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Journal of Maxillofacial and Oral... Mar 2023Stable and accurate positioning of condyle in the glenoid fossa is necessary for maintaining occlusion, facial symmetry and normal function of the temporomandibular...
OBJECTIVE
Stable and accurate positioning of condyle in the glenoid fossa is necessary for maintaining occlusion, facial symmetry and normal function of the temporomandibular joint following segmental resection of mandible. In non-reconstructed mandibular segments or those with fractured reconstruction plates the bony defect gets altered due to contraction or inadvertent muscular pull. This paper describes various techniques used to control dentate and edentate segments of the mandible during reconstruction following an ablative procedure.
DISCUSSION
Secondary mandibular reconstruction has always been a tedious task for the surgeons. Several techniques have been described in literature ranging the use of external fixators, gunning splints and dentures for stabilising mandibular segments. Use of a pre-bent and adapted reconstruction plate is a common practice but may not be feasible in malignancies, benign tumours causing expansion and secondary reconstruction. The current advances in virtual surgical planning allows mandibular reconstruction to be performed in a simpler yet predictable manner.
CONCLUSION
The paper describes techniques ranging from twin K-wire placement to occlusal wafers, 3D printed splints and patient specific implants to enable accurate positioning of the segments and achieve pre-operative form. Advances in virtual surgical planning will continue to allow this field to evolve and to improve the quality of life of the patients.
PubMed: 37041959
DOI: 10.1007/s12663-023-01897-5 -
Journal of Maxillofacial and Oral... Mar 2023Free fibula flap is the commonly used microvascular free tissue transfer for maxillary and mandibular reconstruction to restore form and function after ablative...
OBJECTIVE
Free fibula flap is the commonly used microvascular free tissue transfer for maxillary and mandibular reconstruction to restore form and function after ablative procedures. Bony reconstruction is an important aspect of reconstruction. This paper describes our technique in using virtual surgical planning for secondary reconstruction of the maxilla and mandible using only stereolithographic models.
DISCUSSION
In the recent past, virtual surgical planning has become a game changer in planning complex reconstruction of maxilla and mandible. This becomes even more important in the cases of secondary reconstruction. Virtual surgical planning requires close interaction between the surgeon and the design and manufacturing team. The latter is often done remotely making the process cumbersome and less user friendly. We have been using a simplified version of the virtual surgical planning at a low cost set up with effective outcomes. This report consists of 22 cases in which secondary reconstruction using osteo-cutaneous free fibula flap was carried out using virtual surgical planning. Mock surgery was performed on stereolithographic (STL) models (face and fibula), pre-bending of plates and fabrication of occlusal splints helped in precise translation of the treatment plan to the operating room which in turn helped in reducing the surgical time and attaining more predictable results.
CONCLUSION
Secondary reconstruction of maxilla and mandible is complex and requires meticulous planning to achieve optimal and predictable results which directly improves the quality of life of the patients.
PubMed: 37041941
DOI: 10.1007/s12663-023-01906-7 -
Journal of the Mechanical Behavior of... Jun 2023Although additive manufacturing has been widely applied for occlusal splint (OS) fabrication, it is still unclear whether 3D printing system and post-curing atmosphere...
