Lateral Excursive Movements Research Articles

An investigation of machine learning algorithms for prediction of temporomandibular disorders by using clinical parameters.

This study aimed to predict temporomandibular disorder (TMD) using machine learning (ML) approaches based on measurement parameters that are practically acquired in clinical settings. 125 patients with TMD and 103 individuals without TMD were included in the study. Pain intensity (with visual analog scale), maximum mouth opening (MMO) and lateral excursion movements (with millimeter ruler), cervical range of motion (with goniometer), pressure pain threshold (PPT; with algometer), oral parafunctional behaviors (with Oral Behaviors Checklist), psychological status (with Hospital Anxiety and Depression Scale), and quality of life (with Oral Health Impact Profile) were evaluated. The measurements were analyzed via over 20 ML algorithms, taking into account an extensive parameter tuning and cross-validation process. Results of variable importance were also provided. Bagging algorithm using Multivariate Adaptive Regression Spline (MARS) algorithm (accuracy = 0.8966, area under receiver operating characteristic curve = 0.9387, F1-score = 0.9032) was the best performing model regarding the performance criteria. According to this model, the 5 most important variables for predicting TMD were pain intensity, MMO, lateral excursion and PPT values of masseter and temporalis anterior muscles, respectively. The Bagging algorithm using the MARS algorithm is a robust model that, in combination with clinical parameters, assists in the detection of patients with TMD in settings with limited capabilities. The clinical parameters and ML algorithm proposed in this study may assist clinicians inexperienced in TMD to make a preliminary detection of TMD in clinics where diagnostic imaging tools are limited.

Understanding the relationship between occlusal discrepancies and their role in temporomandibular disorder: A questionnaire-based research

Background: Temporomandibular disorder (TMD) presents as a multifaceted condition that impacts the temporomandibular joint (TMJ), the masticatory muscles, and other related structures. The role of occlusal factors in TMD etiology has been a subject of debate, necessitating further investigation. Aim: This questionnaire-based research aimed to explore the relationship between occlusal discrepancies and their role in TMD. Materials and Methods: The study involved 126 volunteers, comprising 69 females and 57 males, aged between 15 and 40 years, who had no previous history of systemic, musculoskeletal, or neurological disorders. To assess the degree of TMD, the researchers utilized the Fonseca questionnaire, and extra-oral and intra-oral examinations were done to check for occlusal discrepancy which was then classified according to the criteria of Angle’s classification in all three planes along with functional TMJ examination. Results: 55.5% of the population had some of the symptoms of TMJ disorders. Clinical examination showed that 45.2% of the population had tenderness on palpation. Variation of mouth opening was 37.72 ± 0.401 (±1.06%), the right lateral excursive movements were 6.88 ± 0.177 (±2.57%), and left lateral excursive movements were 6.6 ± 0.228 (±3.46%) respectively. The presence of “clicking” or “popping” was noted in 55 (43.6%) participants. Conclusion: The findings suggest that occlusal factors may significantly affect TMD development and symptomatology. Cases with occlusal discrepancies in multiple planes exhibited a significantly high prevalence of signs and symptoms related to TMD.

TMJ anterior disc displacement anchorage surgery: a retrospective study based on a suture-free titanium screw strategy.

To evaluate the feasibility and effectiveness of using a suture-free titanium screw in repositioning anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ). A consecutive sample of twelve patients (fifteen joints) was included in this study. All patients were diagnosed with ADDwoR and showed limited mouth opening or temporomandibular joint pain symptoms. Suture-free titanium screw was placed in the condyle directly following the disc repositioning. Pre- and postoperative evaluation parameters include operation time, the visual analogue scale for pain (VAS), lateral excursion movements (LEM), maximum interincisal opening (MIO), and disc length and position on MRI. In addition, the mandibular condyle height was also measured. Statistical significance was considered when p < 0.05. The unilateral operation time was 58.54 ± 5.43min; during the 6-month period after the operation, the VAS values decreased from 87 ± 6.34 to 14.08 ± 6.65. The MIO increased from 30.07 ± 4.73 to 39.89 ± 1.69mm (p = 0.01). The TMJ disc length was prolonged from 8.23 ± 1.12 to 11.51 ± 1.29mm. The condyles showed significant remodeling, and the height of the condyle increased from 18.24 ± 4.12 increase to 19.6 ± 4.31mm. The LEM was increased from 5.27 ± 0.51 to 6.36 ± 0.62mm. The MRI images showed the stability of the disc in position during the opening and closing of the mouth. The TMJ disc position was stable during the follow-up period. Anteriorly displaced articular disc can be repositioned by a suture-free titanium screw strategy. This technique is an alternative method to address ADDwoR.

Efficacy of arthrocentesis with intra-articular injection of hyaluronic acid and corticosteroid in the treatment of internal derangement of temporomandibular joint.

