Background: A removable partial denture (RPD) is a common treatment available for restoration of partially edentulous ridges. Longitudinal studies indicate that RPDs have been associated with ...increased gingivitis, periodontitis, and abutment mobility.
Methods: A total of 205 patients with RPDs participated in this study. There were 80 males and 125 females aged 38 to 89, with 123 maxillary and 138 mandibular RPDs. Patients were wearing existing RPDs for different periods ranging from 1 to 10 years. A two‐part questionnaire was devised for this study. In the first part, patients answered questions on gender; age; smoking habits; denture age; denture wearing habits; mouth odor; and problems with food accumulating under the denture base, on the outside surface of the denture, and on the outside surface of remaining teeth after eating. The Kennedy classification, material, denture support, denture base shape, and number of teeth in contact, number of existing clasps, and occlusal rests were categorized. The quality of denture construction was also evaluated. In the second part of the questionnaire, baseline recordings of plaque (PI), gingival (GI), and calculus (CI) indexes were made, and Tarbet index (TI), as well as probing depth PD), gingival recession (GR), and tooth mobility (TM) were measured, both on abutment and non‐abutment teeth.
Results: Significant differences (P <0.01) were noted for PI, CI, GI, PD, TM, and GR between abutment and non‐abutment teeth, with abutment teeth showing more disease.
Conclusions: RPD design plays an important role in the state of the periodontium. Appropriate design and good oral hygiene may decrease the appearance of periodontal disease. J Periodontol 2002;73:137‐144.
Temporomandibular disorders (TMD) are the most common source of orofacial pain of a non-dental origin. The study was performed to investigate the therapeutic effect of the conventional occlusal ...splint therapy and the physical therapy. The hypothesis tested was that the simultaneous use of occlusal splint and physical therapy is an effective method for treatment of anterior disc displacement without reduction.
Twelve patients (mean age =30.5 y) with anterior disc displacement without reduction (according to RDC/TMD and confirmed by magnetic resonance imaging) were randomly allocated into 2 groups: 6 received stabilization splint (SS) and 6 received both physical therapy and stabilization splint (SS&PT). Treatment outcomes included pain-free opening (MCO), maximum assisted opening (MAO), path of mouth opening and pain as reported on visual analogue scale (VAS).
At baseline of treatment there were no significant differences among the groups for VAS scores, as well as for the range of mandibular movement. VAS scores improved significantly over time for the SS&PT group (F=28.964, p=0.0001, effect size =0.853) and SS group (F=8.794, p=0.001, effect size =0.638). The range of mouth opening improved significantly only in the SS&PT group (MCO: F=20.971, p=0.006; MAO: F=24.014, p=0.004) (Figure 2). Changes in path of mouth opening differ significantly between the groups (p=0.040). Only 1 patient in SS&PT group still presented deviations in mouth opening after completed therapy while in the SS group deviations were present in 5 patients after completed therapy.
This limited study gave evidence that during the treatment period lasting for 6 months, the simultaneous use of stabilization splint and physical therapy was more efficient in reducing deviations and improving range of mouth opening than the stabilization splint used alone. Both treatment options were efficient in reducing pain in patients with anterior disc displacement without reduction. Despite of objectively diagnosed disruption of temporomandibular joint anatomy, physiological function was regained.
The aim of the study was to evaluate changes in pain intensity and self-perceived quality of life in patients with temporomandibular disorders (TMD) during stabilization splint therapy. The ...hypothesis was that the clinical subtype of TMD, depending on whether pain is of muscular or temporomandibular joint origin, and pain chronicity (acute vs. chronic pain) differently affect treatment response. Thirty patients were included and treated with a stabilization splint in a 6-month clinical trial. Treatment outcomes included pain-free maximal mouth opening (MO), assisted maximal MO, path of MO, asymmetry in lateral excursions, spontaneous pain intensity (visual analog scale, VAS), and self-perceived quality of life (Oral Health Impact Profile, OHIP-14). Overall, VAS and OHIP-14 scores changed significantly over time (VAS: F = 80.85, p < 0.001; OHIP-14: F = 34.78, p < 0.001). After 6 months, changes in pain intensity did not differ significantly between myofascial pain (MP) and disc displacement (DD) groups (F = 0.497, p = 0.685, effect size = 0.018), or between acute pain (AP) and chronic pain (CP) patients (F = 1.856, p = 0.144, effect size = 0.064). Changes in self-perceived quality of life did not differ significantly between MP and DD groups (F = 0.213, p = 0.847, effect size = 0.008), or between AP and CP patients (F = 0.816, p = 0.489, effect size = 0.029). Linear regression analysis was used to assess the contribution of each predictor variable to the explanation of the OHIP summary score variance. Results showed pain reduction (coefficient = 0.303; 95% CI: 0.120 to 0.485) and MO increase (coefficient = 0.149; 95% CI: 0.037 to 0.260) to be independent predictors of the OHIP-14 summary score changes (R2 = 0.453), whereas other variables did not affect treatment outcome as assessed by OHIP-14. In conclusion, during 6-month stabilization splint therapy, significant changes in VAS and OHIP-14 summary scores were found. However, there were no significant differences in improvement rates between subjects with acute and chronic pain. Furthermore, no significant differences in improvement rates were found depending on whether pain was of muscular or temporomandibular joint origin.
