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PubMedDate not supplied

Canine risers: indications and techniques for their use.

Tooth wear leads to alterations in both static and functional occlusal contacts and may contribute to temporomandibular joint disorders and dysfunction. Treatment of tooth wear may be time consuming, expensive and destructive of remaining tooth tissues. Bruxism has been associated with the recording of abnormally high clenching forces. This paper describes a technique for the provision of the canine riser restoration, which deliberately alters the cuspal incline in canine teeth to provide a canine guided occlusion. These restorations may help to control excessive loading of teeth, limit further tooth wear and assist in the management of temporomandibular disorders and dysfunction.

Bruxism↗
PubMed2002

Initial management of temporomandibular disorders.

The existing dental literature does not support the superiority of any one type of treatment to manage TMD. Few studies meet rigorous scientific standards of the randomized clinical trial. This has led to enormous controversy. The initial management of TMD does not have to be controversial. Noninvasive, reversible modalities can be employed that carry very little risk and a high degree of success (Table 4). The success rate of this approach has been studied and determined to be 75% to 90%. Of course, not every patient will get better with this approach. For those who do not improve more advanced techniques must be used, and referral to specialists in TMD, neurology, and rehabilitation medicine may be required. A few patients will need surgery. Initial treatment of TMD requires relatively simple modalities, such as patient education, adherence to a soft diet, reducing oral habits, self-directed home physical therapy, muscle relaxation, the use of medication, and the proper use of bite plates. The majority of TMD patients will respond successfully to these basic treatments.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2002

Dentistry's orphan.

Explore the source record for details and available documents.

Dental Occlusion, Traumatic↗
PubMed2002

The effect of bruxism on treatment planning for dental implants.

Bruxism is a potential risk factor for implant failure. Excessive force is the primary cause of late implant complications. An appreciation of the etiology of crestal bone loss, failure of implants, failure to retain implant restorations, and fracture of components will lead the practitioner to develop a treatment plan that reduces force on implants and their restorations. The forces are considered in terms of magnitude, duration, direction, type, and magnification. Once the dentist has identified the source(s) of additional force on the implant system, the treatment plan is altered to contend with and reduce the negative sequelae on the bone, implant, and final restoration. One viable approach is to increase the implant-bone surface area. Additional implants can be placed to decrease stress on any one implant, and implants in molar regions should have an increased width. Use of more and wider implants decreases the strain on the prosthesis and also dissipates stress to the bone, especially at the crest. The additional implants should be positioned with intent to eliminate cantilevers when possible. Greater surface area implant designs made of titanium alloy and with an external hex design can also prove advantageous. Anterior guidance in mandibular excursions further decreases force and eliminates or reduces lateral posterior force. Metal occlusal surfaces decrease the risk of porcelain fracture and do not require as much abutment reduction, which in turn enhances prosthesis retention. The retention of the final prosthesis or super-structure is also improved with additional implant abutments. Night guards designed with specific features also are a benefit to initially diagnose the influence of occlusal factors for the patient, and as importantly, to reduce the influence of extraneous stress on implants and implant-retained restorations.

Bite Force↗
PubMed2002

The floating bone technique of the vertical ramus in hemifacial microsomia: case report.

This article describes a case in which distraction osteogenesis of the vertical ramus of the mandible was used for a young woman with hemifacial microsomia. Failure of distraction occurred because of the wrong vector of distraction. The floating bone technique was applied to the vertical ramus and was used to correct the malocclusion and to recover the height of the vertical ramus. Complete skeletal correction of the asymmetry was obtained, with excellent esthetic results. The case shows that the floating bone technique is a valid method to help the surgeon in the management of malocclusion after distraction and also in cases of failure of distraction. The floating bone is possible on both the vertical ramus and on the horizontal ramus.

Adolescent↗
PubMed2002

Treatment outcome of headache after occlusal appliance therapy in a randomised controlled trial among patients with temporomandibular disorders of mainly arthrogenous origin.

The aim of this study was to evaluate headaches before and after treatment with a stabilisation appliance and a control appliance in a randomised controlled trial in patients having temporomandibular disorders (TMD) of mainly arthrogenous origin. The effect of treatment was evaluated both in a short and in long-term perspective. 60 patients (mean age 30 years) with TMD of mainly arthrogenous origin were studied. The patients were selected from patients referred for treatment of TMD during a 3-year period to the Department of Stomathognathic Physiology, Faculty of Odontology, Malmö University. The 60 patients included in the study were randomly assigned to a treatment (T) or a control (C) group. The study was performed as a randomised controlled trial including evaluation of treatment effect on tension-type headache after 10 weeks, 6 and 12 months. At the 10 weeks follow-up, the patients who reported a negative treatment outcome and/or discomfort associated with the use of the appliances had their appliances readjusted. Patients who demanded further treatment received a stabilisation appliance (21 patients from the C-group), creating a new mixed (M) group. All the 60 patients reported frequency of headache from rarely up to daily at the start of the study. In the T-group 76% and in the C-group 83% of the patients reported headache at least once a week or more before treatment. At the 10 weeks follow-up, a statistically significant difference was found regarding headache several times a week or more between the T- and C-groups and within the T-group. At the 6 months follow-up, a statistically significant reduction was found in headache several times a week or more in the T- and M-groups. The number of patients with headache once a week or more decreased significantly in the T- and M-groups at the 12 months follow-up. We conclude that the stabilisation appliance seems to have an effect on the frequency of tension-type headache both in a short and in a long-term perspective in patients with TMD of mainly arthrogenous origin.

