Povezanost okluzalnih disharmonija i simptoma temporomandibularnih disfunkcija

Introduction: The influence of occlusal condition on the onset of temporomandibular disorder (TMD) has been strongly debated for many years and is still the source of controversy. Until 1980s, the occlusal factors such as the presence of uncured malocclusions, discrepancies between intercuspal position (ICP) and retruded contact position (RCP) greater than two millimeters, occlusal abnormality, particularly mediotrusion and retrusion, and loss of posterior teeth were considered the primary causes of TMD. Objective: The objective of our study was to find correlation of occlusion disharmonies (difference between ICP and RCP) and present sings and symptoms of TMD. Method: The study involved 60 subjects between 18 and 26 years of age who were divided in two groups. The study group consisted of 30 subjects between 18 and 26 years of age with sings and symptoms of temporomandibular disorders (TMD). TMD was confirmed according to Helkimo index. An average value of Helkimo index in this group was 1. The control group included 30 subjects between 20 and 25 years of age without TMD sings and symptoms. An average value of Helkimo index in this group was 0. The function analysis of cinematic centers position in RCP and ICP was performed in each subject using the computer pantograph Arcus-Digma (KaVo EWL GmbH, Leutkirch, Germany). Results: The results of our study showed that the translation tracing of cinematic points from RCP to ICP was significantly different in TMD subjects and asymptomatic group (p>0.16). In addition, the study revealed that 53.4 % of subjects with sings and symptoms of temporomandibular disorders had marked translation in the lower temporomandibular joint (0.61-1.2 mm) what directed to intracapsular disorders. Conclusion: The results of our study suggested significant difference of RCP and ICP between subjects with sings and symptoms of the temporomandibular disorders and subjects without sings and symptoms.Uvod: Uloga okluzalnih disharmonija u etiologiji temporomandibularnih disfunkcija (TMD) još uvek je kontroverzno pitanje u stručnoj literaturi i kliničkoj praksi. Do osamdeseti h godina prošlog veka smatralo se da su etiološki faktori presudni za nastanak TMD: okluzalni faktori (poput određenih malokluzija), razlike između retrudovanog kontaktnog položaja (RKP) i interkuspalnog položaja (IKP) veće od 2 mm, postojanje okluzalnih smetnji (naročito mediotruzijskih i retruzijskih), kao i gubitak bočnih zuba. Cilj rada: Cilj rada bilo je utvrđivanje veze između okluzalnih disharmonija (razlika između RKP i IKP) i prisutnih znakova (simptoma) TMD. Metod rada: Istraživanjem je obuhvaćeno 60 ispitanika oba pola, starosti od 18 do 26 godina, podeljenih u dve grupe. Studijsku grupu činilo je 30 ispitanika očuvane prirodne okluzije, sa utvrđenim određenim znacima (simptomima) TMD (indeks disfunkcije po Helkimu bio je veći od 1). Kontrolnu grupu činilo je 30 ispitanika očuvane prirodne okluzije, bez registrovanih znakova (simptoma) TMD (indeks disfunkcije po Helkimu bio je jednak 0). Funkcionalna analiza pozicije kinematskih centara u RKP i IKP (EPA te st) vršena je pomoću kompjuterskog pantografa "arkus digma" (proizvođača KaVo EWL GmbH, Lojtkirh, Nemačka). Rezultati: Rezultati su pokazali da je translat orno pomeranje kinematskog cent ra rotacije na relaciji RKP-IKP (mereno na nivou zgloba) signifikantno veće kod ispitanika sa simptomima TMD (p>0,16). Izrazit translatorni pomak u donjem zglobnom prostoru (0,61−1,2 mm) imalo je 53,4% ispitanika iz ove grupe, što upućuje na prisustvo intrakapsularnih poremećaja. Zaključak: Ustanovljeno je postojanje signifikantnih razlika između RKP i IKP kod ispitanika sa znacima i simptomima temporomandibularnih disfunkcija i ispitanika bez ovih znakova

