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1.
BMC Oral Health ; 23(1): 18, 2023 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-36639670

RESUMO

BACKGROUND: Three-dimensional (3D) detailed evaluations of the mandibular mediolateral position, mandibular condylar position, and temporomandibular joint (TMJ) spaces following stabilization splints (SS) therapy in patients with temporomandibular joint disorders (TMD) and mandibular deviation (MD) have not been reported in the available literature. Accordingly, this study aimed to three-dimensionally analyze the skeletal and bony temporomandibular joint changes following stabilization splint therapy in adult patients with temporomandibular joint disorders and mandibular deviation. METHODS: This study is a retrospective clinical study that enrolled 26 adult patients with TMD and MD with a mean age of 24.86 years. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) was used to diagnose TMD. SS was adjusted weekly until occlusal contact stabilization occurred, and then adjusted monthly, patients were instructed to wear it at night for at least 10 h. The SS was removed after the elimination of TMD symptoms (TMJ/muscle pain on palpation, muscle spasm, and clicking) and having both condyles completely seated in a musculoskeletally stable position. Pre- and post-therapeutic Cone Beam Computed Tomography (CBCT) was analyzed. Mandibular mediolateral position, TMJ spaces, and mandibular condyle position were analyzed three-dimensionally using Mimics 21.0 software. Paired t-test or Wilcoxon rank-sum test was performed, and the significance level was considered at P < 0.05. RESULTS: The treatment period with SS therapy was 10.07 ± 3.1 months. The deviated chin was improved in 69.23% of the sample; the range of improvement was > 0 mm ≤ 3.9 mm. The mandibular rotation was significantly decreased from 3.58 ± 2.02° to 3.17 ± 1.60. The deviated side's superior and posterior joint TMJ spaces were significantly increased from 2.49 ± 0.88 mm and 1.25 ± 0.79 mm to 2.98 ± 1.02 mm and 1.86 ± 0.72 mm, respectively. The value of the difference from the bilateral condyle head position to the X and Z axes significantly decreased from 2.50 ± 1.56 mm and 2.30 ± 1.57 mm to 1.64 ± 1.58 mm and 1.82 ± 1.11 mm, respectively. CONCLUSION: The main positional effect of the stabilization splint treatment in TMD patients with MD includes considerable correction of mandibular deviation, improving facial asymmetry, and moving the condyle into a stable condylar position; these were done by promoting the mandible to rotate around the Z (roll) and Y (yaw) axes and by forward, downward, and outward condylar movement on the deviated side, respectively.


Assuntos
Má Oclusão , Placas Oclusais , Transtornos da Articulação Temporomandibular , Adulto , Humanos , Adulto Jovem , Má Oclusão/diagnóstico por imagem , Má Oclusão/terapia , Côndilo Mandibular/diagnóstico por imagem , Estudos Retrospectivos , Contenções , Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/terapia
2.
J Oral Rehabil ; 50(3): 177-193, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36564950

RESUMO

BACKGROUND: Stabilisation splint therapy (SST) and low-level laser therapy (LLLT) are effective-invasive treatment for temporo-mandibular disorder (TMD) patients. However, the specific efficacy of each therapy in patients with chronic closed lock (CCL) from temporo-mandibular joints (TMJ) disc displacement without reduction (DDwoR) remains unknown. OBJECTIVES: The aim of this study was to assess and compare the efficacy of SST and LLLT alone or in combination in patients with CCL from TMJ DDwoR. METHODS: This parallel randomised clinical trial included 42 patients who were diagnosed with CCL from TMJ DDwoR. Patients were allocated equally and randomly into three treatment groups: group I received combined SST and LLLT, group II received LLLT and group III received SST. Maximum mouth opening (MMO), visual analogue scale (VAS), muscle and joint palpation scores and time required to achieve normal state were evaluated at baseline, 1, 2, 4 weeks, 3 and 6 months after the intervention. Data were collected and analysed using SPSS software. RESULTS: Regarding MMO and VAS, a statistically significant improvement was found between group I versus group II and versus group III at all evaluation times. Regarding muscle and joint palpation scores, a statistically significant difference was found between group I versus group III, while non-significant difference was found between group I and group II. A statistically significant faster improvement was found in group I versus group III and versus group II. CONCLUSION: All treatment modalities can be effective in management of CCL from a TMJ DDwoR cases, but the combined SST and LLLT group seems to provide the best and quickest improvement. CLINICAL TRIAL REGISTRATION NUMBER: NCT05548894.