Adult↗
PubMedDate not supplied

A 6- and 12-month follow-up of appliance therapy in TMD patients: a follow-up of a controlled trial.

PURPOSE: This study compared the long-term effects of treatment with a stabilization appliance and treatment with a control appliance in patients with temporomandibular disorders (TMD). MATERIALS AND METHODS: In a controlled trial, 60 TMD patients with temporomandibular joint (TMJ) pain were evaluated after 10 weeks of treatment with either a stabilization appliance or a control appliance. At the 10-week follow-up, the 60 patients were assigned to one of three groups according to their demand for treatment. Group T, the treatment group, comprised 30 patients treated with a stabilization appliance; group C, the control group, comprised nine patients treated with a control appliance; and group M, the mixed treatment group, comprised 21 patients treated with first a control appliance and then a stabilization appliance. Signs and symptoms were evaluated in all three groups at 6- and 12-month follow-ups. RESULTS: At the 6- and 12-month follow-ups, a significant reduction in TMJ pain as measured on a visual analogue scale was found in all three groups, and a significant decrease in signs and symptoms was found in groups T and M. CONCLUSION: After 6 and 12 months of use, the stabilization appliance was found to still be effective in the alleviation of signs and symptoms in patients with TMD. Many patients in group C changed to a stabilization appliance at the 1 0-week follow-up, which significantly reduced the number of patients in this group. Most patients reported positive change in overall subjective symptoms in this trial. The stabilization appliance can therefore be recommended for patients with TMD.

Adult↗
PubMed2002

[Tools available for the diagnosis of obstructive sleep apnea syndrome. Measurements for the evaluation of therapeutic efficacy].

Obstructive sleep apnea syndrome (OSAS) is characterized by the development of repeated episodes of pharyngeal collapse. Respiratory movements attempt to reopen the closed pharynx leading to resumption of ventilation associated with micro-arousals. Three kinds of measurements are needed to establish the diagnosis of OSAS: airflow (reduction or complete interruption), respiratory effort in response to increased airway resistance, micro-arousals associated with the end of the respiratory event. Classically, polysomnography was used to establish sleep architecture using electroencephalography, electromyography and electro-oculography. Air flow was measured by thermistors, chest and abdominal movements and oximetry were monitored. Other more accessible methods can also be used to establish reliable diagnosis. Measuring pulse transit time using ECG and oximeter sensors provide a semi-quantitative measurement of respiratory effort. Likewise, cardiovascular markers (heart rate, blood pressure, pulse time) can be used instead of electroencephalography to establish the arousal pattern. Cardiovascular markers are as sensitive and probably as specific as EEG for identifying micro-arousals. Measuring nasal pressure provides a much less invasive quantitative assessment of airflow than pneumotachography. The shape of the inspiratory signal is also an indirect marker of respiratory effort. These new tools can be used to characterize the three elementary abnormalities observed in OSAS: variations in airflow, increased respiratory effort, fragmented sleep, using a very simplified setting compared with classical techniques. Therapeutic monitoring of OSAS patients, particularly after surgery, should not be limited to physical examination known to lack sufficient sensitivity. It should also include simplified methods or complete polysomnography to obtain a precise measurement of residual respiratory events and sleep pattern after treatment.

Air Pressure↗
PubMed2002

[Treatment of obstructive sleep apnea syndrome with mandibular advancement appliances].

Mandibular advancement device provide a therapeutic option for obstructive sleep apnea syndrome (OSAS). Clinical improvement has been proven in the different available studies, mainly on nocturnal respiratory events and quality of sleep. Less snoring have been noted by bed partners and objective studies have demonstrated a decrease in snoring frequency and intensity. The effects of these appliances on upper airways resistance syndrome is not yet well documented. The significant clinical improvement is secondary to the decrease in the occurrence of apneas and hypopneas. Polysomnographic improvement criteria with an apnea hypopnea index less than 10 per hour has been noted in certain cases, although no improvement or even worsening was noted in other cases. Sleep architecture has also changed in these patients, with a decrease in the time spent in stages 1 and 2, and an increase in the time spent in stages 3, 4 and rapid eye movement sleep. Micro-arousals are also reduced in number. Somnolence and loss of attention are improved; these have been evaluated subjectively or by a well known and approved somnolence scale. In some cases a test for vigilance was done. Our results are identical to those published in the different studies concerning respiratory events and sleep architecture.

Airway Resistance↗
PubMed2003

Cephalometric evaluation of craniofacial and upper airway structures in Japanese patients with obstructive sleep apnea.

In order to investigate the morphological characteristics of Japanese patients with obstructive sleep apnea (OSA) and basis for selection of an oral appliance (OA) therapy, the craniofacial skeleton, soft tissue and upper airway were analyzed on lateral cephalograms from 103 patients with OSA and 98 control subjects. At first, the 103 OSA patients were divided into two groups according to their body mass index (BMI). The results were the following: Micrognathia was a major risk factor of Japanese OSA patients instead of obesity; the narrowing in the hypopharynx was observed due to the inferior-located hyoid bone, especially in the obese group, an enlarged tongue and sticking of fatty-tissue to upper airway wall were observed in addition. Secondly, the 103 OSA patients were treated by OA, and were classified according to the reduction ratio of AHI (rAHI) again. The results suggested that the patients group which showed rAHI > or = 50% had a balanced relationship between the maxilla and mandible. These findings proved that the morphological characteristics specific to Japanese patients with OSA and patients who were allowed to accept the OA therapy were exist.

Adult↗