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At least 685 records · Page 38Linked to original sources
PubMed1995

The hinge axis concept: a radiographic study of its relevance.

The "hinge axis concept" maintains that the mandible moves around a transverse horizontal axis through both condyles. Since it was introduced in the 1920s it has had a profound impact on clinical dental practices all over the world. By use of the radiographic subtraction technique, we demonstrated that an increase in the occlusal vertical dimension of 4 to 7 mm in the retruded position resulted in a small positional change (range 0.31 to 1.84 mm) in an unpredictable direction. Pure rotation did not occur; however, the condylar displacement is probably of minor clinical importance in prosthodontic restoration.

Adolescent↗
PubMed1995

New definition for relating occlusion to varying conditions of the temporomandibular joint.

Centric relation is the accepted term for defining the condylar axis position of intact, completely seated, properly aligned condyle-disk assemblies. However, some structurally deformed temporomandibular joints may function comfortably, even though they do not fulfill the requirements for centric relation. A wide range of temporomandibular disorders from partial to complete disk derangements with or without reduction may adapt to a conformation that permits the joints to comfortably accept maximal compressive loading by the elevator muscles. There has been no accepted terminology to define the condition or position of such joints. The purpose of this article is to define a new term, adapted centric posture, and to explain its rationale and how it is determined. Verification of successful adaptation is an important step in diagnosis, because it rules out structural intracapsular disorders as a source of orofacial pain and establishes responsible guidelines for initiation of occlusal treatment or prosthetic dentistry. It also establishes a much needed terminology for more specific description of temporomandibular joint position and condition for clinical research on the relationship between occlusion and the temporomandibular joints.

Adaptation, Physiological↗
PubMed1996

Elongated styloid process in a temporomandibular disorder sample: prevalence and treatment outcome.

An elongated styloid process is an anatomic anomaly present in 2% to 30% of adults; it is occasionally associated with pain. Its prevalence among patients with classic temporomandibular disorder pain symptoms is unknown. The effect of conservative treatment on patients who have symptoms of temporomandibular disorders and an elongated styloid process is also unknown. The objectives of this study were to determine the prevalence of the elongated styloid process in a sample of patients with temporomandibular disorders and to compare patients with and without the elongated styloid process on initial presenting signs and symptoms and treatment outcome. A total of 100 panoramic radiographs of patients with symptomatic temporomandibular disorders were examined to ascertain the presence or absence of an elongated styloid process. All patients participated in a conservative treatment program of biofeedback and stress management and a flat-plane intraoral appliance. Initial symptoms and treatment outcome of patients with and without an elongated styloid process were compared by use of multivariate analysis of variance on several oral-paraoral and psychosocial-behavioral methods. The prevalence of an elongated styloid process in this clinic sample of temporomandibular disorders was 27%. The patients with or without an elongated styloid process were not significantly different in pretreatment symptoms, and both groups exhibited substantial treatment gains. However, patients with an elongated styloid process showed significantly less improvement on unassisted mandibular opening without pain than did patients who did not have an elongated styloid process. This suggests that an elongated styloid process may place structural limitations on pain-free maximum mandibular opening. The results support conservative management of patients with symptoms of temporomandibular disorders when an elongated styloid process is present.

Adolescent↗
PubMed1997

Tooth intrusion in implant-assisted prostheses.

STATEMENT OF PROBLEM: Numerous reports and surveys have been published on natural tooth abutment intrusion with implant-connected fixed partial dentures. The consensus of these publications was that the cause of intrusion was multifactorial, with causative factors such as disuse atrophy, debris impaction, impaired rebound memory, and mechanical binding. It was also believed that the process was irreversible. PURPOSE: In this article, the limitations with these theories are discussed, and two patient reports of tooth intrusion reversal are reviewed. A review of the current literature is discussed, as well as the current theory of tooth movement in response to dynamic mechanical stimulus, a brief discussion of current experimental procedures and results, and the current recommendations for reversal of intrusion.

Alveolar Process↗
PubMed1998

Effect of a prosthetic appliance for treatment of sleep apnea syndrome on masticatory and tongue muscle activity.

