Three-dimensional comparison between the effects of mandibular advancement device and maxillomandibular advancement surgery on upper airway.

BACKGROUND: The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA. METHODS: The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation. RESULTS: Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and - 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region. CONCLUSIONS: The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.

Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes.

OBJECTIVES: This study aims to assess craniofacial dimensions in obstructive sleep apnea (OSA) patients treated with a mandibular advancement device (MAD) and to identify anatomic influences on OSA severity and MAD therapy outcomes. MATERIALS AND METHODS: Twenty patients with OSA were prospectively treated with MAD. Clinical, cone-beam computed tomography, and polysomnography exams were performed before treatment and 4-6 months after achieving the MAD therapeutic position. Polysomnographic exams and three-dimensional maxillary, mandibular, and upper airway (UA) measurements were evaluated. Pearson's correlation and t-tests were applied. RESULTS: Before MAD treatment, the transverse width measured at the frontomaxillary suture and the angle between the mandibular ramus and Frankfurt horizontal were statistically correlated with apnea and the hypopnea index (AHI), while the gonial angle was correlated with therapeutic protrusion. After MAD treatment, all patients showed a significant AHI reduction and an improvement in minimum oxyhemoglobin saturation. The UA total volume, superior and inferior oropharynx volume, and area were statistically correlated with MAD therapeutic protrusion. The UA total area showed a statistical correlation with the improvement in AHI, and the superior oropharynx volume and area increased significantly. CONCLUSIONS: The transversal frontomaxillary suture width and the mandibular ramus facial angle may influence OSA severity. The gonial angle, volume, and area of all UA regions may indicate the amount of protrusion needed for successful MAD treatment. CLINICAL RELEVANCE: The craniofacial characteristics reported as important factors for OSA severity and MAD treatment outcomes impact therapy planning for OSA patients, considering individual anatomic characteristics, prognosis, and cost benefits.

COVID-19 and dental sleep medicine: risks, precautions and patient guidance.

COVID-19 is the offcial name for the disease caused by SARS-CoV-2, which has become a pandemic, infecting more than 5 million people worldwide. Transmission occurs by inhaling droplets generated when an infected person coughs, sneezes or exhales, or by touching contaminated surfaces and then rubbing their hands over their eyes, nose or mouth. Some infected people become seriously ill, while others have no symptoms, but even though they are asymptomatic, they can still transmit the virus. As vaccines and effective medications do not yet exist, the only way to handle the devastating consequences of the pandemic is prevention. Quality of sleep is essential for the immune system to be prepared to receive, fight and restore itself after a viral infection. Therefore, patients with obstructive sleep apnea (OSA) should continue treatment, and only suspend or change the therapeutic modality under the guidance of a sleep physician. In the era of COVID-19, due to the high probability of contamination promoted by CPAP, the mandibular repositioning device has been considered as the first choice for patients with OSA. However, as the dental approach is at high risk of contamination, due to the proximity of the dental surgeon to the patient, it is essential that the professional who works in this field knows the risks to which they are exposed. Precautions must be adopted and patients should be guided in order to control and use of their intraoral devices.

An Operational Clinical Approach in the Diagnosis and Management of Sleep Bruxism: A First Step Towards Validation.

