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Controversies in occlusion.

The tissues and structures of the stomatognathic system adapt in different ways but in a coordinated manner to functional forces. This adaptive capacity differs from individual to individual and tends to cloud the picture as to how these mechanisms function. This leads to many areas of disagreement as to the role of occlusal trauma in the etiology of periodontal disease; the importance of centric, bite collapse versus arch collapse; the role of incisal guidance in maintaining occlusal stability; canine protected-guided occlusion versus group function; the use of appliances in occlusal therapy; prophylactic versus interceptive occlusal adjustment; and the role of bruxism and other parafunctional habits in occlusal trauma. An attempt is made in this article to clarify these issues.

Animals↗

Temporization.

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Crowns↗

[Bonded bridges].

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Dental Bonding↗

[Value of bite-guard splints for dysfunctions of the masticatory system].

Based on a clinical post-treatment evaluation of 184 patients, the value of bite-guard splints in the treatment of dysfunctions of the masticatory system was assessed. The results clearly showed that successful results (83-89%) could be achieved, if the indications were considered with differentiation. Intracapsular joint diseases could be successfully treated with bite-guard splints, while other treatment concepts had to be applied for myalgia, bruxism and condylar displacement or dislocation.

Adult↗

Subjective and objective evaluation of bruxing patients undergoing short-term splint therapy.

Subjective and objective criteria were utilized to evaluate the effectiveness of short-term bite splint therapy on bruxistic behaviour. A simple bruxism monitoring device was used to check pre-treatment and post-treatment nocturnal bruxism. This preliminary study suggests that short-term splint therapy is effective in eliminating mild to moderate facial pain and dysfunction while reducing bruxistic behaviour. The bruxism monitoring device is a simple and effective tool for diagnosing bruxism quantitatively.

Adult↗

Dental side-effects of mandibular advancement splint wear in patients who snore.

OBJECTIVES: (a) To evaluate the longer term orthodontic side-effects of a Herbst mandibular advancement splint (MAS) in subjects with sleep disordered breathing. (b) To determine whether these are related to dental occlusion, degree of mandibular advancement or duration of appliance wear. DESIGN: Retrospective, cohort study. SETTING: Teaching hospital dental school. PARTICIPANTS: Subjects with sleep disordered breathing who had been wearing an MAS regularly (a minimum of 5 h per night, six nights a week) for at least 2 years. Of 192 subjects who were identified, 30 fulfilled the inclusion criteria and were prepared to attend for review. INTERVENTIONS: Dental casts were obtained and BMI and Epworth Sleepiness Scale scores recorded. These data were compared with those collected when the subject was first referred. A questionnaire was completed concerning MAS use, side-effects and any problems associated with the device. MAIN OUTCOME MEASURES: Changes in incisor tooth position. RESULTS: Median duration of MAS wear was 3.64 years. Small, statistically significant reductions in both vertical (-0.4 mm) and horizontal (-0.5 mm) overlap of the incisor teeth were found. This correlated with the degree of vertical opening of the MAS but was not related to the amount of mandibular protrusion or the duration of appliance wear. CONCLUSIONS: Patients who are considered suitable for MAS should be warned that dental changes may occur. Thus referring surgeons should also be aware of this possibility.

Adult↗

A comparison of negative-pressure dressings versus Bolster and splinting of the radial forearm donor site.

OBJECTIVE: Negative-pressure dressings (NPDs) have been reported to improve split-thickness skin graft survival in some settings; we assessed whether NPDs could improve skin graft results in radial forearm donor sites. METHODS: Between October 2003 and November 2004, 45 radial forearm donor sites underwent split-thickness skin graft immobilization either with conventional bolster dressing and splint or with an NPD. Split-thickness skin graft take was recorded at 1 and 4 weeks postoperatively. RESULTS: Overall split-thickness skin graft healing was improved in the NPD group (92%) compared with the case of conventional splinting (81%) at 4 weeks (P = .10). The rate of major graft loss was less in NPDs (10%) compared with the case of conventional management (28%) after 4 weeks (P = .06). CONCLUSIONS: Split-thickness skin graft survival was significantly improved by the use of NPDs. Because the use of NPDs is expensive, we consider their use only in patients with potential wound-healing problems, when there is a need to monitor the hand, or when immediate postoperative hand immobilization might impede the patient's recovery.

Drainage↗

Quantitative electromyographic diagnosis of myofascial pain-dysfunction syndrome.

The slopes of the V/T curves of masticatory muscles were determined in patients with MPD syndrome, and the changes in the slopes were observed prior to and during electrical muscle stimulation and splint therapy. The slopes of the V/T curves in patients with MPD syndrome were significantly steeper than those of the healthy subjects. In patients with MPD the slopes were decreased by electrical muscle stimulation of moderate duration and by insertion of the splint. These findings suggest that the most simple procedure for the diagnosis of MPD syndrome is to compare the slopes in MPD patients with those of healthy subjects. The observation of the changes in slopes during electrical muscle stimulation and splint therapy permits a more quantitative diagnosis of MPD syndrome. It also permits a quantitative measurement of improvement of symptoms in patients with MPD syndrome.

Adult↗

Ischemic therapy in thrombocytopenia from hypersplenism.

Percutaneous transfemoral arterial balloon occlusion or gelatin sponge embolization of the splenic artery or both were carried out in three high-risk patients with hepatic cirrhosis to reduce splenic hyperfunction and improve severe thrombocytopenia. Although this maneuver raised peripheral platelet counts in each patient, in one patient left upper quadrant pain with splinting of the lower chest cage led to hypostatic lower lobe pneumonia, while in another septic splentitis with gas-forming organisms necessitated splecectomy. Transfemoral occlusion of the splenic artery, although an effective, noninvasive approach to control splenic hyperfunction, has at the same time potential dangers that should be viewed with extreme caution in therapeutic application.

Adult↗

Cross-arch bar splint.

This article describes the use of a round bar connector that will aid the preservation of bone support for two isolated mandibular canines when a fixed partial denture replacing the anterior teeth is contraindicated. If the removable partial denture is constructed with only the two lone-standing canines as abutments, the removable partial denture will move occlusally and gingivally during function, thereby generating forces that may cause bone loss. By the addition of a straight round bar connecting the two canine crowns, the abutments are splinted together and masticatory forces are directed along the long axes of the teeth.

Bite Force↗