Assuntos
Doenças das Cartilagens , Terapia com Luz de Baixa Intensidade , Transtornos da Articulação Temporomandibular , Humanos , Contenções , Disco da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/terapia , Placas Oclusais , Resultado do Tratamento , Articulação Temporomandibular
3.
Ned Tijdschr Tandheelkd ; 129(12): 557-561, 2022 Dec.
Artigo em Holandês | MEDLINE | ID: mdl-36472309

RESUMO

Obstructive sleep apnea is a sleep-related breathing disorder, characterized by repetitive obstruction of the upper airway during sleep. Obstructive sleep apnea can be treated with a mandibular advancement device (MAD), which advances the mandibula into a forward position, thus preventing obstruction of the upper airway. Different MAD designs are available, however, clinically significant differences in effectiveness have not been found. Besides this, a randomized crossover study found the effectiveness of a new 'boil and bite' MAD to be equal to that of the custom MAD. After a 10-year follow-up, too, the MAD has been proven to be a successful treatment option. However, attention must be paid to minimalizing dental side effects, such as tooth repositioning.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Humanos , Placas Oclusais , Estudos Cross-Over , Apneia Obstrutiva do Sono/terapia , Mandíbula , Resultado do Tratamento
4.
J Indian Prosthodont Soc ; 22(1): 65-73, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36510949

RESUMO

Aim: The purpose of this study is to comparatively evaluate the Vitamin D supplementation and stabilization splint therapy in patients exhibiting temporomandibular disorders (TMD). Settings and Design: The study design was double-blinded, parallel-group, randomized and placebo-controlled trial conducted in patients with low Vitamin D and TMDs, which were allocated to two groups, Study group S + D (Stabilization splint with Vitamin D supplementation) and Control Group S (Stabilization Splint with placebo drug). Subjects and Methods: Thirty-six participants of 18-45 years of age gap with Vitamin D deficiency and TMD were included in the study. Preoperative values of Vitamin D levels in ng/ml, comfort mouth opening (CMO) in mm, maximum mouth opening (MMO) in mm, temporomandibular joint (TMJ) tenderness (grading 0-3), Visual analog scale score (VAS Score 0-10 cm), and total energy (TE) integral values of both left and right TMJ's in Hertz (Hz) were recorded using joint vibration analysis All the values of CMO, MMO, TMJ Tenderness and VAS were recorded at each follow-up at 1st week, 1st month, 2nd month, and 3rd month, respectively. Postoperative Vitamin D levels and TE of both TMJs were recorded at end of 3 months. Statistical Analysis Used: For intergroup comparison, Mann-Whitney U-test and Pearson Chi-square tests were done. For Intragroup comparison, Wilcoxon signed rank test was used for comparison. Results: In Intergroup comparison, a significant difference was seen in CMO, VAS score and MMO (P < 0.05) but not among mean values of TE of right and left TMJ, and Vitamin D levels (P < 0.05). In both groups, there were significant statistical variations in CMO, VAS score, MMO, and TE integral before and after treatment in the right and left TMJs (P < 0.05). Conclusions: The study concludes centric stabilization splint helps in improving symptoms of TMD patients and Vitamin D supplementation provided faster relief in those cases.


Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular , Humanos , Vitamina D/uso terapêutico , Resultado do Tratamento , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Contenções , Artralgia
5.
J Indian Prosthodont Soc ; 22(4): 314-327, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36511065

RESUMO

The study aimed to assess the effect of mandibular advancement device (MAD) in patients with obstructive sleep apnea for reduction in 24-h mean blood pressure, sleep quality, Apnea Hypopnea Index (AHI), and patient compliance, compared to continuous positive airway pressure (CPAP), other interventions, or no treatment. Three different databases such as PubMed, EMBASE, and CENTRAL were searched using different search terms till July 2021 as per the inclusion and exclusion criteria. After inclusion of studies, data extraction including risk of bias assessment was done. For each study, we used odds ratio, mean difference, and 95% confidence interval to assess and synthesize the outcomes. The quality of evidence was evaluated as per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Twenty-one randomized controlled trials were included: 497 patients in the MAD group, 239 patients in the CPAP group, and 274 patients in the sham group. In MAD-CPAP comparison, the results favored CPAP in the reduction of AHI of 3.48 (1.76-5.19). However, unclear results were found for sleep quality measured as Epworth Sleepiness Scale (ESS), patient compliance, and 24-h mean blood pressure. In MAD-sham comparison, the results favored MAD in the reduction of AHI of - 8.39 (-10.90--5.88] and ESS of - 0.91 (-1.70--0.12) and favored sham in terms of patient compliance while, unclear results for 24-h mean blood pressure. The GRADE score indicated that the quality of evidence is very low, low, and moderate for different outcomes. CPAP in comparison to MAD and MAD in comparison to sham showed a significant AHI reduction. However, patient compliance and 24-h mean blood pressure were not significantly different in MAD-CPAP or MAD-sham. Quality of evidence is very low and low when MAD was compared with CPAP and sham, respectively, for AHI.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Humanos , Avanço Mandibular/métodos , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Cooperação do Paciente , Placas Oclusais
6.
Artigo em Inglês | MEDLINE | ID: mdl-36361031

RESUMO

BACKGROUND: In obstructive sleep apnoea (OSA), treatment with mandibular advancement devices (MADs) reduces patients' Apnoea-Hypopnoea index (AHI) scores and improves their sleepiness and quality of life. MADs are non-invasive alternatives for patients who cannot tolerate traditional continuous positive airway pressure (CPAP) therapy. The variability of responses to these devices makes it necessary to search for predictors of success. The aim of our study was to evaluate the presence of mandibular torus as a predictor of MAD efficacy in OSA and to identify other potential cephalometric factors that could influence the response to treatment. METHODS: This was a retrospective cohort study. The study included 103 patients diagnosed of OSA who met the criteria for initiation of treatment with MAD. Structural variables were collected (cephalometric and the presence or absence of mandibular torus). Statistical analysis was performed to evaluate the existence of predictive factors for the efficacy of MADs. RESULTS: A total of 103 patients who were consecutively referred for treatment with MAD were included (89.3% men); the mean age of the participants was 46.3 years, and the mean AHI before MAD was 31.4 (SD 16.2) and post- MAD 11.3 (SD 9.2). Thirty-three percent of patients had mandibular torus. Torus was associated with a better response (odds ratio (OR) = 2.854 (p = 0.035)) after adjustment for sex, age, body mass index (BMI; kg/m2), the angle formed by the occlusal plane to the sella-nasion plane (OCC plane to SN), overinjection, and smoking. No cephalometric predictors of efficacy were found that were predictive of MAD treatment success. CONCLUSIONS: The presence of a mandibular torus practically triples the probability of MAD success. This is the simplest examination with the greatest benefits in terms of the efficacy of MAD treatment for OSA.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Placas Oclusais , Qualidade de Vida , Estudos Retrospectivos , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
7.
BMC Oral Health ; 22(1): 527, 2022 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-36424568

