Journal of Craniomandibular Function, 01/2016

Background: Sleep bruxism (SB) can be associated with a number of clinical problems, including orofacial pain, tooth wear, and the failure of dental restorations. Based on these factors, a need emerged to define the best strategies to manage bruxism in the clinical setting. Objectives: The aim of this pilot study was to evaluate the therapeutic efficacy of two different oral appliances (OAs) - an occlusal splint and a functional orthopedic appliance - in reducing SB episodes and orofacial pain. Material and methods: Twenty-six subjects (9 non-bruxers, 17 bruxers) were selected for the study. Each subject was observed for 3 consecutive months, and monitored with a visual analog scale (VAS). Further, all subjects participated in an instrumental recording at home with a portable device (Bruxoff, OT Bioelettronica) to evaluate variation on SB activity through a simultaneous recording of electromyography (EMG) signals from both of the masseter muscles, as well as heart frequency. Intergroup and intragroup variances were analyzed by using a two-way ANOVA test. All statistical procedures were performed with SPSS Statistics V23.0 software (IBM). For each analysis, a P value of < 0.05 was set. Results: Pain sensation significantly reduced, both for the stabilization splint and the functional orthopedic appliance group (P < 0.001) at the 3-month follow-up, with no differences between the two groups. SB episodes did not significantly reduce after 3 months (P < 0.005). Conclusions: This study showed that both particular kinds of OAs could reduce patients' orofacial pain, but that neither appliance showed a statistically significant effect in reducing SB episodes. Further studies are needed on larger and more representative samples followed for a longer period to obtain significant information on SB management. Keywords: sleep bruxism, masseter muscle, occlusal splint, functional device

Obstructive sleep apnea syndrome (OSAS) and snoring occur due to the narrowing of the upper airway. While OSAS can lead to a variety of potentially serious health complications, snoring is not considered a significant medical problem. Mandibular advancement devices (MADs) work by widening the upper airway. In recent years, MADs have emerged as effective, widely accepted treatment modalities for OSAS and snoring. MADs are adjustable, custom-made appliances fabricated from dental impressions. In sleep medicine, MADs make it possible to advance and readjust the position of the mandible millimeter by millimeter over the entire treatment period. This capacity for controlled adjustment (titration) significantly increases the therapeutic effectiveness of these devices and prevents unwanted side effects. Successful MAD therapy requires close interdisciplinary cooperation between medical and dental professionals, and a dentist with a high level of knowledge and experience in the field of dental sleep medicine. The inherent interdisciplinary nature of this new field generates a variety of opportunities for dentists, extending their reach beyond MAD therapy into, for example, orthodontic treatment of sleep disorders in children. Dental sleep medicine is emerging as a wide-ranging and completely new field of dentistry. Keywords: sleep, sleep-related breathing disorders, obstructive sleep apnea syndrome (OSAS), mandibular advancement device (MAD), continuous positive airway pressure (CPAP), guidelines, titration

Osteochondromas are benign, cartilage-covered bone tumors that occur very rarely in the mandibular or facial region. If functionally relevant structures such as the condylar process or the coronoid process are involved, functional impairments may occur. Possible symptoms include facial asymmetry, movement impairment, malocclusion, and pain (especially during occlusal function). Osteochondroma treatment falls within the scope of oral-maxillofacial surgery, and treatment options vary depending on tumor size and growth. In the case described here, a 39-year-old female presented with complaints of pain in the right temporomandibular joint (TMJ) region, increasing facial asymmetry, and limited jaw opening. Imaging studies revealed the presence of a tumor on the right condyle, which was removed by conservative excision. Complete tumor excision was not achieved. However, no tumor growth has been observed to date, after 15 years of follow-up. Keywords: osteochondroma, primary bone tumor, condylar process, excision, recurrence

The maxillomandibular jaw relationship is of key importance in the context of prosthetic/reconstructive dentistry and dental functional therapy. Unfortunately, alterations of the definition for the location of the centric condylar position (CCP) in the past - from posterior to cranial and then to ventrocranial - have led to uncertainties. The accurate determination of the maxillomandibular jaw relationship and the transfer of this to a prosthetic restoration or an occlusal splint are subject to procedural limitations. Under good clinical conditions, the reproducibility of occlusal records and the spatial discrepancies between the recorded position and the jaw position after seating the restoration lie within a range of approximately 0.2 to 0.3 mm. Taking into consideration the guidance mechanisms of natural jaw movements, the intercuspation position (ICP) - taken up without occlusal interferences - is the target (or dependent) variable that is subordinate to the control (or independent) variables of the muscular activity and the joint positions. During manual guidance techniques for determining the jaw relationship, however, the natural guidance mechanisms of the craniomandibular system (CMS) are completely suppressed. If the standards of the dental profession are adhered to, functionally healthy patients are generally able to adapt without symptoms to alterations of the jaw position resulting from and dictated by the procedural requirements of dental treatment. This results in a new, age-appropriate, and functionally healthy state of physiological balance within the CMS. However, older patients, as well as patients with craniomandibular dysfunction (CMD) or a corresponding dental medical history, are characterized by a decreased ability to adapt. Modern rehabilitative dentistry must therefore ensure that extensive neuromuscular adaptation processes are kept to a minimum. Keywords: jaw relationship, control of jaw movements, retruded contact position (RCP), centric condylar position (CCP), craniomandibular system (CMS), craniomandibular dysfunction (CMD)