Trajetoria condilar sagital em protrusão : comparação entre articuladores e metodos de determinação

Orientador: Altair A. Del Bel CuryTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O estudo dos movimentos mandibulares e a determinação da trajetória condilar sagital, durante o movimento de protrusão, têm sido observado em diversos trabalhos da literatura odontológica, cujos resultados demonstraram grande variação. O objetivo deste trabalho foi verificar a relação entre os diferentes métodos propostos para o registro e ajuste da TSCM, empregando, no método Intra-Oral, um articulador do tipo "arcon" (Gnatus 8600) e outro "não-arcon" (Dentatus ARL), verificando também as diferenças nos ângulos obtidos entre estes dois tipos e articuladores, ajustados por um mesmo registro. Os resultados médios obtidos para o método Intra-Oral com articulador "arcon" - Grupo 1 foram: 40,61°, e 40,06°; com articulador "não-arcon" - Grupo 2: de 40,77°, e 43,33°; no método Extra-Oral - Grupo 3: de 45,43°, e 43,37°; no método Radiográfico - Grupo 4: de 53,01°, e 51,97°, para os lados direito e esquerdo respectivamente. Foi observada correlação positiva, para ambos os lados, somente entre os dados do método Intra-Oral (Grupos 1 e 2). Não houve diferenças significantes entre os dados obtidos empregando-se articuladores "arcon" (Grupo 1) e "não-arcon" (Grupo 2) (p>0,05). Pode-se concluir, nas condições experimentais empregadas, que os métodos Radiográfico e Extra-Oral não devem ser utilizados para o ajuste dos articuladores, e ainda que não houve diferenças para o ajuste da TSCM entre os dois tipos de articuladores empregadosAbstract: The study of the mandibular movements and the determination of the condylar sagital pathway during the protrusion movement have been carried out in dental literature and the results obtained demonstrated great variation and controversy among the authors. The purpose of this study is to verify the relationship between the different methods proposed for the registration and adjustment of the condylar pathway using an "arcon" (Gnatus 8600) and a "non-arcon" type (Dentatus ARL), verifying the angle differences obtained, using the same registration. The medium data obtained were, in the Intra-Oral method with the "arcon" type (Group 1), 40,61° to the right side and 40,06° to the left side; with the "non-arcon" type (Group 2), 40,77° to the right side and 43,33° to the left; in the Extra-Oral method (Group 3), 45,43° to the right and 43,37° to the left; in the Radiographic method (Group 4), 53,01° to the right the side and 51,97° to the left. There was correlation (for both sides) between data ofthe Intra-Oral method (Groups 1 and 2). There were no significant differences between the articulators employed (p>0,05). Under these experimental conditions it could be concluded that the Extra-Oral and Radiographic methods should not be used for the adjustment of the articulators without presenting differences related to the Intra-Oral onesDoutoradoDoutor em Clínica Odontológic

Comparative evaluation of the efficacy of occlusal splints fabricated in centric relation or maximum intercuspation in temporomandibular disorders patients

Fabrication of occlusal splints in centric relation for temporomandibular disorders (TMD) patients is arguable, since this position has been defined for asymptomatic stomatognathic system. Thus, maximum intercuspation might be employed in patients with occlusal stability, eliminating the need for interocclusal records. This study compared occlusal splints fabricated in centric relation and maximum intercuspation in muscle pain reduction of TMD patients. Twenty patients with TMD of myogenous origin and bruxism were divided into 2 groups treated with splints in maximum intercuspation (I) or centric relation (II). Clinical, electrognathographic and electromyographic examinations were performed before and 3 months after therapy. Data were analyzed by the Student's t test. Differences at 5% level of probability were considered statistically significant. There was a remarkable reduction in pain symptomatology, without statistically significant differences (p>;0.05) between the groups. There was mandibular repositioning during therapy, as demonstrated by the change in occlusal contacts on the splints. Electrognathographic examination demonstrated a significant increase in maximum left lateral movement for group I and right lateral movement for group II (p;0.05) in the electromyographic activities at rest after utilization of both splints. In conclusion, both occlusal splints were effective for pain control and presented similar action. The results suggest that maximum intercuspation may be used for fabrication of occlusal splints in patients with occlusal stability without large discrepancies between centric relation and maximum intercuspation. Moreover, this technique is simpler and less expensive

Avaliação da efetividade da estimulação neural elétrica por microcorrente (MENS) na dor muscular em pacientes com desordem temporomandibular

