No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Prosthodontic planning in patients with temporomandibular disorders and/or bruxism: A systematic review
Abstract
Statement of problem:
The presence of temporomandibular disorders (TMDs) and/or bruxism signs and symptoms may present multifaceted concerns for the prosthodontist.
Purpose:
The purpose of this systematic review was to evaluate the relationship between prosthetic rehabilitation and TMDs and bruxism.
Material and methods:
Three research questions were identified based on different clinical scenarios. Should prosthodontics be used to treat TMD and/or bruxism? Can prosthodontics cause TMDs and/or bruxism? How can prosthodontics be performed (for prosthetic reasons) in patients with TMDs and/or bruxism? A systematic search in the PubMed database was performed to identify all randomized clinical trials (RCTs) comparing the effectiveness of prosthodontics with that of other treatments in the management of TMDs and/or bruxism (question 1); clinical trials reporting the onset of TMDs and/or bruxism after the execution of prosthetic treatments in healthy individuals (question 2); and RCTs comparing the effectiveness of different prosthodontics strategies in the management of the prosthetic needs in patients with TMDs and/or bruxism (question 3).
Results:
No clinical trials of the reviewed topics were found, and a comprehensive review relying on the best available evidence was provided. Bruxism is not linearly related to TMDs, and both of these conditions are multifaceted. Based on the diminished causal role of dental occlusion, prosthetic rehabilitation cannot be recommended as a treatment for the 2 conditions. In theory, they may increase the demand for adaptation beyond the stomatognathic system's tolerability. No evidence-based guidelines were available for the best strategy for managing prosthetic needs in patients with TMDs and/or bruxism.
Conclusions:
This systematic review of publications revealed an absence of RCTs on the various topics concerning the relationship between TMD and bruxism and prosthodontics. Based on the best available evidence, prosthetic changes in dental occlusion are not yet acceptable as strategies for solving TMD symptoms or helping an individual stop bruxism. Clinicians should take care when performing irreversible occlusal changes in healthy individuals and in patients with TMD and/or bruxism.
... • Impact of bruxism: Bruxism, characterized by teeth grinding or clenching, poses significant challenges in full-arch restorations [18]. The excessive occlusal forces exerted by bruxism can lead to increased mechanical stress on dental restorations, potentially compromising their longevity and structural integrity [19]. ...
... • Long-term implications: Bruxism poses a considerable challenge in the long-term success of full-arch restorations [18]. The continuous occlusal forces exerted during bruxism may lead to wear, chipping, or fracture of restorative materials over time. ...
... Monolithic materials, exemplified by zirconia, are distinguished by their exceptional strength and durability, making them highly resilient to fractures associated with bruxism [18,19]. Their homogeneous structure contributes to enhanced material integrity, enabling greater resistance against wear and chipping caused by bruxing forces [19]. ...
The selection of materials for full-arch restorations remains a critical decision for clinicians, with ongoing debates surrounding the utilization of hybrid versus monolithic materials. This book chapter provides a comprehensive exploration of the considerations, challenges, and implications associated with these material choices. Beginning with an overview of historical and contemporary material landscapes, the chapter delves into the dynamic interplay between hybrid and monolithic materials, examining their respective compositions, clinical suitability, and long-term performance. Discussions encompass a range of factors including prosthetic space requirements, esthetic considerations, clinical challenges such as bruxism and temporomandibular joint issues, as well as patient-specific considerations such as age. Through comparative analyses, the chapter highlights the strengths and weaknesses of each material type, offering insights into their suitability for different clinical scenarios. The chapter concludes with a discussion on future trends and innovations, paving the way for continued advancements in full-arch restoration materials. Overall, this chapter aims to inform clinicians and researchers, facilitating informed decision making and enhancing patient outcomes in implant dentistry.
... Overall, after applying the ROBIS instrument, six systematic reviews were classified as a high risk [9,[32][33][34][35][36] and 25 as a low risk [7,8,[10][11][12][13][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. Regarding the ROBIS domains, it was observed that all systematic reviews in domain 1, were classified as low risk. ...
... In domain 2, thirteen studies were classified as high risk due to an absence of clarity in the applied search strategy and the strategy to retrieve the largest number of studies [9, 32-35, 40, 41, 44, 46, 47, 50, 54, 55], and two were unclear due to an absence of transparency during the process in the search strategy [36,52]. Regarding domain 3, six systematic reviews were classified as high risk [9,[32][33][34][35]55] because they did not present a strategy to minimize errors and avoid bias during the inclusion studies and risk of bias evaluation process. ...
... In domain 4, eight systematic reviews were classified as high risk [9,32,33,35,36,39,48,55] because they did not comment on the heterogeneity of systematic reviews included, and the data to be collected were not reported during the study methodology. The ROBIS evaluation, by domain and their respective questions, are shown in Table S2. ...
Objective
This study aimed to evaluate, qualify, and summarize evidence presented in systematic reviews (SR) on treatments for bruxism.
Methods
The overview was conducted using the PICO strategy: children, adolescents, and adults with bruxism (P) were submitted to different treatments (I) compared to other treatments, placebo, or no treatment (C) in order to evaluate incidence, prevalence, and number of episodes of bruxism (O). The search was carried out in six databases and gray literature up to July 2023. Data were extracted, and the ROBS tool was used, followed by a descriptive synthesis of the results.
Results
A total of 31 SR were included. Sixteen showed a positive effect on episodes of bruxism (BE), while two had negative, one had neutral, and nine had inconclusive effects. Using the risk of bias in systematic reviews tool (ROBIS), risk of bias varied from low (n = 23) to high (n = 5) among the SR. Pharmacological treatment, oral rehabilitation, and other therapeutic approaches presented inconclusive or negative effects on BE, while oral appliances showed controversial effects. Biofeedback, physical therapy, laser therapy, and botulinum toxin showed positive effects on the reduction of BE.
Conclusion
Biofeedback, physical therapy, laser therapy, and botulinum toxin showed positive effects on the reduction of BE; there is still a lack of studies to support the safe and long-term use of these therapies.
Registration number: PROSPERO CRD42021273905.
... La maggior parte del ragionamento alla base della causalità tra malocclusione e TMD, infatti, si basa su prove aneddotiche piuttosto che scientifiche; non c'è evidenza a sostegno di un'aumentata incidenza di TMD nei pazienti con malocclusione [21] . [31][32][33][34] . ...
... Considerazioni pratiche sulla gestione della terapia protesica Sul tema riabilitazione protesica in pazienti affetti da TMD, ad oggi non sono disponibili studi clinici controllati randomizzati (Randomized Controlled Trial, RCTs) e "high-level evidence". In assenza di raccomandazioni o linee guida fondate sull'evidenza scientifica, quando si pianificano modifiche occlusali irreversibili in individui sani e specialmente in pazienti con TMD è raccomandata una condotta terapeutica basata su buon senso e prudenza [31,32] . ...
... Nei casi di TMD l'approccio terapeutico deve essere condotto nel modo più prevedibile possibile [30] . Lavorare con restauri provvisori a lungo termine e utilizzarli come modello per la riabilitazione definitiva, anche se sembrano accorgimenti basati più sull'esperienza del clinico che sull'evidenza scientifica, è ancora probabilmente l'opzione migliore per gestire in sicurezza qualsiasi riabilitazione protesica estesa [31,32] . I cambiamenti occlusali permanenti che comportino una modifica della dimensione verticale dovrebbero essere condotti solo dopo che il paziente ha dimostrato adattabilità alla nuova dimensione verticale [49] (figg. ...
... Several papers suggested that the relationship between TMDs and dental occlusion is weak. 20,21 Nevertheless, patients with TMD symptoms often need a prosthetic treatment, including partial edentulism, esthetic deficiencies, or functional problems. 21,22 Those patients should be managed carefully after a detailed evaluation. ...
... 20,21 Nevertheless, patients with TMD symptoms often need a prosthetic treatment, including partial edentulism, esthetic deficiencies, or functional problems. 21,22 Those patients should be managed carefully after a detailed evaluation. [21][22][23] Different studies introducing iatrogenic changes to dental occlusion reported some interesting considerations. ...
... 21,22 Those patients should be managed carefully after a detailed evaluation. [21][22][23] Different studies introducing iatrogenic changes to dental occlusion reported some interesting considerations. 20,21 Furthermore, as far as bruxism is concerned, several systematic reviews analyzing implant-supported restorations suggest that bruxism may be associated more with mechanical than biological causes. ...
Aim The aim of this systematic review was to evaluate importance of TMJ and assessing the prevalence of temporomandibular joint disorders (TMJD) among the general population. Methodology Five main electronic databases and three grey literature were searched to identify observational studies in which TMJD was diagnosed using the research diagnostic criteria (RDC/TMD) or diagnostic criteria (DC/TMD). The studies were blindly selected by two reviewers based on eligibility criteria. Risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and the “R” Statistics software was used to perform meta-analyses. Results From 2741 articles, 21 were included. Ten studies were judged at low RoB, seven at moderate, and four at high. The TMJD investigated were as follows: arthralgia, disk displacement (DDs) with reduction (DDwR), DDwR with intermittent locking, DDs without reduction (DDwoR) with limited opening, DDwoR without limited opening, degenerative joint disease (DJD), osteoarthritis, osteoarthrosis, and subluxation. The main results from prevalence overall meta-analyses for adults/elderly are as follows: TMJD (31.1%), DDs (19.1%), and DJD (9.8%). Furthermore, for children/adolescents are as follows: TMJD (11.3%), DDs (8.3%), and DJD (0.4%). Considering the individual diagnosis meta-analyses, the most prevalent TMJD is DDwR for adults/elderly (25.9%) and children/adolescents (7.4%).
... It includes instruments for assessing pain behavior, jaw function, and psychosocial functioning and distress. Several papers suggested that the relationship between TMDs and dental occlusion is weak [20,21]. Nevertheless, patients with TMD symptoms often need a prosthetic treatment, including partial edentulism, esthetic deficiencies, or functional problems [21,22]. ...
... Several papers suggested that the relationship between TMDs and dental occlusion is weak [20,21]. Nevertheless, patients with TMD symptoms often need a prosthetic treatment, including partial edentulism, esthetic deficiencies, or functional problems [21,22]. Those patients should be managed carefully after a detailed evaluation [21][22][23]. ...
... Nevertheless, patients with TMD symptoms often need a prosthetic treatment, including partial edentulism, esthetic deficiencies, or functional problems [21,22]. Those patients should be managed carefully after a detailed evaluation [21][22][23]. Different Prosthesis 2022, 4 254 studies introducing iatrogenic changes to dental occlusion reported some interesting considerations [20,21]. Furthermore, as far as bruxism is concerned, several systematic reviews analyzing implant-supported restorations suggest that bruxism may be associated more with mechanical than biological causes [24][25][26][27]. ...
Temporomandibular disorders are a group of conditions affecting the temporomandibular joints, the jaw muscles, and related structures. Patients with temporomandibular signs and/or symptoms frequently present with indications for prosthetic treatment. The management of these patients aims to achieve patient comfort, occlusal stability, and the complex restoration of the teeth. The goal of this review is to provide an overview of the relationship between prosthodontics and temporomandibular disorders and/or bruxism with a focus on the cause-and-effect implications and the strategies for planning prosthetic treatments in patients with temporomandibular disorders and/or bruxism.
... The incidence of TMD is estimated to be 5% to 12% of the population, making it the second most common musculoskeletal disease [2,3]. The need for prosthetic rehabilitation for treating tooth loss, esthetic concerns, or functional problems is common among patients with TMDs [4]. However, these patients are hyper-vigilant to the occlusal and psychological stresses that are often accompanied by prosthodontic treatment, especially if it involves extensive occlusal changes [4,5]. ...
... The need for prosthetic rehabilitation for treating tooth loss, esthetic concerns, or functional problems is common among patients with TMDs [4]. However, these patients are hyper-vigilant to the occlusal and psychological stresses that are often accompanied by prosthodontic treatment, especially if it involves extensive occlusal changes [4,5]. Restorative procedures may be complicated by the presence of TMD [6]. ...
... Patients with TMD symptoms, such as chronic pain, crepitus, and limited mandibular movement, may experience greater discomfort while adapting to their new restorations [3,7]. Therefore, prosthodontic treatment should be planned and implemented carefully, and symptoms should be treated before any permanent restorative procedures [4][5][6]. ...
Background
A 31-year-old woman with crowns, fixed partial prostheses, and dental restorations complained of recurrent pain in the left and right temporomandibular joints during the last 2 years.
Clinical presentation
The symptoms of temporomandibular disorder (TMD) resolved successfully after a 3-month-long treatment with a repositioning splint. Pre- and post-operative cone-beam computed tomography revealed slight changes in the condylar position after splint use. Minimally invasive oral rehabilitation guided by digital design was performed to maintain the acquired stable position. The status of the restorations was good, and the TMD symptoms did not relapse during the 3-year follow-up.
Conclusion
This case report demonstrates the importance of a stable adapted condylar position after extensive prosthodontic treatment.
... A secondary goal of the paper was to clarify that bruxism should not be considered a disorder, but rather assessed as a sign associated with certain underlying habits and conditions as well as some potential clinical consequences. Indeed, high masticatory muscle activity can have negative outcomes such as severe masticatory muscle pain, mechanical fatigue to tooth and restorations and prosthodontic complications [3][4][5][6][7]. Still, it could also be a protective factor for obstructive sleep apnea [8] and gastroesophageal reflux disease (GERD) [9]. ...
... How many years ago did you first start smoking tobacco *daily*? (Item B05 of the GATS) 7. In the *past*, have you smoked tobacco on a daily basis, less than daily, or not at all? (Item B03 of the GATS) i. Daily… ii. ...
Background
Despite the aetiology of awake bruxism (AB) being prevalently linked to psychological factors, several studies suggested that the use of certain substances, such as tobacco smoking, can contribute to the increase in masticatory muscle activities (MMA) during wakefulness.
Objective
The aim of this study is to assess whether there is a correlation between the frequency of awake bruxism behaviours and smoking habits.
Methods
Participants were recruited, without gender or ethnic restriction, at the University of Siena, Siena, Italy, by advertising. Participants completed a questionnaire containing the four‐item patient health questionnaire for anxiety and depression (PHQ‐4) and some items from the Global Adult Tobacco Smoking (GATS) questionnaire. Moreover, they performed one week of awake bruxism behaviours monitoring via the ecological momentary assessment (EMA).
Results
A total of 100 participants (university employees, dentists, undergraduate and post‐graduate students) were included in the study (34 males and 66 females, mean age 24.5 years). Of them, 39% were smokers and 61% were non‐smokers. The multiple variable linear regression analysis results showed a statistically significant correlation between the frequency of awake bruxism behaviours and the PHQ‐4 scores. Specifically, for every 1% increase in PHQ‐4 score, the mean frequency of the AB behaviours increases 5‐fold. Awake bruxism behaviours did not show any statistically significant correlation with the number of smoked cigarettes ( p > 0.05). Mandible bracing significantly correlated with the number of years of smoking ( B = 1.58, p = 0.002).
Conclusions
According to the present study's findings, the frequency of awake bruxism behaviours correlated with symptoms of anxiety and depression but not with smoking status.
... Thus, correction of dental occlusion should not be considered as the primary treatment goal for a TMD patient. 7,[15][16] The standard of care for TMD is currently represented by counseling, cognitive-behavioural therapies, psychological support, occlusal appliances, physiotherapy, pharmacotherapy, with an escalation to surgery in some selected cases. 18,20 As such, prosthodontic treatment is not recommended. ...
... [33][34] In conclusion, considering that no specific occlusal concept has been proven to be superior to the others, the general recommendation for prosthodontists when planning complex prosthodontic treatment is to not put much emphasis on the adaptation capabilities of the stomatognathic system. 16 If important changes are necessary for prosthetic reasons, they should be kept to a minimum and introduced into the patient's mouth gradually and over an extended period of time, in order to evaluate their accommodation capability. The neuroplasticity of the system will allow adaptation. ...
Aim:
The aim of this systematic review is to evaluate the relationship between prosthodontic treatment and temporomandibular disorders (TMD).
Materials and methods:
Two clinical questions have been raised. Can prosthodontic treatment be used as a strategy to manage temporomandibular disorders? Is there any causal relationship between prosthodontic rehabilitation and the onset of TMD? A systematic search was performed in four medical databases to identify Clinical Trials (CT) and Randomized Clinical Trials (RCT) that could answer the two clinical questions.
Results:
Any articles fulfilling the inclusion criteria were found. Therefore, the best available evidence on TMD management and aetiology is discussed in a scoping review with focus on the relationship with prosthodontic treatment.
Conclusions:
Based on current scientific evidence, prosthetic rehabilitation cannot be proposed as a treatment option for TMD patients, based on the effectiveness of other more conservative options as well as the absence of association between features of dental occlusion and TMD. Thanks to the high neuro plastic adaptation skills of the stomatognathic system, prosthodontic rehabilitation cannot be identified as a direct cause of TMD, but clinicians should pay caution when performing relevant occlusal modifications.
