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PubMed2003

Changes in head position due to occlusal supporting zone loss during clenching.

To establish the relationship between the condition of the stomatognathic system and body posture, changes in the head position during clenching were observed and investigated when the occlusal supporting zone was lost unilaterally and bilaterally. The results were as follows: 1. Regardless of the occlusal conditions, the head position was changed by clenching; 2. The occlusal conditions did not affect the changed distance of the head position; 3. The head position was changed forward and down by clenching regardless of the condition of the occlusal supporting zone. The head position changed more laterally to the opposite side of the lost occlusal supporting zone by clenching with the occlusal supporting zone lost unilaterally rather than bilaterally. Based on this study, it is suggested that unilateral loss of the occlusal supporting zone may cause the neck muscles to become inharmonious and thus affect body posture.

Adult↗
PubMed2003

Maxillomandibular relationship in TMD patients before and after short-term flat plane bite plate therapy.

This study assessed the maxillomandibular relationship in temporomandibular disorders (TMD) patients, before and after short-term, flat plane bite plate therapy. It was of interest to determine the incidence and degree of mandibular deviation in a group of TMD patients and whether the mandible would shift to the midline and consequently affect reported symptoms. Seventeen female and three male subjects (age range 19-60) were included in the study. Thirteen subjects were diagnosed with myofascial pain while seven were diagnosed as exhibiting disk displacement with reduction (Research Diagnostic Criteria). After taking impressions for these subjects, casts were fabricated and mounted. Maxillomandibular relationship was evaluated by the Denar Centric Check system (Anaheim, CA). The maxillary and mandibular labial frena were used as a reference to evaluate mandibular shift. Symptom questionnaires were used to assess temporomandibular joint pain and clicking. All subjects exhibited deviation (12 subjects to the right and 8 subjects to the left) prior to bite plate therapy. After flat plane bite plate therapy, the mandibular position of all subjects shifted toward the labial frenum midline position. Based on the Binomial test, the shift was significant (p < 0.001). Measurements on the Centric Check system showed a significant movement of both condyles in the anterio-posterior plane as well as the vertical plane. There was also significant reduction in TMJ pain and clicking (p < 0.01). The results support the hypothesis that the balanced position of the mandible is with frena aligned. When occlusal obstructions are eliminated, the mandible will drift to this position.

Adult↗
PubMed2003

Orthosis thickness and its effect on temporomandibular joint space.

The object of this study was to determine the effect of varying thicknesses of orthoses on temporomandibular (TM) joint space. The TM joint space was measured using the centric cut view of tomographic images. The measurements used selected fixed landmarks of the joint complex anatomy to find joint space. The fixed points used for the measurement of the joint space are no different than the fixed points methodology used in orthodontic cephalometric measurements. The placement of the fixed points on a radiograph is subjective. Degrees of accuracy can be accomplished with consistent use just as in the practice of cephalometric measurements. Results of such measurements do provide a relatively true record of the actual condyle and fossa relationship. The study concluded that the thickness of the orthosis moved the condyle downward and horizontally without regard to its original positioning. If clinicians know the condylar position before and after orthosis placement, a concentric position of the condyle can be established to assist in the patient's second phase treatment. Further research will prove that the physiological and anatomical balance of the temporomandibular joint complex is important in effectively managing craniofacial pain patients.

Humans↗
PubMed1998

Non-surgical treatment of upper airway obstruction in oculoauriculovertebral dysplasia: a case report.

A non-surgical technique for the treatment of upper airway obstruction in oculoauriculovertebral dysplasia using an intra-oral orthopaedic appliance is described, which resulted in respiratory and feeding problems being solved without side-effects. This non-invasive management might also be of major benefit in the treatment of airway obstruction associated with Pierre Robin sequence, mandibular micrognathia in other craniofacial anomalies, or obstructive sleep apnoea.

Airway Obstruction↗
PubMed2001

Oral appliances for the management of severe snoring: a randomized controlled trial.

The aim of this randomized controlled trial was to assess the effectiveness of a mandibular advancement appliance (MAA) in managing severe snoring. Twenty-eight adults with severe snoring and normal overnight oximetry were recruited from sleep disorder clinics. A maxillary placebo appliance and a MAA were worn by each subject for a period of 4-6 weeks each. Questionnaires at baseline and after each appliance period assessed bed partners' reports of snoring severity (loudness and number of nights per week), and patients' records of daytime sleepiness. Twenty-five subjects completed the entire trial. The MAA was significantly more effective than the placebo in reducing the frequency and loudness of snoring, the reported daytime sleepiness and the frequency of morning tiredness. Excessive salivation was the most commonly reported complication. It was concluded that the custom-made MAA was significantly more effective than the placebo in managing the main symptoms of severe snoring. However, not all subjects' partners reported an improvement with the MAA, with 84 per cent reporting a reduction in snoring loudness and 76 per cent reporting snoring on fewer nights per week.

Adult↗
PubMed2001

Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea.