Exacerbation of nighttime sleep-related oromotor activity is often recognized as a relevant clinical entity commonly known as sleep bruxism (SB). Many pragmatic issues about SB diagnosis and management remain controversial. Therefore, within a critical review of the literature, this article proposes an operational clinical approach for SB diagnosis and management, with a focus on three comorbidities frequently occurring in relation to sleep: obstructive sleep apnea (OSA), gastroesophageal reflux disease (GERD), and insomnia. In the absence of any comorbidities, and if clinically justified, short-term medication and/or splints may be considered. If a comorbid condition is suspected, then the patient should be screened for OSA, GERD, and insomnia. For OSA screening, the Epworth Sleepiness Scale, STOP-Bang, and NoSAS questionnaires are available validated tools. For GERD screening, a positive patient report, whether associated or not with clinical signs and symptoms of heartburn and/or regurgitation, can be tested. For insomnia screening, report of difficulties initiating or maintaining sleep or of early morning awakening more than three times a week may be useful for diagnosis clarification. An adequate clinical approach for comorbid SB requires that both SB and the related comorbid condition be properly assessed and managed. Very often, improvement of SB with treatment of the associated condition will confirm the relationship and establish a more precise diagnosis (ie, secondary SB). Clinicians intending to manage SB should be able to identify these possible clinical interactions, and, if needed, perform an integrative multidimensional approach. Some approaches will benefit from a multidisciplinary approach for achieving therapeutic success.

Prevalence of temporomandibular disorders in rugby players.

Rugby is played by more than 3 million people in over 100 countries on 5 continents. Playing rugby can result in 2-3 times more dental and facial trauma than American football or other contact sports. Facial trauma in sports has been associated with the development of temporomandibular disorders (TMDs). This study aimed to determine the prevalence of TMDs in rugby players. The Research Diagnostic Criteria for Temporomandibular Disorders were used to assess 30 rugby players (group 1) and 28 nonathletes (group 2) for TMDs. The chi-square test was used to compare the groups, and a significance level of 5% (P < 0.05) was used for all statistical analyses. The prevalence of TMDs in groups 1 and 2 was 53.3% and 14.3%, respectively (P = 0.002). Myofascial pain was observed in 12 individuals (40%) in group 1 and in 2 individuals (7.1%) in group 2. Seven participants in group 1 (23.3%) received a diagnosis of disc displacement, and 2 participants (7.1%) in group 2 received this diagnosis. Participants in group 1 also reported significantly more tooth clenching than those in group 2 (P = 0.003).

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review.

INTRODUCTION: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. OBJECTIVE: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. METHODS: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. RESULTS: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. CONCLUSION: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review

ABSTRACT Introduction: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. Objective: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. Methods: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. Results: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. Conclusion: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.

RESUMO Introdução: efeitos colaterais oclusais e o desenvolvimento de dor e/ou disfunção do complexo temporomandibular podem levar à baixa adesão ou ao abandono do tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular. Objetivo: fornecer uma revisão abrangente da literatura sobre os efeitos colaterais craniofaciais do tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular. Métodos: foram realizadas buscas eletrônicas sistematicamente no PubMed e na Biblioteca Virtual em Saúde até outubro de 2016. Foram incluídos apenas Ensaios Controlados Randomizados, com o objetivo primário de mensurar objetivamente os efeitos colaterais no complexo craniofacial associados ao uso de aparelhos de avanço mandibular no tratamento do ronco e da apneia obstrutiva do sono. Os pacientes estudados deveriam ter 20 anos de idade ou mais. A avaliação do risco de viés dos trabalhos selecionados seguiu as recomendações do The Cochrane Risk of Bias. Resultados: no total, 62 artigos completos foram avaliados em relação à elegibilidade. Após o processo de revisão, apenas 6 atenderam aos critérios de inclusão. Todos os estudos foram julgados como tendo alto risco de viés. Os efeitos colaterais mais frequentemente encontrados foram de natureza dentária e incluíram uma diminuição do overjet e do overbite. O risco de desenvolvimento de dor ou disfunção do complexo temporomandibular pareceu limitado na avaliação de longo prazo do uso do aparelho de avanço mandibular. Conclusão: as evidências disponíveis são limitadas e sugerem que o tratamento do ronco e da apneia obstrutiva do sono com aparelhos de avanço mandibular resulta em alterações craniofaciais predominantemente dentárias, especialmente nas avaliações de longo prazo. Considerando-se que a apneia obstrutiva do sono é crônica e que os aparelho intrabucais se constituem em uma forma de tratamento contínuo e por tempo indefinido, é necessário um acompanhamento individualizado para monitorar possíveis efeitos colaterais no complexo craniofacial. Também é importante informar aos pacientes sobre esses possíveis efeitos, especialmente àqueles nos quais são esperadas maiores alterações oclusais ou nos quais elas sejam desfavoráveis. Ainda são necessárias avaliações de longo prazo dos efeitos colaterais do tratamento com aparelhos intrabucais, com amostras maiores e mais homogêneas.