Stanje alveolarne kosti u predelu zadržanih zuba u pacijenta sa donjom totalnom

In everyday dental practice, prosthetic treatment of patients having a small number of remaining natural teeth is more or less common and the remaining teeth are kept for improvement of retentive abilities of removable prosthodontics. The essence of the concept discussed herein is that the remaining teeth are to be left in place for purpose of preservatingof the alveolar bone and providing permanent and stable support for complete dentures. Patient M.J.,female had an edentulous upper jaw and 3 remaining lower incisors. After adequate preparation-endodontic treatment, as well as parodontal treatment, clinical crowns were reduced, and then cast cap crowns positioned on parts of dental tissues. Finally, the upper complete denture and lower overdenture were positioned. After the positioning of dentures, a special retroalveolar film holder was placed, dental retroalveolar radiographs were positioned and radiographs were made. The holder was designed to provide intraoral radiograph in selected repeatable positions of radiographs and in the same conditions- standardized procedure, so that it was possible to compare radiograms. Measurements were made on each film for each tooth from its mesial, as well as distal sides, between apexes and coronal borders of alveolar bones. Patient M.J. received dentures and the first radiograph was made at the baseline when cast cap crowns and dentures were positioned in her mouth. Followe-ups were in an identical mode of radiograph and assessing radiographs after 1, 7 and 12 years. We concluded that we achieved a maximum therapeutic effect in such a long period of time. The influence of patients' motivation and better ability to persist in keeping and maintaing oral higiene were main factors for success.Danas se u svakodnevnoj stomatološkoj praksi u slučajevima maksimalne krezubosti veoma često koriste preostali zubi za poboljšanje retencije mobilnih nadoknada. Međutim, suština ovde primenjenog koncepta je da su preostali zubi zadržani sa ciljem da čuvaju alveolarnu kost, obezbeđujući time trajniju i stabilniju potporu totalnoj protezi. Pacijent M J, u gornjoj vilici je bila bezuba, a u donjoj je imala svega 3 preostala zuba (sekutića). Ovi zubi su nakon adekvatne pripreme (endodontski tretman redukcija kliničke krune, parodontalni tretman) zaštićeni livenim kapicama a nakon toga su izrađene mobilne nadoknade: u gornjoj vilici klasična totalna, a u donjoj totalna supradentalna proteza. Na predaji proteza je izrađen specijalni držač Rtg filma i načinjen retroalveolarni snimak ovih zuba. Kao držač poslužila je specijalna kašika izrađena od autoplimerizujućeg akrilata na radnom modelu. S obzirom na normiranu poziciju snimka postupak rtg snimanja bilo je moguće ponoviti na identičan način posle 1, 7 i 12 godina. Može se zaključiti da je postignut maksimalni terapijski efekat u ovom dugom vremenskom periodu. Motivacija i sposobnost pacijenta da održava oralnu higijenu i higijenu nadoknade su glavni faktori za uspeh

Cephalometric Indicators of the Vertical Dimension of Occlusion

The aim of this investigation was to establish precise indicators of the vertical dimension of occlusion (VDO) which could be used as objective parameters in prosthodontic treatment providing exact control of the reconstructed vertical dimension of occlusion, early detection of errors and correction of the vertical dimension of occlusion during complete denture manufacturing. A total of 60 lateral cephalometric radiographs of subjects with natural dentition and class I skeletal jaw relationship, of Serbian nationality from the region of Vojvodina, were included in the investigation. Thirty subjects were males, and thirty females, their age range was 20 to 29 years. Cephalometric analysis was performed by using »Dr. Ceph« computer software (FYI Technologies, GA, USA). By evaluation of the craniofacial complex in subjects with natural dentition, horizontal dentofacial developmental growth was established in the examined sample and it was based on the relationship between the posterior and anterior total facial height (S–Go:N–Me, b X=68.96%, aX=72.8%) and statistically significant differences were found between the sexes in almost all linear dimensions and in the relation between the posterior and the anterior total facial height. Highly significant differences (p<0.001) between the sexes were found in regard to anterior total facial height (N–Me, aX=120.75mm, b X=112.72mm) and the anterior lower facial height (ANS–Me, aX=67.87mm, b X=61.50mm) (p<0.05). The proportions of the upper and lower anterior facial heights (N–ANS:ANS–Me, aX=79.36%, b X=80.63%) were within normal values in both sexes. Facial harmony existed both in men and women. Cephalometric study of the subjects with complete natural dentition included in this study provided important and specific parameters for optimal reconstruction of vertical dimension of occlusion in the treatment of edentulous patients

