Dobór pacjentów do leczenia ortodontycznego : część I : wskazania i uzasadnienie leczenia ortodontycznego

Dobór pacjentów do leczenia ortodontycznego powinien być oparty na wskazaniach opartych na dowodach naukowych potwierdzających, że korekta okluzji przynosi korzyści pacjentowi. Niniejsza publikacja ocenia, dostępne w publikacjach ortodontycznych, dowody naukowe pod kątem korzyści płynących z leczenia ortodontycznego, które eliminują szkodliwe następstwa wad zgryzu. Wzięto pod uwagę czynniki obejmujące uszkodzenia tkanek jamy ustnej, zarówno miękkich i twardych, problemy związane z funkcją żucia oraz czynniki psychospołeczne.The selection of patients for orthodontic therapy should be based on the principle that treatment should offer some advantage for the occlusion and patient as a whole considered on a scientific basis. The present report evaluates the scientific evidence, gained from orthodontic literature, for the advantages gained from orthodontic therapy related to avoidance of detrimental effects arising from malocclusion. Factors considered include damage to oral tissues, both soft and hard, problems involving masticatory function as well as psychosocial factors

Evaluacija Helkimo anamnestičkog indeksa i indeksa disfunkcije kod jednojajčanih blizanaca

Introduction: In 1974 Marti Helkimo designed special questionnaires which were used for entering adequate contemporary data collected by medical history, analyzing the functions of the orofacial system and analyzing occlusion. Data were evaluated numerically with 0, 1 or 5, depending on the severity of the relevant findings and severity of clinical signs or symptoms of dysfunction. Objective: The aim of the research was to establish and evaluate specially designed Helkimos anamnestic and dysfunction index in monozygotic twins. Materials and Methods: A longitudinal prospective study was carried out on a randomized sample of 30 pairs of twins, 20 to 40 years old, and of both sexes. Dedicated design of the questionnaire made it possible to calculate the Helkimos anamnestic index (Ai), based on subjective feeling and positive or negative answers of subjects about the state of their masticatory apparatus. The clinical dysfunction index (Di) represents objective functional analysis of structural and functional disorders of the orofacial complex, because it monitors multiple parameters. Kinematics of the lower jaw, conditions and limited function of the temporomandibular joints, the presence or absence of painful sensations during mandible movements during palpation of the joints and masticatory muscles, and the overall quantification of the incidence of craniomandibular dysfunction were all monitored and evaluated. The study was conducted in accordance with the local and international laws and ethical standards. Results: Medical records of 47 (78.3%) twins did not present the signs and symptoms of craniomandibular dysfunction, i.e., Ai = 0. Twelve respondents were aware of the existence of mild signs of craniomandibular disorders (CMD). Acute and expressed craniomandibular disorder was identified in one of the twins Ai II 1 (1.7%). By evaluating and analyzing the results obtained using Helkimo