Digital evaluation of occlusal forces: comparison between healthy subjects and TMD patients

ABSTRACT Aim: Continuous technological innovation has provided the clinicians to access to a computerized device that can analyse the different characteristics of occlusal contacts. The purpose of this research was to use this device to study the occlusal forces comparing healthy subjects and TMD patients. Materials and Methods: The study was conducted by following specific criteria to select participants, the sample was divided into two homogeneous groups: control group (CG) comprising healthy subjects, and dysfunctional group (DG) comprising TMD patients. The occlusal force analysis was performed using the computerized system T-Scan III V 5.20 T. The data were analysed with statistical methods. Results: The most significant differences emerged between the groups in the average occlusal load distribution and in the location of the centre of occlusal forces (COF). In particular, compared with the CG and the functional standard, reductions in the molar field forces on the second and first molars of 27% and 6.9%, respectively, were observed in the DG. The COF was located in the most forward position in TMD patients compared with healthy subjects. Conclusions: Although the differences in the distribution of the occlusal forces and the location of the occlusal centre of gravity were significant, the relationship between occlusal contacts and TMD remains to be fully clarified. Further research is needed to investigate whether studying occlusal force distributions in both healthy subjects and TMD patients

Ricerca traslazionale dell'analisi digitalizzata delle forze occlusali applicata al paziente con disfunzione temporomandibolare

TRANSLATIONAL RESEARCH OF DIGITAL ANALYSIS OF OCCLUSAL FORCES APPLIED TO THE PATIENT WITH TEMPOROMANDIBULAR DYSFUNCTION ABSTRACT AIM: To date, with the term "Temporomandibular Dysfunction" we indicate a set of pathological pictures involving ATM, masticatory muscles and related structures. In the current state of knowledge, the etiopathogenesis of these dysfunctions is not yet fully clarified. The researchers agree that a series of factors influence the course and constitute the "pattern". Between them, the scientific research has focused its attention on the "occlusal factor", which is still the most controversial and debated today. For his study he focused in particular on the analysis of the occlusal contacts analyzed by number and distribution by using conventional non-digital methods. No study has ever been able to clarify whether certain alterations in the distribution of occlusal contacts detectable on dysfunctional patients were prior or subsequent to the onset of dysfunction and what its role was. The continuous development of technologies in the biomedical field, has made available to researchers a digitized tool, the T-Scan III, able to analyze the occlusal contacts from the point of view of the force that is expressed on them and of their behavior over time. The purpose of this work is to perform a translational research on the digitized analysis of the occlusal forces applied to the patient with temporomandibular dysfunction to evaluate the possibility of its use to support the clinician both during the diagnostic evaluation and in the control phase. MATERIALS AND METHODS: The research is divided into four different phases with a progressive deepening in the evaluation of the data detected by means of the tool. In a first phase, data were compared to 28 healthy subjects with those coming from tests carried out on 35 patients with a diagnosis of temporomandibular dysfunction formulated according to the diagnostic criteria DC / TMD. After this phase, the number of patients under examination was expanded to 160. In the second phase the research was carried out to bring out possible relationships between a given pattern of occlusal forces and a given clinical picture. In the third phase, the occlusal force patterns detected before and after treatment with occlusal splints were compared. Finally, the possible correlation between the distribution of occlusal forces and the three main symptoms associated with dysfunction was studied: cervicalgia, headache, joint pain. The analysis of the occlusal forces was carried out by evaluating the following parameters: percentage of the force referred to the single dental element, to the side (right and left), to the sector (posterior and anterior); behavior of the COF (Center of Occlusal Forces); trend of the black line; occlusiontime (OT); the disclusiontime (DT). RESULTS: The analysis of results highlighted the differences between healthy subjects and dysfunctional patients both from the point of view of the model of distribution of occlusal forces and from the point of view of the behavior of the COF. In the subsequent study phases it was found that there are differences in tendencies that can correlate a given model of force distribution and a given clinical picture. In the research phase on the relationship between occlusal forces and symptoms, it was possible to observe a predictable behavior between occlusal force and symptom intensity evaluated according to the VAS scale. The phase of the research carried out on patients treated with splint, has shown that the evaluation of the forces allows detecting changes in the course of treatment

Relationship between cervical spine and skeletal class II in subjects with and without temporomandibular disorders