Svrha: Temporomandibularni poremećaj (TMP) najčešći su orofacijalni bolni poremećaj nedentalnog podrijetla. Istraživanje je provedeno kako bi se ispitao učinak istodobne primjene okluzijske
udlage i ...fizikalne terapije. Pritom je postavljena hipoteza da je istodobna primjena okluzijske udlage i fizikalne terapije učinkovita metoda za liječenje anteriornog pomaka zglobne pločice bez redukcije. Materijali i postupci: U istraživanje je bilo uključeno 12 pacijenata (srednja dob = 30,5 god.) s anteriornim pomakom zglobne pločice bez redukcije (prema DKI/TMP-u, potvrđeno magnetskom
rezonancijom) nasumično podijeljenih u dvije skupine: šest pacijenata dobilo je stabilizacijsku udlagu (SU), a šest je liječeno stabilizacijskom udlagom i fizikalnom terapijom (SU-FT). Ishodi liječenja uključivali su maksimalno otvaranje usta bez boli (MO), maksimalno asistirano otvaranje usta (MAO), devijaciju/defleksiju pri otvaranju i bol prema vizualno analognoj ljestvici (VAS). Rezultati: Na početku nije bilo razlika između skupina u jakosti boli prema vizualno analognoj ljestvici i rasponu kretnji donje čeljusti. Tijekom liječenja bol je prema vizualno analognoj ljestvici značajno smanjena u obje skupine (SU-FT F = 28,964, p = 0,0001, veličina učinka = 0,853; SU: F = 8,794, p = 0,0011, veličina učinka = 0,638). Raspon otvaranja usta značajno se povećao samo u skupini SU-FT (MO: F = 20,971, p = 0,006; MAO: F = 24,014, p = 0,004). Skupine su se značajno razlikovale s obzirom na devijaciju/defleksiju pri otvaranju (p = 0,040). Nakon terapije, devijacija tijekom otvaranja usta i dalje se pojavljivala samo kod jednog pacijenta u skupini SUFT, prema njih pet u skupini SU. Zaključak: Unatoč ograničenjima ovog istraživanja pokazalo se da istodobna primjena stabilizacijske udlage i fizikalne terapije tijekom šestomjesečnog liječenja rezultira značajnijim povećanjem raspona otvaranja usta i značajnijim smanjenjem devijacija tijekom otvaranja od stabilizacijske udlage koja se upotrebljava bez fizikalne terapije. Obje terapijske opcije pokazale su se djelotvornima u smanjenju boli kod pacijenata s anteriornim pomakom zglobne pločice bez redukcije. Unatoč objektivno dijagnosticiranom poremećaju temporomandibularnog zgloba, fiziološka funkcija je obnovljena.
The purpose of this study was to evaluate the precision of dimensional measurements of the mandible on orthopantomographic images and thus to evaluate their dimensional reliability. Different ...distances denoted by metal markers were measured on 25 dry mandibles. The same mandibles were then positioned in an orthopantomographic machine, and radiographic images of them were made. Measurements of the same distances were made on the panoramic images and then compared with the results of the measurements on the dry mandibles. All results were statistically analyzed. The results showed significant difference between the magnification factor listed by the manufacturer and calculated magnification factors, the latter being closer to 1.00. The study also showed that linear measurements made on only one side of the panoramic image of a mandible were very close to the actual dimensions of the dry mandible, whereas measurements that extended across the midline of the mandible were greatly enlarged because of large magnification factors; therefore, such measurements should not be made.
