: Comparing with control group, the manual time spent in test group was significantly less in all of three procedures (P < .001). The VAS scores for retention were not significantly different (P = .086), but the wearing comfort scores of test group were significantly higher (P < .001). Both maximum depth loss (P = .007) and volumetric loss in test group were significantly less than control group (P = .005). CONCLUSION: In the current study, the digitally manufactured splints exhibit significantly improved comfort and time efficiency than traditional hard splints. Moreover, the new milling material (PEEK) has better wear resistance than acrylic resins.


Asunto(s)
Bruxismo , Bruxismo del Sueño , Resinas Acrílicas , Humanos , Cetonas , Ferulas Oclusales , Polietilenglicoles , Bruxismo del Sueño/terapia , Férulas (Fijadores)
8.
Rev. ADM ; 77(4): 209-215, jul.-ago. 2020. tab
Artículo en Español | LILACS | ID: biblio-1129997

RESUMEN

A continuación se presenta un caso de un paciente de 12 años de edad, con antecedente de bruxismo, con biotipo mesofacial, tercio inferior dolicofacial, hipertonicidad muscular en maseteros, cierre labial forzado con incompetencia labial de 4 milímetros con dolor en sinoviales anteriores inferiores. Los objetivos de tratamiento consistieron en lograr relajación muscular y promover un posicionamiento condilar ortopédicamente funcional y estable, realizar control vertical para disminuir gap interlabial, alinear líneas medias, mantener clase I molar bilateral, clase I canina bilateral y clase I incisiva, crear overjet y overbite adecuados, con recuperación estética y función del segmento anterior. Debido a eventos adversos durante la etapa de cierre de espacios, la clase molar y canina I no se logró, pero se aseguró mediante ameloplastias positivas la función y estética adecuadas para tener un tratamiento de ortodoncia estable a largo plazo (AU)


The following is a case of a 12-year-old patient, with a history of bruxism, with a mesofacial biotype, lower third of the facial area, muscular hypertonicity in the masseters, a forced labial closure with a 4-millimeter labial incompetence with pain in inferior anterior synoviums. Treatment objectives consisted of achieving muscle relaxation and promoting orthopedically functional and stable condylar positioning, perform vertical control to decrease interlabial gap, align midlines, maintain bilateral molar class I, bilateral canine class I and incisive class I, create adequate overjet and overbite, with aesthetic recovery and function of the anterior segment. Due to adverse events during the closing phase of spaces, the molar and canine I class was not achieved, but positive function and aesthetics were ensured by positive ameloplasties in order to have a long-term stable orthodontic treatment (AU)


Asunto(s)
Humanos , Femenino , Niño , Ortodoncia Correctiva , Bruxismo , Relación Céntrica , Esmalte Dental/cirugía , Estética Dental , Aparatos Ortodóncicos , Planificación de Atención al Paciente , Ferulas Oclusales , Resinas Compuestas , México , Relajación Muscular
9.
Rev. ADM ; 77(4): 216-221, jul.-ago. 2020. ilus, tab
Artículo en Español | LILACS | ID: biblio-1130113

RESUMEN

Los pacientes con problemas esqueléticos clase II que han terminado su crecimiento, generalmente, se tratan con cirugía ortognática o extracciones de piezas dentarias. Un objetivo del tratamiento es obtener estabilidad a largo plazo. El presente caso clínico es de un paciente masculino de 15 años de edad con clase II esquelética sagital que se realizó desprogramación neuromuscular con un plano de acrílico, que permitió determinar la verdadera discrepancia intermaxilar y obtener que la articulación temporomandibular estuviera en una posición estable en relación céntrica del paciente previo a su tratamiento ortodóncico prequirúrgico (AU)


In patients with class II skeletal problems who have finished their growth; they are treated with orthognathic surgery or dental extractions usually. One treatment goal is to obtain long-term stability. The present case report is of a 15 years old male patient with skeletal sagittal class II who underwent neuromuscular deprogramming with an acrylic plane, which allowed to determine the true skeletal discrepancy and achieve a stable position of the temporomandibular joint in centric relation before the orthodontic treatment (AU)


Asunto(s)
Humanos , Masculino , Adolescente , Relación Céntrica , Ferulas Oclusales , Cirugía Ortognática , Maloclusión de Angle Clase II/terapia , Planificación de Atención al Paciente , Articulación Temporomandibular/fisiopatología , Cefalometría , Manifestaciones Neuromusculares , México
10.
J Craniomaxillofac Surg ; 48(8): 751-755, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32680670