AIM. To assess changes of cranio-cervical structure and of hyoid bone position in skeletal Class II subjects with and without Temporomandibular disorders (TMD). MATERIAL AND METHODS. The cephalometric analysis of 59 subjects with skeletal Class II were evaluated and compared. The measurements considerated were: ANB as parameter of Class II and C0-C1 distance, C1-C2 distance, cranio-cervical angle and hyoid bone position for the cervical spine analysis. Patients were divided into two subgroups: patients with TMD (group A) and patients without TMD (group B). TMD were evaluated with the Diagnostic Criteria for TMD (DC/TMD). Descriptive statistics and Pearson and Spearman correlation analysis, with p-value <0,005, were performed. RESULTS. C0-C1 and C1-C2 distance values and hyoid bone position resulted within normal range in the majority of patients examined. Cranio-cervical angle was alterated in 33 patients. The reduction of this angle with the increase of the ANB value resulted statistically significant in the group A, according to Pearson correlation index. No other data was statistically significant. CONCLUSIONS. Significant relationship between skeletal Class II and cervical spine cannot be highlighted. The alteration of cranio-cervical angle seems to be mildly present, with backward counterclockwise rotation of the head upon the neck in the sample (group A and B). The presence of TMDs as key factor in changes of neck posture could explain the different result between the two groups about relationship between ANB and cranio-cervical angle. This result should be further analyzed in order to better understand if cervical spine changes could be related to mandibular postural ones in the cranio-cervical space or to temporomandibular joints retropositioning, more recognizable in Class II with TMD, which could determine functional changes in other structures of this unit; neck posture also could be the result of a compensatory/ antalgic mechanism in response to TM

Functional implications of minor mandibular asymmetry: clinical and digital research on a sample of healthy patients

OBJECTIVE.The aim of the study is to evaluate the influence that the mandibular asymmetry could have towards the other components of the Stomathognatic system and to further related structures from a functional point of view. MATERIALS and METHODS. A sample of 18 young asymmetric patients, in healthy status, was investigated with clinical evaluation and questionnaires and digital devices such as Electromiography, Stabilometry, T-scan and Formetric. Descriptive and quantitative statistical analysis were performed. RESULTS. ASIM electromyography index was significant only in a short percentage of the sample. Hypertonia of temporalis muscle in the same side of mandibular deviation and the cross-activation of the contralateral masseter were present. The data of the stabilometric platform showed that only 33% of patients had a load discrepancy between right and left side. All patients presented similar and limited postural anomalies during the Formetric examination. No significant results emerged from statistics . CONCLUSIONS. From the emerging data, mandibular asymmetry does not seem to be considered a potential risk factor for the development of functional anomalies both in the stomatognatic system and in the postural one. The only issue that should be considered is the condylar retrusion of the mandibular shortest side that is a possible destabilizing factor of the TMJ condyle-disc coordination

Functional implications of minor mandibular asymmetry: clinical and digital research on a sample of healthy patients

OBJECTIVE.The aim of the study is to evaluate the influence that the mandibular asymmetry could have towards the other components of the Stomathognatic system and to further related structures from a functional point of view. MATERIALS and METHODS. A sample of 18 young asymmetric patients, in healthy status, was investigated with clinical evaluation and questionnaires and digital devices such as Electromiography, Stabilometry, T-scan and Formetric. Descriptive and quantitative statistical analysis were performed. RESULTS. ASIM electromyography index was significant only in a short percentage of the sample. Hypertonia of temporalis muscle in the same side of mandibular deviation and the cross-activation of the contralateral masseter were present. The data of the stabilometric platform showed that only 33% of patients had a load discrepancy between right and left side. All patients presented similar and limited postural anomalies during the Formetric examination. No significant results emerged from statistics . CONCLUSIONS. From the emerging data, mandibular asymmetry does not seem to be considered a potential risk factor for the development of functional anomalies both in the stomatognatic system and in the postural one. The only issue that should be considered is the condylar retrusion of the mandibular shortest side that is a possible destabilizing factor of the TMJ condyle-disc coordination

STUDIES ON SWITCH-BASED EVENT BUILDING SYSTEMS IN RD13

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Muscular pattern in patients with temporomandibular joint disc displacement with reduction: an electromyographical assessment

Objective: Surface Electromyography of masticatory muscles (sEMG) is used as a tool to support diagnosis and treatment of Temporomandibular disorders (TMDs). The study aimed at examining jaw muscles pattern in individuals with temporomandibular joint disc displacement with reduction (TMJ/DDR). This sort of subjects was supposed to have a different muscular pattern compared to the control group. Materials and methods: Sixty-four women with unilateral TMJ/DDR and forty TMD-free women underwent a sEMG assessment of masticatory muscles. Descriptive statistics were performed. Student T-Test assessed differences between the two groups. Statistical significance was set at ρ &lt; 0.05. Result: The t-test showed statistically significant results only in BAR and SMI scores (ρ value &lt; 0,0001). The other measurements did not differ between the two groups. BAR index values of all healthy subjects were within the reference range. Almost the entire TMJ/DDR group had BAR index out of reference range and anteriorly placed. Conclusion: Women with TMJ/DDR showed an altered recruitment of the jaw muscles, with significant difference between the activity of the couple of temporalis and the one of masseters, compared to the control group. A lower chewing efficiency was found in the DDR group compared to the control one

Multidisciplinary approach with traditional and complementary therapies in patients with temporomandibular disorders and fibromyalgia: a randomized study