STATEMENT OF PROBLEM: The efficiency of an appliance for treatment of sleep apnea shows inordinate interindividual difference. The mechanism of its therapeutic effects remains unresolved. PURPOSE: This study examined the effect of the device on sleep apnea, and masticatory and tongue muscles. MATERIAL AND METHODS: Fifteen patients with sleep apnea syndrome were evaluated polysomnographically, with and without the appliance. Electromyograms (EMG) of genioglossal, masseter, and lateral pterygoid muscles were recorded and EMG amplitudes measured before, during, and after the apneas. Apneas were classified into three types: obstructive, central, and mixed. RESULTS: During obstructive apneas, muscles showed significantly lower EMG amplitudes; whereas during central apneas, no decrease in the mean EMG amplitude was observed. EMG amplitudes increased after insertion of the device. EMG amplitudes during obstructive apneas were significantly increased in the genioglossal (p < 0.03, t test) and lateral pterygoid muscles (p < 0.03) by the device. Obstructive and mixed apneas per hour were significantly reduced by the appliance; however, in contrast, central apneas showed slightly increased. The apnea index decreased significantly (p < 0.002) by the device owing to the paucity of central apneas. CONCLUSIONS: The apnea appliance activated masticatory and tongue muscles during sleep and prevented the upper airway from collapsing. The prosthetic appliance was useful in the treatment of sleep apnea syndrome.

Aged↗
PubMed1998

Tomographic stability of condyle fossa relationships in 40 treated temporomandibular disorder patients.

STATEMENT OF PROBLEM: Condylar position and stability after treatment of 40 temporomandibular disorder patients was studied. PURPOSE: This study determined pretreatment position and posttreatment condylar stability. MATERIAL AND METHODS: Forty temporomandibular disorder patients with symptoms of muscles of mastication pain, temporomandibular joint sounds, attrition, interceptive occlusal contacts, and restricted range of motion were used. Axial corrected midcut sagittal tomograms were made of the 80 temporomandibular joints before treatment. Tracings from the tomograms were used to measure and analyze pretreatment position and posttreatment stability. RESULTS: Pretreatment condyle fossa position was not concentric in 26 of 80 patients (32.5%). Posttreatment condylar position showed no change and was statistically stable. CONCLUSION: In this study of 40 temporomandibular disorder patients, no statistical change in condylar position was detected. Variable condylar positions were found in the 80 pretreatment axial corrected midcut sagittal tomograms. All patients were asymptomatic after 1 year.

Adolescent↗
PubMed1998

A pilot study comparing the efficacy of hard and soft stabilizing appliances in treating patients with temporomandibular disorders.

STATEMENT OF PROBLEM: Soft and hard stabilizing appliances have been used to treat temporomandibular disorders. No data exist to suggest whether a hard or soft appliance is beneficial. PURPOSE: This study compared soft and hard acrylic resin stabilizing appliances in the reduction of masticatory muscle pain in patients with temporomandibular disorders. MATERIALS AND METHODS: Twenty-three patients with at least one clinical sign from the list of diagnostic subgroups of temporomandibular disorders were alternately assigned a hard or soft appliance for temporomandibular disorder treatment. No other temporomandibular disorder treatment (self-care, physical therapy, biofeedback, or muscle or joint injections) was rendered. Each patient was seen by two dentists at each visit. One dentist initially fabricated the appliance and adjusted the appliance on each visit and an examining dentist examined the patient each visit and recorded signs of temporomandibular disorders. The appliance material (soft or hard) was not disclosed to the examining dentist, only to the dentist who fabricated and adjusted the appliance. Patients were examined and appliances were adjusted every 2 to 3 weeks for a minimum of 10 weeks. Masticatory muscles were palpated and charted on each visit. Data were analyzed and subjected to nonparametric Mann-Whitney test. RESULTS: Eighteen of the initial 23 patients, 7 in the hard appliance group and 11 in the soft appliance group finished the study over 10- to 15-week period. Soft and hard appliances performed the same in reduction of masticatory muscle pain. CONCLUSION: This study suggests, based on the limited number of participants, that soft and hard stabilizing appliances may be equally useful in reducing masticatory muscle pain in short-term appliance therapy.

Acrylic Resins↗
PubMed1999

Dental considerations in upper airway sleep disorders: A review of the literature.

STATEMENT OF PROBLEM: Upper airway sleep disorders are becoming recognized as common medical concerns. Multiple treatment options have been advocated, including the use of dental devices. Dental practitioners are being asked by the medical profession to become a part of the treatment team. This may be a challenging task because of the large number of dental devices available, rapid advancement in the understanding of this disease, and numerous publications. PURPOSE: This article reviews the anatomic features and etiologic factors of upper airway sleep disorders and medical and dental treatment options. METHODS: The literature review was conducted with an accepted literature research tool, PubMed, developed by the National Library of Medicine. Key words searched included "obstructive sleep apnea," "sleep apnea," "sleep disorders," and "snoring". CONCLUSION: Dental devices are indicated in snoring and mild-to-moderate obstructive sleep apnea patients after medical evaluation and referral.

Humans↗
PubMed1999

Effect of a prefabricated anterior bite stop on electromyographic activity of masticatory muscles.

