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1.
BMC Oral Health ; 22(1): 218, 2022 Jun 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
2.
Medicina (Kaunas) ; 58(5)2022 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-35630101

RESUMO

Background and Objectives: The aim of the study was to assess the craniovertebral and craniomandibular changes in patients diagnosed with temporomandibular joint disorders (TMD) after physiotherapy combined with occlusal splint therapy. Materials and Methods: There were forty patients (32 females, 80%), diagnosed with TMD, included into the study group. After the initial series of physiotherapy, patients received maxillary occlusal splints to be worn day and night. Participants continued physiotherapy simultaneously with occlusal splint therapy for 6 months. Lateral cephalograms taken in natural head position before and after the end of the therapy were used for measurements. The control group consisted of 15 healthy participants (12 females, 80%), who had taken lateral cephalograms twice, and did not receive any type of occlusal treatment nor physiotherapy in the meantime. Results: Occlusal splint therapy and physiotherapy combined together significantly affected: the vertical position of the mandible (significant increase, p < 0.0001), the sagittal position of mandible (significant decrease, p = 0.0065), as well as the width of the functional space between C1 and C2 (significant decrease, p = 0.0042). Moreover, the cervical lordosis was restored after the end of the treatment (p < 0.0001). Conclusions: Cooperation of physiotherapists with dental practitioners is necessary in the treatment of patients with TMD, including temporomandibular joint osteoarthritis.


Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular , Animais , Estudos de Casos e Controles , Odontólogos , Feminino , Humanos , Modalidades de Fisioterapia , Papel Profissional , Transtornos da Articulação Temporomandibular/terapia
3.
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
4.
Int J Prosthodont ; 35(2): 163-173, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35507529

RESUMO

PURPOSE: To assess the effect of stabilization splint (SS) thickness on temporomandibular disorders (TMDs). MATERIALS AND METHODS: Participants were selected from patients who applied to the clinic with a complaint of temporomandibular disorders (TMDs). Symptoms were evaluated with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Regarding the treatment plan, patients were divided into two groups: the 2-mm-thick splint group (2-mm TSG) and the 4-mm-thick splint group (4-mm TSG). They used SSs at night (8 hours) and were recalled 1, 2, 3, and 6 months after splint insertion. At the end of the study, 72 patients (2-mm TSG = 39, 4-mm TSG = 33) had completed the 6-month follow-up. The SPSS program was used for statistical analysis. The results of the analysis were evaluated at a significance level of .05. RESULTS: Pain in the muscles decreased significantly in the muscle disorders and combined groups (both 2- and 4-mm TSG) after 6 months of treatment (P < .05). In the combined group, TMJ sounds significantly decreased after 6 months of treatment, and there was a statistically significant difference between the 2-mm TSG and the 4-mm TSG (P = .045). Also, in the combined group, maximum unassisted opening (MUO) values of patients treated with 2-mm-thick splints decreased after 6 months of treatment (P = .022). CONCLUSION: Both 2-mm-thick and 4-mm-thick splints were effective in the treatment of muscle disorders and disc displacements, especially in muscle-related pain and TMJ sound symptoms.


Assuntos
Contenções , Transtornos da Articulação Temporomandibular , Humanos , Placas Oclusais , Dor , Transtornos da Articulação Temporomandibular/terapia , Resultado do Tratamento
6.
Medicina (Kaunas) ; 58(2)2022 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-35208549

RESUMO

Obstructive sleep apnea (OSA) remains a prominent disease state characterized by the recurrent collapse of the upper airway while sleeping. To date, current treatment may include continuous positive airway pressure (CPAP), lifestyle changes, behavioral modification, mandibular advancement devices, and surgical treatment. However, due to the desire for a more convenient mode of management, pharmacological treatment has been thoroughly investigated as a means for a potential alternative in OSA treatment. OSA can be distinguished into various endotypic or phenotypic classes, allowing pharmacological treatment to better target the root cause or symptoms of OSA. Some medications available for use include antidepressants, CNS stimulants, nasal decongestants, carbonic anhydrase inhibitors, and potassium channel blockers. This review will cover the findings of currently available and future study medications that could potentially play a role in OSA therapy.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Placas Oclusais , Sono , Apneia Obstrutiva do Sono/tratamento farmacológico
7.
Int J Sports Physiol Perform ; 17(5): 791-795, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35130510