analysis, positive dysfunction index (Di> 0), or certain signs and symptoms of impaired function of TMJ were established in 23 twins (38.3%), while the index dysfunction equal to 0 (dI = 0) was found in 37 (61.7%) twins. Spearman's correlation (0.728) demonstrates there is a coefficient of interdependence and mutual association between anamnestic index (Ai) and the dysfunction index (Di), with statistic significance at 1% (p = 0.000). Conclusion: This comparative statistical analysis showed there is a correlation between anamnestic index (Ai) and clinical dysfunction index (Di) by Helkimo et al.Uvod: Marti Helkimo je 1974. godine dizajnirao posebne upitnike za unošenje adekvatnih podataka dobijenih anamnezom, analizom funkcija orofacijalnog sistema i analizom okluzije. Podaci se vrednuju numerički sa 0, 1 ili 5, u zavisnosti od odgovarajuće izraženosti nalaza i težine kliničkog znaka, odnosno simptoma disfunkcije. Cilj: Cilj oralno-epidemiološkog i funkcionalnog ispitivanja je utvrđivanje i vrednovanje specijalno dizajniranog anamnestičkog indeksa i indeksa disfunkcije po Helkimu kod jednojačanih blizanaca. Materijal i metode: Longitudinalno prospektivno ispitivanje izvršeno je na randomizovanom uzorku od 30 parova jednojajčanih blizanaca, podjednake polne zastupljenosti i hronološkog uzrasta od 20 do 40 godina. Namenski istraživački dizajn kliničkog upitnika omogućio je izračunavanje anamnestičkog indeksa (Ai) po Helkimu, na osnovu subjektivnog osećaja i pozitivnih ili negativnih odgovora ispitanika o stanju njihovog mastikatornog aparata. Klinički indeks disfunkcije (Di) predstavlja objektivnu funkcionalnu analizu strukturnih i funkcionalnih poremećaja orofacijalnog kompleksa, zahvaljujući zbiru parametara dobijenih vrednovanjem kinematike donje vilice, stanja i limitirane funkcije temporomandibularnih zglobova, prisustva ili odsustva bolnih senzacija pri kretnjama mandibule, tokom palpacije donjoviličnih zglobova i mastikatornih mišića, odnosno sveukupnoj kvantifikaciji učestalosti kraniomandibularnih disfunkcija. Istraživanja su sprovedena u skladu s lokalnim i međunarodnim pravima i etičkim normama. Rezultati: U anamnezi 47 (78,3%) blizanaca ne navodi znake i simptome kraniomandibularnih disfunkcija, odnosno ima Ai=0. Subjektivno svesni postojanja blagih znakova kraniomandibularnih disfunkcija (KMD) bilo je 12 ispitanika, a akutni, izraziti kraniomandibularni poremećaji identifikovani su kod jednog blizanca Ai II 1 (1,7% ). Vrednovanjem i analizom rezultata dobijenih kliničkom funkcionalnom analizom po Helkimu, pozitivni indeks disfunkcije (Di >0), odnosno određeni znaci i simptomi poremećene funkcije TMZ ,utvrđeni su kod 23 jednojajčana blizanca (38,3%), dok je indeks disfunkcije jednak 0 (Di=0) registrovan kod 37 (61,7%) blizanaca, koji nemaju kraniomandibularne poremećaje (KMD). Spiarmanova korelacija (0,728) dokazuje da postoji koeficijent međuzavisnosti, odnosno obostrane povezanosti anamnestičkog indeksa ( Ai) i indeksa disfunkcije (Di) statistički značajan na nivou 1% (p=0,000). Zaključak: Ova komparativna statistička analiza pokazala je da postoji uzajamna povezanost anamnestičkog indeksa (Ai) i kliničkog indeksa disfunkcije (Di) po Helkimu

