Occlusal Indicators Used in Dental Practice: A Survey Study.

INTRODUCTION: The function of the masticatory apparatus is complete when the dentition is intact with contact between the individual teeth and proper occlusion with the antagonists. For years, occlusal contacts have been studied to determine their exact location and describing various materials and methods for their registration such as paper foil, silk, and Shimstock foil. For years, occlusal contacts have been studied to determine their exact location and describe various materials and methods for their registration such as paper foil, silk, shim stock foil, the T-Scan system, and more recently the OccluSense system. The primary aim of the study was at evaluating which of the occlusal indicators is the most commonly used in practice, and the secondary aim was whether dentists are willing to use digital methods to examine occlusion. MATERIALS AND METHODS: The main primary information of the survey was collected by sending electronically anonymous questionnaires to 2014 dentists, randomly selected from all regions of the country. 228 questionnaires were filled in and returned. To achieve the goal of the study, the self-developed questionnaire was created and tested to survey the opinion about the use of occlusal indicators in dental practice. Each questionnaire contains questions about the sociodemographic and professional status of the people in the group and their opinion about the positives and negatives and the effectiveness of occlusal indicators. RESULTS: The obtained results confirm the statement that the most frequently used occlusal indicator in dental practice is the articulation paper. Articulation foil and silk are used less frequently than articulation paper. Of the listed quality indicators, Shimstock foil is rarely used in practice. Of the indicated quantitative indicators, the T-Scan system is more used than the OccluSense system. In the era of rapid technology development, the opinion and desire of dentists to increasingly want to introduce in their clinical practice quantitative methods are the digital diagnosis of occlusion. CONCLUSION: In any dental practice, if technically possible, digital methods would be used, giving more accurate and reliable data on the registered occlusal contacts.

Influence of occlusal reduction on pain after endodontic treatment: a systematic review and meta-analysis.

The purpose of this systematic review was to analyze the influence of occlusal reduction on the postoperative pain levels after endodontic treatment (instrumentation and obturation of the root canal system). This review followed the PRISMA statement and was registered at PROSPERO (CRD42018107918). Two independent reviewers searched the Lilacs, Cochrane Library, PubMed (Medline), Web of Science, Scopus, Scielo, and ScienceDirect for articles published until April 2021. The research question was, "Does occlusal reduction decrease postoperative pain in endodontically treated teeth?". Only randomized clinical trials were included. The RevMan 5 program was used for meta-analysis, calculating the relative risk (RR) and 95% confidence interval (CI) of the dichotomous outcome (presence or absence of pain). The search strategies retrieved 4114 studies. Twelve studies were included for qualitative analysis and nine for quantitative analysis. The meta-analysis results did not reveal a significant difference in the reduction of postoperative pain levels for endodontic instrumentation at 6, 12, 24, 48 h and for endodontic obturation at 6 or 12 h after occlusal reduction. According to the GRADE tool, the analyzed outcome was classified as having a moderate level of certainty. It is concluded that occlusal reduction does not interfere with postoperative pain levels after endodontic treatment.

Reabilitação neuroclusal em paciente odontopediátrico com mordida cruzada posterior unilateral: relato de caso clínico / Neuro-occlusal rehabilitation in pediatric dental patient with unilateral posterior crossbite: clinical case report

Objetivo: relatar a sequência clínica de tratamento para descruzar uma mordida cruzada posterior unilateral na dentição decídua por meio da reabilitação neuroclusal. Relato de caso: o caso clínico foi realizado em um paciente do sexo masculino, com 5 anos de idade, diagnosticado com mordida cruzada posterior unilateral funcional do lado direito. Após a verificação de interferências dentais nos caninos e molares em oclusão cêntrica, realizaram-se os ajustes oclusais. Seguiu-se então o protocolo para confecção de pistas diretas de Planas, utilizando resina composta em planos inclinados na metade vestibular da face oclusal dos dentes 84 e 85 e na face vestibular dos dentes 53, 54 e 55. Logo após a confecção das pistas, observou-se a correção da mordida cruzada e a estabilidade na mudança postural da mandíbula. Considerações finais: a reabilitação neuroclusal por meio de pistas diretas de Planas apresenta grande eficácia na correção da mordida cruzada posterior, proporcionando estabilidade mandibular e estímulo para o crescimento e desenvolvimento crânio-maxilo-facial. (AU)

