The therapy of masticatory muscle pain with oral splints Schindler, Hans J; Hugger, Alfons; Türp, Jens C
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen,
2013, Letnik:
107, Številka:
4-5
Journal Article
Recenzirano
Myofascial masticatory muscle pain is the second most frequent pain-related complaint in the orofacial region. Like unspecific musculoskeletal pain in other body segments, masticatory muscle pain is ...characterised by a multifactorial aetiology. The aim of this article is to document the current knowledge about the therapy with oral splints. It is shown that in both the short and long term, oral appliances can achieve sufficient pain relief in the majority of patients. In chronic myofascial jaw pain associated with psychosocial impairment in patients, effectiveness of splint therapy is limited, though. Within an interdisciplinary pain management programme, additional involvement of a psychotherapist is essential.
The purpose of this study was to develop an easy-to-use procedure for individual registration and to test its accuracy. Unlike common principles, the method should be based on a transfer of the ...articulator geometry to the patient.
The system consists of an articulator holding a bite plate in a standard position. The bite plate connects to an electronic recording system, which transfers the articulator's condylar points virtually to the patient's mandible by a centric relation record. The trajectories of the transferred points are recorded during mandibular protrusions and laterotrusions. From the trajectories, sagittal condylar and Bennett angles are measured and are adjusted at the articulator after mounting of the casts via the bite plate. Using a mechanical testing device, the accuracy of the measured angles was examined by comparison with preset values varying from 10 to 60 degrees (condylar angle) and from 0 to 40 degrees (Bennett angle) in 10-degree increments.
The mean deviations of measured condylar angles from preset values ranged between 1.5 and 0 degrees. The mean deviations of the Bennett angles ranged from -0.5 to -1.3 degrees.
The transfer of articulator geometry to the patient reduces the number of individual parameters necessary to imitate jaw motion to the condylar and Bennett angles. This leads to a significant simplification in registration and cast transfer. Since the required parameters are recorded with high accuracy, the method could be an alternative to traditional sophisticated instrumental registration.
The anatomy of the human temporomandibular joint region has been investigated mainly under the conditions of dental occlusion. The aim of the present study was to elucidate the topographical ...situations in other functional positions such as wide-open mouth, protrusion and lateral displacement. The respective mouth positions were adjusted before fixation and controlled by magnetic resonance tomography. The temporomandibular joint regions were embedded in epoxy resin, and cut serially in the sagittal or the frontal plane.
Wide-open mouth: The articular disc lies with its intermediate zone between the articular tubercle and the dorsal convexity of the condylar process, and thus adapts the articulating surfaces of the bones perfectly to each other. Massive enlargement of the retroarticular cushion is seen, whereas the loose connective tissue on the anterior side of the joint appears completely compressed.
Protrusion: The disc lies with its intermediate zone between the convexities of the condylar process and the articular eminence. On the lateral side it appears to be compressed between mandible and temporal bone. The retroarticular cushion is moderately enlarged. The anterior compartment of loose connective tissue is smaller than in occlusion.
Lateral displacement: On the working side the articular disc is in a stabilized position between the bony joint elements. The balancing condyle is in a protruded position with the retroarticular cushion reaching into the dorso-lateral half of the mandibular fossa.
Conclusion: Protrusion appears as the position with the highest mechanical stress upon the articular disc.
The ontogenic profile of expression of four members of the Bcl-2 family (Bcl-2, Bcl-x, Bax and Bak) was examined in the mouse by immunohistochemistry using paraffin sections. All four members were ...expressed in changing patterns during critical stages of tooth morphogenesis. Expression was detected in epithelial cell populations including the dental lamina, internal dental epithelium (IDE; differentiating ameloblasts), stratum intermedium and stellate reticulum cells, as well as in the condensed dental mesenchyme. The temporo-spatial localization of the various members of the Bcl-2 family in dental epithelium and mesenchyme showed striking overlapping areas but often their expression patterns differed. In general, contemporaneous co-expression of the Bcl-2 and Bax proteins, and of the Bcl-x and Bak proteins was noted in various types of cells during the developmental process, with the intensity of Bcl-2>Bax and of Bak>Bcl-x. Expression was pronounced at sites where interaction between surface ectoderm and induced mesenchyme takes place, and at the enamel knot, which is regarded as organization/regulating center for tooth development. Around birth, after the structural maturation was accomplished, the expression was down-regulated. The absence of elevated expression of each of these four members of the Bcl-2 family after birth in the teeth suggests that these proteins are relevant during the accomplishment of the basic architecture but not once the structure of the tooth is established.
Practice-related diagnostic classification of orofacial pain Türp, Jens Christoph; Hugger, Alfons; Schindler, Hans
Schweizer Monatsschrift fur Zahnmedizin = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia,
2004, Letnik:
114, Številka:
5
Journal Article
In this article, a practical diagnostic classification of orofacial pain for use in the general dental practice is presented. In contrast to the detailed taxonomy proposed by Okeson (1995), this ...classification is limited to those pain conditions dentists are confronted with most frequently. Furthermore, the fundamental differences of somatic versus neuropathic pain, localized versus widespread pain, and acute versus chronic pain are emphasized. Principles of managing the different pain entities are suggested.
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