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1.
J Indian Prosthodont Soc ; 21(4): 356-365, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34810363

RESUMO

Background: Contradicting evidence regarding the effects of occlusal splint therapy in the management of Temporomandibular disorder (TMD) and promising results shown by muscle energy technique. Aim: To determine and compare the effects of occlusal splint therapy, muscle energy technique, and combined treatment with education for self-management and counseling in the management of TMD. Study Design and Settings: Randomized clinical trial. Methodology: A total of 160 participants diagnosed with TMD according to Diagnostic Criteria/TMD axis I were randomly allocated into four treatment groups with equal allocation ratio using random numbers table. The main inclusion criteria were the presence of pain in the preauricular area, TMJ and/or muscles of mastication and maximum mouth opening <40 mm. Group A participants received muscle energy technique, Group B participants received occlusal splint therapy, Group C participants received combined treatment, and Group D participants received education for self-management and counseling (control). Control group treatment was provided to all the trial participants. Statistical Analysis: Intragroup comparison was made using Friedman test and Wilcoxon test while intergroup comparison was done using Kruskal-Wallis test and Mann-Whitney U test. Results: Intensity of pain on a visual analog scale and maximum mouth opening were measured at baseline, at 1 week, at 2 weeks, at 1 month, and after 3 months. Conclusion: Muscle energy technique, occlusal splint therapy and combined treatment significantly reduce pain compared to controls and muscle energy and combined treatment are superior to other groups for mouth opening improvements in patients with TMD.


Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular , Humanos , Músculos , Medição da Dor , Transtornos da Articulação Temporomandibular/terapia , Resultado do Tratamento
2.
Artigo em Inglês | MEDLINE | ID: mdl-34639640

RESUMO

The role of the dento-mandibular apparatus and, in particular, occlusion and jaw position, received increased attention during last years. In the present study, we aimed to systematically review, on the light of the new potential insights, the published literature covering the occlusal splint (OS) applications, and its impact on exercise performance. A structured search was carried out including MEDLINE®/PubMed and Scopus databases with additional integration from external sources, between March and June 2021. To meet the inclusion criteria, studies published in the English language, involving humans in vivo, published from 2000 to 2021 and that investigated the role of occlusal splints on athletes' performance were selected. Starting from the 587 identified records, 17 items were finally included for the review. Four main aspects were considered and analyzed: (1) occlusal splint characteristics and occlusion experimental conditions, (2) jump performance, (3) maximal and explosive strength, and (4) exercise technique and biomechanics. The results of the systematic literature analysis depicted a wide heterogenicity in the experimental conditions and suggested the application of the OS as a way to improve athletes' or individuals' oral health, and as a potential tool to optimize marginal aspects of exercise performance.


Assuntos
Mandíbula , Placas Oclusais , Atletas , Exercício Físico , Humanos
3.
J Mech Behav Biomed Mater ; 124: 104813, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34530298

RESUMO

AIM: The aim of this in vitro study was to assess the mechanical properties of five commercially available subtractive computer-aided design and computer-aided manufacturing (CAD-CAM) milled splint materials, as well as to compare them with conventional heat-polymerized and autopolymerizing resins used in the construction of conventional splints. MATERIAL AND METHODS: Five CAD-CAM milled (ProArt CAD Splint, Therapon Transpa, Temp Premium Flexible Transpa, Cast, and Aqua), one autopolymerizing (Palapress), and one heat-polymerized (Paladon 65) resin materials were evaluated. Flexural strength, E-modulus, Vickers hardness, fracture toughness, fracture work, water sorption, and water solubility were measured. Samples were evaluated after dry and water storage for 30 days at 37 °C. Data were collected and statistically analyzed. RESULTS: Under both storage circumstances, the flexural strength values of Paladon 65, Therapon Transpa, Temp Premium Flexible Transpa, and Aqua were statistically non-significant (P=0.055). The polycarbonate-based CAD-CAM material Temp Premium Flexible Transpa had the highest statistically significant values of the fracture toughness and fracture work (P<0.001). Moreover, it exhibited the lowest percentages of water sorption and water solubility among the investigated materials (P<0.001). All of the CAD-CAM materials exhibited dry elastic moduli greater than Palapress and lower than Paladon 65. One of the CAD-CAM materials, Cast, had the highest dry Vickers hardness value, which was non-significant when compared to Therapon Transpa (P=0.762). CONCLUSION: CAD-CAM polycarbonate-based splint materials exhibit higher fracture toughness and fracture work as well as lower water sorption and solubility than polymethyl methacrylate-based ones. The mechanical characteristics of the assessed CAD-CAM milled splint materials were not typically superior to those of the conventional heat-polymerized resin. However, some of them outperformed the autopolymerizing acrylic resin in terms of flexural strength, surface microhardness, water sorption, and water solubility.


