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1.
Med. oral patol. oral cir. bucal (Internet) ; 25(6): e775-e783, nov. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-197186

RESUMEN

BACKGROUND: Chronic pain from temporomandibular disorders (TMDs) is caused by a somatosensory disturbance due to sustained activation of central nervous system nociceptive pathways, which can induce changes in neuroplasticity in the thalamus, basal ganglia and limbic system, as well as disturbances in the somatosensory, prefrontal and orbitofrontal cortex and cognitive impairment. The main objective of this study was to determine the discrimination capacity of mandibular and tongue laterality between women with chronic TMDs and asymptomatic women. MATERIAL AND METHODS: This descriptive-comparative study examined 2 groups with a total of 30 women. All participants were between the ages of 23 and 66 years and were assigned to the chronic TMD group or the asymptomatic group according to the inclusion criteria. We employed a mobile application developed specifically for this study to measure the accuracy and reaction time (RT) of mandibular and tongue laterality discrimination. RESULTS: The chronic TMD group had a lower success rate in laterality discrimination (mean mandibular accuracy of 40% and mean tongue accuracy of 67%) than the asymptomatic group (mean mandibular accuracy of 61% and mean tongue accuracy of 90%). These results showed statistically significant differences between the groups for mandibular laterality discrimination (d, 1.14; p < 0.01) and tongue laterality discrimination (d, 0.79; p = 0.03). The asymptomatic group had faster RTs than the chronic TMD group. The data revealed statistically significant differences for the right mandibular RT (d, 0.89; p=0.02) and right tongue RT (d, 0.83; p = 0.03). However, there were no significant differences for left mandibular and left tongue RT. CONCLUSIONS: We found that the women with chronic TMDs had a lower success rate and slower RTs in the discrimination of mandibular laterality when compared with the asymptomatic women


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Asunto(s)
Humanos , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Aplicaciones Móviles , Mandíbula/fisiopatología , Lengua/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Enfermedad Crónica , Reproducibilidad de los Resultados , Estadísticas no Paramétricas , Valores de Referencia , Tiempo de Reacción
2.
Codas ; 32(4): e20190132, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32321007

RESUMEN

PURPOSE: This study aimed at validating the MBGR Orofacial Myofunctional Assessment Protocol (MBGR Protocol) for adults with Temporal Mandibular Disorders (TMD). METHODS: The study sample was composed of 30 adults: 15 with TMD (disc displacement with reduction according to the Research Diagnostic Criteria for Temporomandibular Disorders) and 15 control individuals. The validation process encompassed the content, criterion, and construct of the protocol, as well as its inter- and intra-rater agreement levels and sensitivity and specificity values, considering a 5% statistical significance level. RESULTS: The following validities were confirmed: of content, as the MBGR Protocol covers all functional issues present in patients with TMD; of criterion, with significant correlations between the MBGR and Orofacial Myofunctional Evaluation with Scores (OMES) protocols; of construct, differentiating individuals with and without Orofacial Myofunctional Disorders (OMD) as for pain on palpation and mandible range of motion, with significant correlation between the MBGR clinical evaluation and that using a digital algometer, as well as confirmation of the instrumental assessment for the breathing mode classification. Agreement ranged from poor to very good and from reasonable to very good for the inter- and intra-rater power analyses, respectively. High sensitivity and specificity values were observed. CONCLUSION: The MBGR Protocol proved to be valid for use in adults presented with TMD with disc displacement with reduction and controls, covering all aspects that enable the analysis of OMD in these individuals.


Asunto(s)
Trastornos de Deglución/diagnóstico , Músculos Faciales/fisiopatología , Mandíbula/fisiopatología , Tamizaje Masivo/instrumentación , Trastornos de la Articulación Temporomandibular/diagnóstico , Adolescente , Adulto , Estudios de Casos y Controles , Trastornos de Deglución/fisiopatología , Femenino , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Trastornos del Movimiento/diagnóstico , Trastornos del Movimiento/fisiopatología , Dimensión del Dolor , Sensibilidad y Especificidad , Trastornos de la Articulación Temporomandibular/fisiopatología , Adulto Joven
3.
J Appl Oral Sci ; 28: e20190399, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32348443

