Combined Orthodontic-Prosthetic Therapy of TMD Patients (Case Report)

Prikazan je slučaj pacijentice u dobi od 25 godina s izraženim simptomima i znakovima TMD-a. Kliničkim pregledom utvrđeno je da su zubi 25, 26, 46 izvađeni i nenadomješteni. Zabilježena je i distopija gornjega desnog očnjaka te veći broj rotiranih i nagnutih zuba te dijastema uzrokovanih gubitkom zuba. U početnom djelu terapije izrađena je nagrizna udlaga koja je ublažila postojeće simptome. Za potpuno riješenje problema izabrana je kombinacija ortodontsko pretprotetske terapije i sanacija gubitka zuba prikladnim fiksnim protetskim nadomjeskom. Terapija je počela ortodontskim pomicanjem tehnikom “straight wire” i 0,22” Roth bravicama. Nivelacija je započeta okruglom žicom promjera 0,14” i završena žicom kvadratnoga presjeka dimenzija 0,16” x 0,16”. Cijelokupan ortodontski tretman trajao je 11 mjeseci. Protetska terapija uključila je izradbu dvaju fiksnih keramičkih mostova. Prvi je uključivao zube 24 i 27, a drugi zube 45 i 47. Mostovi su izrađeni uz uporabu artikulatora (Artex NK) i nakon toga dodatno usklađeni u ustima. Osim estetske sanacije navedeni su radovi eliminirali i simptome i znakove TMD-a.A 25 year-old female came to the practice with symptoms typical of temporomandibular dysfunction. Clinical examination revealed that there were several teeth missing: 25, 26, 46. Dystopia of the right upper canine and several teeth rotations, titling and spaces caused by tooth loos were noticed. After utilizing a stabilization splint which relieved the original symptoms, orthodontic therapy, followed by prosthodontic work, was chosen as definitive therapy. Straight wire technique was applied using 0.22” Roth fixed braces. Nivelation was started with 0.14” wire and finished with 0.16” x 0.16” square wire. Procedure was conducted during a 3 month period. Then the canine was derotated and returned to its correct positon, using 0.16” round wire and finishing with 0.16” x 0.16” square wire. Whole the orthodontic treatment lasted for 11 months and provided solid ground for prosthodontic treatment. Prosthodontic treatment included two fixed prosthodontic restorations. One including abutments on teeth 24 and 27, and the other on teeth 45 and 47. Abrasive metal ceramic was choosen for those restorations. Restorations were made using articulator Artex NK and finally fitted in the mouth. The final result eliminated all symptoms of TMD and was aesthetically pleasing for tha patient

Temporomandibular Dysfunctions (TMD) in Contemporary Practice

Temporomandibularne disfunkcije u svim svojim patološkim oblicima čine sve češći problem u suvremenoj stomatološkoj praksi. Sustavan pristup dijagnostici s obzirom na prikupljanje i interpretaciju podataka o pacijentu jedan je od primarnih ciljeva u tretmanu znakova i simptoma TMD-a. Prema W. Bellu dijagnoza TMD-a mora obuhvatiti: • pravilnu identifikaciju i klasifikaciju poremećaja • razumijevanje mehanizma nastanka i mjesta boli • utvrđivanje etioloških čimbenika, ako je moguće • bazirati prognozu s obzirom na djelotvornost terapije. Temeljem navedenih načela temporomandibularna disfunkcija ne može se smatrati jedinstvenim patološkim entitetom već skupinom bolesti koja se javlja sličnim preklapajućim simptomima. Posljedično, terapija svih oblika TMD-a nikako ne može biti ista. Osim uobičajenih kliničkih postupaka u dijagnostici TMD-a upotrebljavaju se i računalni postupci poput elektromiografije, elektrosonografije elektrokinetička i aksiografska mjerenja koja omogućuju da se lakše postavi pravilna dijagnoza i izabere prikladna terapija.Temporomandibular dysfunction in al its variety tends to present a problem with high morbidity and increasing prevalence in the dental office. A systematic approach to gathering and interpreting clinical evidence must be the primary goal when dealing with patients who suffer from TMD signs and symptoms. According to W. Bell diagnosis of TMD must: • Properly identify and classify the disorder. • Establish the mechanism of dysfunction and the source of pain. • Determine the etiology, if possible. • Provide a basis prognosis in the light of effective therapy. As a result of these principles we can canclude that TMD is not an acceptable diagnosis. It refers to a group of diseases with overlapping and similar signs and symptomatologies and cannot be solely used to determine appropriate therapy. Apart from good clinical judgement the patient can benefit from any inanimate objective measuring device which improves the clinician’s sensory acuity. Information obtained from electomyography, electrosonography, electrokinetic and axiographic tracings analyzed properly can aid in assessing what a specific TM disorder does to a patient and the effect treatment has on that disorder