Effectiveness of Maxillomandibular advancement (MMA) surgery in sleep apnea treatment: Case report.

Obstructive sleep apnea (OSA) is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA) surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI)=25.2) and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI) were considerably improved after six months (IAH =6.7) and one year of treatment (IAH=0.2).

Professional karate-do and mixed martial arts fighters present with a high prevalence of temporomandibular disorders.

BACKGROUND/AIM: Facial trauma in sports has been associated with temporomandibular disorders. Because of the intensity and duration of training needed for elite-level competitions, high-performance athletes can have two to five times more traumatic injuries than recreational athletes. This study aimed to investigate the prevalence of temporomandibular disorders in high-performance martial arts fighters and compare it with the prevalence in recreational athletes and non-athletes. MATERIAL AND METHODS: The Research Diagnostic Criteria for Temporomandibular Disorders was used to diagnose and classify professional karate-do practitioners (group I; n = 24), amateur karate-do practitioners (group II; n = 17), high-performance mixed martial arts fighters (group III; n = 13), and non-athletes (n = 28). The groups were compared with the chi-square test and tested for the difference between two proportions using a significance level of 5% (P < 0.05). RESULTS: The prevalence of temporomandibular disorders in groups I (54.2%; P = 0.003) and III (61.5%; P = 0.002) was significantly higher than in group IV (14.3%). The prevalence in group II was similar to that in group IV (P > 0.05). A diagnosis of arthralgia from disk displacement was made more frequently in groups I (45.8%; P = 0.013) and III (38.5%; P = 0.012) than in group IV (7.1%). The chronic pain associated with TMD was low intensity and low disability. CONCLUSIONS: While there was a high prevalence of temporomandibular disorders in the professional athletes in our study, the prevalence of the condition in recreational athletes was similar to that in individuals who did not practice martial arts.

Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome, / O impacto das alterações da via aérea superior na adesão e sucesso do tratamento com aparelho intraoral na Síndrome da Apneia Obstrutiva do Sono

ABSTRACT INTRODUCTION: The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). OBJECTIVE: To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. METHODS: Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared. RESULTS: 28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p = 0.02), smaller cervical circumference (p = 0.05), and lower AHI at baseline (p = 0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p = 0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence. CONCLUSION: MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.

RESUMO INTRODUÇÃO: O Aparelho Intraoral (AIO) é uma opção para tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS). OBJETIVOS: Avaliar a influência das alterações da VAS e esqueléticas faciais através de uma avaliação clinica sistematizada no sucesso e adesão ao (AIO) em pacientes com (SAOS). MÉTODO: Estudo prospectivo em que foram avaliados 30 pacientes com SAOS leve a moderada e indicação de AIO. Protocolo incluiu questionários de sono e queixas nasais; polissonografia e avaliação da VAS por rinoscopia anterior e oroscopia. Os parâmetros analisados foram comparados entre pacientes com sucesso e insucesso, e com boa e má adesão à terapia. RESULTADOS: Completaram o protocolo 28 pacientes. O sucesso ao tratamento foi de 64,3% e a adesão 60,7%. Os fatores associados ao sucesso foram menor idade, menor circunferência cervical e menor IAH basal. Quanto à presença de alterações nasais, houve predomínio de pacientes sem alteração nasal entre os pacientes com sucesso comparados àqueles com insucesso (p = 0,04); o que não foi observado em relação à adesão. Quanto às alterações faríngeas e alterações esqueléticas faciais, não houve significância. CONCLUSÃO: O sucesso do tratamento com AIO foi significativamente menor nos pacientes com alterações nasais, porém a adesão não foi influenciada pela presença de alterações de VAS ou esqueléticas faciais.