RESUMO

Wearing an intraoral jaw-protruding splint could enhance respiratory function in clinical settings and eventually exercise performance. PURPOSE: The authors studied the acute effect of wearing a lower-jaw-forwarding splint at different protruding percentages (30% and 50%) across a wide range of running exercise intensities. METHODS: A case study was undertaken with a highly trained and experienced 27-year-old female triathlete. She performed the same incremental intermittent treadmill running protocol on 3 occasions wearing 3 different intraoral devices (30% and 50% maximum range and a control device) to assess running physiological and kinematic variables. RESULTS: Both the 30% and 50% protruding splints decreased oxygen uptake and carbon dioxide production (by 4%-12% and 1%-10%, respectively) and increased ventilation and respiratory frequency (by 7%-12% and 5%-16%, respectively) along the studied running intensities. Exercise energy expenditure (approximately 1%-14%) and cost (7.8, 7.4, and 8.0 J·kg-1·m-1 for 30%, 50%, and placebo devices, respectively) were also decreased when using the jaw-protruding splints. The triathlete's lower limbs' running pattern changed by wearing the forwarding splints, decreasing the contact time and stride length by approximately 4% and increasing the stride rate by approximately 4%. CONCLUSIONS: Wearing a jaw-protruding splint can have a positive biophysical effect on running-performance-related parameters.


Assuntos
Corrida , Contenções , Adulto , Fenômenos Biomecânicos , Teste de Esforço , Feminino , Humanos , Mandíbula/fisiologia , Placas Oclusais , Corrida/fisiologia
8.
Acta Otorhinolaryngol Ital ; 42(1): 89-96, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35129540

RESUMO

OBJECTIVE: This retrospective study aimed to verify the outcomes of stabilising occlusal splint therapy prescribed to 22 patients with unilateral definite Ménière's disease and comorbid temporomandibular joint disorder. METHODS: The results of a battery of audiometric and vestibular tests were recorded before and after 6 months of treatment, as well as the scores of disease-specific questionnaires. RESULTS: The average hearing threshold in the affected ear and the acoustic immittance were unchanged. No spontaneous and positional nystagmus were recorded. Caloric hypo-responsiveness and vestibular myogenic evoked responses did not vary. No changes of stabilometric body sway parameters in eyes opened condition and with optokinetic stimulation delivered to the unaffected labyrinth were observed. A significant reduction was recorded in eyes closed condition and with the optokinetic stimulation toward the affected ear. The Tinnitus Handicap Inventory, the Situational Vertigo Questionnaire and the Numeric Pain Rating Scale scores improved. The number of vertigo attacks was reduced. CONCLUSIONS: Occlusal splint therapy is a favourable option to reduce aural symptoms of Ménière's disease and comorbid temporomandibular joint disorder, even if its pathophysiological mechanism remains elusive.


Assuntos
Doença de Meniere , Transtornos da Articulação Temporomandibular , Vestíbulo do Labirinto , Humanos , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Doença de Meniere/terapia , Placas Oclusais , Estudos Retrospectivos , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/terapia
9.
Rev Mal Respir ; 39(4): 321-327, 2022 Apr.
Artigo em Francês | MEDLINE | ID: mdl-35184955

RESUMO

INTRODUCTION: Mandibular advancement devices, more simply known as Oral Appliances (OAs), represent one of the current treatments for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). The primary objective of the study was to measure their efficacy in the severe OSAHS population. The secondary objectives were to determine predictive factors for the OA efficacy and to determine the tolerance and frequency of treatment discontinuation. METHODS: OA efficacy outcomes based on Apnea-Hypopnea Index (AHI) reduction, complications, and discontinuation rates were collected from 271 prospectively followed severe OSAHS patients treated with OAs. RESULTS: OA treatment reduced the AHI by a mean 21.5 respiratory events/h, P<10-5. The complete response rate was 19.3%. With their OAs, 70.7% of patients presented AHI reduction>50% and 58.5% of patients exhibited AHI less than 15/h. The effectiveness of OA on AHI did not vary significantly over time (P=0.0936). OA was discontinued by 9.6% of patients, mainly due to its ineffectiveness, and more rarely because of intolerance. CONCLUSIONS: Mandibular advancement orthosis is an effective and well-tolerated treatment for severe OSAHS. In 70.7% of the cases studied, the oral appliance reduced AHI by at least 50%, and it should be more systematically proposed in the event of failure or refusal of CPAP treatment.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Placas Oclusais , Apneia Obstrutiva do Sono/terapia , Síndrome , Resultado do Tratamento
10.
J Clin Sleep Med ; 18(6): 1547-1555, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35088708