Aim: Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome characterized by widespread musculoskeletal pain and tenderness at specific anatomic sites (tender points. The association of FM with other musculoskeletal comorbidities, such as Temporo-Mandibular Dysfunction (TMD) is common. The randomized study was aimed at evaluate the analgesic effect of Okada Purifying Therapy (OPT) when administered in combination with duloxetine in patients with Temporo-Mandibular Disorders (TMDs) and Fibromyalgia (FM). Okada PurifyingTherapy (OPT) is a practice of alternative medicine in which patients are treated with a technique that uses bioenergy, or qi produced by practitioner’s palm, without physically touching. Methods: Patients with TMDs visited at Policlinico Umberto I, Head-neck Department, Rome who were diagnosed with FM were selected for the study between 2010 and 2015. The final sample was composed of 31 patients: 15 patientswere treated only with duloxetine for 8 weeks (Group I or Control Group) and 16 patients received also OPT treatment (Group II). All OPT session was performed by a single well-trained certified practitioner for a period of 50 minutes. Cranio-mandibular index, total tenderness score, Brief Pain Inventory Modified Short Form, Fibromyalgia Impact Questionnaire, Beck Depression Inventory and State and Trait Anxiety Inventory-1 were assessed at the beginning (T0), during the course (T1) and after therapy (T2). Descriptive and inferential statistics were performed. Results: In all the outcomes analyzed, both groups showed an improvement in particular between T0 and T1 and a progressive decrease of it between T1 and T2. No differences in any of the selected outcomes were observed between the two groups during the trial. No side effects due to the drug were registered in group II compared to group I. Conclusion: The additional complementary treatment (OPT) does not seem to give the patients with TMDs and FM any further benefit but it could improve pharmacological tolerability of the traditional drug therapy. in further investigations the aim could be to administer Okada therapy alone in patients who do not accept pharmacological therapy with duloxetine, comparing results with a control group with a placebo therapy

Acupoints for the treatment of temporomandibular disorders: a literature review

Aim: Acupuncture is successfully used for the treatment of Temporomandibular Disorders (TMDs), especially for pain of articular or muscular origin. The scientific literature shows a great number of usable acupoints and techniques of stimulation. This review aims to analyze the acupoints and the techniques most used in the treatment of TMDs symptoms and compare its effectiveness. Methods: Computer retrieval was performed with Medline, PubMed, Scopus. The dates of the articles surveyed ranged from 2009 to February 2019. Terms used for the search were "Acupuncture points" AND "TMD” OR “TMJ”. The inclusion criteria were: (1) publications in English; (2) controlled clinical trials; (3) patients with TMD of muscular or articular origin; and (4) studies that used acupuncture only for treatment. Results: Out of 83 titles retrieved, 41 abstracts were read and 21 full articles were selected and categorized according to the following classes: TMDs, acupoints location, techniques of stimulation, effectiveness of therapy. TMDs of muscle origin are absolutely the most treated diseases (18 papers: 85.7%). Out of a total of 49 selected acupoints, the most used were: “Hegu” (LI4) (16 papers: 76,2%); “Jiache” (ST6) (13 papers: 62%); “Xiaguan” (ST7) (10 papers: 47,6%); “Fengchi” (GB20) (8 papers: 38%); “Quanjiao” SI18 (6 papers: 28,6%) and Ashi points (6 papers: 28,6%). According to points location, the combination of local and distal points was used in most cases (11 papers: 50%). Distal points only were used in some cases (5 papers: 23.8%), while local points only were never used. Other locations (ashi/trigger points, microsystems) were used in 28,6% of cases (6 papers). Concerning the techniques of stimulation, the somatic acupuncture was the most used (12 papers: 57,1%), followed by dry needling and laser acupuncture (4 papers: 19%). Acupuncture therapies were effective in 90,5% of cases, regardless of the technique used. Conclusion: Acupuncture treatments for TMDs are effective, regardless of the technique of stimulation used, but extremely varied. In the clinical practice there are some acupoints most used but there is no evidence of standardized protocols. The acupoints selection based on the diagnosis of TMD is not clear in literature. There is a need for well-designed randomized controlled trials (RCT) including the use of acupuncture points on a diagnostic basis. This could allow a better evaluation of the additional benefit of acupuncture for managing TMD

Gnathological and osteopathic treatments with digital evaluations before and after therapies: a case report of a patient with Ehlers-Danlos syndrome

Background. Ehlers-Danlos syndromes (EDS) are inherited connective tissue disorders, requiring specific care along with a multidisciplinary approach by an expert medical staff, as for both the diagnosis and the treatment management. Chronic generalized pain and musculoskeletal dysfunctions due to joint hypermobility are common traits. Temporomandibular disorders (TMDs) are among the most frequent complaints. The authors report the diagnostic and therapeutic management of an EDS subject. Case presentation. A 33-year old woman with Ehlers-Danlos syndrome, hypermobile type, was clinically evaluated and treated. She underwent a gnathological therapy with an anterior repositioning splint and proprioception exercises, and a physical rehabilitation through an osteopathic manipulation treatment (OMT). Technology - surface Electromyography (sEMG) of masticatory muscles, T-scan and stabilometric platform- supported diagnostic and therapeutic phases, giving objective and quantifiable information on the patient's assessment before and after treatments. Conclusion. According to a targeted therapeutic strategy, both the gnathological and the osteopathic therapy proved to be effective in improving patient's symptomatology and functionality, as confirmed by digital findings