Assuntos
Desenho Assistido por Computador , Placas Oclusais , Materiais Dentários , Resistência à Flexão , Teste de Materiais , Polimetil Metacrilato , Propriedades de Superfície
4.
J Contemp Dent Pract ; 22(6): 615-619, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34393116

RESUMO

AIM AND OBJECTIVE: Force platforms are widely used to evaluate the relationship between bodily posture and jaw positions. The aim and objective of this clinical prospective study was to evaluate the effect of occlusal splints on bodily posture using force platforms. MATERIALS AND METHODS: Forty-seven female patients with temporomandibular disorders (TMD) underwent a clinical and postural examination before and during an occlusal treatment with an upper splint. Six postural stabilometric examinations were performed under different visual conditions. Postural stability was assessed using a force platform (SATEL). Subjects were evaluated in static and dynamic conditions, with open and closed eyes, at baseline, at 1 week, and at 3 months. Changes in stabilometric parameters (sway area and sway length) were assessed and compared. RESULTS: In static and dynamic positions, the sway surface area decreased significantly after the occlusal guard placement with closed eyes (p-value, 0.012). Likewise, the sway surface area decreased significantly in the dynamic lateral position with closed eyes (p-value, 0.018) and in anteroposterior dynamic position with open eyes (p-value, 0.031). The mean sway length decreased significantly after the placement of the occlusal guard when participants were in the lateral position with open eyes (p-value, 0.025) and in the anteroposterior position with open eyes (p-value, 0.014). On a 3-month assessment, the mean surface and mean length decreased significantly after the placement of the occlusal guard for practically all the static and dynamic positions. CONCLUSION: The sway surface area and sway length decreased significantly with the use of occlusal splints Clinical significance: In female patients with TMD, the use of an occlusal splint is associated with a postural improvement evaluated by posturo-stabilometric tests.


Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular , Feminino , Humanos , Equilíbrio Postural , Postura , Estudos Prospectivos , Transtornos da Articulação Temporomandibular/terapia
5.
Rev Mal Respir ; 38(8): 807-815, 2021 Oct.
Artigo em Francês | MEDLINE | ID: mdl-34454816

RESUMO

BACKGROUND: Multidisciplinary consultation of sleep-disorders can include recommendation of a mandibular advancement device (MAD) for some patients with obstructive sleep apnea syndrome (OSAS). AIM: To assess the outcomes of patients for whom an oral MAD was prescribed following multidisciplinary consultation for OSAS in a University Hospital Center. METHODS: All patients referred by hospital or community specialist who had visited this specialized service from December 2015 to December 2017 and to whom an MAD was prescribed were included in this study. The objective was to analyze their clinical course after this consultation and to assess the effectiveness of these devices in this population. RESULTS: In all, 184 patients were seen by the multidisciplinary consultation between December 2015 and December 2017. An MAD was offered to 148 patients and 70 of these went on to have one. Of these 52 of them received follow-up polygraphy (PG) with it in place. This confirmed effectiveness in 18 cases (decrease of at least 50% of the AHI. The average AHI went from 34.8/hr to 22.5/hr. Sixty-five of the 148 patients were lost to follow-up. CONCLUSION: After specialized consultation on sleep-disorders, only one-third of the patients to whom an OA was prescribed had polygraphic exam. OA was less effective than in equivalent series. Correctives measures (such as a multidisciplinary standard sheet) have been set up to ensure a close follow-up of patients.