The aims of this study were to investigate possible orthodontic side-effects following the use of mandibular advancement devices (MAD) in adults with snoring and sleep apnoea. A second objective was to analyse the effect of the appliance design. Seventy-five patients treated with MAD and 17 reference patients were studied at follow-up after 2.5 +/- 0.5 years. In the test group, 47 patients were provided with soft elastomeric devices, while the remaining 28 patients received hard acrylic devices. The treatment induced a change in overjet of -0.4 +/- 0.8 mm (mean +/- SD) and a change in overbite of -0.4 +/- 0.7 mm (mean +/- SD). These changes were larger than those found in the reference group (P < 0.01). The odds ratio (OR) for the largest quartile of reduction in overjet was 3.8 in patients using hard acrylic devices compared with those using soft elastomeric devices (P < 0.05). A large reduction in overjet in patients using the hard acrylic devices was unrelated to the degree of mandibular protrusion by the device. The OR for a large reduction in overjet in patients using the soft elastomeric devices with a protrusion of 6 mm or above was 6.8 compared with smaller mandibular protrusions (P < 0.05). The results indicate that the orthodontic side-effects are small during the treatment of adult subjects with MAD for snoring and sleep apnoea, especially in patients using soft elastomeric devices with mandibular protrusions of less than 6 mm. The follow-up of patients treated with MAD is recommended, as individual patients may experience marked orthodontic side-effects.

Acrylic Resins↗
PubMed2002

A comparative study of two mandibular advancement appliances for the treatment of obstructive sleep apnoea.

Mandibular advancement appliances (MAAs) are accepted as a treatment option for snoring and mild obstructive sleep disorders. In the present clinical study two differently designed devices were examined for their effectiveness in treating obstructive sleep apnoea (OSA). The study was based on an assessment of 26 patients with a polysomnographic diagnosis of mild OSA [22 men, four women; mean body mass index 27.3 kg/m2 (SD 3.1); mean age 56.8 years (SD 5.2); mean respiratory disturbance index (RDI): 16.0 events/hour (SD 4.4)]. After insertion of the first MAA and a 6-8-week habituation period, a cardio-respiratory home-sleep study was carried out. Following a 2-3-week period with no treatment, the second appliance was inserted. The sequence of the devices was randomized. Once the patients had become accustomed to the second appliance, another somnographic registration was carried out. Daytime sleepiness, snoring, and sleep quality were assessed subjectively on a visual analogue scale. The results showed that a statistically significant improvement in the respiratory parameters was achieved with both appliances (P < 0.01). However, the activator [RDI: 5.5 events/hour, SD 3.3; apnoea index (AI): 3.4 events/hour, SD 2.1] was significantly more effective (P < 0.01) than the Silencor (RDI, 7.3 events/hour, SD 5.3; AI: 5.8 events/hour, SD 3.2). No difference was recorded in the subjective assessment of the therapeutic effects. Both appliances reduced daytime sleepiness and snoring and improved sleep quality, and both influenced the treatment outcome.

Activator Appliances↗
PubMed2002

Cranial base considerations between apnoeics and non-apnoeic snorers, and associated effects of long-term mandibular advancement on condylar and natural head position.

One hundred consecutively medically referred patients (58 apnoeic and 42 asymptomatic snorers) were reviewed cephalometrically at six-monthly intervals (6-30 months) following treatment for obstructive sleep apnoea (OSA) and/or habitual snoring by mandibular advancement. Eighty-seven males and 13 females (mean age 49 years, SD 8.5, range 33-74) were included in this study. Reference points and planes in the cranial base, nasopharynx, and mandibular condyle were digitized with a Reflex Metrograph and their means converted to linear and angular measurements. No statistically significant differences were observed between the apnoeic and non-apnoeic groups in either their skeletal or cranial base measurements. All linear cranial base dimensions were, however, reduced in the apnoeic group, with the exception of the distance (S-SE). Following mandibular advancement, statistically significant changes were observed in vertical condylar position (Cd-vert) with changes occurring at 6 (P < 0.012), 18 (P < 0.043), and 24 months (P < 0.007). No changes in horizontal condylar position (Cd-horiz) were found. Significant changes were observed in natural head position (NHP) with a reduction from an extended (NSL-vert 99.7 degrees) to a more upright NHP (NSL-vert 93.0, P < 0.001).

Adult↗
PubMed2002

Moulding of the generate to control open bite during mandibular distraction osteogenesis.