Praćenje nivoa alveolarne kosti u predelu zadržanih zuba kod pacijenata sa donjom totalnom supradentalnom protezom desetogodišnja longitudinalna studija

Aim: The aim of this study was to evaluate the effects of overdentures on the condition of alveolar bone around the remaining teeth over 10 years. Materials and Methods: After preparation of all the remaining abutment teeth in the lower jaw, overdentures were fabricated for 22 patients. The radiographs were made at the delivery stage, then 6 and 10 years after delivery. The radiographs were evaluated using the grid scale and the film holder made it possible to repeate x-ray procedure in every patient in the same manner. Results: We concluded that we achieved the maximum therapeutic effect. Conclusion: Good oral hygiene is the key of success with overdentures.Cilj: Cilj ove studije bio je da se izmere efekti supradentalnih proteza na stanje alveolarne kosti u predelu zadržanih zuba za vreme od 10 godina. Materijal i metod: Nakon pripreme svih zadržanih "patrljaka zuba" u donjoj vilici, načinjene su donje totalne supradentalne proteze za 22 pacijenta. Dentalne radiografije tih zuba su urađene na početku, pri predaji proteza, a zatim 6 i 10 godina nakon predaje. Dentalni rentgenski snimci upoređivani su uz pomoć žičane mrežice i držača rentgen filma koji su pripremljeni za svakog pacijenta i svaki zub idividualno čime je bila obezbeđena izrada identično pozicioniranih dentalnih radiografija u različitim vremenskim periodima. Rezultati: Dobijeni rezultati ove studije ukazuju da je postignut maksimalan terapeutski efekat u pacijenata sa malim brojem preostalih, parodontloški loših zuba. Zaključak: Dobra oralna higijena je ključ uspeha tretmana supradentalnim protezama

Meki materijali za trajno podlaganje mobilnih proteza

Materials that have been used for permanent lining of removable dentures have long elastic phase and, therefore, their usage is indicated in patients -where the age, general health status and the condition of oral tissues require the permanent coushioning effect upon oral mucosa. This article describes their chemical composition and physical properties, as -well as the factors determining their stability in the oral environment. The numerous advantages and disadvantages of these materials in the clinical practice have been emphasized and the procedure of their clinical usage has been clearly outlined.Materijali za trajno podlaganje mobilnih proteza imaju dugu elastičnu fazu, pa je njihova primena indikovana kod pacijenata kod kojih starost, opšte zdravstveno stanje ili stanje oralnih tkiva zahtevaju trajno amortizovanje mastikatornih sila. U radu su opisani kemijski sastav, fizičke osobine ovih materijala kao i faktori koji determinišu njihovu postojanost u oralnoj sredim. Istaknute su brojne prednosti, kao i nedostaci mekih materijala i opisan je postupak njihove kliničke primene