RESUMO

STUDY OBJECTIVES: It has been suggested that treatment for obstructive sleep apnea (OSA) reduces cardiovascular risk. So far, knowledge is limited about the difference in the reduction of this risk between mandibular advancement device (MAD) and continuous positive airway pressure (CPAP) therapy. The aim of this study was to compare the cardiovascular effects of MAD vs CPAP therapy in patients with moderate OSA. METHODS: Patients with an apnea-hypopnea index of 15-30 events/h were randomized to either MAD or CPAP therapy. At baseline and after 12-month follow-up, 24-hour ambulant blood pressure measurements and laboratory measurements were performed. Ambulant blood pressure measurements consisted of 24-hour, daytime and night-time systolic and diastolic blood pressure and heart rate measurements. Laboratory measurements consisted of serum lipid values, creatinine, high-sensitivity C-reactive protein, plasma glucose, hemoglobin A1c glycated hemoglobin, proinflammatory cytokines, soluble receptor for advanced glycation end-products, chemokines, and adhesion molecules. RESULTS: Of the 85 randomized patients with moderate OSA, data were available for 54 patients (n = 24 MAD, n = 30 CPAP) at 12-month follow-up and showed that apnea-hypopnea index significantly decreased with either therapy. In the MAD group, soluble receptor for advanced glycation end-products and glycated hemoglobin were significantly higher after 12 months' follow-up compared to baseline. No significant changes were found between MAD and CPAP treatments for all outcomes. CONCLUSIONS: Treatment of patients with moderate OSA with either MAD or CPAP therapy had no profound effects on major cardiovascular risk factors after 12 months. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Title: MRA Therapy vs CPAP Therapy in Moderate OSAS; Identifier: NCT01588275; URL: https://clinicaltrials.gov/ct2/show/NCT01588275. CITATION: Uniken Venema JAM, Knol-de Vries GE, van Goor H, Westra J, Hoekema A, Wijkstra PJ. Cardiovascular and metabolic effects of a mandibular advancement device and continuous positive airway pressure in moderate obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2022;18(6)1547-1555.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Hemoglobina A Glicada , Humanos , Placas Oclusais , Receptor para Produtos Finais de Glicação Avançada , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
11.
J Mech Behav Biomed Mater ; 126: 105053, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34998068

RESUMO

OBJECTIVES: To investigate the volumetric and vertical loss of occlusal splints manufactured by conventional (heat-cure), subtractive (CAD/CAM) and additive (3D-printing) methods. METHODS: Six occlusal splint materials were investigated (n = 126), using three manufacturing methods: heat-cured, CAD/CAM and 3D-printed built-in three different printing angles (0°,45°and 90°). Block-on-ring wear testing was performed with extracted human molars as the antagonist. All samples were tested with an applied force of 49N at 1 Hz and 60RPM in artificial saliva at 37 °C for six and 12 months. Scanning electron microscopy images were analysed to evaluate the wear on the tooth enamel and in the splint material. Volumetric and vertical wear loss were statistically analysed. RESULTS: The lowest volumetric and vertical loss was observed in CAD-CAM materials (6.44 ± 1.77 mm3 and 48.3 ± 7.14 µm) with no statistical significance to the heat-cured material (17.22 ± 9.23 mm3 and 148 ± 121.1 µm) after 12 months (p < 0.172). The mean volumetric loss of 3D printed materials ranged from 0.25 ± 0.15 mm3 to 0.29 ± 0.1 4mm3 with no statistical difference, whereas, the differences in vertical loss from 131.63 ± 44.1 µm to 493 ± 79.19 µm were statistically significant (p < 0.001). The highest vertical loss was observed in the KeySplint Soft 3D printed at 90° (385.35 ± 82.37 µm), whereas FreePrint Splint 2.0 with a build angle of 0° had the highest volumetric loss (204.59 ± 25.67 mm3). CONCLUSION: CAD-CAM material had the highest wear resistance followed by heat-cured material.KeySplint Soft and FreePrint Splint 2.0 3D printed materials would be preferred for patients that do not have severe bruxing episodes. No significant wear of human enamel after six and 12 months was observed under SEM for any tested materials.


