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Head & Face Medicine Jan 2007The paradigmatic shift to evidence-based dentistry (EBD) that relates to occlusal therapy, selective occlusal adjustment (OA) and stabilization splints therapy (SS) for... (Review)
Review
The paradigmatic shift to evidence-based dentistry (EBD) that relates to occlusal therapy, selective occlusal adjustment (OA) and stabilization splints therapy (SS) for TMDs has had an unfavourable impact on the teaching of many of the important aspects of occlusion needed in dental practice. The teaching of OA systematically in dental schools has been nearly abandoned because of the belief that OA is an irreversible procedure and gives the impression that it is without merit elsewhere in the management of occlusion. However, a particular dose of knowledge and practice of occlusion that is necessary for all aspects of dental care should be taught systematically in dental schools. The uses and misuses of OA and SS and their limitations should be emphasized because of their importance to bring clinical reality into the dental curriculum. Thus, and irrespective of EBD induced contradictions, OA and SS should still have a significant place in systematically teaching of occlusal therapy. However, there are many more aspects of the management of occlusion that should to be considered. Hopefully, because of their importance, other aspects of the management of occlusion will once again become a significant part of the dental curriculum.
Topics: Dental Occlusion; Education, Dental; Humans; Malocclusion
PubMed: 17201917
DOI: 10.1186/1746-160X-3-1 -
Medicina Oral, Patologia Oral Y Cirugia... May 2014To investigate the relation between occlusal loading and peri-implant clinical parameters (probing depth, bleeding on probing, gingival retraction, width of keratinized...
OBJECTIVES
To investigate the relation between occlusal loading and peri-implant clinical parameters (probing depth, bleeding on probing, gingival retraction, width of keratinized mucosa, and crevicular fluid volume) in patients with implant-supported complete fixed prostheses in both arches.
MATERIAL AND METHODS
This clinical study took place at the University of Valencia (Spain) dental clinic. It included patients attending the clinic for regular check-ups during at least 12 months after rehabilitation of both arches with implant-supported complete fixed ceramo-metallic prostheses. One study implant and one control implant were established for each patient using the T-Scan®III computerized system (Tesco, South Boston, USA). The maxillary implant closest to the point of maximum occlusal loading was taken as the study implant and the farthest (with least loading) as the control. Occlusal forces were registered with the T-Scan® III and then occlusal adjustment was performed to distribute occlusal forces correctly. Peri-implant clinical parameters were analyzed in both implants before and two and twelve months after occlusal adjustment.
RESULTS
Before occlusal adjustment, study group implants presented a higher mean volume of crevicular fluid (51.3 ± 7.4 UP) than the control group (25.8 ± 5.5 UP), with statistically significant difference. Two months after occlusal adjustment, there were no significant differences between groups (24.6 ± 3.8 UP and 26 ± 4.5 UP respectively) (p=0.977). After twelve months, no significant differences were found between groups (24.4 ± 11.1 UP and 22.5 ± 8.9 UP respectively) (p=0.323). For the other clinical parameters, no significant differences were identified between study and control implants at any of the study times (p>0.05).
CONCLUSIONS
Study group implants receiving higher occlusal loading presented significantly higher volumes of crevicular fluid than control implants. Crevicular fluid volumes were similar in both groups two and twelve months after occlusal adjustment.
Topics: Bite Force; Dental Prosthesis, Implant-Supported; Female; Gingival Crevicular Fluid; Humans; Male; Middle Aged; Periodontal Index; Pilot Projects; Time Factors
PubMed: 24316708
DOI: 10.4317/medoral.19477 -
Srpski Arhiv Za Celokupno Lekarstvo 2004The objective of this paper was to show the historical perspective of the "long centric" occlusal concept and its importance in the modern dentistry, especially from the... (Review)
Review
The objective of this paper was to show the historical perspective of the "long centric" occlusal concept and its importance in the modern dentistry, especially from the gnathological aspect. The "long centric" concept represents therapeutic modality used in modern dentistry and occlusal adjustment in all patients showing differences in strong and weak closure of the lower jaw starting from the position of physiological rest. "Long centric" concept is applied only for anterior teeth and occlusal movements from rather than toward the center. Whenever the "long centric" parameters are not adequate, occlusal disturbance, resulting from the "wedge" effect during the initial closure of the lower jaw, is present. Different degrees of abrasion or hypermobility of the teeth are often the result of the above-mentioned occlusal disturbances and can potentially trigger bruxism and malfunction. Modus procedendi should be the regular approach of every dentist to any occlusion, because only the built-in "long centric" efficiently contributes to the occlusal stability of the anterior portion of the dentition. All occlusions should be routinely tested regarding their need for "long centric", especially when the extensive therapeutic interventions (conservative, prosthetics) of the occlusal complex are required.