Assuntos
Avanço Mandibular , Placas Oclusais , Humanos , Encaminhamento e Consulta , Sono , Resultado do Tratamento
6.
J Oral Rehabil ; 48(10): 1129-1134, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34320246

RESUMO

BACKGROUND: Little is known about the effect of the type of splint material, heat-cured PMMA (HC) or chemical-cured PMMA (CC) on the wear of opposing tooth surfaces. OBJECTIVE: The aim of this in vitro study was to evaluate two-body wear of dentin, enamel, glass-ceramic or one of four resin composites when opposing splint materials, namely ProBase HC and CC. METHODS: The two-body wear of bovine dentine, bovine enamel, glass-ceramic IPS e.max CAD (EMAX) and four composites (Filtek Z250 [Z250], Clearfil AP-X [AP-X], Clearfil Majesty Posterior [CMP], Filtek Supreme XTE [FSE]) opposing three antagonists (HC and CC and stainless steel as control) were evaluated in the ACTA wear machine. In addition, all the surfaces were evaluated with scanning electron microscopy. RESULTS: The highest average wear was observed in the case of dentin. The lowest average wear was found EMAX. In every case-except for EMAX-the wear rate was higher with HC than with CC (all differences being statistically significant). CONCLUSIONS: The level of wear of enamel, dentin and various resin composites was higher in contact with HC than in CC, the wear of dentin being the highest. In the case of a patient with no or little tooth wear or whose teeth are restored with composite material or glass-ceramic, the splint HC might be preferred because of its better durability. However, when the splint is in contact with opposing dentin preservation of the dentin, CC might be the best choice.


Assuntos
Desgaste de Restauração Dentária , Desgaste dos Dentes , Animais , Bovinos , Resinas Compostas , Esmalte Dentário , Humanos , Teste de Materiais , Placas Oclusais , Propriedades de Superfície , Desgaste dos Dentes/terapia
7.
Head Face Med ; 17(1): 27, 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34256775

RESUMO

BACKGROUND: Virtual surgery planning (VSP) is believed to reduce inaccuracies in maxillary positioning compared to conventional surgery planning (CSP) due to the elimination of face-bow transfer and laboratory steps. However, there is still a lack of comparative studies for the accuracy of splint-based maxillary positioning in CSP versus VSP. Therefore, the objective of this retrospective, observational study was to compare if splints produced by VSP and CSP reach postoperative outcomes within clinically acceptable limits. METHODS: The planned and actual postoperative results of 52 patients (VSP: n = 26; CSP: n = 26) with a mean age of 24.4 ± 6.2 years were investigated by three-dimensional (3D) alignment with planning software. The conventional treatment plan was digitized, so that the evaluation of both methods was performed in the same manner using the same coordinate system. Inaccuracies were measured by sagittal, vertical and transversal deviations of the upper central incisors and the inclination of the maxillary occlusal plane between the planned and achieved maxillary positions. RESULTS: Both methods demonstrated significant differences between the planned and actual outcome. The highest inaccuracies were observed in vertical impaction and midline correction. No significant differences between CSP and VSP were observed in any dimension. Errors in vertical and sagittal dimension intensified each other. CONCLUSIONS: In conclusion, splint-based surgeries reached similar results regardless of the applied planning method and splint production.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Cirurgia Assistida por Computador , Adolescente , Adulto , Humanos , Imageamento Tridimensional , Maxila/diagnóstico por imagem , Maxila/cirurgia , Placas Oclusais , Estudos Retrospectivos , Adulto Jovem
8.
Sensors (Basel) ; 21(10)2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-34066273