... Considering the dearth of evidence for the efficacy of occlusal equilibration in the management of TMD, the evidence for occlusal rehabilitation with fixed restorations is even more scarce and, therefore, to justify the reorganization of a patient's occlusal scheme as a treatment would be a significant leap of faith. 17,18 There are patients who would benefit from a fullmouth reconstruction for prosthodontic reasons who also have a TMD. Following successful conservative treatment of the TMD, this small group should be provided with a prosthodontically ideal occlusion, but with no promise that this will prevent future symptoms. ...
... The management of these patients can be extremely difficult due to their reduced adaptive capacity for occlusal change and, therefore, will often involve a pre-treatment appliance and an extended period of provisionalization. 17 Additive techniques can be used for replacement of missing teeth, and there is research to demonstrate an association between reduced posterior support, through missing posterior units, and TMD symptoms. 19 It has been postulated that such patients posture their mandible to gain better masticatory function. ...
Considering the complex biopsychosocial nature of temporomandibular disorders (TMD), irreversible interventions of any kind should be used with extreme caution. Frequently they are reserved for those patients who have not achieved adequate control with reversible measures and in whom a significant improvement is anticipated. Irreversible restorative interventions range from the simple adjustment of a single restoration or tooth up to an occlusal equilibration, and may use a subtractive, additive or combined approach. This article, the last in a series of six, reviews the available evidence in the use of irreversible restorative interventions in the management of TMD, demonstrates some of the commonly used techniques and provides some guidance for the general dental practitioner (GDP) considering this approach.
CPD/Clinical Relevance: The GDP needs to be aware of when to, and more importantly when not to, consider making irreversible changes to a patient's dentition with the aim of managing their TMD.
... While it is thought that morphological and pathophysiological factors may be related to bruxism, the importance of psychosocial factors in its etiology is becoming clearer, particularly in the case of awake bruxism (6,7). Indeed, psychological and social factors appear to be critical in the transition from non-symptomatic bruxism or teeth clenching to a painful disorder (8). Thus, traditional approaches centered on occlusal interventions are being replaced by more comprehensive approaches which place special emphasis on psychosocial factors which are considered by some authors to be the most important etiopathological factor in bruxism (8)(9)(10). ...
... Indeed, psychological and social factors appear to be critical in the transition from non-symptomatic bruxism or teeth clenching to a painful disorder (8). Thus, traditional approaches centered on occlusal interventions are being replaced by more comprehensive approaches which place special emphasis on psychosocial factors which are considered by some authors to be the most important etiopathological factor in bruxism (8)(9)(10). ...
Numerous studies have analyzed the relationship between psychological factors and bruxism. However, the data are often obscured by the lack of precise diagnostic criteria and the variety of the psychological questionnaires used. The purpose of this study is to determine the association between awake bruxism and psychological factors (anxiety, depression, sociability, stress coping, and personality traits). With this aim, 68 participants (13 males) completed a battery of psychological questionnaires, a self-reported bruxism questionnaire, and a clinical examination. Based on their scores on the bruxism questionnaire and the clinical examination, subjects were divided into two groups. Subjects who met the criteria for “probable awake bruxism” were assigned to the case group (n = 29, five males). The control group (n = 39, nine males) was composed of subjects who showed no signs or symptoms of bruxism in the examination nor in the questionnaire. The probable awake bruxism group presented significantly higher levels of trait and state anxiety, symptoms of somatization, and neuroticism than the control group. Despite this, and when their problem coping strategies were considered, awake bruxers showed higher levels in Positive Reappraisal (p < 0.05), a strategy generally considered as adaptive. In conclusion, although awake bruxers in our study showed larger levels of anxiety, somatization, and neuroticism, they also displayed more adapted coping strategies, while according to previous data TMD patients (which generally also present high levels of anxiety, somatization and neuroticism) might tend to present less adaptive coping styles. Thus, awake bruxism may play a positive role in stress coping, which would be compatible with the hypothesis of mastication as a means of relieving psychological tension. This finding should be further confirmed by future research comparing TMD patients with definitive awake bruxers and controls and using larger and more representative samples.
... Consideration must be given to the biomechanical consequences of bruxism on the TMJ and masticatory muscles [13]. Several systematic reviews [14,15] investigated the association between bruxism and muscle pathology (myalgia) or intra-articular pathology (arthralgia, joint sounds or osseous degeneration). The parameters that are used to describe the TMJ's structural integrity are the shape and inclination of the articular eminentia (the sagittal condylar inclination-SCI and the Bennett angle-BA) [16]. ...
Background/Objectives: Eccentric bruxism is a complex parafunctional activity that involves grinding of teeth and occurs more frequently during sleep. This study aimed to assess differences in condylar parameters (sagittal condylar inclination -SCI and Bennett angle -BA) and mandibular and condylar kinematics during functional and parafunctional movements in bruxers and non-bruxers and to assess a digital method for quantifying eccentric bruxism using an optical jaw tracking system (Modjaw®). Methods: The study group included subjects diagnosed with eccentric bruxism according to validated clinical diagnostic criteria. A control group of non-bruxer subjects with demographic characteristics similar to the study group was considered. Each participant underwent Modjaw® examination twice to assess the recordings’ repeatability. The anterior guidance, mastication, and simulated eccentric bruxism were recorded. The SCI and BA were computed. The trajectories of interincisal inferior point (IIP), left condyle (LC), and right condyle (RC) in the frontal (F), sagittal (S), and horizontal (H) planes were outlined in rectangles to calculate areas of mastication and areas of eccentric bruxism (mm²). Intraclass correlation coefficient (ICC) was used to assess the recordings’ repeatability. Comparisons between groups were performed using Student’s t- and Mann–Whitney tests. The receiver–operator characteristic (ROC) curve was used to assess the diagnostic quality of the digital method. Results: Twenty bruxers (10 F and 10 M) and 20 non-bruxers (10 F and 10 M) were included. The ICC had values higher than 0.85. SCI, BA, and area of mastication for IIP, LC, and RC were similar between the groups (p > 0.05). The area of eccentric bruxism was significantly wider in the bruxers (p < 0.001). According to the ROC curve, the following cut-off areas (mm²) for eccentric bruxism were found in F, S, and H planes: IIP (18.05, 13.43, 16.28); LC (3.74, 10.83, 3.35); and RC (4.21, 10.63, 2.9), corresponding to sensitivity > 0.8, specificity > 0.75 and area under the curve (AUC) > 0.85. Conclusions: Mandibular and condylar kinematics during functional movements were similar in bruxers and non-bruxers. A novel digital method for quantifying eccentric bruxism was found using Modjaw®, which could serve as a tool for early detection of eccentric bruxism before the onset of clinical consequences.
... Bu hastalar dikkatli bir şekilde yönetilmeli ve protetik tedavi uygulayan diş hekimleri TMB'ler ve bruksizm hakkındaki güncel kavramlara hakim olmalıdır. 34 Çalışmaya katılan diş hekimlerinin %63.9'u değerlendirme sırasında hastalarının çoğunun kronik olduğunu bildirmiştir (Tablo 2). Bir TMB akut olduğunda bariz bir etiyolojiye yönelik hızlı bir tedavi uygulanması genelde semptomların azaltılması için yeterliyken, semptomlar uzayıp kronikleştiğinde genellikle oklüzal aparey gibi basit dental prosedürlerle çözülmez. ...
Amaç: Bu çalışmanın amacı, Adana’daki diş hekimlerinin Temporomandibular bozukluklara (TMB) olan yaklaşımını ve TMB’nin konservatif tedavisinde önemli bir yaklaşım olan fizyoterapi hakkındaki farkındalıklarını kesitsel olarak değerlendirmektir. Gereç ve Yöntemler: Araştırmanın evrenini 2024 yılı içerisinde Adana ilinde görev yapmakta olan 1072 diş hekimi oluşturmaktadır. Araştırmada çevrimiçi anket formu veri toplama aracı olarak kullanılmıştır. Anketin içeriğinde demografik ve iş deneyimi, hasta popülasyonu ve yönlendirmeleri ile ilgili sorular, fizyoterapinin rolü ile ilgili bilgilendirici bir poster ve sonrasında bununla ilgili sorular yer almaktadır. Veriler, istatistiksel olarak Ki-kare, Kolmogorov-Smirnov ve Mann Whitney U testleri kullanılarak p
... More invasive treatment options, such as occlusal equilibration, orthodontic correction, and occlusal adjustments with restorations, have also been investigated by researchers. However, systematic reviews highlight the lack of sufficient randomized controlled trials to confirm the effectiveness of these treatments [92,93]. This lack of evidence has led clinicians to emphasize conservative strategies as the gold standard in managing TMD, reserving invasive procedures for cases unresponsive to less invasive therapies. ...
Occlusion plays a fundamental role in the long-term success of dental restorations by influencing both their functional stability and durability. This review explores the occlusal considerations for various restorative modalities, including fixed and removable prostheses, implant-supported restorations, and adhesive restorations. Special attention is given to the biomechanical principles involved, such as force distribution, stress management, and the role of occlusion in temporomandibular joint health. Diagnostic tools, including traditional and digital techniques such as T-Scan and OccluSense, are discussed to highlight their relevance in detecting occlusal disharmony. Additionally, the review examines the effects of parafunctional habits on restoration longevity and the influence of occlusal trauma on prosthetic outcomes. Despite advances in materials and technology, achieving functional occlusion remains essential in minimizing complications and ensuring patient comfort. This review underscores the need for proper occlusal analysis during treatment planning to enhance clinical outcomes and extend the lifespan of dental restorations.
... According to the latest Glossary of Prosthodontic Terms (GPT) 2023, the Tenth Edition, the following definition is ventured: "Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation, and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or maxillofacial tissues by using biocompatible substitutes" [2]. Moreover, this specialty includes the management of temporomandibular joint (TMJ) disorders [3,4], bruxism [5], and maxillofacial patients, offering the prosthetic solution to the rehabilitation of congenital or acquired oral defects such as cleft palate, oral cancer, or traumatic injuries [6]. ...
As the discipline of prosthodontics evolves, it encounters a dynamic landscape characterized by innovation and improvement. This comprehensive analysis underscores future developments and transformative solutions across its various subspecialties: fixed, removable, implant, and maxillofacial prosthodontics. The narrative review examines the latest advancements in prosthetic technology, focusing on several critical areas. The integration of artificial intelligence and machine learning into prosthetic design and fitting processes is revolutionizing the field, serving as a common thread that links these innovative technologies across all subspecialties. This includes advancements in automated diagnostics, predictive analysis, and treatment planning. Furthermore, the review offers a forward-looking perspective on how these innovations are influencing each prosthetic dentistry domain, patient outcomes, and current clinical practices. By thoroughly analyzing contemporary research and emerging technologies, the study illustrates how these advancements represent a growing focal point of interest in developing countries, such as Romania, with the potential to redefine the trajectory of prosthetic rehabilitation and enhance patient care not only within this country but also beyond.
... Among the painful TMD of muscular origin, the most frequent is myofascial pain (MP). At present, the therapeutic management of TMD is approached using a medical multidisciplinary model, and the treatment options range from conservative, noninvasive therapeutic measures to more aggressive treatment interventions [4]. However, in most of the mild and moderate cases of TMD, a significant clinical improvement can be obtained with conservative therapeutic modalities [5][6][7][8][9][10][11][12][13][14]. ...
Objective
The aim of this study is to perform a qualitative and quantitative analysis of the scientific literature regarding the use of acupuncture and laser acupuncture in the treatment of pain associated with temporomandibular disorders (TMDs). The aim of this article was to assess the clinical evidence for acupuncture and laser acupuncture therapies as treatment for temporomandibular joint disorder (TMD).
Materials and methods
This systematic review includes randomized clinical trials (RCTs) of acupuncture and laser acupuncture as a treatment for TMD compared to other treatments. Systematic searches were conducted in 3 electronic databases up to July 2023; PubMed, EMBASE, and SCOPUS databases. All RCTs of acupuncture for TMD were searched without language restrictions. Studies in which no clinical data and complex interventions were excluded. The Cochrane risk of bias tool (RoB 2) tool was employed to analyze randomized controlled trials. A Meta-analysis was performed in order to investigate a quantitative analysis comparing acupuncture and laser acupuncture to placebo.
Results
A total of 11 RCTs met our inclusion criteria. The findings show that acupuncture is short-term helpful for reducing the severity of TMD pain with muscle origin. Meta-analysis revealed that the Acupuncture group and Laser Acupuncture group had a higher efficacy rate than the Placebo control group, showing a high efficacy of Acupuncture and Laser Acupuncture group in the treatment of temporomandibular.
Conclusions
In conclusion, our systematic review demonstrate that the evidence for acupuncture as a symptomatic treatment of TMD is limited. Further rigorous studies are, however, required to establish beyond doubt whether acupuncture has therapeutic value for this indication. However high efficacy of Laser Acupuncture in the treatment of temporomandibular disorders was reported.
... The treatment plan was aimed to correct the cant of the occlusal plane to help reduce TMD symptoms [1] while providing appropriate canine and incisal guidance and eliminating occlusal interferences [2,3]. Reconstructing the cusps is crucial to flattening the occlusal table, but the patient has rejected it, making the task challenging [4][5][6]. To gain knowledge about the 3D condition of the matter, we took a CT X-ray [7][8][9]. ...
Clinicians in daily orthodontic practice will face referral cases from another orthodontist; the reasons are variable, from because the patient moved to a new location, being unable to finish the case, or patient dissatisfaction. Most of the time, there will be no reason to reject the inquiry and to continue the treatment as much as possible. The case is a skeletal Class III with extracted left and right upper first bicuspids. All the cusps of the posterior teeth were flattened, with the anterior relation being end-to-end. The cant of the occlusal plane higher on the right side is obvious. The patient suffered from temporal mandibular disorder (TMD) and found it difficult to chew without pain. The TMD might have been related to the one-sided clenching habit as well as the deviated occlusal plane. As the patient refused surgical treatment, all efforts focused on how to bring the case to a better condition for the benefit of the patient and to finish the orthodontic treatment. A modified surgical plate (Anka plate) was used to treat the case, and the results were summarized and reported.
... analog, digital, milled, occlusal device, occlusion, precision 1 | INTRODUCTION Temporomandibular disorders (TMD), and bruxism are common conditions with high prevalence rates reported in clinical practice. 1,2 For the vast majority of clinicians an occlusal device (OD) is the first evidence-based treatment of choice for these conditions. [3][4][5][6][7] Over recent years, the use of intraoral Scanners (IOSs) have become more widespread in all dental disciplines. ...
Objective:
To evaluate the volumetric changes on occlusal surface of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal devices fabricated following a fully digital workflow after occlusal adjustment, compared to those fabricated with an analog workflow.
Materials and methods:
Eight participants were included in this clinical pilot study, receiving two different occlusal devices fabricated with two different workflows, fully analog and fully digital. Every occlusal device was scanned before and after the occlusal adjustments to compare the volumetric changes using a reverse engineering software program. Moreover, three independent evaluators assessed a semi-quantitative and qualitative comparison using visual analog scale and dichotomous evaluation. The Shapiro-Wilk test was performed to validate normal distribution assumption, and a dependent t-Student test for paired variables was used to determine statistically significant differences (p-value < 0.05).
Results:
The root mean square value was extracted from the 3-Dimensional (3D) analysis of the occlusal devices. The average values of the root mean square were higher for the analogic technique (0.23 ± 0.10 mm) than the digital technique (0.14 ± 0.07 mm) but the differences were not statistically significant (paired t-Student test; p = 0.106) between the two fabrication techniques. The semiquantitative visual analog scale values between the impression for the digital (5.08 ± 2.4 cm) and analog (3.80 ± 3.3 cm) technique were significant (p < 0.001), and statistically significant differences values were assessed for evaluator 3 compared to the other evaluators (p < 0.05). However, the three evaluators agreed on the qualitative dichotomous evaluation in 62% of the cases, and at least two evaluators agreed in 100% of the evaluations.
Conclusions:
Occlusal devices fabricated following a fully digital workflow resulted in fewer occlusal adjustments, as they could be a valid alternative to those fabricated following an analog workflow.
Clinical significance:
Fabricated occlusal devices following a fully digital workflow could have some advantages over analog workflow such reduce occlusal adjustments at delivery appointment, which can result in reduced chair time and therefore increased comfort for the patient and clinician.
... On the contrary, the clinician should be aware that such patients may be more complex due to those problems. 5 Similarly, the correction of dental occlusion has even been extended by some practitioners to the "correction" of body posture abnormalities, without this treatment being backed up by any solid scientific evidence. [6][7][8][9] Yet, many patients do report feeling better following all the above treatments-but what does that really mean in terms of actual treatment necessity? ...