Objective: To report the clinical treatment sequence to uncross a unilateral posterior crossbite in deciduous dentition using neuro-occlusal rehabilitation. Case report: The clinical case was performed in a 5-year-old male patient diagnosed with a functional unilateral posterior crossbite on the right side. After verifying dental interferences with canines and molars in centric occlusion, the occlusal adjustments were performed. The protocol for producing Planas direct tracks was followed using composite resin in inclined planes in the buccal half of the occlusal surface of teeth 84 and 85 and in the buccal surface of teeth 53, 54, and 55. After the preparation of tracks, the crossbite correction and the stability in postural mandibular change were observed. Final considerations: Neuro-occlusal rehabilitation using Planas direct tracks is highly effective in correcting posterior crossbite, providing mandibular stability and stimulus for the growth and development of the maxillofacial skull. (AU)

Estabilidad esquelética postoperatoria en la cirugía ortognática bimaxilar convencional vs. rotación del complejo maxilomandibular / Postoperative skeletal stability in conventional bimaxillary orthognathic surgery vs rotation of the maxillomandibular complex

Introducción: La estabilidad esquelética postoperatoria en cirugía ortognática ha sido objeto de evaluación durante el paso del tiempo. Diversos autores han reportado que se produce una disminución de la misma en diversos movimientos de los maxilares en ocasiones utilizados en casos de rotación del complejo maxilomandibular. El objetivo del presente trabajo fue comparar la estabilidad esquelética postoperatoria de la cirugía ortognática bimaxilar convencional vs. cirugía ortognática bimaxilar con rotación del complejo maxilomandibular en pacientes sometidos a cirugía ortognática en el Servicio de Cirugía Oral y Maxilofacial del Hospital Militar Central de Bogotá, entre enero de 2012 hasta julio de 2016. Materiales y métodos: Se trata de un estudio retrospectivo. Se llevó a cabo análisis cefalométrico para comparar la estabilidad esquelética entre los pacientes de cirugía ortognática bimaxilar convencional vs. los pacientes de cirugía ortognática bimaxilar con rotación del complejo maxilomandibular durante tres momentos: preoperatorio (T1), postoperatorio inmediato (T2), postoperatorio al menos de seis meses (T3). Resultados: Se obtuvo una cohorte de 45 pacientes sometidos a cirugía ortognática bimaxilar convencional o cirugía ortognática bimaxilar con rotación del complejo maxilomandibular. La mayoría de las medidas realizadas mostraron que no existe diferencia significativa de estabilidad a largo plazo en ambos grupos. Conclusiones: La cirugía ortognática con rotación del complejo maxilomandibular, tanto en sentido horario como antihorario, es un procedimiento estable cuando se utiliza fijación interna rígida, cuando se está en presencia de articulacion temporomandibular (ATM) sanas y cuando la rotación se lleva a cabo en un punto a través del cóndilo mandibular

Introduction: Postoperative skeletal stability in orthognathic surgery has been evaluated over time, several authors have reported a decrease of it in movements of the jaws occasionally used in cases of alteration of the maxillo-mandibular complex. The aim of the present study was to compare the postoperative skeletal stability of conventional bimaxillary orthognathic surgery versus bimaxillary orthognathic surgery with rotation of the maxillo-mandibular complex in patients undergoing orthognathic surgery at the Oral and Maxillofacial Surgery Service of the Central Military Hospital of Bogotá between January 2012 until July 2016. Materials and methods: A retrospective study was conducted. We performed a cephalometric analysis to compare the skeletal stability between patients with conventional bimaxillary orthognathic surgery versus bimaxillary orthognathic surgery patients with maxillo-mandibular alteration during 3 moments: before surgery (T1), right after the surgery (T2), at least 6 months after surgery (T3). Results: A cohort of 45 patients undergoing conventional bimaxillary orthognathic surgery or bimaxilar orthognathic surgery with rotation of the maxillo-mandibular complex was obtained. Most of the measurements showed that there is no significant difference in long-term stability in both groups. Conclusions: Orthognathic surgery with rotation of the maxillo-mandibular complex both clockwise and counter-clockwise is a stable procedure when rigid internal fixation is used, when the temporomandibular joints (TMJs) are healthy and stable and when rotation is performed at a point through the mandibular condyle