Učestalost kraniomandibularnih disfunkcija u populaciji vojnika Republike Srbije

Introduction. The aim of this study was to determine the prevalence of cra- niomandibular dysfunction (CMD) in the military personel of the Republic of Serbia, as well as the distribution of sings and symptoms of CMD in this population group. Material and methods. The epidemiological investigation included 284 male persons between 18-25 years of age. The sample consisted of Military Academy students, and soldiers from different regions of the Republic of Serbia. A questionnaire was designed using Helkimo's clinical dysfunction index and sings and symptoms of CMD were evaluated, namely the anamnestic index (Ai) and the dysfunction index (Di). Results. According to the anamnestic dysfunction index (Ai), 85% of persons among the examined group presented without any symptoms of CMD (Ai=0), 14% had mild symptoms (Ai =1) and 1% had severe symptoms of CMD (Ai=5). Functional analysis of the orofacial system in the examined group (evaluation of dysfunction index - Di) revealed, however, that 70% of solders had at least one sign of CMD, precisely a dysfunction index Di>0. The analysis of signs and symptoms of CMD revealed that disturbances in mandibular kinematics were the most prevalent sign of CMD in this population group, which was confirmed in 56% of examined persons. Disturbed functions of temporomandibular (TM) joints (click, and reciprocal click, deviation and deflection during mandibular opening) were established in 31% of examined persons, and sensitivity of TM joints and masticatory muscles during palpation in 4% of examined persons. Pain during mandibular movements was established only in 1% of examined persons. Conclusion. The results of this investigation point to significant prevalence of Craniomandibular disorders in the examined population group. The incidence of TMJ and masticaory muscle pain in 4% of examined persons and of pain during mandibular movements only in 1% of examined persons, points to presence of mild or initial types of CMD in this population group.Cilj istraživanja bio je da se utvrdi učestalost kraniomandibularnih disfunkcija kod vojnih obveznika na teritoriji R. Srbije kao i zastupljenost pojedinih znakova i simptoma kraniomandibularne disfunkcije u ovoj popularnoj grupi. Epidemiološka istraživanja su obuhvatila grupu od 284 osobe muškog pola (pitomci vojne akademije i vojni obveznici iz različitih regiona Republike Srbije uzrasta 18-25 godina). Za potrebe ovih istraživanja korišćen je upitnik odnosno anamnestički indeks i indeks disfunkcije prema Helkimu istraživanja su pokazala da 85% ispitanika u anamnezi ne navodi bilo kakve simptome kraniomandibularnih disfunkcija (anamnesticilni indeks=0) 14% navodi postojale blagih simptoma (anamnesticilm indeks=1) dok 1% navodi izrazite simptome ovih poremećaja (anamnestički indeks=5). Funkcijska analiza orofacijalnog sistema (vrednovanje indesa disfunkcije indeks disfunkcije)ukazuje, međutim, da 70% vojnih obveznika ima bar neki znak kraniomandibularne disfunkcije odnosno indeks disfunkcije (indeks disfunkcije veći od nule). Analizom pojedinih znakova i simptoma kraniomandibularne disfunkcije utvrđeno je da je poremećena pokretljivost donje vilice najzastupljeniji znak kraniomandibularne disfunkcije u ovoj populacionoj grupi utvrđen kod 56% ispitanika. Poremećaji u funkcionisanju temporomandibularnih zglobova (zvučni signali, devijacije, defleksije mandibule pri otvaranju usta utvrđeni su kod 31% ispitanika, a palpatorna osetljivost temporomandibularnog zgloba, mastikatornih mišića kod 4% ispitanika. Bolne senzacije pri kretnjama donje vilice utvrđene su kod 1% ispitanika. Istraživanja ukazuju na značajnu učestalost kraniomandibularne disfunkcije u ispitivanoj populacionoj grupi. Činjenice da se palpatorna osetljivost temporomandibularnog zgloba mastikatornih mišića sreće samo kod 4% ispitanika a bolna osetljivost samo kod 1% ispitanika ukazuju da se radi o blagim odnosno početnim oblicima kraniomandibularnih disfunkcija

The relationship of occlusal disharmonies and symptoms of temporomandibular disorders

Introduction: The influence of occlusal condition on the onset of temporomandibular disorder (TMD) has been strongly debated for many years and is still the source of controversy. Until 1980s, the occlusal factors such as the presence of uncured malocclusions, discrepancies between intercuspal position (ICP) and retruded contact position (RCP) greater than two millimeters, occlusal abnormality, particularly mediotrusion and retrusion, and loss of posterior teeth were considered the primary causes of TMD. Objective: The objective of our study was to find correlation of occlusion disharmonies (difference between ICP and RCP) and present sings and symptoms of TMD. Method: The study involved 60 subjects between 18 and 26 years of age who were divided in two groups. The study group consisted of 30 subjects between 18 and 26 years of age with sings and symptoms of temporomandibular disorders (TMD). TMD was confirmed according to Helkimo index. An average value of Helkimo index in this group was 1. The control group included 30 subjects between 20 and 25 years of age without TMD sings and symptoms. An average value of Helkimo index in this group was 0. The function analysis of cinematic centers position in RCP and ICP was performed in each subject using the computer pantograph Arcus-Digma (KaVo EWL GmbH, Leutkirch, Germany). Results: The results of our study showed that the translation tracing of cinematic points from RCP to ICP was significantly different in TMD subjects and asymptomatic group (p&gt;0.16). In addition, the study revealed that 53.4 % of subjects with sings and symptoms of temporomandibular disorders had marked translation in the lower temporomandibular joint (0.61-1.2 mm) what directed to intracapsular disorders. Conclusion: The results of our study suggested significant difference of RCP and ICP between subjects with sings and symptoms of the temporomandibular disorders and subjects without sings and symptoms