Aims: To describe how some management practices in the field of orofacial musculoskeletal disorders (also described as temporomandibular disorders [TMDs]) are based on concepts about occlusal relationships, condyle positions, or functional guidance; for some patients, these procedures may be producing successful outcomes in terms of symptom reduction, but in many cases, they can be examples of unnecessary overtreatment. Methods: The authors discuss the negative consequences of this type of overtreatment for both doctors and patients, as well as the impact on the dental profession itself. Special focus is given to trying to move the dental profession away from the old mechanical paradigms for treating TMDs and forward to the more modern (and generally more conservative) medically based approaches, with emphasis on the biopsychosocial model. Results: The clinical implications of such a discussion are apparent. For example, it can be argued that the routine use of Phase II dental or surgical treatments for managing most orofacial pain cases represents overtreatment, which cannot be defended on the grounds of symptom improvement (ie, "successful" outcomes) alone. Similarly, there is enough clinical evidence to conclude that complex biomechanical approaches focusing on the search for an ideal specific condylar or neuromuscular position for the management of orofacial musculoskeletal disorders are not needed to produce a positive clinical result that is stable over time. Conclusion: Typically, overtreatment successes cannot be easily perceived by the patients or the treating dentists because the patients are satisfied and the dentists feel good about those outcomes. However, neither party knows whether an excessive amount of treatment has been provided. Therefore, both the practical and ethical aspects of this discussion about proper treatment vs overtreatment deserve attention.
... While this is not an inclusive list of indications, it is also true that, in most cases, similar treatment results can be achieved and maintained by using the existing MI and modify it, if needed, by minimal progressive changes. 82 It should be clear, as a consequence, that any of these choices is therefore arbitrary and can be adopted in the context of a pragmatic, cost-effective and least invasive treatment approach. ...
Background:
Few terms and concepts have been so extensively debated in dentistry as the words "centric relation" (CR). Debates involve its biological, diagnostic and therapeutic usefulness.
Methods:
A review of the literature on the current concepts on CR as a diagnostic or therapeutic aid in dentistry was provided. Clinical trials assessing the superiority of one CR recording method over the others to identify patients with temporomandibular disorders (TMDs) (diagnostic use) or to manage patients with prosthodontic or orthodontic needs (therapeutic use) were tentatively included.
Results:
Due to the absence of literature addressing either of the above targets a comprehensive overview was provided. The diagnostic use of CR as a reference position to identify the correct position of the temporomandibular joint (TMJ) condyle within the glenoid fossa is not supported, and lacks anatomical support. From a therapeutic standpoint, the use of CR can be pragmatically useful in prosthodontics as a maxillo-mandibular reference position when occlusal re-organization is warranted and/or when the position of maximum intercuspation (MI) is no longer available.
Conclusions:
The derived occlusal goals from a diagnostic misuse of CR are generally the result of circular reasoning, i.e., a technique is based on the recording of a certain condylar position that is believed to be "ideal" and the treatment is considered successful when such position is shown by the specific instrument that was manufactured for that purpose. The term "Centric Relation" might be replaced with the term "Maxillomandibular Utility Position".
... On the contrary, the clinician should be aware that such patients may be more complex due to those problems. 5 Similarly, the correction of dental occlusion has even been extended by some practitioners to the "correction" of body posture abnormalities, without this treatment being backed up by any solid scientific evidence. [6][7][8][9] Yet, many patients do report feeling better following all the above treatments-but what does that really mean in terms of actual treatment necessity? ...
Aims:
To describe how some management practices in the field of orofacial musculoskeletal disorders (also described as temporomandibular disorders [TMDs]) are based on concepts about occlusal relationships, condyle positions, or functional guidance; for some patients, these procedures may be producing successful outcomes in terms of symptom reduction, but in many cases, they can be examples of unnecessary overtreatment.
Methods:
The authors discuss the negative consequences of this type of overtreatment for both doctors and patients, as well as the impact on the dental profession itself. Special focus is given to trying to move the dental profession away from the old mechanical paradigms for treating TMDs and forward to the more modern (and generally more conservative) medically based approaches, with emphasis on the biopsychosocial model.
Results:
The clinical implications of such a discussion are apparent. For example, it can be argued that the routine use of Phase II dental or surgical treatments for managing most orofacial pain cases represents overtreatment, which cannot be defended on the grounds of symptom improvement (ie, "successful" outcomes) alone. Similarly, there is enough clinical evidence to conclude that complex biomechanical approaches focusing on the search for an ideal specific condylar or neuromuscular position for the management of orofacial musculoskeletal disorders are not needed to produce a positive clinical result that is stable over time.
Conclusion:
Typically, overtreatment successes cannot be easily perceived by the patients or the treating dentists because the patients are satisfied and the dentists feel good about those outcomes. However, neither party knows whether an excessive amount of treatment has been provided. Therefore, both the practical and ethical aspects of this discussion about proper treatment vs overtreatment deserve attention.
... Similarly, the prevalence of temporomandibular disorders is reported to be higher among younger age groups, and the prevalence tends to reduce with increasing age. [8][9][10] As dental practitioners, the role of teeth in TMDs has to be identified and isolated as a different cause. Hence the rationale of the study was to help the dental community identify occlusion as one of the major causes of TMD, thus helping in patient education and management. ...
Objective: To assess the temporomandibular disorders among patients with occlusal interferences. Study Design: Cross-sectional study. Place and Duration of Study: Prosthodontics Department, Armed Force Institute of Dentistry, Rawalpindi Pakistan, from Jul to Dec 2020. Methodology: Consecutive patients presenting with symptoms of occlusal interferences, including pain, clicking and limited mouth opening to the prosthodontics department, were included in the study. History was taken from each patient, and a detailed oral checkup was done to evaluate the presence or absence of TMDs in patients with occlusal interferences after informed consent. Results: The mean age was 30.44±5.95 years. Out of 380 patients with occlusal inferences, 208(54.7%) patients were diagnosed with temporomandibular disorders. No significant difference was found in the distribution of TMDs with regard to age (p=0.559) and gender (p=0.755). Conclusion: The presence of temporomandibular disorders among patients with occlusal interferences was quite common.This presence is equally common in different age groups and both genders.Keywords: Balancing interferences, Occlusal interferences, Protrusive interferences, Temporomandibular joint, Temporomandibular disorders
... Occlusion is considered a minor etiological factor for TMDs according to the concept in current literature. [12] The concept that irreversible occlusal changes should be the end procedure of any TMD treatment implies that something is deranged with the occlusion and that such abnormality initiates TMD symptoms. Moreover, there are very less evidence supporting this. ...
... Situations involving generalized tooth wear require instead a more comprehensive approach: occlusal vertical dimension (OVD) increase is, in fact, frequently needed to obtain aesthetic improvement in such cases [3][4][5][6]. However, the debate regarding the most suitable method to safely increase OVD is still ongoing in the literature [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Over the last years, the introduction of accurate three-dimensional imaging exams, such as magnetic resonance imaging (MRI) or cone beam computed tomography (CBCT), gave to the clinician an objective tool to take under control the position of the temporomandibular joint (TMJ) during OVD increase. ...
This study describes the clinical workflow for occlusal vertical dimension (OVD) increase in patients showing extensive tooth wear and mild teeth misalignment/crowding. A patient affected by dental erosion and occlusal abnormalities was treated to improve her situation. After ascertaining sound condyle and temporomandibular joint (TMJ) conditions, an OVD increase was sought to provide enough inter-occlusal space for the restorations. The use of TMJ three-dimensional imaging throughout the clinical procedures allowed to objectively track the condyle and disk position and confirm a steady condyle–glenoid cavity relationship before definitive restorations placement. Sectional clear aligner therapy prior to totally additive prosthetic rehabilitation allowed obtaining slight derotation and movements of anterior teeth, thus maximizing sound tissue preservation. Adhesively luted restorations were finally delivered on both anterior and posterior sectors. At the end of the treatment, the pre-operative TMJ balance appeared successfully preserved, and the patient was satisfied with the aesthetic and function achieved.
... Convencionalmente, pensava-se que a DTM era causada pela perda de suporte oclusal e aumento na carga da articulação, o que levaria à predisposição ao deslocamento do disco articular e doenças degenerativas da articulação (Carlsson, 2010;Dhanda, et al., 2011;Abdelnabi & Swelem, 2015;de S Leão et al., 2017). Entretanto, estudos atuais sugerem que a DTM pode causar todos esses transtornos e ser originada por múltiplos fatores, como traumatismos (macro ou microtraumas), doenças sistêmicas, fatores psicológicos, ansiedade, genética, entre outros, seguindo o modelo biopsicossocial (Abudet al., 2011;Badel et al., 2012;Papagianni, et al., 2013;Campos et al., 2014;Ribeiro et al., 2014;Katyayan et al., 2016;Manfredini & Poggio, 2017). ...
Objetivo. Avaliar a prevalência dos sintomas das Disfunções Temporomandibulares (DTM) em pacientes com necessidades reabilitadoras, por meio da avaliação de prontuários de pacientes atendidos nas clínicas de graduação de Prótese Total Removível (PTR) e Prótese Parcial Removível (PPR) e no Centro de Especialidades Odontológicas (CEO) do Hospital Universitário de Brasília (HUB/Ebserh), no período de 2016 a 2021. Metodologia. Foi realizado levantamento de prontuários, analisando os seguintes itens: queixa principal e relatos de dores de cabeça, obtidos na anamnese e avaliação da articulação temporomandibular no exame físico. Após levantamento dos prontuários, os dados coletados foram tabelados e analisados quantitativamente.Resultados. Foram analisados 124 prontuários impressos, entre estes, 24 eram de usuários de PTR, 46 de PPR e 54 de PTR e PPR associadas. A prevalência de sintomas de DTM foi de 11,29% (n=14) em usuários de PTR, 19,35% (n=24) em usuários de PPR e 16,93% (n=21) em pacientes com PTR/PPR associadas, resultando em 47,58% (n=59) da totalidade dos prontuários avaliados. Dessa porcentagem, 38,70% (n=48) eram do gênero feminino, na faixa etária de 39 aos 79 anos.Conclusão. De acordo com os resultados obtidos, a prevalência de sintomas de DTM em pacientes com necessidades reabilitadoras por próteses dentárias removíveis totais e/ou parciais foi de 47,58%, acometendo mais as mulheres (38,70%), de 39 a 79 anos.
... The included sample teeth used by Ferrari et al. [38] were all in similar clinical situations in which occlusal wear was very light, not present or absent [38]. In most prosthetic therapies (relatively small amounts of restorative treatments, e.g., up to two or three units of crown or bridge work), the static position of the occlusion between the arches and the dynamic occlusal relationship should not be altered during treatment [65][66][67]. No information on endodontically treated posterior teeth with severe wear is available. ...
Background:
To determine the survival rates of endodontically treated posterior teeth (EDPT) restored with partial coverage all-ceramic crowns with or without the use of fiber posts.
Methods:
MEDLINE and Cochrane searches were conducted in order to identify Randomized Clinical Trials (RCTs) related to endodontically treated posterior teeth restored with partial coverage crowns. The search period was extended until February 2020 and only in vivo, human, and studies in the English language were included. A manual search was also conducted and additional articles, if found, were included in the database.
Results:
The initial search for the selected databases identified 495 studies, which were all screened for inclusion through titles, abstracts and full-text reading. Out of these 495 studies, only one article met the eligibility criteria and was included in this systematic review. Statistical analysis could not be performed.
Conclusions:
Only one RCT was identified in this systematic review. More clinical evidence is necessary to assess the survival rate of EDPT with partial-coverage crowns. This systematic review failed because it did not find scientific evidence to support the use of indirect bonded restorations on EDPT.
... [2][3][4] Despite the existence of a broad consensus regarding a limited OVD increase as a clinically safe procedure, there is still considerable debate in the literature concerning the proper procedures to successfully and reliably increase the OVD. [5][6][7][8][9] Most authors seem to indicate that increasing the OVD of asymptomatic patients does not lead to the development of temporomandibular disorder (TMD) symptoms. 10 According to Abduo,6 since any restorative material can be applied on the occlusal surface in a space of 2 mm, 11,12 a 4 mm interarch space (and an OVD increase within 5 mm interincisally) should be always considered adequate for a comprehensive rehabilitation and safe from the clinical perspective, on the condition that the patient does not have TMJ problems. ...
A safe method to increase the occlusal vertical dimension (OVD) in patients with mild temporomandibular symptoms (such as tenderness upon palpation) is described. After a temporomandibular joint magnetic resonance (MR), an OVD increase was sought, pursuing pure rotational movement without condyle displacement. Prior to definitive rehabilitation, an additional MR confirmed steady and healthy condyle‐disc‐fossa relationships. The aid of magnetic resonance is suggested when planning occlusal vertical dimension increasing procedures, as it allows to objectively assess a healthy pre‐operative temporomandibular joint balance and to keep it unchanged throughout the whole treatment.
... Em publicações recentes (Manfredini & Poggio, 2017), afirma-se que contatos prematuros podem, quando muito, causar um trauma oclusal localizado, sendo tratado através de sua remoção. Esses acontecimentos não mostraram alteração relevante na análise electromiográfica do músculo masseter. ...
O estudo da oclusão, além ser uma das áreas mais controversas da odontologia, também traz medo a diversos profissionais quanto a seus conceitos e correta aplicação e correlação. Entretanto, a correta análise do sistema estomatognático e da relação oclusal do paciente garante, apesar de tudo, uma reabilitação mais segura para o paciente e para o profissional. O objetivo desse estudo foi analisar e exibir índices através de uma revisão sistemática relacionada ao ensino contemporâneo da odontologia e o preparo dos profissionais para diagnosticar e tratar condições temporomandibulares e oclusais, incluindo suas disfunções. A revisão foi realizada segundo parâmetros da organização Cochrane, através de referências inclusas por buscas nas bases Science Direct, PubMed, LILACS e Google Scholar, todas em inglês. A pesquisa mostrou apresentou um grande desconhecimento por parte de estudantes e profissionais sobre o estudo da oclusão, evidenciando uma lacuna na didática dessa área que se arrasta por décadas. Essa realidade perpetua a difusão de conceitos sem embasamento científico, enquanto alguns profissionais se preocupam, e tentam por si mesmos, definir parâmetros de diagnóstico e tratamento para os pacientes cobertos por essa área de abrangência.
... [18][19][20][21][22][23] Thus, most SRs (N=12) included study designs of a mixed nature, of which 9 focused on clinical studies, 1 on a classification system, 1 on a laboratory study and 1 was a case report. [24][25][26][27][28][29][30][31][32][33][34][35] AMSTAR-1 includes 11 questions related to the structure and methodology of a SR ( Table 1). Only 6 of the included 18 SRs were appraised using AMSTAR-1 as they fit the criteria, and had a favourable score following this evaluation. ...
Conduct an overview of systematic reviews (SRs) reviewed by clinical assistants (CAs) in-training. SRs relating to clinical procedures and theoretical concepts, critiqued by CAs were included. Review authors independently screened the results of the requested SRs and evaluated these using the AMSTAR-1 checklist and AMSTAR-2 tool. Differences regarding study outcomes were resolved by consultation. Articles (N=37) submitted to the researcher included 35 reviews published in accredited journals. Of the reviews, only 18 were SRs as stated in their titles and these were of mixed designs and quality; and 17 were either non-structured and biased literature or critical reviews. SR topics reviewed in-training varied; and included temporo-mandibular disorders, implants and implant-supported prosthesis. AMSTAR-1 scores were favourable; scores were low for most SRs using AMSTAR-2, including those with randomized controlled trials only, with the exception of one review that had no randomized controlled trials but fulfilled the critical domain criteria. Students’ misconceptions regarding what constitutes good SRs which are translatable into clinical practice are emphasized, impacting their learning. CAs lack of appraisal skills related to SRs which may influence clinical practices are highlighted.
... Analleged causal relationship between "malocclusion" and TMDs has been proposed.Therefore, diseased individuals should have a higher frequency of the purported causal factor than its absence as being the basic pre-requisite to broaden the depth of an assessment of causal hypothesis [24]. Studies support the absence of consistent, clinically relevant associations between TMD and the various features of dental occlusion [12,23,[25][26][27][28][29][30][31][32][33]. Based on these results, irreversible occlusal changes of prosthodontic or orthodonticrehabilitation cannot be recommended for the management or even the prevention of such TMD. ...
n this literature review relevant published studies were searched for in PubMed, from 2015 to 2020. It was concluded that DTM and NCCLs are multifactorial diseases, of which occlusion is not a causative factor; in addition to the biological failures of dental implants. However, regarding the mechanical failures of dental implants, occlusion can be considered a causative factor.
... In several systematic literature reviews, researchers found a number of | 899 TANG eT Al. aberrations associated with AI, but not sufficiently systematic to allow for secondary analysis and synthesis of the findings. 2,3 Most patients with AI, with the passage of time, are often accompanied by alteration of vertical dimension of occlusion (VDO). Therefore, the clinician's primary goal is to restore the patient's dentition for ideal or adaptable VDO and function. ...
The report describes a 27‐year‐old female patient with amelogenesis imperfecta (AI) accompanied by nocturnal bruxism, who was treated with a combination of occlusal splint and full‐mouth fixed prosthetic rehabilitation through follow‐ups within 2 years. Soft splint protection, regular follow‐up, and monitoring of carries are guaranteed to maintain a long‐term curative effect. The report describes a 27‐year‐old female patient with amelogenesis imperfecta (AI) accompanied by nocturnal bruxism, who was treated with a combination of occlusal splint and full‐mouth fixed prosthetic rehabilitation through follow‐ups within 2 years. Soft splint protection, regular follow‐up, and monitoring of carries are guaranteed to maintain a long‐term curative effect.
