Initial Treatment of Prosthetic Patients with a Michigan Splint

Michiganska udlaga prekriva sve okluzijske plohe zubnoga niza, a služi u inicijalnom protetskom liječenju u dijagnostici i liječenju temporomandibularnih poremećaja. Najčešća je indikacija mialgija žvačnoga mišičja i artralgija čeljusnoga zgloba. Udlagom se otklanjaju simptomi i postiže samonamještanje donje čeljusti u nov pacijentu prikladan položaj bez subjektivnih smetnji. Kako bi se zaštitila tvrda zubna tkiva zbog bruksizma, može se nositi duže vrijeme. Zbog stabilnosti i retencije na ležištu češće se odabire gornji zubni niz. Okluzijska ploha udlage izvedena je u obliku ravnih ploha. Na njima se ostvaruju ravnomjerni dodiri radnih kvržica antagonističke čeljusti u području slobode u centriku. U ekskurzivnim kretnjama donje čeljusti ostvaruje se vođenje očnjakom i diskluzija preostalih zuba. Nošenje udlage prekida se postupno u intervalima tako da se pacijent polagano odvikava i pomalo smanjuje duljinu nošenja. Pretpostavke uspješnoga liječenja jesu pozorna izradba udlage u artikulatoru, redovita kontrola stanja tijekom nošenja udlage i kontrola okluzijskih odnosa.The Michigan splint covers all occlusal surfaces of the dental arch and is used in initial prosthetic treatment during the diagnosis and treatment of temporomandibular disorders. The most frequent indication is myalgia of the masticatory muscles and arthralgia of the temporomandibular joint. The splint eliminates symptoms and realises self-positioning of the mandible into a new position, which is acceptable for the patient. It can be worn for a longer period with the object of protecting the hard dental tissue due to bruxism. Because of stability and retention on the base the upper dental arch is more frequently chosen. The occlusal surface of the splint is fabricated in the form of flat surfaces on which equal contacts of the working cusps of the antagonistic jaws are achieved in the area of freedom in the centric. In excursive movements of the mandible disocclusion of the remaining teeth is realised, guided by the canine. Interrupted wearing of the splint follows during an interval of gradual disuse and reduction in the period of wearing. Success of the treatment is conditioned by careful fabrication of the splint in the articulator, regular check-ups while wearing the splint and occlusal relations

Functional Impressions in Complete Denture and Overdenture Treatment

Gubitak zuba može uzrokovati gubitak pacijentove okluzijske, žvačne, estetske, fizionomske, fonetske i psihosocijalne funkcije. Najčešća metoda terapije potpuno bezubih pacijenata i onih s malim brojem preostalih zuba su potpune ili pokrovne proteze. Jedan od najvažnijih kliničkih i laboratorijskih postupaka u njihovoj izradi jest izrada funkcijskog otiska. Svrha ovog rada je prikazati postupke uzimanja funkcijskih otisaka u izradi potpunih i pokrovnih proteza korištenjem standardnih tehnika i materijala. Točan funkcijski otisak, zajedno s ostalim pravilno provedenim kliničkim i laboratorijskim postupcima, osigurava dobru retenciju i stabilizaciju proteze, što je preduvjet da se pacijentu vrate izgubljene funkcije.Tooth loss can cause loss of occlusal, masticatory, esthetic, physiognomic, phonetic and psychosocial function of patients. The most frequently used treatment method of completely edentulous patients and patients with a small number of remaining teeth are complete dentures or overdentures. One of the most important clinical and laboratory procedures in their fabrication is functional impression taking. The aim of this paper was to present procedures of taking functional impressions in fabrication of complete dentures and overdentures, using standardized techniques and materials. An accurate functional impression together with other correctly performed clinical and laboratory procedures ensure good retention and stability of dentures, which is a precondition for restoring patients’ lost functions