Treatment of obstructive sleep apnea with mandibular advancement appliance over prostheses: A case report.

Treatment with a mandibular advancement device (MAD) is recommended for mild obstructive sleep apnea (OSA), primary snoring and as a secondary option for Continuous Positive Airway Pressure, because it has better adherence and acceptance. However, edentulous patients do not have supports to hold the MAD. This study aimed to present a possible to OSA treatment with MAD in over complete upper and partial lower dentures. The patient, a 38-year-old female with mild OSA, was treated with a MAD. The respiratory parameter, such as apnea-hypopnea index, arousal index and oxyhemoglobin saturation was improved after treatment.

Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome.

INTRODUCTION: The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). OBJECTIVE: To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. METHODS: Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared. RESULTS: 28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p=0.02), smaller cervical circumference (p=0.05), and lower AHI at baseline (p=0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p=0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence. CONCLUSION: MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.

Prevalence of sleep bruxism in children: A systematic review

INTRODUCTION: Prevalence of sleep bruxism (SB) in children is subject to discussions in the literature. OBJECTIVE: This study is a systematic literature review aiming to critically assess the prevalence of SB in children. METHODS: Survey using the following research databases: MEDLINE, Cochrane, EMBASE, PubMed, Lilacs and BBO, from January 2000 to February 2013, focusing on studies specifically assessing the prevalence of SB in children. RESULTS: After applying the inclusion criteria, four studies were retrieved. Among the selected articles, the prevalence rates of SB ranged from 5.9% to 49.6%, and these variations showed possible associations with the diagnostic criteria used for SB. CONCLUSION: There is a small number of studies with the primary objective of assessing SB in children. Additionally, there was a wide variation in the prevalence of SB in children. Thus, further, evidence-based studies with standardized and validated diagnostic criteria are necessary to assess the prevalence of SB in children more accurately. .

INTRODUÇÃO: a prevalência de bruxismo do sono (BS) na população infantil é tema de discussões na literatura. OBJETIVO: assim, este trabalho, por meio de uma revisão sistemática, teve como objetivo avaliar, de forma crítica, a prevalência de BS em crianças. MÉTODOS: foi feito um levantamento nas bases de pesquisa MEDLINE, Cochrane, Embase, PubMed, Lilacs e BBO, entre os anos de 2000 e fevereiro de 2013, com enfoque em estudos que avaliaram especificamente a prevalência de BS em crianças. RESULTADOS: após a aplicação dos critérios de inclusão, chegou-se a quatro estudos. Entre os artigos selecionados, as taxas de prevalência de BS variaram de 5,9% a 49,6%, sendo que essas variações apresentaram possíveis associações com os critérios diagnósticos para BS. CONCLUSÃO: verifica-se um número reduzido de estudos que apresentaram o objetivo primário de avaliar o BS em crianças, além de uma grande variação nas taxas de prevalência. Torna-se necessária a realização de novos estudos, baseados em métodos de evidências e com critérios diagnósticos padronizados e validados, para avaliar com maior precisão a prevalência do BS em crianças. .

Total temporomandibular joint alloplastic reconstruction / Reconstrução aloplástica total da articulação temporomandibular

BACKGROUND AND OBJECTIVES: Temporomandibular disorders are made up of a variety of diseases involving masticatory muscles, temporomandibular joint or both. With clinical treatment, most patients improve function and pain, however when this therapy has unfavorable results, surgical treatment should be considered. Total joint reconstruction with joint prosthesis is a type of surgical procedure. This study aimed at evaluating current status of temporomandibular joint reconstructions with total prostheses. CONTENTS: A review was carried out by crossing selected descriptors in the last 25 years about prosthetic reconstruction of joint structures of the temporomandibular joint. CONCLUSION: The scarcity of highly relevant scientific studies on temporomandibular joint reconstruction with prosthesis makes impossible a systematic review, leading the procedure to be still seen and indicated with caution...