Orofacijalni bolni poremećaji (OFP), temporomandibularni poremećaji (TMP) i komorbidna stanja – suvremene koncepcije i edukacija studenata dentalne medicine

Orofacial pain refers to pain associated with hard and soft tissues of the head, face and neck, which send impulses through the trigeminal nerve to the CNS to be interpreted as pain. Headaches, neurogenic, musculoskeletal and psychophysiologic pathology, cancer, autoimmune phenomena and tissue trauma represent the diagnostic range for the complaint of OFP. Various potential for pain from trigeminal receptive fields is the cause for a collaboration between the specialists belonging to different fields of medicine and those belonging to different fields of dental medicine. All of them participate in the evaluation and management of OFP. TMD is considered to be the main part of OFP and most practitioners are focused on evaluation, diagnostics and therapy of the disorder. In the sixties, W. Bell inaugurated the term temporomandibular disorder, which was generally accepted in praxis. This term suggested that apart from the problems regarding TMJ, there were also problems concerning masticatory muscles and all disorders associated with the function of masticatory system and their associated tissues. Different diagnostic systems and protocols are available for the research and classification of the TMD patients. The most common protocol used in research is RDC/TMD protocol (Research Diagnostic Criteria), which enables diagnoses according two axes: Axis I with somatic, and Axis II with psychophysical diagnoses, mostly for chronic TMP patients. In chronic TMP/OFP patients there is an increased probability of comorbid conditions. A need for modern diagnostics and management of TMP/OFP encouraged the development of a new course in graduate and postgraduate education of dental medicine students.Orofacijalni bolni poremećaji (OFP), temporomandibularni poremećaji (TMP) i komorbidna stanja; suvremene koncepcije i edukacija studenata dentalne medicine Orofacijalna bol podrazumijeva bol vezanu za tvrda i meka tkiva u području glave, lica i vrata koja putem trigeminalnog živca odašilje impulse koji se u CNS-u interpretiraju kao bol. Glavobolje, neurogena, muskuloskeletna i psihofizička patologija te tumori, infekcije, autoimuni fenomeni i tkivne traume mogu biti u dijagnostičkom opsegu orofacijalne boli. Raznoliki potencijal za bol nastalu u receptivnom području n. trigeminusa razlog je da evaluacija i terapija orofacijalne boli zahtijevaju suradnju različitih grana medicine, pri čemu posebnu zadaću ima dentalna medicina i njezine specijalističke grane. Temporomandibularni poremećaj (TMP) smatra se glavnim područjem orofacijalne boli i većina praktičara uglavnom se fokusira na procjenu, dijagnozu i terapiju toga poremećaja. Šezdesetih je godina W. Bell predložio naziv temporomandibularni poremećaj (engl. TMD, hrv. TMP) koji je postao popularan i opće prihvaćen. Ta sintagma sugerira ne samo probleme u temporomandibularnim zglobovima, nego uključuje i mastikatorne mišiće i sve poremećaje povezane s funkcijom mastikatornog sustava i okolnih tkiva. Za potrebe istraživanja i klasifikaciju ispitanika postoje različiti dijagnostički kriteriji i protokoli, a danas je najčešći RDC/ TMD (Research Diagnostic Criteria) koji dijagnoze razvrstava po dvije osi (os I. s dijagnozama somatskih i os II. s dijagnozama psihogenih podloga, većinom kod kroničnih TMP-a). Kod kroničnih pacijenata s TMP/OFP-om povećana je mogućnost komorbidnih stanja. U dentalnoj je medicini potreba za suvremenim dijagnosticiranjem i zbrinjavanjem TMP/OFP-a rezultirala uvođenjem posebnog kolegija na dodiplomskoj razini, a i u poslijediplomskoj edukaciji