Caries of Croatian Army Recruits

Predmet je istraživanja pojavnost karijesa u novaka Hrvatske vojske s obzirom na osobitosti pojedinih društvenih zajednica. U 190 novaka karijes je utvrđen upotrebom DMFT indeksa. Ispitanici su podijeljeni prema prebivalištu (gradsko, prigradsko, seosko) i prema dobi. Zdrave zube imalo je 5 (2,6%) ispitanika. Prosječna DMFT vrijednost iznosi 7,76 (DT:2,03; MT:1,49; FT:4,25). Postoji statistički znatna razlika između DT (p = 0,009) i FT (p < 0,001) vrijednosti ovisno o prebivalištu. Za seosku sredinu iznosile su DT:2,59 i FT:2,87, a za gradsku DT:1,52 i FT:5,48. Vrijednosti ispitanika prema dobi bile su DMFT (p = 0,008), DT (p < 0,001), MT (p = 0,022) i FT (p < 0,001). Istraživanje čestoće karijesa u novaka poticaj je daljnjim sustavnim istraživanjima u manjim društveno-ekonomskim skupinama te upozorava da je potrebno poboljšati preventivne mjere u dječjoj i adolescentnoj dobi.The object of this study is the occurrence of caries in Croatian Army recruits with regard to specific qualities of certain social communities. Caries was diagnosed in 190 recruits by means of DMFT index. Subjects were classified according to residence (urban, suburban, rural) and age. Healthy teeth were determined in 5 (2.6%) subjects. The average DMFT value was 7.76 (DT:2.03; MT:1.49; FT:4.25). Statistically significant difference was found between DT (p = 0.009) and FT (p < 0.001) values depending on residence. For rural environment the following values were established DT:2.59 and FT:2.87, and for urban environment DT:1.52 and FT:5.48. Subject values according to age were DMFT (p = 0.008), DT (p < 0.001), MT (p = 0.022) and FT (p < 0.001). The study of caries frequency in recruits is incentive for further systematic studies in smaller socio economic groups and reveals the necessity for improvement in preventive program both during childhood and adolescence

Strateške sposobnosti malih i srednjih tehnoloških poduzeća u Hrvatskoj

Ovaj se rad bavi mogućnostima identifikacije strateških sposobnosti malih i srednjih poduzeća iz sektora "visoke tehnologije", relevantnih za specifične uvjete poslovanja u tranzicijskom okruženju. Nakon pregleda teorijskih obilježja strateških/ ključnih sposobnosti, iznose se rezultati analize dobiveni longitudinalnim istraživanjem uzorka poduzeća iz navedenog sektora u Splitsko-dalmatinskoj županiji i gradu Zagrebu, pri čemu je posebna pozornost posvećena inovativnim pristupima strateškom upravljanju, uz pomoć čega se poduzetnici suočavaju s nesigurnim okruženjem. Temeljem empirijskih rezultata, a uzevši u obzir relevantnu metodologiju studija slučaja, u zaključku se rada predlažu preliminarne odrednice konkurentskih prednosti navedenih organizacija i identificiraju budući istraživački zadaci

Prevalence of Temporomandibular Disorder Subtypes in Croatian Patients

Dijagnostički kriteriji za istraživanje temporomandibularnih poremećaja (DKI/TMP) izvorno su razvijeni u Sjedinjenim Američkim Državama, prevedeni su i upotrebljavaju se za klasifikaciju pacijenata s TMP prema fizikalnoj dijagnozi (os I) te prema nesposobnosti izazvanom boli i psihološkom statusu (os II) u hrvatskih pacijenata s TMP. Nalazi osi I i II DKI/TMP protokola uspoređivali su se s nalazima iz švedske, američke i azijske skupine pacijenata s TMP. Stotinu pedeset i četiri konzekutivna pacijenta (117 žena i 37 muškaraca) upućena na Zavod za stomatološku protetiku i Zavod za oralnu kirurgiju, Zagreb, Hrvatska, sudjelovalo je u istraživanju. Prosječna dob za hrvatsku populaciju bila je 39 ± 14,5 godina. Raspodjela frekvencija i deskriptivna statistika dobivena je uporabom statističkoga SPSS paketa za Windowse (SPSS, Chicago, IL), te su se hi-kvadrat statistički testovi (P < 0,05) izvodili kako bi se ispitale razlike između spolova. Poremećaj skupine I (mišićni) bio je nađen u 64,9% pacijenata; poremećaj skupine II (pomak diska) bio je nađen u 31,8% i 27,3% pacijenata u desnim i lijevim čeljusnim zglobovima, pojedinačno; poremećaj skupine III (artralgija, artritis, artroza) bio je nađen u 21,4% i 26% pacijenata u desnim i lijevim čeljusnim zglobovima, pojedinačno. Procjena psihološkog statusa pream Osovini II pokazala je da 19,5% pacijenata pokazuje izražene rezultate depresije i 27,3% visoke rezultate nespecifičnih fizikalnih simptoma (somatizacija). Psihosocijalna disfunkcija opažena je u 21,4% pacijenata na osnovi rezultata stupnjevane kronične boli. Nalazi osi I i II hrvatskih apeijenata s TMP općenito su bili slični nalazima u švedskim, američkim i azijskim populacijama. U sve 4 populacije žene u reproduktivnoj dobi činile su većinu pacijenata. Mišićni poremećaji bili su najčešći tip TMP. Znatan dio pacijenata s TMP bio je depresivan i pokazivao je visoku somatizaciju. Ovi rezultati pokazuju da je DKI/TMP protokol valjan u klasificiranju pacijenata s TMP, te da omogućuje mođukulturalnu usporedbu i usporedbu kliničkih nalaza između različitih kliničkih centara.The Research Diagnostic Criteria for Temporomandibular Discorders (RDC/TMD) guidelines, originally developed in the United States, were translated and used to classify TMD patients on physical diagnosis (Axis I) and pain-related disability an psychological status (Axis II) in Croatiana TMD patients. The RDC/TMD Axis I and II findings were compared to those of Swedish , American and Asian TMD patients. One hundred and fifty-gour consecutive patients (117 female and 37 male) referred to the Department of Prosthodontics and Department of Oral Surgery in Zagreb, Croatia, were enrolled in the study. The mean age of the Croatian population was 39 ± 14,5 years. Frequency distributions and descriptive statistics were obtained through the use of SPSS version 10 for Windows (SPSS, Chicago, IL), and chi-square (2-sided) statistical analyses were performed (P < 0,05) to evaluate gender differences. Group I (muscle) disorder was found in 64,9% of the patients; Group II (disc displacement) disorder was found in 31,8% and 27,3% of the patients in the right and left joints, respectively; Group III (arthralgia, arthritis, arthrosis) disorder was found in 21,4% and 26% of the patients in teh right and left joints, respectively. Axis II assessment of psychological status showed that 19,5% of patients yielded severe depression scores and 27,3% yielded high nonspecific physical symptom scores (somatization). Psychosocial dysfunction was observed in 21,4% of patients based on graded chronic pain scores. Axis I and II findings of Croatian TMD patients were generally similar to their Swedich, American and Asian cohorts. In all 4 populations, women of child-bearing age represented the majority of patients. Muscle disorders were the most prevalent type of TMD. A substantial portion of TMD patients were depressed and experienced severe somatization. These rezults suggest that the RDC/RMD guidelines are valuable in helping to classify TMD patients and allowing multicenter and cross-cultural comparison of clinical findings