Lesões cervicais não cariosas: uma abordagem no controle da dor e tratamento

Objetivo: o objetivo deste trabalho é relatar um caso clínico de hipersensibilidade severa associada a múltiplas lesões cervicais não cariosas, entender o mecanismo de ação e a eficácia dos agentes dessensibilizantes. Relato de caso: paciente do gênero masculino, 38 anos de idade, compareceu à clínica da Faculdade Morgana Potrich com um quadro de hipersensibilidade em vários elementos, bem como, a presença de lesão cervical não cariosa em alguns desses elementos. Durante a anamnese o paciente relatou o hábito de escovar os dentes várias vezes ao dia logo após se alimentar, exercendo muita força durante o ato, relatou também fazer consumo diário de cerveja que possui um pH ácido. Ao realizar análise da oclusão notou-se um desequilíbrio oclusal e contato prematuro nos dentes 24 e 34. O tratamento de escolha para esse caso foi o ajuste oclusal seguido do uso de dessensibilizantes e restaurações em resina composta nos dentes que havia a presença de lesões cervicais não cariosas com perda de estrutura dentária. Considerações finais: após esse tratamento, realizado em várias sessões, foi possível devolver ao paciente a função e eliminar a dor provocada pela hipersensibilidade, proporcionando uma melhor qualidade de vida para esse paciente.

Objective: This study aims to report a clinical case of severe hypersensitivity associated with multiple non-carious cervical lesions and to understand the mechanism of action and the efficacy of desensitizing agents. Case report: A 38-year-old male patient attended the clinic at Faculdade Morgana Potrich with the hypersensitivity of several elements and the presence of non-carious cervical lesion in some of these elements. During anamnesis, the patient reported the habit of toothbrushing several times a day soon after eating, exerting a lot of force in such activity; he also reported the daily consumption of beer, which has an acidic pH. The occlusal analysis showed occlusal disorder and premature contact in teeth 24 and 34. The treatment of choice for this case was the occlusal adjustment followed by the use of desensitizers and composite resin restorations on the teeth with non-carious cervical lesions with loss of dental structure. Final considerations: After this treatment, which was performed in several sessions, it was possible to return function to the patient and eliminate the pain caused by hypersensitivity, providing a better quality of life for this patient.(au)

Occlusal adjustment after local resection of type 1 condylar osteochondroma.

To evaluate the feasibility of the orthodontic traction after local resection of the condylar osteochondroma (OC).From November 2011 to September 2016, consecutive patients with condylar OC who underwent orthodontic extraction after local resection of the mass were reviewed. Clinical data and cone-beam computed tomography (CT) were obtained before treatment (T0), 1 week after surgery (T1), and at least 6-month follow-up after OC resection (T2). Repeated-measures analysis of variance with Bonferroni multiple-comparison test was used to compare the 3-dimensional cephalometric variables at different time points and the paired t test was used to compare changes of temporomandibular joint (TMJ) space between the 2 sides at T1 and T2.The sample consisted of 23 patients (16 females and 7 males). The mean postoperative follow-up interval was 10.9 months. No recurrence was observed during the postoperative follow-up period. Facial symmetry and occlusion were greatly improved. B deviation and the distance of gonion on the OC-affected side to the Frankfort horizontal (FH) were significantly improved from T0 to T1 and T2 (P < .01). The anterior space (AS) and superior space (SS) of the OC-affected side were significantly larger than that of the contralateral side at T1 in parasagittal CT views (P < .05), while no difference was found between the two sides at T2.Local resection is an effective technique with less damage to the condyle. The application of postoperative directional traction could guide the condyle into the fossa, achieve normal TMJ space and stable occlusion, and eventually provide functional and esthetic outcomes.