Evaluation of Helkimo anamnestic and dysfunction index in identical twins

Introduction: In 1974 Marti Helkimo designed special questionnaires which were used for entering adequate contemporary data collected by medical history, analyzing the functions of the orofacial system and analyzing occlusion. Data were evaluated numerically with 0, 1 or 5, depending on the severity of the relevant findings and severity of clinical signs or symptoms of dysfunction. Objective: The aim of the research was to establish and evaluate specially designed Helkimos anamnestic and dysfunction index in monozygotic twins. Materials and Methods: A longitudinal prospective study was carried out on a randomized sample of 30 pairs of twins, 20 to 40 years old, and of both sexes. Dedicated design of the questionnaire made it possible to calculate the Helkimos anamnestic index (Ai), based on subjective feeling and positive or negative answers of subjects about the state of their masticatory apparatus. The clinical dysfunction index (Di) represents objective functional analysis of structural and functional disorders of the orofacial complex, because it monitors multiple parameters. Kinematics of the lower jaw, conditions and limited function of the temporomandibular joints, the presence or absence of painful sensations during mandible movements during palpation of the joints and masticatory muscles, and the overall quantification of the incidence of craniomandibular dysfunction were all monitored and evaluated. The study was conducted in accordance with the local and international laws and ethical standards. Results: Medical records of 47 (78.3%) twins did not present the signs and symptoms of craniomandibular dysfunction, i.e., Ai = 0. Twelve respondents were aware of the existence of mild signs of craniomandibular disorders (CMD). Acute and expressed craniomandibular disorder was identified in one of the twins Ai II 1 (1.7%). By evaluating and analyzing the results obtained using Helkimo analysis, positive dysfunction index (Di> 0), or certain signs and symptoms of impaired function of TMJ were established in 23 twins (38.3%), while the index dysfunction equal to 0 (dI = 0) was found in 37 (61.7%) twins. Spearman's correlation (0.728) demonstrates there is a coefficient of interdependence and mutual association between anamnestic index (Ai) and the dysfunction index (Di), with statistic significance at 1% (p = 0.000). Conclusion: This comparative statistical analysis showed there is a correlation between anamnestic index (Ai) and clinical dysfunction index (Di) by Helkimo et al.Uvod: Marti Helkimo je 1974. godine dizajnirao posebne upitnike za unošenje adekvatnih podataka dobijenih anamnezom, analizom funkcija orofacijalnog sistema i analizom okluzije. Podaci se vrednuju numerički sa 0, 1 ili 5, u zavisnosti od odgovarajuće izraženosti nalaza i težine kliničkog znaka, odnosno simptoma disfunkcije. Cilj: Cilj oralno-epidemiološkog i funkcionalnog ispitivanja je utvrđivanje i vrednovanje specijalno dizajniranog anamnestičkog indeksa i indeksa disfunkcije po Helkimu kod jednojačanih blizanaca. Materijal i metode: Longitudinalno prospektivno ispitivanje izvršeno je na randomizovanom uzorku od 30 parova jednojajčanih blizanaca, podjednake polne zastupljenosti i hronološkog uzrasta od 20 do 40 godina. Namenski istraživački dizajn kliničkog upitnika omogućio je izračunavanje anamnestičkog indeksa (Ai) po Helkimu, na osnovu subjektivnog osećaja i pozitivnih ili negativnih odgovora ispitanika o stanju njihovog mastikatornog aparata. Klinički indeks disfunkcije (Di) predstavlja objektivnu funkcionalnu analizu strukturnih i funkcionalnih poremećaja orofacijalnog kompleksa, zahvaljujući zbiru parametara dobijenih vrednovanjem kinematike donje vilice, stanja i limitirane funkcije temporomandibularnih zglobova, prisustva ili odsustva bolnih senzacija pri kretnjama mandibule, tokom palpacije donjoviličnih zglobova i mastikatornih mišića, odnosno sveukupnoj kvantifikaciji učestalosti kraniomandibularnih disfunkcija. Istraživanja su sprovedena u skladu s lokalnim i međunarodnim pravima i etičkim normama. Rezultati: U anamnezi 47 (78,3%) blizanaca ne navodi znake i simptome kraniomandibularnih disfunkcija, odnosno ima Ai=0. Subjektivno svesni postojanja blagih znakova kraniomandibularnih disfunkcija (KMD) bilo je 12 ispitanika, a akutni, izraziti kraniomandibularni poremećaji identifikovani su kod jednog blizanca Ai II 1 (1,7% ). Vrednovanjem i analizom rezultata dobijenih kliničkom funkcionalnom analizom po Helkimu, pozitivni indeks disfunkcije (Di >0), odnosno određeni znaci i simptomi poremećene funkcije TMZ ,utvrđeni su kod 23 jednojajčana blizanca (38,3%), dok je indeks disfunkcije jednak 0 (Di=0) registrovan kod 37 (61,7%) blizanaca, koji nemaju kraniomandibularne poremećaje (KMD). Spiarmanova korelacija (0,728) dokazuje da postoji koeficijent međuzavisnosti, odnosno obostrane povezanosti anamnestičkog indeksa ( Ai) i indeksa disfunkcije (Di) statistički značajan na nivou 1% (p=0,000). Zaključak: Ova komparativna statistička analiza pokazala je da postoji uzajamna povezanost anamnestičkog indeksa (Ai) i kliničkog indeksa disfunkcije (Di) po Helkimu