... It is difficult to diagnose TMD in older adults because the symptoms are simultaneous with age-related biochemical and physiological alterations 21 , which could increase its prevalence in this age group 22,23 . Regarding age, it was verified that older people tend to develop more resilience in the stomatognathic system, helping them better adjust to the alterations that come with aging 24,25 . ...
Purpose:
to investigate whether chronic pain and depression are factors associated with temporomandibular dysfunction (TMD) in older adults with Parkinson's disease.
Methods:
a cross-sectional study using the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire. The clinical variables studied were chronic pain, depression, nonspecific physical symptoms including and excluding items of pain, and dentures use. The associations between the dependent and independent variables were evaluated by the chi-square odds ratio, with a 95% confidence interval.
Results:
a total of 81 older adults met the eligibility criteria - 67% were males, 74% were married or had a partner, 43% reported earning 1 to 2 minimum wages, and 47% were in the moderate stage of Parkinson's disease. TMD was identified in 22% of the sample, 12% reporting chronic pain. The statistical analysis showed an association between TMD and chronic pain (p = 0.001, OR = inf, 95% CI = 12.13 - inf) and between TMD and moderate-to-severe depression (p = 0.014, OR = 4.8, 95% CI = 1.14 - 23.51).
Conclusion:
it was verified that chronic pain and moderate-to-severe depression were the factors associated with TMD in older adults presented with Parkinson's disease.
Temporomandibular disorder (TMD) is an umbrella term referring to the dysfunction and pathologic conditions of the musculoskeletal and neuromuscular elements of the temporomandibular joint (TMJ), masticatory muscles, and adjacent structures. The most common clinical manifestations of TMD are masticatory muscle pain, limited range of mouth opening, noise from the TMJ, and chronic myofascial pain. Almost every discipline in dentistry played some role in the development of this topic. Each dental specialty looked at TMD from their own perspective and biases using their own terminology to describe the problems and suggest their treatment plans. The etiology of TMD has always been a controversial topic and has evolved over the last few years. Recent research from the fields of behavioral sciences, psychology, genetics, pain pathophysiology, neurophysiology, and endocrinology has significantly revolutionized our understanding of TMDs and how they should be managed. TMDs are no longer believed to be caused by a single factor only with a gradual shift from the dental-based and mechanical model to a biopsychosocial medical model. In this chapter, we will discuss the role of the different factors that are believed to be involved in the etiology of TMD.
Aim
Temporomandibular disorders (TMD) comprise ailments involving the jaw joint (temporomandibular joint) and its associated anatomical structures. The complexity involved in TMD is primarily due to its broad spectrum of conditions, clinical signs and symptoms variability, and multifactorial etiology. Considering the above, the present study was performed to help understand the prevailing knowledge and awareness of TMD among Indian dentists in the context of the new specialty “orofacial pain”.
Settings and Design
Questinnaire study and review.
Materials and Methods
The questionnaire was distributed using a web-based portal nationwide among Indian dentists. Dentists were invited to participate, clearly stating that the intent and purpose of the questionnaire was to record the existing knowledge and awareness concerning temporomandibular disorders among Indian dentists. The questionnaire was segregated into three sections: pathogenesis, diagnosis, and management of TMDs. The questions were recorded using a Likert three-point scale (1=agree; 2=disagree; 3=not aware). 310 dentists participated in the survey, among which 105 were general dentists (BDS [Bachelor of Dental Surgery] graduates), and 205 were dentists with specialist training (MDS [Masters of Dental Surgery] graduates).
Statistical Analysis Used
The results obtained from the study participants was used to calculate the percentage and frequency, following which tabulations were made based on graduate type and clinical experience. The values obtained from all three sections were recorded, and the responses were analysed using Pearson’s Chi-Square test with statistical significance kept at P < 0.05.
Results
Results of the study disclosed that only 58.1% of general dentists and 46.8% of specialists were confident in handling temporomandibular disorder patients. Splint therapy was the preferred treatment modality for general dentists, whereas dentists with specialist training preferred occlusal rehabilitation.
Conclusion
The results of the current survey indicate that Indian dentists lack sufficient training in dental schools on all three sections and face difficulty diagnosing and treating TMDs.
L’usure est la détérioration produite par l’usage. Au niveau des tissus dentaires, c’est une manifestation progressive et cumulative qui dépend de nombreux mécanismes complexes. Elle est le plus souvent physiologique, car elle n’engendre pas de douleur, ne perturbe ni la fonction ni l’esthétique, et car elle est corrélée à l’âge des individus. Dans la plupart des cas, aucune prise en charge n’est donc requise, en dehors de simples mesures de prévention. Chez certains individus, difficiles à identifier en pratique clinique, l’usure dentaire est probablement aggravée par le bruxisme lié au sommeil (et possiblement par le bruxisme d’éveil), car certaines conditions physicochimiques sont susceptibles d’être rassemblées lors de l’activité des muscles masticateurs (ex. : importantes contraintes occlusales, hyposialie favorisée par un syndrome d’apnées du sommeil, acidité intrabuccale liée à un reflux gastro-œsophagien). Lorsqu’elle devient pathologique, une prise en charge s’impose. Dans un premier temps, celle-ci doit permettre d’évaluer et d’intercepter les potentiels facteurs de risque qui se surajoutent (ex. : surconsommation de sodas, trouble des conduites alimentaires, brossage dentaire iatrogène), sans oublier que l’usure dentaire (telle qu’elle est classiquement évaluée) n’est qu’un faible indicateur de la présence et de la sévérité du bruxisme lié au sommeil (tel qu’il est classiquement évalué). Dans un second temps, des mesures de réhabilitation orale sont parfois nécessaires. En l’absence de recommandation quant à la meilleure technique à adopter, les thérapeutiques restauratrices doivent toujours être non invasives et réversibles en première intention. Toutes ces actions sont actuellement peu individualisées. Les recherches futures devront permettre d’identifier des phénotypes d’individus particuliers afin d’améliorer, en présence d’une usure dentaire pathologique, la précision du diagnostic et de mieux cibler et prédire les résultats de la prise en charge selon des stratégies de gestion personnalisées.
Objective
In many esthetic treatments, clinicians may consider the option to modify the maxillo mandibular position. A raise of the vertical dimension of occlusion (VDO) may help restore esthetics, increase the space for dental materials, and reduce the invasiveness of dental procedures. Traditionally, VDO increases are done by using the centric relation (CR) position. Despite a long history of use, the neuromuscular effects of different maxillo mandibular relations are not fully studied. The aim of this study was to investigate the effect of alterations of maxillo‐mandibular relation from maximal intercuspal position (MIP) to a raised VDO CR position on jaw‐elevator muscle activity.
Materials and Methods
Fifteen healthy individuals were asked to carry out maximal voluntary clenching (MVC) in MIP and in CR on individual splints. Electromyographic (EMG) activity of the masseter and anterior temporalis muscles was assessed in μV as the root mean square of the amplitude. Specific indexes and ratios were also computed. Data analyzed in MIP and CR were compared by paired student's t ‐tests.
Results
MVC levels were not negatively affected by a VDO increase in CR position. On the contrary masseter muscles showed a statistically significant increase ( p < 0.005). No significant effect on the anterior temporalis was observed.
Conclusion
These results suggest that no immediate negative effect on maximum voluntary clenching was induced by a VDO increase in CR position. A slight increase observed in EMG clenching levels could be explained by the increase in VDO when clenching on the splint.
Clinical Implications
The results of this study support the use of CR position as a pragmatic reference position due to the absence of relevant or negative changes in neuromuscular function.
BACKGROUND: Bruxism is a phenomenon where psychological and exogenous biological factors act in greater percentage. Several genetic polymorphisms have been described in GABAA receptors, and some have been associated with motor limitations, such as the rs1805057 polymorphism of the GABRB1 gene (GABAA), which found a haplotype associated with a lower limitation in movement in acute pain processes. The aim to identify the clinical phenotypes in bruxism patients METHODS: Eligibility criteria were as follows: observational studies, case control studies, odds ratios, bruxism, patients, and a keyword search that included [[bruxism]], OR [[temporomandibular joint disorders]] OR [[sleep bruxism]], OR [[awake bruxism]], OR [[polymorphism]] or [[GABAA]], or [[serotonin]] , using the Boolean operators AND, OR and NOT RESULTS: Were included 210 identified records in databases; 50 records from other sources; 117 records were deleted after determining they were duplicates; 42 studies were included in qualitative synthesis ; finally, who met inclusion requirements 5 studies were included in synthesis. The comparison of global DNA methylation profiles in patients with bruxism shows a possible genetic influence on their etiology, indicating that patients with HTR2A rs2770304 alleles are at increased risk CONCLUSION: the HTR2A rs2770304 allele leads to an increased risk of bruxism
Temporomandibular joint pathology in combination with the development of pathological processes in the muscles and cranial dysfunction manifests as a complicated clinical picture, which leads to difficulties in diagnostic. In the diagnostics of disorders of the neuromuscular apparatus and the temporomandibular joint, modern clinical, instrumental, functional and radiological examination methods are widely used with biomechanical digital analysis, which require systematization. The aim of the study was development of a strategic structured sequence of diagnostic of patients with temporomandibular disorders and occlusal interferences. The highest percentage of diagnosed joint and combined (joint + muscle) disorders, both among men and among women, namely: joint in 114 patients (38,65 %) and combined in 97 patients (32,89 %), which together made up 71,54 %, and this is exactly the kind of pathology that, in combination with occlusal interferences, is the most difficult in the treatment process. Among confirmed temporomandibular disorders accounted only muscle disorders in 12,88 % (4,07 % in men and 8,81 % in women). The number of women who applied for help is in 2,3 times higher than the number of men, and 81,75% of patients who applied for help were aged from 21 to 50 years, that is, the most productive period of a person's life. Among the pathologies that imitated temporomandibular disorders (more than 10 %) prevailed: osteochondrosis of the cervical spine (17,39 %), contracture of masticatory muscles (post-injection, traumatic) (13,04%) and neuropathology (10,87%). The diagnosis of temporomandibular disorders was rejected in 15,59 % of observations, which indicates the need for a thorough examination of such patients and the involvement of specialists for additional consultation, such as in the field of dentistry (for example, an orthodontist or maxillofacial surgeon), or in the field of general medicine ( psychologist, neurologist, rheumatologist, otolaryngologist, etc.).
ZUSAMMENFASSUNG Parodontologen sowie Prothetiker werden zukünftig aufgrund der demografischen Entwicklung vermehrt mit komplexen Planungen von verschiedenen Lückengebisssituationen im parodontal kompromittierten Gebiss konfrontiert sein. Das synoptische Behandlungskonzept bildet die Grundlage für eine langfristig erfolgreiche kaufunktionelle und ästhetische Rehabilitation. So sollte eine zielgruppengerechte, interdisziplinäre Therapiestrategie verfolgt werden, die entscheidende Aspekte verschiedener Fachdisziplinen berücksichtigt. Erreichbar ist dies durch ein mehrstufiges Behandlungskonzept, bestehend aus Befundung, vorläufiger Planung, interdisziplinärer Stabilisie rungsphase, Reevaluation der Pfeilerwertigkeit und definitiver prothetischer Planung, dessen Stufen nacheinander durchlaufen werden. Erst im Anschluss wird der Patient mit definitivem Zahnersatz versorgt. Dabei spielen langfristige Aspekte wie beispielsweise die Möglichkeit einer Erweiterbarkeit sowie die parodontalhygienische Gestaltung eine zentrale Rolle. Kombiniert festsitzend-heraus-nehmbare Varianten mit quadrangulärer Abstützung können dabei als sicheres und vorhersagbares Therapiekonzept in Betracht gezogen werden. Unabhängig von der gewählten Therapievariante sollte sich ein strukturiertes und risikoadaptiertes Recall-Programm anschließen.
INDIZES prothetische Gesamtplanung, prothetische Pfeilerwertigkeit, synoptisches Behandlungskonzept, Backward-Planning, Perioprothetik, herausnehmbarer Zahnersatz, dentale Implantate, Parodontitis, Zahnextraktion
Objective:
To investigate characteristics of temporomandibular joint (TMJ) idiopathic condylar resorption (ICR) and analyze the related factors.
Methods:
A total of 755 consecutive patients (150 with ICR and 605 with anterior disc displacement [ADD]) from July 2015 to December 2018 were recruited. A comprehensive questionnaire characterizing the multidimensional impact of the TMJ was designed. Clinical examination and radiological evaluation were also performed. The odds ratio for each variable in the ICR group versus the ADD group was computed using logistic regression analysis.
Results:
Multivariate logistic regression analysis showed significant correlations between mouth opening restriction, disease course, mandibular retrusion, mandibular retrusion progression, skeletal Class II profile, and overjet in ICR patients.
Conclusion:
These results suggest that a longer ADD disease course might have a strong relationship with ICR.
Bruxism is a term that encompasses a range of presentations of rhythmic and repetitive muscular activity. For many, this is not a significant problem but for some, the behaviour leads to significant problems and extensive tissue damage. This is different to temporomandibular disorders. This paper will review methods of managing cases where bruxism is destructive, or potentially destructive, before needing to resort to full reconstruction. Bruxism is challenging to control. The aim for early management is to limit tissue damage at an early stage rather than await extensive destruction that is then difficult to manage. There is also a significant financial burden to delaying intervention.Interventions at this stage range from pharmacological to splint therapy. Guidance on splint choice and design is provided. Bruxism is challenging to control. The aim for early management is to limit tissue damage at an early stage rather than await extensive destruction that is then difficult to manage. There is also a significant financial burden to delaying intervention. Interventions at this stage range from pharmacological to splint therapy. Guidance on splint choice and design is provided.
Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.
Objective:
The term temporomandibular disorders (TMDs) encompasses a variety of disorders of the temporomandibular joint (TMJD) and the associated musculature (MMD). Occlusion and its role in the genesis of TMDs is one of the most controversial topics in this arena. The objective of the narrative review was to summarize the implications of TMDs and its relationship to dental occlusion in two scenarios: 1) TMD as an etiologic factor in dental occlusal changes; 2) The role of dental occlusion as a causative factor in the genesis of TMDs.
Data sources:
Indexed databases were searched from January 1951 to August 2021 using the terms TMJ, TMD, temporomandibular disorders, temporomandibular joint, and dental occlusion.
Conclusion:
There is lack of good primary research evaluating true association and showing the cause-and-effect relationship between dental occlusion and TMD. Systematic reviews suggest that the role of occlusion as a primary factor in the genesis of TMDs is low to very low. However, a variety of TMDs can lead to secondary changes in dental occlusion. Distinction between the two is paramount for successful management.
Objective:
This article provides an updated overview of restorative procedures of endodontically treated teeth.
Clinical considerations:
The different techniques and procedures to restore an endodontic treated tooth were considered in the last decades. While they are generally performed using bonding procedures in combination with or without the placement of a post into the root to build up the abutment, there has been a lack of interest in restorative difficulties that can be faced. Failures are represented such as debonding of the post, fracture of the root, decementation, and/or fracture of the restoration, microleakage of the margins. Essentially, the presence of a sufficient failure is considered a key point of a long prognosis. Different clinical factors can directly influence the type of restoration and the longevity of the treatment. The restorative difficulty evaluation system (RDES) is proposed in this article. This new system is composed of eight different clinical factors that are divided into six levels of difficulties. The RDES is composed of 1. Endodontic complexity and outcome, 2. Vertical amount of coronal residual structure and dimension of the pulp chamber, 3. Horizontal amount of coronal residual structure, 4. Restoration marginal seal, 5. Local interdisciplinary conditions, 6. the complexity of the treatment planning, 7. Functional need, 8. Dental wear and esthetic need.
Conclusion:
This article reviews the RDES and outlines critical steps and tips for clinical success.
Clinical significance:
The RDES allows to any clinician to evaluate restorative difficulties when an endodontic treated tooth must be restored, combines clinical aspects that can involve from the single tooth to a full mouth rehabilitation.
Resumen
Bruxismo de sueño es un comportamiento al que se vinculan una variedad de explicaciones, síntomas y terapias. El objetivo de esta revisión es entregar una visión actualizada de la fisiopatología, diagnóstico y tratamiento del bruxismo de sueño que aporte al acercamiento clínico general. La etiología de bruxismo de sueño es relacionada con procesos fisiológicos multisistémicos complejos, como desregulación central de sistemas motores y neuro-masticatorios entre otros. Estas características son comunes con otras patologías y condiciones y de esta forma se le relaciona a actividades que podrían favorecer la actividad muscular mandibular. El diagnóstico se realiza a través de los datos anamnésicos/clínicos y se puede confirmar mediante polisomnografía, incluyendo estudio electromiográfico de los músculos masticatorios y grabación audiovisual. Dada las diferentes posibilidades de evaluar bruxismo de sueño, se ha sugerido clasificarlo por niveles de diagnóstico resguardando el criterio de profundizar cada caso según la necesidad de salud general. La falta de rigor en la evaluación del bruxismo y la posterior selección terapéutica hace difícil interpretar la abundante evidencia científica disponible. De ahí que la selección de las variadas terapias sugeridas se debe realizar con criterio y mesura. Se debe alentar a los clínicos en adquirir el conocimiento necesario para evaluar e identificar la relación de signos y síntomas observados en pacientes con bruxismo de sueño de otras posibles coexistencias y se queda a la espera de futura investigación en diagnóstico y terapia que cumpla con la debida solidez metodológica.