JUSTIFICATIVA E OBJETIVOS: As disfunções temporomandibulares são constituídas por uma variedade de doenças que envolvem os músculos da mastigação, a articulação temporomandibular ou ambos. Por meio de tratamento clínico, a grande maioria dos pacientes apresenta melhora da função e do quadro de dor, porém quando essa terapia não apresenta resultados favoráveis, o tratamento cirúrgico deve ser considerado. A reconstrução total da articulação através de próteses articulares é uma das formas de tratamento cirúrgico. O objetivo deste estudo foi avaliar o estágio atual das reconstruções da articulação temporomandibular, por meio de próteses totais. CONTEÚDO: Realizou-se uma revisão por meio do cruzamento dos descritores selecionados no período dos últimos 25 anos sobre reconstrução por próteses das estruturas articulares da articulação temporomandibular. CONCLUSÃO: A escassez de artigos científicos de grande relevância relacionados à reconstrução por próteses de articulação temporomandibular gera a impossibilidade da realização de uma revisão sistemática, o que faz com que o procedimento ainda seja visto e indicado com cautela...

Viscosupplementation as a treatment of internal derangements of the temporomandibular joint: retrospective study

Background and objectives: There are many non invasive treatment modalities for internal temporomandibular joint derangements described in the literature, including counseling, drug therapy, physical therapy and interocclusal devices. However, some patients become refractory to conservative treatments and procedures such as arthrocentesis, arthroscopy and temporomandibular joint surgery are indicated. Viscosupplementation is a less invasive, low cost approach with good short and long term results. This study aimed at discussing viscosupplementation to treat internal temporomandibular joint alterations with results after four months of follow-up. Methods: Participated in the study 55 patients with reducing and non reducing disc displacement and osteoarthritis refractory to conservative treatments who were submitted to sodium hyaluronate infiltrations. There has been statistically significant pain improvement for all groups. Results: Patients with non reducing disc displacement and osteoarthritis had significant mouth opening improvement. Such results were constant along the four months of follow-up. Conclusion: Viscosupplementation with sodium hyaluronate may be considered a good alternative to functionally reestablish temporomandibular joint in the short term in patients with internal alterations refractory to conservative treatments.

Justificativa e objetivos: As formas de tratamento consideradas não invasivas para as alterações internas das articulações temporomandibulares descritas na literatura são muitas, incluindo aconselhamento, farmacoterapia, fisioterapia e dispositivos interoclusais. No entanto, alguns pacientes tornamse refratários aos tratamentos conservadores, sendo indicados procedimentos como artrocentese, artroscopia e cirurgias das articulações temporomandibulares. A viscossuplementação é uma abordagem pouco invasiva, de baixo custo e com bons resultados em curto e médio prazo. O objetivo deste estudo foi discutir a viscossuplementação no tratamento das alterações internas da articulação temporomandibular com os resultados depois de quatro meses de acompanhamento. Métodos: Cinquenta e cinco pacientes com deslocamento de disco com redução, deslocamento de disco sem redução e osteoartrite refratários a tratamentos conservadores foram submetidos a infiltração com hialuronato de sódio. Foi observada melhora estatisticamente significativa para dor nos três grupos. Resultados: Pacientes com deslocamento de disco sem redução e osteoartrite apresentaram aumento significativo da abertura bucal. Estes resultados se mantiveram constantes ao longo dos quatro meses de acompanhamento. Conclusão: A viscossuplementação com hialuronato de sódio pode ser considerada uma boa alternativa no reestabelecimento funcional da articulação temporomandibular em curto prazo em pacientes com alterações internas refratárias a tratamentos conservadores.

