ELECTROMYOGRAPHIC EVALUATION OF THE EFFICACY OF MYOFUNCTIONAL THERAPY IN PATIENTS WITH ATYPICAL SWALLOWING

ABSTRACT Objectives: Swallowing is a complex physiologic function developing mostly in the first years of life. After 6 years old, if a complete maturation is not achieved, swallowing persists as \u201catypical swallowing\u201d (AS). The therapy provided to re-educate this dysfunction is based on the myofunctional treatment (MFT). The aim of this study was to detect functional (electromyographical) and clinical (orofacial muscular evaluation with score (OMEs) protocol) effects of MFT in a group of patients with AS so to highlight any differences in the muscular activation pattern and muscular orofacial behavior. Materials and Methods: 20 adolescents and young adults (4 males and 16 females, mean age 17.85 years, SD 4.80) with AS were selected for this study. Standardized surface electromyographic (ssEMG) analysis was performed by the same operator to detect the activity of masseter (MM), temporalis (TA) and submental (SM) muscles before (T1) and after (T2) the logopedic treatment. The MFT was performed by the same speech therapist according to the Garliner method for a period of 10 weeks. The speech therapist completed the OMEs protocol at T1 and T2. A Student-t test for paired data was carried out to detect differences between T1 and T2 for both ssEMG and OMEs data. Then, a 1-way ANOVA variance test was performed to detect any differences between the different couples of muscles at T1 and T2. In addition, ssEMG data at T1 and T2 were compared with ssEMG obtained in a control (C) group of 18 adolescents and young adult patients (8 males and 10 females, mean age 17.28 years, SD 2.56) with bimolar class 1 and without AS. Results: From the starting group of 20 patients, 15 patients completed the MFT (4 males and 11 females, mean age 17.72 years, SD 5.21). At T2, AS patients showed a significantly shorter duration of activation for each couple of muscles and for the whole duration act of swallowing (p<.0001) as well as higher intensity of the SM activity (p<.01) than at T1. Within the AS group, at T1 the masticatory muscles (MM and TA) showed lower duration of activation (p<.05) and lower intensity of the spike (p<.0001) than SM. At T2, masticatory muscles also showed lower values for the activation index (IMPACT) (p<.0001) and for the spike position (p<.01) than SM. At T2. The OMEs protocol showed a significant increase for the total evaluation (p<.01) and specifically for appearance and posture (p<.01) and functions (p<.0001). If compared to C group, the AS group at T1 showed significantly longer duration of activation for each couple of muscles and for the whole duration act of swallowing (p<.0001) as well as lower intensity of the SM activity (p<.05) than controls. At T2 all the ssEMG data detected in AS patients showed a general improvement and moved toward the control values. The differences between AS and C groups about the duration of activation of each couple of muscles and the whole duration act of swallowing were lower at T2 than at T1 even if still significantly different from C ones (p<.0001). Conclusion: MFT confirms itself as an effective method in the treatment of AS dysfunction permitting a shortening of the muscular activation pattern, an increase in SM activity and a general improvement in the orofacial muscular behavior making them closer to the data obtained in controls. ssEMG and OMEs protocol represent valid and useful methods in the analysis of the swallowing function and in establishing the effects of the MFT

Cephalometric traits in children and adolescents with and without atypical swallowing : a retrospective study

Aim It has been suggested that atypical swallowing (AS) may negatively influence the skeletal and alveolar development, but its specific effects are still unclear. The aim of this work is to compare the cephalometric characteristics of children and adolescents with and without AS. Materials and methods Study design: Case-control retrospective cross-sectional study. One hundred patients with (AS group) and 100 patients without AS (control group, C) were retrospectively selected. Their cephalometric data before orthodontic treatment were compared using a 3-way ANOVA variance test to detect any differences between groups considering: the type of swallowing (AS vs C); whether or not the second dentition was completed (SDC vs SDNC); and the gender (males-M and females-F). In addition, a Student-t test for unpaired data was carried out to detect differences between M and F within the AS and C groups. Results When compared to the controls, AS patients showed a significantly decreased SNB angle (p&lt;.01), increased ANB and SN^Go. Me angles (p&lt;.0001), increased overjet and lower facial height (p&lt;.01), decreased overbite (p&lt;.0001), and increased proclination of the upper incisors. AS-SDC patients also showed significantly increased alveolar length. Within the AS and C groups, skeletal and alveolar measurements were larger in males, with higher significance in the C group, suggesting a different trend of growth in AS patients. Conclusion AS seems to affect the skeletal growth causing mandibular clockwise rotation, skeletal Class II, open bite and incisor proclination. To compensate for these effects, an increase in alveolar growth together with molar eruption seems to be induced

