Iacopo Cioffi

Oral parafunctions as risk factors for diagnostic TMD subgroups.

The frequency of diurnal clenching and/or grinding and nail-biting habits was assessed in patients affected by temporomandibular disorders (TMDs) and in healthy controls in order to investigate the possible association between these oral parafunctions and different diagnostic subgroups of TMDs. The case group included 557 patients (127 men, mean age +/- SD = 34.5 +/- 15.4 years; 430 women, mean age +/- SD = 32.9 +/- 14.1 years) affected by myofascial pain or disc displacement or arthralgia/arthritis/arthrosis. The control group included 111 healthy subjects (55 men, mean age +/- SD = 37 +/- 15.2 years; 56 women, mean age +/- SD = 38.2 +/- 13.8 years). Multinomial logistic regression analysis was used to assess the association between oral parafunctions and TMDs, after adjusting for age and gender. Daytime clenching/grinding was a significant risk factor for myofascial pain (odds ratio (OR) = 4.9, 95% confidence interval (CI): 3.0-7.8) and for disc displacement (OR = 2.5, 95% CI: 1.4-4.3), nail biting was not associated to any of the subgroups investigated. Female gender was a significant risk factor for myofascial pain (OR = 3.8; 95% CI: 2.4-6.1), whereas the risk factor for developing disc displacement decreased with ageing. No association was found between gender, age and arthralgia/arthritis/arthrosis.

Efficacy of the Sander bite-jumping appliance in growing patients with mandibular retrusion: a randomized controlled trial

OBJECTIVES The efficacy of functional appliances remains highly debated. This randomized controlled trial investigated the skeletal and dentoalveolar effects determined by the Sander bite-jumping appliance (BJA). The null hypothesis to be tested was that the appliance would not induce supplementary mandibular growth compared to untreated controls. SETTING AND SAMPLE POPULATION This study was carried out at the Section of Orthodontics, University of Naples Federico II, Italy. Forty-six patients receiving a clinical diagnosis of skeletal and dental class II due to mandibular retrusion were either allocated to a treatment (23 patients;15 boys, 8 girls; mean age ± SD: 10.9 ± 1.3 years) or to an untreated control group (23 patients;11 boys, 12 girls; mean age ± SD: 10.5 ± 1.2 years), by using a balanced block randomization. METHODS Lateral cephalograms were taken before and after treatment and used for comparisons. Measurements were analyzed by descriptive statistics, univariate and multivariate statistical tests. RESULTS Treated individuals had a significant increase in mandibular length (6.4 ± 2.3 vs. 3.5 ± 2.5 mm; p < 0.001), overjet reduction (-5.0 ± 2.9 vs. 0.3 ± 1.2 mm; p < 0.001) and molar relationship improvement (-5.3 ± 2.4 vs. 0.1 ± 1.1 mm; p < 0.001) compared to controls. The use of the appliance did not significantly affect jaw divergence. Proclination of lower incisors was slightly greater (3.0°, p = 0.023) in treated patients than in controls. The increase in mandibular length was not significantly influenced by cervical stage (p = 0.40). CONCLUSION The BJA can effectively correct class II malocclusions by a combination of dentoalveolar and skeletal effects. The long-term stability of the correction needs to be evaluated.

Implant Therapy in Irradiated Patients

In this multicenter study, submerged implants were prospectively followed to evaluate their long-term prognosis in irradiated patients. In a total of 77 patients treated for oral or neck cancer, 188 implants were consecutively placed. After a healing period, the successfully integrated implants were restored with 69 removable and 38 fixed restorations. The implants cumulative survival and success rates were evaluated over a period of at least 36 months. In addition, cumulative success rates were calculated for implant subgroups divided per implant site (mandible or maxilla), radiation dosage, and the time interval between the last irradiation and implant placement. During the healing period, 20 implants did not successfully integrate, whereas 168 implants were classified as success (including both survival and success rates). The analysis of implant subgroups showed slightly more favorable cumulative success rate for mandibular implants (98.4%) compared with maxillary implants (57.1%) and clearly better success rate for a radiation dosage minor of 50-Gy doses. A time greater than 12 months as interval between last irradiation and implant placement seems not to promote better clinical results.