Prevalence of sleep bruxism in children: a systematic review.

INTRODUCTION: Prevalence of sleep bruxism (SB) in children is subject to discussions in the literature. OBJECTIVE: This study is a systematic literature review aiming to critically assess the prevalence of SB in children. METHODS: Survey using the following research databases: MEDLINE, Cochrane, EMBASE, PubMed, Lilacs and BBO, from January 2000 to February 2013, focusing on studies specifically assessing the prevalence of SB in children. RESULTS: After applying the inclusion criteria, four studies were retrieved. Among the selected articles, the prevalence rates of SB ranged from 5.9% to 49.6%, and these variations showed possible associations with the diagnostic criteria used for SB. CONCLUSION: There is a small number of studies with the primary objective of assessing SB in children. Additionally, there was a wide variation in the prevalence of SB in children. Thus, further, evidence-based studies with standardized and validated diagnostic criteria are necessary to assess the prevalence of SB in children more accurately.

Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review.

INTRODUCTION: In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ) is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve function in patients who present arthrogenic temporomandibular disorders. OBJECTIVE: This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. METHODS: Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. RESULTS: After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. CONCLUSION: After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.

Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review

INTRODUCTION: In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ) is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve patients' functions who present arthrogenic temporomandibular disorders. OBJECTIVE: This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. METHODS: Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October of 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. RESULTS: After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. CONCLUSION: After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.

INTRODUÇÃO: em algumas situações, o tratamento conservador das alterações internas da articulação temporomandibular apresenta-se pouco responsivo. Nessas condições, torna-se necessária a realização de tratamentos que visem reduzir a dor e melhorar a função dos pacientes frente a disfunções temporomandibulares articulares. OBJETIVO: esse trabalho, por meio de uma revisão sistemática de literatura, teve como objetivo analisar a efetividade de infiltrações intra-articulares com corticosteroides e com hialuronato de sódio no tratamento para as alterações internas da ATM. MÉTODOS: foi feito levantamento nas bases de pesquisa MEDLINE, Cochrane, EMBASE, PubMed, Lilacs e BBO, abrangendo os anos de 1966 a outubro de 2010, com enfoque em estudos clínicos controlados randomizados ou quase-randomizados, cegos ou duplo-cegos. RESULTADOS: após a aplicação dos critérios de inclusão, chegou-se a nove artigos, sendo que sete eram estudos clínicos controlados randomizados duplo-cego e dois eram estudos clínicos controlados randomizados apenas cegos. CONCLUSÕES: pela análise da literatura, verifica-se que a infiltração intra-articular com corticosteroides e hialuronato de sódio parece ser um método efetivo no tratamento das alterações internas da ATM. Porém, são necessários mais estudos clínicos controlados randomizados, com amostras representativas e tempo de acompanhamento longo, para avaliar a real efetividade da técnica.

Eletromiografia de superfície em disfunção temporomandibular: revisão sistemática / Surface electromyography for temporomandibular disorders: systematic review

JUSTIFICATIVA E OBJETIVOS: A eletromiografia de superfície (ES) permite uma avaliação não invasiva do fenômeno bioelétrico durante o estado de repouso do músculo avaliado bem como a comparação com sua atividade durante a contração muscular. O objetivo deste estudo foi avaliar a efetividade do uso de ES em pacientes diagnosticados com disfunção temporomandibular segundo os critérios Research Diagnostic Criteria for Temporomandiublar Disorders (RDC/TMD) eixo I. CONTEÚDO: A revisão de literatura foi realizada a partir das bases de dados LILACS, Medline e Scielo, cobrindo o período de janeiro de 1987 a fevereiro de 2012. Ensaios clínicos randomizados e controlados, ensaios clínicos e testes clínicos que avaliaram ES, sinais e sintomas de desordens temporomandibulares (DTM) diagnosticados pelo critério RDC/TMD foram incluídos. A estratégia de busca resultou em 182 artigos, dos quais oito preencheram os critérios de inclusão, sendo que um caracterizava um estudo clínico randomizado e sete eram estudos longitudinais sem critérios de randomização. Em todos os estudos, o método utilizado para detectar e analisar a atividade elétrica dos músculos da mastigação (corpo do masseter e feixe anterior do temporal) foi a ES, sendo empregada com certa facilidade e seguindo os padrões para o exame. No entanto, foram utilizados diferentes modelos experimentais e seleção das amostras, causando dificuldades na comparação dos resultados. CONCLUSÃO: Dentro das limitações deste estudo, foi possível constatar que embora a ES em DTM não deva ser utilizada para diagnóstico, ela pode auxiliar no acompanhamento da evolução dos tratamentos de DTM.