RESUMEN

Objectives To evaluate the acoustic properties of the /s/ sound in individuals with different occlusion types and to investigate relationships between these properties and cephalometric measurements. Methodology Sixty patients were divided into three groups based on malocclusion. Group 1 included 20 patients (mean age: 14.85±2.01 years) with Class I skeletal and dental relationships. Group 2 included 20 patients (mean age: 13.49±1.78 years) with Class II skeletal and dental relationships. Group 3 included 20 patients (mean age: 12.46±2.62 years) with Class III skeletal and dental relationships. Cephalometric tracings were obtained from cephalometric radiographs. All included patients were native speakers of Turkish. The /s/ sound was selected for center of gravity analysis. Correlations between cephalometric values and acoustic parameters were also investigated. Results The center of gravity of the /s/ sound had the lowest value in Group 2 (p<0.05). For the /s/ sound in Group 3, moderate positive correlations were found between center of gravity and Sella-Nasion to Gonion-Gnathion angle (p<0.05, r=0.444) Lower incisor to Nasion-B point (p<0.023, r=0.505), and Lower incisor to Nasion-B point angle (p<0.034; r=0.476). No correlation was found in other cephalometric measurements. Conclusions The /s/ sound was affected by malocclusion due to the changing place of articulation. Therefore, referral to an orthodontist for malocclusion treatment especially patients with class III in the early period is suggested for producing acoustically ideal sound.


Asunto(s)
Cefalometría , Maloclusión/fisiopatología , Acústica del Lenguaje , Trastornos del Habla/fisiopatología , Adolescente , Niño , Femenino , Humanos , Masculino , Maloclusión/complicaciones , Maloclusión/diagnóstico por imagen , Mandíbula/anatomía & histología , Mandíbula/fisiopatología , Maxilar/anatomía & histología , Maxilar/fisiopatología , Estudios Prospectivos , Radiografía , Valores de Referencia , Trastornos del Habla/diagnóstico por imagen , Trastornos del Habla/etiología , Estadísticas no Paramétricas , Lengua/anatomía & histología , Lengua/fisiopatología , Turquia
4.
J Craniofac Surg ; 31(3): 716-719, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32049900

RESUMEN

BACKGROUND: Maxillomandibular advancement is an effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeleton. The authors sought to determine whether an advancement of 10 mm predicts surgical success and if any correlation existed between the magnitude of mandibular/maxillary advancement and improvement in polysomnography metrics using aggregated individual patient data from multiple studies. METHODS: A search of the PubMed database was performed to identify relevant articles that included preoperative and postoperative polysomnography data and measurements of the advancement of both the maxillary and mandibular portions of the face in patients with normal or class I malocclusion. Each patient was stratified into "Success" or "Failure" groups based on criteria defining a "Success" as a 50% preoperative to post-operative decrease in AHI or RDI and a post-operative AHI or RDI <20. RESULTS: A review of the PubMed database yielded 162 articles. Review of these resulted in 9 manuscripts and a total of 109 patients who met the inclusion criteria. There was no statistically significant difference in the amount of anterior advancement of either the mandible (P = 0.96) or the maxilla (P = 0.23) between the "Success" or "Failure" groups. CONCLUSIONS: While there is a paucity of individual data available, the current data does not support an ideal amount of maxillary or mandibular advancement that is required to obtain a surgical success in the treatment of OSA. Until a multicenter, prospective, randomized trial is performed, surgical planning should be tailored to patient-specific anatomy to achieve the desired result.


Asunto(s)
Maloclusión de Angle Clase I/cirugía , Apnea Obstructiva del Sueño/etiología , Humanos , Maloclusión de Angle Clase I/complicaciones , Mandíbula/fisiopatología , Avance Mandibular , Maxilar/cirugía , Polisomnografía , Resultado del Tratamiento
5.
Int J Pediatr Otorhinolaryngol ; 131: 109883, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31968274

RESUMEN

OBJECTIVE: To characterize the eating behavior, orofacial, speech myofunctional conditions, and facial temperature of children with congenital heart disease. METHOD: This is a cross-sectional and analytical study. The sample consisted of 30 children with heart disease (cyanotic or acyanotic; mean of 5.48 ± 0.84 years old) and 28 healthy children (4.98 ± 0.64 years old). Parents were given a questionnaire to assess eating behaviors (Montreal Children's Hospital Feeding Scale). The orofacial myofunctional assessment protocol (OMES-E), the Child Language Test (ABFW), and thermography infrared of facial temperature were used. Data analysis was conducted by student's t-tests, Chi-square, logistic regression, and correlation analysis. RESULTS: Eating behavior in Parents did not perceive eating behavior differences between the heart disease and control groups. However, the percentage of children with some feeding difficulty was higher in the heart disease group. There was a difference between groups regarding the appearance and posture of structures, the mobility of the mandibular and cheek, swallowing function, and the total function score. Thermographic variables did not differ between the groups, but better performance in orofacial functions correlated with the temperature of the labial commissure and lower lip points. CONCLUSIONS: The frequency of children with eating difficulties was higher among those with congenital heart disease, as was the increased facial temperature at the medial eyelid commissions point when submitted to interventional procedures. The orofacial myofunctional aspects showed changes in posture and position, mobility, and orofacial functions among children with heart disease as compared to the control group. There was a correlation between the temperature of the thermo-anatomical points of the labial commissure and the lower lip as well as the OMES-E function score.


