Variação da aplicação da força de palpação digital utilizada no exame clínico de disfunção temporomandibular e dor orofacial

OBJECTIVE:The present research aims to evaluate the calibration of digital palpation pressure as well as to assess the inter-examiner variation and mean pressure used by a sample consisting of 56 professionals of the TMJ disorders and Orofacial Pain area.METHODS:Each participant was asked to press a digital balance to approach 1.0 kg and subsequently 0.5 kg without seeing the display, in order to obtain a blind data. The values of 1.0 kg and 0.5 kg are recommended by the Research Diagnostic Criteria for Temporomandibular Disorder in the refined Axis I, the Physical Assessment. Participants were considered calibrated when they applied the correct pressure in at least 4 of the 5 measurement taken; within a 20% variation interval (pressures between 0.4 and 0.6 kg were acceptable for the reference value of 0.5 kg and between 0.8 and 1.2 kg for the reference value of 1.0kg). The t-student test was used to analyze data (p≤0.05).RESULTS:70% of the sample was classified as non- calibrated for the 0.5 kg pressure while 57% were not calibrated for the 1.0 kg pressure. The mean inter-examiner variations, 0.3 kg for the pressure set at 0.5kg and 0.6 kg for the pressure set at 1.0 kg, were considered high.CONCLUSION:The mean pressures applied by participants (0.7 kg for joint palpation and 1.4 kg for muscle palpation) were also considered high in comparison with those recommended by the Research Diagnostic Criteria for Temporomandibular Disorder, but acceptable according to the tendency of applying higher values of 1.0 - 1.5 kg, as proven by recent study.OBJETIVO:Avaliar a calibração da força de palpação digital, bem como determinar a variação intra-examinador e a força média aplicada por uma amostra composta de 56 profissionais que atuam na especialidade de disfunção temporomandibular e dor orofacial.MÉTODOS:Foi solicitado a cada participante que pressionasse o centro de uma balança digital, sem visualizar o display, o valor que acreditasse ser correspondente à 1,0 kg e, posteriormente, a 0,5 kg, recomendados pelo protocolo de exame físico do Eixo I do Consortium, the Research Diagnostic Criteria for Temporomandibular Disorders. Foram considerados calibrados aqueles que aplicassem a força correta, aceitando-se uma variação de 20% (entre 0,4 e 0,6 kg para o menor valor e 0,8 a 1.2 kg para o maior valor), em 4 das 5 aferições realizadas. Na análise dos dados foi utilizado o teste t de Student (p≤0,05).RESULTADOS:70% da amostra foi classificada como não calibrada para a força de 0,5 kg e 57% não calibrada para 1,0 kg. A variação média intra-examinador de 0,3 kg para o peso de 0,5 kg e 0,6 kg para o de 1,0 kg foram consideradas altas.CONCLUSÃO:A força média aplicada pelos participantes (0,7 kg para palpação articular e 1.4 kg para palpação muscular) foi maior que o recomendado pelo Consortium, the Research Diagnostic Criteria for Temporomandibular Disorders, entretanto encontra-se de acordo com a tendência em aplicar valores mais altos entre 1,0 e 1,5 kg, validado em estudo recente.Centro de Excelência OdontológicaFaculdade São Leopoldo MandicUniversidade Federal de São Paulo (UNIFESP) Departamento de MorfologiaUNIFESP, Depto. de MorfologiaSciEL

Use of Bone Marrow Aspirate Concentrate (BMAC) Associated with Hyperbaric Oxygenation Therapy in Maxillary Appositional Bone Reconstruction. A Randomized Clinical Trial

