Seminars in Orthodontics最新文献

This systematic review aimed to investigate the efficacy of orthodontic tooth movement (OTM) through bone regenerated with osteoconductive grafts, together with the risk of root resorption (RR), in relation to the material and the timing of force initiation. Following PRISMA-ScR guidelines, three major electronic databases were searched (PubMed, EMBASE, and Cochrane). Only studies which reported on the primary outcome (OTM rate) were included. Investigations with fewer than 3 participants/groups and an absence of controls were excluded. The final sample consisted of 16 randomized and controlled clinical trials. Among them, 9 reported on RR (the secondary outcome). The articles showed substantial heterogeneity and low-moderate quality. Most studied OTM through alloplasts (7) and xenografts (8), 3 addressed allografts, 3 autografts and 6 analyzed 2 grafts. Timing for force initiation varied from 0 to 13 weeks post-grafting. Based on limited evidence, it can be cautiously concluded that most graft materials have either no impact or slightly impair OTM, with no significant increase in RR. Xenografts might impede OTM and increase RR risk. The optimal timing for force application depends on the state of bone healing. Future studies are mandatory for deciding on the ideal graft and timing for optimal OTM in each clinical setup.

The closure of an edentulous space with the orthodontic movement of adjacent teeth even if affected by severe loss of periodontal support is a treatment option nowadays supplanted by the implant-born crown substitution and periodontal regenerative/reconstructive therapy. Nevertheless it is important not to forget some fundamentals of dental research that still justify, even more when combined with the most recent innovations in the field of mucogingival surgery and guided tissue regeneration, the alternative of orthodontic space closure. The latter indeed represents a valuable alternative in many malocclusions complicated by lost maxillary incisors, first of all in the growing patients and when the gingival margins are visible during speech and smile.

This article will outline crucial details about the orthodontic management of the reduced periodontal tissues in the pressure area.

Enamel interproximal reduction (IPR), also known as stripping, is an orthodontic procedure used by many clinicians, especially in non-extraction cases. It aims to reduce the mesiodistal diameter of teeth by removing interproximal enamel. This therapeutic option allows to obtain space in the dental arch to achieve tooth alignment, in case of mild or moderate crowding, and to preserve the papilla avoiding the onset of black triangles. IPR is an irreversible procedure, and it requires an accurate case examination to avoid damage, such as demineralization of the enamel or periodontal complications, that can compromise both aesthetics and oral health. When performing IPR, orthodontists can change the contact point between the teeth and move it closer to the alveolar crest, thus improving esthetics by reducing the black triangles. However, there is also a risk for worsening periodontal health due to root proximity although, according to the literature, periodontal indices, such as clinical attachment loss (CAL) and bleeding on probing (BOP), seem to be not significantly affected by IPR.

Temporomandibular disorders (TMDs) are a group of musculoskeletal conditions affecting the masticatory system and which are best defined based on symptoms and signs reflective of the underlying disease process. Etiology – the cause of disease – is best considered as risk determinants due to the complexity of TMDs in terms of the broad range of factors that place an individual at risk for initial development of a TMD and at risk for transition from an acute disorder to a chronic disorder. Identified risk determinants act together in unique patterns across individuals; notably, painful TMDs seldom occur in isolation of other risk determinants. While occlusal characteristics have been proposed as a primary etiology for TMDs, the evidence remains weak and unconvincing. In contrast, the evidence is strong for a wide range of intersecting factors to act as risk determinants for initial onset of a painful TMD, and which contribute further when pain becomes chronic due to bidirectional relationships between a primary pain condition and its risk determinants. These include overuse behaviors, pain sensitivity, psychological distress, injury, and the presence of other health and pain disorders. Overall, the evidence points to TMDs as system level disorders residing within a person at risk due to any of these identified risk determinants, and when more than one is present, the risk increases substantially. This complexity requires evolved standards of care for evaluation and treatment of the identified risk determinants based on available evidence.

The relationship between psychological factors and the overall health of patients with Juvenile Idiopathic Arthritis (JIA) is evident, yet the specific impact of the presence of Temporomandibular Joint (TMJ) signs or symptoms is not fully understood. This article seeks to elucidate the current knowledge of the relationship between TMJ signs and symptoms, psychosocial factors, and broader clinical manifestations in JIA patients. To investigate this relationship further, the present article will also present the results of a study including a total of 73 JIA patients, consisting of 56 females and 17 males (mean age 12.2 ± 2.8 years old; range 6–16). These patients were examined according to the diagnostic criteria for temporomandibular disorders (DC/TMD). Self-reported questionnaires were used to investigate the psychosocial aspects of stress, anxiety, depression, and catastrophizing. General quality of life and disease activity were assessed with the JAMAR questionnaire (Juvenile Arthritis Multidimensional Assessment Report). For inferential statistics, the Pearson r coefficient, linear regression models and T test for unpaired data were used. The level of significance was P<0.05. Increased general disease activity and significant impacts on quality of life were associated with increased psychological distress. The four psychosocial factors examined, including anxiety, stress, catastrophizing, and depression, all had a negative impact on the quality of life, symptomatology, and disease activity. Specifically, anxiety and catastrophizing influenced the relationship between the presence of symptoms and the reported quality of life where higher levels of anxiety and catastrophizing increased the impact of the symptoms on the quality of life. Finally, the presence of TMJ signs and/or symptoms did not exacerbate the psychosocial domains but affected the functional aspect of the patient.