Implant surfaces exposed to the oral cavity and treated with toothpaste containing oxygen releasing compound : a morphological controlled clinical trial

Aim of the present in vivo study is to assess if a toothpaste containing an oxygen releasing compound (AX) is able to reduce the biofilm formation on implants with rough surface compared to a control toothpaste, without affecting the microstructure of the tested surface. Methods: In this double blind, cross-over, controlled clinical trial, a total of fourteen healthy volunteers were recruited. For each subject, two mandibular splints (test and control) were created with one implant fixed on the right lingual side of the mandibular arch. The splint was continuously worn for 5 days and the daily hygiene was performed wearing the splint and using the test (AX) or control toothpaste. Implants were analyzed at scanning-electron-microscopy and at laser profilometer for the assessment of biofilm adhesion (% of areas free from biofilm-FA) and surface changes (morphology and roughness). Results: FA resulted significantly higher in test than in control implants. No differences were found between groups in term of biofilm organization, surface microstructure and roughness. Discussion: Daily use of toothpaste containing AX seems to reduce the amount of biofilm adherent to the rough implant surface without corrosion or degradation of the titanium surface

Rapid Maxillary Expander and Eruption Guidance Appliance therapy in skeletal Class II: cephalometric considerations

AIM: The use of rapid maxillary expander (RME) combined with eruption guidance appliances (EGA) represents a valid method in the treatment of skeletal Class II deep bite patients. In this paper a retrospective cephalometric study of the effects of RME and EGA therapy in Class II deep bite patients is described and compared with the treatment effects of patients with the same malocclusion treated only by RME. MATERIALS AND METHODS: Pre and post treatment cephalometric radiographs of 47 Class II division 1 deep bite growing patients treated with RME followed by EGA (mean age 9.65 years) (Group 1) were compared with those obtained from a control group (Group 2) of 44 patients (mean age 9.34 years) treated with RME only. The following cephalometric values were analized: SNA; SNB; ANB; SN-PNS.ANS; SN-Go.GN; N-Me; S-Go. RESULTS: Improvement in maxillo-mandibular relationship was observed in both groups with significantly higher decrease of SNA and ANB in group 1. The cranio-maxillary relation shows a tendency to grow downward and backward in both groups. Both anterior and posterior total facial heights showed a significant increase in group 1. CONCLUSIONS: RME followed by EGA therapy in Class II skeletal deep bite patients has shown better results compared with RME therapy without functional appliance

The efficacy of myofunctional therapy in patients with atypical swallowing

Purpose: The myofunctional treatment (MFT) is a conventional therapy in the treatment of oral disease like atypical swallowing (AS). Functional (standardized surface electromyographic analysis\u2014ssEMG) and clinical (\u201corofacial muscular evaluation with score\u201d protocol\u2014OMES) analyses were conducted to detect the effects of MFT (10 weeks session) in a group of patients with AS. Methods: ssEMG was performed to analyze the activity of masseter (MM), temporalis (TA), and submental (SM) muscles before (T1) and after (T2) the MFT in a group of 15 patients. OMES was completed at the same timepoints. A Student-t test was carried out to detect differences between T1 and T2 for ssEMG data, and a signed RANK test was used for OMES ones. One-way ANOVA variance test was performed to detect any differences between the different couples of muscles at each timepoint. Results: After MFT, patients showed a shorter duration of the whole act of swallowing (p &lt;.0001), higher intensity of the SM activity (p &lt;.01) than at T1. At T2 masticatory muscles showed lower values for the activation index (ANOVA, p &lt;.0001) and for the spike position (ANOVA, p &lt;.01) than SM. The OMES protocol showed a significant increase for the total evaluation score (p &lt;.01), appearance-posture (p &lt;.01) and functions (p &lt;.001). Conclusions: MFT permits a shortening of the muscular activation pattern and an increase in SM activity. The improvement of oral functionalities is possible and identifiable thanks to the use of standardized protocols