RESUMO Introdução: O bruxismo é uma patologia causada por movimentos mandibulares anômalos. Esses movimentos excessivos podem causar desgaste dentários e perda de dimensão vertical de oclusão [DVO]. Objetivo: O objetivo deste estudo foi relatar um caso de reabilitação protética em porcelana de paciente bruxômano com desgaste dentário severo. Considerações finais: Concluiu-se que o tratamento reabilitador em paciente bruxômano pode melhorar a função, a estabilidade oclusal e que a recuperação da DVO é fator importante para a estética facial do paciente. PALAVRAS-CHAVE: Bruxismo; prótese dentária; desgaste dos dentes ABSTRACT Introduction: Bruxism is a patology caused by abnormal mandibular movements. These excessive movements may cause tooth wear and loss of vertical dimension. Objective: The purpouse of this study was to report a case of porcelain rehabilitiation a patient with bruxism and severe tooth wear. Final consideration: It was concluded that a porcelain rehabilitation on a patient with bruxism can inhace function, oclusasl stability and also the restablishment of the vertical dimension hels patient facial aesthetetics.
This study analyzes whether generalized joint hypermobility (GJH) is a risk factor for temporomandibular joint disorders (TMD). Therefore, we evaluated the potential association between TMD clicking and GJH diagnosis. We worked with the following hypothesis: patients with GJH would have a higher prevalence of TMJ clicking than those without it, making GJH a risk factor for joint disorders. Two hundred and fourteen students from the School of Dentistry of Universidad de la República del Uruguay (UdelaR) were examined: 161 female and 53 male, aged 18 to 30 (average age: 23.8 years, SD=2.7). Each participant was given a questionnaire, and a clinical examination was performed to diagnose GJH using the Beighton score (BS), clicking, history of maxillofacial trauma, orthodontics, full dentition, open lock, and shift. A calibrated blind researcher (kappa inter-rater click calibration = 0.68; intra-rater BS score=0.82, click=1) performed all the examinations. The Ethics Committee approved the study, and all the participants signed an informed consent. A multiple logistic regression model was used to analyze the data statistically. GJH prevalence was 34.16% in women and 7.55% in men; clicking prevalence was 24.22% in women and 11.32% in men. There was a significant association between sex (OR=3.244, p-value 0.018) and history of trauma (OR=2.478, p-value 0.041) and the presence of clicking. No association was found between clicking and GJH. Female sex and history of trauma could be risk factors for TMJ disorders. The lack of association between GJH and clicking in this age group (18-30) suggests that GJH may not be a risk factor for developing these pathologies.
Statement of problem
Screening for temporomandibular disorders (TMDs) is important in research and clinical practice. The short-form Fonseca Anamnestic Index (SFAI) was recently introduced but had only been validated for muscle disorders.
Purpose
The purpose of this clinical study was to determine the diagnostic accuracy of the SFAI and its discrete and pooled items in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) benchmark.
Material and methods
A total of 866 consecutive participants with TMDs and 57 TMD-free controls (aged ≥18 years) were recruited. The participants (n=923; mean age 32.8 ±13.3 years; women 79.2%) answered the FAI, and TMD diagnoses were derived based on the DC/TMD protocol and algorithms. The 5-item SFAI, which comprised 2 pain-related and 3 function-related TMD questions, was subsequently acquired and assessed with reference to the DC/TMD diagnoses. The receiver operating characteristics (ROC) was used to verify accuracy (area under the curve [AUC]) and the best cutoff points. Sensitivity, specificity, predictive values, and likelihood ratios were also examined.
Results
Pain-related (PT) and intra-articular (IT) TMDs were present in 48.3% (446/923) and 82.7% (763/923) of the participants, respectively. The SFAI demonstrated high accuracy for identifying all TMDs, PT, and IT (AUC of 0.97, 0.99, and 0.97, respectively). The best cutoff points were 12.5 for all TMDs/IT and 17.5 for PT. Sensitivity of the SFAI ranged from 90.7% to 97.5% while specificity varied from 93.0% to 96.5%, with the highest values for PT. As positive predictive values (99.4% to 99.5%) were greater than negative ones (41.7% to 83.3%), the SFAI was better at detecting the presence than the absence of TMDs. With reference to PT, the sensitivity, and specificity of the 2 discrete and pooled pain-related questions (questions 3 and 4), extended from 82.3% to 99.3% and 77.2% to 96.5% respectively. With regard to IT diagnoses, sensitivity and specificity ranged from 56.0% to 98.3% and 86.0% to 98.3% for the 3 discrete and pooled function-related items (questions 1, 2, and 5).
Conclusions
The SFAI presented high degrees of diagnostic accuracy in relation to the DC/TMD and can be used for screening TMDs. SFAI scores between 15 and 50 points should be used to identify the presence of TMDs, with scores ≥20 points specifying possible pain-related TMDs.
Purpose
: The purpose of this Best Evidence Consensus Statement is to report on the prevalence, potential causes or association, treatment and cure of bruxism.
Materials and Methods
: A literature search limited to Clinical trials, Randomized Controlled Trials, Systematic Reviews and Meta Analyses, with the key words bruxism, and prevalence identified 22 references, bruxism and causation 21, bruxism and treatment 117 and bruxism and cure none.
Results
: Prevalence received 5 references which were relevant to the question researched. Causation received 11 relevant references, treatment 34 relevant references and cure none. Eighteen additional references were culled from the reference lists in the aforementioned articles.
Conclusions
: Due to variations in demographics and the dependence on anamnestic data, the true prevalence of bruxism in any specific population is unknown. There is moderate evidence that psychosocial factors such as stress, mood, distress, nervousness, and feeling blue are associated with sleep bruxism (SB) as well as caffeine, alcohol, and smoking. There is no consensus on what symptoms of SB or awake bruxism (AB) should be treated. There is some evidence that occlusal devices and bio feedback therapies can be utilized in SB treatment. There is conflicting evidence in the use of Botulinum toxin A and no compelling evidence for the use of drug therapy to treat SB. There is not an established cure for bruxism. The clinician is best served in using caution in the dental rehabilitation of patients with severe occlusal wear.
This article is protected by copyright. All rights reserved
Objective:
Several intraarticular injections, including dextrose and lidocaine, are reported to reduce pain and dysfunction in temporomandibular dysfunction (TMD) and increase maximal jaw opening; our goal was to determine whether dextrose/lidocaine outperforms sterile water/lidocaine for TMD.
Design:
Pragmatic randomized controlled trial.
Setting:
Outpatient clinic.
Subjects:
Chronic (≥3 months) of moderate-to-severe (≥6/10) jaw or facial pain meeting research-specific TMD criteria.
Intervention:
Blinded intraarticular dextrose prolotherapy (DPT) (20% dextrose/0.2% lidocaine) versus intraarticular lidocaine (0.2% lidocaine in sterile water) at 0, 1, and 2 months. Participants were then unblinded and offered DPT by request for 9 additional months.
Main outcome measures:
Primary: Numerical Rating Scale (0-10 points) score for facial pain and jaw dysfunction; percentage achieving ≥50% improvement in pain and dysfunction (0, 3, and 12 months). Secondary: Maximal interincisal opening (MIO; 0 and 3 months). Intention-to-treat analysis was by joint using mixed-model regression.
Results:
Randomization of 29 participants (25 female, 47 ± 17 years, 43 joints) produced similar groups. Three-month pain and dysfunction improvements were similar, but more DPT-treated joints improved by ≥50% in pain (17/22 vs. 6/21; p = 0.028). The MIO improved in both groups (5.6 ± 5.8 mm vs. 5.1 ± 7.0 mm; p = 0.70). From 3 to 12 months, minimal DPT was received by original DPT and lidocaine recipients, 0.5 ± 0.9 and 0.6 ± 1.5 injections, respectively, with only 2 out of 21 joints in the original lidocaine group receiving more than 1 dextrose injection after 3 months. Twelve-month analysis revealed that joints in the original DPT group improved more in jaw pain (4.8 ± 2.4 points vs. 2.6 ± 2.9 points; p = 0.026) and jaw dysfunction (5.3 ± 2.6 points vs. 2.7 ± 2.3 points; p = 0.013). More DPT than lidocaine-treated joints improved by ≥50% in both pain (19/22 vs. 5/21; p = 0.003) and dysfunction (17/22 vs. 7/21; p = 0.040). There were no adverse events; satisfaction was high.
Conclusions:
Intraarticular DPT resulted in clinically important and statistically significant improvement in pain and dysfunction at 12 months compared to lidocaine injection (ClinicalTrials.gov identifier NCT01617356).
Purpose:
The aim of this study was to determine an appropriate cutoff value and the number of nights of sleep with the portable single-channel EMG device (GrindCare) necessary for a valid sleep bruxism (SB) diagnosis.
Methods:
Twenty consecutive post-graduate students and staff at Bauru School of Dentistry composed the sample. Each participant underwent the GrindCare for five consecutive nights and the polysomnography (PSG). The discrimination between bruxers and non-bruxers was based only on the PSG analysis. Data about electromyography per hour with GrindCare (EMG/h) and PSG (bursts/h) were scored.
Results:
There were positive correlations between the two devices for EMG/h and bursts/h in three and five consecutive nights. Bland-Altman analysis of the EMG bursts/h showed positive agreement between the methods. The receiver operating characteristic (ROC) analyses also showed that using a minimum of 18 EMG/h for three nights and 19 EMG/h for five nights in GrindCare as cutoffs resulted in a 90 % specificity and positive likelihood ratio equal to 5.
Conclusions:
GrindCare is able to discriminate SB diagnosed by PSG and gold standard criteria, when used for three or five consecutive nights, and it may be a valid choice in clinical practice for SB assessment.
AIMS: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments.
METHODS: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings.
RESULTS: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions.
CONCLUSION: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
Case-control studies have documented clinical manifestations of chronic temporomandibular disorder (TMD), whereas clinical predictors of TMD development are largely unknown. We evaluated 41 clinical orofacial characteristics thought to predict first-onset TMD in a prospective cohort study of U.S. adults aged 18 to 44 years. During the median 2.8-year follow-up period, 2,737 people completed quarterly screening questionnaires. Those reporting symptoms were examined and 260 people were identified with first-onset TMD. Univariate and multivariable Cox regression models quantified associations between baseline clinical orofacial measures and TMD incidence. Significant predictors from baseline self-report instruments included oral parafunctions, prior facial pain and its life-impact, temporomandibular joint noises and jaw locking, and nonspecific orofacial symptoms. Significant predictors from the baseline clinical examination were pain on jaw opening and pain from palpation of masticatory, neck, and body muscles. Examiner assessments of temporomandibular joint noise and tooth wear facets did not predict incidence. In multivariable analysis, nonspecific orofacial symptoms, pain from jaw opening, and oral parafunctions predicted TMD incidence. The results indicate that only a few orofacial examination findings influenced TMD incidence, and only to a modest degree. More pronounced influences were found for self-reported symptoms, particularly those that appeared to reflect alterations to systems beyond the masticatory tissues.
Perspective
OPPERA's prospective cohort study identifies predictors of first-onset TMD comprising self-reported orofacial symptoms and examination findings. The results suggest a complex pattern of TMD etiology that is influenced by disorders locally, in masticatory tissues, and systemically, in pain-regulatory systems.
Some management strategies for chronic orofacial pain are influenced by models (e.g., Vicious Cycle Theory, Pain Adaptation Model) proposing either excitation or inhibition within a painful muscle. The aim of this study was to determine if experimental painful stimulation of the masseter muscle resulted in only increases or only decreases in masseter activity. Recordings of single-motor-unit (SMU, basic functional unit of muscle) activity were made from the right masseters of 10 asymptomatic participants during biting trials at the same force level and direction under infusion into the masseter of isotonic saline (no-pain condition), and in another block of biting trials on the same day, with 5% hypertonic saline (pain condition). Of the 36 SMUs studied, 2 SMUs exhibited a significant (p < 0.05) increase, 5 a significant decrease, and 14 no significant change in firing rate during pain. Five units were present only during the no-pain block and 10 units during the pain block only. The findings suggest that, rather than only excitation or only inhibition within a painful muscle, a re-organization of activity occurs, with increases and decreases occurring within the painful muscle. This suggests the need to re-assess management strategies based on models that propose uniform effects of pain on motor activity.
To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined bruxism as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism). For the operationalisation of this definition, the expert group proposes a diagnostic grading system of 'possible', 'probable' and 'definite' sleep or awake bruxism. The proposed definition and grading system are suggested for clinical and research purposes in all relevant dental and medical domains.
Many dentists believe that sleep bruxism (SB) is a pathogenic factor in myofascial temporomandibular disorder (TMD), but almost all supportive data rely on patients' self-reports rather than on direct observation.
The authors administered a structured self-report interview to determine whether a large and well-characterized sample of patients with myofascial TMD (124 women) experienced SB more often than did matched control participants (46 women). The authors then used data from a two-night laboratory-based polysomnographic (PSG) study to determine whether the case participants exhibited more SB than the control participants.
The results of independent sample t tests and χ(2) analyses showed that, although self-reported rates of SB were significantly higher in case participants (55.3 percent) than in control participants (15.2 percent), PSG-based measures showed much lower and statistically similar rates of SB in the two groups (9.7 percent and 10.9 percent, respectively). Grinding noises were common in both case participants (59.7 percent) and control participants (78.3 percent).
Most case participants did not exhibit SB, and the common belief that SB is a sufficient explanation for myofascial TMD should be abandoned.
Although other reasons to consider treating SB may exist, misplaced concern about SB's sustaining or exacerbating a chronic myofascial TMD condition should not be used to justify SB treatment.
To estimate the contribution of various occlusal features of the natural dentition that may identify self-reported bruxers compared to nonbruxers.
Two age- and sex-matched groups of self-reported bruxers (n = 67) and self-reported nonbruxers (n = 75) took part in the study. For each patient, the following occlusal features were clinically assessed: retruded contact position (RCP) to intercuspal contact position (ICP) slide length (< 2 mm was considered normal), vertical overlap (< 0 mm was considered an anterior open bite; > 4 mm, a deep bite), horizontal overlap (> 4 mm was considered a large horizontal overlap), incisor dental midline discrepancy (< 2 mm was considered normal), and the presence of a unilateral posterior crossbite, mediotrusive interferences, and laterotrusive interferences. A multiple logistic regression model was used to identify the significant associations between the assessed occlusal features (independent variables) and self-reported bruxism (dependent variable).
Accuracy values to predict self-reported bruxism were unacceptable for all occlusal variables. The only variable remaining in the final regression model was laterotrusive interferences (P = .030). The percentage of explained variance for bruxism by the final multiple regression model was 4.6%. This model including only one occlusal factor showed low positive (58.1%) and negative predictive values (59.7%), thus showing a poor accuracy to predict the presence of self-reported bruxism (59.2%).
This investigation suggested that the contribution of occlusion to the differentiation between bruxers and nonbruxers is negligible. This finding supports theories that advocate a much diminished role for peripheral anatomical-structural factors in the pathogenesis of bruxism.
The relationship between the dental occlusion and temporomandibular disorders (TMDs) has been one of the most controversial topics in the dental community. In a large epidemiological cross-sectional survey - the Study of Health in Pomerania (Germany) - associations between 15 occlusion-related variables and TMD signs or symptoms were found. In other investigations, additional occlusal variables were identified. However, statistical associations do not prove causality. By using Hill's nine criteria of causation, it becomes apparent that the evidence of a causal relationship is weak. Only bruxism, loss of posterior support and unilateral posterior crossbite show some consistency across studies. On the other hand, several reported occlusal features appear to be the consequence of TMDs, not their cause. Above all, however, biological plausibility for an occlusal aetiology is often difficult to establish, because TMDs are much more common among women than men. Symptom improvement after insertion of an oral splint or after occlusal adjustment does not prove an occlusal aetiology either, because the amelioration may be due to the change of the appliance-induced intermaxillary relationship. In addition, symptoms often abate even in the absence of therapy. Although patients with a TMD history might have a specific risk for developing TMD signs, it appears more rewarding to focus on non-occlusal features that are known to have a potential for the predisposition, initiation or perpetuation of TMDs.
To conduct a systematic review with meta-analysis of randomized controlled trials (RCTs) that have assessed the efficacy of intraoral orthopedic appliances to reduce pain in patients with temporomandibular disorders affecting muscle and joint (TMJD) compared to subjects receiving placebo control, no treatment, or other treatments.