RESUMO

OBJECTIVE: To evaluate the effect of hard stabilization splints (HSS), counselling and exercise therapies, respectively, for the painful temporomandibular disorder (TMD) in patients seeking for orthodontic treatment through magnetic resonance imaging (MRI) and clinical examination. MATERIALS AND METHODS: Eighty-seven TMD patients were divided into two groups according to their therapies: the HSS group (n = 43) comprising of patients treated with HSS, counselling and masticatory muscle exercises; the control group (n = 44) comprising of patients treated with counselling and masticatory muscle exercises alone. All patients had orthodontic therapies after the first treatment phase. The joint pain and clicking of all patients were recorded via clinical examination. MRIs of HSS groups were taken before (T0), after the first phase (T1), and after the orthodontic treatment (T2). Parameters indicating the condyles and articular discs were evaluated. Clinical symptom (pain and clicking) changes among T0, T1 and T2 time point were detected in the two groups respectively. The significant differences between HSS and control groups, as well as between male and female were tested at T1 and T2. Position changes of condyles and discs in HSS group among T0, T1 and T2 were detected in male and female respectively. RESULTS: After the first treatment phase, there was no difference in the decrease of facial pain between the two group, as well as between male and female in the two groups (P > 0.05). Clicking decreasing was not statistically significant. After the whole orthodontic periods, the TMJ pain relapsed in female of the control group, and the number of female's pain joints was more than male's (P < 0.05). In the HSS group, the posterosuperior movements of discs and the anteroposterior movements of condyles were recorded in closing position (P < 0.05). After the whole orthodontic periods, female's disc-condyle angles increased, the discs to HRP distance decreased and condyles to VRP distance increased when compared with the data of T1 (P < 0.05). CONCLUSIONS: For the orthodontic patients with painful TMD, HSS combined with counselling and exercise therapies before orthodontic treatment could provide pain relief. HSS is helpful to improve the position and relation of discs and condyles. In addition, male's prognosis is better than female's in terms of stability.


Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular , Humanos , Masculino , Feminino , Estudos Retrospectivos , Transtornos da Articulação Temporomandibular/terapia , Transtornos da Articulação Temporomandibular/diagnóstico , Dor Facial/etiologia , Dor Facial/terapia , Terapia por Exercício
8.
Dent Mater J ; 41(6): 916-922, 2022 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-36288940

RESUMO

The aim of this in vitro study was to evaluate the wear and surface hardness of nine materials for conventional manufacturing, subtractive milling, and 3D printing of occlusal splints, as well as to evaluate the differences in wear and surface hardness between rigid and flexible 3D-printed occlusal splint materials. Two-body wear and Vickers hardness tests were performed. The vertical wear depth and Vickers hardness values were statistically analyzed. Vertical wear depth and surface hardness values were statistically significant among the investigated materials (p<0.05). The lowest vertical wear depth was observed for the heat-cured resin (27.5±2.4 µm), PMMA-based milled material (30.5±2.8 µm), and autopolymerizing resin (36.7±6.3 µm), with no statistical difference (p<0.05). Flexible 3D-printed and CAD-CAM milled polycarbonate-based splint materials displayed lower surface hardness and higher wear than the PMMA-based materials. PMMA-based splint materials displayed the most consistent surface hardness and wear resistance regardless of the manufacturing technology.


Assuntos
Placas Oclusais , Polimetil Metacrilato , Dureza , Teste de Materiais , Desenho Assistido por Computador , Impressão Tridimensional , Propriedades de Superfície
9.
Adv Exp Med Biol ; 1384: 373-385, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36217096

RESUMO

Mandibular advancement splint (MAS) therapy is the leading alternative to continuous positive airway pressure (CPAP) therapy for the treatment of obstructive sleep apnoea. A MAS is an oral appliance which advances the mandible in relation to the maxilla, thus increasing airway calibre and reducing collapsibility. Although it is less effective than CPAP in reducing the apnoea-hypopnoea index (AHI), it has demonstrated equivalence to CPAP in a number of key neurobehavioural and cardiovascular health outcomes, perhaps due to increased tolerability and patient adherence when compared to CPAP. However, response to MAS is variable, and reliable prediction tools for patients who respond best to MAS therapy have thus far been elusive; this is one of the key clinical barriers to wider uptake of MAS therapy. In addition, the most effective MAS devices are custom-made by a dentist specialising in the treatment of sleep disorders, which may present financial or accessibility barriers for some patients. MAS devices are generally well tolerated but may have side effects including temporomandibular joint (TMJ) dysfunction, hypersalivation, tooth pain and migration as well as occlusal changes. A patient-centred approach to treatment from a multidisciplinary team perspective is recommended. Evidence-based clinical practice points and areas of future research are summarised at the conclusion of the chapter.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Placas Oclusais , Cooperação do Paciente , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
10.
J Craniofac Surg ; 33(7): 2005-2010, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36201697

