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.

颅颌运动仿真系统(牙合)接触精度初探

目的 探讨颅颌运动仿真系统的骀接触模拟精度,为该仿真系统的应用提供依据.方法 制作10副石膏模型并上(牙合)架.用(牙合)架模拟侧方运动,三维扫描侧方运动终点(牙合)架上的上下颌模型,重建数字化上下颌模型作为对照组.运用仿真系统模拟耠架的侧方运动,以仿真系统输出的侧方运动终点的数字化上下颌模型为试验组.通过比较试验组与对照组下颌牙列之间的位置差异评价仿真系统的(牙合)接触模拟精度.结果 仿真系统模拟的下颌牙列与对照组下颌牙列之间的绝对平均距离为(0.18±0.05)mm;在前后左右四个分区中,两组右后牙区之间的绝对平均距离最大,为(0.19±0.07)mm.结论 该仿真系统的体外胎接触模拟精度为0.19mm.

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)

Avaliação da estabilidade da cirurgia de avanço mandibular através da superposição de modelos tridimensionais

Embora a cirurgia de avanço mandibular seja considerada um procedimento altamente estável, existem algumas preocupações clínicas em relação a mudanças nos côndilos e nos segmentos proximais, que podem levar a recidiva sagital e abertura de mordida. A avaliação dos resultados da cirurgia através de ferramentas de geração e superposição de modelos virtuais tridimensionais (3D) permite a identificação e quantificação dos deslocamentos e remodelação óssea que podem ajudar a explicar as interações entre os componentes dentários, esqueléticos e de tecido mole que estão relacionados a resposta ao tratamento. Este estudo observacional prospectivo avaliou, através de tomografia computadorizada de feixe cônico (CBCT), mudanças na posição/remodelação 3D dos ramos mandibulares, côndilos e mento. Assim, exames CBCT de 27 pacientes foram adquiridos antes da cirurgia (T1), imediatamente após a cirurgia(T2), e 1 ano após a cirurgia(T3). Uma técnica automática de superposição na base do crânio foi utilizada para permitir a avaliação das mudanças ocorridas nas regiões anatômicas de interesse (RAI). Os deslocamentos foram visualizados e quantificados em mapas coloridos 3D através da ferramenta de linha de contorno (ISOLINE). Pelo teste t pareado compararam-se as mudanças entre T1-T2 e T2-T3. O coeficiente de correlação de Pearson verificou se os deslocamentos ocorridos nas RAI foram correlacionados entre si e entre os tempos de avaliação. O nível de significância foi determinado em 0,05. O avanço mandibular médio foi de 6,813,2mm em T2 e 6,363,41mm em T3 (p=0,13). Entre T2 e T3, a posição do mento variou positivamente (≥2mm) em 5 pacientes negativamente em 7. 12% dos pacientes sofreram recidivas ≥4mm. Para todas as outras RAI avaliadas, apenas a porção inferior dos ramos (lado direito - 2,342,35mm e lado esquerdo 2,972,71mm) sofreram deslocamentos médios >2mm com a cirurgia. No acompanhamento em longo prazo, esse deslocamento lateral da porção inferior dos ramos foi mantido (lado direito - 2,102,15mm, p=0,26; e lado esquerdo -2,762,80, p=0,46), bem como todos os outros deslocamentos observados (p>0,05). As mudanças na posição do mento foram correlacionadas a adaptações pós-cirúrgicas nos bordos posteriores dos ramos (esquerdo r=-0,73 e direito r=-0,68) e côndilos (esquerdo r=-0,53 e direito r=-0,46). Os deslocamentos médios sofridos pelas estruturas do lado esquerdo foram suavemente maiores do que no direito. Correlações dos deslocamentos ocorridos entre T1-T2 e T2-T3 mostraram que: os deslocamentos dos côndilos esquerdos com a cirurgia foram negativamente correlacionados às adaptações pós-cirúrgicas destes (r=-0,51); e que o deslocamento da porção superior do ramo esquerdo com a cirurgia foi correlacionado à adaptação pós-cirúrgica ocorrida nos bordos posteriores (r=0,39) e côndilos do mesmo lado (r=0,39). Pode-se concluir que: (1) os deslocamentos causados pela cirurgia foram de modo geral estáveis no acompanhamento de 1 ano, mas identificou-se uma considerável variação individual; (2) as mudanças pós-cirúrgicas na posição do mento foram correlacionadas a adaptações sofridas pelos côndilos e bordos posteriores dos ramos; e que (3) deslocamentos suavemente maiores causados pela cirurgia nas estruturas do lado esquerdo levaram a maiores adaptações pós-cirúrgicas no segmento proximal deste lado.

A cephalometric study of class II malocclusions treated with mandibular surgery

INTRODUCTION:

Class II malocclusion is often associated with retrognathic mandible. Some of these problems require surgical correction. The purposes of this study were to investigate treatment outcomes in patients with Class II malocclusions whose treatment included mandibular advancement surgery and to identify predictors of good outcomes.
METHODS:

Pretreatment and posttreatment cephalometric radiographs of 90 patients treated with mandibular advancement surgery by 57 consultant orthodontists in the United Kingdom before September 1998 were digitized, and cephalometric landmarks were identified. Paired samples t tests were used to compare the pretreatment and posttreatment cephalometric values for each patient. For each cephalometric variable, the proportion of patients falling within the ideal range was identified. Multiple logistic regression analysis was performed to identify predictors of achieving ideal range outcomes for the key skeletal (ANB and SNB angles), dental (overjet and overbite), and soft-tissue (Holdaway angle) measurements.
RESULTS:

An overjet within the ideal range of 1 to 4 mm was achieved in 72% of patients and was more likely with larger initial ANB angles. Horizontal correction of the incisor relationship was achieved by a combination of 75% skeletal movement and 25% dentoalveolar change. An ideal posttreatment ANB angle was achieved in 42% of patients and was more likely in females and those with larger pretreatment ANB angles. Ideal soft-tissue Holdaway angles (7 degrees to 14 degrees ) were achieved in 49% of patients and were more likely in females and those with smaller initial SNA angles. Mandibular incisor decompensation was incomplete in 28% of patients and was more likely in females and patients with greater pretreatment mandibular incisor proclination. Correction of increased overbite was generally successful, although anterior open bites were found in 16% of patients at the end of treatment. These patients were more likely to have had initial open bites.
CONCLUSIONS:

Mandibular surgery had a good success rate in normalizing the main dental and skeletal relationships. Less ideal soft-tissue profile outcomes were associated with larger pretreatment SNA-angle values, larger final mandibular incisor inclinations, and smaller final maxillary incisor inclinations. The use of mandibular surgery to correct anterior open bite was associated with poor outcomes.

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.