The effect of Microcurrent Electrical Nerve Stimulation (MENS) was evaluated and compared with occlusal splint therapy in temporomandibular disorders (TMD) patients with muscle pain. Twenty TMD patients were divided into four groups. One received occlusal splint therapy and MENS (I); other received splints and placebo MENS (II); the third, only MENS (III) and the last group, placebo MENS (IV). Sensitivity derived from muscle palpation was evaluated using a visual analogue scale. Results were submitted to analysis of variance (pA efetividade da Estimulação Neural Elétrica por Microcorrente (MENS) foi avaliada e comparada à terapia por Placas Oclusais em pacientes com desordens temporomandibulares (DTM) de origem muscular. Vinte pacientes foram divididos em quatro grupos. Um recebeu a terapia por placas interoclusais e MENS (I); outro, placas e MENS placebo (II), o terceiro, somente MENS (III) e o último grupo, MENS placebo (IV). Os resultados obtidos foram submetidos a uma análise de variância (

Prevalence of signs and symptoms of the temporomandibular dysfunction and anxiety in a population of brazilian students coming from a municipal school in Jaboticabal, state of São Paulo

Objetivos: Avaliar a prevalência de sinais e sintomas da disfunção temporomandibular e dos diferentes níveis de ansiedade em crianças, por meio de um levantamento epidemiológico em escolares do ensino fundamental. Métodos: Foram selecionados 304 alunos de escolas particulares do município de Jaboticabal, São Paulo, sendo 83 da 4ª série, 117 da 6a série e 104 da 8ª série (Comitê de Ética em Pesquisa: 200501873). A amostragem composta por crianças de ambos os gêneros, com idade entre 9 a 15 anos foi avaliada por meio de três questionários auto-aplicáveis, sendo um deles para quantificar o grau da disfunção temporomandibular (Índice de Fonseca) e outros dois para determinar o nível de ansiedade (IDATE C).Resultados : Observou-se que 64,5% possuem sinais e sintomas de disfunção temporomandibular. Este mesmo grupo apresentou alta pre -valência do nível médio de ansiedade sendo Estado: “Como estou me sentindo” e Traço: “Como eu geralmente me sinto”. Os resultados mostraram 96,7% e 63,5%, respectivamente. Ainda com relação a ansiedade traço (relacionada à personalidade), 36,5% das crianças apresentaram nível alto de ansiedade. Conclusão : A grande parte das crianças do ensino fundamental possui sinais e sintomas de disfunção temporomandibular e apresenta-se bastante ansiosa. _______________________________________________________________________________ ABSTRACTObjectives: The aim of this study was to evaluate prevalence of signs and symptoms of temporomadibular dysfunction and anxiety levels in children, by means of an epidemiological study which was accomplished in scholars from Elementary and Junior High School.Methods: A total of 304 students coming from the Municipal School of Jaboticabal/SP were selected, being 83 from the 4th grades, 117 from the 6th grades and 104 from the 8th grades (Committee of Ethics in Research: 200501873). The sample was composed by children of both genders, ages ranging from 9 to 15 years old. The evaluation was performed by means of three self-applicable questionnaires: one to quantify the temporomadibular dysfunction degree (Index of Fonseca), and two to determine the anxiety level (IDATE C). Results : It was observed that 64.5% presented signs and symptoms of temporomadibular dysfunction. The same group showed high prevalence of anxiety (“How do I feel?”) and Personality Trait anxiety (“How do I usually feel?”). Results showed 96.7% and 63.5%, respec-tively. Still regarding the anxiety related to personality trait 36.5% of the studied children presented high level of anxiety.Conclusion : A great number of children coming from Elementary and Junior High Schools showed signs and symptoms of Temporomadibular dysfunction and anxiety

Temporomandibular joint dysfunction and anxiety in graduate dentistry

As Desordens Temporomandibulares são doenças que afetam as articulações temporomandibulares e músculos da mastigação do aparelho estomatognático. Fatores psicossociais desempenham papel importante na etiopatogenia dessa doença. O objetivo deste estudo é avaliar a relação entre o grau de desordem temporomandibular e o nível de ansiedade em estudantes de graduação em Odontologia, em três períodos do curso (1o ao 4o semestres, 5o ao 7o, e 8o ao 10o semestres), por meio dos questionários auto-aplicáveis Índice Anamnésico de Fonseca e do Inventário de Ansiedade Traço-Estado (IDATE). Os dados foram tabulados e posteriormente analisados por meio dos testes estatísticos Kruskal-Wallis e correlação de Pearson, ao nível de significância de 1%. Os resultados mostraram correlação positiva e diferença estatisticamente significante entre DTM e ansiedade, em todos os períodos avaliados; e um nível mais alto de ansiedade foi observado no período intermediário do curso (5o ao 7o semestres). Concluímos que houve relação diretamente proporcional entre DTM e ansiedade nos alunos avaliados, estatisticamente significante, independente do estágio cursado; o maior nível de ansiedade foi observado no grupo formado por alunos do 5o ao 7o semestres, contudo sem nenhuma significância estatística. Torna-se importante desenvolver uma estratégia para o controle do estresse e da ansiedade dos alunos no curso de graduação em Odontologia. _________________________________________________________________________________ ABSTRACTThe Craniomandibular disorders are illnesses that affect the joints temporomandibulares and muscles of the chew. Psycho-logical and social factors are important role in the etiology of this illness. The objective of this study is to evaluate the relation between the degree of craniomandibular disorders and the level of anxiety in students of graduation in Dentistry, in three periods of the course, by means of the auto-applicable questionnaires Fonseca’s Index and of the State Trait Anxiety Inventory (STAI). The data had been tabulated and analyzed by means of the statistical tests Kruskal-Wallis and correlation of Pearson, to the level of signifcance of 1%. The results had shown to positive correlation and statistically signifcant difference between craniomandibular disorders and anxiety, in all the evaluated periods; e a higher level of anxiety was observed in the intermediate period of the course (5o to 7o semesters). We conclude that it had directly proportional relation between craniomandibular disorders and anxiety in the evaluated students, statistically signifcant, independent of the attended a course period of training; the biggest level of anxiety was observed in the group formed for students of 5o to 7o semesters, however without no signifcance statistics; and is important to develop a strategy for the control of stress it and the anxiety of the pupils in the course of graduation in Dentistry