Transverse changes determined by rapid and slow maxillary expansion – a low-dose CT-based randomized controlled trial

OBJECTIVES To compare transverse skeletal changes produced by rapid (RME) and slow (SME) maxillary expansion using low-dose computed tomography. The null hypothesis was that SME and RME are equally effective in producing skeletal maxillary expansion in patients with posterior crossbite. SETTING AND SAMPLE POPULATION This study was carried out at the Department of Oral Sciences, University of Naples Federico II, Italy. Twelve patients (seven males, five females, mean age ± SD: 10.3 ± 2.5 years) were allocated to the SME group and 14 patients (six males, eight females, mean age ± SD: 9.7 ± 1.5 years) to the RME group. MATERIALS AND METHODS All patients received a two-band palatal expander and were randomly allocated to either RME or SME. Low-dose computed tomography was used to identify skeletal and dental landmarks and to measure transverse maxillary changes with treatment. RESULTS A significant increase in skeletal transverse diameters was found in both SME and RME groups (anterior expansion = 2.2 ± 1.4 mm, posterior expansion = 2.2 ± 0.9 mm, pterygoid expansion = 0.9 ± 0.8 mm). No significant differences were found between groups at anterior (SME = 1.9 ± 1.3 mm; RME = 2.5 ± 1.5 mm) or posterior (SME = 1.9 ± 1.0 mm; RME = 2.4 ± 0.9 mm) locations, while a statistically significant difference was measured at the pterygoid processes (SME = 0.6 ± 0.6 mm; RME = 1.2 ± 0.9 mm, p = 0.04), which was not clinically relevant. CONCLUSION Rapid maxillary expansion is not more effective than SME in expanding the maxilla in patients with posterior crossbite.

Macroscopic Analysis of Human Masseter Compartments Assessed by Magnetic Resonance Imaging

The human masseter is divided into compartments by aponeuroses. So far, the qualitative and quantitative features of these compartments and their aponeuroses have been scarcely investigated. This study investigated the three-dimensional compartmentalization of the masseter muscle and tested the hypothesis that aponeurosis content varies systematically across different masseter subportions as well as between genders. The right masseter of 14 healthy participants was scanned by magnetic resonance, and the outlines of muscle and aponeuroses were segmented and rendered in three dimensions by AMIRA software. The internal architecture of the masseter muscle varied markedly across individuals, with respect to the number, shape and location of the compartments delimited by aponeuroses. Aponeuroses were widely represented inside the masseter, amounting to 7.1 ± 2.1% of its volume. The aponeurosis content varied systematically across masseter subvolumes and did not differ between genders after adjusting for body height and weight.

Effect of somatosensory amplification and trait anxiety on experimentally induced orthodontic pain.

The perception of pain varies considerably across individuals and is affected by psychological traits. This study aimed to investigate the combined effects of somatosensory amplification and trait anxiety on orthodontic pain. Five-hundred and five adults completed the State Trait Anxiety Inventory (STAI) and the Somatosensory Amplification Scale (SSAS). Individuals with combined STAI and SSAS scores below the 20th percentile (LASA group: five men and 12 women; mean age ± SD = 22.4 ± 1.3 yr) or above the 80th percentile (HASA group: 13 men and seven women; mean age ± SD = 23.7 ± 1.0 yr) were selected and filled in the Oral Behaviors Checklist (OBC). Orthodontic separators were placed for 5 d in order to induce experimental pain. Visual analog scales (VAS) were administered to collect ratings for occlusal discomfort, pain, and perceived stress. Pressure pain thresholds (PPT) were measured. A mixed regression model was used to evaluate pain and discomfort ratings over the 5-d duration of the study. At baseline, the LASA group had statistically significantly higher PPT values for the masseter muscle than did the HASA group. During the experimental procedure, the HASA group had statistically significantly higher discomfort and pain. A significant difference in pain ratings during the 5 d of the study was found for subjects in the HASA group. Higher OBC values were statistically significantly positively associated with pain. Somatosensory amplification and trait anxiety substantially affect experimentally induced orthodontic pain.

Short-Term Sensorimotor Effects of Experimental Occlusal Interferences on the Wake-Time Masseter Muscle Activity of Females with Masticatory Muscle Pain

