Trends of Occlusal Appliance Therapy among Resident Dental Surgeons

Objective: Current study was planned to assess the trends of occlusal appliance construction and selection, among the resident dental surgeons. Method: Data was collected from 51 residents at Fatima Memorial Dental Hospital, which were given a questionnaire that had 20 questions. The frequency of each answer was calculated and compared between residents of different departments and was analyzed by SPSS version 20. Results: The selection and construction of occlusal appliances among the residents was inappropriate. Soft occlusal appliances were the most selected and practiced appliance. Occlusal appliances need to be revisited in the literature with easy to practice guidelines. Keywords: Occlusal appliances, Soft occlusal appliances, Temporo-mandibular joints.

Orthognathic Surgery for Mandible

Mandible, a horseshoe shaped bone of the facial skeleton, is one of the sturdy bones in humans. Prominent chin is a unique feature of anatomically modern man in comparison with his anthropological ancestors. The simian shelf has reduced to two genial tubercles to which two muscles are attached. The neck of the condyle has narrowed and acts as a buffer to budge by fracture if there is a severe force on the prominent chin. These evolutionary changes facilitated increased space for the tongue as men started articulation. It articulates with the temporal bone by two inter-dependent Temporo-mandibular joints. Mandible is important in both function and aesthetics.Mandible can be cut into multiple pieces and re-arranged and fixed to achieve aesthetic and functional changes. Facial bones have a tremendous capacity to regenerate and heal provided proper blood supply is ensured to the cut segments. Ostoetomies of the mandible can be done on ramus, body, chin, dento-alveolar region, inferior border, etc. Most of these procedures are done intraorally. Technological advancements have aided orthognathic surgery at large. This chapter envisages to elaborate different techniques of osteotomy of mandible.

Establishing surface projection of Temporo- Mandibular Joint using tragus of ear as landmark

Introduction: The temporo-mandibular joint (TMJ) is a synovial joint between the articular fossa of the temporal bone and the mandibular condyle. It is condylar variety of joint. The most important functions of the TMJ are mastication and speech and are of great interest to anatomists, dentists, orthodontists and oro-maxillo-facial surgeons. The study was conducted with objective to establish the surface projection of Temporo-mandibular joint (TMJ) using tragus of ear as land mark. Materials and methods: Twenty five cadavers dissected in pre auricular area on both right and left side were studied. Out of 25 cadavers, 18 were male and seven were females. The temporo-mandibular joints were exposed on both sides, keeping the tragus of the ear intact. Altogether fifty temporo-mandibular joints were studied. On living persons, condylar head of TMJ were palpated while the subjects were carrying out side to side movement of lower jaw. The distance between the summit of the tragus and the marking on condylar head was measured with the help of divider and scale. Result: The mean distance in millimeter (mm) from midpoint of condylar head to the summit of tragus in all living subjects and cadavers (n=150) was 12.5 ± 3.5 mm and the mean length of distal phalanx of fore finger in all living subjects and cadavers (n=150) was 22 ± 4 mm. Conclusion: The mandibular condyle can be palpated at 12.5 ± 3.5 mm distance from summit of tragus of ear (i.e. Half-length of distal phalanx of fore finger which is 22 ± 4 mm) just below the inferior border of zygomatic arch.

ANALYSIS OF EFFICIENCY OF THE TEMPORO-MANDIBULAR DISORDERS TREATMENT

Relevance. Treatment of the temporo-mandibular joint (TMJ) dysfunctions still stays an urgent issue of modern stomatology. Its significance is predisposed for its high incidence and annual increase in patients’ referrals as well as diversity of it clinical manifestations, complexity of diagnosis and treatment, variability of clinical pattern, which requires a multi-disciplinary approach. According to Ukrainian and foreign authors, the TMJ pathologies take up the third place after caries and parodontal diseases, being diagnosed in 20 % of children and almost 87 % of adults. The share of patients with the TMJ dysfunction increases every year. The 79 % are represented with the intra-capsular disorders of the temporo-mandibular joints. The study was necessitated by the fact that there is still no single agreement in the treatment methods and definite treatment protocols regarding the intracapsular TMJ disorders. Objectives: analysis of efficiency of the TMJ intracapsular disorders patients’ treatment using the pathogenetically rationalized conservative and mini-invasive surgical methods. Methods and materials. The study includes the data of 38 patients with complaints of the TMJ region pain and the TMJ dysfunction. All patients were examined according to the common protocol. According to the disorder stage, the patients were administered either the conservative treatment course using the treatment tray on the mandible or maxilla, with the subsequent orthopedic or prosthetic treatment, or the splint therapy with subsequent surgical intervention. Results. Having analyzed the dynamical pattern of the treatment outcomes within the study, it has been detected that the surgical injection correction of the TMJ disorders was effective in all examined patients. To provide for the long-term steady treatment outcome the prosthetic-orthopedic rehabilitation measures were indicated, aimed at preserving the correct occlusion relation. Conclusion. The method of hyaluronic acid preparations injection into the TMJ cavity as a stage of the TMJ dysfunction therapy has proven its effectiveness in all the examined patients. In order to achieve the long-term steady result, the patients were recommended prosthetic-orthopedic rehabilitation for producing and supporting the occlusion relation.