RESUMO

A mandibular advancement device (MAD) is a commonly used treatment modality for patients with mild-to-moderate obstructive sleep apnea. Although MADs have excellent therapeutic efficacy, dental side effects were observed with long-term use of MADs. The aim of this study was to analyze the force distribution on the entire dentition according to the materials and design of the MADs. Three types of MADs were applied: model 1 (single layer of polyethylene terephthalate glycol (PETG)), model 2 (double layer of PETG + thermoplastic polyurethane (TPU)), and model 3 (core-reinforced multilayer). In the maxilla, regardless of the model, the incisors showed the lowest force distribution. In most tooth positions, the force distribution was lower in models 2 and 3 than in model 1. In the mandible, the mandibular second molar showed a significantly lower force in all models. The mandibular incisors, canines, and molars showed the highest force values in model 1 and the lowest values in model 3. Depending on the material and design of the device, the biomechanical effect on the dentition varies, and the core-reinforced multilayered MAD can reduce the force delivered to the dentition more effectively than the conventional single- or double-layer devices.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Humanos , Placas Oclusais , Resultado do Tratamento
9.
Biomed J ; 44(3): 353-362, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34144940

RESUMO

BACKGROUND: Previous computer-generated splints were designed and produced without modification than the traditional occlusal splints, which did not facilitate surgeon's intraoperative judgment in the single-splint two-jaw orthognathic surgery. Modifications of the digital occlusal splint can be achieved using computer-aided design and computer-aided manufacturing (CAD/CAM) software. This study reported the design, clinical application and validation of a novel CAD/CAM occlusal splint. METHODS: The maxillary and mandibular segments were fixed into the final occlusal splint and moved to the planned position according to the 3-dimensional simulation. The composite occlusal splint has 4 orthogonal bars to facilitate intraoperative assessment of the dental and skeletal midline, facial soft tissue midline, occlusal plane, upper tooth show, facial symmetry and facial bone position. To validate the surgical outcome, 5 parameters including pitch, roll and yaw rotations, midline deviation and chin position were measured on the virtual plan and the postoperative cone-beam computed tomography images to quantify the difference. RESULTS: The results showed no significant differences in the 5 parameters between the simulation and postoperative images. The root-mean-square difference between the conventional splints and CAD/CAM surgical splint ranged from 0.18 to 0.31 mm by superimposition of the two image models. All patients were satisfied with the treatment outcomes. Overall, this novel occlusal splint is ideal for verification of the maxillomandibular position during surgery. CONCLUSION: The novel composite occlusal splint provided useful and informative check to verify the maxillomandibular complex (MMC) position and facial appearance in single-splint two-jaw orthognathic surgery.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Desenho Assistido por Computador , Humanos , Mandíbula , Placas Oclusais , Contenções
10.
Shanghai Kou Qiang Yi Xue ; 30(2): 210-213, 2021 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-34109365

RESUMO

PURPOSE: To investigate the clinical effect of modified posterior dental splint in the treatment of anterior disk displacement without reduction of the temporomandibular joint (TMJ). METHODS: Eight-nine patients with anterior disk displacement without reduction of the TMJ who were treated in Stomatology Hospital of Guangzhou Medical University from October 2016 to October 2017 were selected in the study. 47 patients in the first group were treated by modified posterior dental splint, while 42 patients in the second group were treated by stabilization splint. The patients' pain index, mouth opening degrees were collected before treatment,3 months, 6 months, and 1 year after treatment. Statistical analysis of the data was performed using SPSS 18.0 software package, multivariate test was used to compare the indicators between the two groups. RESULTS: The effect of modified posterior dental splint on treating limited mouth opening was better than those of stabilization splint(P<0.05). In the treatment of joint pain, the two splints had no significant difference(P>0.05). CONCLUSIONS: Modified posterior dental splint is a new type of splint for the treatment of TMJ disorders. It is suitable for clinical application.