RESUMO

The evolution of virtual surgical planning (VSP) in the last 2 decades has led to improved precision and efficiency for orthognathic surgery, both pre- and intraoperatively. This study evaluates a single surgeon's experience with this technology over the past 6 years. Patients undergoing orthognathic surgery using VSP with the senior author between 2015 and 2021 were retrospectively reviewed. Virtual surgical planning -specific data including incidence of midline/cant correction, occlusal equilibration, serial splints, segmental osteotomies, and custom plates were recorded and analyzed. Sixty patients undergoing orthognathic surgery using simulated VSP in the study period were retrospectively reviewed. Mean age at time of surgery was 23.5±7.9 years. Forty-nine patients (81.7%) underwent LeFort I osteotomy combined with at least 1 additional procedure (eg,unilateral or bilateral sagittal split osteotomy, condylectomy, genioplasty, etc.). Twenty-six (43.3%) of patients in the studied cohort underwent maxillary midline correction, 30.0% required occlusal equilibration, 36.7% underwent maxillary molar cant correction, 30.0% underwent mandibular cant correction, and 21.7% required both maxillary and mandibular cant correction. Three patients required serial splinting, and 15 patients (25.0%) required modification of splint design. Custom plates were utilized in 15 patients (25.0%). This study demonstrates the utility of VSP in accurately detecting occlusal cants, asymmetry, and occlusal interferences. Virtual surgical planning also allows for a dynamic preoperative planning process, offering the surgeon a high degree of versatility in splint design, and the ability to fabricate multiple customized splints for each case. This is particularly useful in patients with limited or unpredictable soft tissue elasticity.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Cirurgiões , Cirurgia Assistida por Computador , Adolescente , Adulto , Humanos , Placas Oclusais , Procedimentos Cirúrgicos Ortognáticos/métodos , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos , Adulto Jovem
12.
Int J Rheum Dis ; 25(9): 1053-1059, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35785423

RESUMO

AIM: Splint therapy is a well-established modality in the management of temporomandibular joint disorders (TMDs). We aimed to evaluate and compare the effectiveness of hard and soft splints in the symptomatic management of TMDs using the modified Helkimo index. METHODS: This study included 91 patients diagnosed with TMDs. Participants were randomly allocated into two treatment groups. All these patients were treated by hard or soft stabilization splint therapy. Group 1: hard splint group, n = 42 (mean age - 31.62 ± 8.5 years), 10 males and 32 females; group 2: soft splint group, n = 49 (mean age - 32.86 ± 9.06 years), 13 males and 36 females. The anamnestic and clinical dysfunction component of the modified Helkimo index was used to evaluate the outcomes at baseline (T0 ), first month (T1 ), and third month (T2 ). RESULTS: Symptoms such as clicking of the joints, temporomandibular joint (TMJ) pain and muscle pain showed improvement in both groups (P < .05). Restriction and deviation of mouth opening did not show significant improvement in either group. The patients who underwent hard splint therapy showed an early improvement of symptoms at T1 (P < .05). However, there was no statistical difference in the improvement of symptoms between hard and soft splints at T2 . CONCLUSION: Both hard and soft stabilization splints were effective in the symptomatic management of TMDs. However, hard splints provide an earlier reduction of symptoms.