Topics: Centric Relation; Dental Occlusion, Centric; Humans; Occlusal Adjustment
PubMed: 15938227
DOI: 10.2298/sarh0412441m -
Journal of Prosthodontic Research Feb 2021The purpose of this study was to evaluate the occlusal force adjusting ability of implant-supported overdenture (IOD) wearers, as compared with natural teeth and...
PURPOSE
The purpose of this study was to evaluate the occlusal force adjusting ability of implant-supported overdenture (IOD) wearers, as compared with natural teeth and complete dentures.
METHODS
Subjects were those with natural dentition (ND group; 19 subjects), those with implant-supported overdentures (IOD group; 7 subjects), and those with complete dentures (CD group; 14 subjects). Subjects were asked to hold test foods (peanuts and biscuits mounted on a custom-made apparatus with a force transducer) between their anterior incisors (hold phase) and split test foods (split phase). The mean value of the occlusal force during the hold phase (hold force), the peak force rate during the split phase (peak force rate), the time required to split test foods (duration), and the maximum occlusal force in the split phase (split force) were selected as outcomes. Data were analyzed with Wilcoxon's signed rank test, the Kruskal-Wallis test, and multiple regression analysis (Statistical significance levels: 5%).
RESULTS
For peanuts, the peak force rate for the ND group was significantly higher than the IOD and CD groups. The duration of the CD group was significantly longer than the ND and IOD groups. Multiple regression analysis indicated that even with adjustment for age and sex, there were significant differences in the peak force rate between the ND and the IOD, CD groups, and in the duration between the ND and CD group.
CONCLUSIONS
Subjects with IODs showed superior ability to adjust occlusal force, as compared with complete dentures, although it didn't match the natural dentition.
Topics: Bite Force; Dental Prosthesis, Implant-Supported; Denture Retention; Denture, Complete, Lower; Denture, Overlay; Humans; Mandible
PubMed: 32938862
DOI: 10.2186/jpr.JPOR_2019_376 -
Anesthesia Progress 1984Review of the literature indicates that most routine orofacial dysfunctions are characterized by deep pain. Various disorders of the masticatory systems, particularly... (Review)
Review
Review of the literature indicates that most routine orofacial dysfunctions are characterized by deep pain. Various disorders of the masticatory systems, particularly musculoskeletal conditions, are thought to be triggered by occlusal disharmonies. The pain component develops following a pattern of bruxism, muscle hyperactivity, fatigue and spasm. Treatment for most disorders has been to modify the occlusion, although the rational for doing so appears questionable.CRITICAL ISSUES IN THE FIELD OF OCCLUSION RELATED TO OROFACIAL PAIN ARE REVIEWED: occlusal disharmonies, coincidence of retruded-intercuspal contact positions, non-working side interferences, maximum intercuspation of teeth, occlusal adjustment, and occlusal appliances.The studies reviewed fail to support the clinical objective of obtaining equal contact at retruded and intercuspal positions and that the lateral pterygoid muscles stabilize the temporomandibular joint. The relationship between non-working side interferences and pain dysfunction is also not readily supported by controlled studies. Occlusal adjustment appears to be unsatisfactory as a modality for management of pain: not all patients improved following treatment, some relapse occurs even with the most stable contacts, and other treatments such as intra-articular injections of corticosteroids reduced symptoms more readily. Occlusal splints seem to reduce most clinical signs and symptoms on both a short-term and long-term basis. Placement of mandibular orthopedic repositioning appliances results in reduction of pain in some patients, but usually this treatment is followed by extensive rehabilitation.Six major areas are suggested for clinical studies that attempt to relate occlusion to management of orofacial pain. These include: establishment of an ideal jaw position, sequencing of symptoms in the pain history, relationship of pain to other symptoms, development of physiological methods to assess how occlusal modification affects pain perception and pain tolerance, and determination of which treatment modalities produce the most effective relief of pain.