RESUMEN

INTRODUCTION: To evaluate the feasibility of safely managing subcondylar fractures using an original surgical procedure combining an intraoral approach, the use of a custom-made occlusal overlay splint, and intraoperative imaging. MATERIALS AND METHODS: Condylar fragment was freed from surrounding soft tissues, was laterally exposed to the ramus, and a miniplate was fixed in place for osteosynthesis. An overlay splint maintaining the dental occlusion was used to facilitate reduction and stabilization during fixation. Intraoperative monitoring by cone-beam computed tomography (CBCT) was performed before completing the fixation. RESULTS: Between November 2018 and June 2019, 10 patients were treated using this procedure. The median length of the proximal condylar fragment was 29 mm (range 24-39 min). Five patients had an associated mandibular fracture. The median duration of the condylar fracture surgery was 54.5 min (range 38-79 min). All patients had satisfactory reduction and osteosynthesis with no complications. CONCLUSION: It is feasible to safely manage subcondylar fractures with this surgical procedure that could facilitate open reduction using intraoral approaches. Occlusal splints maintain downward pressure on the rami bilaterally and symmetrically, helping to anatomically reposition condylar process fractures. Intraoperative imaging is used to monitor this step.


Asunto(s)
Fracturas Mandibulares , Fijación Interna de Fracturas , Humanos , Cóndilo Mandibular , Ferulas Oclusales , Reducción Abierta
11.
BMC Oral Health ; 20(1): 174, 2020 06 22.
Artículo en Inglés | MEDLINE | ID: mdl-32571384

RESUMEN

BACKGROUND: This study aimed to demonstrate that the material of the occlusal splint can be chosen according to the needs of individual patients and contribute to the knowledge of the wear rate of these materials. METHODS: In this study, four occlusal splint materials (Sr Ivocap Heat Cured, Valplast, SR Ivocap Elastomer and Eclipse) and three antagonists (natural tooth enamel, inCoris TZI and IPS e.max Press ceramic materials) were used. Each wear test was performed using a chewing simulator (n = 16; test load: 50 N; number of cycles: 10,000, 20,000 and 30,000; continuous rinsing with water at 30 °C for the wet condition). The Shapiro Wilk test was used for normal distribution suitability. Antagonist on average wear quantities both main effects and interactions of material, cycle and condition factors were investigated by Univariate variance analysis. Multiple comparisons were examined using the Games-Howell test. RESULTS: There was a statistically significant effect of the difference in materials on the amount of wear (p < 0.001). Furthermore, there was a statistically significant difference among the mean values of all materials (p > 0.001). The highest mean value was obtained with Eclipse (0,318 µm3), and the lowest mean value was obtained with Valplast (0,134 µm3). CONCLUSION: Our study found differences in the in vitro wear rate among various occlusal splint materials.


Asunto(s)
Cerámica , Esmalte Dental/efectos de los fármacos , Ferulas Oclusales , Humanos , Ensayo de Materiales , Propiedades de Superficie
12.
Acta Odontol Scand ; 78(8): 580-589, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32421379

RESUMEN

OBJECTIVE: This systematic review aimed to assess the efficacy of occlusal splints in the treatment of temporomandibular disorders (TMDs). MATERIAL AND METHODS: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Four databases (Medline via Pubmed, Web of Science, Embase and Scopus) were searched, the last search was conducted on April 2020. Randomised controlled trials (RCTs) employing the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as diagnostic criteria and including occlusal splint as one of the experimental groups were included in the present study. The data from the included studies were extracted and assessed for risk of bias. RESULTS: Eleven studies were included. The sample size ranged from 12 to 96 subjects. The male to female ratio was 0 to 25%. The mean length of follow-up was 4 months. Occlusal splint had a positive effect on mandibular movements in all included studies. Seven studies showed a positive effect of occlusal splint on chronic pain reduction and pain intensity, while two others showed improvement of temporomandibular joint clicking sounds and locking of the jaws. Moreover, improvements in mouth opening, depression, and anxiety symptoms, were reported in four studies. CONCLUSIONS: An occlusal splint can be considered as a non-invasive treatment approach for patients with TMD, especially those with signs and symptoms of restriction of mandibular movement and pain. Moreover, the present findings highlighted an urgent need of a standardised consensus regarding the prognostic evaluation of TMD.


