Influence of craniofacial morphology on temporomandibular disorders, bite force, masticatory performance and chewing ability

Orientador: Renata Cunha Matheus Rodrigues GarciaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A morfologia craniofacial no sentido vertical está relacionada com as proporções e configurações da musculatura mastigatória, a qual pode ser influenciada pela presença de disfunções temporomandibulares (DTMs), afetando as funções orofaciais, como por exemplo, a mastigação e deglutição. Desta forma, dois estudos foram conduzidos e compõem esta tese. O objetivo no primeiro estudo foi verificar a presença da associação entre DTM e morfologia craniofacial. Para tanto, foram selecionados duzentos voluntários (com idade entre 18 e 50 anos) da Faculdade de Odontologia de Piracicaba, os quais foram divididos em dois grupos: (1) voluntários com DTM (n = 100, sendo 90 indivíduos do gênero feminino e 10 do gênero masculino) (idade média 27,80 ± 6,10 anos), e (2) voluntários sem DTM (n = 100, sendo 90 indivíduos do gênero feminino e 10 do gênero masculino) (idade média 25,90 ± 5,20 anos). O diagnóstico de DTM foi realizado por meio do sistema de diagnóstico Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Em seguida, foram obtidas telerradiografias convencionais em norma lateral e após análise cefalométrica de Ricketts os voluntários foram classificados como Braquifaciais, Mesofaciais ou Dolicofaciais. O segundo estudo objetivou avaliar a influência da morfologia craniofacial na força máxima de mordida; na performance e habilidade mastigatórias em indivíduos com DTM sintomática. Para tanto, indivíduos do primeiro estudo que apresentaram tempo de dor de no mínimo 3 meses, com intensidade maior ou igual a cinquenta milímetros mensurada por meio da escala visual analógica (EVA) foram incluídos. Desta maneira, 48 indivíduos (com idade entre 18 e 45 anos) do gênero feminino com DTM sintomática (idade média 27,71 ± 5,79 anos) foram divididos em 3 grupos: (1) braquifacial (n = 22); (2) mesofacial (n = 13); e (3) dolicofacial (n = 13). A função mastigatória foi avaliada por meio da mensuração da força máxima de mordida, performance e habilidade mastigatórias. Para o primeiro estudo os dados foram submetidos aos testes de Tukey-Kramer e qui-quadrado de razão de verossimilhança, e para o segundo estudo foi utilizado análise de variância um fator seguido de teste de Tukey-Kramer (?=0,05). Os resultados do primeiro estudo demonstraram que não houve associação entre a morfologia craniofacial e a presença de DTM (p = 0,6622), no entanto observou-se associação entre a morfologia craniofacial e a presença de dor (p = 0,0077). No segundo estudo, verificou-se diferença significante na força máxima de mordida (p = 0,0001) entre os grupos, sendo os maiores valores encontrados em indivíduos braquifaciais, no entanto não foram encontradas diferenças na performance mastigatória (p=0,4543). Em acréscimo, houve diferença significante (p=0,0141) entre os grupos na habilidade mastigatória de apenas um dos componentes avaliados, no qual os indivíduos braquifaciais apresentaram os melhores valores de habilidade. Apesar de não ter sido observada associação entre a morfologia craniofacial e DTM, evidencia-se a importância de uma atenção especial em indivíduos braquifaciais, os quais estão mais susceptíveis a apresentarem DTM sintomática. Além disso, a morfologia craniofacial influenciou a força máxima de mordida, mas não afetou a performance e habilidade mastigatórias em indivíduos com DTM sintomáticaAbstract: Vertical craniofacial morphology is related with the proportions and settings of masticatory muscles, which can be influenced by the presence of temporomandibular disorders (TMD), affecting the orofacial functions, such as mastication and deglutition. Thus, two studies were conducted and compose this thesis. The aim of the first study was to investigate the presence of association between craniofacial morphology and TMD. Two hundred volunteers (ranging from 18 to 50 years) were selected from Piracicaba Dental School and were divided into two groups: 1) volunteers with TMD (n = 100, 90 females and 10 males) (mean age 27.80 ± 6.10 years), and 2) volunteers without TMD (n = 100, 90 females and 10 males) (mean age 25.90 ± 5.20 years). TMD was diagnosed by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Subsequently, lateral cephalometric radiographs were obtained and analyzed by Ricketts' cephalometric analysis and the volunteers were classified as Brachyfacial, Mesofacial or Dolichofacial. The second study assessed the influence of craniofacial morphology on maximum bite force; masticatory performance and chewing ability in subjects with painful TMD. Subjects from the first study presenting pain for at least 3 months, with a minimum pain intensity of 50 mm measured using a visual analog scale (VAS) were included. Thus, fourty-eight female subjects with TMD (ranging from 18 to 45 years) (mean age 27.71 ± 5.79 years) were divided into three groups: 1) brachyfacial (n = 22); 2) mesofacial (n = 13); and 3) dolichofacial (n = 13). Masticatory function was assessed through maximum bite force, masticatory performance and chewing ability tests. For the first study data were submitted to Tukey-Kramer and to the Likelihood Ratio Chi-Square tests and for the second, data were analyzed using ANOVA one-way, followed by Tukey-Kramer test (?=0,05). The results of the first study demonstrated that there was no association between craniofacial morphology and TMD (p = 0.6622). However, craniofacial morphology was associated with painful TMD (p = 0.0077). In the second study, significant difference (p = 0.0001) was observed in maximum bite force values among the three groups, being the higher values exhibited by brachyfacial individuals. No difference (p > 0.05) was found for masticatory performance values among groups. In adittion, the ability to chew only one of the evaluated foods was significant among the groups (p = 0.0141), and brachyfacial subjects showed the best chewing ability. Although there was no association between craniofacial morphology and TMD, attention should be given to brachyfacial subjects, which are more susceptible to present TMD pain symptoms. In addition, craniofacial morphology influenced the maximum bite force, without impairing the masticatory performance and chewing ability of painful TMD subjectsDoutoradoProtese DentalDoutora em Clínica Odontológic