Topics: Chronic Disease; Dental Occlusion; Dental Occlusion, Balanced; Dental Occlusion, Centric; Face; Facial Muscles; Humans; Malocclusion; Mouth Protectors; Pain; Pain Management; Splints; Temporomandibular Joint Dysfunction Syndrome
PubMed: 6375467
DOI: No ID Found -
Medicina Oral, Patologia Oral Y Cirugia... Mar 2015Muscular hyperactivity is a potential source of symptoms in patients with temporal-mandibular disorders. An adequate occlusal adjustment may relieve such symptoms. This...
OBJECTIVES
Muscular hyperactivity is a potential source of symptoms in patients with temporal-mandibular disorders. An adequate occlusal adjustment may relieve such symptoms. This study aims to measure the effect of shortening the protrusive disclusion time (DT) and balancing the center of occlusal forces (COF) on the EMG recordings and assess the pain reported by chronic patients one month after the computer-guided occlusal adjustment.
STUDY DESIGN
The sample studied comprised 34 patients suffering from chronic facial pain in which the EMG activity of both masseters was recorded by electromyography. By selective grinding we alleviated all the occlusal interferences during the mandibular protrusion from the habitual closure position in order to establish an immediate posterior disclusion and an equilibration of the COF.
RESULTS
At follow-up 76.5% of the patients reported no facial pain. Moreover, the EMG activity and protrusive DT were significantly reduced, and occlusal and muscular function were significantly more symmetric than at baseline.
CONCLUSIONS
According to this EMG study, this computer-guided occlusal adjustment is able to reduce the activity of the masseters and the self-reported muscular pain of patients one-month after treatment.
Topics: Adult; Bite Force; Chronic Pain; Diagnostic Self Evaluation; Electromyography; Facial Pain; Female; Follow-Up Studies; Humans; Male; Middle Aged; Occlusal Adjustment; Prospective Studies; Therapy, Computer-Assisted; Treatment Outcome; Young Adult
PubMed: 25475783
DOI: 10.4317/medoral.20272 -
Journal (Canadian Dental Association) Sep 2002The purpose of this article is to review the clinical features, diagnosis and management of the cracked tooth syndrome (CTS). The condition refers to an incomplete... (Review)
Review
The purpose of this article is to review the clinical features, diagnosis and management of the cracked tooth syndrome (CTS). The condition refers to an incomplete fracture of a vital posterior tooth that occasionally extends into the pulp. A lack of awareness of the condition coupled with its varied clinical features can make diagnosis of CTS difficult. Common symptoms include an uncomfortable sensation or pain from a tooth that occurs while chewing hard foods and which ceases when the pressure is withdrawn. The patient is often unable to identify the offending tooth or quadrant involved, and may report a history of numerous dental procedures with unsatisfactory results. Successful diagnosis and management requires an awareness of the existence of CTS and the appropriate diagnostic tests. Management options depend on the nature of the symptoms and extent of the lesion. These options include routine monitoring, occlusal adjustments, placement of a cast restoration and endodontic treatment. A decision flowchart indicating the treatment options available to the dental practitioner is presented.
Topics: Bruxism; Cracked Tooth Syndrome; Decision Trees; Dental Occlusion, Traumatic; Dental Restoration, Permanent; Humans; Molar; Occlusal Adjustment
PubMed: 12323102
DOI: No ID Found -
The Journal of Advanced Prosthodontics Jun 2019The aim of this study was to evaluate the effect of occlusal adjustments on the surface roughness of yttria-tetragonal zirconia polycrystal (Y-TZP) and wear of opposing...
PURPOSE
The aim of this study was to evaluate the effect of occlusal adjustments on the surface roughness of yttria-tetragonal zirconia polycrystal (Y-TZP) and wear of opposing artificial enamel.