Asunto(s)
Ferulas Oclusales , Trastornos de la Articulación Temporomandibular , Femenino , Humanos , Masculino , Mandíbula , Ensayos Clínicos Controlados Aleatorios como Asunto , Trastornos de la Articulación Temporomandibular/diagnóstico , Trastornos de la Articulación Temporomandibular/terapia , Resultado del Tratamiento
13.
Pain Res Manag ; 2020: 6195601, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32454921

RESUMEN

In recent years, the number of patients applying for prosthetic treatment due to temporomandibular joint disorders (TMD) has been increasing. The main methods for treating disorders are the use of occlusal splints and physiotherapeutic rehabilitation as supportive treatment. Radio waves are electromagnetic waves with radiation frequency between 3 Hz and 3 THz, used for physiotherapeutic treatment of skeletal muscle relaxation in the range of 3 to 6 MHz. The rehabilitation effect of these waves is based on diathermy by means of high-voltage quick alternating current. Aim. The aim of the study was to evaluate the influence of radiofrequency waves on the pain of the masticatory muscles in the course of TMD and the usefulness of these procedures in the supporting treatment of these disorders. Materials and Methods. Patients aged 19 to 45 years, of both sexes, reported to the Consulting Room of TMD at the Institute of Dentistry in Krakow to undertake prosthetic treatment of TMD (I a-according to RDC/TMD). Study group (SG) consists of 20 patients who had 10 supportive treatments with radiofrequency currents. In the case of application of radiation to the muscle area, the energy was 20 J to the area of the masticatory muscles, the frequency was 3 MHz, bipolar technique, the duration of the procedure was 10 minutes, and the coupling substance was a gel for ultrasound examinations. The control group (CG) consisted of 20 patients who had 10 supportive treatments with sonophoresis procedures. For the area of masticatory muscles, 0.9 W/cm2 treatments were applied, the duty factor was 80%, the treatment time was 10 minutes, and the medical substance was 25% Voltaren gel. Results. Analysis of the results of the first clinical examinations (axis I) conducted in both groups shows a homogeneous clinical material and similar results. The second clinical examination revealed improved clinical parameters, but it showed a greater improvement in the SG. In the SG, the mean level of VAS was 6.25, and the extreme values were 5.9-0.14, the median was 2.15, and the standard deviation was 1.54. In the CG, the average value of VAS was 6.20 (peak of 5.2-0.7), the median was 2.4, and the standard deviation was 1.87. Summary. The search for new methods of supportive treatment of TMD is an important research direction due to the complex etiology of this disease and the lack of an explicit treatment algorithm. Conclusion. The results of our own research clearly indicate that the use of the radiofrequency waves brings pain relief and improvement of clinical parameters to a greater extent than in sonophoresis. It can be a very important new method in supportive treatment of TMD. Research needs to be continued.


Asunto(s)
Terapia por Radiofrecuencia/métodos , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Femenino , Humanos , Masculino , Músculos Masticadores/efectos de la radiación , Persona de Mediana Edad , Ferulas Oclusales , Adulto Joven
14.
J Biol Regul Homeost Agents ; 34(3): 747-756, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32456403

RESUMEN

Orthopedic temporomandibular joint (TMJ) instability is very common among children and adults. It is often associated with pain in the cervicofacial region, and muscle contraction. To investigate whether muscle contraction can cause permanent posterior rotation of the head and whether treatment with splint and kinetotherapy is efficient, a literature review was carried out of patients with pain in the cervicofacial area. Additionally, the case of a 15-year old patient presenting with permanent posterior rotation of cra¬nium, with no movement between the first two vertebra and pain in the cervicofacial area was reported. Kinetotherapy followed by rapid maxillary expansion improved the function of cervical vertebrae and re¬duced the cervicofacial pain within the first two weeks. Kinetotherapy, rapid maxillary expansion, and or¬thodontic treatment with a stable joint position could be a good therapy to control occipital-atlas function.


Asunto(s)
Inestabilidad de la Articulación/complicaciones , Técnica de Expansión Palatina , Trastornos de la Articulación Temporomandibular , Adolescente , Vértebras Cervicales , Humanos , Ferulas Oclusales , Dolor , Manejo del Dolor , Dimensión del Dolor , Trastornos de la Articulación Temporomandibular/terapia
15.
Ned Tijdschr Tandheelkd ; 127(3): 171-176, 2020 Mar.
Artículo en Holandés | MEDLINE | ID: mdl-32343277

RESUMEN

3D virtual planning optimises the predictability of orthognathic surgery. The planning is based on a cone beam computed tomography-scan of the patient as well as a plaster model, and is transferred to the patient by a 3D printed occlusal splint. In 3D printing the build angle influences, among other things, the accuracy (in earlier research, proven in dental crowns), manufacturing time and capacity. In this research, using 10 plaster models, 3 different build angles (0°, 30° and 90°) are compared. The fit of the splints was tested by 2 physicians using plaster models. According to this small sample, the fit does not depend on the build angle. When considering the manufacturing time and capacity, there is a preference for the 90º oriëntation, because it increases the manufacturing capacity and decreases the manufacturing time per splint.