Distraction osteogenesis of the craniofacial skeleton has become a widely accepted, safe, and effective means of craniofacial reconstructive surgery. Despite excellent results in general, there are still some uncertainties related to the procedure, such as development of an anterior open bite (AOB) during mandibular distraction. The aim of this study was to examine whether 'moulding of the generate', i.e. use of intermaxillary elastics during the active distraction phase is possible to close the mandibular plane angle and open bite. Three subjects, 13- and 15-year-old males and a 7-year-old female, underwent mandibular linear and angular bilateral distraction osteogenesis with moulding of the generate. Lateral cephalograms were obtained before the introduction of elastics and following distraction, once the activation was stopped and the patients were ready for the consolidation phase. Conventional cephalometric measurements were used to assess possible changes in the mandibular plane angle and incisor position. Three different anchorage systems (dental, orthopaedic, and skeletal) were used for placement of the intermaxillary elastics. Cephalometric examination showed that the mandibular plane angle was decreased during active distraction osteogenesis with the introduction of elastics and angulation of the distraction device. Depending on the type of elastic anchorage system, smaller or greater amounts of extrusion of the incisors were noted. Moulding of the generate during active distraction can be performed to reduce the mandibular plane angle and open bite. To prevent unwanted dentoalveolar changes from occurring during elastic traction, skeletal rather than dental fixation of the elastics is recommended. Intrusive mechanics may be incorporated into the orthodontic appliances to balance extrusive force by the moulding elastics.

Adolescent↗
PubMed1999

Transoral maxillary distraction osteogenesis of an unrepaired bilateral alveolar cleft.

Distraction osteogenesis has gained acceptance as a viable modality for lengthening hypoplastic skeletal structures in the maxillofacial region. A case of the application of this technique to advance the maxilla in an unrepaired bilateral alveolar cleft via a transoral approach is presented. The distraction devices were applied bilaterally to the zygomatic buttress region with the activating arms protruding from the oral cavity. A high Le Fort I osteotomy was performed under general anesthesia and, prior to distraction, the three maxillary segments were unified with an occlusal acrylic splint. Activation was begun 6 days after placement, at a rate of 1 mm per day, until the planned maxillary advancement had been achieved. An 8-week period of consolidation was allowed prior to removal of the devices.

Alveoloplasty↗
PubMed1999

Congenital trismus secondary to masseteric fibrous bands: endoscopically assisted exploration.

The authors present an 18-month-old female infant with congenital trismus. Computed tomography and magnetic resonance imaging were not helpful in determining the cause. A surgical endoscope was used to explore her temporomandibular joints and temporal fossae, thus avoiding the morbidity of a bicoronal incision. The cause was bilateral fibrous bands on the anterior border of the masseter muscles. Incision of these fibrous bands led to relief of the trismus. This finding is consistent with a previously described variant of the Hect-Beals-Wilson trismus-pseudocamptodactyly syndrome. This patient, however, had no evidence of the autosomal dominant inheritance pattern nor did she exhibit pseudocamptodactyly, both of which are generally ascribed to this syndrome. Unfortunately the trismus recurred 3 months postoperatively.

Abnormalities, Multiple↗
PubMed1994

Parafunctional habits, nightguards, and root form implants.

Occlusal schemes and designs of fixed and removable implant prostheses must satisfy requirements for the innocuous vertical loading of root form implants. Parafunctional habits (clenching, bruxing, or engaging) can transmit forces to the supporting bone that may result in destructive lateral stresses and overloading. Most nocturnal parafunctional habits can be ameliorated by acrylic resin nightguards.

Alveolar Bone Loss↗
PubMed2002

Recognizing and managing parafunction in the reconstruction and maintenance of the oral implant patient.

A primary goal in the reconstruction of the dental implant patient is to achieve the lowest stress possible on the abutments, both artificial and natural. Bidez and Misch use the formula [figure: see text] [formula: see text] to explain that the stress can be easily lowered by increasing "A," by using larger implants, or by using additional implants. Another equally important method of lowering the stress is to reduce and manage the force application (F). The majority of completed implant cases can well tolerate applied forces from mastication and swallowing, both of which are close to 50 pounds per square inch, but it is the destructive power from DCS that can easily range from 500 to 1,000 pounds per square inch with which this article is concerned.

Behavior Therapy↗
PubMed2002

Vertical dimension of occlusion in implant dentistry: significance and approach.

Understanding the principles of occlusion as they relate to managing bite forces on implants is extremely important to maintain the longevity of dental implant prostheses. Specifically, altering vertical dimension of occlusion (VDO) scientifically and predictably is critical to the creation of proper tooth form and guidance when fabricating a full-arch implant-supported prosthesis.

Aged↗
PubMed1995

Medical treatment of sleep apnea.

Obstructive sleep apnea is a common disorder. Since 1981 the treatment of choice has shifted from tracheostomy or weight loss to uvulopalatopharyngoplasty and then to continuous positive airway pressure. This review encompasses the most recent literature, focusing mainly on current treatment options and other potential and experimental modes of therapy. We review in detail continuous positive airway pressure therapy, including unwanted effects; compliance and possible ways to improve it; and ways to deal with the difficult patient. We also review dental appliances, electrical stimulation, and potential hormonal and nicotine treatment.

Administration, Cutaneous↗
PubMed1997

Oral self-mutilation by a 17-month-old child with Lesch-Nyhan syndrome.

We report a 17-month-old boy who was a known case of Lesch-Nyhan syndrome and presented with self-inflicted oral ulcerations of his lips and cheeks. He had a normal complement of caries-free deciduous teeth. Initially a conservative approach was planned and a bite plate made, but as a result of poor compliance and persistent ulceration and after consultation with his parents it was decided to extract all deciduous teeth.

Cheek↗