MATERIALS AND METHODS
Twenty-five Y-TZP slabs from each brand (Lava, 3M and Bruxzir, Glidewell Laboratories) with different surface conditions (Control polished - CPZ; Polished/ground - GRZ; Polished/ground/repolished - RPZ; Glazed - GZ; Porcelain-veneered - PVZ; n=5) were abraded (500,000 cycles, 80 N) against artificial enamel (6 mm diameter steatite). Y-TZP roughness (in µm) before and after chewing simulation (CS) and antagonist steatite volume loss (in mm) were evaluated using a contact surface profilometer. Y-TZP roughness was analyzed by three-way analysis of variance (ANOVA) and teatite wear by two-way ANOVA and Tukey Honest Difference (HSD) (=.05).
RESULTS
There was no effect of Y-TZP brand on surface roughness (=.216) and steatite loss (=.064). A significant interaction effect (<.001) between surface condition and CS on Y-TZP roughness was observed. GZ specimens showed higher roughness after CS (before CS - 3.7 ± 1.8 µm; after CS - 13.54 ± 3.11 µm), with partial removal of the glaze layer. Indenters abraded against CPZ (0.09 ± 0.03 mm) were worn more than those abraded against PVZ (0.02 ± 0.01 mm) and GZ (0.02 ± 0.01 mm). Higher wear caused by direct abrasion against zirconia was confirmed by SEM.
CONCLUSION
Polishing with an intraoral polishing system did not reduce the roughness of zirconia. Wear of the opposing artificial enamel was affected by the material on the surface rather than the finishing technique applied, indicating that polished zirconia is more deleterious to artificial enamel than are glazed and porcelain-veneered restorations.
PubMed: 31297175
DOI: 10.4047/jap.2019.11.3.162 -
Revista Cientifica Odontologica... 2022The aim of optimal dentistry is to stabilise the stomatognathic system (teeth, periodontium, muscles and temporomandibular joint). All of these must work in harmony, as...
The aim of optimal dentistry is to stabilise the stomatognathic system (teeth, periodontium, muscles and temporomandibular joint). All of these must work in harmony, as together they provide optimal care from diagnosis through planning to treatment. However, many clinicians currently give little importance to the identification of premature contacts and/or interferences prior to any dental treatment, which should be taken into account to provide improved stability in mandibular closure, correct anterior and canine guidance in mandibular movements.This clinical case describes the treatment of a patient with a diagnosis of functional occlusal disorder due to premature contact, whose treatment consisted of an occlusal adjustment by selective wear, following the technique described by the author Klineberg, with the aim of preserving the dental structure as much as possible while maintaining control during the occlusal adjustment and returning the greatest number of symmetrical and pointed contacts.
PubMed: 38389550
DOI: 10.21142/2523-2754-1003-2022-122 -
Journal (Canadian Dental Association) 2012As implant treatment becomes part of mainstream dental therapy, dental offices should implement protocols for individualized, systematic and continuous supportive care... (Review)
Review
As implant treatment becomes part of mainstream dental therapy, dental offices should implement protocols for individualized, systematic and continuous supportive care of the peri-implant tissues. This review article suggests guidelines for maintenance care of dental implants. The preliminary assessment should begin with updating the patient's medical and dental histories. The clinical implant should be examined to evaluate the following: condition of the soft tissues, plaque index, clinical probing depth, bleeding on probing, suppuration, stability of soft-tissue margins, keratinized tissue, mobility and occlusion. If the clinical signs suggest the presence of peri-implantitis, radiography of the site is advisable, to confirm the diagnosis. Appropriate treatment should be pursued according to any diagnosis reached during the examination, including (but not limited to) instructions on oral hygiene, removal of supra- and sub-gingival plaque and calculus, occlusal adjustment, relining of a removable prosthesis or surgery.
Topics: Clinical Protocols; Dental Care; Dental Implants; Dental Plaque Index; Humans; Medical History Taking; Peri-Implantitis; Periodontal Diseases; Periodontal Index
PubMed: 23306040
DOI: No ID Found