Mandibular Movement Restoration Through Bilateral Coronoidectomy by Intraoral Approach

The present study aimed at reporting a clinical and surgical case of bilateral coronoidectomy, using an intraoral approach. The patient is a 26-year-old man, who sought attendance complaining of a gradual reduction of his oral opening in the past 3 years; however, he had an aggravation in the last 2 months. After clinical examination and imaging evaluation, the diagnosis of coronoid process hyperplasia was confirmed, and the surgical treatment was proposed. Under general anesthesia, with nasotracheal intubation guided by a nasofiberendoscope, using an intraoral approach, the bilateral coronoidectomy was performed. In the immediate postoperative period, an increase of the buccal opening measured 29 mm, representing an enhancement of 11 mm, and in the 30th postoperative day, it measured 31.12 mm. During the clinical follow-up period, a reestablishment of the mandibular movements was observed. Therefore, coronoidectomy by an intraoral approach and the physiotherapy performed in the postoperative period were efficient procedures.

Terapêutica interdisciplinar para fratura cominutiva de côndilo por projétil de arma de fogo: enfoque miofuncional

TEMA: ferimentos causados por projéteis de arma de fogo apresentam alta incidência na região da cabeça e face. A articulação temporomandibular pode estar envolvida, além de estruturas anatômicas importantes como o nervo facial, necessitando de equipe multidisciplinar para efetuar tratamento adequado. PROCEDIMENTOS: apresentação de caso clínico de fratura condilar cominutiva causada por projétil de arma de fogo tratado de forma não-cirúrgica associado à terapia miofuncional orofacial. Paciente encaminhado para avaliação e procedimentos fonoaudiológicos após conduta da equipe de cirurgia bucomaxilofacial, sem remoção do projétil, alojado superficialmente, próximo da origem do músculo esternocleidomastóideo à direita, com fratura condilar cominutiva e lesão do nervo facial. Foram aspectos observados em avaliação: mordida aberta anterior, importante redução da amplitude dos movimentos mandibulares com desvios para o lado acometido, ausência de lateralidade contralateral, dor muscular, paralisia e parestesia em terço médio e superior da hemiface direita. Realizadas sessões de terapia miofuncional seguindo protocolo específico para traumas de face constando de: drenagem de edema; manipulações na musculatura levantadora da mandíbula ipsilateral; ampliação e correção dos movimentos mandibulares; procedimentos específicos referentes à paralisia facial e reorganização funcional direcionada. RESULTADOS: após oito semanas de terapia os resultados obtidos mostram restabelecimento de amplitude e da simetria dos movimentos mandibulares, reorganização da mastigação, adequação da deglutição e fala, remissão da sintomatologia dolorosa e remissão da paralisia do terço médio. CONCLUSÃO: o tratamento conservador da fratura por meio da terapia miofuncional orofacial resultou na reabilitação funcional da mandíbula e face dirigindo os movimentos e estimulando a adequação das funções estomatognáticas.

Joint vibrations analysis in asymptomatic volunteers and symptomatic patients

The joint sound is a common sign in TMD, the diagnosis is important to establish the treatment of pathological alterations which occur in the TMJ. In this study, two groups were selected: 1, Asymptomatic volunteers; and 2, Symptomatic patients who were diagnosed in a clinical examination. After the initial examination, they were submitted to evaluation using electrovibratography (SonoPAK II, BioResearch Assoc., Inc., Milwaukee, Wisconsin). The analysis of results indicated that the averages of the vibratory energy in the symptomatic group presented higher values in all stages of the mandibular movement when compared to the averages of vibratory energy registered in the asymptomatic group.

Estudo cinesiográfico do espaço de pronúncia do som /s/ em indivíduos dentados e desdentados

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudo cinesiográfico da deglutição em indivíduos com dentição natural e com próteses totais

Pós-graduação em Reabilitação Oral - FOAR

Estudo prospectivo sobre a utilização de próteses totais implantossuportadas em pacientes edêntulos

