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Class II malocclusion: why, when and how to treat this anomaly in mixed dentition with fixed functional appliances.
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EMG and pain severity evaluation in patients with TMD using two different occlusal devices.
PURPOSE: The purpose of this study was to compare the electromyographic (EMG) activity level and signs and symptoms in patients with myogenous temporomandibular disorders (TMD) treated with two different types of occlusal devices. MATERIALS AND METHODS: Eleven TMD patients were treated with maxillary occlusal devices. The first group received a flat-plane stabilization occlusal device, while the second group received an anatomic occlusal device that maintained the anatomy of the original occlusal surfaces. The severity of signs and symptoms and the masseter EMG activity were recorded and evaluated before treatment and at 72 hours, 2 weeks, and 4 weeks following the delivery of the occlusal device. EMG activity was measured during maximum clenching and during chewing on the right and left sides. The EMG was also recorded for seven normal subjects as a control group. RESULTS: All patients showed reduction of reported and clinically found muscle pain, with no statistically significant differences between the two groups. A reduction in the EMG activity level at maximum clenching was seen in both patient groups, but was significant only with the anatomic occlusal device. Mean EMG activity during chewing was highly variable within and between groups. CONCLUSION: The subjective and objective improvements with both types of occlusal devices suggest that either type of occlusal device can be beneficial to TMD patients.
Ehlers Danlos syndrome.
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Bruxism and intraoral orthotics.
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Diagnostic orthotics to establish the functional mandibular-maxillary relationship for orthodontic corrections.
Under optimal anatomic and physiologic circumstances, there exists a harmonious and functional balance between the occlusion, muscles of mastication and joint relationships referred to as a functional bite relationship. A diagnosis and treatment to the habitual bite relationship is provided if the function of the joints, muscles and associated structures is determined to be normal. If compromises of form or function are determined, a diagnostic orthotic is an essential tool to evaluate why the habitual bite position is not the best functional bite position and to also help determine a better functional relationship to avoid tissue and system compromise. The benefit of the diagnostic orthotic is the ability to establish an arbitrary reversible diagnostic relationship, evaluate the tissue and system response to this new association over time, and determine if the new treatment position is better for the patient than the habitual bite association.
Nociceptive trigeminal inhibition--tension suppression system: a method of preventing migraine and tension headaches.
Dentists and physicians see countless patients suffering from various types of headaches. Various modes of therapy are used in an attempt to treat these patients. As a result of this study, it appears that a common factor to migraine and tension-type headaches may be chronic clenching. If this is the case, then dentists may treat headache patients more effectively than previously suspected through the use of a dental appliance.
Physical self-regulation training for the management of temporomandibular disorders.
AIMS: To evaluate the long-term effectiveness of a brief skills training program for the management of chronic facial muscle pain. This program of physical self-regulation (PSR) involved primarily training in breathing, postural relaxation, and proprioceptive re-education. METHODS: Physical self-regulation training was presented by a dentist during two 50-minute sessions spaced at 3-week intervals and was compared to a standard dental care (SDC) program that included a flat-plane intraoral appliance and self-care instructions provided by a dentist. Participants (n = 44) were initially evaluated by a dentist experienced in the diagnosis and management of orofacial pain and were determined to have myofascial pain (Type 1a and 1b diagnoses per the Research Diagnostic Criteria) prior to random assignment to either the PSR or SDC conditions. Posttreatment evaluations 6 weeks and 26 weeks after treatment had begun were conducted by a dentist who was not aware of which treatment the participants received. RESULTS: Initial results indicated that pain severity and life interference from pain were reduced in both groups (P < 0.001), while perception of control was increased (P < 0.001), as was incisal opening without pain (P < 0.05). At the 26-week follow-up, the PSR group reported less pain (P < 0.04) and greater incisal opening, both with (P < 0.04) and without (P < 0.01) pain, than the SDC group. There were also significant decreases (P < 0.05) in affective distress, somatization, obsessive-compulsive symptoms, tender point sensitivity, awareness of tooth contact, and sleep dysfunction for both groups over time. CONCLUSION: The findings support the use of PSR for the short- and long-term management of muscle pain in the facial region. These results are discussed in terms of the potential mechanisms by which self-regulation treatment strategies are effective for the management of these pain disorders.
A randomized clinical trial using research diagnostic criteria for temporomandibular disorders-axis II to target clinic cases for a tailored self-care TMD treatment program.
