Miguel Pais Clemente

Application of Infrared Thermal Imaging in a Violinist with Temporomandibular Disorder.

Temporomandibular disorders (TMD) consist of a group of pathologies that affect the masticatory muscles, temporomandibular joints (TMJ), and/or related structures. String instrumentalists, like many orchestra musicians, can spend hours with head postures that may influence the biomechanical behavior of the TMJ and the muscles of the craniocervicomandibular complex (CCMC). The adoption of abnormal postures acquired during performance by musicians can lead to muscular hyperactivity of the head and cervical muscles, with the possible appearance of TMD. Medical infrared thermography is a non-invasive procedure that can monitor the changes in the superficial tissue related to blood circulation and may serve as a complement to the clinical examination. The objective of this study was to use infrared thermography to evaluate, in one subject, the cutaneous thermal changes adjacent to the CCMC that occur before, during, and after playing a string instrument.

Three-dimensional analysis of the cranio-cervico-mandibular complex during piano performance.

Piano players, as well as other musicians, spend a long time training to achieve the best results, sometimes adopting unnatural body positions that may cause musculoskeletal pain. This paper presents the preliminary results of a study targeting the analysis of the head and cervical postures of 17 piano players during musical performance. It was found, as a common feature, that the players tilt the head to the right and forward towards the score and keyboard. Players who know the score by heart tend to move their heads more compared to the ones who have to keep their eyes on the score.

A Prosthodontic Treatment Plan for a Saxophone Player: A Conceptual Approach

Introduction: A wind instrumentalist was diagnosed with a periapical lesion on tooth 21. The prosthetic rehabilitation options were considered with respect to the embouchure mechanism of the saxophonist. The underlying mechanism associated with the embouchure of the saxophone player was observed in this particular case in order to understand if asymmetrical forces were transmitted to the upper central incisors. Periapical lesions can be harmful to the oral health of musicians. The treatment options thus have to be taken into consideration with special focus on the need for oral rehabilitation on the anterior maxilla. Material and Methods: The patient underwent a radiographic examination with a panoramic X-ray. Subsequently, two piezoresistive sensors (FlexiForce™) were placed on the upper surface of the mouthpiece in order to quantify the pressure applied to the central incisors during the embouchure. In order to understand the values involved during this procedure, the saxophone player was required to play three different notes at different pitches: high, medium, and low. This procedure was repeated three times for each pitch in order to obtain a medium value for each note. Signal acquisition was obtained within software developed for this purpose, with the voltage output observed in LabView 2011®. Results: The panoramic X-ray showed a periapical lesion with the characteristics of a radicular cyst on tooth 21. The FlexiForce™ piezoresistive sensors allowed us to find that greater force (kg) was being applied to tooth 11 in comparison to tooth 21 during the embouchure mechanism. Conclusions: The sensors used in this research are acceptable for identifying the tooth where the greatest pressure is applied during the mouthpiece stabilization. In the case of executing an oral rehabilitation procedure for wind instrumentalists, a clinical examination can be complemented with the aid of bioengineering and the inherent development of sensor technology in order to better understand the embouchure mechanism. Likewise, the prosthetic rehabilitation should be taken into consideration in order to provide minimal changes to the musician’s performance.

Orofacial trauma management in a wind instrument player

Background: Regarding the orofacial structures, musical performance in wind instrumentalists can promote undesirable pressures on teeth which can be the origin of orofacial pain. Objective: This article addresses the therapeutic options for a clarinet player, which has tooth mobility and orofacial pain due to the occurrence of an orofacial trauma. Methods: The clarinetist had an alteration in his embouchure due to an orofacial trauma and consequent difficulty on playing his instrument. The authors had to deal with the mobility and restoration of the compromised endodontically tooth. After the stages of the oral rehabilitation a homemade fitted appliance, the Embouchure Stabilization Mouthpiece Appliance – ESMA was made to reduce abnormal and undesired forces on the upper central incisors, evaluated by piezoresistive sensors. Results: The implemented treatment of the central incisor is crucial for the embouchure and musical performance of the clarinetist. The dental treatment fulfilled the necessary conditions for its maintenance; otherwise, the placement of a removable prosthodontics on the upper right central incisor would probably not allow the clarinetist to play anymore. However, the proposed device, ESMA, was constructed for the anterior upper incisal block, allowed the musician to perform and continuing playing the clarinet. Conclusions: The evolution of dental techniques will enhance better solutions for patients in general. There will be always uncertainty towards the response of the biological tissues; however, by understanding the forces that are being applied during musical performance, one may contribute to player’s well-being.

