Istodobna pojavnost boli u području glave, lica i vrata te depresije u ratnih veterana s post-traumatskim stresnim poremećajem

This study investigated the relationship between chronic head, face and neck pain, and the level of depression in Croatian war veterans with post-traumatic stress disorder (PTSD). The presence of self-reported pain, pain on digital palpation, and pain severity in masticatory and neck muscles, temporomandibular joints and sinuses, as well as the level of depression were assessed in a group of war veterans with PTSD (n=52). Control groups consisted of war veterans without PTSD (n=50) and healthy men that were not engaged in war actions and were free from PTSD (n=50). The number of self-reported pain and number of painful sites were correlated with the level of depression. More self-reported pain and painful sites were recorded in the group of war veterans with PTSD as compared with either war veterans without PTSD or healthy men. Furthermore, PTSD patients mostly suffered from severe depression. There was a statistically significant positive correlation between all investigated pain parameters and level of depression. As the most important finding, the present study demonstrated chronic head, face and neck pain to be related to depression in PTSD patients.Svrha ovoga rada bila je istražiti odnos između kronične boli u području glave, lica i vrata te razine depresije u skupini hrvatskih ratnih veterana s post-traumatskim stresnim poremećajem (PTSP). U skupinama ratnih veterana s PTSP-om (n=52), ratnih veterana bez PTSP-a (n=50) i zdravih muškaraca koji nisu sudjelovali u Domovinskom ratu i ne boluju od PTSP-a (n=50) određivani su: samoizvještavanje boli, broj bolnih točaka i stupanj bolnosti pri digitalnoj palpaciji žvačnih mišića i mišića vrata, temporomandibularnih zglobova i sinusa. Broj samoizvještavajućih bolnih lokacija i broj bolnih točaka pri palpaciji korelirani su sa stupnjem depresije. U skupini ratnih veterana s PTSP-om zabilježeno je statistički značajno više samoizvještavajućih bolnih lokacija i više bolnih točaka pri palpaciji nego u skupinama ratnih veterana bez PTSP-a i zdravih muškaraca. Bolesnici s PTSP-om bili su uglavnom visoko depresivni. Utvrdili smo statistički značajnu pozitivnu korelaciju između svih istraživanih parametara boli i stupnja depresivnosti. Glavni zaključak ovoga istraživanja je da je kronična bol u području glave, lica i vrata povezana s depresijom u bolesnika s PTSP-om

Istodobna pojavnost boli u području glave, lica i vrata te depresije u ratnih veterana s post-traumatskim stresnim poremećajem

This study investigated the relationship between chronic head, face and neck pain, and the level of depression in Croatian war veterans with post-traumatic stress disorder (PTSD). The presence of self-reported pain, pain on digital palpation, and pain severity in masticatory and neck muscles, temporomandibular joints and sinuses, as well as the level of depression were assessed in a group of war veterans with PTSD (n=52). Control groups consisted of war veterans without PTSD (n=50) and healthy men that were not engaged in war actions and were free from PTSD (n=50). The number of self-reported pain and number of painful sites were correlated with the level of depression. More self-reported pain and painful sites were recorded in the group of war veterans with PTSD as compared with either war veterans without PTSD or healthy men. Furthermore, PTSD patients mostly suffered from severe depression. There was a statistically significant positive correlation between all investigated pain parameters and level of depression. As the most important finding, the present study demonstrated chronic head, face and neck pain to be related to depression in PTSD patients.Svrha ovoga rada bila je istražiti odnos između kronične boli u području glave, lica i vrata te razine depresije u skupini hrvatskih ratnih veterana s post-traumatskim stresnim poremećajem (PTSP). U skupinama ratnih veterana s PTSP-om (n=52), ratnih veterana bez PTSP-a (n=50) i zdravih muškaraca koji nisu sudjelovali u Domovinskom ratu i ne boluju od PTSP-a (n=50) određivani su: samoizvještavanje boli, broj bolnih točaka i stupanj bolnosti pri digitalnoj palpaciji žvačnih mišića i mišića vrata, temporomandibularnih zglobova i sinusa. Broj samoizvještavajućih bolnih lokacija i broj bolnih točaka pri palpaciji korelirani su sa stupnjem depresije. U skupini ratnih veterana s PTSP-om zabilježeno je statistički značajno više samoizvještavajućih bolnih lokacija i više bolnih točaka pri palpaciji nego u skupinama ratnih veterana bez PTSP-a i zdravih muškaraca. Bolesnici s PTSP-om bili su uglavnom visoko depresivni. Utvrdili smo statistički značajnu pozitivnu korelaciju između svih istraživanih parametara boli i stupnja depresivnosti. Glavni zaključak ovoga istraživanja je da je kronična bol u području glave, lica i vrata povezana s depresijom u bolesnika s PTSP-om