AIMS: To carry out a randomized clinical trial (RCT) contrasting usual conservative treatment of TMD by clinical TMD specialists with a structured self-care intervention, targeted to clinic cases independent of TMD physical diagnosis, who were reporting minimal levels of psychosocial dysfunction; the intervention was delivered by dental hygienists in lieu of usual treatment. METHODS: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used to target subjects who exhibited minimal TMD-related psychosocial interference. Criteria for study inclusion were: (1) self-report of facial and/or masticatory muscle pain discomfort for which usual care was prescribed by the clinic TMD specialist; (2) RDC/TMD Axis II graded scale of chronic pain (GCP) score of 0, I, or II-Low. (3) Age 18 to 70 years. RESULTS: On 1-year follow-up, while both groups showed improvement in all clinical and self-report categories measured, patients in the tailored self-care treatment program compared to usual TMD treatment showed significantly; (a) decreased TMD pain, (b) decreased pain-related interference in activity; (c) reduced number of masticatory muscles painful; (d) fewer additional visits for TMD treatment. Groups were comparable with regard to measures of vertical range of motion. The self-care program was associated with consistent, but non-statistically significant, trends towards lower levels of depression and somatization. Ability to cope with TMD, knowledge concerning TMD and patient satisfaction was significantly enhanced for the self-care group. No participating patients experienced physical or personal adverse effects during the 1-year post-treatment follow-up period. CONCLUSION: Use of RDC/TMD psychosocial assessment criteria can contribute to successful clinical decision-making for the management of TMD.
Prosthodontic restoration of vertical dimension with all-ceramic crowns.
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Snoring and sleep apnea: dental and medical perspectives. Interview by Mark J. Friedman.
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Nociceptive trigeminal inhibition--tension suppression system: a method of preventing migraine and tension headaches.
Dentists and physicians see countless patients suffering from various types of headaches. Various modes of therapy are used in an attempt to treat these patients. As a result of this study, it appears that a common factor to migraine and tension-type headaches may be chronic clenching. If this is the case, then dentists may be able to treat headache patients more effectively than previously suspected through the use of a dental appliance.
Pseudo-dental pain and sensitivity to percussion.
Two case reports examine a little-known cause of dental pain and sensitivity to percussion. Contrary to the traditional assumption that pain and sensitivity to percussion almost always are diagnostic of pulpal inflammation and/or necrosis, these symptoms actually may be referred to the sensitive tooth from trigger points in the masticatory muscles. Therefore, myofascial pain syndrome must be ruled out in patients who have dental pain and display sensitivity to percussion.
Compliance and its role in successful treatment of an advanced periodontal case: review of the literature and a case report.
Periodontal disease is a chronic disease that is perceived by many patients to be nonthreatening. Periodontal therapy has been shown to be less effective if a regular periodontal maintenance schedule is not followed after completion of active therapy. Periodontal maintenance is an integral part of successful periodontal therapy.
[Evaluation of oral therapy methods in the treatment of snoring and obstructive sleep apnea].
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Stability of maxillary advancement for correction of skeletal Class III malocclusion after combined maxillary and mandibular procedures: preliminary results of an active control equivalence trial for semirigid and rigid fixation of the maxilla.
In this paper preliminary results are presented of a prospective study designed to examine the effect of maxillary fixation methods on postoperative stability. The purpose of this study was to evaluate the stability of Le Fort I osteotomy stabilized with semirigid fixation of the maxilla (SRMF) or rigid fixation of the maxilla (RMF). All patients had skeletal Class III malocclusion and underwent bimaxillary surgery (Le Fort I maxillary advancement with or without superior repositioning and bilateral sagittal split osteotomies of the mandible). Standardized cephalometric analysis was performed on serial radiographs of 42 patients immediately before surgery, 1 week after surgery, after release of fixation, and 1 year postoperatively. The patients were randomized into 2 treatment groups: 23 patients received RMF (group A), and 19 patients received SRMF (group B). Within the groups, patients showed good stability with regard to their baseline characteristics. To show the therapeutic equivalence of the 2 treatments, analysis of the recorded data followed the approach for an equivalence trial. The mean surgical advancement was 5.34 +/- 1.50 mm for group A and 4.51 +/- 1.37 mm for group B. The mean amount of postsurgical relapse was 0.98 +/- 1.27 mm for group A and 0.30 +/- 1.04 mm for group B. Group A patients experienced 93% of their relapse (0.92 mm) during fixation, while group B patients experienced 96% of their relapse (0.29 mm) after release of fixation. RMF provided better stability than SRMF for all maxillary landmarks in the vertical plane. All considered points both in horizontal and vertical plane exhibited full equivalence for 95% confidence intervals, which seems to indicate equivalent stability between the surgical procedures.
Occlusion, prosthodontic treatment, and temporomandibular disorders: a review.
The purpose of this article is to review the literature on the relationship between occlusal discrepancies and temporomandibular disorders (TMD) and to summarize the guidelines of treating TMD by prosthetic rehabilitation. To date, the relationship between occlusal condition and TMD has not been confirmed, although there is a current trend toward making a weak correlation between occlusal interference and TMD. Furthermore, several types of occlusal discrepancies have been considered as variable features of the norm. But unstable occlusion in the intercuspal position may cause TMD. In cases of restored dentition, the problem is probably different and iatrogenic TMD are not rare. Namely, malformed occlusal surfaces, defects in anterior guidance, occlusal curvature, and vertical dimension may lead to some TMD trouble. According to these recent concepts the treatment modalities of TMD have been changed. Conservative treatments such as counseling, behavioral modification, physical therapy, pharmacotherapy, and interocclusal appliances should be the first choice, and treatments that lead to drastic changes of occlusion are not recommended.
Controlling the vertical dimension--the other dimension.
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