TMD Therapy With Chair-Side Composite Inlays

U pojedinim slučajevima kod posteriornih zuba teško destruiranih karijesnim lezijama nije moguć adekvatan i potpuno estetski tretman. Kao alternativa nameću se kompozitni inlay, onlay i overlay, izrađeni neposredno u ordinaciji. Takvi radovi mogu biti izrađeni u specijalnim parcijalnim artikulatorima (npr. Easy Croc, Girrbach Dental Gmbh, Njemačka) što ih čini visokovrsnim funkcijskim nadomjeskom koji je moguće upotrijebiti i u tretmanu TMD-a. Otiske uzimamo posebnom bimaksilarnom žlicom i izravno izlijevamo u supertvrdoj sadri u artikulatoru. Uobičajeni kompozitni materijal modelira se u artikulatoru uzimajući u obzir okluzalnu morfologiju susjednih zuba i gnatološka načela izradbe okluzalne plohe. Modeliran nadomjestak moguće je polimerizirati izvan usta jednokratnim osvjetljavanjem, što eliminira nastanak učinka kontrakcijskoga stresa zbog polimerizacije u ustima i povećava stupanj polimerizacije samoga materijala. Gotov rad isprobamo i uskladimo u ustima te cementiramo kemijski i svjetlosno polimerizirajućim kompozitnim cementom. Takvi nadomjesci koje je moguće izraditi i u ordinaciji povećavaju strukturni integritet ekstenzivno oštećenih posteriornih zuba i predstavljaju adekvatan konačan tretman nekih oblika TMD-a.In some cases of heavily damaged posterior teeth, especially those on which endodontic treatment was performed, there is no possibility for full prosthodontic treatment. An alternative is chair side made composite inlay, onlay and overlay. These fillings can be made in the special partial articulator (Easy Croc, Girrbach Dental Gmbh, Germany) which makes them sutiable for final treatment of temporomandibular dysfunctions. Impressions are taken by a special a bimaxillary tray which is then poured into stone type IV gypsum and at the same time mounted in an articulator. Standard composite resin is modelled according to similar occlusal morphology of neighbouring teeth and gnathological rules. Occlusion is then adjusted in the articulator and programmed to a chosen occlusal scheme. Complete work is finally polymerized outside the mouth which eliminates shrinking stress and increases polymerization ratio. After try in, such work finally cemented using composite dual luting cements and then polished. Such chair side made prosthodontic devices increases the structural integrity of heavily damaged posterior teeth and can provide adequate treatment for the TMD patient

Electromyographic Evaluation of Masticatory Muscle Activity in Patients with Temporomandibular Dysfunction