Asunto(s)
Deglución/fisiología , Cara , Conducta Alimentaria/fisiología , Cardiopatías Congénitas/fisiopatología , Masticación/fisiología , Temperatura Cutánea , Estudios de Casos y Controles , Niño , Preescolar , Estudios Transversales , Femenino , Cardiopatías Congénitas/complicaciones , Humanos , Masculino , Mandíbula/fisiopatología , Postura/fisiología
6.
Med Biol Eng Comput ; 58(2): 383-399, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31853774

RESUMEN

The osseous regeneration of large bone defects is still a major clinical challenge in maxillofacial and orthopedic surgery. Previous studies demonstrated that biphasic electrical stimulation (ES) stimulates bone formation; however, polyimide electrode should be removed after regeneration. This study presents an implantable electrical stimulation bioreactor with electrodes based on liquid crystal polymer (LCP), which can be permanently implanted due to excellent biocompatibility to bone tissue. The bioreactor was implanted into a critical-sized bone defect and subjected to ES for one week, where bone regeneration was evaluated four weeks after surgery using micro-CT. The effect of ES via the bioreactor was compared with a sham control group and a positive control group that received recombinant human bone morphogenetic protein (rhBMP)-2 (20 µg). New bone volume per tissue volume (BV/TV) in the ES and rhBMP-2 groups increased to 132% (p < 0.05) and 174% (p < 0.01), respectively, compared to that in the sham control group. In the histological evaluation, there was no inflammation within the bone defects and adjacent to LCP in all the groups. This study showed that the ES bioreactor with LCP electrodes could enhance bone regeneration at large bone defects, where LCP can act as a mechanically resistant outer box without inflammation. Graphical abstract To enhance bone regeneration, a bioreactor comprising collagen sponge and liquid crystal polymer-based electrode was implanted in the bone defect. Within the defect, electrical current pulses having biphasic waveform were applied from the implanted bioreactor.


Asunto(s)
Reactores Biológicos , Regeneración Ósea/fisiología , Mandíbula/patología , Mandíbula/fisiopatología , Polímeros/química , Animales , Hueso Esponjoso/diagnóstico por imagen , Hueso Esponjoso/patología , Hueso Esponjoso/fisiopatología , Estimulación Eléctrica , Electrodos , Masculino , Mandíbula/diagnóstico por imagen , Osteogénesis , Conejos , Microtomografía por Rayos X
7.
Lasers Med Sci ; 35(1): 181-192, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31396794

RESUMEN

This study compared the efficacy of low-level laser therapy (LLLT) versus laser acupuncture therapy (LAT) in patients with temporomandibular disorders (TMDs). In this randomized, double-blind clinical trial, 45 TMD patients were randomly divided into three groups. In group 1 (LLLT), a GaAlAs laser was applied on painful masticatory muscles and TMJs (810 nm, 200 mW, 30 s per point, Gaussian beam, spot size 0.28 cm2, 21 J/cm2) two times a week for 5 weeks. In group 2 (LAT), the laser was emitted bilaterally on acupuncture points (ST6, ST7, LI4) with the same settings as the LLLT group. Group 3 (placebo) underwent treatment with sham laser. The patients were evaluated before treatment (T1), after 5 (T2) and 10 (T3) laser applications, and 1 month later (T4). The mandibular range of motion as well as pain intensity in masticatory system was recorded at each interval. There was no significant difference in mouth opening between the groups (p > 0.05), but the amount of lateral excursive and protrusive movements was significantly greater in LLLT and LAT groups than the placebo group at some intervals (p < 0.05). The overall pain intensity and pain degree at masticatory muscles (except temporal muscle) and TMJs were significantly lower in both experimental groups than the placebo group at most intervals after therapy (p < 0.05). Both LLLT and LAT were effective in reducing pain and increasing excursive and protrusive mandibular motion in TMD patients. LAT could be suggested as a suitable alternative to LLLT, as it provided effective results while taking less chair time.


