Cranio-The Journal of Craniomandibular & Sleep Practice最新文献

Objective: This study aimed to evaluate the level of knowledge and attitude toward obstructive sleep apnea (OSA) in Palestinian Authority.

Methods: An online cross-sectional questionnaire was conducted from January 2025 to March 2025 and targeted senior dental students at Arab American University and Palestinian dental practitioners. A 37-item questionnaire including demographics, knowledge, and attitude categories was created using Google Drive.

Results: A total of 585 senior dental students and dental practitioners responded to the survey, with a mean total knowledge score of 17.9 ±4.72 out of 23, and attitude score of 21.49 ±3.41 out of 28. Senior dental students revealed the highest knowledge level while the general dental practitioners showed the lowest.

Conclusions: Dental practitioners had insufficient knowledge about OSA and a neutral attitude regarding OSA patients' management and referrals. Thus, revision of curricula in dental schools and organizing more educational programs about OSA are needed.

Objective: To describe the characteristics of trigeminal autonomic cephalalgias (TAC) presenting as orofacial pain.

Methods: A web search was performed on various databases to find relevant case reports or series reporting TAC presenting in V2 and/or V3 of the trigeminal ‎nerve distribution. Headaches were classified according to the International Classification of Headache Disorders III and the International Classification of Orofacial Pain. Descriptive analyses were employed, and multivariable linear regression models assessed the factors associated with (i) longer time since the onset of TAC and (ii) a higher number of previous providers‎ at the time of report.

Results: Intraoral/tooth pain was reported by 47% (n = 34) of cases, with 11 without headache or V1 involvement. Cases had an average of 2.2 autonomic symptoms ‎‎(standard deviation (SD) = 1.3), 4.5 years since onset (SD = 5.3), and 2.6 previous ‎providers (SD = 1.5) at the time of the report. Autonomic symptoms increased as the time since pain onset (n = 50, β = 1.30, p = .026) and age (β = 0.13, p = .032) ‎increased when adjusted for sex and the trigeminal distribution of involvement. The number of previous providers tended to be lower for TAC with shorter episodes (β = -1.48, SD = 0.47, p = .004) than for TAC with long attacks or continuous pain.

Conclusion: Orofacial TAC present a diagnostic challenge for clinicians. Multidisciplinary care and more education are recommended. Further research is needed to properly understand them.

Objective: To investigate possible correlations between depression, anxiety and stress in subjects with instrumental diagnosis of sleep bruxism (SB) and to identify a link between clinical data and sleep-time muscular activity.

Methods: 170 subjects underwent clinical investigation and instrumental night recordings for SB assessment with a portable electromyographyic (EMG) device. The Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS) were used for psychological evaluation.

Results: Anxiety was statistically associated with SB index and SB-related tonic contractions. Subjects with high perceived stress scores showed higher numbers of total masseter contractions and SB-related phasic contractions.

Conclusion: Emotional states showed a statistically significant association with SB events, as assessed based on the count of episodes over 10% of the maximum voluntary contraction (MVC) preceded by a 20% increase of heart rate.

Objective: This commentary critically examines the validity of the Canine Protected Occlusion concept, from both biological and evidence-based perspectives.

Methods: An extensive review of the pertinent literature related to the topic of Canine Protected Occlusion was conducted by the authors.

Results: Canine Protected Occlusion is neither the optimal or preferred functional occlusion in dentistry. The foundational principles of this concept are not supported by any biologic reasoning or scientific evidence. Furthermore, Canine Protected Occlusion recordings fail to reflect or represent any type of physiologic mandibular motion and function or occlusal loading in humans.

Conclusions: The functional occlusion contacts that clinicians should focus on most are those in or close to maximum intercuspation. This perspective aims to discourage practitioners from undertaking unnecessary extensive and invasive procedures to establish Canine Protected Occlusion in all patients, especially when this is not substantiated by evidence-based literature.

Objective: This research aims to introduce using antegonial notch angular measurements on lateral cephalometry as a simple low-dose radiographic approach for monitoring mandibular growth in children after TMJA treatment.

Methods: This retrospective cohort study used dental records to identify eligible patients: healthy children with true unilateral TMJA who underwent conservative gap arthroplasty followed by post-operative physiotherapy. The primary outcome was changes in antegonial notch angular measurements over time. Secondary outcomes included correlations between antegonial notch angular measurements and two growth-related conventional cephalometric angles (SNB and ANB). We also explored the relationship between changes in antegonial notch angle over time and study covariates.

Results: Eleven patients aged 4 to 9.5 years with unilateral bony TMJA for periods ranging from 9 to 20 months who had undergone conservative gap arthroplasty followed by physiotherapy were included. Significant increases were observed in antegonial notch angles on both the affected and non-affected sides after treatment (p < .05), indicating resumed mandibular growth. Although the affected side remained significantly smaller than the non-affected side at both timepoints (p= 0.033 and 0.005), asymmetry did not change significantly over time (p= 0.273), suggesting parallel bilateral growth. Positive correlations were found between antegonial notch changes and SNB (p= 0.039-0.047). Multivariate regression indicated that TMJA duration significantly influenced changes in the affected-side notch angle (p= 0.004).