AIMS To investigate the effects of the application of an acute alteration of the occlusion (ie, interference) on the habitual masseter electromyographic (EMG) activity of females with temporomandibular disorders (TMD)-related muscular pain during wakefulness. METHODS Seven female volunteers with masticatory myofascial pain participated in a crossover randomized clinical trial. Gold foils were glued on an occlusal contact area (active occlusal interference, AI) or on the vestibular surface of the same molar (dummy interference, DI) and left for 8 days. The masseter electromyogram was recorded during wakefulness in the natural environment by portable recorders under interference-free, dummy-interference, and active-interference conditions. The number, amplitude, and duration of EMG signal fractions with amplitudes above 10% of the maximum voluntary contraction (activity periods, APs) were computed in all experimental conditions. Muscle pain, headache, and perceived stress were each assessed with a visual analog scale (VAS), and an algometer was used to assess masseter and temporalis pressure pain thresholds. Data were analyzed by means of analysis of variance. RESULTS The frequency and duration of the recorded APs did not differ significantly between the experimental conditions (P>.05), but a small and significant reduction of the EMG mean amplitude of the APs occurred with AI (P<.05). Neither the VAS scores for muscular pain, headache, and perceived stress nor the pressure pain thresholds changed significantly throughout the entire experiment (P>.05). CONCLUSION An active occlusal interference in female volunteers with masticatory muscle pain had little influence on the masseter EMG activity pattern during wakefulness and did not affect the pressure tenderness of the masseter and temporalis.

Social impairment of individuals suffering from different types of chronic orofacial pain

BackgroundThe daily life of patients suffering from orofacial pain is considerably impaired as compared to healthy subjects. The aim of this study was to investigate the influence of different categories of orofacial pain on the habitual life of adult individuals.MethodsSeven hundred eighty-one individuals with orofacial pain were recruited from an initial sample of 1,058 patients. All the individuals were allocated to groups according to their diagnosis: myofascial pain (group A, 676 subjects, 525 females and 151 males; mean age ± SD = 35.2 ± 12.6), migraine (group B, 39 subjects, 29 females and 10 males; mean age ± SD 36.0 ± 10.7), and both myofascial pain and migraine (group C, 66 subjects, 56 females and 10 males, mean age ± SD = 35.6 ± 10.8). Characteristic pain intensity (CPI), disability days (DD), disability score (DS), and graded chronic pain intensity (GCPS) were calculated according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II. Depression and somatization (nonspecific physical symptoms) scores were also calculated.ResultsA significant association between groups and GCPS categories was found (p < 0.0001). Post hoc tests showed a significant difference between groups A and B and between A and C, but not between B and C. In group A, the most frequent GCPS score was grade II. The most frequent GCPS score in groups B and C was grade III, indicating a moderate limiting impairment. This score was more frequent in group B (41%) than in the other groups (group A = 20.6%, group C = 34.8%). GCPS grade IV was more frequent in group C (19.7%) than in the other groups. Group C had significantly higher scores for nonspecific physical symptoms than group A (p < 0.05).ConclusionsMyofascial pain and migraine sensibly affect the common daily life of adult individuals. The comorbidity of both conditions determines a major impairment.

Chronic pain and weather conditions in patients suffering from temporomandibular disorders: a pilot study

OBJECTIVES Patients with temporomandibular disorders (TMDs) often report increased pain in response to changes in weather conditions. Nevertheless, scientific evidence supporting this relationship is scarce. The aim of this study was to assess a potential relationship between pain intensity and meteorological factors, through a newly developed, portable device, in patients affected by chronic masticatory muscle pain. METHODS Seven female subjects were diagnosed with myofascial pain of the masticatory muscles, according to RDC/TMD criteria, were recruited, and participated in the study. Each patient was provided with a portable data logger that recorded and stored weather variables (atmospheric pressure, air humidity, temperature) every 15 min. Patients were asked to record the level of perceived pain on an electronic visual analogue scale (VAS) every hour. The relationship between meteorological variables and pain scores was investigated using separate generalized least squares regression models with a correlation structure estimated via autoregressive integrated moving average models. RESULTS Individual VAS trajectories in the study period were different. The effect of meteorological factors on VAS scores was statistically significant in five subjects, with at least one main effect and/or one two-way interaction between meteorological variables being significant. CONCLUSIONS The analyses suggest the existence of different interindividual responses to climatic changes. However, the identified putative role of meteorological variables and of their two-way interactions suggests that further investigations on larger samples may be useful to assess the research question under examination.

Quality of randomised controlled trials in dentistry

Randomised controlled trials (RCTs) are regarded as the best study designs to test the efficacy of medical and dental intervention. Many reports, however, have shown that at the moment the quality of dental RCT reports is still poor, and further efforts to improve it are necessary. It has been suggested that trials that are not well designed provide biased estimates of the treatment effects and that a journals impact factor is not related to the quality of RCTs published. For these reasons, before trusting RCT reports, a careful assessment of the study selected is needed. Randomisation, blinding, allocation concealment, drop outs analysis are essential quality components of RCTs. Many systems for RCTs quality assessment are available. In this report the concept of quality of RCTs will be critically evaluated and the most commonly used instruments available for quality assessment of RCTs in dental research will be reviewed.