Asunto(s)
Terapia por Acupuntura , Terapia por Luz de Baja Intensidad , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Método Doble Ciego , Femenino , Humanos , Láseres de Semiconductores/uso terapéutico , Masculino , Mandíbula/fisiopatología , Mandíbula/efectos de la radiación , Dolor/complicaciones , Rango del Movimiento Articular/efectos de la radiación , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/radioterapia , Resultado del Tratamiento
8.
Lasers Med Sci ; 35(2): 439-445, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31325122

RESUMEN

The aim of the present study was to evaluate the effect of intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes on pain, mandibular range of motion, and functioning in women with myogenous temporomandibular disorder. A randomized, sham-controlled, double-blind clinical trial was conducted involving 30 women with myogenous temporomandibular disorder diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders. The participants were randomly allocated to two groups (active and sham photobiomodulation). The evaluations involved this use of the visual analog scale, digital calipers, and a functional scale. Photobiomodulation was administered intraorally in the region of the pterygoid muscles, bilaterally, in all participants for a total of six sessions. Evaluations were performed on five occasions: prior to the intervention, immediately after the first session, 24 h and 48 h after the first session, and after the six sessions. Significant differences between groups were found regarding pain (p ≤ 0.01) and functioning (p ≤ 0.04). However, no statistically significant difference was found regarding range of mandibular motion. The findings demonstrate that intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes diminishes pain and improves functioning but does not exert an influence on mandibular range of motion in women with temporomandibular disorder.Trial registration: NCT02839967.


Asunto(s)
Terapia por Luz de Baja Intensidad , Dolor/radioterapia , Trastornos de la Articulación Temporomandibular/fisiopatología , Adulto , Método Doble Ciego , Femenino , Humanos , Mandíbula/fisiopatología , Mandíbula/efectos de la radiación , Dolor/fisiopatología , Dimensión del Dolor , Rango del Movimiento Articular , Factores de Tiempo , Escala Visual Analógica
9.
J. appl. oral sci ; 28: e20190399, 2020. tab, graf
Artículo en Inglés | LILACS, BBO - Odontología | ID: biblio-1101253

RESUMEN

Abstract Objectives To evaluate the acoustic properties of the /s/ sound in individuals with different occlusion types and to investigate relationships between these properties and cephalometric measurements. Methodology Sixty patients were divided into three groups based on malocclusion. Group 1 included 20 patients (mean age: 14.85±2.01 years) with Class I skeletal and dental relationships. Group 2 included 20 patients (mean age: 13.49±1.78 years) with Class II skeletal and dental relationships. Group 3 included 20 patients (mean age: 12.46±2.62 years) with Class III skeletal and dental relationships. Cephalometric tracings were obtained from cephalometric radiographs. All included patients were native speakers of Turkish. The /s/ sound was selected for center of gravity analysis. Correlations between cephalometric values and acoustic parameters were also investigated. Results The center of gravity of the /s/ sound had the lowest value in Group 2 (p<0.05). For the /s/ sound in Group 3, moderate positive correlations were found between center of gravity and Sella-Nasion to Gonion-Gnathion angle (p<0.05, r=0.444) Lower incisor to Nasion-B point (p<0.023, r=0.505), and Lower incisor to Nasion-B point angle (p<0.034; r=0.476). No correlation was found in other cephalometric measurements. Conclusions The /s/ sound was affected by malocclusion due to the changing place of articulation. Therefore, referral to an orthodontist for malocclusion treatment especially patients with class III in the early period is suggested for producing acoustically ideal sound.


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Acústica del Lenguaje , Trastornos del Habla/fisiopatología , Cefalometría , Maloclusión/fisiopatología , Valores de Referencia , Trastornos del Habla/etiología , Trastornos del Habla/diagnóstico por imagen , Lengua/anatomía & histología , Lengua/fisiopatología , Turquia , Radiografía , Estudios Prospectivos , Estadísticas no Paramétricas , Maloclusión/complicaciones , Maloclusión/diagnóstico por imagen , Mandíbula/anatomía & histología , Mandíbula/fisiopatología , Maxilar/anatomía & histología , Maxilar/fisiopatología
10.
Cient. dent. (Ed. impr.) ; 16(3): 181-190, sept.-dic. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-185992