Influence of the Hinge Axis Transfer Modality on the Three-Dimensional Condylar Shift Between the Centric Relation and the Maximum Intercuspation Positions

Svrha: Željelo se odrediti utječe li način registracije i prijenosa šarnirske osi (prijenos obraznim lukom spram prosječnog montiranja) s ispitanika u artikulator na trodimenzionalni pomak kondila između položaja centrične relacije (CR) i maksimalne interkuspidacije (MI). Materijal i metode: U istraživanju su sudjelovala 32 potpuno ozubljena ispitanika (16 muškaraca i 16 žena). Inkluzijski kriteriji studije obuhvatili su asimptomatske ispitanike s normalnim okluzijskim odnosima (Angleova klasa I) u dobi od 20 do 33 godine (prosječna dob 22,6 ± 4,7 godina). Trodimenzionalni pomak kondila (anteroposteriorni, superoinferiorni i mediolateralni) između položaja centrične relacije (CR) i maksimalne interkuspidacije (MI) bio je analiziran upotrebom indikatora položaja mandibule (MPI, SAM Prazisionstechnik GmbH, München, Njemačka). Rezultati: Prosječni trodimenzionalni pomak kondila iznosio je 0,13 ± 0,12 milimetara za prijenos obraznim lukom i 0,22 ± 0,23 milimetra za prosječno montiranje. Nisu zabilježene statistički značajne razlike između spolova. Rezultati Mann-Whitneyjeva testa pokazali su statistički značajne razlike za anteroposteriorni i superoinferiorni pomak kondila (P < 0,001). Razlika u mediolateralnom pomaku nije bila statistički značajna. Zaključak: S obzirom na odstupanja unutar trodimenzionalnog pomaka kondila, prijenos obraznim lukom pokazao se točnijim u odnosu prema prosječnom montiranju u poluprilagodljivi artikulator. No prosječne vrijednosti trodimenzionalnog pomaka kondila nisu odstupale od normalnih vrijednosti, pa nemaju kliničko značenje. Prema tome, pouzdanima se mogu smatrati oba načina prijenosa (prijenos obraznim lukom i prosječno montiranje) kod asimptomatskih ispitanika s normalnom okluzijom.Purpose. The purpose of the study was to determine whether the hinge axis registration and the transfer modality (facebow transfer vs. average mounting) from the subject to the articulator affect the three-dimensional condylar shift between the centric relation (CR) and the maximum intercuspation (MI) position. Material and Methods. The study was comprised of 32 fully dentate subjects (16 male and 16 female). Only the asymptomatic participants with normal occlusal relations (Angle class I) aged 20 - 33 (mean age 22.6 ± 4.7) met the inclusion criteria. Three-dimensional condylar shift (anteroposterior, superoinferior and mediolateral shift) between the centric relation position (CR) and the maximum intercuspation (MI) position was analyzed by means of Mandibular Position Indicator (SAM Prazisionstechnik GmbH, Muenchen, Germany). Results. The average three-dimensional condylar shift was 0.13 ± 0.12 mm for facebow transfer and 0.22 ± 0.23 mm for average mounting. There were no statistically significant differences noted between genders. The results of the Mann-Whitney test showed statistically significant differences for anteroposterior and superoinferior condylar shift (P < 0.001). However, the difference in the mediolateral shift was not statistically significant. Conclusions. In order to find discrepancies within the three-dimensional condylar shift, facebow transfer proved to be more accurate than the average mounting in the semi-adjustable articulator. However, the average value of three-dimensional shifts of the condyle did not differ from normal values and they did not have clinical significance. Thus, both ways of transfer modalities (facebow transfer and average mounting) in asymptomatic subjects with normal occlusion can be considered reliable

Reproducibility of Centric Relation Techniques by means of Condyle Position Analysis