A search strategy of MEDLINE, the Cochrane Library, the Cochrane CENTRAL Register, and manual search identified all English language publications of RCTs for intraoral appliance treatment of TMJD pain during the years of January 1966 to March 2006. Two additional studies from 2006 were added during the review process. Selection criteria included RCTs assessing the efficacy of hard and soft stabilization appliances, anterior positioning appliances, anterior bite appliances, and other appliance types for TMJD pain. Pain relief outcome measures were used in the meta-analyses, and the QUORUM criteria for data abstraction were used. A quality analysis of the methods of each RCT was conducted using the CONSORT criteria. The review findings were expressed both as a qualitative review and, where possible, as a mathematical synthesis using meta-analysis of results.
A total of 47 publications citing 44 RCTs with 2,218 subjects were included. Ten RCTs were included in two meta-analyses. In the first meta-analysis of seven studies with 385 patients, a hard stabilization appliance was found to improve TMJD pain compared to non-occluding appliance. The overall odds ratio (OR) of 2.46 was statistically significant (P = .001), with a 95% confidence interval of 1.56 to 3.67. In the second meta-analysis of three studies including 216 patients, a hard stabilization appliance was found to improve TMJD pain compared to no-treatment controls. The overall OR of 2.15 was positive but not statistically significant, with a 95% confidence interval of 0.80 to 5.75. The quality (0 to 1) of the studies was moderate, with a mean of 55% of quality criteria being met, suggesting some susceptibility to systematic bias may have existed.
Hard stabilization appliances, when adjusted properly, have good evidence of modest efficacy in the treatment of TMJD pain compared to non-occluding appliances and no treatment. Other types of appliances, including soft stabilization appliances, anterior positioning appliances, and anterior bite appliances, have some RCT evidence of efficacy in reducing TMJD pain. However, the potential for adverse events with these appliances is higher and suggests the need for close monitoring in their use.
Several works showed a decreased role for occlusion in the etiology of temporomandibular disorders (TMD). Nonetheless, it may be hypothesized that occlusion acts as a modulator through which bruxism activities may cause damage to the stomatognathic structures. To test this hypothesis, a logistic regression model was created with the inclusion of clinically diagnosed bruxism and eight occlusal features as potential predictors for temporomandibular joint (TMJ) pain in a sample of 276 consecutive TMD patients. The final logit showed that the percentage of the total log likelihood for TMJ pain explained by the significant factors was small and amounted to 13.2%, with unacceptable levels of sensitivity (16.4%). The parameters overbite > or = 4 mm combined with clinically diagnosed bruxism [OR (odds ratio) 4.62], overjet > or = 5 mm (OR 2.83), and asymmetrical molar relationship combined with clinically diagnosed bruxism (OR 2.77) were those with the highest odds for disease, even though none of those values was significant with respect to confidence intervals. Thus, the hypothesis under evaluation has to be rejected. It is possible that future studies with a higher discriminatory power for the different bruxism activities might be indicated to get deeper into the analysis of the potential mechanisms through which occlusion may play a role, even if small, in the etiology of the different TMD.
The objective of this experimental study was to assess the efficacy and safety of a reinforced adjustable mandibular advancement appliance (MAA) on sleep bruxism (SB) activity compared to baseline and to a mandibular occlusal splint (MOS) in order to offer an alternative to patients with both tooth grinding and respiratory disorders during sleep.
Twelve subjects (mean age: 26.0 +/- 1.5 years) with frequent SB participated in a short-term (three blocks of 2 weeks each) randomized crossover controlled study. Both brain and muscle activities were quantified based on polygraphic and audio/video recordings made over 5 nights in a sleep laboratory. After habituation and baseline nights, 3 more nights were spent with an MAA in either a slight (25%) or pronounced (75%) mandibular protrusion position or with an MOS (control). Analysis of variance and Friedman and Wilcoxon signed-rank tests were used for statistical analysis.
The mean number of SB episodes per hour was reduced by 39% and 47% from baseline with the MAA at a protrusion of 25% and 75%, respectively (P < .04). No difference between the two MAA positions was noted. The MOS slightly reduced the number of SB episodes per hour without reaching statistical significance (34%, P = .07). None of the SB subjects experienced any MAA breakage.
Short-term use of an MAA is associated with a significant reduction in SB motor activity without any appliance breakage. A reinforced MAA design may be an alternative for patients with concomitant tooth grinding and snoring or apnea during sleep.
Background:
Centric relation (CR) has been a controversial subject in dentistry for more than a century. For at least the past four decades, issues involving CR have been of interest to orthodontists. The definition of CR has changed over the past half-century from a retruded, posterior and, for the most part, superior condyle position to an anterior-superior condyle position.
Type of studies reviewed:
The authors addressed the historical and contemporary orthodontic perspective of CR. The source material for this review came mainly from literature and searches the lead author accumulated over the last 30 years. As there is no evidence-based (EB) model level 3 (systemic) review on the topic of CR, the best evidence on this subject was gleaned only from a thorough examination and evaluation at EB model level 2 (experience plus best available sample studies). There was, however, enough high-quality EB model level 2 information on the topic of CR for the authors to draw conclusions on the basis of a scientific appraisal of relevant research.
Results:
Although the reliability of CR records has been substantiated, the records' validity has little to no evidentiary support. In addition, population-based sample studies and consensus statements from national conferences support the view that the positions of the temporomandibular joint (TMJ) condyles in relation to the glenoid fossa or CR position are not diagnostic of temporomandiblar disorders. There appears to be little to no benefit of using gnathologic records and articulator-mounted dental casts to discern discrepancies in maximum intercuspation of the teeth coincident with TMJ condyles in an anterior-superior CR position in orthodontic patients.
Clinical implications:
The benefit of using gnathologic CR records and articulators in orthodontics has not been substantiated by scientific evidence.
Strategies for recruitment of masseter muscle motor units (MUs), provoked by constant bite force, for different vertical jaw relations have not previously been investigated. The objective of this study was to analyse the effect of small changes in vertical jaw relation on MU recruitment behaviour in different regions of the masseter during feedback-controlled submaximum biting tasks. Twenty healthy subjects (mean age: 24·6 ± 2·4 years) were involved in the investigation. Intra-muscular electromyographic (EMG) activity of the right masseter was recorded in different regions of the muscle. MUs were identified by the use of decomposition software, and root-mean-square (RMS) values were calculated for each experimental condition. Six hundred and eleven decomposed MUs with significantly (P < 0·001) different jaw relation-specific recruitment behaviour were organised into localised MU task groups. MUs with different task specificity in seven examined tasks were observed. The RMS EMG values obtained from the different recording sites were also significantly (P < 0·01) different between tasks. Overall MU recruitment was significantly (P < 0·05) greater in the deep masseter than in the superficial muscle. The number of recruited MUs and the RMS EMG values decreased significantly (P < 0·01) with increasing jaw separation. This investigation revealed differential MU recruitment behaviour in discrete subvolumes of the masseter in response to small changes in vertical jaw relations. These fine-motor skills might be responsible for its excellent functional adaptability and might also explain the successful management of temporomandibular disorder patients by somatic intervention, in particular by the use of oral splints.
Objectives:
To assess if subjects with a clinical diagnosis of temporomandibular disorders (TMDs) have a similar prevalence of orthodontic history as a population of TMD-free individuals and to assess if those subjects who have a history of ideal orthodontics have fewer symptoms than those with a history of nonideal orthodontics.
Materials and methods:
Two groups of age- and sex-matched individuals belonging to either a study ("TMD") or a control group were recruited. Subjects who underwent orthodontic treatment were classified as having a history of ideal or nonideal orthodontics based on the current presence of normal values in five reference occlusal features.
Results:
The correlation with a history of orthodontic treatment was not clinically significant for any of the TMD diagnoses (ie, muscle pain, joint pain, disc displacement, arthrosis), with Phi (Φ) coefficient values within the -0.120 to 0.058 range. Within the subset of patients with a history of orthodontics, the correlation of ideal or nonideal orthodontic treatment with TMD diagnoses was, in general, not clinically relevant or was weakly relevant.
Conclusions:
Findings confirmed the substantial absence of clinically significant effects of orthodontics as far as TMD is concerned. The very low correlation values of a negative or positive history of ideal or nonideal orthodontics with the different TMD diagnoses suggest that orthodontic treatment could not have a true role for TMD.
Among different malocclusions, posterior cross-bite is thought to have a strong impact on the correct functioning of the masticatory system. The association between unilateral posterior cross-bite (UPCB) and temporomandibular joint (TMJ) clicking, however, remains still controversial. The aim of this study was to investigate whether the presence of UCPB during early adolescence increases the risk of reporting TMJ clicking after a long-term follow-up. A longitudinal survey design was carried out in a group of 12-year-old young adolescents, who were examined at baseline for TMJ clicking sounds and unilateral posterior cross-bite. After 10 years, 519 subjects could be reached by a telephone survey. Standardised questions were used to collect self-reported TMJ sounds and to determine whether participants had received an orthodontic treatment. Logistic regression analysis revealed a significant association between unilateral posterior cross-bite and subjectively reported TMJ clicking (odds ratio = 6·0; 95% confidence limits = 3·4-10·8; P < 0·0001). The incidence of TMJ clicking was 12%. At a ten-year follow-up, self-reports of TMJ clicking were significantly associated with the presence of UPCB at baseline, but not with the report of having received an orthodontic treatment. Within the limitation of this study, the presence of unilateral posterior cross-bite in young adolescents may increase the risk of reporting TMJ sounds at a 10-year follow-up. The provision of an orthodontic treatment, however, does not appear to reduce the risk of reporting TMJ sounds.
© 2015 John Wiley & Sons Ltd.
This paper updates the bruxism management review published by Lobbezoo et al. in 2008 (J Oral Rehabil 2008; 35: 509-23). The review focuses on the most recent literature on management of sleep bruxism (SB) in adults, as diagnosed with polysomnography (PSG) with audio-video (AV) recordings, or with any other approach measuring the sleep-time masticatory muscles' activity, viz., PSG without AV recordings or electromyography (EMG) recorded with portable devices. Fourteen (N = 14) papers were included in the review, of which 12 were randomised controlled trials (RCTs) and 2 were uncontrolled before-after studies. Structured reading of the included articles showed a high variability of topics, designs and findings. On average, the risk of bias for RCTs was low-to-unclear, whilst the before-after studies had several methodological limitations. The studies' results suggest that (i) almost every type of oral appliance (OA) (seven papers) is somehow effective to reduce SB activity, with a potentially higher decrease for devices providing large extent of mandibular advancement; (ii) all tested pharmacological approaches [i.e. botulinum toxin (two papers), clonazepam (one paper) and clonidine (one paper)] may reduce SB with respect to placebo; (iii) the potential benefit of biofeedback (BF) and cognitive-behavioural (CB) approaches to SB management is not fully supported (two papers); and (iv) the only investigation providing an electrical stimulus to the masseter muscle supports its effectiveness to reduce SB. It can be concluded that there is not enough evidence to define a standard of reference approach for SB treatment, except for the use of OA. Future studies on the indications for SB treatment are recommended.
© 2015 John Wiley & Sons Ltd.
Studies of the condyle-mandibular fossa relationship are common, although the role of this relationship in the development of a temporomandibular disorder remains controversial.
The purpose of this study was to quantitatively evaluate the condyle-mandibular fossa relationship in young individuals with intact dentitions and compare it to that between individuals with and without symptoms of temporomandibular disorder.
Volunteers were classified as asymptomatic (n=20) or symptomatic (n=20) according to research diagnostic criteria for temporomandibular disorders. Each participant underwent 2 cone beam-computed tomography scans of the middle and lower third of the face: 1 scan of the maximum intercuspation position and 1 of the centric relationship position. The distance between the condyle and mandibular fossa was measured on frontal and lateral images of the temporomandibular joint. The condylar position was compared across groups (asymptomatic, symptomatic) by using the Mann-Whitney U test (α=.05). Within each group, the condylar position was compared across maximum intercuspation and centric relationship positions by using the Mann-Whitney U test (α=.05).
No statistically significant differences were found in condylar positions between centric relationships and maximum intercuspation in either asymptomatic or symptomatic young adults, and no significant differences were found between asymptomatic and symptomatic young adults.
The condyle-mandibular fossa relationships of these young adults were similar in the centric relationships and maximum intercuspation positions when evaluated by computed tomography. The presence or absence of temporomandibular disorder was not correlated with the condyle position in the temporomandibular joint.
Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
Occlusion has been an important consideration in orthodontics since the beginning of the discipline. Early emphasis was placed on the alignment of the teeth, the stability of the intercuspal position, and the esthetic value of proper tooth positioning. These factors remain important to orthodontists, but orthopedic principles associated with masticatory functions must also be considered. Orthopedic stability in the masticatory structures should be a routine treatment goal to help reduce risk factors associated with developing temporomandibular disorders.
Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.
Sleep bruxism (SB) is a term covering different motor phenomena with various risk and etiological factors and potentially different clinical relevance, especially as far as its possible protective role against obstructive sleep apnea (OSA) is concerned. The present expert opinion discusses the possible temporal relationships between the two phenomena.
Four hypothetical scenarios for a temporal relationship may be identified: (1) the two phenomena are unrelated; (2) the onset of the OSA event precedes the onset of the SB event within a limited time span, with SB having a potential OSA-protective role; (3) the onset of the SB event precedes the onset of the OSA event within a limited time span, with SB having an OSA-inducing effect; and (4) the onset of the OSA and SB event occurs at the same moment.
Literature findings on the SB-OSA temporal relationship are inconclusive. The most plausible hypothesis is that the above scenarios are all actually possible and that the relative predominance of one specific sequence of events varies at the individual level. SB activity may be protective against OSA by protruding the mandible and restoring airway patency in those subjects who benefit from mandibular advancement strategies or may even be related to OSA induction, as a consequence of airways' mucosae swelling resulting from a SB-induced trigeminal cardiac reflex.
Clinicians should keep in mind that the SB-OSA relationship is complex and that interindividual differences may explain the possible different SB-OSA relationships, with particular regard to the anatomical site of obstruction.
In this paper, the authors review the rationale and history of mandibular repositioning procedures in relation to temporomandibular disorders (TMDs) as these procedures have evolved over time. A large body of clinical research evidence shows that most TMDs can and should be managed with conservative treatment protocols that do not include any mandibular repositioning procedures. Although this provides a strong clinical argument for avoiding such procedures, very few reports have discussed the biologic reasons for either accepting or rejecting them. This scientific information could provide a basis for determining whether mandibular repositioning procedures can be defended as being medically necessary. This position paper introduces the biologic concept of homeostasis as it applies to this topic. The continuing adaptability of teeth, muscles, and temporomandibular joints throughout life is described in terms of homeostasis, which leads to the conclusion that each person's current temporomandibular joint position is biologically "correct." Therefore, that position does not need to be changed as part of a TMD treatment protocol. This means that irreversible TMD treatment procedures, such as equilibration, orthodontics, full-mouth reconstruction, and orthognathic surgery, cannot be defended as being medically necessary.
Copyright © 2015 Elsevier Inc. All rights reserved.
Background:
This paper systematically reviews the MEDLINE and SCOPUS literature to answer the following question: Is there any evidence that bruxism may cause periodontal damage per se?
Methods:
Clinical studies on humans, assessing the potential relationship between bruxism and periodontal lesions (i.e., decreased attachment level, bone loss, tooth mobility/migration, altered periodontal perception) were eligible. Methodologic shortcomings were identified by the adoption of the Critical Appraisal Skills Program quality assessment, mainly concerning the internal validity of findings according to an unspecific bruxism diagnosis.
Results:
The six included articles covered a high variability of topics, without multiple papers on the same argument. Findings showed that the only effect of bruxism on periodontal structures was an increase in periodontal sensation, whereas a relationship with periodontal lesions was absent. Based on the analysis of Hill criteria, the validity of causation conclusions was limited, mainly owing to the absence of a longitudinal evaluation of the temporal relationship and dose-response effects between bruxism and periodontal lesions.
Conclusions:
Despite the scarce quantity and quality of the literature that prevents sound conclusions on the causal link between bruxism and the periodontal problems assessed in this review, it seems reasonable to suggest that bruxism cannot cause periodontal damage per se. It is also important to emphasize, however, that because of methodologic problems, particularly regarding sleep bruxism assessment, more high-quality studies (e.g., randomized controlled trials) are needed to further clarify this issue.
Objective:
The hypothesis that dental malocclusions may be a risk factor for temporomandibular disorders (TMD) has been greatly debated in the literature. Whilst the association between features of dental occlusion and TMD has been proven weak, if existing, it seems that the transfer of such knowledge into clinical practice is yet to be completed. This study evaluated the prevalence of static and dynamic malocclusion features in a population of TMD patients and compared it with literature data on the general population.
Method and materials:
A total of 625 consecutive TMD patients (75% female; aged 34.2 ± 6.7 years, range 25-44 years) were examined and were clustered into four groups on the basis of pain absence (ie, disk displacement and/or arthrosis without pain), or pain presence within the muscles and/or the temporomandibular joint (TMJ). As for the occlusal features, posterior crossbite, excessive overbite, anterior open bite, excessive overjet, and molar and canine asymmetry were recorded as static malocclusion findings. Medio-/laterotrusive interferences and slide length from retruded contact position (RCP) to maximum intercuspation (MI) ≥ 2 mm were also recorded as dynamic malocclusion findings. The ɸ correlation coefficient assessed the strength of the correlation between each occlusal feature and the presence of pain-related TMD condition.