Although additive manufacturing has been widely applied for occlusal splint (OS) fabrication, it is still unclear whether 3D printing system and post-curing atmosphere would play a role in the wear resistance of additive-manufactured OS. Therefore, the aim of this study was to evaluate the effect of 3D printing system (liquid crystal display (LCD) and digital light processing (DLP)) and post-curing atmosphere (air and nitrogen gas (N)) on the wear resistance of hard and soft OS materials for additive-manufactured OSs (KeySplint® Hard and Soft). The evaluated properties were microwear (by two-body wear test) and nano-wear resistances (by nanoindentation wear test) as well as flexural strength and flexural modulus (by three-point bending test), surface microhardness (by Vickers hardness test), and nanoscale elastic modulus (reduced elastic modulus) and nano surface hardness (by nanoindentation test). For the hard material, the surface microhardness, microwear resistance, reduced elastic modulus, nano surface hardness, and nano-wear resistance were significantly affected by the printing system (p < 0.05), while all the evaluated properties except flexural modulus were significantly affected by the post-curing atmosphere (p < 0.05). Meanwhile, both the printing system and post-curing atmosphere significantly affected all the evaluated properties (p < 0.05). The specimens additive-manufactured by DLP printer tended to show higher wear resistance in the hard material groups and lower wear resistance in the soft material groups when compared to those by LCD printer. The post-curing at N atmosphere significantly enhanced the microwear resistance of hard material groups additive-manufactured by the DLP printer (p < 0.05) and soft material groups additive-manufactured by the LCD printer (p < 0.01), while it significantly enhanced the nano-wear resistance of both hard and soft material groups regardless of the printing system (p < 0.01). It can be concluded that 3D printing system and post-curing atmosphere affect the micro- and nano-wear resistance of tested additively manufactured OS materials. In addition, it can be also concluded that the optical printing system providing higher wear resistance depends on the material type, and using nitrogen gas as a protection gas during post-curing enhances the wear resistance of tested materials.
Topics: Materials Testing; Occlusal Splints; Printing, Three-Dimensional; Flexural Strength; Nitrogen; Surface Properties
PubMed: 37028121
DOI: 10.1016/j.jmbbm.2023.105799 -
Children (Basel, Switzerland) Mar 2023Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical... (Review)
Review
Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.
PubMed: 36980163
DOI: 10.3390/children10030605 -
BMC Oral Health Mar 2023This systematic review aims to examine the existing original studies to determine the effectiveness of occlusal splints (OSs) in the management of orofacial myalgia and...
BACKGROUND
This systematic review aims to examine the existing original studies to determine the effectiveness of occlusal splints (OSs) in the management of orofacial myalgia and myofascial pain (MP) in comparison with no treatment or other interventions.
MATERIALS AND METHODS
Based on the inclusion and exclusion criteria of this systematic review, randomized controlled trials were qualified, in which the effectiveness of occlusal splint therapy in the management of muscle pain was examined in comparison with no treatment or other interventions. This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The authors searched three databases (PubMed, CINAHL (The Cumulative Index to Nursing and Allied Health Literature) and Scopus) for English publications published between January 1, 2010, and June 1, 2022. The last database search was carried out on June 4, 2022. Data were extracted from the included studies and assessed for risk of bias using the revised Cochrane risk-of-bias tool for randomized trials.
RESULTS
Thirteen studies were identified for inclusion in this review. In total, 589 patients were diagnosed with orofacial muscle pain who underwent education and various forms of therapy including different types of OSs, light emitting diode therapy, acupuncture, low-level laser therapy, device-supported sensorimotor training, Kinesio Taping, myofunctional therapy, and physical therapy. All studies included demonstrated a high risk of bias.
CONCLUSIONS
There is insufficient evidence regarding whether OS therapy in the treatment of orofacial myalgia and MP offers an advantage over other forms of interventions or no treatment. Further reliable clinical studies in this area are needed to improve the quality of research, which should be performed with larger groups of blinded respondents and controls.
CLINICAL RELEVANCE
Due to the large-scale nature of orofacial muscle pain, it is assumed that each dental clinician will meet patients with orofacial muscle pain repeatedly in daily practice; hence, the review of the effectiveness of OSs in the management of orofacial myalgia and MP is necessary.
Topics: Humans; Myalgia; Occlusal Splints; Facial Pain
PubMed: 36978070
DOI: 10.1186/s12903-023-02897-0 -
Cureus Mar 2023Temporomandibular disorders (TMDs) are common and affect the temporomandibular joint (TMJ) and surrounding musculoskeletal tissues. Although traditional rehabilitative...
