César Bataglion

Emg analysis after laser acupuncture in patients with temporomandibular dysfunction (TMD). Implications for practice

The aim of this study was to analyze the effect of low level laser applied to acupuncture points of patients diagnosed with temporomandibular dysfunction (TMD). Ten patients aged between 20 and 50 years were clinically examined with regard to pain and dysfunction of the masticatory system. They received laser applications (GaAlAs diode laser, 780 nm wavelength; 70 mW power output, 35 j/cm(2)) in acupuncture specific points (Ig4, C3, E6, E7) once a week, for ten sessions. The range of jaw movement was registered after each session and visual analogue scale (VAS) was applied. Results were analyzed (SPSS-15.0-Chicago) during the comparison, before and after treatment. Statistical tests showed significant improvements (p < 0.01) in painful symptoms and electromyographic activities of masseter muscles in maximal habitual occlusion after laser applications but no significant improvements (p = 0.05) in measurements of mandibular movements. The laser therapy in specific acupuncture points promoted improvement of symptoms and it may be used as complementary therapy for TMD.

A Preliminary Protocol for Multi-Professional Centers for the Determination of Signs and Symptoms of Temporomandibular Disorders

Abstract The objective of the present study was to test a protocol for the quantification of the frequency and severity of signs and symptoms of temporomandibular disorders (TMD) according to patient perception during two phases of investigation. The protocol was developed based on the signs and symptoms most frequently reported in the literature and on the circumstances in which they produce discomfort. Eighty-four patients diagnosed with TMD by functional examination of the masticatory system responded to the protocol questions and indicated the severity of signs and symptoms using an eleven point numerical scale (Phase 1). Forty-two patients were fitted with an occlusal splint (treated group) and the remaining participants did not use a splint (control group). The protocol questions were asked after 50 days of treatment (Phase 2). Based on the results of nonparametric statistical analysis, the incidence of signs and symptoms was high in Phase 1 and significant, with no difference between the groups, whereas the treated and control groups differed in Phase 2. A comparison between Phases 1 and 2 showed that only the treated group presented a reduction in the severity of signs and symptoms. The study showed that using this protocol, it is possible to define the frequency and severity of symptoms as well as the effect of the treatment. The advantage of this protocol is that it would complement the data obtained using clinical examination with information provided by the patient in a measurable manner.

Immediate implants placed into infected sockets: a case report with 3-year follow-up

The esthetics and functional integrity of the periodontal tissue may be compromised by dental loss. Immediate implants became a viable option to maintain the periodontal architecture because of their anatomic compatibility with the dental socket and the possibility of eliminating local contamination. This article describes the procedure of immediate implant placement in the anterior maxilla replacing teeth with chronic periapical lesions, which were condemned due to endodontic lesions persisting after failed endodontic treatment and endodontic surgery, and discusses the relationship between the procedure and periapical lesions. Surgical removal of hopeless teeth 11, 12 and 21 was performed conservatively in such a way to preserve the anatomy and gingival esthetics. A second surgical access was gained at the apical level, allowing the debridement of the surgical chamber for elimination of the periapical lesion, visual orientation for setting of the implants and filling of the surgical chamber with xenogenous bovine bone graft. After this procedure, the bone chamber was covered with an absorbent membrane and the healing screws were positioned on the implants. Later, a provisional partial removable denture was installed and the implants were inserted after 6 months. After 3 years of rehabilitation, the implants present satisfactory functional and esthetic conditions, suggesting that immediate implant placement combined with guided bone regeneration may be indicated for replacing teeth lost due to chronic periapical lesions with endodontic failure history in the anterior maxilla.

Involvement of dental occlusion and trigeminal neuralgia: A clinical report

I n 1773, trigcminal neuralgia was denoted as tic douloureux or Fothcrgills disease. 1 During a pain episode the facial muscles related to expression and mastication usually contract, which justifies the definition as tic douloureux. 2 Most patients reported in the literature were women aged 50 to 70 years, ~-6 with greater involvement of the right side of the face. ~,3,5 The pain can be provoked by stimulating the triggering zones in some areas of the face; however, pain is provoked less frequently in the mucosal areas of the mouth. 4 Stimulation is usually caused by activities such as hair-combing, chewing, swallowing, tooth-brushing, yawning, and touching ones face. s The major therapies for trigcminal neuralgia are drug treatment and surgical intervention. 3,5 The drug of choice is carbamazepinc, although it may have undesirable side effects after prolonged use. Other medications, such as diphenylhydantoin and baclofen, have bccn used with good clinical results y , s Surgical intervention is reserved for patients who no longer respond to drug treatment2; however surgery does not ahvays produce the expected results. It has been suggested that neuralgia may be associated with pain because ofmyofascial dysfunction or some other temporomandibular disorder (TMD) and that functional and occlusal dental treatment may reduce pain. However, the patients in question may not have had genuine trigeminal neuralgia or may have had a superimposed TMD that, if properly treated, would have resulted in an improvement of symptoms .4 Physiotherapy with resources such as diathermy, therapeutic ultrasonography, and therapeutic laser treatment for painful symptoms 7 is fully acceptable in the treatmcnt ofTMDs. 8,9 Studies have demonstrated that these treatment methods significantly reduce the duration of symptoms provoked by these disorders. 7a°,u Gray et al. u recommended therapeutic laser applications for a 4-week period and reported that the maximal effect of this type of treatment occurred during the third or fourth week.