Orofacijalni bolni poremećaji (OFP), temporomandibularni poremećaji (TMP) i komorbidna stanja; suvremene koncepcije i edukacija studenata dentalne medicine Orofacijalna bol podrazumijeva bol vezanu ...za tvrda i meka tkiva u području glave, lica i vrata koja putem trigeminalnog živca odašilje impulse koji se u CNS-u interpretiraju kao bol. Glavobolje, neurogena, muskuloskeletna i psihofizička patologija te tumori, infekcije, autoimuni fenomeni i tkivne traume mogu biti u dijagnostičkom opsegu orofacijalne boli. Raznoliki potencijal za bol nastalu u receptivnom području n. trigeminusa razlog je da evaluacija i terapija orofacijalne boli zahtijevaju suradnju različitih grana medicine, pri čemu posebnu zadaću ima dentalna medicina i njezine specijalističke grane. Temporomandibularni poremećaj (TMP) smatra se glavnim područjem orofacijalne boli i većina praktičara uglavnom se fokusira na procjenu, dijagnozu i terapiju toga poremećaja. Šezdesetih je godina W. Bell predložio naziv temporomandibularni poremećaj (engl. TMD, hrv. TMP) koji je postao popularan i opće prihvaćen. Ta sintagma sugerira ne samo probleme u temporomandibularnim zglobovima, nego uključuje i mastikatorne mišiće i sve poremećaje povezane s funkcijom mastikatornog sustava i okolnih tkiva. Za potrebe istraživanja i klasifikaciju ispitanika postoje različiti dijagnostički kriteriji i protokoli, a danas je najčešći RDC/ TMD (Research Diagnostic Criteria) koji dijagnoze razvrstava po dvije osi (os I. s dijagnozama somatskih i os II. s dijagnozama psihogenih podloga,
većinom kod kroničnih TMP-a). Kod kroničnih pacijenata s TMP/OFP-om povećana je mogućnost komorbidnih stanja. U dentalnoj je medicini potreba za suvremenim dijagnosticiranjem i zbrinjavanjem TMP/OFP-a rezultirala uvođenjem posebnog kolegija na dodiplomskoj razini, a i u poslijediplomskoj edukaciji.
Temporomandibular disorder (TMD) is a common name for a series of pathologic conditions with similar signs and symptoms, which can lead to a disturbed and altered function of the stomatognathic ...system. Most of these conditions are of a multifactorial etiology, which can pose difficulties in obtaining a precise and accurate diagnosis. However, TMD is an ever more common and serious problem in contemporary dental practice and at general medical offices, so a more systematic approach in its diagnosis including data collection and interpretation is necessary. Accordingly, accurate diagnosis of TMD requires proper identification and classification of the dysfunction, as well as recognition of the mechanism and origin of pain occurrence.
Abstract Object Few studies quantify reactions of masticatory muscles during clenching at different occlusal positions in individuals with different anterior and posterior guidance relationship and ...different number of working-side occlusal contacts. The hypothesis that altered incisal guidance (IG) and a different number of working-side occlusal contacts in complete denture wearers (CDW) change a pattern of temporal muscle activity and loadings to the mandible during clenching in incisal and lateral positions was tested. Design EMG activity during clenching in incisal (IP) and left (LOP) and right lateral occlusal (ROP) positions was compared between dentate subjects (DS) with steeper IG than condylar guidance (PG) and canine or canine + first premolar guidance in laterotrusive movements with CDWs who had steeper PG than IG and group function. EMG values were expressed as percentages of maximum voluntary clenching in maximum intercuspation (ICP) in each individual. Results The CDWs exhibited significantly higher posterior temporal muscle (TP) activity in IP and during lateral biting on mediotrusive side than DSs. Their coronoid process had to be pulled backward by TP fibers to rotate condyle in a counter-clockwise direction (PG > IG); contrary DSs had to rotate condyle in a clockwise direction to compensate for vertical overlap (IG > PG). Group function allowed more working-side contacts in CDWs and significantly higher anterior temporalis (TA) activity. Conclusion Alteration of IG–PG ratio and a number of occlusal contacts during lateral clenching change a pattern of TA and TP activity in CDWs and a direction of mandibular loadings, although age related changes might also be responsible.