A modified technique for the intraoral assessment of static occlusal contacts.

This article describes a procedure in which articulating paper is modified for the intraoral assessment of static occlusal contacts. The rectangular-shaped articulating paper is modified by creating parallel cuts at 2- to 3-mm intervals perpendicular to its long side without completely separating the paper. This modification may improve the accuracy in determining occlusal contacts and therefore facilitate an occlusal adjustment procedure.

Design of Complete Dentures by Adopting CAD Developed for Fixed Prostheses.

The demand for complete dentures is expected to increase worldwide, but complete dentures are mainly designed and fabricated manually involving a broad series of clinical and laboratory procedures. Therefore, the quality of complete dentures largely depends on the skills of the dentist and technician, leading to difficulty in quality control. Computer-aided design and manufacturing (CAD/CAM) has been used to design and fabricate various dental restorations including dental inlays, veneers, crowns, partial crowns, and fixed partial dentures (FPDs). It has been envisioned that the application of CAD/CAM technology could reduce intensive clinical/laboratory work for the fabrication of complete dentures; however, CAD/CAM is seldom used to fabricate complete dentures due to the lack of suitable CAD software to design virtual complete dentures although the CAM techniques are in a much advanced stage. Here we report the successful design of virtual complete dentures using CAD software of 3Shape Dental System 2012, which was developed for designing fixed prostheses instead of complete dentures. Our results demonstrated that complete dentures could be successfully designed by the combination of two modeling processes, single coping and full anatomical FPD, available in the 3Shape Dental System 2012.

Avaliação da qualidade nas finalizações ortodônticas utilizando modelos digitais / Evaluation of the quality in orthodontic finalizations through digital models

A finalização ortodôntica é uma etapa crucial para a obtenção do equilíbrio oclusal e estético. A avaliação da qualidade nas finalizações ortodônticas atende a critérios clínicos já conhecidos, porém, depende de uma análise subjetiva por parte do profissional envolvido. Vários estudos se propuseram a criar índices para a avaliação da qualidade dos tratamentos ortodônticos, porém, todos eles encontraram dificuldades frente a subjetividade nas análises. Este estudo tem como objetivo criar uma metodologia de processos para análise computacional objetiva da qualidade nas finalizações ortodônticas.Para tanto, serão utilizados o escaneamento intraoral, bem como a construção de modelos virtuais e análise comparativa dos diferentes estágios do tratamento. O objetivo é padronizar a avaliação das finalizações ortodônticas e o processo de monitoramento da terapêutica administrada, facilitar a comunicação profissional x paciente e profissional x profissional, auxiliando nos tratamentos multidisciplinares e trazendo objetividade as análises qualitativas(AU)

The completion of orthodontic treatment is a crucial step in obtaining occlusal and aesthetic balance. The evaluation of the quality in the orthodontic finalizations fulfills already known clinical criteria, however, it depends on a subjective analysis by the professional involved. Several studies have attempted to create index for the evaluation of the quality of orthodontic treatments, all of which have found difficulties regarding subjectivity in the analyzes. This study aims to create a methodology of processes for objective computational analysis of quality in orthodontic finalizations. Intraoral scanning will be used, as well as the building of virtual models and comparative analysis of the different stages of the treatment. The objective is to achieve standardization in the evaluation of orthodontic finalizations, as well as a monitoring process of the administered therapy, facilitating professional communication x patient and professional x professional, assisting in the multidisciplinary treatments and bringing objectivity to the qualitative analyzes(AU)

Reabilitação protética provisória em resina acrílica por meio do sistema CAD/CAM ­ acompanhamento de um ano / Provisional acrylic prosthetic rehabilitation using the CAD/CAM system ­ one-year follow-up