RESUMEN

Introducción: La osteonecrosis de los maxilares inducida por medicamentos (MRONJ) es una reacción adversa severa causada por determinados fármacos empleados para el tratamiento del cáncer y la osteoporosis que cursa con una destrucción progresiva del hueso de los maxilares. Actualmente, no se ha establecido un protocolo de tratamiento ideal para el manejo de la enfermedad. En los últimos años, el desarrollo de los concentrados plaquetarios autólogos (CPA) y su empleo en la mejora de la cicatrización ósea en el área oral ha ido en aumento. El objetivo de este trabajo es determinar la efectividad de la aplicación de CPA en el lecho quirúrgico en pacientes con riesgo de desarrollar MRONJ o con MRONJ ya establecida. Material y métodos: Se realizó una búsqueda bibliográfica en las plataformas MEDLINE/PubMed, Science Direct y Cochrane Central Registred of Controlled Trials (CENTRAL) desde el año 2003 al 2018.Resultados: Fueron incluidos 28 artículos originales en los cuáles se trataron 299 casos con MRONJ con CPA logrando la curación en 274 (92%). Y se emplearon los CPA en la prevención de la enferme-dad en 1.970 situaciones quirúrgicas en pacientes con riesgo de MRONJ sometidos a cirugías orales y no se desarrolló la enfermedad en ninguno de los casos. Conclusiones: Debido al bajo nivel de evidencia de los estudios revisados, a la heterogeneidad entre los mismos y al tamaño muestral reducido, los resultados obtenidos no aportan evidencia científica suficiente que demuestre una ventaja objetiva en el empleo de CPA en el tratamiento y prevención de la MRONJ


Purpose: Medication related osteonecrosis of the jaws (MRONJ) is an adverse drug reaction consisting on progressive bone destruction in the maxilofacial region of patients with cancer or osteoporosis under treatment with certain drugs. The management of patients with MRONJ remains controversial as an ideal treatment protocol has not been yet established. Autologous platelet concentrates (APC) have demonstrated to improve bone healing. The aim of the present systematic review is to evaluate the effectiveness of APC’s application for treatment and prevention of MRONJ. Methods: a bibliographic research was performed on the following databases: MEDLINE/PubMed, ScienceDirect and Cochrane Central Registred of Controlled Trials (CENTRAL). Results: 28 studies were included, reporting on 299 patients affected by MRONJ were treated in combination with APC, satisfactory healing was observed in 92%. Additionaly, APC for MRONJ prevention were used in 1.970 risky patients undergoing oral surgery procedures, and none of them developed osteonecrosis.Conclusion: Although the results obtained using APC for MRONJ prevention are satisfactory, due to the low level of evidence, the heterogenety and small simple size of the studies, cannot be demonstrated that the use of APC is beneficial for the treatment and prevention of MRONJ


Asunto(s)
Humanos , Osteonecrosis/inducido químicamente , Osteonecrosis/prevención & control , Fibrina Rica en Plaquetas , Osteonecrosis de los Maxilares Asociada a Difosfonatos/epidemiología , Osteonecrosis/terapia , Mandíbula/efectos de los fármacos , Mandíbula/fisiopatología , Plaquetas/metabolismo , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico , Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia
11.
J Long Term Eff Med Implants ; 29(1): 79-86, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31679205

RESUMEN

The All-on-4 treatment concept is a felicitous approach for treatment of edentulous mandible. Mandibular flexure plays a decisive role in several restorative failures-for instance, screw loosening, particularly in widely separated implant supports such as those utilized in All-on-4 treatment methods. We investigated the effect of mandibular flexure on stress distribution and likelihood of bone loss or growth in the implanted mandible using two frequently used All-on-4 methods of implantation: parallel and tilted. Three-dimensional finite-element models of mandible and dental implants together with their compartments were developed. Assuming sagittal symmetry for the mandible, only half of the full geometry was considered. In the parallel model, two dental implants were inserted into the mandible perpendicular to the occlusal plane. In the tilted model, the posterior implant was rotated 30° around the buccal-lingual axis. In both models, maximum stress was detected at the neck region of the posterior implant. This maximum stress was greater in the tilted model than in the parallel model. However, since the corresponding strain was considerably lower in the parallel model, according to mechanostat theory several elements in the parallel model were at risk of bone loss. In contrast, the greater strain in the tilted model decreased the likelihood of bone loss. These findings suggest that use of tilted implants in the treatment of edentulous mandible would reduce the probability of bone loss in vulnerable parts of the osseous tissue surrounding dental implants.


Asunto(s)
Pérdida de Hueso Alveolar/etiología , Implantación Dental/métodos , Arcada Edéntula/cirugía , Mandíbula , Estrés Mecánico , Adulto , Fenómenos Biomecánicos , Resorción Ósea , Simulación por Computador , Implantación Dental/efectos adversos , Implantes Dentales/efectos adversos , Análisis de Elementos Finitos , Humanos , Mandíbula/fisiopatología , Enfermedades Mandibulares/etiología , Modelos Teóricos
13.
J Biomech ; 95: 109320, 2019 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-31472969