Examination of temporomandibular disorders in the orthodontic patient: a clinical guide

The possible association between orthodontic treatment and temporomandibular disorders (TMD) is a topic of great interest in the current literature. The true role of orthodontic therapy on the etiology of TMD, however, is still uncertain. From the clinical prospective, a thorough examination of the stomatognathic system is always necessary in order to detect possible TMD signs and symptoms prior to the beginning of the orthodontic therapy. Caution should be exercised when planning, performing and finalizing orthodontics, especially in patients who with history of signs and symptoms of TMD. The clinician must always eliminate patient's pain and dysfunction before initiating any type of orthodontic mechanics. Muscle incoordination, unstable disc-condyle relationship and bone alterations are usual TMD conditions that can interfere with the presenting occlusal relationship. This article reviews these aspects and presents a detailed clinical guide for the examination of the orthodontic patient, considering aspects related to facial pain and dysfunction

Innovation in prediction planning for anterior open bite correction

This study applies recent advances in 3D virtual imaging for application in the prediction planning of dentofacial deformities. Stereo-photogrammetry has been used to create virtual and physical models, which are creatively combined in planning the surgical correction of anterior open bite. The application of these novel methods is demonstrated through the surgical correction of a case

Temporomandibular disorders : a case-control study

Objective: To compare the risk factors and clinical manifestations of patients with temporomandibular disorders (TMDs) diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (axis I) versus an age and gender matched control group. Study D esign: A total of 162 patients explored according to the RDC/TMD (mean age 40.6±18.8 years, range 7-90; 11.1% males and 88.9% females) were compared with 119 controls, measuring differences in TMD risk factors (sleep disturbances, stress, psychoactive medication, parafunctions, loss of posterior support, ligament hyperlaxity) and clinical variables (joint sounds, painful muscle and joint palpation, maximum aperture). Results: Myofascial pain (MFP) (single or multiple diagnoses) was the most frequent diagnosis (42%). The most common diagnostic combination was MFP plus arthralgia (16.0%). Statistically significant differences were observed in clenching (OR 2.3; 95%CI: 1.4-3.8) and in maximum active aperture (MAA) on comparing the two groups both globally (TMD vs. controls) (patients 36.7±8.6 mm, controls 43.1±5.8 mm; F=45.41, p = 0.000) and on comparing according to diagnostic categories. MFP explained most of the observed differences in the risk factors: stress perception (OR=1.98;I.C.:1.01-3.89), psychoactive medication (OR=2.21; I.C.:1.12-4.37), parafunctions (OR=2.14;I.C.:1.12-4.11), and ligament laxity (OR=2.6;I.C.:1.01-6.68). Joint sounds were more frequent in patients with MFP (39.7% vs. 24.0%; ?2=4.66; p=0.03), and painful joint palpation was more common in patients with disc displacement with reduction (DDWR)(15.9% vs. 5.0%; ?2 = 5.2; p = 0.02) and osteoarthrosis (20.8% vs. 5.0%; ?2 = 7.0; p = 0.008). Conclusions: There is a high prevalence of signs and symptoms of TMDs in the general population. Significant differences are observed in clenching and MAA between patients and controls considered both globally and for each diagnostic category individually. The analyzed risk factors (except loss of posterior support) show a statistically significant OR for the diagnosis of MFP

EFFECTS OF MALOCCLUSION ON ORAL HEALTH RELATED QUALITY OF LIFE (OHRQoL): A CRITICAL REVIEW

Objectives: The purpose of this paper is to provide a useful critical review relating to the effects of malocclusion on the physical, social, and psychological aspects of the Quality of Life (QoL) of patients. Methods: The information presented in previous articles was reviewed. They include reviews, meta-analyses, cross-sectional studies, retrospective and prospective longitudinal studies, and randomized controlled trials. These full-text English-language papers were studied to determine the effects of malocclusion on QoL. Results: Recent studies have found that malocclusion is associated with higher levels of dissatisfaction with appearance, and have the potential to negatively impact Oral Health Related Quality of Life (OHRQoL). However, due to the differences in study designs, population demographics studied, and methods of assessment of physical, social, and psychological health, the evidence needs more analysis. Conclusion: In recent years, attention to patient-centered assessment has greatly increased. The orthodontist’s point of view has expanded from dentofacial esthetics to the patient’s overall OHRQoL. This leads to increase in dental practitioners comprehensively and rigorously, thus assessing the effects of malocclusion on QoL. The demand on standardized, valid, and reliable data collection instruments will increase as practices treats malocclusion issues to elevate patient’s overall OHRQoL

Trastornos temporamandibulares más frecuentes relacionados a pacientes con tratamiento de ortodoncia revisión bibliográfica

Throughout the years, temporomandibular disorders (TMD) have been studied and their relationship with dentistry. TMD are characterized by noise in the joint, limitation of jaw movement and pain in the muscles of mastication. The role of orthodontics with temporomandibular disorders has been much debated. Many studies mention that orthodontics are causing TMD and could make these even worse. However, other studies mention that TMD are not caused by an orthodontic treatment and that the signs and symptoms could rather disappear as the treatment progresses. In this work a literary review is going to be made to see if orthodontics will cause an increase or decrease while the orthodontic treatment is performed.A lo largo de los años, se han ido estudiando los trastornos temporomandibulares (TTM) y su relación con la odontología. Los TTM se caracterizan por presentar ruidos en la articulación, limitación de movimientos mandibulares y dolores en los músculos de la masticación. El papel que cumple la ortodoncia con los trastornos temporomandibulares ha sido muy debatido. Muchos estudios mencionan que la ortodoncia es causante de los TTM y que hace que estos se agraven. Sin embargo, otros estudios mencionan que los TTM no son desarrollados por un tratamiento de ortodoncia y que más bien los signos y síntomas que se presentan van a ir desapareciendo a medida que el tratamiento va avanzando. En este trabajo se va a realizar una revisión bibliográfica de si la ortodoncia causa que los TTM aumenten o disminuyan al momento en el que se lleva a cabo el tratamiento de ortodoncia