Pacientes com perdas dentárias posteriores sobrecarregam os dentes anteriores, causando desgastes dentários e, em muitos casos, fraturas, alterando a dimensão vertical de oclusão (DVO). Este trabalho teve como objetivo apresentar um caso clínico de perda dental posterior com desgaste e fratura dos dentes anteriores, e alteração da dimensão vertical. Paciente apresentava implantes dentais instalados na região posterior superior e inferior. Foram instalados minipilares sobre os implantes, cuja profundidade gengival era maior do que 1 mm, e os outros implantes moldados diretamente da plataforma. A moldagem foi realizada utilizando transferentes para moldeira aberta. Foram utilizados Jig de Lúcia e cilindros de titânio para o registro oclusal do paciente, e posterior montagem em articulador. Foram instalados scanbodies sobre os análogos colocados nos modelos do paciente, que foram jateados com pó opacifi cador e levados em um scanner de bancada para o escaneamento ­ primeiramente, os modelos; em seguida, o registro interoclusal. Os dados foram processados no software do sistema para a realização dos projetos das coroas provisórias e enviados para uma fresadora M5 da Zirkonzanh. As coroas foram fresadas em um bloco de resina acrílica e instaladas, e os ajustes necessários foram realizados. Após a colocação dos provisórios posteriores, foram realizadas nova moldagem e montagem em articulador semiajustável para o enceramento dos dentes anteriores. Após o paciente aprovar o enceramento, foram confeccionadas facetas em resina fotopolimerizável nos elementos dentais anteriores. Após um ano de acompanhamento, as coroas sobre implante apresentaram aspectos favoráveis e ausência de fraturas.

Patients with posterior tooth loss overload the anterior teeth, causing dental wear and in many cases fractures, altering the vertical dimension of occlusion (OVD). This paper aims to present a clinical case of posterior tooth loss with wear and fracture of the anterior teeth and alteration of the vertical dimension. The patient presented with dental implants installed in the upper and lower posterior regions. Minipillars were installed on the implants where the gingival depth was greater than 1 mm and a direct impression was made on the other´s implant platforms. Using open tray transfers. Lucia JIG and titanium cylinders were used for the occlusal registration and assembly in the articulator. Scanbodies were connected over the dental implant analogs, which were sandblasted with opacifi er powder and taken on a bench scanner for scanning. First the models and then the interocclusal register. Data were processed in the system software for the provisional crown designs and sent to an M5 zirkonzanh milling machine and the crowns milled in a block of acrylic resin. The crowns were installed and the necessary adjustments were made. After the installation of the posterior extensions, new impressions and semi-adjustable articulator assembly were performed to waxup the anterior teeth. Upon patient's approval, veneers were made in light-cured resin in the anterior dental elements. After a year of follow-up the dental implant crowns have favorable aspects and absence of fractures.

Phantom bite: a real or a phantom diagnosis? A case report.

This case report describes computer-guided occlusal therapy in a patient who met the unified diagnostic criteria for phantom bite. After a review of the patient's medical history, along with a diagnostic work-up that included cone beam computed tomography, temporomandibular joint vibration analysis, and digital occlusal analysis, problematic dental components were discovered (including prolonged disclusion time and imbalanced bite force). A digital occlusal analyzer evaluated the patient's occlusion and systematically guided the necessary changes. After reduction of the disclusion time and correction of the occlusal force imbalance, the patient reported significant improvement in comfort. The results suggest that phantom bite could be an abnormal occlusal condition and not a psychological or neurologic somatoform disorder.

Treatment of frictional dental hypersensitivity (FDH) with computer-guided occlusal adjustments.

OBJECTIVE: To verify the efficacy of treating dentin/dental hypersensitivity (DH) to Cold Ice Water Swish testing before and after subjects undergo the Immediate Complete Anterior Guidance Development (ICAGD) computer-guided occlusal adjustment. METHODS: One hundred chronically dysfunctional patients with known cold sensitivity swished ice water intraorally to elicit a DH response scored on a Visual Analog Scale (VAS). The subjects then underwent the ICAGD coronoplasty, which was followed by a second ice water swish scored with a second VAS. The pre to post ICAGD Disclusion Time values and VAS scores were statistically evaluated by the Wilcoxon Signed Rank for Paired Difference test. The subjects were divided into subgroups with DH sensitivities <4 and ≥4, and analyzed. Limitations were as follows: abfractions were not quantified, dysfunctional symptom resolution was not determined, each subject was their own control, one clinician administered all ice water tests, and protrusive excursions were not included. RESULTS: Disclusion Time reductions from ICAGD were significant (2.11-0.55 s. p = 0.0000). The DH score changes showed highly significant decreases from pre to post ICAGD (p < 0.0001). CONCLUSIONS: A partial etiology for cold tooth sensitivity exists, resultant from prolonged occlusal surface excursive movement frictional contacts. This cold sensitivity can be lessened with measured, computer-guided occlusal adjustments.