Comparison of Parameters for Programming Adjustable Dental Articulators by Using Wax Eccentric Records and Arcus Digma Device

Svrha istraživanja: Programiranje zglobnih mehanizama/parametara (kondilni nagib staze i Bennettov kut) prilagodljivih dentalnih artikulatora preduvjet je za obavljanje položaja i kretnji donje čeljusti. Svrha istraživanja bila je ispitati značajne razlike između dviju metoda (voštani ekscentrični registrati i uređaj Arcus Digma) mjerenjem tih zglobnih parametara upotrebom triju različitih dentalnih artikulatora (SAM 3, Protar 7 i Artex CR). Materijal i metode: U istraživanju je sudjelovalo 30 asimptomatskih mlađih ispitanika – studenata Stomatološkog fakulteta (u dobi 25,7 ± 2,9 godina), bili su podijeljeni prema spolu i imali su normalnu okluziju (Angleova klasa I). Nakon uzimanja anatomskih otisaka obaju zubnih lukova, za svakog ispitanika izliveni su radni modeli u tvrdoj sadri. Vrijednosti lijevoga i desnog sagitalnog nagiba kondila i Bennettova kuta, s pomoću dviju metoda voštanih ekscentričnih protruzivnih i lateralnih registrata te uređaja Arcus Digma, bili su izmjereni u svrhu programiranja već spomenutih zglobnih parametara u trima različitim sustavima artikulatora. Rezultati: Prosječne vrijednosti izmjerenih parametara kondilnoga nagiba staze i Bennettova kuta voštanih ekscentričnih registrata bile su više (u prosjeku za 5º do 10º) u odnosu prema vrijednostima izmjerenima uređajem Arcus Digma. Statistički značajne razlike nađene između izmjerenih zglobnih parametara (p < 0,025) bile su pod utjecajem dizajna artikulatora i metoda mjerenja (t-test za zavisne uzorke i MANOVA test). Zaključak: Upotreba uređaja Arcus Digma može se smatrati znatno pouzdanijom i prikladnijom metodom za individualizirano programiranje dentalnih artikulatora u usporedbi s metodom voštanih ekscentričnih registrata.Objectives: Programming of joint mechanism/parameters (sagittal condylar inclination and Bennett angle) of adjustable dental articulators is a prerequisite for performing positions and movements of the mandible. The aim of the study was to test significant differences between the two methods (wax eccentric records and Arcus Digma device) of measuring these joint parameters by using three different dental articulators (SAM 3, Protar 7; and Artex CR). Materials and Methods: Thirty asymptomatic younger (age 25.7 ± 2.9 years) subjects (dental medicine students) divided by gender, with normal occlusion (Angle class I) participated in the study. After taking anatomical impressions of both dental arches, master casts were made of hard dental plaster for each subject. The values of the left and right sagittal condylar inclination and Bennett angle by the two methods of wax eccentric protrusive and lateral records and Arcus Digma device were measured for the purpose of programming the mentioned joint parameters in three different articulator systems. Results: The average values of the measured parameters of sagittal condylar inclination and Bennett angle of wax eccentric records were higher (ranging from 5ºto 10º) in relation to the values measured by Arcus Digma device. Statistically significant differences found between the measured joint parameters (p <0.025) were influenced by the articulator system design and measurement methods (t-test for dependent samples and MANOVA). Conclusion: The use of Arcus Digma device should be considered reliable and valid for individualized programming of dental articulators, rather than the use of wax eccentric records