RESUMEN

Serious mandibular diseases such as tumor or osteonecrosis often require segmental or marginal mandibulectomy, the latter with improved outcome thanks to preserved mandibular continuity. Nevertheless, gradual osteolytic and/or osteosclerotic skeletal changes frequently indicate repetitive resections. Based on the fundamental adaptivity of bone to mechanical loads, the question arose whether resection-related anatomical alterations trigger relevant pathological skeletal adaptations. For a clinical case after mandibular box resection due to progressive osteoradionecrosis (ORN), routine biomechanical loading was simulated by finite element method, respecting pathology-related anatomy, tissue properties, and biting capacity. By 3D-visualization of the mandible's pathological development from follow-up-CT's over four years, remarkable correspondences of skeletal resorptions and increased unphysiological strain were revealed. Higher unphysiological load was correlated with more serious and earlier skeletal alterations. Three months post-operatively, serious buccal destruction at the distal resection corner occurred in correspondence with dominant tensile strain. At the resection, elevated strain caused by reduced alveolar height corresponded to skeletal compromise, observed 8-9 months post-operatively. ORN-related lesions, diagnosed before resection, entailed unphysiological strain coinciding with local skeletal alterations. Simulations with "healthy" instead of pathological tissue coefficients induced quantitative improvements of 25-33%, but without fundamental change. These results suggest a decisive contribution of resection-related biomechanical skeletal adaptations to this patient's mandibular decline with hemimandibulectomy about 2.5 years after the first resection. However, mechanical stress concentrations in sharp angles as the distal resection corner and reduced stability due to decreased alveolar height generally bear the danger of pathological biomechanics and severe skeletal adaptations for patients after mandibular box resection.


Asunto(s)
Resorción Ósea/patología , Mandíbula/cirugía , Modelos Biológicos , Estrés Mecánico , Fenómenos Biomecánicos , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/fisiopatología , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Mandíbula/fisiopatología , Tamaño de los Órganos , Tomografía Computarizada por Rayos X
14.
BMC Oral Health ; 19(1): 205, 2019 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-31484524

RESUMEN

BACKGROUND: Bruxism is among the habits considered generally as contributory factors for temporomandibular joint (TMJ) disorders and its etiology is still controversial. METHODS: Three-dimensional models of maxilla and mandible and teeth of 37 patients and 36 control subjects were created using in-vivo image data. The maximum values of stress and deformation were calculated in 21 patients six months after using a splint and compared with those in the initial conditions. RESULTS: The maximum stresses in the jaw bone and head of mandible were respectively 4.4 and 4.1 times higher in patients than in control subjects. Similar values for deformation were 5.8 and 4.9, respectively. The maximum stress in the jaw bone and head of mandible decreased six months after splint application by up to 71.0 and 72.8%, respectively. Similar values for the maximum deformation were 80.7 and 78.7%, respectively. Following the occlusal splint therapy, the approximation of maximum deformation to the relevant values in control subjects was about 2.6 times the approximation of maximum stress to the relevant values in control subjects. The maximum stress and maximum deformation occurred in all cases in the head of the mandible and the splint had the highest effectiveness in jaw bone adjacent to the molar teeth. CONCLUSIONS: Splint acts as a stress relaxer and dissipates the extra stresses generated as well as the TMJ deformation and deviations due to bruxism. The splint also makes the bilateral and simultaneous loading possible and helps with the treatment of this disorder through regulation of bruxism by creating a biomechanical equilibrium between the physiological loading and the generated stress.


Asunto(s)
Bruxismo/terapia , Ferulas Oclusales , Trastornos de la Articulación Temporomandibular/terapia , Bruxismo/diagnóstico , Análisis de Elementos Finitos , Humanos , Mandíbula/fisiopatología
15.
Med Hypotheses ; 130: 109280, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31383322

RESUMEN

There is large support in literature linking tinnitus to dental occlusion and temporomandibular joint disorders (TMD). However, there is no model to explain such a link. This hypothesis explains how the fusimotor system of the muscles innervated by the trigeminal motor nucleus is affected by inadequacies in the occlusion of the teeth that cause changes in posture and movement of the mandible. Reptile to mammal evolution shows that stomatognathic structures underwent changes related to mastication. Among several changes, there was the appearance of a new articulation between the mandible and skull: the temporomandibular joint. The bones of the old reptile joint, quadrate-articular, have detached from the mandible and are part of the middle ear bone chain. The former becomes the incus and the latter the malleus. This bone change also carried the tensor tympani and its trigeminal motor innervation. Inadequate occlusal contacts give rise to an adapted function of the mandible and the most common compensatory muscular response is hypertonia involving all mandibular muscles, including the tensor tympani. A fundamental clinical feature that demonstrates the involvement of the trigeminal fusimotor system is the characteristic pain by palpation, but no pain on the mandibular movement. Muscle pain is always felt in the dermatome innervated by the mandibular branch of the trigeminal nerve, which carries the motor fibers, reported as tightening, similar to cramp, and has regular behavior in intensity, duration and frequency. In addition, the patient has increased musculature volume, detected by palpation of certain anatomical landmarks, but with loss of functional efficiency. The neuromotor control of the mandibular movements is poor and when asked to make lateral jaw movement touching the teeth, it is common to observe that the patient moves the lips, eyes, and even turns the head in the same direction as the movement. There is also difficulty eating hard foods and talking fast. Tongue biting while chewing is frequent, meaning that these non-physiological events surpass protective reflex circuits. The report of ear pain, tinnitus, blocked ear sensation and sudden hearing loss is common in such patients, compatible with the tonic contraction of the tensor tympani. The fusimotor system hypothesis is able to explain all events related to the symptoms and helps to establish a correct diagnosis for certain types of hearing disorders.