Results:
No significant correlation was seen between the various malocclusion findings and the presence of any pain-related TMD condition, with ɸ values ranging from -0.081 to +0.043 for molar asymmetry and laterotrusive interferences, respectively. The prevalence findings in this TMD population were within the range reported from general population studies.
Conclusions:
In adult subjects, static or dynamic malocclusion findings show similar prevalence irrespective of the presence of any specific pain-related TMD condition. Also, the prevalence values are similar to the available data at general population level. Based on the above, general practitioners should note that occlusal features may not be considered a discriminant factor for TMD.
Objective:
There are contradicting results on the efficacy of stabilization splint treatment on temporomandibular disorders (TMD). The aim of this randomized control trial was to assess the efficacy of stabilization splint treatment on TMD-related facial pain during a one-year follow-up.
Method:
The sample consisted of 80 TMD patients who were randomly assigned to two groups; splint group (n=39) and control group (n=41). The patients in the splint group were treated with a stabilization splint and received counseling and instructions for masticatory muscle exercises. The controls received only counseling and instructions for masticatory muscles exercises.
The outcome variables were the change in the intensity of facial pain (as measured with VAS, visual analogue scale) between baseline and one-year follow-up as well as the patients’ subjective estimate of treatment outcome. The differences in VAS changes between the groups were analyzed using variance analysis and linear regression models.
Result:
Facial pain decreased in both groups but the difference in VAS change between the groups was not statistically significant. In the linear regression analysis the group status did not associate with the change in VAS after adjustment for baseline VAS, gender, age, length of treatment and general health status. After one-year follow-up, 27.6% of the patients in the splint group and 37.5% of the patients in the control group reported “very good” treatment effects.
Conclusion:
The findings of this study did not show stabilization splint treatment to be more effective in decreasing facial pain than masticatory muscle exercises and counseling alone in treatment of TMD over a one-year follow-up.
Objectives:
To assess the effectiveness of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea syndrome (OSAS) over a long-term follow-up in patients non-compliant with continuous positive airway pressure (CPAP) and to identify potential predictive factors of response to MADs.
Methods:
Fifteen OSAS patients were enrolled. Apnea-hypopnea index (AHI) and daytime sleepiness were assessed at baseline and at the end of follow-up. Potential baseline predictors of treatment effectiveness were assessed.
Results:
AHI and Epworth Sleepiness Scale (ESS) scores improved significantly with MADs. Sixty per cent of patients were 'responders', of whom 33% were 'full responders'. Sixty-seven per cent of patients showed total compliance. No correlations between the potential predictors and the response to MAD therapy were found.
Discussion:
Effectiveness of MAD therapy was shown over a long-term follow-up in OSAS patients with low compliance to CPAP. Efforts to identify predictive success factors fell short.
Purpose:
This before and after study evaluated the effects of a mandibular advancement device (MAD) on sleep bruxism (SB) activity and its associated signs and symptoms.
Materials and methods:
Nineteen young adults (39.9 ± 12.9 years, 58% women) with a clinical history of SB without sleep or neurologic disorders and no spontaneous temporomandibular disorder pain were selected. SB activity was assessed after a habituation period of 2 weeks. The results of a 3-month treatment with a thermoplastic monoblock MAD were compared to baseline using electromyogram polysomnography and the BiteStrip, a portable EMG device. Sleep disorders were assessed and validated against the polysomnography sleep assessment questionnaire (SAQ). Additionally, common signs and symptoms of SB were evaluated with the research diagnostic criteria for temporomandibular disorders. Occlusal force was compared to baseline using a cross-arch force transducer.
Results:
There was a significant improvement in both SB activity and sleep scores (including SB episodes per hour) according to the BiteStrip and the SAQ, respectively. There was also a significant reduction in the signs and symptoms of SB, including grinding and/or clenching, temporomandibular joint (TMJ) sounds, muscle pain, and occlusal force. None of the SB subjects experienced MAD breakage, but in 24% of patients, the MAD treatment had to be interrupted due to TMJ/muscle pain and/or discomfort.
Conclusion:
The MAD treatment resulted in the reduction of SB activity, SB signs and symptoms, sleep disorders, and occlusal force.
Recent polysomnographic (PSG) studies showed that the sleep bruxism (SB) event is preceded by a sudden shift in autonomic cardiac activity. Therefore, heart rate could be the simplest-to-record parameter for use in addition to portable home EMG monitoring to improve the accuracy in automatic detection of SB events. The aim of the study was to compare the detection of SB episodes by combined surface electromyography and heart rate (HR) recorded by a compact portable device (Bruxoff(®) ), with the scoring of SB episodes by a PSG recording. Twenty-five subjects (14 'probable' bruxers and 11 non-bruxers) were selected for the study. Each subject underwent the Bruxoff and the PSG recordings during the same night. Rhythmic masseter muscle activities (RMMAs) were scored according to published criteria. Correlation coefficients and the Bland-Altman plots were calculated to measure the correlation and agreement between the two methods. Results showed a high correlation (Pearson's r = 0·95, P < 0·0001) and a high agreement (bias = 0·05) between Bruxoff and the PSG. Furthermore, the receiver operating characteristic curve analysis showed a high sensitivity and specificity of the portable device (92·3% and 91·6%, respectively) when the cut-off was set at 4 SB episodes per hour according to published criteria. The Bruxoff device showed a good diagnostic accuracy to differentiate RMMA from other oromotor activities. These findings are important in the light of the need for simple and reliable portable devices for the diagnosis of SB both in the clinical and research settings.
The first purpose of this study was to translate the Oral Behaviours Checklist (OBC) into Dutch and to examine its psychometric properties. The second purpose was to examine the correlations between scores on the OBC and facial pain, while controlling for the possible confounding effects of psychosocial factors, such as stress, depression, somatisation and anxiety. The OBC was translated, following the international RDC/TMD consortium guidelines. Its psychometric properties were examined by assessing the test-retest reliability and concurrent validity [correlations between the OBC and the previously developed Oral Parafunctions Questionnaire (OPQ)]. Participants were 155 patients with TMD (77% female; mean age and s.d. = 43·6 and 14·4 years). The translation of the OBC into Dutch proceeded satisfactorily. The psychometric properties of the Dutch OBC were good; test-retest reliability was excellent (ICC = 0·86, P < 0·001). Concurrent validity was good: the correlation between the OBC and OPQ was high (r = 0·757, P < 0·001), while the correlations between individual items ranged from 0·389 to 0·892 (P < 0·001). Similar to previous Dutch studies using the OPQ, no significant correlation was found between oral parafunctions and facial pain (r = 0·069, P = 0·892). No significant correlations could be found between oral parafunctional behaviours and facial pain.
The present investigation was performed in a population of patients with temporomandibular disorders (TMD), and it was designed to assess the correlation between self-reported questionnaire-based bruxism diagnosis and a diagnosis based on history taking plus clinical examination. One-hundred-fifty-nine patients with TMD underwent an assessment including a questionnaire investigating five bruxism-related items (i.e. sleep grinding, sleep grinding referral by bed partner, sleep clenching, awake clenching, awake grinding) and an interview (i.e. oral history taking with specific focus on bruxism habits) plus a clinical examination to evaluate bruxism signs and symptoms. The correlation between findings of the questionnaire, viz., patients' report, and findings of the interview/oral history taking plus clinical examination, viz., clinicians' diagnosis, was assessed by means of φ coefficient. The highest correlations were achieved for the sleep grinding referral item (φ = 0·932) and for the awake clenching item (φ = 0·811), whilst lower correlation values were found for the other items (φ values ranging from 0·363 to 0·641). The percentage of disagreement between the two diagnostic approaches ranged between 1·8% and 18·2%. Within the limits of the present investigation, it can be suggested that a strong positive correlation between a self-reported and a clinically based approach to bruxism diagnosis can be achieved as for awake clenching, whilst lower levels of correlation were detected for sleep-time activities.
Objectives:
To answer the clinical research question: in patients with myofascial pain, are there any differences in the surface electromyography (sEMG) activity of muscles of the painful and nonpainful sides that can be detected by commercially available devices?
Methods:
The study sample (N = 39; 64% F, mean age 35.7 ± 15 years) consisted of patients seeking for temporomandibular disorders Temporomandibular Disorders (TMD) treatment and meeting Research Diagnostic Criteria for TMD (RDC/TMD) diagnosis of myofascial pain, with pain referred only in muscles on one side. They underwent sEMG of jaw muscles to record levels of standardized sEMG activity at rest, as well as during maximum clenching on teeth for the four investigated muscles, viz., bilateral masseter and temporalis. The existence of differences between sEMG values of muscles of the painful and nonpainful sides during the standardization test (i.e., clenching on cotton rolls) at rest and during clenching on teeth was assessed.
Results:
At the study population level, differences between the sEMG values of muscles of the painful and nonpainful sides were not significant in any conditions, viz., either at rest or during clenching tasks. At the individual level, the difference between the sEMG activity of painful and nonpainful sides was very variable.
Conclusions:
The above findings were not supportive of the existence of any detectable difference in sEMG activity between jaw muscles of the painful and nonpainful sides in patients with unilateral myofascial pain. Centrally mediated mechanism for pain adaptation may explain these findings, and the role of sEMG as a diagnostic tool for muscle pain needs to be carefully reconceptualized.
Aims:
To perform a systematic review of the literature dealing with the prevalence of bruxism in adult populations.
Methods:
A systematic search of the medical literature was performed to identify all peer-reviewed English-language papers dealing with the prevalence assessment of either awake or sleep bruxism at the general population level by the adoption of questionnaires, clinical assessments, and polysomnographic (PSG) or electromyographic (EMG) recordings. Quality assessment of the reviewed papers was performed according to the Methodological evaluation of Observational REsearch (MORE) checklist, which enables the identification of flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. For each included study, the sample features, diagnostic strategy, and prevalence of bruxism in relation to age, sex, and circadian rhythm, if available, were recorded.
Results:
Thirty-five publications were included in the review. Several methodological problems limited the external validity of findings in most studies, and prevalence data extraction was performed only on seven papers. Of those, only one paper had a flaw less external validity, whilst internal validity was low in all the selected papers due to their self-reported bruxism diagnosis alone, mainly based on only one or two questionnaire items. No epidemiologic data were available from studies adopting other diagnostic strategies (eg, PSG, EMG). Generically identified "bruxism" was assessed in two studies reporting an 8% to 31.4% prevalence, awake bruxism was investigated in two studies describing a 22.1% to 31% prevalence, and prevalence of sleep bruxism was found to be more consistent across the three studies investigating the report of "frequent" bruxism (12.8% ± 3.1%). Bruxism activities were found to be unrelated to sex, and a decrease with age was described in elderly people.
Conclusion:
The present systematic review described variable prevalence data for bruxism activities. Findings must be interpreted with caution due to the poor methodological quality of the reviewed literature and to potential diagnostic bias related with having to rely on an individual's self-report of bruxism.
Belief in and rejection of a relationship of occlusion and temporomandibular joint (TMJ) condyle-fossa position with normal and abnormal function are still contentious issues. Clinical opinions can be strong, but support in most published data (mostly univariate) is problematic. Distribution overlap, low sensitivity and specificity are a common basis to reject any useful prediction value. Notwithstanding, a relationship of form with function is a basic tenet of biology. These are multifactor problems, but the questions mostly have not been analysed as such. This review moves the question forward by focusing on TM joint anatomic organisation as the multifactor system it is expected to be in a closed system like a synovial joint. Multifactor analysis allows the data to speak for itself and reduces bias. Classification tree analysis revealed useful prediction values and usable clinical models which are illustrated, backed up by stepwise logistic regression. Explained variance, R(2) , predicting normals from pooled TMJ patients was 32·6%, sensitivity 67·9%, specificity 85·7%; 37% versus disc displacement with reduction; and 28·8% versus disc displacement without reduction. Significant osseous organisational differences between TM joints with clicking and locking suggest that this is not necessarily a single disease continuum. However, a subset of joints with clicking contained characteristics of joints with locking that might contribute to symptom progression versus resistance. Moderately strong models confirm there is a relationship between TMJ osseous organisation and function, but it should not be overstated. More than one model of normals and of TM derangement organisation is revealed. The implications to clinical decision-making are discussed.
Purpose:
To systematically review the literature on the role of bruxism as a risk factor for the different complications on dental implant-supported rehabilitations.
Material and methods:
A systematic search in the National Library of Medicine's Medline Database was performed to identify all peer-reviewed papers in the English literature assessing the role of bruxism, as diagnosed with any other diagnostic approach (i.e., clinical assessment, questionnaires, interviews, polysomnography, and electromyography), as a risk factor for biological (i.e., implant failure, implant mobility, and marginal bone loss) or mechanical (i.e., complications or failures of either prefabricated components or laboratory-fabricated suprastructures) complications on dental implant-supported rehabilitations. The selected articles were reviewed according to a structured summary of the articles in relation to four main issues, viz., "P" - patients/problem/population, "I" - intervention, "C" - comparison, and "O" - outcome.
Results:
A total of 21 papers were included in the review and split into those assessing biological complications (n = 14) and those reporting mechanical complications (n = 7). In general, the specificity of the literature for bruxism diagnosis and for the study of the bruxism's effects on dental implants was low. From a biological viewpoint, bruxism was not related with implant failures in six papers, while results from the remaining eight studies did not allow drawing conclusions. As for mechanical complications, four of the seven studies yielded a positive relationship with bruxism.
Conclusions:
Bruxism is unlikely to be a risk factor for biological complications around dental implants, while there are some suggestions that it may be a risk factor for mechanical complications.
Purpose:
This study was conducted to determine statistically the most repeatable mandibular position of 3 centric relation methods.
Materials and methods:
Three centric relation recording methods commonly reported in the literature were selected: bimanual mandibular manipulation with a jig, chin point guidance with a jig, and Gothic arch tracing. Fourteen healthy adult volunteers (7 males and 7 females), with an average age of 26.61 +/- 4.20 years and no history of extractions, temporomandibular joint dysfunction, or orthodontic treatment, were selected for the study. Accurate casts were mounted on an articulator (Denar D4A) by means of a facebow and maximum intercuspation silicone registration record. A mechanical 3-dimensional mandibular position indicator was constructed and mounted on the articulator enabling the operator to analyze the mandibular positions in 3 spatial axes (x, anteroposterior; y, superoinferior; z, mediolateral shift). Each centric relation method was recorded four times on each subject (at baseline, 1 hour, 1 day, and 1 week at approximately the same time of day). Records were transferred to the articulator, and data were extracted using a stereomicroscope modified to accept the mandibular position indicator.
Results:
Variability within subjects ranged from 0.03 mm (left-side z axis for the bimanual method) to 1.6 mm (left-side y axis for the Gothic arch method). To indicate the least variable (most repeatable) method a comparison was made using the F test. The bimanual method was the most consistent, showing between 10.11 (p = 1) and 0.438 (p = 0.005) times less variation than the Gothic arch method (the least consistent). The repeatability of the chin point guidance method was somewhere between the other 2 methods.
Conclusions:
The results of this study showed that of the 3 centric relation methods evaluated, the bimanual manipulation method positioned the condyles in the temporomandibular joint with a more consistent repeatability than the other 2 methods, whereas the Gothic arch was the least consistent method.
The association of bruxism with craniofacial pain and symptoms of dysfunction of the masticatory system was assessed in a sample of 483 adult subjects, aged 18–75 years and selected from the general population living in the municipality of Segrate, a metropolitan area in northern Italy. Subjects were interviewed by a questionnaire about oral conditions, occurrence of symptoms of masticatory disturbances, craniofacial and neck pain. The overall prevalence of bruxism was 31˙4% (95% confidence interval (CI): 27˙3–35˙5%). At univariate analysis bruxism was significantly associated with craniofacial pain, difficulty in closing the mouth, difficulty in opening the mouth wide or in locking the mouth, temporomandibular joint sounds, pain on movement, a feeling of stiffness or fatigue of the jaws, and neck pain. After adjustment for reciprocal influences and confounding variables, logistic regression analysis disclosed a strong independent association of bruxism with difficulty in closing the mouth (adjusted odds ratio, (OR): 2˙84, 95% CI: 1˙68–4˙48), and a weaker relationship with craniofacial pain (adjusted OR: 1˙84, 95% CI: 1˙16–2˙93) and temporomandibular joint sounds (adjusted OR: 1˙64, 95% CI: 1˙00–2˙69). The findings show that in the general adult population there is a complex connection among bruxism, craniofacial pain and symptoms of masticatory disturbances. Furthermore, they suggest that the most direct relationship of bruxism may be with difficulties in mouth movements, but also an independent association may exist with craniofacial pain and other symptoms of temporomandibular disorder.