Objective: Temporomandibular disorders (TMD) are the most common source of orofacial pain of a non-dental origin. The study was performed to investigate the therapeutic effect of the conventional ...occlusal splint therapy and the physical therapy. The hypothesis tested was that the simultaneous use of occlusal splint and physical therapy is an effective method for treatment of anterior disc displacement without reduction. Materials and Methods: Twelve patients (mean age =30.5 y) with anterior disc displacement without reduction (according to RDC/TMD and confirmed by magnetic resonance imaging) were randomly allocated into 2 groups: 6 received stabilization splint (SS) and 6 received both physical therapy and stabilization splint (SS&PT). Treatment outcomes included pain-free opening (MCO), maximum assisted opening (MAO), path of mouth opening and pain as reported on visual analogue scale (VAS). Results: At baseline of treatment there were no significant differences among the groups for VAS scores, as well as for the range of mandibular movement. VAS scores improved significantly over time for the SS&PT group (F=28.964, p=0.0001, effect size =0.853) and SS group (F=8.794, p=0.001, effect size =0.638). The range of mouth opening improved significantly only in the SS&PT group (MCO: F=20.971, p=0.006; MAO: F=24.014, p=0.004) (Figure 2). Changes in path of mouth opening differ significantly between the groups (p=0.040). Only 1 patient in SS&PT group still presented deviations in mouth opening after completed therapy while in the SS group deviations were present in 5 patients after completed therapy. Conclusion: This limited study gave evidence that during the treatment period lasting for 6 months, the simultaneous use of stabilization splint and physical therapy was more efficient in reducing deviations and improving range of mouth opening than the stabilization splint used alone. Both treatment options were efficient in reducing pain in patients with anterior disc displacement without reduction. Despite of objectively diagnosed disruption of temporomandibular joint anatomy, physiological function was regained. Key words Temporomandibular Joint; Dislocations; Pain; Occlusal Splints; Exercise Therapy; Physical Therapy Modalities Svrha: Temporomandibularni poremecaj (TMP) najcesci su orofacijalni bolni poremecaj nedentalnog podrijetla. Istrazivanje je provedeno kako bi se ispitao ucinak istodobne primjene okluzijske udlage i fizikalne terapije. Pritom je postavljena hipoteza da je istodobna primjena okluzijske udlage i fizikalne terapije ucinkovita metoda za lijecenje anteriornog pomaka zglobne plocice bez redukcije. Materijali i postupci: U istrazivanje je bilo ukljuceno 12 pacijenata (srednja dob = 30,5 god.) s anteriornim pomakom zglobne plocice bez redukcije (prema DKI/TMP-u, potvrdeno magnetskom rezonancijom) nasumicno podijeljenih u dvije skupine: sest pacijenata dobilo je stabilizacijsku udlagu (SU), a sest je lijeceno stabilizacijskom udlagom i fizikalnom terapijom (SU-FT). Ishodi lijecenja ukljucivali su maksimalno otvaranje usta bez boli (MO), maksimalno asistirano otvaranje usta (MAO), devijaciju/defleksiju pri otvaranju i bol prema vizualno analognoj ljestvici (VAS). Rezultati: Na pocetku nije bilo razlika izmedu skupina u jakosti boli prema vizualno analognoj ljestvici i rasponu kretnji donje celjusti. Tijekom lijecenja bol je prema vizualno analognoj ljestvici znacajno smanjena u obje skupine (SU-FT F = 28,964, p = 0,0001, velicina ucinka = 0,853; SU: F = 8,794, p = 0,0011, velicina ucinka = 0,638). Raspon otvaranja usta znacajno se povecao samo u skupini SU-FT (MO: F = 20,971, p = 0,006; MAO: F = 24,014, p = 0,004). Skupine su se znacajno razlikovale s obzirom na devijaciju/defleksiju pri otvaranju (p = 0,040). Nakon terapije, devijacija tijekom otvaranja usta i dalje se pojavljivala samo kod jednog pacijenta u skupini SUFT, prema njih pet u skupini SU. Zakljucak: Unatoc ogranicenjima ovog istrazivanja pokazalo se da istodobna primjena stabilizacijske udlage i fizikalne terapije tijekom sestomjesecnog lijecenja rezultira znacajnijim povecanjem raspona otvaranja usta i znacajnijim smanjenjem devijacija tijekom otvaranja od stabilizacijske udlage koja se upotrebljava bez fizikalne terapije. Obje terapijske opcije pokazale su se djelotvornima u smanjenju boli kod pacijenata s anteriornim pomakom zglobne plocice bez redukcije. Unatoc objektivno dijagnosticiranom poremecaju temporomandibularnog zgloba, fizioloska funkcija je obnovljena. Kljucne rijeci temporomandibularni zglob; dislokacije; bol; okluzalna udlaga; terapija vjezbanjem; fizikalna terapija
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