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

Objectives: To evaluate the long-term effectiveness of arthrocentesis in patients with TMJ disc displacement without reduction (DDWoR) and to identify prognostic factors that may influence treatment outcomes.

Methods:  This study comprised 78 patients diagnosed with TMJ/DDWoR according to the DC/TMD and treated with arthrocentesis between 2014 and 2022. Patients were evaluated preoperatively, postoperatively, and at long-term follow-up using the Visual Analog Scale (VAS) for pain and maximum mouth opening (MMO) for function. Treatment success was assessed according to clinician-assessed criteria and patient self-evaluation.

Results: Significant improvements in both pain and function were observed postoperatively and sustained through long-term follow-up (both p < .001). The success rate was 53.85% according to clinician-assessed criteria and 56.41% based on patient-reported outcomes. VAS scores were significantly associated with success outcomes across all time points (p < .05). Age showed a statistically significant positive association with self-evaluation success (p = .035).

Conclusion: Results support that arthrocentesis is an effective treatment option for patients with TMJ/DDWoR.

Background: Bruxism, the most common repetitive oral behavior, is reported widely in young adults due to excessive stress and sleep abnormalities. If left undiagnosed, it may cause pathologic alteration in condylar morphology.

Methods: This Institutional Ethics Committee approved cross-sectional comparative study comprised of 100 patients, equally divided into groups. The study group diagnosed based on the self-reported questionnaire while control group patients were recruited retrospectively. The patients were evaluated using CBCT.

Results: Flattening 26 (52%) and sclerosis 31 (62%) were more frequent in bruxers than non-bruxers (p < .05). Surface erosion 4 (8%) and osteophytes 14 (28%) were also noted in bruxers. Interestingly, non-bruxers also showed osteophytes 16 (32%) and surface erosion 9 (18%), which became the point to be focused on.

Conclusion: Condylar alterations were more frequently observed in participants with possible bruxism. Prompt intervention can be inculcated to halt progress of the condition.

Trial registration: The study has been registered under Clinical trial registry - India (CTRI registration number: CTRI/2023/05/052782) on May 17, 2023.

Objective: To review and synthesize published case reports on the use of sphenopalatine ganglion (SPG) block in orofacial and headache disorders, focusing on techniques and clinical outcomes.

Methods: A review of 55 case reports and series extracted data on 29 papers, including diagnoses, SPG block technique, anesthetic or drug, outcomes, and adverse effects.

Results: SPG block was reported in trigeminal neuralgia and neuropathies, burning mouth syndrome, non-specified facial pain, autonomic cephalalgias, migraine, tension type headache, COVID related headache and acute cephalalgias. The most frequently used technique was intranasal with cotton tip applicators, with lidocaine 2-10% as the most common agent. Most reports document relief, but long-term data is not available. Neurogenic pain conditions and migraine showed superior therapeutic responses to the SPG block procedure.

Conclusion: SPG block appears effective and safe, though higher-level evidence is still needed.

Introduction: Oral dysesthesia (OD) is a chronic orofacial pain disorder characterized by abnormal sensations - burning, tingling, altered taste, or phantom foreign body perception without identifiable mucosal pathology. Frequently conflated with Burning Mouth Syndrome, OD exhibits a heterogeneous clinical profile warranting distinct diagnostic consideration.

Methods: This narrative review explored potential mechanisms underlying OD, including peripheral and central sensitization, neurotransmitter imbalances, hormonal and psychosomatic influences, and proprioceptive dysregulation, particularly neurosensory mismatch involving trigeminal proprioceptive and nociceptive convergence.

Results: Proprioceptive dysregulation may contribute to OD through processes analogous to phantom limb phenomena. Current management - pharmacologic, behavioral, and neuromodulatory - remains limited by mechanistic non-specificity. Preliminary concepts of a custom-fabricated oral device suggest it may modulate proprioception, provide sensory gating, mechanical protection, and potential drug delivery as a non-pharmacologic adjunct.

Conclusion: Theoretical application of such a device could influence maladaptive feedback loops, representing a potential multimodal therapeutic approach that warrants further investigation.

Objective: To evaluate the knowledge of Italian physiotherapists regarding temporomandibular disorders (TMD) management and to investigate the use of evidence-based strategies.

Methods: A survey was distributed to 412 Italian physiotherapists collecting data on demographics, education, TMD knowledge, assessment, and treatment strategies.

Results: Most respondents (73.3%) reported no formal TMD training during their bachelor, and more than half (51.0%) treated no TMD patients in an average month. 67.2% provided a TMDs definition according to literature, and 92.0% recognized the primary structural pain generators. 21.8% were familiar with the DC/TMD diagnostic criteria, while misconceptions persisted regarding occlusion (26.7% endorsing a causal role) and posture (28.6%). 81.1% used education , and 88.3% adopted a multimodal strategy consistent with guidelines.

Conclusions: Italian physiotherapists showed good general TMDs knowledge and frequent use of guideline-consistent treatment. However, limited undergraduate exposure, variable postgraduate education, and persisting misconceptions highlight the need for more standardized and evidence-based training in this context.