Asunto(s)
Oclusión Dental , Trastornos de la Articulación Temporomandibular/complicaciones , Articulación Temporomandibular/fisiopatología , Acúfeno/etiología , Evolución Biológica , Humanos , Hipercinesia , Mandíbula/fisiopatología , Masticación , Modelos Teóricos , Movimiento , Músculo Temporal/patología , Tensor del Tímpano , Diente/fisiopatología , Núcleo Motor del Nervio Trigémino
16.
Am J Orthod Dentofacial Orthop ; 156(2): 178-185, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31375227

RESUMEN

INTRODUCTION: This study aimed to identify significant factors affecting the spontaneous angular changes of impacted mandibular third molars as a result of second molar protraction. Temporary skeletal anchorage devices in the missing mandibular first molar (ML-6) or missing deciduous mandibular second molar (ML-E) with missing succedaneous premolar spaces provided traction. METHODS: Forty-one mandibular third molars of 34 patients (10 male and 24 female; mean age 18.3 ± 3.7 years) that erupted after second molar protraction were included in this study. They were classified into upright (U) and tilted (T) groups. Linear and angular measurements were performed at the time of treatment initiation (T1) and of ML-6 or ML-E space closure (T2). Regression analyses were used to identify significant factors related to third molar uprighting. RESULTS: Nolla stage (odds ratio [OR] 4.1), sex (OR 0.003 for male), third molar angulation at T1 (OR 1.1), missing tooth space (OR 0.006), rate of third molar eruption (OR 23.3), and rate of second molar protraction (OR 0.2) significantly affected third molar uprighting. Age, third molar angulation at T1, rate of third molar eruption, and rate of second molar protraction were significant factors for predicting third molar angulation at T2. CONCLUSIONS: Available space for third molar eruption before and after second molar protraction is not associated with uprighting of erupting third molars. Older patients whose third molars are in greater Nolla stage, are in a more upright position at T1, and have a greater eruption rate have a greater chance for third molar uprighting. Alternatively, an increase in second molar protraction rate results in mesial tipping of the third molars.


Asunto(s)
Maloclusión/prevención & control , Maloclusión/fisiopatología , Mandíbula/fisiopatología , Tercer Molar/fisiopatología , Diente Impactado/fisiopatología , Adolescente , Adulto , Puntos Anatómicos de Referencia , Diente Premolar , Femenino , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Mandíbula/anatomía & histología , Mandíbula/diagnóstico por imagen , Diente Molar/anatomía & histología , Diente Molar/diagnóstico por imagen , Diente Molar/fisiopatología , Tercer Molar/anatomía & histología , Tercer Molar/diagnóstico por imagen , Aparatos Ortodóncicos , Cierre del Espacio Ortodóncico , Ortodoncia Correctiva , Erupción Dental , Diente Primario , Diente Impactado/complicaciones , Diente Impactado/diagnóstico por imagen , Adulto Joven
17.
Biomed Res Int ; 2019: 1680158, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31321229

RESUMEN

Introduction: Dental aplasia is an anomaly in which the number of teeth is reduced. It is the most commonly occurring dental anomaly during tooth development. Treatment management of patients with dental aplasia is challenging. Objectives: The aim of this retrospective clinical study was to analyze the survival and success rates of dental implants placed in hypodontic patients, rated with different criteria. Methods: Forty-three patients were diagnosed with dental aplasia and treated with dental implants between November 2000 and February 2016. The variables assessed included the plaque level, bleeding on probing, probing depth, implant mobility, implant stability, and implant loss. To analyze the peri-implant bone level, a panoramic X-ray of each patient was taken. The results were compared with X-rays taken immediately after implantation. Results: Thirty-seven patients (16 males; 21 females) participated in this study. In total, 155 implants (86 maxillary; 69 mandibular) were inserted. Two of the 155 implants failed; the in situ survival rate was 98.7%. The success rate according to the criteria of Buser et al. was 96.8%, and that according to the criteria of Albrektsson et al. was 88.4%. Conclusion: The survival and success rates of dental implants in patients with congenitally absent teeth were very high and did not differ significantly from results achieved in an unaffected population. Dental implants are a reliable therapy for patients with dental aplasia.