Assuntos
Contenções , Transtornos da Articulação Temporomandibular , Feminino , Humanos , Masculino , Placas Oclusais , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia , Resultado do Tratamento
13.
Artigo em Inglês | MEDLINE | ID: mdl-35805630

RESUMO

BACKGROUND: Cranial surface electromyography is assumed to analyze the correlation between the stomatognathic apparatus and the muscular system and its implications on the physical status of professional athletes. The purpose of this paper is to evaluate surface cranial electromyography as an aid in the diagnosis and treatment of occlusal and muscular disorders in professional athletes. METHODS: A sample of 25 athletes (mean age 23 years, 20 men and 5 women) underwent electromyographic recording; among them, 13 had a sports injury condition (symptomatic athletes), while 12 were in perfect physical condition (asymptomatic athletes). At odontostomatological examination, 6 showed cranio-mandibular disorders (dysfunctional athletes), while 19 showed no disorders (functional athletes). The treatment plan to resolve the symptoms of the dysfunctional athletes was chosen based on the electromyographic data. One month after the start of therapy with an occlusal splint, a follow-up was performed, and the results were compared with the initial data. RESULTS: Statistical analysis showed that the chosen therapy following the use of electromyography was effective in 72% of cases, while 28% of patients did not respond to therapy (p = 0.028). CONCLUSIONS: The use of cranial electromyography in competitive athletes is a valuable tool in therapeutic choice aimed at balancing occlusal loads and improving the patient's global tonic postural attitude, resulting in positive feedback in the qualitative assessment of sports performance.


Assuntos
Placas Oclusais , Crânio , Adulto , Atletas , Eletromiografia , Feminino , Humanos , Masculino , Adulto Jovem
14.
J Clin Pediatr Dent ; 46(3): 219-224, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35830638

RESUMO

OBJECTIVE: Bruxism is defined as a parafunctional activity. It could be in diurnal or nocturnal form, based on the time it occurs. The purpose of the study compares the effectiveness of occlusal splint treatments in children with nocturnal bruxism using the BiteStrip®. STUDY DESIGN: The muscle activity of children was measured using the BiteStrip®. The groups used occlusal splints during nighttime sleep for three months, at the end of which their muscle activity were measured again through the use of the BiteStrip®. RESULTS: Muscle pain in palpation and pain in the dynamic position of TMJ pain was significantly reduced in patients using soft occlusal splint (p=0.01). There was no significant change in the BiteStrip® score in both group I (p=0.11) and group II (p=0.61). CONCLUSION: Soft occlusal splints could reduce pain caused by nocturnal bruxism on muscle and TMJ. The relationship between treatment results and BiteStrip® scores of patients using soft occlusal splint or hard occlusal splint are not significantly.


Assuntos
Bruxismo do Sono , Criança , Humanos , Placas Oclusais , Dor , Bruxismo do Sono/terapia , Contenções , Resultado do Tratamento
15.
J Sleep Res ; 31(6): e13673, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35734809

RESUMO

Mandibular advancement device (MAD) treatment outcome for obstructive sleep apnea (OSA) is variable and patient dependent. A global, clinically applicable predictive model is lacking. Our aim was to combine characteristics obtained during drug-induced sleep endoscopy (DISE), awake nasendoscopy, and computed tomography scan-based computational fluid dynamic (CFD) measurements in one multifactorial model, to explain MAD treatment outcome. A total of 100 patients with OSA were prospectively recruited and treated with a MAD at fixed 75% protrusion. In all, 72 underwent CFD analysis, DISE, and awake nasendoscopy at baseline in a blinded fashion and completed a 3-month follow-up polysomnography with a MAD. Treatment response was defined as a reduction in the apnea-hypopnea index (AHI) of ≥50% and deterioration as an increase of ≥10% during MAD treatment. To cope with missing data, multiple imputation with predictive mean matching was used. Multivariate logistic regression, adjusting for body mass index and baseline AHI, was used to combine all potential predictor variables. The strongest impact concerning odds ratios (ORs) was present for complete concentric palatal collapse (CCCp) during DISE on deterioration (OR 28.88, 95% confidence interval [CI] 1.18-704.35; p = 0.0391), followed by a C-shape versus an oval shape of the soft palate during wakefulness (OR 8.54, 95% CI 1.09-67.23; p = 0.0416) and tongue base collapse during DISE on response (OR 3.29, 95% CI 1.02-10.64; p = 0.0464). Both logistic regression models exhibited excellent and fair predictive accuracy. Our findings suggest DISE to be the most robust examination associated with MAD treatment outcome, with tongue base collapse as a predictor for successful MAD treatment and CCCp as an adverse DISE phenotype.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Humanos , Placas Oclusais , Vigília , Estudos Prospectivos , Hidrodinâmica , Carbonil Cianeto m-Clorofenil Hidrazona , Endoscopia/métodos , Resultado do Tratamento , Fenótipo , Sono
16.
Sleep Med Rev ; 64: 101644, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35653952