Recent advance in appliances and materials enhancing therapy of disorders of the stomatognathic system

Purpose: Dysfunctions of the stomatognathic system are treated with a lot of appliances. The aim of the work was to evaluate the current state in the field of diagnostic techniques and technological advance in appliances and materials enhancing therapy of occlusion disorders of the stomatognathic system. Design/methodology/approach: The principles of appliances functioning, manufacturing technology and materials were analysed. The analysis was made on the basis of the literature review and patent databases, conducting searches for a combination of keywords: dental material, occlusion, disorder, bruxism, clenching, grinding, appliance, therapy, tongue, oral, exerciser, trainer, mandible muscle, bite splint, dental plate. In the case of principles of functioning, devices that require insertion into the mouth are included in the tests. In technology and materials, attention has been paid to necessity of involving a dental technician or ability to perform appliance intra-orally ("chairside"), as well as mass production with possibility of custom fit. Findings: The most widespread in the treatment of disorders of the stomatognathic system are thermoformed materials and devices that are introduced between the dental arches to counteract occlusions of all teeth or selected teeth or force the position of the mandible in relation to the maxilla. Devices that function differently are those in which therapeutic effects result from toning of activity of the elevating mandibular muscles by provoking activity of the opposing muscles lowering the mandible or reducing intra-oral space, for example, by sublingual plates or tongue trainers. Appliances are mainly manufactured of: poly (ethylenevinyl acetate) or polycarbonates, as also mouldable polymers such as: acrylics, polyesters and rubbers. Research limitations/implications: Electronic devices that are not intended to therapy but used only to track mandible mobility or muscle activity during sleep were not taken into account. Practical implications: Solutions activating the action of the opposing muscles to the muscles lifting the mandible are few, and among them one device is retained on teeth without interfering in occlusion. Originality/value: Dental materials for devices for treatment of occlusion disorders are selected with no understanding the influence of elastic and frictional material properties and structure stiffness on the distribution of occlusion forces between the teeth and reactions in temporo-mandibular joints.

The evolution of articulators – part I

Summary One of the objectives of prosthetic dentistry is to restore teeth in harmony with temporo-mandibular joints. Articulator is a device that allows an operator to fabricate a restoration that will be physiologically and psychologically successful. But how much do we really know about the origin of articulators? First articulator designs attempted to duplicate anatomic relationships and functional movements. More sophisticated articulators evolved as more new knowledge about anatomy, mandibular movements and mechanical principles were obtained. The aim of this article was to describe the origin, history and evolution of articulators through the years. For this article, an electronic search was performed across three databases (Science Direct, PubMed and Google Scholar) for relevant citations. Keywords such as articulators, history, early articulators were used alone and in combination for the search. The option of “related articles” was also utilized. Finally, search was performed on the review articles and the most relevant papers were selected.

A Clinical Jaw Movement Training Robot for Mouth Opening/Closing and Lateral Movement Training

This paper discusses a jaw movement training robot implementing a 6-DOF (degrees of freedom) parallel mechanism, and its application to mouth opening and closing and lateral movement training. Temporomandibular joints (TMJ) syndrome prevents patients from opening their mouths or moving their jaws easily due to problems with mandibular joints, mastication muscles, and other organs involved in food chewing. Conventional therapy involves simple mouth opening apparatuses, although individual techniques vary with the physician. We developed and improved a jaw movement training robot that aids jaw opening and closing and lateral jaw movement training. This system consists of a 6-DOF slave manipulator representing a patient manipulator and a 2-DOF or 3-DOF master manipulator representing the doctor command manipulator.

Oro-dental manifestations of the Schwartz-Jampel syndrome

A boy with the Schwartz-Jampel syndrome (chondrodystrophic myotonia) had a number of oro-dental complications.These included difficulty in tooth extraction and orthodontic care due to a small oral aperture and rigidity of the temporo-mandibular joints. General anaesthesia was hazardous because of a propensity to malignant hyperthermia, and endotracheal intubation was difficult because of shortness and rigidity of the neck and the small size of the laryngeal structures.Awareness of these potential problems is crucial for anaesthesia and comprehensive dental management. The radiological demonstration of dentigerous cysts is a hitherto unreported observation in this disorder.