Asunto(s)
Pérdida de Hueso Alveolar/prevención & control , Implantación Dental Endoósea/métodos , Implantes Dentales de Diente Único , Implantes Dentales , Adulto , Anciano , Pérdida de Hueso Alveolar/fisiopatología , Diseño de Prótesis Dental/métodos , Femenino , Humanos , Masculino , Mandíbula/fisiopatología , Maxilar/fisiopatología , Persona de Mediana Edad
19.
Niger J Clin Pract ; 22(6): 754-762, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31187758

RESUMEN

Background: Reconstruction of bone defects in oral and maxillofacial surgery has widespread uses. In recent years, the capacity of various biomaterials alone or in combination with bone graft materials to increase bone healing has been an intensive research topic. The aim of this study is to evaluate the efficacy of hyaluronic acid and/or bone graft material on bone healing in defects created in the rat mandible. Methods: In our study, rats were divided into 4 groups. Group 1 is designated to be treated with no materials, Group 2 with graft material, Group 3 with only hyaluronic acid, and Group with hyaluronic acid and graft material. A critical-size defect of 5 mm in diameter was created bilaterally in the rat mandibles and the rats were divided into the indicated groups accordingly. At the end of the postoperative 6th week, the experiment was terminated. The right halves of the mandibles were evaluated immunohistochemically and histopathologically in terms of bone healing, and the left in terms of mineralization level via microcomputed tomography. Results: Histopathological evaluation showed that healing in the empty group was significantly lower than the other groups that were treated with materials (P < 0.05); but the difference between the material-treated groups was not significant. Immunohistochemical evaluation revealed that the staining was moderately positive/strongly positive in all groups, but the difference between the groups was not significant. The highest mineralization values observed in the defected areas that belonged to 2 groups using hyaluronic acid, and the difference between them was found to be statistically significant (P < 0.05). The lowest mineralization values observed in the defected areas was most frequent in the group where only the hyaluronic acid was used, and there was a statistically significant difference between the other groups (P < 0.05). Conclusion: In conclusion, the use of hyaluronic acid alone or in combination with bone grafting has been shown to contribute positively to the improvement of bone defects in the jaw area.


Asunto(s)
Materiales Biocompatibles/uso terapéutico , Trasplante Óseo , Ácido Hialurónico/uso terapéutico , Enfermedades Mandibulares/cirugía , Cicatrización de Heridas , Animales , Regeneración Ósea/efectos de los fármacos , Calcificación Fisiológica/efectos de los fármacos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/fisiopatología , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/patología , Ratas , Cicatrización de Heridas/efectos de los fármacos , Microtomografía por Rayos X
20.
Eur J Oncol Nurs ; 40: 111-119, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31229200

RESUMEN

PURPOSE: The purpose of the study was to investigate the effects of a mouth-opening intervention for postoperative trismus and remote support provided via telephone following hospital discharge for intervention adherence in patients with oral cancer. METHODS: The study is a parallel randomized trial. Patients admitted at a general hospital for oral cancer surgery were recruited and randomly assigned to either the experimental or the active control group. Both groups underwent a 12-week intervention program, including warm compress, masticatory muscle massage, and jaw exercise. Subjects in the experimental group received additional support via telephone following hospital discharge. Data on intervention adherence maximum interincisal opening and mandibular function impairment were collected at baseline, week 4, and week 12. RESULTS: Sixty subjects (30 in each group) that completed the study were included in the analysis. At week 12, the intervention practice time in the experimental group was 299.67 min (95% CI: 223.44-357.89) more than that of the active control group. From baseline to week 12, the change in maximum interincisal opening was 10.30 mm (95% CI: 8.22-12.37) greater in the experimental than in the active control group. The change in mandibular function impairment score was -0.36 (95% CI: -0.44 to -0.28) greater in the experimental than in the active control group. CONCLUSIONS: The study results support the effect of remote support via telephone for enhancing adherence to the intervention protocol, and the effect of the intervention program for alleviating trismus and mandibular function impairments in patients who receive curative surgery for oral cancer.


Asunto(s)
Neoplasias de la Boca/cirugía , Complicaciones Posoperatorias/prevención & control , Consulta Remota , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Trismo/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Mandíbula/fisiopatología , Persona de Mediana Edad , Resultado del Tratamiento
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