RESUMO

Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. The aim of this systematic review is to identify predictors of the efficacy of oral appliance (OA) therapy for OSA in adult patients. This review focuses on performing the quantitative analysis by subgroups based on the response criteria used in the literature and based on the type of device. PubMed, EMBASE, Scopus, Web of Science and Cochrane databases was conducted to identify potentially relevant studies published until Dec 2021. The search identified 1343 preliminary references. A total of 99 studies met the eligibility criteria and were included in the review, and 60 in the meta-analysis. The quality of studies was assessed using the Newcastle-Ottawa scale and the Cochrane scale. Based on meta-analysis, and considering a low to moderate evidence profile according to the GRADE scale, responders are younger patients, with smaller neck circumference, lower body mass index. Responders have shorter maxillary length, lower anterior and posterior facial height, a shorter distance from the hyoid bone to the third cervical vertebra, a shorter airway length, a smaller minimum airway cross-sectional area and a higher minimum oxygen saturation during sleep. Responders needed a lower optimal continuous positive airway pressure than non-responders. The type of device has not affected the results of the meta-analysis. The criterion "AHI <10 and reduction AHI >50%" is the one that provides the "weight" of significance for several variables. This criterion should be taken into consideration for future studies to predict OSA treatment by OA.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Adulto , Pressão Positiva Contínua nas Vias Aéreas/métodos , Humanos , Placas Oclusais , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
17.
BMC Oral Health ; 22(1): 218, 2022 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-35655203

RESUMO

BACKGROUND: Precise orthognathic surgical splints are important in surgical-orthodontic treatment. This study aimed to propose a standardized protocol for three-dimensional (3D)-printed splints and assess the precision of splints with different occlusal coverage on the dentition (occlusal coverage depth, OCD), thus optimizing the design of 3D-printed splints to minimize the seemingly unavoidable systematic errors. METHODS: Resin models in optimal occlusion from 19 patients were selected and scanned. Intermediate splints (ISs) and final splints (FSs) with 2-mm, 3-mm, 4-mm, and 5-mm OCDs were fabricated and grouped as IS-2, IS-3, IS-4, IS-5, FS-2, FS-3, FS-4, and FS-5, respectively. The dentitions were occluded with each splint and scanned as a whole to compare with the original occlusion. Translational and rotational deviations of the lower dentition and translational deviations of the landmarks were measured. RESULTS: For vertical translation, the lower dentitions translated inferiorly to the upper dentition in most of the splints, and the translation increased as OCD got larger. Vertical translations of the dentitions in 89.47% of IS-2, 68.42% of IS-3, 42.11% of IS-4, 10.53% of IS-5, 94.74% of FS-2, 63.16% of FS-3, 26.32% of FS-4, and 21.05% of FS-5 splints were below 1 mm, respectively. For pitch rotation, the lower dentitions rotated inferiorly and posteriorly in most groups, and the rotation increased as OCD got larger. Pitch rotations of the dentitions in 100% of IS-2, 89.47% of IS-3, 57.89% of IS-4, 52.63% of IS-5, 100.00% of FS-2, 78.95% of FS-3, 52.63% of FS-4, and 47.37% of FS-5 splints were below 2°, respectively. On the other hand, the transversal and sagittal translations, roll and yaw rotations of most groups were clinically acceptable (translation < 1 mm and rotation < 2°). The deviations of ISs and FSs showed no statistical significance at all levels of coverage (P > 0.05). CONCLUSIONS: A protocol was proposed to generate 3D-printed ISs and FSs with normalized basal planes and standardized OCDs. Deviations of the ISs and FSs were more evident in the vertical dimension and pitch rotation and had a tendency to increase as the OCD got larger. ISs and FSs with both 2-mm and 3-mm OCD are recommendable regarding the precision relative to clinical acceptability. However, considering the fabrication, structural stability, and clinical application, ISs and FSs with 3-mm OCD are recommended for accurate fitting.


