DIFFERENCE BETWEEN MANDIBULLAR MOVEMENTS ON ATHLETES WITH INJURIES TO THE STOMATHOGNATIC SYSTEM AND ATHLETES WITHOUT SUCH INJURIES

Abstract

Sve veća popularnost športa i vježbanja, pored zdravstvene koristi, dovodi i do većeg broja ozljeda, a dio tih ozljeda otpada na ozljede stomatognatog sustava. Prema podacima iz literature, ozljede stomatognatog sustava tijekom športa su česte, ali relativno lagane. Traume stomatognatog sustava mogu prouzročiti promjene u odnosima zglobnih tijela temporomandibularnih zglobova, odnosno promijeniti kretnje kondila. Svrha ovog istraživanja je ustanoviti postoje li razlike u kretnjama kondila temporomandibularnih zglobova, a time i mandibule kod športaša koji su zadobili udarac (markotraumu) u lice i športaša koji nisu zadobili udarac u lice tijekom karijere. U istraživanju su sudjelovala 132 športaša; od toga 84 špotaša koji su zadobili udarac u lice i 48 športaša koji nisu zadobili udarac u lice. Športaši koji su zadobili udarac u lice, odmah poslije udarca imali su ukočenost/bol žvačnih mišića, bol u području temporomandibularnih zglobova i limitaciju kretnji mandibule. Nakon nekoliko dana ili tjedana svi simptomi su prvobitno umanjeni, a potom su u potpunosti nestali. U vrijeme istraživanja svi športaši bili su bez simptoma temporomandibularnih promjena prema protokolu RDC/TMD i u potpunosti su zadovoljni funkcijom svojeg stomatognatog sustava tj. nisu imali nikakve subjektivne ili objektivne simptome disfunkcije. Pomoću ultrazvučnog uređaja ARCUSDigma (KaVO, Bieberach an den Ries, Njemačka) svim športašima registrirane su kretnje kondila i protetske simfize. Rezultati ukazuju da športaši koji su zadobili udarac u lice imaju promjene u putanjama kretnji temporomandibularnih zglobova. Športaši koji su preživjeli makrotraumu imaju promjene u kretnjama temporomandibularnog zgloba na strani udarca u vidu limitacije kretnje tijekom protruzije, mediotruzije, laterotruzije i retruzije. Kontralateralni zglob ima veći raspon kretnji protruzije i mediotruzije od prosječnog. To ukazuje na djelovanje kompenzatornog mehanizma stomatognatog sustava koji omogućuje normalno funkcioniranje bez simptoma disfunkcije. Prilikom rekonstruktivnih zahvata kod športaša koji su dobili udarac u lice na desnoj ili lijevoj strani, ukoliko se uzimaju prosječne vrijednosti za programiranje artikulatora, dolazi do stvaranja jatrogenih interferenci koje mogu prouzročiti disfunkciju stomatognatog sustava. Prevenirati i/ili smanjiti broj stomatognatih ozljeda moguće je korištenjem individualnih štitnika za zube. Potrebno je, također, potaknuti edukaciju i informiranost o štitnicima za zube športaša, ali i trenera, roditelja i doktora dentalne medicine kako bi se postotak korištenja štitnika za zube povećao.Objective: The increased popularity of sports and exercising, apart from being beneficial to health, also results in a larger number of injuries, a part of which are also injuries to the stomatognathic system. According to the data from literature orofacial injuries during sports activities are frequent, but relatively minor. Trauma to the stomatognathic system can cause morphological malformation to the parts of temporomandibular joints. Such changes will differ paths and values of condylar movements. Purpose of this investigation is to determine differences between movements of the temporomandibular joints, thereby mandibular movements, in group of athletes who get blow in the face (micro trauma) and athletes who did not get blow to the face in sports career. Methods: The sample consisted of 132 athletes, 84 was athletes who get blow to the face and 48 was who didn’t get blow to the face. Athletes with anamnestic blow to the jaws, immediately after injury, they have had stiffness/pain of masticatory muscles, pain in region of TMJ, and limitation of jaw movements. All symptoms diminished and finally were gone after some days or weeks after injury. In time of investigation all of them were completely without any symptom of temporomandibular dysfunction according to RDC/TMD protocol, and were completely satisfied with function of the stomatognathic system. To all athletes ultrasound device ARCUSdigma (KaVO, Bieberach an den Ries, Germany) was used for tracing movements of mandibular condyle, mandibular movements at the point of mandibular incisors and tracing the paths of movements. Results: The results indicate that athletes who sustained a blow to the face have changes in the paths of movement of temporomandibular joints. Athletes who survived the macro trauma have changes in the path of temporomandibular joints on the impact side, in terms limitation of the path movements in protrusion, mediotrusion, laterotrusion and retrusion. The contralateral joint has a greater range of the path of protrusion and mediotrusion than average. Conclusions: Revealed results suggests that athletes who have had a macro trauma on the one side, joint of that side have limitation of movement, while the contralateral joint has a greater range of protrusion and mediotrusion than average. This suggests the action of compensatory mechanisms of stomatognathic system that allows normal function of the system without any symptoms of temporomandibular joints and/or dysfunction of the system. If reconstructive procedure is need to athletes who get blow to the right or left side of face, and if taking the average value, can cause introduction of the interferences that lead to dysfunction of the entire stomatognathic system. It is possible to prevent injuries to the stomatognathic system or to reduce severity of injuries by wearing individual intraoral custom-fabricated mouthguards. It is therefore necessary to encourage more education and provide more information on mouthguards for athletes, but also for trainers, parents and doctor of dental medicine in order to increase their usage