Average chewing pattern improvements following Disclusion Time reduction.

OBJECTIVES: Studies involving electrognathographic (EGN) recordings of chewing improvements obtained following occlusal adjustment therapy are rare, as most studies lack 'chewing' within the research. The objectives of this study were to determine if reducing long Disclusion Time to short Disclusion Time with the immediate complete anterior guidance development (ICAGD) coronoplasty in symptomatic subjects altered their average chewing pattern (ACP) and their muscle function. METHODS: Twenty-nine muscularly symptomatic subjects underwent simultaneous EMG and EGN recordings of right and left gum chewing, before and after the ICAGD coronoplasty. Statistical differences in the mean Disclusion Time, the mean muscle contraction cycle, and the mean ACP resultant from ICAGD underwent the Student's paired t-test (α = 0.05). RESULTS: Disclusion Time reductions from ICAGD were significant (2.11-0.45 s. p = 0.0000). Post-ICAGD muscle changes were significant in the mean area (p = 0.000001), the peak amplitude (p = 0.00005), the time to peak contraction (p < 0.000004), the time to 50% peak contraction (p < 0.00001), and in the decreased number of silent periods per side (right p < 0.0000002; left p < 0.0000006). Post-ICAGD ACP changes were also significant; the terminal chewing position became closer to centric occlusion (p < 0.002), the maximum and average chewing velocities increased (p < 0.002; p < 0.00005), the opening and closing times, the cycle time, and the occlusal contact time all decreased (p < 0.004-0.0001). CONCLUSION: The average chewing pattern (ACP) shape, speed, consistency, muscular coordination, and vertical opening improvements can be significantly improved in muscularly dysfunctional TMD patients within one week's time of undergoing the ICAGD enameloplasty. Computer-measured and guided occlusal adjustments quickly and physiologically improved chewing, without requiring the patients to wear pre- or post-treatment appliances.

Reabilitação protética com componentes dinâmicos ­ relato de caso / Prosthetic rehabilitation with dynamic components ­ case report

Os componentes dinâmicos surgiram como alternativa para reabilitar implantes inclinados em até 20°, possibilitando o restabelecimento da estética, função e reduzindo os custos do procedimento. Sendo assim, o objetivo deste trabalho é apresentar um relato de caso utilizando esses componentes. Durante o exame clínico foi diagnosticado que os implantes apresentavam profundidade gengival rasa, inclinação e paralelismo desfavoráveis. Dessa forma, foi optado pela utilização de pilares retos com componentes dinâmicos, que irão corrigir a inclinação do orifício de acesso do parafuso da prótese definitiva.

Dynamic components were created as an alternative to rehabilitate tilted implants until 20º angled. This component allows aesthetic and function rehabilitation with lower cost comparing to angled abutments. The aim of this study was to present a case report us-ing these dynamic components. The patient presented tilted implants with gingival shallow depth, with unfavourable parallelism. Thus, straight abutment and dynamic components were concomitantly used to correct the access screw hole inclination of final the prosthesis.