Factors associated to the occurrence of joint sounds

Objetivou-se neste trabalho verificar a associação do sexo, classe econômica, qualidade do sono e estresse com a ocorrência de vibrações articulares. A população deste estudo constituiu-se inicialmente por 160 indivíduos de ambos os sexos do município de Piacatu, São Paulo, Brasil, nos quais aplicou-se o Questionário de Fonseca, para verificar o grau de DTM. Posteriormente, os indivíduos com disfunção moderada e severa foram classificados economicamente por meio do Critério de Classificação Econômica Brasil (CCEB), responderam à tradução do Questionário de Avaliação do Sono de Toronto (SAQ) e a Escala de Reajustamento Social (SRRS), para verificar o grau de estresse. Realizou-se também exame eletrovibratográfico. Do total, 37 (23,1%) indivíduos apresentavam disfunção moderada ou severa, sendo que destes, 20 (54,1%) eram do sexo feminino, 21 (56,8%) pertenciam a “Classe D”, 29 (78,4%) apresentavam distúrbios do sono, 24 (64,8%) graus mais elevados de estresse e 19 (51,4%) vibração articular. Há associação estatisticamente significativa da qualidade do sono e classe econômica na ocorrência de vibrações articulares.This study aimed to verify the association of gender, economic class, quality of sleep and stress with the occurrence of joint vibration. The population of this study was made up initially by 160 individuals of both sexes in the city of Piacatu, São Paulo, Brazil, which applied the Fonseca’s Questionnaire, to check the degree of temporomandibular joint dysfunction (TMD). Later, individuals with moderate and severe dysfunction were classified economically through the Criterion of Economic Classification Brazil (CCEB), aswered to the translation of the Sleep Assessment Questionnaire of Toronto (SAQ) and the Social Readjustment Rating Scale (SRRS), to verify the degree of stress. There was also an examining of electrovibratographic. From the total, 37 (23.1%) subjects had moderate or severe dysfunction, of which 20 (54.1%) were female, 21 (56.8%) belonged to “D Class”, 29 (78.4%) had sleep disorders, 24 (64.8%) higher degrees of stress and 19 (51.4%) joint vibration. There is a statistically significant association between quality of sleep and economic class in the occurrence of joint vibration

Comparative evaluation of the efficacy of occlusal splints fabricated in centric relation or maximum intercuspation in temporomandibular disorders patients

Fabrication of occlusal splints in centric relation for temporomandibular disorders (TMD) patients is arguable, since this position has been defined for asymptomatic stomatognathic system. Thus, maximum intercuspation might be employed in patients with occlusal stability, eliminating the need for interocclusal records. This study compared occlusal splints fabricated in centric relation and maximum intercuspation in muscle pain reduction of TMD patients. Twenty patients with TMD of myogenous origin and bruxism were divided into 2 groups treated with splints in maximum intercuspation (I) or centric relation (II). Clinical, electrognathographic and electromyographic examinations were performed before and 3 months after therapy. Data were analyzed by the Student's t test. Differences at 5% level of probability were considered statistically significant. There was a remarkable reduction in pain symptomatology, without statistically significant differences (p>0.05) between the groups. There was mandibular repositioning during therapy, as demonstrated by the change in occlusal contacts on the splints. Electrognathographic examination demonstrated a significant increase in maximum left lateral movement for group I and right lateral movement for group II (p0.05) in the electromyographic activities at rest after utilization of both splints. In conclusion, both occlusal splints were effective for pain control and presented similar action. The results suggest that maximum intercuspation may be used for fabrication of occlusal splints in patients with occlusal stability without large discrepancies between centric relation and maximum intercuspation. Moreover, this technique is simpler and less expensive