Objectives: The objective of this study was to evaluate bone reconstruction using xenograft alone and associated with bone marrow aspirate concentrate (BMAC) and hyperbaric oxygen therapy. Material and Methods: Twenty-four maxillary edentulous patients were randomly assigned into three groups: Control group (CG)—xenograft bone alone (n = 8); Group 1 (G1)—xenogeneic bone block combined with BMAC (n = 8), and Group 2 (G2)—xenogeneic bone block combined with BMAC and hyperbaric oxygenation (n = 8). Bone biopsies were harvested 6 months after grafting. Vital Mineralized Tissue (VMT), Non-vital Mineralized Tissue (NVMT), and Non-Mineralized Tissue (NMT) were measured. Computed tomography was also performed on three occasions T0 (preoperative), T4 (4 months postoperative), and T8 (8 months postoperative). The difference between T4 and T8 values with respect to T0 was used to determine the thickness level gain after 4 and 8 months, respectively. Results: The tomographic evaluation did not show significant differences between the groups either at 4 or at the 8 months postoperatively. Regarding the histomorphometric analysis, CG had the lowest percentages of VMT (36.58 ± 9.56%), whereas G1 and G2 had similar results (55.64 ± 2.83% and 55.30 ± 1.41%, respectively). Concerning NMT and NVMT levels, the opposite was observed, with CG levels of 51.21 ± 11.54% and 11.16 ± 2.37%, G1 of 39.76 ± 11.48% and 3.65 ± 0.87%, and G2 of 40.3 ± 11.48% and 4.10 ± 0.87%, respectively. Conclusions: The use of bone block xenograft associated with BMAC resulted in a significant increase of bone neoformation when compared to the xenograft alone, though hyperbaric oxygenation did not enhance the results.Odontologí

Padrão de desoclusão em indivíduos com fissura lábio-palatina completa

OBJECTIVE: to analyze the pattern of disocclusion during excursive mandibular movements and presence or absence of occlusal interferences and occlusal pathologies (gingival recession and abfraction). METHOD: examination of 120 individuals divided into two groups, as follows: Group 1 - 90 patients with complete cleft lip and palate (study group), subdivided into 30 patients with complete left unilateral cleft lip and palate, 30 patients with complete right unilateral cleft lip and palate and 30 patients with complete bilateral cleft lip and palate; Group 2 - 30 individuals without clefts (control group). RESULTS: 58.8% of patients in Group 1 presented unilateral or bilateral canine guidance, 26.6% presented unilateral or bilateral group function and 54.4% presented lateral movements through the posterior teeth. Regarding protrusive movements, 80% presented anterior guidance and 20% presented posterior guidance. In Group 2, 69.6% of individuals presented unilateral or bilateral canine guidance, 43.2% presented unilateral or bilateral group function and only 13.3% presented lateral movements through the posterior teeth; 3.4% presented protrusion through the posterior teeth. CONCLUSIONS: there was no difference in the pattern of disocclusion between subgroups of patients with clefts. Group 2 presented predominance of bilateral group function, whereas Group 1 presented a higher prevalence of posterior guidance during lateral movements. Protrusion occurred primarily through anterior guidance in Group 2 and through the posterior teeth in Group 1. There was high prevalence of occlusal interferences at the molar area for both groups, yet with no correlation with occlusal pathologies (recession and abfraction).OBJETIVO: avaliar o padrão de desoclusão apresentado nos movimentos excursivos mandibulares e a presença ou não de interferências oclusais e patologias relacionadas à oclusão (recessão gengival e abfração). MÉTODO: exame de 120 indivíduos, divididos em 2 grupos: Grupo 1 - 90 pacientes com fissura completa de lábio e palato, subdivididos em 30 pacientes com fissura completa de lábio e palato unilateral esquerda, 30 pacientes com fissura completa de lábio e palato unilateral direita e 30 com fissura completa de lábio e palato bilateral; e Grupo 2 - 30 indivíduos sem fissuras (grupo controle). RESULTADOS: 58,8% do Grupo 1 apresentaram guia canina uni ou bilateralmente, 26,6% apresentaram desoclusão com função em grupo uni ou bilateral e 54,4% realizaram estes movimentos laterais através dos dentes posteriores; 80% dos pacientes do Grupo 1 realizava protrusão pelos dentes anteriores e 20 % pelos posteriores. Para o Grupo 2, guia canina uni ou bilateral foi observada em 69,6% dos indivíduos, 43,2% apresentaram função em grupo uni ou bilateral e somente 13,3% realizaram os movimentos laterais pelos dentes posteriores. Apenas 3,4% dos indivíduos do Grupo 2 apresentaram protrusão pelos dentes posteriores. CONCLUSÕES: não houve diferença estatisticamente significativa no padrão de desoclusão entre os subgrupos de pacientes com fissuras. O Grupo 2 apresentou predominância de função em grupo bilateral, enquanto o Grupo 1 apresentou maior prevalência de guia posterior durante os movimentos laterais. A protrusão ocorreu principalmente por guia anterior no Grupo 2 e pelos dentes posteriores no Grupo 1. Houve alta prevalência de interferências oclusais na região de molares para ambos os grupos, entretanto sem correlação com patologias oclusais (recessão e abfração)