Assuntos
Placas Oclusais , Impressão Tridimensional , Desenho Assistido por Computador , Humanos , Teste de Materiais , Propriedades de Superfície
12.
Am J Orthod Dentofacial Orthop ; 161(3): e277-e286, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34776321

RESUMO

INTRODUCTION: Occlusal stabilization splint is the most common treatment modality for temporomandibular joint disorders, but the optimal thickness is still uncertain. This study investigated the effect of the occlusal splint with different thicknesses on the stress distribution of the temporomandibular joint. METHODS: Cone-beam computed tomography and magnetic resonance images were used to reconstruct the maxillofacial and disc, and the unilateral anterior disc displacement without reduction was established manually as the basic model. Occlusal splint with 5 different thickness levels (2, 3, 4, 5, and 6 mm) was added to the basic model as the study models. The displacement and stress distribution of the disc were evaluated. RESULTS: The maximum von Mises stress of the condylar cartilage was the largest on the affected side, whereas the maximum von Mises stress of the disc was the largest on the unaffected side. The disc stress on the affected side was mainly distributed on the posterior zone and the intermediate zone for the unaffected side. The maximum von Mises stress of the bilaminar region on the affected side was greater than the unaffected side. The stress of the disc and bilaminar region was the lowest on the affected side in the 2 mm model. The disc displacement on the affected side gradually increased, whereas, on the unaffected side, it fluctuated. CONCLUSIONS: These results showed that occlusal stabilization splint could decrease the stress of disc and bilaminar region, and 2 mm was considered the optimal thickness for the treatment of unilateral temporomandibular joint anterior disc displacement without reduction.


Assuntos
Luxações Articulares , Transtornos da Articulação Temporomandibular , Análise de Elementos Finitos , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/terapia , Imageamento por Ressonância Magnética , Placas Oclusais , Contenções , Articulação Temporomandibular , Disco da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/terapia
13.
Br J Oral Maxillofac Surg ; 60(3): 350-356, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34756640

RESUMO

The aim of the study was to investigate and compare short and long-term effects of occlusal splints (OS), ultrasound (US), and high-intensity laser therapy (HILT) in patients with painful temporomandibular joint (TMJ) disc displacement with reduction (DDWR). This prospective, randomised, single-blinded, controlled clinical study was conducted on patients with DDWR at a university oral and maxillofacial surgery clinic. A total of 140 patients were allocated randomly to four groups (OS, US, HILT, and control), with 35 patients in each. Patients were evaluated for pain, range of motion of the jaw, disability, and quality of life. A total of 132 patients completed the study. In all treatment groups (OS, US, and HILT), a significant improvement was observed in terms of pain, function, disability, and quality of life, at both weeks four and 12 compared with the control group (p < 0.001). Improvements in VAS pain and maximum mouth opening were not significantly different between the treatment groups. However, compared with the OS group, there was a significant improvement in the HILT and US groups in terms of total Oral Health Impact Profile (OHIP-14) and Jaw Functional Limitation Scale-20 (JFLS-20) scores at week four, but no difference between the groups at week 12. The results of this study show that OS, US, and HILT are effective treatments for pain and functional jaw movements in patients with DDWR. HILT, a new method, can be an alternative treatment in cases of TMD.


Assuntos
Disco da Articulação Temporomandibular , Transtornos da Articulação Temporomandibular , Humanos , Placas Oclusais , Dor , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Articulação Temporomandibular , Disco da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/terapia , Resultado do Tratamento
14.
Acta Odontol Scand ; 80(4): 315-320, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34892994

RESUMO

OBJECTIVE: To evaluate the effect of anterior repositioning splint (ARS) on maximum bite force (MBF) values in patients with disc interference disorders (DID). MATERIAL AND METHODS: Twenty-two patients with disc interference disorders and 22 healthy subjects participated in to study. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I have been used to diagnose DID patients. All patients received ARS therapy for 6 weeks. The MBF measurement was performed with Flexi-Force piezo-resistive sensors for both healthy subjects and patients before and after ARS therapy. RESULTS: A significant difference was recorded by the increase of the mean MBF values after the use of the ARS in the patient with disc derangements (p < .05). CONCLUSIONS: APS therapy is efficient for eliminating pain and increasing MBF of the patients with DID. In addition, the use of FlexiForce sensors may be a practical solution to assess the bite force in the clinical setting.