Promene mineralnih sastava mandibulnog tela u osteoporozi

The aim of investigation was to determine physical-chemic characteristics of selected segments of mandibular corpuses from 2 cadavers which would be indicators to determine changes of bone compositions due to osteoporosis. 3 samples from massive mandibular body from cadaver where teeth of lower arch persisted and 3 samples from mandibular edentulous corpus from another cadaver were investigated. External borders of samples were assigned. In the same x-ray exposing and in identical processing 2 orthopantomographs were made and optical densities(OPDs) of regions of interest were analyzed using DT II 05 (EU(England,UK)). Samples of similar dimensions were cut and then analyzed by scanning-electronic microscopy (Philips,EU). Using bensol as liquid phase on 200C in pycnometer, densities of samples of bones were analyzed. Values of OPDs, in U/mm2, amount: -2.48-sample(S)l, -2.86 S2, -2.51 S3, -0.90 S4, -1.40 S5, -0.62 S6. Statistically significant, to p lt 0.01 totals of cancellous sites were established in comparisons: of S6 and of S4, of SI and of S5 as well as of S2 and of S4, and to p lt 0.1 were established in comparisons: of Sl and of S3, of SI and of S6, of S2 and of S5, of S2 and of S6, of S3 and of S4, as well as of S6 and of S4. Mean thickness of cortical lamellae, in mm, amount: 17.9 ± 7.51 in S1, 12.22 + 1.17 in S2, 31.03 ± 8.91 in S3, 9.31 ± 3.89 in S4, 23.9 ± 11.7 in S5 and 4.06 ± 1,02 in S6. Densities in g/cm3, amount: 1.9658 for S1, 2.1141 for S2, 2.0748 for S3, 2.1296 for S4 2.2231 for S5 and 2.1357 for S6. Differences of densities and of compositions of non-osteoporotic mandibular-body samples, and of mandibular osteoporotic samples were determined.Osteoporoza jeste značajno i zastupljeno oboljenje kada dominiraju procesi razgrađivanja kostnih supstanci u humanim organizmima. Za razliku od činjenica da u literaturi postoje brojni prikazi – makroskopski patološki preparati, mikroskopski patološki preparati, šematizovane ilustracije itd. skoro da nema podataka ni o promenama fizičkih parametara, niti o uticajima kompleksnih hemijskih jedinjenja u kostnim supstancama izmenjenim usled osteoporoza na fizičko-hemijske osobenosti izmenjene kosti, tako da dosta toga još uvek nije ispitano u vezi karakteristika, izmena sastava i fizičko-hemijske osobenosti osteoporoznih kosti. (Kanis 1994; 1996, WHO 1994 Kršljak 1995, Novaković i Giordani 1996, Poštić, Marković, Veselinović Tijanić i Zec 2001). Svakako bi trebalo da bude interesantno i značajno proceniti šta je izmenjeno u makrostrukturama i šta je sve izmenjeno u mikrostrukturama kosti oštećenih usled osteoporoza. Čini se da je važno utvrditi kako bi trebalo delovati na nivou jedinjenja i potencijalno na nivou molekula. Stoga je potrebno ispitati kako bi, na osnovu izmena u mikrostrukturama kosti, trebalo inicirati pozitivno remodelovanje kostne supstance, da li su formirana jedinjenja kakva je potrebno razgraditi zato što su apsolutno nepovoljna ili je moguće delovati, bez obzira na formirana odnosno preformirana jedinjenja, apozicijama potrebnih i u smislu osteogenih potencijala kvalitetnih jedinjenja na nivoima mikrostruktura. Ispitivanjima fizičko-hemijskih promena mikrostruktura kosti trebalo bi da budu utvrđeni karakteristični podaci, tako da bi na osnovu karakterističnih podataka trebalo proceniti da li bi aplikovanjima posebno sintetisanih jedinjenja odnosno specifičnih supstanci i aplikovanjima posebno kombinovanih supstanci bilo moguće poboljšati strukture kosti, ojačati segmente kosti - poboljšati fizičko-hemijska svojstva i sprečiti frakture segmenata kosti