Objective: To evaluate whether phenotypic classification according to the PALM framework (pharyngeal collapsibility, arousal threshold, loop gain, and muscle responsiveness) can predict postoperative outcomes in patients with obstructive sleep apnea (OSA) undergoing maxillomandibular advancement (MMA). Secondary objectives were to explore its usefulness in preoperative planning and to assess the influence of body mass index (BMI) on surgical response.

Methods: A retrospective study was conducted on 59 patients with OSAS who underwent MMA between 2017 and 2023. Patients were classified using a modified PALM system based on preoperative AHI and therapeutic CPAP pressure requirements. Postoperative outcomes were assessed by polysonnography, and regression analyses examined the relationship between percentage changes in AHI and BMI.

Results: PALM 1 patients showed a significantly greater reduction in AHI compared with PALM 2 patients and higher rate of surgical success.No significant correlation was found between changes in AHI and BMI.

Conclusion: PALM phenotyping demonstrated predictive value for MMA outcomes, supporting a more personalized approach to OSA management.

Objective: To compare asymmetry in occlusal contact area, number of occlusal contact points, and number of occluding tooth pairs between healthy individuals and patients with temporomandibular disorders (TMDs) categorized by the DC/TMD.

Methods: A cross-sectional analytical study was conducted on 49 participants aged 18-45 years, divided into five groups: healthy, muscle pain, joint pain, combined muscle and joint pain, and joint disorder. Occlusal contacts at maximum intercuspation were recorded using an intraoral scanner. STL files were analyzed to quantify occlusal contact area, contact points, and occluding tooth pairs. Clinical and psychosocial variables were assessed using standardized questionnaires.

Results: Intra-examiner reliability was high (ICC = 0.90). No significant between-group differences were found in demographic characteristics or occlusal asymmetry measures (p ≥ .05).

Conclusion: No statistically significant differences in occlusal asymmetry were found among TMD subgroups or healthy individuals. Current evidence does not support the use of intraoral scanning of occlusal contacts for diagnosing or differentiating TMDs.

Objective: To evaluate the position and orientation of the mandibular proximal segment and the volume of condylar and coronoid processes in class II and III patients submitted to bimaxillary orthognathic surgery, using cone beam computed tomography scans.

Methods: Class II and III patients who underwent bimaxillary orthognathic surgery were evaluated by fusing their preoperative virtual planning and postoperative outcomes. The CBCT scans were import into Dolphin Imaging Software and the images were superimposed. The superimposition of the planned and postoperative CBCT images was performed with the voxel-based method. Results: Differences were found in condylar resorption between class II and III.

Conclusion: The displacement of the mandibular proximal segment after orthognathic surgery was negligible and supported by the condyle and coronoid process, which demonstrated with a clinically non-relevant resorption and postoperative stability.

Objective: This systematic review determined whether occlusal appliance use influences the sleep of individuals with sleep bruxism.

Material and methods: Six databases and the gray literature were searched to identify randomized and non-randomized clinical trials comparing slow wave sleep and sleep quality of sleep bruxers before and after occlusal appliance use. The Risk of Bias was assessed using Cochrane tools and Meta-analyses were performed to compare data. The Certainty of the evidence was evaluated by Grading of Recommendations Assessment, Development, and Evaluation approach.

Results: Two randomized and eight non-randomized studies were included. Meta-analyses indicated that soft and hard appliances influenced the slow-wave sleep and sleep quality of sleep bruxers, as determined by polysomnography (Z = 5.58; p < .001), the Pittsburgh Sleep Quality Index (Z = 3.45; p < .001), and the Sleep Assessment Questionnaire (Z = 48.1; p < .001).

Conclusion: Occlusal appliance use significantly impacts slow-wave sleep and sleep quality in sleep bruxism individuals, regardless of appliance design or material.

Objective: To explore the relationship between parenting styles and children's personality traits and parental-reported sleep bruxism (SB).

Methods: A total of 301 parents/caregivers of Brazilian children participated in this cross-sectional study and answered an online questionnaire addressing sociodemographic characteristics, sleep-related behaviors and parent-reported SB. The Brazilian versions of the Parenting Styles and Dimensions Questionnaire and the Eysenck Personality Questionnaire-Junior assessed children's parenting styles and personality traits. Descriptive analysis and multinomial logistic regression were used.

Results: Boys (OR=2.07; 95% CI=1.09-3.91) whose snoring (OR=2.98; 95% CI=1.55-5.73) were associated with mild parent-reported SB. Boys (OR=2.61; 95% CI=1.20-5.70) and high levels of neuroticism (OR=2.27; 95% CI=1.06-4.860) were associated with moderate/severe parent-reported SB. Authoritarian parenting attitudes decreased the likelihood of moderate/severe parent-reported SB (OR=0.37; 95% CI=0.16-0.86).

Conclusions: Parents/caregivers who exhibited more authoritarian attitudes reported a lower prevalence of moderate/severe children SB. Neuroticism trait and snoring influenced the severity of parent-reported SB.