Assuntos
Força de Mordida , Transtornos da Articulação Temporomandibular , Humanos , Placas Oclusais , Contenções , Transtornos da Articulação Temporomandibular/terapia
15.
J Clin Sleep Med ; 18(3): 903-909, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34728052

RESUMO

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is associated with cardiovascular comorbidities such as left ventricular (LV) hypertrophy. Whether OSA is an independent etiological factor for this hypertrophic remodeling is yet unknown. Continuous positive airway pressure partially reverses this hypertrophy, but data regarding the effect of mandibular advancement devices on LV remodeling are scarce. The aim of this prospective trial is to evaluate the effect of mandibular advancement device therapy on LV geometry and function in patients with OSA. METHODS: At baseline and 6-month follow-up, participants underwent a home sleep apnea test, 24-hour ambulatory blood pressure monitoring and a 2-dimensional Doppler and tissue Doppler echocardiography. RESULTS: Sixty-three patients (age: 49 ± 11 years; body mass index: 27.0 ± 3.4 kg/m2; baseline apnea-hypopnea index home sleep apnea test: 11.7 [8.2; 24.9] events/h) completed the 6-month follow-up visit. Overall, blood pressure values and parameters of LV function were within normal ranges at baseline and did not change under mandibular advancement device therapy. In contrast, the interventricular septum thickness was at the upper limits of normal at baseline and showed a significant decrease at 6-month follow-up (11.1 ± 2.1 mm vs 10.6 ± 2.0 mm, P = .03). This significant improvement is only found in responders but not in nonresponders. There was no correlation between the decrease of interventricular septum thickness and the change in blood pressure. CONCLUSIONS: In mildly obese, normotensive patients with OSA we observed significant reverse hypertrophic remodeling after 6 months of successful mandibular advancement device therapy, with maintained normotensive systemic blood pressure. This suggests that OSA is an independent factor in the pathophysiology of LV hypertrophy in these patients. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Evaluation of the Cardiovascular Effects of the MAS in the Treatment of Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02320877; Identifier: NCT02320877. CITATION: Dieltjens M, Vanderveken OM, Shivalkar B, et al. Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea. J Clin Sleep Med. 2022;18(3):903-909.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Adulto , Monitorização Ambulatorial da Pressão Arterial , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Hipertrofia , Avanço Mandibular/métodos , Pessoa de Meia-Idade , Placas Oclusais , Estudos Prospectivos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
16.
J Oral Rehabil ; 49(5): 553-572, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34865235

RESUMO

BACKGROUND: Mandibular advancement devices (MADs) are used as an alternative to continuous positive airways pressure to treat obstructive sleep apnoea (OSA) patients, but to date, specific data on the adherence to MAD therapy are lacking. OBJECTIVES: The aim of the present systematic review was to investigate the dropout rate and adherence of OSA patients to different custom-made (CM) and non-custom-made (NCM) MAD therapies. SEARCH METHODS: An electronic search was performed in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, LILACS and Web of Science. SELECTION CRITERIA: Randomised controlled trials (RCTs) assessing the compliance to customised and not customised MADs in the treatment of adult OSA patients were included. DATA COLLECTION AND ANALYSIS: The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration's tool for assessing risk of bias in RCT. The dropout rate of each study was computed and the adherence to MAD therapy in terms of hours per night and nights per week was extracted from each study. RESULTS: Thirty-two RCTs were included. The risk of bias resulted low in most of the studies. The GRADE scores indicated that the quality of evidence was from very low to moderate. The meta-analyses showed that the mean dropout rate did not significantly differ between CM and NCM MADs: The overall mean dropout rate was 0.171 [0.128-0.213] with a mean follow-up of 4.1 months. The hours per night adherence was significantly higher for CM MADs (6.418 [6.033-6.803]) compared to NCM MADs (5.107 [4.324-5.890]. The meta-regression showed that the dropout rate increases significantly during time (p < .05). CONCLUSIONS: There is a very low to moderate quality of evidence that the dropout rate of MAD therapy is similar among CM and NCM MADs, that the dropout rate increases significantly during time and that CM MADs have higher hours per night adherence compared with NCM MAD. REGISTRATION: The study protocol was registered on PROSPERO (n. CRD42020199866).