Prospective study of a group of pre-university students evaluating anxiety and depression relationships with temporomandibular disorders

Objectives: The aim of this prospective longitudinal study was to evaluate the relationships between anxiety, depression, and temporomandibular disorders (TMD) in a sample of pre-university students submitted to a stressful event. Study design: 153 students from a pre-university course (82 females and 71 males between 16 and 31 years old) were given a survey about TMD symptoms and a survey about anxiety and depression scale at the beginning and the end of the preparatory course (August 2009-T1, and November 2009-T2). Results: Results were analyzed using a chi-square test and Odds Ratio (OR), significance level of á = 0.05. Statistical significance were found to depression rates in students with TMD (16% on T1 and 26% on T2, p = 0.001) as well as in general sample (12% on T1 and 22% on T2, p = 0.009), anxiety and TMD symptoms presented constant rates in both periods. Increased risk of having TMD were found in participants with anxiety (OR 2.6 in T2 and 5.6 in T1) and depression (2.0 in T2 and 3.3 in T1), but only anxiety reach statistical significance in both periods. Conclusions: TMD symptoms were a fluctuating variable that exchange between some individuals of this study. Independently of the TMD, depression rates significant increased in the evaluated period. Finally, anxiety was the psychological symptom related to the increased risk of having TMD

Maxillary Sinus Augmentation Combining Bio-Oss with the Bone Marrow Aspirate Concentrate: A Histomorphometric Study in Humans

Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC) method to a xenogeneic bone graft (Bio-Oss) in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years), 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n=8) or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n=8). Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p0.05) of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.). Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures

Relação entre a densidade mineral óssea e a resistência à compressão de blocos ósseos xenógenos / Relationship between bone mineral density and compressive strength of xenogenous bone blocks

O objetivo deste estudo foi avaliar a densidade mineral óssea (DMO), a resistência final à compressão (RFC), e a eventual correlação entre os valores dessas variáveis, de quatro blocos ósseos xenógenos comercialmente disponíveis no Brasil para aplicações em implantodontia. Trinta e dois espécimes dos materiais de enxertia analisados foram divididos em 4 grupos de estudo (n = 8): Grupo 1 (G1), Biocollagen (Bioteck, Arcugnano, Itália); Grupo 2 (G2), Bio-Graft, (Geistilich, Wolhusen, Suíça); Grupo 3 (G3), OrthoGen (Baumer, Mogi Mirim, SP, Brasil); e Grupo 4 (G4), Bonefill (Bionnovation, Bauru, SP, Brasil). A DMO foi determinada por meio da análise da densidade óptica dos materiais, observada em imagens tomográficas de alta definição, e expressa em unidades Hounsfield (HU). A RFC foi determinada por meio de um ensaio mecânico de compressão e expressa em Newton (N). Os valores de DMO encontrados para os grupos G1, G2, G3 e G4 foram significativamente diferentes, a saber, 354,3 HU, 317,7 HU, 206,5 HU e 145,6 HU, respectivamente (p ? 0,05). Os valores de RFC encontrados para os grupos G1, G2, G3 e G4 também foram significativamente diferentes, a saber, 685,18 N, 563,18 N, 915,20 N e 1399,70 N, respectivamente (p ? 0,05). Observou-se uma correlação positiva e moderada entre a DMO e a RFC apenas no G4 (p = 0,015; r2 = 0,655). A análise dos resultados demonstrou que os blocos de enxerto ósseo xenógenos com uma menor DMO tendem a ter uma maior RFC