Asunto(s)
Ferulas Oclusales , Procedimientos Quirúrgicos Ortognáticos , Diseño Asistido por Computadora , Coronas , Humanos , Imagenología Tridimensional , Impresión Tridimensional
16.
J Oral Rehabil ; 47(7): 889-901, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32306424

RESUMEN

OBJECTIVE: This study was conducted to evaluate the changes of temporomandibular joints (TMJs) through magnetic resonance imaging (MRI) scanning and the electrical changes in mandibular movement and masticatory muscle surface of mild-to-moderate obstructive sleep apnoea-hypopnoea syndrome (OSAHS) patients before and after treatment with mandibular advancement device (MAD). METHODS: This was a single-centre, prospective study recruiting OSAHS patients undergoing treatment with MAD in Department of Stomatology, Yannan Hospital, Kunming, China. Patients were recruited from February 2015 to October 2015, and TMJ changes were observed in MRI scanning before and after 18 months of treatment with MAD in cohort 1. The second cohort of the patients were recruited from January 2014 to September 2015 and electrical changes in mandibular movement and masticatory muscle surface of patients before and after 6 months of treatment with MAD. RESULTS: In the cohort 1, TMJ changes analysed through MRI scanning, before and after 18-month treatment with MAD, there was no significant deviation in the angle of joint disc position. A minor change in the position relationship between condylar process, articular disc and articular fossa but not significant was observed. There was no significant difference in the shape and magnitude of mandibular incision edge movement, percussion movement, masticatory movement and condylar central trajectory among the recruited OSAHS patients, before and after 6 months of MAD treatment as analysed through electromyography. CONCLUSION: In this study, from the results it was evident that the effect of MAD on the stomatognathic system of OSAHS patients is minimal.


Asunto(s)
Avance Mandibular , Apnea Obstructiva del Sueño , China , Humanos , Ferulas Oclusales , Estudios Prospectivos
17.
J Orthod ; 47(2): 181-184, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32338118

RESUMEN

Adult orthodontics is now mainstream, made all the more acceptable by the advent of removable aligners. These patients may also coincidentally suffer from snoring and obstructive sleep apnoea (OSA), for which the indefinite wearing of a mandibular advancement device (MAD) during sleep may be required. Indefinite removable nocturnal orthodontic retention is now established practice. This case report describes a cast chrome cobalt MAD and its application in the management of a patient who, having very successfully managed his snoring and mild OSA with a removable cast chrome cobalt MAD, wished to continue this management while undergoing active orthodontic treatment using removable aligners. He also wished to wear a chrome cobalt MAD to incorporate orthodontic retention and inter occlusal splinting as part of his MAD on completion of his active orthodontic treatment.


Asunto(s)
Avance Mandibular , Apnea Obstructiva del Sueño , Adulto , Cobalto , Humanos , Masculino , Ferulas Oclusales , Ronquido , Resultado del Tratamiento
18.
J Craniofac Surg ; 31(4): 960-965, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32149977

RESUMEN

PURPOSE: The present study summarized selection of guiding plate combined with surgical navigation for microsurgical mandibular reconstruction. METHODS: Data from preoperative maxillofacial enhanced computed tomography (CT) scans were imported to ProPlan CMF. The authors performed virtual mandibulectomy and superimposed 3-dimensional (3D) iliac images on mandibular defects. Guiding plates including mandibular fixation device, reconstruction plate, guiding model, and occlusal splint for various mandibular hemimandibular central lateral (HCL) defects were fabricated to fix bilateral residual mandible. The model was scanned, and data were imported into ProPlan CMF and the intraoperative navigation system. Through landmark points upon the guiding plate, position of the residual mandible was determined during surgical navigation. Intraoperative navigation was used to implement the virtual plan. Sagittal, coronal, axial, and 3D reconstruction images displayed by the navigation system were used to accurately determine osteotomy sites and osteotomy trajectory during surgery. Surgical probe guidance was used to mark the osteotomy line and transfer the virtual procedure to real-time surgery. Accuracy was evaluated using chromatographic analysis. RESULTS: Different guiding plates combined with surgical navigation could be used for various mandibular defects, including mandibular fixation devices for LCL defects, reconstruction plates for LC/L/C defects, and guiding models and occlusal splints for H/L/LC defects (including mandibular ramus). In our study, average and largest shift of the mandible and osteotomy site was <5 mm. CONCLUSION: The authors summarized different ways of combining guiding plates with surgical navigation for reconstruction of various mandibular defects, which could improve clinical outcomes of this procedure with high accuracy.