Registration and Measurement of Opening and Closing Jaw Movements and Rotational Mandibular Capacity by Using the Method of Electronic Axiography

The aim of this study was to register and measure lower jaw movements, to analyse the measured length of opening and closing movements and to analyse the rotational mandibular capacity during the maximal opening of the mouth in the position of centric relation. Our objective was to determine the average values for each mandible and temporomandibular joint movement, as well as to determine the accuracy of electronic axiography, while diagnosing temporomandibular joint disorders. A statistical analysis was performed in order to evaluate whether significant differences between the length of the measured movements in asymptomatic and symptomatic subjects could be found. A symptomatic group consisted of 51 subjects with temporomandibular disorders. A control group consisted of 43 subjects without signs and symptoms of temporomandibular joint disorders. Each subject was registered by the GAMMA CADIAX system for registration of position and movement of the lower jaw, which consists of a conventional SAM axiograph, an electronic device for drawing curves by means of a computer. No significant differences were found between the groups of subjects for the measured variables. The results of the length of the mandibular and condyle movements, along with the rotational capacity of the mandible are important, in spite of unreliable indicators of temporomandibular joint function. Description analysis of a graphic recording of mandibular and TMJ movement remains an accurate evaluation method for the determination of TMJ dysfunction

Initial Treatment of Prosthetic Patients with a Michigan Splint

Michiganska udlaga prekriva sve okluzijske plohe zubnoga niza, a služi u inicijalnom protetskom liječenju u dijagnostici i liječenju temporomandibularnih poremećaja. Najčešća je indikacija mialgija žvačnoga mišičja i artralgija čeljusnoga zgloba. Udlagom se otklanjaju simptomi i postiže samonamještanje donje čeljusti u nov pacijentu prikladan položaj bez subjektivnih smetnji. Kako bi se zaštitila tvrda zubna tkiva zbog bruksizma, može se nositi duže vrijeme. Zbog stabilnosti i retencije na ležištu češće se odabire gornji zubni niz. Okluzijska ploha udlage izvedena je u obliku ravnih ploha. Na njima se ostvaruju ravnomjerni dodiri radnih kvržica antagonističke čeljusti u području slobode u centriku. U ekskurzivnim kretnjama donje čeljusti ostvaruje se vođenje očnjakom i diskluzija preostalih zuba. Nošenje udlage prekida se postupno u intervalima tako da se pacijent polagano odvikava i pomalo smanjuje duljinu nošenja. Pretpostavke uspješnoga liječenja jesu pozorna izradba udlage u artikulatoru, redovita kontrola stanja tijekom nošenja udlage i kontrola okluzijskih odnosa.The Michigan splint covers all occlusal surfaces of the dental arch and is used in initial prosthetic treatment during the diagnosis and treatment of temporomandibular disorders. The most frequent indication is myalgia of the masticatory muscles and arthralgia of the temporomandibular joint. The splint eliminates symptoms and realises self-positioning of the mandible into a new position, which is acceptable for the patient. It can be worn for a longer period with the object of protecting the hard dental tissue due to bruxism. Because of stability and retention on the base the upper dental arch is more frequently chosen. The occlusal surface of the splint is fabricated in the form of flat surfaces on which equal contacts of the working cusps of the antagonistic jaws are achieved in the area of freedom in the centric. In excursive movements of the mandible disocclusion of the remaining teeth is realised, guided by the canine. Interrupted wearing of the splint follows during an interval of gradual disuse and reduction in the period of wearing. Success of the treatment is conditioned by careful fabrication of the splint in the articulator, regular check-ups while wearing the splint and occlusal relations