To explore the relationship between sleep bruxism (SB), painful temporomandibular disorders (TMD) and psychologic status in a cross-sectional study. The sample consisted of 272 individuals. The Research Diagnostic Criteria for TMD (RDC/TMD) was used to diagnose TMD; SB was diagnosed by clinical criteria proposed by The American Academy of Sleep Medicine. The sample was divided into four groups: (1) patients without painful TMD and without SB, (2) patients without painful TMD and with SB, (3) patients with painful TMD and without SB and (4) patients with painful TMD and with SB. Data were analysed by Odds Ratio test with a 95% confidence interval. Patients with SB had an increased risk for the occurrence of myofascial pain (OR = 5·93, 95% CI: 3·19-11·02) and arthralgia (2·34, 1·58-3·46). Group 3 had an increased risk for moderate/severe depression and non-specific physical symptoms (10·1, 3·67-27·79; 14·7, 5·39-39·92, respectively), and this risk increased in the presence of SB (25·0, 9·65-64·77; 35·8, 13·94-91·90, respectively). SB seems to be a risk factor for painful TMD, and this in turn is a risk factor for the occurrence of higher depression and non-specific physical symptoms levels, but a cause-effect relationship could not be established.
In the dental profession, the belief that bruxism and dental (mal-)occlusion ('the bite') are causally related is widespread. The aim of this review was to critically assess the available literature on this topic. A PubMed search of the English-language literature, using the query 'Bruxism [Majr] AND (Dental Occlusion [Majr] OR Malocclusion [Majr])', yielded 93 articles, of which 46 papers were finally included in the present review*. Part of the included publications dealt with the possible associations between bruxism and aspects of occlusion, from which it was concluded that neither for occlusal interferences nor for factors related to the anatomy of the oro-facial skeleton, there is any evidence available that they are involved in the aetiology of bruxism. Instead, there is a growing awareness of other factors (viz. psychosocial and behavioural ones) being important in the aetiology of bruxism. Another part of the included papers assessed the possible mediating role of occlusion between bruxism and its purported consequences (e.g. tooth wear, loss of periodontal tissues, and temporomandibular pain and dysfunction). Even though most dentists agree that bruxism may have several adverse effects on the masticatory system, for none of these purported adverse effects, evidence for a mediating role of occlusion and articulation has been found to date. Hence, based on this review, it should be concluded that to date, there is no evidence whatsoever for a causal relationship between bruxism and the bite.
Temporomandibular disorders (TMD) represent a group of chronic painful conditions involving the muscles of mastication and the temporomandibular joint. Several studies have reported that TMD is associated with enhanced sensitivity to experimental pain. Twenty-three TMD subjects and 24 pain-free matched control subjects participated in a set of studies which were designed to evaluate whether the temporal integrative aspects of thermal pain perception are altered in TMD patients compared with control subjects. Specifically, we have examined in both TMD patients and in age- and gender-matched control subjects: (1) the time-course and magnitude of perceived pain evoked by the application of sustained 7-s noxious thermal stimuli (45–48°C) to the face and forearm, (2) the central summation of C-fiber-mediated pain produced by applying brief trains of noxious heat pulses to the skin overlying the ventral aspect of the right palm and (3) the ability to discriminate small increments in noxious heat applied to facial and volar forearm skin. Data collected from these studies indicate that TMD patients show enhanced temporal integration of thermal pain compared with control subjects. TMD patients show greater thermal C-fiber-mediated temporal summation than pain-free subjects and they report a greater magnitude of sustained noxious heat pulses applied to either the face or the forearm than control subjects. In contrast to these findings, TMD and pain-free subjects are equally able to discriminate and detect small increments of heat applied to noxious adapting temperatures. These findings suggest that the augmented temporal integration of noxious stimuli may result from alterations in central nervous system processes which contribute to the enhanced pain sensitivity observed in TMD patients.
The aim of this investigation was to perform a review of the literature dealing with the issue of relationships between dental occlusion, body posture and temporomandibular disorders (TMD). A search of the available literature was performed to determine what the current evidence is regarding: (i) The physiology of the dental occlusion-body posture relationship, (ii) The relationship of these two topics with TMD and (iii) The validity of the available clinical and instrumental devices (surface electromyography, kinesiography and postural platforms) to measure the dental occlusion-body posture-TMD relationship. The available posturographic techniques and devices have not consistently found any association between body posture and dental occlusion. This outcome is most likely due to the many compensation mechanisms occurring within the neuromuscular system regulating body balance. Furthermore, the literature shows that TMD are not often related to specific occlusal conditions, and they also do not have any detectable relationships with head and body posture. The use of clinical and instrumental approaches for assessing body posture is not supported by the wide majority of the literature, mainly because of wide variations in the measurable variables of posture. In conclusion, there is no evidence for the existence of a predictable relationship between occlusal and postural features, and it is clear that the presence of TMD pain is not related with the existence of measurable occluso-postural abnormalities. Therefore, the use instruments and techniques aiming to measure purported occlusal, electromyographic, kinesiographic or posturographic abnormalities cannot be justified in the evidence-based TMD practice.
Objectives:
A key aspect of complex restorative therapy is reconstruction of a new three-dimensional jaw relation. The objective of this study was to test the hypotheses that the initially recorded jaw relation would deviate substantially from the jaw position of the prosthetic reconstruction and that activity ratios of the jaw muscles would be significantly different for each of these jaw positions.
Materials and methods:
In 41 healthy subjects, 41 examiners incorporated intraoral occlusal devices fabricated with all the technical details and procedures commonly used during prosthetic reconstructions. The jaw positions in centric relation with the incorporated occlusal devices were telemetrically measured in the condylar, first molar and incisal regions, relative to intercuspation. Electromyographic (EMG) activity of the temporalis and masseter muscles was recorded, and activity ratios were calculated for homonymous and heteronymous muscles.
Results:
The recorded jaw relation differed significantly (p < 0.001) from the jaw position reconstructed with the intraoral occlusal devices. The initially recorded jaw relation was reproduced with the intraoral occlusal device with spatial accuracy of approximately 0.3 mm in the condylar, molar and incisal regions. The EMG ratios between centric relations and the reconstructed positions were significantly different (p < 0.05) for the temporal muscle and the temporalis/masseter ratio.
Conclusions:
The findings revealed that three-dimensional jaw-relation recording may be reproduced in a simulated prosthetic reconstruction within the accuracy reported for replicate intraoral bite recordings.
Clinical relevance:
Centric relation recordings may be reproduced in a prosthetic reconstruction with the spatial accuracy of 0.3 mm.
The aims of this investigation were to report the frequency of temporomandibular disorders (TMD) diagnoses and the prevalence of self-reported awake and sleep bruxism as well as to describe the possible differences between findings of two specialised centres as a basis to suggest recommendations for future improvements in diagnostic homogeneity and accuracy. A standardised Research Diagnostic Criteria for TMD (RDC/TMD) assessment was performed on patients attending both TMD Clinics, viz., at the University of Padova, Italy (n=219; 74% women) and at the University of Tel Aviv, Israel (n=397; 79% women), to assign axis I physical diagnoses and to record data on self-reported awake and sleep bruxism. Significant differences were shown between the two clinic samples as for the frequency of TMD diagnoses (chi-square, P<0·001) and the prevalence of at least one positive response to bruxism items (chi-square, P<0·001). The more widespread use of TMJ imaging techniques in one clinic sample led to a higher prevalence of multiple diagnoses, and the higher prevalence of self-reported bruxism in patients with myofascial pain alone described in the other clinic sample was not replicated, suggesting that the different adoption of clinical and imaging criteria to diagnose TMD may influence also reports on their association with bruxism. From this investigation, it emerged that the features of the study samples as well as the different interpretation of the same diagnostic guidelines may have strong influence on epidemiological reports on bruxism and TMD prevalence and on the association between the two disorders.
Bruxism is commonly considered a detrimental motor activity, potentially causing overload of the stomatognathic structures and representing a risk factor for dental implant survival. The available literature does not provide evidence-based guidelines for the management of bruxers undergoing implant-retained restorations. The present paper reviewed current concepts on bruxism etiology, diagnosis and management, underlining its effects on dental implants in an attempt to provide clinically useful suggestions based on scientifically sound data. Unfortunately, very little data exists on the subject of a cause-and-effect relationship between bruxism and implant failure, to the point that expert opinions and cautionary approaches are still considered the best available sources for suggesting good practice indicators. By including experimental literature data on the effects of different types of occlusal loading on peri-implant marginal bone loss along with data from studies investigating the intensity of the forces transmitted to the bone itself during tooth-clenching and tooth-grinding activities, the authors were able to compile the suggestions presented here for prosthetic implant rehabilitations in patients with bruxism.
Today the clinician is faced with widely varying concepts regarding the number, location, distribution and inclination of implants required to support the functional and parafunctional demands of occlusal loading. Primary clinical dilemmas of planning for maximal or minimal numbers of implants, their axial inclination, lengths and required volume and quality of supporting bone remain largely unanswered by adequate clinical outcome research. Planning and executing optimal occlusion schemes is an integral part of implant supported restorations. In its wider sense this includes considerations of multiple inter‐relating factors of ensuring adequate bone support, implant location number, length, distribution and inclination, splinting, vertical dimension aesthetics, static and dynamic occlusal schemes and more.
Current concepts and research on occlusal loading and overloading are reviewed together with clinical outcome and biomechanical studies and their clinical relevance discussed. A comparison between teeth and implants regarding their proprioceptive properties and mechanisms of supporting functional and parafunctional loading is made and clinical applications made regarding current concepts in restoring the partially edentulous dentition. The relevance of occlusal traumatism and fatigue microdamage alone or in combination with periodontal or peri‐implant inflammation is reviewed and applied to clinical considerations regarding splinting of adjacent implants and teeth, posterior support and eccentric guidance schemes.
Occlusal restoration of the natural dentition has classically been divided into considerations of planning for sufficient posterior support, occlusal vertical dimension and eccentric guidance to provide comfort and aesthetics. Mutual protection and anterior disclusion have come to be considered as acceptable therapeutic modalities. These concepts have been transferred to the restoration of implant‐supported restoration largely by default. However, in light of differences in the supporting mechanisms of implants and teeth many questions remain unanswered regarding the suitability of these modalities for implant supported restorations. These will be discussed and an attempt made to provide some current clinical axioms based where possible on the best available evidence.
The biomechanical load during strong bruxism activity reportedly causes many dental/oral problems. However, it is unknown whether the magnitude of muscle activity during sleep is controllable. In this study, the relationship between the magnitude of muscle activity during sleep and types of tooth contacts was examined, including anterior and posterior guidance, in order to clarify how occlusion factors contribute to sleep bruxism (SB). An EMG-2-axis accelerometer system was used for monitoring patterns and activities of SB. Bruxchecker was used to evaluate tooth contacts during SB, and a condylograph was used to measure posterior guidance (sagittal condylar inclination). Results show that grinding rather than clenching or tapping was observed in the high SB group, and there was Incisor-Canine-Premolar-Molar (ICPM) tooth contact during SB grinding movement. The canine occlusal guidance (COG) was flatter in the low SB group than in the moderate SB group. Relative canine occlusal guidance (rCOG), which is the difference between the sagittal condylar inclination (SCI) and COG, was larger in the low SB group than that in the high SB group. These findings suggest that the grinding pattern must be controlled to prevent strong bruxism, and that the muscle activity during bruxism can be reduced by controlling the tooth contact pattern during SB grinding.
Long-term trials are needed to capture information regarding the persistence of efficacy and loss to follow-up of both mandibular advancement device (MAD) therapy and continuous positive airway pressure (CPAP) therapy.
The aim of the study was to compare these treatment aspects between MAD and nasal CPAP (nCPAP) in a 1-year follow-up.
Forty-three mild/moderate obstructive sleep apnea patients (52.2 ± 9.6 years) with a mean apnea-hypopnea index (AHI) of 20.8 ± 9.9 events/h were randomly assigned to two parallel groups: MAD (n = 21) and nCPAP (n = 22). Four polysomnographic recordings were obtained: one before treatment, one for the short-term evaluation, and two recordings 6 and 12 months after the short-term evaluation. Excessive daytime sleepiness (EDS) was also evaluated at the polysomnographic recordings.
The initially achieved improvements in the AHI remained stable over time within both groups (p = 0.650). In the nCPAP group, the AHI improved 4.1 events/h more than in the MAD group (p = 0.000). The EDS values showed a gradual improvement over time (p = 0.000), and these improvements were similar for both groups (p = 0.367). In the nCPAP group, more patients withdrew from treatment due to side effects than in the MAD group.
The absence of significant long-term differences in EDS improvements between the MAD and the nCPAP groups with mild/moderate obstructive sleep apnea may indicate that the larger improvements in AHI values in the nCPAP group are not clinically relevant. Moreover, nCPAP patients may show more problems in accepting their treatment modality than MAD patients.
There is no evidence about the effects of different types of orthodontic braces for problems associated with the joint between the lower jaw and skull. When the joint between the lower jaw and the base of the skull is not working well (temporomandibular disorders (TMD)), it can lead to abnormal jaw movement or locking, noises (clicking or grating), muscle spasms, tenderness or pain. TMD is very common, and it is believed by some that it may be caused by the occlusion (the way the teeth bite), trauma or psychological stress. There is also a belief that the pain associated with TMD is similar, in that respect, to low back pain and may be related to variations of a person's individual pain perception. Changes in the way the teeth meet can be produced by the use of active orthodontic appliances. This review found that there is no evidence from trials to show that active orthodontic treatment can prevent or relieve temporomandibular disorders adding support to teeth not being part of its cause. It is suspected that we do not know the real cause of TMD at present.
The present paper aims to systematically review the literature on the temporomandibular disorders (TMD)-bruxism relationship published from 1998 to 2008.
A systematic search in the National Library of Medicine's PubMed database was performed to identify all studies on humans assessing the relationship between TMD symptoms and bruxism diagnosed with any different approach. The selected articles were assessed independently by the 2 authors according to a structured reading of articles format (PICO).
A total of 46 articles were included for discussion in the review and grouped into questionnaire/self-report (n = 21), clinical assessment (n = 7), experimental (n = 7), tooth wear (n = 5), polysomnographic (n = 4), or electromyographic (n = 2) studies. In several studies, the level of evidence was negatively influenced by a low level of specificity for the assessment of the bruxism-TMD relationship, because of the low prevalence of severe TMD patients in the studied samples and because of the use of self-report diagnosis of bruxism with some potential diagnostic bias.
Investigations based on self-report or clinical bruxism diagnosis showed a positive association with TMD pain, but they are characterized by some potential bias and confounders at the diagnostic level (eg, pain as a criterion for bruxism diagnosis). Studies based on more quantitative and specific methods to diagnose bruxism showed much lower association with TMD symptoms. Anterior tooth wear was not found to be a major risk factor for TMD. Experimental sustained jaw clenching may provoke acute muscle tenderness, but it is not analogous to myogenous TMD pain, so such studies may not help clarify the clinical relationship between bruxism and TMD.
The frequency of diurnal clenching and/or grinding and nail-biting habits was assessed in patients affected by temporomandibular disorders (TMDs) and in healthy controls in order to investigate the possible association between these oral parafunctions and different diagnostic subgroups of TMDs. The case group included 557 patients (127 men, mean age +/- SD = 34.5 +/- 15.4 years; 430 women, mean age +/- SD = 32.9 +/- 14.1 years) affected by myofascial pain or disc displacement or arthralgia/arthritis/arthrosis. The control group included 111 healthy subjects (55 men, mean age +/- SD = 37 +/- 15.2 years; 56 women, mean age +/- SD = 38.2 +/- 13.8 years). Multinomial logistic regression analysis was used to assess the association between oral parafunctions and TMDs, after adjusting for age and gender. Daytime clenching/grinding was a significant risk factor for myofascial pain (odds ratio (OR) = 4.9, 95% confidence interval (CI): 3.0-7.8) and for disc displacement (OR = 2.5, 95% CI: 1.4-4.3), nail biting was not associated to any of the subgroups investigated. Female gender was a significant risk factor for myofascial pain (OR = 3.8; 95% CI: 2.4-6.1), whereas the risk factor for developing disc displacement decreased with ageing. No association was found between gender, age and arthralgia/arthritis/arthrosis.
To summarize literature data about the role of psychosocial factors in the etiology of bruxism.
A systematic search in the National Library of Medicine's PubMed Database was performed to identify all peer-reviewed papers in the English literature dealing with the bruxism-psychosocial factors relationship. All studies assessing the psychosocial traits of bruxers (by using questionnaires, interviews, and instrumental and laboratory exams) and reviews discussing the contribution of those factors to the etiology of bruxism were included in this review.
A total of 45 relevant papers (including eight reviews) were retrieved with a search strategy combining the term "bruxism" with the words stress, anxiety, depression, psychosocial and psychological factors. The majority of data about the association between psychosocial disorders and bruxism came from studies adopting a clinical and/or self-report diagnosis of bruxism. These studies showed some association of bruxism with anxiety, stress sensitivity, depression and other personological characteristics, apparently in contrast with sleep laboratory investigations. A plausible hypothesis is that clinical studies are more suitable to detect awake bruxism (clenching type), while polysomnographic studies focused only on sleep bruxism (grinding type).
Wake clenching seems to be associated with psychosocial factors and a number of psychopathological symptoms, while there is no evidence to relate sleep bruxism with psychosocial disorders. Future research should be directed toward the achievement of a better distinction between the two forms of bruxism in order to facilitate the design of experimental studies on this topic.