Various techniques have been used to treat internal temporomandibular joint derangements (TMJ ID), with arthrocentesis one of the most successful in reducing symptoms and promoting function. In cases of TMJ ID, this research study compares and evaluates the efficacy of arthrocentesis with injections of corticosteroids (CS) or hyaluronic acid (HA). This prospective randomized, non-blinded study involving 91 patients with symptoms of TMJ ID treated by arthrocentesis followed by intra articular injection of 1 ml of either corticosteroid (group A) or HA (group B) . Maximum mouth opening, lateral excursive movements, TMJ pain at rest and during function, masticatory efficiency, pre-treatment functional TMJ limitation and subjective judgment of efficacy of treatment were assessed with millimeter scale. All the parameters measured before the procedure and further followed at 1st week, 1st month, 3rd month and 6th month post-procedure. Maximum mouth opening post procedure improved significantly in Group B at follow up visits (P < 0.05). Subjects in group B showed significant reduction in pain at rest (P = 0.001) at 1 week and 1 month follow up & increased masticatory efficiency at 6 months (P = 0.042) as compared to that of group A subjects. Injection of HA post-TMJ arthrocentesis is found be comparatively more effective method of treating TMD IDs with resultant decrease in pain & improved functionality of the jaw. TMJ arthrocentesis along with injection of HA could serve as a possible alternative to treat chronic TMJ pain sufferers who are unresponsive to conservative medical therapies.

Open vs Closed Management of Condylar Fracture Our Experience of 100 Cases in a Suburban Tertiary Care Hospital.

Retrospective Observational Study. Mandibular condyle fractures are distinctive among maxillofacial injuries in which they disrupt mandibular function in a way that other traumatic injuries do not. Condylar fractures can be treated using either the conservative (closed reduction and immobilisation) or surgical (open reduction and internal fixation) approaches. Both of these modalities of treatment have advantages and disadvantages, as well as indications and contraindications. The purpose of this study is to compile and compare our experience in the management of condylar fractures through open and closed reduction. The present retrospective analysis included a total 100 patients of condylar fractures in patients > 18years of age who were randomly divided into nonsurgical and surgical group based on Edward Ellies criteria. In the present study, the outcomes of conservative vs surgical management of condylar fractures were discussed in terms of seven parameters, including the maximal inter-incisal mouth opening, protrusive and lateral excursive movements of the mandible, status of occlusion, deviation of mandible during mouth opening, temporo-mandibular disorders and facial nerve paralysis which were measured and evaluated pre- and post-operatively at different intervals of time. Follow-up period was for 6months. It was noted that the main cause of condylar fracture was trauma with a male predilection with an average age of 32.6 ± 1.2years. Subcondylar fracture was the commonest type of condylar fracture that we encountered. 33.3% of the patients had restricted mouth opening and 57% of the patients had deranged occlusion. 37% of the patients were treated surgically and 48.6% of these fractures were approached using peri-angular approach. More patients had an increased mouth opening and a stable occlusion at the 6months follow-up when compared to that of the 2month follow up. From the above study we can conclude that the treatment plan should be patient specific and follow the algorithm for a particular type of fracture. We endorse the same based on our experience in treating condylar fractures over the last 5years. The art of decision making solely depends on the surgeon's expertise in managing condylar fractures.

Yang’s keyhole plate versus conventional plate for treatment of mandibular sub-condylar fractures

Objectives: The use of a keyhole plate vs two miniplates in the treatment of mandibular subcondylar fractures. Materials and methods:Twenty patients were randomized into two equal groups. Ten patients with subcondylar fractures were treated with two Yang's keyhole plates in Group I. Ten patients with subcondylar fractures were treated with two conventional miniplates in Group II. Maximum mouth opening (MMO), Protrusive excursive movement, Lateral excursive movement, and Time for reduction and fixation were all used to evaluate patients clinically vertical height of ramus, and antero-posterior condylar angulation are all measured radiographically. Results: There was a statistically non-significant difference between the study and control groups at all intervals regarding MMO, Protrusive excursive movement, Lateral excursive movement, vertical height of the ramus, antero-posterior condylar angulation, but was significant at time for reduction and fixation. Conclusion: reducing a mandibular condylar fracture using a YK-plate, the results were similar and the operating time was quicker than when utilizing a traditional mini plate fixation.

An Evaluation of Jaw Tracking Movements in Patients with Total Joint Replacements versus a Control Group.

Background and Objectives: One form of treatment for degenerative temporomandibular joint diseases such as osteoarthritis, rheumatic arthritis, TMJ ankylosis, and condylar resorption is total joint replacement. The aim of this study was to examine the function of the temporomandibular joint after prosthetic joint replacement. Materials and methods: Fifteen patients with unilateral or bilateral TMJ total joint replacements and 15 healthy controls were evaluated via a SICAT JMT+ device. This non-invasive system measures 3D position and linear movements in all degrees of freedom and allows undisturbed functional mandibular movements to provide a quantitative evaluation. In addition, a TMJ questionnaire consisting of the subjective symptoms was also obtained. To date, no similar studies have been cited in the literature. Results: Mandibular movements after prosthetic joint replacement were recorded during opening, closing, protrusion, and lateral excursive movements and were all significantly decreased compared to those of controls. In the treatment group, the maximum incisal opening was 33.46 ± 5.47 mm, left lateral movement was 1.91 ± 2.7 mm, right lateral movement was 1.74 ± 1.74 mm, and protrusive movement was 2.83 ± 2.05 mm. The p-value comparison study and control group indicated significant difference (p < 0.0001) between the two groups. The study group stated a high level of satisfaction with the total joint replacement. Conclusion: Within the limitations of the study, the following conclusions can be drawn: (1) TMJ replacement patients showed significantly limited jaw movements compared to the control group; (2) a small percentage of TMJ replacement patients still present low levels of pain but improved chewing ability and quality of life.