Assuntos
Luxações Articulares , Transtornos da Articulação Temporomandibular , Humanos , Luxações Articulares/terapia , Placas Oclusais , Contenções , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/terapia
11.
J Oral Rehabil ; 48(8): 901-908, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33983628

RESUMO

BACKGROUND: Contingent vibratory feedback stimuli applied by a specially designed oral appliance (OA) have been reported to be effective in reducing sleep bruxism (SB). However, the inhibitory effects of the OA, which occur immediately after OA delivery, may have confounded this finding. OBJECTIVE: This study sought to shed light on the effects of vibratory stimuli on SB after the OA adaptation period, when its inhibitory effects are diminished. METHODS: Fourteen 'definite' SB patients were enrolled. A force-based bruxism detection system was utilised to trigger a vibrator attached to the OA. Masseter electromyographic activity during sleep was recorded at home using portable polysomnography. After using the OA without vibratory stimulus for 16 nights (adaptation period), intermittent vibratory stimuli were applied every other half-hour for four nights (intervention period). Electromyographic activity over 10% of the maximum voluntary contraction was regarded as a SB episode. The number and the total duration of SB episodes per hour of sleep were calculated for the sessions with and without stimuli separately and averaged for four intervention nights. The effects of stimuli on these two variables were evaluated. RESULTS: The number and the total duration of the sessions without stimuli were 5.2 episodes/h and 35.3 s/h, respectively. These values significantly decreased to 3.9 episodes/h and 15.1 s/h (p < .05) for the sessions with vibratory stimuli. CONCLUSION: Contingent vibratory stimulus via an OA may be effective for the management of SB even after adaptation to OA.


Assuntos
Bruxismo do Sono , Eletromiografia , Humanos , Músculo Masseter , Placas Oclusais , Polissonografia , Bruxismo do Sono/terapia , Contenções , Resultado do Tratamento
12.
J Oral Rehabil ; 48(8): 927-936, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33977548

RESUMO

BACKGROUND: The efficiency of the mandibular advancement device (MAD) in patients with obstructive sleep apnoea syndrome (OSAS) has been demonstrated. Nevertheless, the behaviour of the upper airway once MAD is placed and titrated, and its correlation with the apnoea-hypopnoea index (AHI) is still under discussion. OBJECTIVES: To analyse the morphological changes of the upper airway through a bi- and three-dimensional study and correlate it with the polysomnographic variable, AHI. METHODS: Patients were recruited from two different hospitals for the treatment of OSAS with a custom-made MAD. A cone-beam computer tomography and a polysomnography were performed at baseline and once the MAD was titrated. RESULTS: A total of 41 patients completed the study. Treatment with MAD reduced the AHI from 22.5 ± 16.8 to 9.2 ± 11.6 (p ≤ .05). There was a significant increase of the total airway volume with MAD from 21.83 ± 7.05 cm3 to 24.19 ± 8.19 cm3 , at the expense of the oropharynx. Moreover, the correlation between the improvement of the AHI and the augmentation of the volume of the upper airway was not statistically significant. CONCLUSIONS: The oral device used in this prospective study increased the mean upper pharyngeal airway volume and significantly reduced the AHI. Future studies that measure the muscular tone are needed to completely understand the association between the AHI and the physiological and anatomical response of the upper airway.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Humanos , Placas Oclusais , Polissonografia , Estudos Prospectivos , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
13.
Ann Palliat Med ; 10(6): 6122-6132, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33977737