Temporomandibular disorders (TMDs) are common and affect the temporomandibular joint (TMJ) and surrounding musculoskeletal tissues. Although traditional rehabilitative treatments such as physiotherapy, occlusal splints, orthodontics, and electrotherapy effectively manage TMDs, chiropractic therapy is emerging as a promising non-invasive treatment option. We report a 39-year-old female patient with TMD who underwent chiropractic therapy, including spinal adjustments, soft tissue therapy, and exercise rehabilitation. After four weeks of treatment, the patient reported a complete resolution of symptoms and an improved quality of life score. Thereafter, the patient continued chiropractic treatment monthly for six months, during which she reported no symptoms and demonstrated improvements in her spinal range of motion, open-mouth anatomy, and cervical lordosis. This case study highlights the efficacy of applying an interdisciplinary approach to treating TMD and the potential of chiropractic therapy as a valuable treatment option for managing TMD.
PubMed: 36945237
DOI: 10.7759/cureus.36377 -
Polimery W Medycynie 2023Occlusal splints can protect teeth during bruxism, preventing tooth wear, as well as during sports activities, shielding them from impacts.
BACKGROUND
Occlusal splints can protect teeth during bruxism, preventing tooth wear, as well as during sports activities, shielding them from impacts.
OBJECTIVES
To verify the influence of thermal cycles and disinfection on the roughness, microhardness and color of polyethylene terephthalate glycol/thermoplastic polyurethane (PETG/TPU) and poly(methyl methacrylate) (PMMA).
MATERIAL AND METHODS
Thirty-six PETG/TPU samples and 36 PMMA samples were prepared (ø10 mm × 3 mm). Six groups were created according to the material and the disinfection method used (n = 12 each): PETG/TPU (glister), PETG/TPU (hypochlorite), PETG/TPU (soap), PMMA (glister), PMMA (hypochlorite), and PMMA (soap). Roughness, Knoop microhardness and color evaluations were performed before the experiments (T1), after thermocycling (T2) and after disinfection (T3). Three-way repeated measures analysis of variance (ANOVA) and Tukey's test were used for statistical evaluations.
RESULTS
For roughness and color, ANOVA showed statistical significance based on the interaction between thermal cycling, material and disinfectant factors. In terms of Knoop microhardness, ANOVA showed statistical significance based on the interaction between thermal cycling and material factors.
CONCLUSIONS
Roughness results were clinically acceptable in all groups at all time points, except the PETG/TPU and PMMA groups disinfected with hypochlorite. Microhardness significantly increased for both materials after thermal cycling, and at all time points, the microhardness of PMMA was significantly higher than that of PETG/TPU. After thermal cycling, the color changes were clinically unacceptable in all groups.
Topics: Polymethyl Methacrylate; Disinfection; Hypochlorous Acid; Materials Testing; Soaps; Surface Properties
PubMed: 36929643
DOI: 10.17219/pim/159350 -
Clinical Oral Investigations May 2023To compare the effects of two types of titratable mandibular advancement devices (MADs), namely MAD-H (allowing limited vertical opening) and MAD-S (allowing free... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparisons of the effects of two types of titratable mandibular advancement devices on respiratory parameters and upper airway dimensions in patients with obstructive sleep apnea: a randomized controlled trial.
OBJECTIVES
To compare the effects of two types of titratable mandibular advancement devices (MADs), namely MAD-H (allowing limited vertical opening) and MAD-S (allowing free vertical opening), on respiratory parameters and upper airway dimensions in patients with mild to moderate obstructive sleep apnea (OSA).
MATERIALS AND METHODS
Patients with mild to moderate OSA (5 ≤ apnea-hypopnea index (AHI) < 30 /h) were randomly assigned to two parallel MAD groups. All MADs were subjectively titrated according to a standardized protocol during a 3-month follow-up. Every patient underwent two polysomnographic recordings, and two cone beam computed tomography scans in supine position: one at baseline and another one after 3 months with the MAD in situ. The primary outcome variables were the AHI in supine position (AHI-supine) and the minimal cross-sectional area of the upper airway in supine position (CSAmin-supine).