The objective of this study was to evaluate the impact of replacing conventional mandibular complete dentures by complete fixed dentures on the oral health-related quality of life and kinesiographic parameters of maxillary edentulous patients. Material and Methods: edentulous patients (n = 16) received one set of new complete dentures and after the intraoral adjustments and adaptation period (30 days), the Brazilian version of Oral Health Impact Profile for assessing edentulous subjects (Ohip-Edent) was used to evaluate the oral health-related quality of life (OHQOL) of the participants. Additionally, the kinesiograph instrument K6-I (Myotronics Research Inc., Seattle, WA) was used to record opening and closure range of movement, mandibular movement, and the pattern of maxillary complete denture movement on chewing. Afterwards, the patients had their mandibular complete dentures replaced by a complete fixed denture and the same evaluation protocol was performed after 3 and 6 months. Ohip-Edent responses were analyzed using Wilcoxon's test for repeated measures (α = .05) and Kinesiographic data using the Student´s t test (α = .05). Results: The Ohip-Edent showed an improvement of general oral health-related quality of life after 3 and 6 months of the treatment with complete fixed dentures. Kinesiographic recordings revealed a significant increase on maximum mandibular movements of vertical opening and no differences for the movement of the maxillary complete denture on chewing after treatment with complete fixed dentures was observed. Conclusion: the installation of complete fixed dentures improved the OHQOL and changed mandibular movements, with increases in vertical amplitude of maximal opening.

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

To evaluate the pattern of maxillary complete denture movement during chewing for free-end removable partial dentures (RPD) wearers, compared to maxillary and mandibular complete denture wearers. Eighteen edentulous participants (group I) and 10 volunteers with bilateral posterior edentulous mandibles (group II) comprised the sample. Measures of mean denture movement and its variability were obtained by a kinesiographic instrument K6-I Diagnostic System, during the mastication of bread and a polysulphide block. Data were analysed using two-way anova (alpha = 0.05). Upper movement during chewing was significantly lower for group II, regardless of the test food. The test food did not influence the vertical or lateral position of the denture bases, but more anterior dislocation was found when polysulphide blocks were chewed. Group II presented lower intra-individual variability for the vertical axis. Vertical displacement was also more precise with bread as a test food. It can be concluded that mandibular free-end RPD wearers show smaller and more precise movements than mandibular complete denture wearers.

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Class I malocclusion treatment: Influence of a missing mandibular incisor on anterior guidance

This case report describes the orthodontic treatment of a patient with a deep-overbite Angle Class I malocclusion, agenesis of a mandibular central incisor, and 2 supernumerary teeth, which caused impaction of the mandibular first premolars. The 15-year-old patient also had a convex profile, maxillary dentoalveolar protrusion, and deficiency of space for the correct alignment of teeth. Therefore, treatment consisted of fixed appliance therapy, cervical headgear, extraction of the supernumeraries and the mandibular and maxillary first premolars, and mesiodistal reduction of the maxillary incisors to solve the arch perimeter discrepancy as much as possible with interproximal stripping. This method of treatment significantly improved the patient`s facial and dental esthetics and provided a good functional occlusion, despite the absence of a mandibular incisor, which generally impairs achieving adequate incisal guidance. (Am J Orthod Dentofacial Orthop 2010;138:109-17)

Forebrain projections to brainstem nuclei involved in the control of mandibular movements in rats

Mandibular movements occur through the triggering of trigeminal motoneurons. Aberrant movements by orofacial muscles are characteristic of orofacial motor disorders, such as nocturnal bruxism (clenching or grinding of the dentition during sleep). Previous studies have suggested that autonomic changes occur during bruxism episodes. Although it is known that emotional responses increase jaw movement, the brain pathways linking forebrain limbic nuclei and the trigeminal motor nucleus remain unclear. Here we show that neurons in the lateral hypothalamic area, in the central nucleus of the amygdala, and in the parasubthalamic nucleus, project to the trigeminal motor nucleus or to reticular regions around the motor nucleus (Regio h) and in the mesencephalic trigeminal nucleus. We observed orexin co-expression in neurons projecting from the lateral hypothalamic area to the trigeminal motor nucleus. In the central nucleus of the amygdala, neurons projecting to the trigeminal motor nucleus are innervated by corticotrophin-releasing factor immunoreactive fibers. We also observed that the mesencephalic trigeminal nucleus receives dense innervation from orexin and corticotrophin-releasing factor immunoreactive fibers. Therefore, forebrain nuclei related to autonomic control and stress responses might influence the activity of trigeminal motor neurons and consequently play a role in the physiopathology of nocturnal bruxism.

Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts (R) total joint prostheses Part IV - Soft tissue response

The purpose of this Study was to evaluate Soft tissue response to rnaxillo-mandibular counter-clockwise rotation, with TMJ reconstruction and mandibular advancement using TMJ Concepts (R) total joint prostheses, and maxillary osteotomies in 44 females. All patients were operated at Baylor University Medical Center, Dallas TX, USA, by one Surgeon (Wolford). Eighteen patients had genioplasties with either porous block hydroxyapatite or hard tissue replacement implants (Group 2) 26 had no genioplasty (Group 1). Surgically, the maxilla moved forward and upward by counter-clockwise maxillo-mandibular rotation with greater horizontal movement in Group 2. Vertically, both groups showed diversity of maxillo-mandibular mean movement. Group I showed a consistent 1:0.97 ratio of hard to soft tissue advancement at pogonion; Group 2 results were less consistent, with ratios between 1:0.84 and 1:1.02. Horizontal changes in upper lip morphology after maxillary advancement/impaction, VY closure, and alar base cinch sutures showed greater movement in both groups, than observed in hard tissue. Counter-clockwise rotation of the maxillo-mandibular complex using TMJ Concepts total joint prostheses resulted in similar soft tissue response as previously reported for traditional maxillo-mandibular advancement without counter-clockwise rotation of the occlusal plane. The association of chin implants, in the present sample, showed higher variability of soft tissue response.

Orthodontic movement of teeth with intraosseous defects: histologic and histometric study in dogs

The purpose of this study was to evaluate histologically, in dogs, the periodontal healing of 1-walled intraosseous defects in teeth that were subjected to orthodontic movement toward the defects. The defects were surgically created bilaterally at the mesial aspects of the maxillary second premolars and distal aspects of the mandibular second premolars of 4 mongrel dogs. One week after creating the defects, an orthodontic appliance was installed, and the teeth were randomly assigned to 1 of 2 treatment groups: those in the test group received a titanium-molybdenum alloy rectangular wire spring that performed a controlled tipping root movement, and those in the control group received a passive stainless steel wire. Active orthodontic movement of the test teeth lasted 2 months and was followed by a stabilization period of another 2 months, after which the animals were killed. Throughout the study, routine daily plaque control was performed on the dogs with a topical application of a 2% chlorhexicline gel. The results showed no difference between the groups, with some regularization of the defects and periodontal regeneration limited to the apical portion of the defects. Histometric analysis showed a significant difference in bone height; on average, it was 0.53 mm smaller in the test group. It was concluded that orthodontic movement does not interfere with the healing of 1-walled intraosseous defects, with the exception of the linear extent of new bone apposition.

Electromyographic analysis of superior belly of the omohyoid muscle and anterior belly of the digastric muscle in mandibular movements

The superior belly of the omohyoid muscle and the anterior belly of the digastric muscle, were studied electromyographically in 20 young volunteers. For each muscle, 1 pair of monopolar electrodes was employed. One was a surface electrode and the other a needle electrode, which was inserted in the belly of the muscle. The surface electrode was placed 1 cm apart from the needle electrode. The most marked action of both muscles was on the movement of lowering the mandible. They also act in those movements for the performance of which they have associated a component of lowering the jaw, propulsion, laterality to the right and the left and retrusion. They are not active in the resting position and during jaw movements of elevation, extrusion and protrusion. Both muscles are active most of the time, simultaneously, but it is not possible to demonstrate that there is a synchronism between their actions.

Combination of orthodontic movement and periodontal therapy for full root coverage in a miller class iii recession: A case report with 12 years of follow-up

One of the main purposes of mucogingival therapy is to obtain full root coverage. Several treatment modalities have been developed, but few techniques can provide complete root coverage in a class III Miller recession. Thus, the aim of this case report is to present a successful clinical case of a Miller class III gingival recession in which complete root coverage was obtained by means of a multidisciplinary approach. A 17-year-old Caucasian female was referred for treatment of a gingival recession on the mandibular left central incisor. The following procedures were planned for root coverage in this case: free gingival graft, orthodontic movement by means of alignment and leveling and coronally advanced flap (CAF). The case has been followed up for 12 years and the patient presents no recession, no abnormal probing depth and no bleeding on probing, with a wide attached gingiva band. A compromised tooth with poor prognosis, which would be indicated for extraction, can be treated by orthodontic movement and periodontal therapy, with possibility of 100% root coverage in some class III recessions.