RESUMO

BACKGROUND: This systematic review of the literature was to compare the effects of exercise therapy and occlusal splint therapy on pain and mobility in individuals with painful temporomandibular disorders (TMD). METHODS: PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched for English publications from database root to March 1, 2020. Search terms were [("temporomandibular joint disorders" or "temporomandibular disorders" or "craniomandibular disorders" or "orofacial pain" or "myofascial pain" or "myofascial pain" or "facial pain") AND (exercise or "physical therapy modalities" or physiotherapy or "exercise therapy") AND ("splints" or "occlusal splints" or "stabilization splint" or "occlusal appliance" or "occlusal splint therapy")]. We included randomized controlled trials that evaluated the effects of therapeutic exercise therapy and occlusal splint therapy, and were published in English. Trial quality was assessed with the Physiotherapy Evidence Database scale. RESULTS: Six studies were included (498 patients: 251 occlusal splint therapy, 247 therapeutic exercise). The results revealed that exercise therapy was not superior to occlusal splint therapy for pain reduction in patients with painful TMD (P=0.08; weighted standardized mean difference -0.29; 95% CI, -0.62 to 0.04). The effectiveness of occlusal splint therapy and exercise therapy was found to be equivalent in the maximum mouth-opening range (P=0.51; weighted standardized mean difference 0.12; 95% CI, -0.24 to 0.48), right laterotrusion (P=0.99; weighted standardized mean difference -0.00; 95% CI, -0.31 to 0.31), left laterotrusion (P=0.32; weighted standardized mean difference 0.16; 95% CI, -0.16 to 0.48), and protrusion (P=0.77; weighted standardized mean difference 0.06; 95% CI, -0.32 to 0.43) for painful TMD patients. CONCLUSIONS: Given the limitations of the study, the small number of studies included in the sub-analysis for pain relief and the maximum mouth-opening range, and the small overall standardized mean difference for pain relief and mandibular movement observed, no high-quality evidence was found to distinguish the clinical effectiveness between occlusal splint therapy and exercise therapy for painful TMD patients. It appears that more randomized controlled trials comparing the effects of exercise therapy and occlusal splint therapy need to be implemented.


Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular , Terapia por Exercício , Humanos , Dor , Resultado do Tratamento
14.
Int J Comput Dent ; 24(1): 53-63, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-34006063

RESUMO

AIM: Limited data are available on the fitting properties of prototyped occlusal appliances. The aim of the present study was to assess the fitting of prototyped splints digitally designed with different offset values and generated with two different biocompatible resins. MATERIALS AND METHODS: Ten dental digital models were included, and occlusal splints were designed with different offset values (0.0, 0.05, 0.10, 0.15, 0.20, and 0.25 mm). Each splint was 3D printed using two different biocompatible resins, and the gap between the splint and the teeth was recorded by placing impression material. A specific 3D technology was used to assess the gap volume between the splint and the teeth and to calculate the Euclidean distance between the surface points of two digital models, with and without the gap volume. RESULTS: The splints with a 0.20-mm offset value showed smaller gap volume and deviation analysis values compared with those with offset values of 0.15 and 0.25 mm (P < 0.05). These results were consistent with both types of biocompatible resins used. For each offset value tested, the gap volume and deviation value analysis did not significantly differ between the splints printed with the two different resins. CONCLUSION: According to the present findings, the 0.20-mm offset value would be the best choice when digitally designing occlusal appliances.


Assuntos
Placas Oclusais , Humanos
15.
Clin Plast Surg ; 48(3): 497-506, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051901

RESUMO

The introduction of distraction osteogenesis to frontofacial monobloc advancement has increased the safety of the procedure. One hundred forty-seven patients with syndromic craniosynostosis underwent frontofacial monobloc advancement using 4 internal distractors. Twenty-five were aged 18 months or less. Ten patients presented with a tracheostomy, 5 (50%) were decannulated after surgery, and 3 others (30%) required an additional intervention before decannulation. Six patients required the addition of a transfacial pin and external traction. Very early frontofacial monobloc with 4 internal distractors is a safe and effective treatment to protect the ophthalmic, neurologic, and respiratory functions in infants with severe syndromic craniosynostosis.