RESULTS
A total of 49 patients were recruited, and 31 patients (21 men and 10 women) with a mean (± SD) age of 48.5 (± 13.9) years and a mean AHI of 16.6 (± 6.7) /h completed the study. In the per-protocol analysis, there was no significant difference between MAD-H (n = 16) and MAD-S (n = 15) in their effects on AHI-supine (P = 0.14) and CSAmin-supine (P = 0.59). Similar results were found in the intention-to-treat analysis (P = 0.47 and 0.57, respectively).
CONCLUSIONS
Within the limitations of this study, we conclude that there is no significant difference in the effects of an MAD allowing limited vertical opening and an MAD allowing free vertical opening on respiratory parameters and upper airway dimensions in patients with mild to moderate OSA.
CLINICAL RELEVANCE
MADs allowing limited vertical opening and allowing free vertical opening have similar effects on respiratory parameters and upper airway dimensions in patients with mild to moderate OSA.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02724865. https://clinicaltrials.gov/ct2/show/NCT02724865.
Topics: Male; Humans; Female; Adult; Middle Aged; Occlusal Splints; Mandibular Advancement; Sleep Apnea, Obstructive; Cone-Beam Computed Tomography; Treatment Outcome
PubMed: 36928350
DOI: 10.1007/s00784-023-04945-z -
Postural Disharmony Causing Myofacial Pain: A Case Report and Review of Literature of the Treatment.Journal of Maxillofacial and Oral... Dec 2022Myofacial pain, a chronic painful condition of muscle origin, has numerous precipitating factors, if undiagnosed or left untreated could lead to compromised function and...
Myofacial pain, a chronic painful condition of muscle origin, has numerous precipitating factors, if undiagnosed or left untreated could lead to compromised function and poor quality of life. In this case report, a female patient giving a history of 10 years of pain in the head and neck region was eventually diagnosed with myofacial pain secondary to bowing posture. The patient was successfully treated with combination of treatment modalities (TENS therapy, exercises, occlusal splint, etc.), which resulted in relief from chronic pain and improvement in quality of life.
PubMed: 36896091
DOI: 10.1007/s12663-019-01281-2 -
International Journal of Environmental... Feb 2023Since obstructive sleep apnea (OSA) management with a mandibular advancement device (MAD) is likely to be life-long, potential changes in mandibular movements during...
Since obstructive sleep apnea (OSA) management with a mandibular advancement device (MAD) is likely to be life-long, potential changes in mandibular movements during therapy should be investigated. The purpose of this study was to use a method that has already been shown to be reliable in order to determine whether the range of antero-posterior mandibular excursion, the procedure upon which MAD titration is based, varies between baseline (T0) and at least 1 year of treatment (T1). The distance between maximal voluntary protrusion and maximal voluntary retrusion determined using the millimetric scale of the George Gauge was retrospectively collected from the medical records of 59 OSA patients treated with the MAD and compared between T0 and T1. A regression analysis was performed to evaluate the influence of treatment time, MAD therapeutic advancement and the patient's initial characteristics in excursion range variation. A statistically significant increase of 0.80 ± 1.52 mm (mean ± standard deviation, < 0.001) was found for antero-posterior mandibular excursion. The longer the treatment time ( = 0.044) and the smaller the patient's mandibular excursion at T0 ( = 0.002), the greater the increase was. These findings could be explained by a muscle-tendon unit adaptation to the forward mandibular repositioning induced by the MAD. During MAD therapy, patients can develop a wider range of antero-posterior mandibular excursion, especially those with a smaller initial excursion capacity.
Topics: Humans; Retrospective Studies; Occlusal Splints; Treatment Outcome; Mandibular Advancement; Sleep Apnea, Obstructive
PubMed: 36834252
DOI: 10.3390/ijerph20043561