Bite force in temporomandibular dysfunction (TMD) and healthy complete denture wearers

The signs and symptoms of temporomandibular dysfunction (TMD) may contribute to reduce bite force and muscular activity. The aims of this study were to compare bite force in complete denture wearers with TMD (TMD group) and without TMD (healthy group).The TMD group consisted of 9 individuals, who had worn a maxillary and a mandibular complete removable denture for more than 10 years. The healthy group consisted of 9 participants who wore dentures and had satisfactory interocclusal and maxillomandibular relationship. Helkimo Index was used to analyze the dysfunction level. Maximum bite force was measured using a digital dynamometer with capacity of 100 kgf and adapted to oral conditions.The TMD group presented smaller mean bite force values than the healthy group, though without statistical significance (p>0.05). This outcome suggests that the TMD signs and symptoms and the structural conditions of the dentures did not affect the maximal bite force of complete denture wearers.

Combination therapies in the treatment of temporomandibular disorders: a clinical report

Numerous implant systems exist that have the versatility to create a custom implant abutment with an anatomic shape. This clinical report describes the use of a digital scanner with CAD/CAM technology to create (copy mill) an anatomically shaped abutment.

Nocturnal sleep architecture is altered by sleep bruxism

OBJECTIVE Sleep is a complex behaviour phenomenon essential for physical and mental health and for the body to restore itself. It can be affected by structural alterations caused by sleep bruxism. The aim of this study was to verify the effects of sleep bruxism on the sleep architecture parameters proposed by the American Academy of Sleep Medicine. DESIGN The sample comprised 90 individuals, between the ages of 18 and 45 years, divided into two groups: with sleep bruxism (n=45) and without sleep bruxism (n=45). The individuals were paired by age, gender and body mass index: a polysomnography was performed at night. RESULTS Statistically significant differences were found between (P≤0.05) individuals with sleep bruxism and individuals without sleep bruxism during total sleep time (P=0.00), non-rapid eye movement (NREM) total sleep time (P=0.03), NREM sleep time stage 3 (P=0.03), NREM sleep latency (P=0.05), sleep efficiency (P=0.05), and index of microarousals (P=0.04). CONCLUSIONS Sleep bruxism impairs the architecture of nocturnal sleep, interfering with total sleep time, NREM sleep latency, and sleep efficiency.

Impact of sleep bruxism on masseter and temporalis muscles and bite force.

Abstract Objectives: This study aimed to analyze the impact of sleep bruxism (SB) on electromyography (EMG) activity and the thickness of the masseter and temporal and maximal molar bite force. Method: Ninety individuals, aged between 18 and 45 years, were selected and divided into two groups: Group I (case group, 45 individuals with SB) and Group II (control group, 45 individuals without SB). A diagnosis of SB was made from polysomnography. Results: The data obtained from EMG and the muscle thickness and the maximal molar bite force were tabulated (SPSS 21.0), normalized, and subjected to statistical analysis (p ≤ 0.05). Comparisons between the groups showed significant differences regarding the habitual chewing of hard food for the left temporalis muscle (p = 0.04) and the chewing of soft food for the right masseter muscle (p = 0.04), but no significant differences for the measurements of muscle thickness and maximal molar bite force. Discussion: The present data suggest that SB negatively altered the masticatory muscles’ functions. Based on the results of this research, it can be concluded that individuals with SB showed decreased EMG activity in the masticatory muscles.

Tooth wear: use of overlays with metallic structures

ABSTRACT This work is a clinical case report of a patient presenting with marked tooth wear in all teeth, a reduction in the vertical dimension of occlusion, and fatigue in the muscles of mastication. The treatment proposed and effected used a muscle-relaxing appliance and mandibular and maxillar overlay appliances which were adjusted according to the occlusal contacts, vertical dimension of occlusion, and the mandibular positioning. The results obtained were satisfactory in terms of relaxing the muscles involved, reestablishing the dimensions of the lower third of the face, and the functional activities of deglutition, mastication, and speech.

Reestablishment of occlusion through overlay removable partial dentures: a case report

Loss of posterior teeth may cause an imbalance in the stomatognathic system. Overlay removable partial dentures (ORPD) are a reversible and relatively inexpensive treatment for patients with severely worn teeth. This paper presents a treatment with ORPD in a 55-year-old male patient who had severe attrition in the maxillary and mandibular teeth, temporomandibular joint pain and reduced vertical dimension of occlusion (VDO). The treatment consisted in the reestablishment of the VDO using Lucias jig, fabricating removable partial denture with reconstruction of the worn teeth without preparation. This therapy can be used as an alternative treatment to provide esthetic, function and stable occlusion in patients with severely worn teeth.