Assuntos
Disostose Craniofacial/cirurgia , Osteogênese por Distração/métodos , Disostose Craniofacial/complicações , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Ossos Faciais/anormalidades , Ossos Faciais/cirurgia , Feminino , Humanos , Lactente , Masculino , Placas Oclusais , Osteogênese por Distração/instrumentação , Síndromes da Apneia do Sono/etiologia , Síndromes da Apneia do Sono/cirurgia , Traqueostomia
16.
J Oral Rehabil ; 48(7): 785-797, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33797785

RESUMO

OBJECTIVES: (i) To evaluate the effect of three different interventions on treatment outcomes and (ii) to determine how the frequency of oral parafunction influences the effectiveness of the different therapeutic modalities. METHODS: Forty-five participants were randomly assigned into three treatment groups [physical therapy (PT), stabilisation splint (SS) and control therapy (CT)]. According to Oral Behavior Checklist score, participants were divided into "high-frequency parafunction" (HFP) and low-frequency parafunction" (LFP) group. Primary (spontaneous pain and characteristic pain intensity) and secondary outcomes (range of mouth opening, anxiety symptoms, quality of life, perceived stress and global functional limitation) were evaluated during six-month treatment period. RESULTS: Participants in PT group showed a significant reduction in characteristic pain intensity (p = .047, η2  = 0.243) when compared to SS and CT group, but significant improvement in spontaneous pain was found in all treatment groups. Patients treated with PT and SS exhibited significantly stronger improvement in pain-free mouth opening than patients in CT group (3rd month: p=.037, η2=0.258; 6th month: p = .005, η2  = 0.383). Within-group analyses showed significant decrease of perceived stress, anxiety symptoms and global functional limitation only in PT group over a six-month treatment period. Participants with HFP presented significantly greater levels of anxiety (3rd month: p = .009, η2  = 0.275; 6th month: p = .041, η2  = 0.176) than participants with LFP. Within-group analyses, however, showed significant improvement of anxiety, but also the decrease of perceived stress and improvement of global limitation for the HFP group but not for the LFP group. CONCLUSION: Although no treatment can be marked as superior in terms of spontaneous pain relief, PT was more effective when observing relief of characteristic pain intensity. In HFP group the reduction of anxiety, stress and functional limitation was present regardless of the applied therapy. TRIAL REGISTRATION: ClinicalTrials.gov NCT04694274. Registered on 01/04/2021.


Assuntos
Qualidade de Vida , Transtornos da Articulação Temporomandibular , Humanos , Placas Oclusais , Medição da Dor , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-33804517

RESUMO

PURPOSE: The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. METHODS: This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. RESULTS: We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. CONCLUSION: Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Adulto , Endoscopia , Humanos , Placas Oclusais , Polissonografia , Prognóstico , Estudos Prospectivos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
18.
Spec Care Dentist ; 41(5): 572-578, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33826161

RESUMO

AIM: To present an occlusal splint effective for alleviating masticatory disturbance in Duchenne muscular dystrophy (DMD). CASE REPORT: A 13-year-old male DMD patient with masticatory disturbance presented with an open bite, with occlusal contact only between the first and second molars bilaterally and reduced masticatory performance. We applied an occlusal splint that achieved occlusal contact for all teeth and monitored its effects on masticatory function over 6 years. The occlusal splint increased occlusal contact points from 11 to 60. Although occlusal force remained at 13.9-16 kg, masticatory performance increased, and the number of mastication strokes increased from 124 to 169. Masseter muscle activity decreased from 76.8% to 33.4% maximum voluntary contraction (MVC) and digastric muscle activity increased from 8.7% to 18.0% MVC. Time from start of peanut mastication to swallowing decreased, and the vertical mastication cycle diameter and its width on the habitual side increased. CONCLUSIONS: Masticatory disturbance in a DMD patient was alleviated using an occlusal splint. The number of mastication strokes and the digastric to masseter muscle activity ratio were increased. Furthermore, the mastication cycle was enlarged, which increased masticatory movement. As masseter muscle activity during mastication decreased, the occlusal splint likely reduced muscle fatigue during masticatory movement.