Pojam temporomandibularna disfunkcija (TMD) obuhvaća mnoge poremećaje u vezi sa žvačnim mišićima i temporomandibularnim zglobovima. U vezu s nastankom TMD-a najčešće se dovode okluzalni, traumatski, psihosocijalni i sustavski čimbenici. Svrha ovoga istraživanja bila je ustanoviti postoji li promijenjena aktivnost žvačnih mišića u ispitanika s poremećajem te utvrditi mogućnosti dijagnostike temporomandibularnih poremećaja metodom elektromiografije. U ispitivanju je sudjelovalo 40 ispitanika: 13 ispitanika sa simptomima temporomandibularne disfunkcije i 27 asimptomatskih ispitanika, usporedivih po spolu i dobi. Elektromiografska mjerenja provedena su na šest mišića (desni i lijevi prednji temporalis, maseter i digastrikus) u osam referentnih položaja. Ispitivanje odnosa vrijednosti mioelektričkih signala pojedinog mišića desne i lijeve strane u skupini zdravih ispitanika u lateralnim okluzijskim položajima i u maksimalnim lateralnim položajima pokazalo je znatno veću aktivnost temporalnoga mišića radne strane (p0,05). Razlika u vrijednosti mioelektričkih signala između asimptomatske i simptomatske skupine pronađena je za desni i lijevi maseter u maksimalnoj interkuspidaciji s 50% MVC (p<0,05), kod kojih su veće vrijednosti nađene u simptomatskoj skupini. Rezultati ovoga istraživanja pokazali su postojanje promjena aktivnosti žvačnih mišića u ispitanika s TMD-om te potvrdili mogućnost uporabe elektromiografije u dijagnostici temporomandibularnih poremećaja.The term temporomandibular dysfunction (TMD) encompasses a group of disorders of the masticatory muscles and temporomandibular joints. Major precipitating factors are occlusal, traumatic, psychosocial and systemic factors. The aim of this investigation was to determine possible altered muscular function in patients with TMD, as well as to determine the need for EMG application in TMD diagnosis. Forty young adults participated in this study: 13 subjects with signs and symptoms of TMD and 27 asymptomatic subjects, sex and age matched. Surface EMG recordings were obtained from left and right anterior temporal muscle, left and right masseter muscle and from left and right digastric muscle in eight mandibular positions. Right side to left side ratio of examined muscles myoelectrical signals in lateral occlusal and maximal lateral positions for the asymptomatic group showed significantly higher activity of the working side anterior temporal muscle (p0.05). Comparison of myoelectrical signals in the position of maximal intercuspation of teeth between the patients and the controls, showed significantly higher activity in right and left masseter muscle at 50% MVC (p<0.05) in the symptomatic group. Results of this investigation showed the presence of altered masticatory muscle activity in TMD patients and confirmed the use of electromyography in TMD diagnosis

Pregled potencijalnih primjena, koristi i rizika od nanosenzora i nanotehnologija u hrani

Usage of nanotechnology in food with all of its possible different applications has potential to significantly change today’s ways of food manufacturing and packaging as well as to alter fundamental functionality of food. Application of nanotechnology in food increases food safety, allows better delivery of new functional ingredients and extends product life. Food nanotechnology implies nanotechnology application in food package manufacturing and nanotechnology application directly to food products. Production of nanopackages implies usage of nanosensors for detection of contaminants and pathogens, nanosensors for product tracking and control, nanoparticles for improvement of mechanical properties and biodisintegration of a package. New food ingredients in food can be delivered by means of colloids, liposomes, nanoemulsions or nanolaminats, thus transforming food products into health preparation or a medicine. Increased research in the field of nanofood application and a possible nanofood mass production can perhaps lead to health risk for consumers; hence it is important to pass new scientifically based regulations which will define usage of food nanotechnology.Upotreba nanotehnologije u području hrane sa svojim mogućim raznovrsnim primjenama ima mogućnost da uvelike promijeni ne samo dosadašnji način proizvodnje i pakiranja već transporiranja i čuvanja hrane. Upotrebom nanotehnologija u hrani povećava se sigurnost hrane, omogućuje kvalitetnija dostava novih funkcionalnih sastojaka pomoću hrane, te produljuje vijek trajanja proizvoda. Pod pojmom nanotehnologije u hrani podrazumijeva se primjena nanotehnologija u proizvodnji pakovina za hranu i primjena nanotehnologija izravno na prehrambene proizvode. U proizvodnji nanopakovina upotrebljavaju se nanosenzori za detekciju patogena i kontaminanata, nanosenzori za sljedivost i kontrolu proizvoda, nanočestice za poboljšavanje mehaničkih svojstava i biorazgradivosti pakovine, te nanočestice antibakterijskih svojstava. Dostava novih sastojaka u hranu obavlja se pomoću koloida, liposoma, nanoemulzija ili nanolaminata čime prehrambeni proizvod postaje zdravstveni preparat ili lijek. Povećanje istraživanja primjene nanohrane nose sa sobom i moguće opasnosti od uzimanja nanohrane po zdravlje potrošača, te će se morati donijeti znanstveno utemeljeni propisi koji će definirati upotrebu nanotehnologija u hrani