BACKGROUND AND OBJECTIVES: Surface electromyography (SE) provides a non invasive evaluation of the bioelectric phenomenon of the evaluated muscle at rest, as well as the comparison with its activity during muscle contraction. This study aimed at evaluating the effectiveness of SE in patients with temporomandibular disorders according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I criteria. CONTENTS: Literature was reviewed as from LILACS, ­Medline and Scielo databases in the period from January 1987 to February 2012. Randomized controlled clinical trials, clinical trials and clinical tests evaluating signs and symptoms of temporomandibular disorders (TMD) diagnosed according to RDC/TMD were included. Search strategy has resulted in 182 articles of which eight have fulfilled inclusion criteria, being one randomized clinical trial and seven longitudinal studies without randomization criteria. In all studies, SE was the method used to detect and evaluate electric activity of masticatory muscles (body of the masseter and anterior temporal bundle), being somewhat easily applied and following test standards. However, different experimental models and sample selections were used, making difficult the comparison of results. CONCLUSION: In spite of the limitations of this study, it was possible to observe that although SE should not be used to diagnose TMD, it may help the follow up of TMD treatment evolution.

Botulinum toxin for treating muscular temporomandibular disorders: a systematic review

OBJECTIVE: This study, through a systematic literature review, aims to analyze the effectiveness of Botulinum Toxin as a treatment for masticatory myofascial pain and muscles temporomandibular disorders (TMD). METHODS: Survey in research bases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1966 and April 2011, with focus in randomized or quasi-randomized controlled clinical trials, blind or double-blind. RESULTS: After applying the inclusion criteria, 4 articles comprised the final sample: 3 were double-blind randomized controlled clinical trials and 1 was single-blind randomized controlled clinical trial. CONCLUSIONS: According to the literature, there is lack of evidence about the real effectiveness of botulinum toxin in the treatment of masticatory myofascial pain and muscular TMD. Thus, further randomized controlled clinical trials, with representative samples and longer follow-up time, to assess the real effectiveness of the technique are needed.

OBJETIVO: este trabalho, por meio de uma revisão sistemática da literatura, teve como objetivo analisar a efetividade da toxina botulínica como tratamento para dor miofascial mastigatória e disfunções temporomandibulares (DTM) musculares. MÉTODOS: pesquisa nas bases de dados Medline, Cochrane, Embase, Pubmed, Lilacs e BBO, no período entre 1966 e abril de 2011, com enfoque em estudos clínicos controlados randomizados ou quase-randomizados, cegos ou duplo-cegos. RESULTADOS: após a aplicação dos critérios de inclusão, chegou-se a 4 artigos, sendo que 3 eram estudos clínicos controlados randomizados duplo-cego e 1 era estudo clínico controlado randomizado simples-cego. CONCLUSÕES: pela análise da literatura, verificou-se um número reduzido de evidências significativas sobre a real efetividade da toxina botulínica no tratamento da dor miofascial e de DTM musculares. Assim, são necessários novos estudos clínicos controlados randomizados, com amostras representativas e tempo de acompanhamento longo, para avaliar a real efetividade da técnica.