Svrha: Ovom studijom željela se odrediti ponovljivost kliničkih tehnika centrične relacije (bimanualna manipulacija, vođenje bradom i Rothova metoda) s pomoću analize položaja čeljusnih zglobnih glavica (kondila). Ispitanici i postupci: Trideset dva potpuno ozubljena asimptomatska ispitanika (16 žena i 16 muškaraca) s normalnim okluzijskim odnosom (Angleova klasa I) sudjelovala su u ovoj studiji. Njihova prosječna dob bila je 22,6 ± 4,7 godina. Indikator položaja mandibule (MPI) bio je korišten za analizu trodimenzionalnog [anteroposteriorni (ΔX), superoinferiorni (ΔZ), mediolateralni (ΔY)] pomaka kondila čeljusnih zglobova izazvanog razlikom između položaja centrične relacije (CR) i maksimalne interkuspidacije (MI) na razini zubnih lukova. Rezultati: Prosječna vrijednost i standardna devijacija trodimenzionalnog pomaka kondila testiranih kliničkih tehnika za određivanje CR-a iznosila je 0,19 ± 0,34 milimetra. Značajne razlike unutar njih zabilježene su za anteroposteriorni pomak kondila na desnoj strani straga (Δ Xdn/st; P ≤ 0,012) i za superoinferiorni pomak na lijevoj strani dolje (Δ Zld; P ≤ 0,011); značajne razlike između testiranih tehnika bile su uočene za anteroposteriorni pomak kondila na desnoj strani straga (Δ Xdn/st, P ≤ 0,037), superoinferiorni pomak kondila na desnoj strani dolje (ΔZdd, P ≤ 0,004), na lijevoj strani dolje (Δ Zld, P ≤ 0,005) i na lijevoj strani gore (Δ Zlg, P ≤ 0,007). Zaključak: Bimanualna manipulacija, vođenje bradom i Rothova metoda kliničke su tehnike za određivanje CR-a jednake točnosti i ponovljivosti kod asimptomatskih ispitanika s normalnim okluzijskim odnosom.Purpose: The aim of this study was to determine the reproducibility of clinical centric relation (CR) registration techniques (bimanual manipulation, chin point guidance and Roth’s method) by means of condyle position analysis. Material and methods: Thirty two fully dentate asymptomatic subjects (16 female and 16 male) with normal occlusal relations (Angle class I) participated in the study (mean age, 22.6 ± 4.7 years). The mandibular position indicator (MPI) was used to analyze the three-dimensional (anteroposterior (ΔX), superoinferior (ΔZ), mediolateral (ΔY)) condylar shift generated by the difference between the centric relation position (CR) and the maximal intercuspation position (MI) observed in dental arches. Results: The mean value and standard deviation of three-dimensional condylar shift of the tested clinical CR techniques was 0.19 ± 0.34 mm. Significant differences within the tested clinical CR registration techniques were found for anteroposterior condylar shift on the right side posterior (Δ Xrp; P ≤ 0.012); and superoinferior condylar shift on the left side inferior (Δ Zli; P ≤ 0.011), whereas between the tested CR registration techniques were found for anteroposterior shift on the right side posterior (ΔXrp, P ≤ 0.037) and superoinferior shift on the right side inferior (ΔZri, P ≤ 0.004), on the left side inferior (ΔZli, P ≤ 0.005) and on the left side superior (ΔZls, P ≤ 0.007). Conclusion: Bimanual manipulation, chin point guidance and Roth’s method are clinical CR registration techniques of equal accuracy and reproducibility in asymptomatic subjects with normal occlusal relationship

Influence of background on natural tooth colour coordinates: an in vivo evaluation

The aim of this study was to evaluate the influence of different backgrounds on spectrophotometric colour values of natural teeth. Twenty volunteers (10 males and 10 females) with a mean age of 25years and 9months (±3years and 2months) were each subjected to 4 spectrophotometric measurements of their upper right central incisor. Each sample was measured with alternatively black, 50% grey, white or no background (positive control). ΔE medians ranged from 0.9 to 5.9. All artificial backgrounds presented significant differences (p0.05). If an artificial background needs to be used, as for example when performing in vitro studies, preference should be given to a black background as it approaches best the clinical situation (i.e. no background). Even if no statistically significant differences were found when compared with the grey background, the black background should be preferred due to its lower ΔE medians, standard deviation as well as lower minimum and maximum values

Masticatory Muscle and Temporomandibular Joint Pain in Croatian War Veterans with Posttraumatic Stress Disorder

The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. The clinical examination consisted of palpation of the masticatory muscles, the prominent neck musculature, and TMJ. The examination technique used and the definition of items were previously tested for reliability and validity. 93% of the subjects with PTSD had masticatory muscle tenderness compared to 45.65% of the subjects in the control group (c 2=51.46, p<0.0001). The most frequent painful location in the subjects with PTSD was the left lateral pterygoid site in 88%, and in subjects of the control group the right lateral pterygoid site in 28.26% of cases. The most painful location in the PTSD group was the left lateral pterygoid site in 72%, and in the control group the left posterior digastric in 4.35% of cases. 58% of the subjects with PTSD had TMJ tenderness compared to 3.26% of subjects in the control group (c 2=66.23, p<0.0001). The most frequent painful location of TMJ in both groups was the left posterior capsule; in the PTSD group 38% and in subjects in the control group 2.17% of cases. The most painful location was the left posterior capsule in 28% of subjects with PTSD, while not one subject in the control group reported severe painful sensitivity. The very high frequency and intensity of pain in subjects with PTSD confirms the effect of stress on muscle and joint sensitivity, i.e. perception of pain

Alterations in the Masseter Muscle and Plasma IL-6 Level Following Experimentally Induced Occlusal Interference and Chronic Stress – A Study in Rats