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Adulto , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Placas Oclusais , Ensaios Clínicos Controlados Aleatórios como Assunto , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
17.
Cranio ; 40(2): 119-125, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31996119

RESUMO

Objective: This study aims to determine whether changes in dental occlusion are correlated to body posture during walking and running.Methods: Fifteen healthy subjects were assessed by a prosthodontist and deemed asymptomatic. Analyses of gait and running were performed in three conditions, in random order: a) occlusal splint; b) placebo splint; and c) no splint. The occlusal splint used in this study positioned the mandible in a stable position. Kinematic data was collected using a 3D motion capture system.Results: Changes in dental occlusion induced by occlusal splints did not influence body sway during gait or running. No significant differences were found between any of the test conditions.Conclusion: Occlusal splints have no effect on body sway during gait or running. High inter-subject variability in kinematic parameters was found, which should be considered in future studies.


Assuntos
Placas Oclusais , Corrida , Fenômenos Biomecânicos , Marcha , Humanos , Mandíbula , Contenções
18.
Cranio ; 40(2): 97-106, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31910746

RESUMO

Objective: To investigate the effectiveness and adverse events of mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA) and to identify predictive clinical parameters for therapy success.Methods: A retrospective analysis of 318 patients indicated for MAD therapy, observed in a large teaching hospital in the Netherlands.Results: Ninety-seven patients (65.5%) achieved therapy success. A significant decrease in AHI (apnea-hypopnea index) and OSA-related symptoms was observed. None of the analyzed OSA-characteristics proved to be a significant predictive parameter for therapy success. Side-effects were reported in 54.4% of the patients, with temporomandibular dysfunction (27.0%) being the most frequent. Seventy-four patients (23.3%) discontinued treatment due to side-effects or therapy failure.Conclusion: MAD proved to be effective in the treatment of OSA and can be a viable alternative to CPAP in patients with severe OSA. Side-effects were relatively common and led to termination of therapy in 1 out of 10 cases.


Assuntos
Avanço Mandibular , Placas Oclusais , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Avanço Mandibular/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
19.
Cranio ; 40(1): 14-22, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914871

RESUMO

Objective: The aim of this paper is to report quantitative and qualitative characteristics of bruxism events recorded in sleeping humans with a new smart ambulatory system specifically designed to measure dental clenching and grinding forces. The device is wireless and rechargeable, which enables its use over extended periods.Methods: Thirty recordings were obtained from volunteer subjects who wore the device at home during 10 consecutive nights (Clinicaltrials.gov N° NCT03363204).Results: The recordings showed that the system was able to successfully monitor bruxism during 10 consecutive nights, allowing a quantitative (number, duration, intensity, distribution during the night), as well as a qualitative characterization of the bruxism events (clenching vs. grinding).Discussion: This system could offer new perspectives in the field of bruxism, either as a research tool for clinical studies or as a medical device for the ambulatory home-based monitoring of bruxism.


Assuntos
Bruxismo , Bruxismo do Sono , Humanos , Monitorização Fisiológica , Placas Oclusais , Sono , Bruxismo do Sono/diagnóstico , Contenções
20.
J Sports Med Phys Fitness ; 62(3): 375-381, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33871235

RESUMO

BACKGROUND: Several studies have been proposed with the aim to demonstrate correlations between the dento-mandibular apparatus and the skeletal muscle system of the human body even in regions distant from the oral cavity. However, a definite conclusion cannot be drawn. The aim of this paper is to demonstrate a possible correlation between dental occlusion and sport performances in track and field athletes. METHODS: Sixteen track and field athletes were enrolled for the study and were randomly divided in three groups: Untreated control group, Placebo group (with a lower plaque without occlusal coverage) and Treated group (with occlusal splint). Changes in sprint and jump performance were assessed on a weekly basis for 5 consecutive weeks, during which athletes had to wear oral devices, except for the first week of baseline, for at least 3 trainings lasting 2 hours per week . All participants performed the countermovement jump (CMJ), the drop jump (DJ), the 10m and 30m sprint tests, always on the same day on the week. RESULTS: No statistically significant difference resulted between Control group and Placebo group and between Control group and Treated group. However, it was possible to observe a clinical improvement of measurements obtained, especially for CMJ, 10m and 30m sprint tests. No variation neither statistical neither clinical was observed in DJ test analysis. CONCLUSIONS: Even if statistically it was not possible to demonstrate an improvement in sport performance, most of the athlete analyzed showed better results during training session with occlusal splint compared to athlete without occlusal splint, in countermovement jump, in 10m and 30m sprint tests.


Assuntos
Desempenho Atlético , Atletismo , Atletas , Humanos , Força Muscular , Placas Oclusais
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