Craniofacial Morphology Affects Bite Force In Patients With Painful Temporomandibular Disorders

Craniofacial morphology affects masticatory performance in healthy dentate subjects, but little is known about its effects in patients with painful temporomandibular disorders (TMDs). Forty-eight female patients (mean age of 28±5.8 years) with painful TMDs underwent lateral cephalometric radiography. Using Ricketts' cephalometric analysis and the Vert method, subjects were assigned to three groups according to their craniofacial morphology: brachyfacial (n=22), mesofacial (n=13), and dolichofacial (n=13). Research diagnostic criteria for TMD were used to confirm the TMD diagnosis for each patient. Pain intensity was reported by each patient based on a visual analog scale (VAS). Maximum bite force (MBF) was measured with pressure sensors placed on the first molar site. Masticatory performance (MP) was assessed by chewing a silicone-based artificial material and determining the resulting particle size by the sieve method. Chewing ability (CA) was evaluated for seven food types and analyzed by a VAS questionnaire. Data were analyzed by one-way ANOVA followed by a Tukey-Kramer test (p<0.05). MBF differed in each group, with brachyfacial patients having the highest MBF values. There was no difference in MP among the groups. The groups differed only in their ability to chew one of the seven evaluated food types. In summary, craniofacial morphology affects the MBF without impairing MP or CA in patients with painful TMDs.27561962

Soft tissues changes after immediate and delayed single implant placement in esthetic area: a systematic review

The aim of the present study was to conduct a systematic review of the literature to compare soft tissue aspects of immediate and delayed implant placement in esthetic areas. This review of literature was conducted in the following databases: MEDLINE (Pub Med), Lilacs, Scielo, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). For those studies that met the inclusion/exclusion criteria, the results were analyzed and summarized according to the treatment protocol used for implant placement. The primary parameters taken into consideration were papilla level (PL) and marginal mucosa level (MML) around implants. Four randomized controlled trials (RCT) were selected for analysis, but all were deemed as being of poor quality according to quality assessment. No studies reported any statistically significant differences concerning the soft tissue esthetic parameters analyzed around immediate or delayed implants at any follow-up periods reported. However, PL results seemed to be more reliable than were MML results, due to the PL standardization of the method of analysis, which showed a tendency for poorer results around immediately placed implants. In conclusion, although the results are based on only a few poor quality RCTs, both treatment options for implant placement demonstrated similar outcomes in the esthetic area, especially when PL was considered41561261

Aplicações clínicas do enceramento diagnóstico na reabilitação oral – uma revisão de literatura

O Enceramento de diagnóstico consiste no planejamento de um caso clínico, apresentando soluções customizadas para cada caso. O objetivo do presente trabalho é apresentar uma revisão crítica da literatura científica, apresentando os conceitos, definições, empregos e limitações do enceramento de diagnóstico. Entre os objetivos desta técnica está o de oferecer, através de estudo prévio, uma resolução clínica efetiva ao paciente. Os desfechos clínicos proporcionados por esta ferramenta são: à devolução da anatomia oclusal e; os determinantes da oclusão, para que haja uma perfeita harmonia entre os elementos dentários com os movimentos mandibulares. Sendo de fundamental importância para as reabilitações bucais, esta técnica apresenta diferentes metodologias que buscam um objetivo final único, a devolução do equilíbrio do sistema estomatognático. Desta forma, o enceramento de diagnóstico possibilita o planejamento personalizado para cada caso clínico e integração entre profissionais da área, resultando em uma perfeita função e estética da prótese dental, e consequentemente harmonia do sistema estomatognático

Mastication Movements And Sleep Quality Of Patients With Myofascial Pain: Occlusal Device Therapy Improvements.

Patients with myofascial pain experience impaired mastication, which might also interfere with their sleep quality. The purpose of this study was to evaluate the jaw motion and sleep quality of patients with myofascial pain and the impact of a stabilization device therapy on both parameters. Fifty women diagnosed with myofascial pain by the Research Diagnostic Criteria were enrolled. Pain levels (visual analog scale), jaw movements (kinesiography), and sleep quality (Epworth Sleepiness Scale; Pittsburgh Sleep Quality Index) were evaluated before (control) and after stabilization device use. Range of motion (maximum opening, right and left excursions, and protrusion) and masticatory movements during Optosil mastication (opening, closing, and total cycle time; opening and closing angles; and maximum velocity) also were evaluated. Repeated-measures analysis of variance in a generalized linear mixed models procedure was used for statistical analysis (α=.05). At baseline, participants with myofascial pain showed a reduced range of jaw motion and poorer sleep quality. Treatment with a stabilization device reduced pain (P<.001) and increased both mouth opening (P<.001) and anteroposterior movement (P=.01). Also, after treatment, the maximum opening (P<.001) and closing (P=.04) velocities during mastication increased, and improvements in sleep scores for the Pittsburgh Sleep Quality Index (P<.001) and Epworth Sleepiness Scale (P=.04) were found. Myofascial pain impairs jaw motion and quality of sleep; the reduction of pain after the use of a stabilization device improves the range of motion and sleep parameters.1121330-