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 3 / Diagnosis and management of fractures teeth associated with parafunction: part 3

Presentar un tratamiento preventivo que consiste en la realización de un ajuste oclusal y de una placa neuromiorrelajante, en un paciente con facetas de desgaste debidas a parafunción. Caso clínico: un paciente de 28 años de edad consultó por un control. Se observaron facetas de desgaste patológicas en el esmalte de la pieza dentaria 4.7, con una relación cúspide/fosa profunda, por lo que se decidió realizar una remodelación oclusal y confeccionar una placa de protección neuromiorrelajante, a fin de evitar una posible fractura de la pieza. Conclusión: un diagnóstico correcto y temprano de las facetas dentarias patológicas en el esmalte y su posible tratamiento son fundamentales para evitar opsibles fracturas dentarias asociadas a la parafunción...(AU)

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 3 / Diagnosis and management of fractures teeth associated with parafunction: part 3

Presentar un tratamiento preventivo que consiste en la realización de un ajuste oclusal y de una placa neuromiorrelajante, en un paciente con facetas de desgaste debidas a parafunción. Caso clínico: un paciente de 28 años de edad consultó por un control. Se observaron facetas de desgaste patológicas en el esmalte de la pieza dentaria 4.7, con una relación cúspide/fosa profunda, por lo que se decidió realizar una remodelación oclusal y confeccionar una placa de protección neuromiorrelajante, a fin de evitar una posible fractura de la pieza. Conclusión: un diagnóstico correcto y temprano de las facetas dentarias patológicas en el esmalte y su posible tratamiento son fundamentales para evitar opsibles fracturas dentarias asociadas a la parafunción...

Electromyographic and patient-reported outcomes of a computer-guided occlusal adjustment performed on patients suffering from chronic myofascial pain.

OBJECTIVES: Muscular hyperactivity is a potential source of symptoms in patients with temporal-mandibular disorders. An adequate occlusal adjustment may relieve such symptoms. This study aims to measure the effect of shortening the protrusive disclusion time (DT) and balancing the center of occlusal forces (COF) on the EMG recordings and assess the pain reported by chronic patients one month after the computer-guided occlusal adjustment. STUDY DESIGN: The sample studied comprised 34 patients suffering from chronic facial pain in which the EMG activity of both masseters was recorded by electromyography. By selective grinding we alleviated all the occlusal interferences during the mandibular protrusion from the habitual closure position in order to establish an immediate posterior disclusion and an equilibration of the COF. RESULTS: At follow-up 76.5% of the patients reported no facial pain. Moreover, the EMG activity and protrusive DT were significantly reduced, and occlusal and muscular function were significantly more symmetric than at baseline. CONCLUSIONS: According to this EMG study, this computer-guided occlusal adjustment is able to reduce the activity of the masseters and the self-reported muscular pain of patients one-month after treatment.

Reconstrução da guia canina em ouro: relato de caso clínico / Reconstruction of the canine guide in gold: a case report

Este relato visa mostrar a reconstituição da guia canina em um paciente com oclusão em balanceio bilateral, situação caracterizada pela ausência de desoclusão dos dentes posteriores, nas movimentações laterais da mandíbula. Com o objetivo de preservar estes dentes e suas estruturas periodontais, foram confeccionadas restaurações de ouro inciso-palatinas nos caninos superiores, sem comprometimento da estética, para que os mesmos pudessem atuar de forma alternada na desoclusão dos molares e pré-molares, durante as excursões mandibulares. O procedimento restaurador teve acompanhamento fotográfico e radiográfico ao longo de 19 anos, concluindo-se que o procedimento restaurador contribuiu para a preservação dos dentes posteriores e suas estruturas de suporte, eliminando as forças oclusais oblíquas que antes incidiam sobre estes elementos, devido à inexistência da guia canina que provocava perda óssea vestibular e consequente retração gengival. (AU)

This report aims to show the reconstitution of canine guidance in a patient with bilateral balanced occusion, a situation characterized by the absence of deocclusion of posterior teeth, the lateral shift of the mandible. In order to preserve these teeth and their periodontal structures, incisal-palatines gold restorations were placed on maxillary canines, without compromising aesthetics, so that they could act alternately on deocclusion molars and premolars, during mandibular excursions. The restorative procedure had photographic and radiographic follow-up over 19 years, concluding that the restorative procedure contributed to preserve the posterior teeth and their supporting structures, eliminating the oblique occlusal forces than before focused on these elements, due to the lack of canine guidance, which caused buccal bone loss and consequent gingival recession. (AU)