Craniofacial structures&apos; development in prenatal period : An MRI study

IntroductionThe development of skeletal structures (cranial base, upper and lower) and upper airways spaces (oropharyngeal and nasopharyngeal) of the skull has always been an issue of great interest in orthodontics. Foetal MRI images obtained as screening exam during pregnancy can help to understand the development of these structures using a sample cephalometric analysis. Material and MethodsA total of 28 MRI images in sagittal section of foetuses from 20th to 32th weeks of gestation were obtained to dispel doubts about the presence of skeletal malformations. Cephalometric measurements were performed on MRI T2-dependent images acquired with a 1.5 T scanner. The Software Osirix 5 permits to study sagittal and vertical dimensions of the skull analysing linear measurements, angles and areas of the skeletal structures. ResultsVertical and sagittal dimension of cranial base, maxilla and mandible grow significantly (P<.01) between the second and third trimester of gestational period as well as nasopharyngeal and oropharyngeal spaces (P<.05). High correlation between the development of anterior cranial base and functional areas devoted to speech and swallow is demonstrated (r: .97). ConclusionsThe development of craniofacial structures during foetal period seems to show a close correlation between skeletal features and functional spaces with a peak between the second and third trimester of gestation. MRI images result helpful for the clinician to detect with a sample cephalometric analysis anomalies of skeletal and functional structures during prenatal period

Electromyographic analysis of the oral phase of swallowing in subjects with and without atypical swallowing: A case-control study

Background: Swallowing is a complex physiologic function developing mostly in the first years of life. After 6&nbsp;years old, if mature deglutition is not achieved, swallowing persists as \u201catypical swallowing\u201d (AS). Objective: The aim of this study was to detect any electromyographical differences in the muscular activation pattern in patients with and without AS. Materials and methods: 38 adolescents and young adults were selected for this study: 20 with atypical swallowing (AS group) and 18 without (C group). Standardised surface electromyographic analysis was performed by the same operator to detect the activity of masseter (MM), temporalis (TA) and submental (SM) muscles. A Student t test for unpaired data was carried out to detect differences between the AS and C groups. A 1-way ANOVA was performed to detect any differences between the three couples of muscles. Results: When compared to controls, AS patients showed a significantly longer duration of activity for each couple of muscles and for the whole duration of swallowing act (P&nbsp;&lt;&nbsp;0.0001) as well as lower intensity of the SM activity (P&nbsp;&lt;&nbsp;0.05) than controls. Within the AS and C groups, masticatory muscles (MM and TA) showed lower duration of activation (P&nbsp;&lt;&nbsp;0.01) and lower intensity of the spike (P&nbsp;&lt;&nbsp;0.0001) than SM. Within the C group, masticatory muscles also reached their activation spike earlier (1-way ANOVA, P&nbsp;&lt;&nbsp;0.01) than SM. Conclusion: Two different muscular performance models have been defined: patients with AS showed a longer activity of all the muscles involved with a lower intensity of SM activity than that of controls

Development of a tool to assess the methodological quality of studies reporting on archaeologically excavated human skeletons: an international Delphi study

Methodological bias can directly affect the interpretation of research data. Studies reporting on excavated skeletons represent a valuable source of information in medicine, dentistry, archaeology and anthropology, and forensic sciences. However, these studies represent a specific setting with their own methodology, for which no quality assessment tool is available. The aim was to develop a critical appraisal tool to assess the methodological quality of studies reporting on archaeologically excavated human skeletons. An international Delphi study was therefore conducted to support item generation and ensure content validity for a new tool. Experts from the following domains were consulted: dentistry, forensic sciences, archaeology and anthropology, general medicine, epidemiology, and statistics. Participants judged the relevance and comprehensiveness of items retrieved from the literature. Consensus was predefined as 75% agreement between experts, and achieved within two Delphi rounds. As a result, 44 and 32 participants completed the first and second Delphi rounds, respectively, achieving consensus on 17 items. This research provides the first evidence-based tool for the methodological assessment of studies reporting on archaeologically excavated skeletons. Clinicians and researchers can use this tool for critical appraisal of studies or when performing systematic reviews. Future research will focus on psychometric testing of the newly developed tool.</p