Conclusion: Based on these preliminary data, antegonial notch angular measurements on lateral cephalometric radiographs may offer a simple, reliable, and low-radiation alternative for monitoring mandibular growth in children after TMJA treatment. Further studies with larger sample sizes are required to support our findings.

Background: The MyotonPRO is a valid, portable device to assess musculoskeletal tissue properties, but its reliability for cervico-mandibular muscles remains unclear.

Objective: To evaluate the intra/inter-rater and intra/inter-session reliability of the MyotonPRO in cervico-mandibular muscle assessment.

Methods: A total of 30 measurements were performed on 15 healthy participants by two raters at two moments. MyotonPRO evaluated tone, stiffness, elasticity, relaxation time, and creep. Reliability was calculated using intraclass correlation coefficients (ICC), standard error of measurement, and minimal detectable change.

Results: Intra-rater intra-session reliability was good to excellent (ICC = 0.753-0.976). Inter-session values were moderate to good (ICC = 0.585-0.888), with excellent reliability for ECOM relaxation time (ICC = 0.955) and masseter elasticity (ICC = 0.910). Inter-rater reliability was moderate to good (ICC = 0.686-0.896).

Conclusion: The MyotonPRO is a reliable tool for assessing cervico-mandibular muscle mechanical properties across different raters and sessions.

Objective: This study aimed to clarify frequency distribution of number and peak amplitude of electromyographic (EMG) waveforms of sleep bruxism (SB) in outpatients with clinical diagnosis of SB (probable bruxer: P-bruxer).

Methods: Subjects were 40 P-bruxers. Masseteric EMG during sleep was measured at home using a wearable EMG system. EMG waveforms with amplitude of more than two times the baseline and with duration of 0.25 s were extracted as SB bursts. Clusters of bursts, i.e. SB episodes, were also scored.

Results: There were large variations among the subjects in numbers of SB bursts and episodes and in burst peak amplitude. As for burst peak amplitude within a subject, a wide right-tailed frequency distribution was shown with the highest frequency at the class of 5-10% maximum voluntary contraction.

Conclusion: The number and amplitude of SB waveforms for P-bruxers were distributed over a wide range, indicating the existence of large individual differences.

Objective: The aim of the current study was to describe the pattern of otological symptoms in patients with rheumatoid arthritis (RA), having clinical temporomandibular joint (TMJ) involvement. This issue had not been previously addressed.

Methods: A questionnaire and examination findings protocol was applied for 141 patients with RA and 141 control subjects.

Results: Otological symptoms (otalgia, hearing loss, tinnitus, and vertigo), all had a significantly higher incidence in RA patients, compared to control subjects (P = .001).

Conclusion: The onset and maintenance of otological symptoms in patients with TMJ involvement by RA probably result from peripheral, as well as central nervous system alterations in sensory stimuli programming.

Objective: The aim is to measure the maximum mouth opening (MMO) of healthy children between the ages 4 and 18 years.

Methods: Six hundred seventy-four children between ages 4 and 18 years were included in the study. Individuals with dentofacial anomaly, temporomandibular joint disease, infection, trauma, and rheumatic disease were not included in the study. The MMO of the participants was measured with a vernier caliper. Demographic information such as weight, height, and age was recorded.

Results: The MMO was calculated to be 46.62 mm in boys and 45.96 mm in girls. The MMO value increased with increasing age. However, no difference was observed in terms of gender in the same age group.

Conclusion: In this study, normal MMO values between the ages 4 and 18 years were determined. It is to have differences in age group and society-based examinations. For this reason, it is important to know the normal values of each society in terms of age groups.

Objective: To investigate the relationship between aerodynamic characteristics of the upper airway and severity of obstructive sleep apnea (OSA) in adults.

Methods: Ninety-seven adult OSA patients underwent polysomnography and cone beam computed tomography (CBCT). The anatomical and aerodynamic characteristics were measured based on CBCT images and computational fluid dynamics modelling of the upper airway.

Results: After controlling for patients' gender, age, and body mass index (BMI), the maximum velocity during inspiration (In-Vmax) led to the largest increase in the explanatory power of apnea-hypopnea index (AHI) variation. The In-Vmax was closely correlated with the minimum axial area, and their relationship was represented by an inversely proportional fitted curve.

Conclusions: The In-Vmax was the most relevant to OSA severity, and it could be used to assist in recognizing severe OSA patients and as a primary variable to evaluate treatment outcomes of OSA. The In-Vmax was closely related to the most constricted area of the upper airway.