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Contenções , Humanos , Placas Oclusais , Procedimentos Cirúrgicos Ortognáticos/métodos , Impressão Tridimensional , Dimensão Vertical
18.
J Craniomaxillofac Surg ; 50(8): 609-614, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35760659

RESUMO

The aim of this study is to compare the accuracy of maxilla positioning in orthognathic surgery with the use of custom-made devices (cutting guides and patient-fitted osteosynthesis plates) comparing to CAD/CAM splints. A prospective randomized study was performed. Patients with dentofacial deformities undergoing orthognathic surgery were compared, using customized guides (experimental group) vs. CAD/CAM surgical splints (control group) for the repositioning of the upper maxilla. Preoperative and postoperative CT scans were used to compare positioning and fixation of the maxilla in the three planes of space. A total of 30 patients were included in the study (15 patients in each study group). The mean error obtained with customized guides was 0.8 mm (range 0.1-1.9) in the anterior-posterior axis, 0.4 mm (range 0-1.4) in the vertical axis and 0.2 mm (range 0-1.1) in the horizontal axis. There were statistically significant differences in the anterior-posterior and vertical axes in favour of the customized implants, whereas there were no differences in the horizontal plane. Furthermore, there was a mean reduction of the operative time of 36.5 min in the experimental group. Within the limitations of the study it seems that patient specific surgical guides should be preferred when accuracy of repositioning of the maxilla and saving operative time are the priority.


Assuntos
Implantes Dentários , Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Cirurgia Assistida por Computador , Desenho Assistido por Computador , Humanos , Imageamento Tridimensional , Maxila/cirurgia , Placas Oclusais , Estudos Prospectivos
19.
Chron Respir Dis ; 19: 14799731211052301, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35512250

RESUMO

We aimed to evaluate and compare the effects of continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) in reducing the intensity of sleep bruxism (SB) in patients with obstructive sleep apnea (OSA). Forty-eight adults with OSA were subjected to single-night full polysomnography (PSG) in the Sleep Laboratory of the Wroclaw Medical University. The respiratory events and bruxism episodes were scored according to the standards of the American Academy of Sleep Medicine. The patients were assigned to the CPAP treatment or the MAD treatment in accordance to apnea-hypopnea index (AHI). The second PSG examination was conducted during the MAD or CPAP treatment to assess the effect of treatment on bruxism episode index (BEI) and AHI. The mean AHI and mean BEI in the study material were estimated to be 30.05 ± 15.39 and 5.10 ± 5.31, respectively. The bruxism parameters were significantly decreased in both the CPAP and MAD groups. Compared to the MAD, the CPAP treatment was more effective in reducing AHI; however, there was no significant difference in effectiveness of CPAP and MAD treatment in BEI reduction. Both CPAP and MAD treatments were effective against SB coexisting with OSA. Due to the application of these treatment options, the risk of OSA should be estimated in patients with SB.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Bruxismo do Sono , Adulto , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Placas Oclusais , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Bruxismo do Sono/complicações , Bruxismo do Sono/terapia , Resultado do Tratamento
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