Wind Instrumentalists and Temporomandibular Disorder: From Diagnosis to Treatment

Introduction: Temporomandibular disorders (TMD) involve the presence of pain or dysfunction on certain areas of the Cranio-Cervico-Mandibular Complex (CCMC), such as the masticatory muscles, the temporomandibular joint (TMJ) and associated structures like the postural muscles of the cervical region, can be considered as a sub-group of musculoskeletal disorders. Wind instrument players, as a consequence of their musical performance and its relation with the CCMC, can develop a TMD associated to muscle hyperactivity of certain elevator muscles, or even an increase of the intra-articular pressure in the functioning of the TMJ throughout musical activity. Aim: The objective of this paper is to describe the necessary and elementary steps in the diagnoses and treatment of a wind instrumentalist with a temporomandibular disorder, with the introduction of infrared thermography during this procedure. This case study also has the purpose of presenting the usefulness of piezoresistive sensors in the analysis of the clarinettists’ embouchure. Methodology: A Caucasian, 30-year-old female clarinettist was assessed through a clinical examination following the Diagnostic Criteria for TMD (RDC/TMD), as a complementary tool of diagnosis, a thermal imaging infrared camera, Flir E60 (Wilsonville, OR, USA), was used in order to analyse the above referred articular and muscular regions. The complementary examination protocol implemented with this clarinet player also involved the analyses of the embouchure with the support of piezoresistive sensors. Results: The clinical outcomes resulting from this work were based on the RDC/TMD diagnoses indicated that the clarinet player had an internal derangement on both TMJ, with an osteoarthritis on the left TMJ and an anterior disc displacement with reduction on the right TMJ. The infrared thermograms that were analysed, verified the existence of a temperature differential of the anterior temporal muscle (0.1 °C), the TMJ (0.1 °C) and the masseter muscle (0.7 °C), and after the occlusal splint therapy the asymmetry related to the master muscle reduced to 0.3 °C. The high pitches can reach values of 379 g of force induced to the tooth 21 comparing to the 88 g of force applied on tooth 11. The embouchure force measurements consistently presented greater forces during the higher notes, followed by the medium notes and finally the low notes and this happened with higher pressures being transmitted always to tooth 21. Conclusion: Performing arts medicine should understand the major importance of the dentistry field in the daily life of a professional musician, and the significance of implementing routine screening procedures of dental examinations, with infrared thermograms examination of distinct areas of the CCMC, as well as the use of sensors on the analyses of an eventual asymmetrical embouchure. Employing these techniques in dentistry will create the chance of preventing the overuse of some anatomical structures, with an early diagnosis and the correct monitoring of these areas.

Thermographic Evaluation of the Saxophonists’ Embouchure

The orofacial complex is the primarily link between the instrument and the instrumentalist when performing the musician’s embouchure. The contact point is established between the saxophonist lower lip, the upper maxillary dentition and the mouthpiece. The functional demands of the saxophone player and consequent application of forces with an excessive pressure can significantly influence the orofacial structures. A thermographic evaluation was performed to an anatomical zone vital for the embouchure, such as the lip of the saxophonist. Substantial temperature changes occurred before and after playing saxophone. The specificity of the embouchure regarding the position of the lower lip inside the oral cavity, the anatomy and position of the central lower incisors can be some of the factors involved in the origin of the existing temperature differences on the thermographic evaluation.