Assuntos
Distrofia Muscular de Duchenne , Placas Oclusais , Adolescente , Força de Mordida , Humanos , Masculino , Mastigação , Distrofia Muscular de Duchenne/complicações , Distrofia Muscular de Duchenne/terapia
19.
Gen Dent ; 69(3): 42-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33908877

RESUMO

The aim of this study was to compare PETG/TPU (polyethylene terephthalate glycol/thermoplastic polyurethane) with PETG (polyethylene terephthalate glycol), based on color stability and microhardness. Sixty circular specimens (10 mm in diameter × 3 mm thick) were fabricated (30 PETG/TPU and 30 PETG). The specimens in both groups were submitted to 2000 thermal cycles in alternating baths of 60 seconds at 5°C ± 1°C and 55°C ± 1°C. The specimens were then divided into subgroups (n = 10) that were disinfected 15 minutes per day for 60 days in 1 of 3 solutions: liquid soap, 2% chlorhexidine, or Listerine. Color change (∆E*) and Knoop microhardness tests were performed at baseline (T0), after thermocycling (T1), and after disinfection (T2). Analysis of variance (ANOVA) and Tukey test were used (P < 0.05). ANOVA showed that there was no statistically significant difference in color change between the 2 materials after thermocycling (∆E*1) or after disinfection (∆E*2), regardless of the disinfectant. Intragroup comparisons (Listerine, liquid soap, and 2% chlorhexidine) of the 3 PETG/TPU groups or 3 PETG groups after disinfection revealed no statistically significant difference for microhardness. Comparison of PETG/TPU with PETG based on the overall mean microhardness showed that the PETG/TPU had a significantly greater mean surface hardness value (P < 0.05). The Tukey test revealed statistically significant increases in microhardness at T1 and T2 for PETG/TPU and PETG so that T0 < T1 < T2 (P < 0.05). Both thermoplastic materials demonstrated an increase in hardness after thermocycling and after disinfection, and both showed similar color changes regardless of the disinfection method. Based on the color evaluation, the liquid soap proved to be the best option for disinfection of PETG/TPU and PETG, because the color change (∆E* value) was clinically acceptable for both materials.


Assuntos
Desinfetantes , Desinfecção , Cor , Dureza , Humanos , Teste de Materiais , Placas Oclusais , Propriedades de Superfície
20.
Int J Prosthodont ; 34(2): 173-182, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33882564

RESUMO

PURPOSE: To compare the efficacy of low-dose laser therapy to that of conservative treatment using two different occlusal splints (stabilization and anterior repositioning splints) in patients with internal derangements of the temporomandibular joint (TMJ). MATERIALS AND METHODS: The study population consisted of patients with disc displacement with reduction diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and Axis II. In addition, disc displacement with reduction was confirmed in all patients using TMJ ultrasonography. These tests were conducted for 6 months with an interim control in the third month. The "clicking" sound from the joint on opening and closing the mouth and the extent to which the mouth opened vertically and laterally were assessed. In all, 20 patients received low-dose laser therapy, 20 were treated with a stabilization splint, and 20 were treated with an anterior repositioning splint. In addition, 10 untreated patients were included as a patient control group, and a further 10 healthy subjects were included as a healthy control group. Changes in the condition were assessed based on the results of the RDC/TMD Axis II and with the use of an algometer. RESULTS: The anterior repositioning splint group showed improvement in the "clicking" sound during mouth opening. Lateral movement improved significantly in patients who received laser therapy. In the patient control group, the click disappeared during mouth opening, the algometrically determined pain improved, and the lateral movement increased. There were no statistically significant differences between groups in the improvement of vertical mouth movement or in the clicking sound during mouth closing. CONCLUSION: Each treatment modality applied in this study separately produced positive results for the clicking sound, restrictions in vertical and lateral movements, and reduction of the pressure pain threshold observed in cases of TMJ irregularity. The decision regarding which treatment modality should be employed can be made based on the patient's symptoms. However, this study also indicates that TMJ derangements can resolve spontaneously when left untreated.


Assuntos
Luxações Articulares , Transtornos da Articulação Temporomandibular , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/terapia , Mandíbula , Placas Oclusais , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/terapia
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