Asunto(s)
Placas Óseas , Mandíbula/cirugía , Reconstrucción Mandibular , Microcirugia , Cirugía Asistida por Computador , Adulto , Femenino , Humanos , Masculino , Osteotomía Mandibular , Reconstrucción Mandibular/métodos , Persona de Mediana Edad , Ferulas Oclusales , Osteotomía , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X , Adulto Joven
19.
J Craniofac Surg ; 31(4): 976-979, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32195835

RESUMEN

PURPOSE: The purpose of this study was to assess the clinical interventions and the accuracy of maxillary reposition using a computer-aided design/computer-aided manufacturing (CAD/CAM) splint derived via surgical simulation. MATERIALS AND METHODS: The retrospective study comprised 24 patients who underwent bimaxillary surgery. The patients were assigned to 1 of 2 groups by a way of maxillary repositioning. One group received conventional intermediate wafers and the other CAD/CAM wafers during Le Fort I osteotomy. We recorded operation time, blood loss, the operative accuracy. Accuracy was analyzed by 3-dimensional computed tomography images before and immediately after the operation. The evaluation points were the right maxillary first incisor (U1), the right maxillary second molar (M2-right), and the left maxillary second molar (M2-left). RESULTS: The 2 groups did not differ significantly in operation time and blood losses. The vertical axis of U1 data differed significantly between the 2 groups (P = 0.008). None of the horizontal, vertical, or anteroposterior axis of M2-right data differed significantly, and anteroposterior axis of M2-left data differed significantly (P = 0.0296). The CAD/CAM group 3-dimensional distance errors were less than those of the conventional group for all points. CONCLUSION: Placement of CAD/CAM splint allowed highly accurate repositioning; the accuracy exceeded that afforded by conventional model surgery using a facebow and articulator.


Asunto(s)
Enfermedades Maxilares/diagnóstico por imagen , Enfermedades Maxilares/cirugía , Procedimientos Quirúrgicos Ortognáticos , Férulas (Fijadores) , Adolescente , Adulto , Femenino , Humanos , Imagenología Tridimensional/métodos , Masculino , Ferulas Oclusales , Procedimientos Quirúrgicos Ortognáticos/métodos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Adulto Joven
20.
Int J Comput Dent ; 23(1): 11-16, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32207457

RESUMEN

AIM: The present study aimed to evaluate intraoral microsensors for the objective measurement of patient compliance during splint therapy and to comparatively analyze the duration of mandibular and maxillary splint application in patients with myofascial pain. MATERIALS AND METHODS: Thirty-two patients with sole myofascial pain without limited opening (Research Diagnostic Criteria for Temporomandibular Disorders [RDC/TMD] Ia) were divided into two groups. To ensure patient comparability, all pressure-sensitive sites from the initial palpation were summarized as pain scores. The subjects in group 1 were treated with maxillary stabilization splints, and those in group 2 with mandibular stabilization splints. All splints were equipped with a microsensor without interfering static or dynamic occlusion. Wear pattern was recorded at three intervals of 30 days each. Following the observation period, the data were retrieved and statistically evaluated using multi-factor analysis of variance (ANOVA) and the Bland-Altman analysis. RESULTS: During the observation period, maxillary splints were applied in 44.4% and mandibular splints in 44.2% of the days. Regarding patient compliance, there was no significant difference between the maxillary and mandibular splints (P = 0.359). Patients with an increased pain score (P < 0.0001) and female patients (P = 0.013) wore their splints significantly more often. The wear time decreased over the observation period, whereas only the initial and terminal interval differed significantly across both the mandibular and maxillary splint groups (P < 0.0001). CONCLUSION: The microsensor used in the present study was an effective and reliable tool for monitoring patient compliance in patients with temporomandibular disorders (TMD). This method also allows for the reliable recording of intraoral splint application prior to the required bite elevations. The two types of splints analyzed in the present study had no significant influence on compliance.


Asunto(s)
Férulas (Fijadores) , Trastornos de la Articulación Temporomandibular , Femenino , Humanos , Mandíbula , Ferulas Oclusales , Dolor , Resultado del Tratamiento
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