This study was undertaken to examine the alteration of masseter and plasma interleukin-6 after inducing occlusal interference and chronic stress. Male Wistar rats were submitted to chronic stress procedure, exposed to occlusal interference, or exposed to both mentioned procedures. Whole blood and masseter tissue were collected to determine interleukin-6 level, measured by means of ELISA. Masseter pain was evaluated using the orofacial formalin test. Masseter interleukin- 6 level was significantly higher in animals submitted to combination of occlusal interference and chronic stress than in the control group (p<0.05). There was positive and significant correlation between pain response and masseter interleukin-6 level (r=0.5741; p<0.0003). No significant differences in plasma interleukin-6 level were found between groups (p>0.05), as well as no correlation with pain (p>0.05). Combination of occlusal interference and chronic stress leads to strong local reaction characterized by high levels of masseter interleukine-6. High concentrations of muscle interleukin-6 and its correlation with pain point to inflammatory background of masticatory muscle pain

Influence of Chronic Stress and Oclusal Interference on Masseter Muscle Pain in Rat

This study aimed to investigate the individual effects of chronic stress and occlusal interference, as well as their combined influence on masseter muscle pain. Experiments were performed on 28 male Wistar rats. Animals were submitted to chronic stress procedure, exposed to occlusal interference, or exposed to both mantioned procedures. At the end of the procedure animals were submitted to orofacial formalin test, and nociceptive behavioral response was evaluated. Statisticaly significant diference of nociceptive behavioral response in chronicaly stressed rats and in the animals with occlusal interference in comparation to the control group were not obtained (p>0.05). In contrast, nociceptive behavioral response was significantly increased in rats submitted to both of experimental procedures (p<0.01). These findings suggest that only combination of occlusal interference and chronic stress influence masseter muscle pain

Depression, Somatization and Anxiety in Female Patients with Temporomandibular Disorders (TMD)

The aim of this research was to determine the possible differences in degrees of depression, somatization and anxiety between the acute and chronic female patients with temporomandibular disorders (TMD), and whether these differences exist in healthy female patients. Ninety female patients were involved in this research; 60 of them were TMD patients of the Dental Polyclinic, while other 30 females came for a rutine recall visit and had no problem related to TMD. Patients were aged 22 to 67 years, the average age being 38.5±12 years. All patients were asked to fill in the RDC/TMD protocol and three psychological tests (Emotions Profile Index, Somatization Scale and life Events Scale). Following the analysis of the RDC/TMD protocol and psychological tests, it was determined that the chronic female patients had higher depression and somatization scores in comparison with the acute patients (p<0.01); the acute patients self-perceive higher levels of anxiety in relation to the control group; furthermore, the patients reporting higher levels of depression were more inclined to somatization and had experienced a greater number of stress events in the past six months. It is beyond doubt that patients suffering from the TMD’s exhibit higher levels of depression, somatization and anxiety compared to the healthy ones, which proves that physiological factors may play a predisposing role in combination with reduced level of body tolerance to pain, and a decreased tolerance to stress

Group 2 ITI Consensus Report: Prosthodontics and implant dentistry

ObjectivesWorking Group 2 was convened to address topics relevant to prosthodontics and dental implants. Systematic reviews were developed according to focused questions addressing (a) the number of implants required to support fixed full‐arch restorations, (b) the influence of intentionally tilted implants compared to axial positioned implants when supporting fixed dental prostheses (FDPs), (c) implant placement and loading protocols, (d) zirconia dental implants, (e) zirconia and metal ceramic implant supported single crowns and (f) zirconia and metal ceramic implant supported FDPs.Materials and methodsGroup 2 considered and discussed information gathered in six systematic reviews. Group participants discussed statements developed by the authors and developed consensus. The group developed and found consensus for clinical recommendations based on both the statements and the experience of the group. The consensus statements and clinical recommendations were presented to the plenary (gathering of all conference attendees) and discussed. Final versions were developed after consensus was reached.ResultsA total of 27 consensus statements were developed from the systematic reviews. Additionally, the group developed 24 clinical recommendations based on the combined expertise of the participants and the developed consensus statements.ConclusionsThe literature supports the use of various implant numbers to support full‐arch fixed prostheses. The use of intentionally tilted dental implants is indicated when appropriate conditions exist. Implant placement and loading protocols should be considered together when planning and treating patients. One‐piece zirconia dental implants can be recommended when appropriate clinical conditions exist although two‐piece zirconia implants should be used with caution as a result of insufficient data. Clinical performance of zirconia and metal ceramic single implant supported crowns is similar and each demonstrates significant, though different, complications. Zirconia ceramic FDPs are less reliable than metal ceramic. Implant supported monolithic zirconia prostheses may be a future option with more supporting evidence.</p