STATEMENT OF PROBLEM: Patients are often treated for signs and symptoms in the masticatory musculature, which may be manifested as pain and/or conditions that cause difficulty in recording jaw relation records. A quick, easy method to alleviate these signs and symptoms would be helpful. PURPOSE: This study measured the effect of a prefabricated anterior bite stop on the electromyographic activity of the anterior temporalis, posterior temporalis, masseter and anterior digastric during clenching, and grinding tasks. MATERIAL AND METHODS: A prefabricated anterior bite stop was fabricated for 30 randomly selected subjects. Electromyographic surface electrodes were placed on the right and left sides of these muscles. Electromyographic activity was measured during clenching and grinding both with and without the anterior bite stop. RESULTS: The anterior bite stop had a significant effect in decreasing electromyographic activity for both clenching and grinding for all the tested muscles, except the anterior digastric. CONCLUSIONS: For this patient population, the ready-made anterior bite stop reduced electromyographic muscle activity for the anterior and posterior temporalis and the masseter muscles during both clenching and grinding.

Adult↗
PubMed1999

Can dental prostheses influence vocal parameters?

STATEMENT OF THE PROBLEM: Alterations to the oral cavity caused by dental prostheses can affect speech articulation, whereas the influence of dental prostheses on the voice is unknown. For 1 patient, the fundamental frequency rose by up to 5 semitones during speech and his voice range was enlarged by up to 4 semitones when a thin denture was used instead of his normal denture. In this patient, intraoral needlepoint registration revealed a more rostral position of the mandible with the thin denture when compared with the normal denture. PURPOSE: This study evaluated the effects of such changes on phonation by varying the dentures of 20 subjects in line with those of the first patient. MATERIAL AND METHODS: The volumes of the test dentures were reduced and the vertical and horizontal dimensions of occlusion were varied. The influences of these changed dentures on speaking fundamental frequency, voice range (in semitones), and lowest and highest frequencies of the voice range were examined with a Homoth phonomat. RESULTS: A statistically significant influence of the different dentures on the investigated voice parameters was not proven; however, audible changes to the voice parameters for persons were documented. CONCLUSIONS: Variations of thickness and or volume of dentures and of the vertical and horizontal dimension of occlusion may result in unpredictable audible changes to the voice. Patients should be informed about possible effects of modified or new dentures on their voice.

Acrylic Resins↗
PubMed1999

Comparison of clinical profiles and treatment outcomes of an elderly and a younger temporomandibular patient group.

STATEMENT OF PROBLEM: Older temporomandibular disorder patients with more general complications and health problems may have a different clinical profile and be likely to react less favorably to conservative treatment. PURPOSE: This retrospective study compared the clinical profiles of a young (20 to 30 years) and an older (50 to 70 years) group of patients with pain and dysfunction in the temporomandibular region and to analyze treatment outcomes. METHODS: Clinical profiles and treatment outcomes were studied with a standardized protocol and the Helkimo Pain and Dysfunction Index up to 1 year after initial examination. RESULTS: Younger and older patients with temporomandibular disorder differed only in pain intensity at initial examination, but the outcome of conservation treatment was equally successful. CONCLUSION: Conservative treatment resulted in a significant alleviation of pain and dysfunction in almost 85% of patients. Both the younger and the older patient groups benefitted from this treatment protocol and therefore can be treated in the same fashion.

Adult↗
PubMed2004

The influence of pre- and intraoperative positioning of the condyle in the centre of the articular fossa on the position of the disc in orthognathic surgery. A magnetic resonance study.

OBJECTIVE: We investigated the changes in the temporomandibular joint (TMJ) after bilateral sagittal split osteotomy of the mandible for orthognathic surgery and the influence of positioning of the condylar process in the centre of the articular fossa before and during the operation for preventing changes in the TMJ postoperatively. STUDY DESIGN: A total of 28 patients with mandibular retrognathism had bilateral sagittal split osteotomies for mandibular advancement. In one group of 14 patients (28 TMJ), the condyles were placed in the centre of the articular fossa before and during the operation, and in the other group they were not. Differences on magnetic resonance imaging (MRI) were calculated and the results were evaluated. RESULTS: The main differences were found at maximal mouth opening. 15/28 TMJs (54%) that had not been positioned changed the position of the disc from physiological to anterior disc derangement with and without reduction postoperatively. In the 28 that had been positioned, changes were found in only 3 TMJs (11%) postoperatively. CONCLUSIONS: Fixing the condylar process in the centre of the articular fossa intraoperatively before bilateral sagittal split osteotomy is a factor in preventing postoperative structural changes in the temporomandibular joint.

Humans↗