Procedures in Implantology, Prosthodontics and Surgery/ by André Antonio Pelegrine [and three others].

This book describes the most commonly used techniques in Oral Rehabilitation. It has been designed in a step-by-step manner, using study models to standardize how procedures should be performed in an ideal scenario. In this textbook, every chapter contains the description of a technique, its aim and the rationale for each step, which provides students with the tools to grasp the logical reasoning behind each procedure. The volume is divided into three parts: (1) Surgery; (2) Tooth-supported prosthodontics and (3) Implant-supported prosthodontics.This textbook is rich in photographic images and.1 online resourc

Distribution of stress on TMJ disc induced by use of chincup therapy: assessment by the finite element method

ABSTRACT Objective: To assess the distribution of stress produced on TMJ disc by chincup therapy, by means of the finite element method. Methods: a simplified three-dimensional TMJ disc model was developed by using Rhinoceros 3D software, and exported to ANSYS software. A 4.9N load was applied on the inferior surface of the model at inclinations of 30, 40, and 50 degrees to the mandibular plane (GoMe). ANSYS was used to analyze stress distribution on the TMJ disc for the different angulations, by means of finite element method. Results: The results showed that the tensile and compressive stresses concentrations were higher on the inferior surface of the model. More presence of tensile stress was found in the middle-anterior region of the model and its location was not altered in the three directions of load application. There was more presence of compressive stress in the middle and mid-posterior regions, but when a 50o inclined load was applied, concentration in the middle region was prevalent. Tensile and compressive stresses intensities progressively diminished as the load was more vertically applied. Conclusions: stress induced by the chincup therapy is mainly located on the inferior surface of the model. Loads at greater angles to the mandibular plane produced distribution of stresses with lower intensity and a concentration of compressive stresses in the middle region. The simplified three-dimensional model proved useful for assessing the distribution of stresses on the TMJ disc induced by the chincup therapy

Distribution of stress on TMJ disc induced by use of chincup therapy: assessment by the finite element method

<div><p>ABSTRACT Objective: To assess the distribution of stress produced on TMJ disc by chincup therapy, by means of the finite element method. Methods: a simplified three-dimensional TMJ disc model was developed by using Rhinoceros 3D software, and exported to ANSYS software. A 4.9N load was applied on the inferior surface of the model at inclinations of 30, 40, and 50 degrees to the mandibular plane (GoMe). ANSYS was used to analyze stress distribution on the TMJ disc for the different angulations, by means of finite element method. Results: The results showed that the tensile and compressive stresses concentrations were higher on the inferior surface of the model. More presence of tensile stress was found in the middle-anterior region of the model and its location was not altered in the three directions of load application. There was more presence of compressive stress in the middle and mid-posterior regions, but when a 50o inclined load was applied, concentration in the middle region was prevalent. Tensile and compressive stresses intensities progressively diminished as the load was more vertically applied. Conclusions: stress induced by the chincup therapy is mainly located on the inferior surface of the model. Loads at greater angles to the mandibular plane produced distribution of stresses with lower intensity and a concentration of compressive stresses in the middle region. The simplified three-dimensional model proved useful for assessing the distribution of stresses on the TMJ disc induced by the chincup therapy.</p></div