The aim of the present manuscript is to give a narrative overview for clinicians summarizing the knowledge concerning a phenomenon that they may frequently come across in both children and adults: sleep (SB) and awake (AB) bruxism. Indeed, prevalence rates in adults range from 8 % to 16 % for SB and 22 % to 30 % for AB, whilst in children they raise up to 40 %.

The complex relationship between bruxism, the most common underlying primary and/or comorbid conditions, and the potential clinical consequences for both AB and SB in children and adults will be considered.

In addition, in view of the fact that over the last few decades the demand for orthodontic treatment at all ages has increased, the correlation between bruxism-related masseter muscle activity (MMA) and the use of orthodontic appliances (i.e., fixed appliances and clear aligners) is also discussed, along with the proposal of some clinical recommendations.

Degenerative Joint Disorders (DJD) of the Temporomandibular Joint (TMJ) represent a challenging and multifaceted group of conditions that severely impact the joint's function and quality of life. This comprehensive review delves into the etiology, pathogenesis, clinical manifestations, and contemporary management strategies of TMJ-OA. While systemic illnesses, aging processes, hormonal factors, and behavioral factors have been implicated in its development, recent evidence highlights the pivotal role of mechanical overloading in initiating a series of degenerative changes within the TMJ.

Painful joints, a hallmark of TMJ-OA, result from the soft tissues around the affected joint and reflexive muscle spasm, following Hilton's law, which innervates the joint's muscles and overlying skin. This self-preservation reflex protects against further joint damage. Moreover, painful symptoms may arise from subchondral bone destruction.

Recognizing the importance of understanding the biomechanical environment within the TMJ, this review underscores its relevance in identifying the mechanisms behind TMJ pain and disability. Furthermore, it discusses the potential application of tissue engineering in TMJ reconstruction, emphasizing the need to learn from past TMJ implant experiences.

In the context of treatment, the review highlights the significance of managing TMJ-OA, focusing on restoring function and reducing pain. Treatment modalities span from non-invasive therapies to surgical options, with the latter reserved for cases unresponsive to conservative approaches and severely affecting an individual's quality of life.

This review serves as a vital resource for both clinicians and researchers, offering insights into the multifaceted nature of TMJ-OA and the evolving landscape of its diagnosis and management, incorporating biomechanical considerations and potential advances in tissue engineering. Understanding the complexities of TMJ-OA is instrumental in enhancing the care and well-being of individuals affected by this condition.

The field of orthodontics has seen a recent increase in the number of patients over the age of 50 seeking treatment and also an increase in the use of cone beam technology. Similar to other joints in the body, the temporomandibular joint (TMJ) is associated with age-related degeneration. However, unlike other joints, degeneration of the TMJ is rarely symptomatic and when there is pain, it is usually self-limiting. In this article, we will review: (a) the incidence and prevalence of TMJ degenerative diseases, (b) similarities and differences of TMJ vs knee degenerative diseases, and (c) current treatment recommendations for TMJ degenerative diseases. In the vast majority of people, radiographic evidence of TMJ degeneration is an incidental finding. Future longitudinal research is needed to follow the natural course of TMJ degenerative patients.

Objectives

Occlusal Tactile Acuity (OTA) is the ability to detect small thicknesses between occluding teeth. Individuals diagnosed with Burning Mouth Syndrome (BMS) often refer an uncomfortable sensation associated with their occlusion. The aim of the current study was to measure the OTA in BMS patients, and to compare it with that of age and gender matched pain free controls.

Materials and methods

25 BMS patients and 25 controls were enrolled. The OTA was tested with 10 different thicknesses: 9 aluminium foils (8 –72 µm with a constant increment of 8 µm) and 1 sham test (without foil), each thickness being tested 10 times in random order (100 tests in total).

Results

Significantly increased OTA was observed in the BMS group, compared to the controls group, for the foil thicknesses between 8 µm and 48 µm. Furthermore, BMS patients showed substantial impairment in the detection of the sham test, even if this finding did not reach statistically significance (P = 0.743).

Conclusions

BMS patients presented increased ability to detect small thicknesses between antagonist teeth during intercuspation. These findings might explain the high somatosensory distortion referred by those patients, in absence of objective clinical findings.