Promene mineralnih sastava mandibulnog tela u osteoporozi

The aim of investigation was to determine physical-chemic characteristics of selected segments of mandibular corpuses from 2 cadavers which would be indicators to determine changes of bone compositions due to osteoporosis. 3 samples from massive mandibular body from cadaver where teeth of lower arch persisted and 3 samples from mandibular edentulous corpus from another cadaver were investigated. External borders of samples were assigned. In the same x-ray exposing and in identical processing 2 orthopantomographs were made and optical densities(OPDs) of regions of interest were analyzed using DT II 05 (EU(England,UK)). Samples of similar dimensions were cut and then analyzed by scanning-electronic microscopy (Philips,EU). Using bensol as liquid phase on 200C in pycnometer, densities of samples of bones were analyzed. Values of OPDs, in U/mm2, amount: -2.48-sample(S)l, -2.86 S2, -2.51 S3, -0.90 S4, -1.40 S5, -0.62 S6. Statistically significant, to p lt 0.01 totals of cancellous sites were established in comparisons: of S6 and of S4, of SI and of S5 as well as of S2 and of S4, and to p lt 0.1 were established in comparisons: of Sl and of S3, of SI and of S6, of S2 and of S5, of S2 and of S6, of S3 and of S4, as well as of S6 and of S4. Mean thickness of cortical lamellae, in mm, amount: 17.9 ± 7.51 in S1, 12.22 + 1.17 in S2, 31.03 ± 8.91 in S3, 9.31 ± 3.89 in S4, 23.9 ± 11.7 in S5 and 4.06 ± 1,02 in S6. Densities in g/cm3, amount: 1.9658 for S1, 2.1141 for S2, 2.0748 for S3, 2.1296 for S4 2.2231 for S5 and 2.1357 for S6. Differences of densities and of compositions of non-osteoporotic mandibular-body samples, and of mandibular osteoporotic samples were determined.Osteoporoza jeste značajno i zastupljeno oboljenje kada dominiraju procesi razgrađivanja kostnih supstanci u humanim organizmima. Za razliku od činjenica da u literaturi postoje brojni prikazi – makroskopski patološki preparati, mikroskopski patološki preparati, šematizovane ilustracije itd. skoro da nema podataka ni o promenama fizičkih parametara, niti o uticajima kompleksnih hemijskih jedinjenja u kostnim supstancama izmenjenim usled osteoporoza na fizičko-hemijske osobenosti izmenjene kosti, tako da dosta toga još uvek nije ispitano u vezi karakteristika, izmena sastava i fizičko-hemijske osobenosti osteoporoznih kosti. (Kanis 1994; 1996, WHO 1994 Kršljak 1995, Novaković i Giordani 1996, Poštić, Marković, Veselinović Tijanić i Zec 2001). Svakako bi trebalo da bude interesantno i značajno proceniti šta je izmenjeno u makrostrukturama i šta je sve izmenjeno u mikrostrukturama kosti oštećenih usled osteoporoza. Čini se da je važno utvrditi kako bi trebalo delovati na nivou jedinjenja i potencijalno na nivou molekula. Stoga je potrebno ispitati kako bi, na osnovu izmena u mikrostrukturama kosti, trebalo inicirati pozitivno remodelovanje kostne supstance, da li su formirana jedinjenja kakva je potrebno razgraditi zato što su apsolutno nepovoljna ili je moguće delovati, bez obzira na formirana odnosno preformirana jedinjenja, apozicijama potrebnih i u smislu osteogenih potencijala kvalitetnih jedinjenja na nivoima mikrostruktura. Ispitivanjima fizičko-hemijskih promena mikrostruktura kosti trebalo bi da budu utvrđeni karakteristični podaci, tako da bi na osnovu karakterističnih podataka trebalo proceniti da li bi aplikovanjima posebno sintetisanih jedinjenja odnosno specifičnih supstanci i aplikovanjima posebno kombinovanih supstanci bilo moguće poboljšati strukture kosti, ojačati segmente kosti - poboljšati fizičko-hemijska svojstva i sprečiti frakture segmenata kosti