Computerized occlusal analysis of two different removable retainers used during retention phase- A Randomized controlled trial

ABSTRACT Aim: To evaluate and compare occlusal contact force distribution, occlusion time and disclusion time following wear of Begg’s wrap around retainer and Vacuum formed retainer after completion of orthodontic treatment using a T-scan III. Materials and Methods: Twenty subjects after completion of active orthodontic treatment were randomly allocated into two groups, Group I – Begg’s wrap-around retainer (n-10) and Group II–vacuum formed retainer (n-10) one patient was lost to follow up in each group and the final sample size assessed at T1 in each group was 9. T-scan III was used at two-time intervals, T0 – first scan taken immediately after debonding and T1 – taken during retention any time between 10 and 12 months. Comparison of parameters within the groups was done using paired t-test and comparison between the groups was done using independent t-test. Results: No statistically significant difference in the distribution of occlusal contact forces was noted in both groups at T0 and T1 (p value<0.05). Disclusion time reduced in both groups at T1 but a statistically significant reduction in the disclusion time of left lateral excursive movement and protrusive movements (p value<0.05) was noted (T0-T1) in Group I. Statistically significant increase in the occlusion time was noted in Group II (T0-T1) at T1 between the two groups. Conclusion: No differences in occlusal contact force distribution was noted within and between the two groups. Disclusion time reduced in subjects on Begg’s wrap around retainers indicating favourable muscle activity and Occlusion time increased in subjects on vacuum formed retainers.

Accurate Treatment of Condylar Fracture Assisted by Three-Dimensional Prototype and Bioresorbable Plates

Although open treatments of condylar fracture have become the conventional treatment option, the accuracy is often not guaranteed. The purpose of this study was to improve the accuracy of fracture reduction assisted by three-dimensional (3D) prototype and bioresorbable plates in the treatment of condylar fractures.This was a prospective cohort study. Patients with condylar fractures were treated by surgery from October 2017 to November 2019 at School of Stomatology of China Medical University (Shenyang, China). The patients in the experimental group were treated with 3D-prototype and fixed with absorbable plates. Patients in the control group were treated routinely reduction and fixed with absorbable plates. Primary predictor variables were surgical treatment. Primary outcome was accurate reduction. Secondary outcomes were postoperative efficacy including maximum mouth opening, occlusal status, lateral excursion movements, and patient satisfaction. Other variables of interest included age, sex, type of patients. Continuous variables are reported as mean ± standard deviation. χ2 test and t test were used for analysis.The sample was composed of 48 patients (65 sides) who were treated surgically (25 men, 23 women; mean age, 39.50 year; range, 17 to 65 year) ; 27 patients (38 sides) were treated with the 3D-prototype approach and 21 patients (27 sides) were treated with the traditional approach. All 48 patients completed reduction and fixation of fractures. Preoperative and postoperative CT comparisons showed that 4 patients did not achieve accurate reduction, all in the control group, of which 3 patients had occlusal disorder. All patients in the experimental group achieved accurate reduction, of which 1 patient had occlusal disorder.Our results suggest that using 3D prototype for bending the bioresorbable plate is an effective method for accurate treatment of condylar fracture.

Using the Digital Occlusal Analysis (T-Scan NOVUS) in Diagnosis the MFDS in Iraqi Patients During Lateral Excursion Movements

Using the Digital Occlusal Analysis (T-Scan NOVUS) in Diagnosis the MFDS in Iraqi Patients During Lateral Excursion Movements

Selecting an appropriate occlusal scheme when fabricating implant- supported fixed dental prostheses: a systematic review

Background Dental implants are ankylosed in the bone without a periodontal ligament resulting in a lack of micro-mobility during chewing. Consequently, occlusion with dental implants may be at greater risk, specifically when the teeth come into contact in lateral excursive movements. Objective A systematic review of the literature was performed to identify occlusal concepts that were most favorable for implant-retained fixed restorations. Data Sources A search of the literature was conducted using PubMed and EndNote literature online software databases. Keywords were used to assist in the identification of the literature. Study Selection The literature search identified 49 articles using PubMed and 33 articles using the author created EndNote database. Data Extraction Two occlusal concepts were identified, namely mutually protected occlusion and group function unilateral occlusion. None of the articles demonstrated clear scientific evidence to identify superiority of one concept over the other. Data Synthesis Based upon the systematic review of the literature, no scientific evidence was identified favoring any specific occlusal concept.

Changing trends in the management of condylar fractures.

Our aim was to evaluate the functional outcomes and complications of mandibular condylar fractures managed surgically and non-surgically. Patients were identified retrospectively from audit data and clinical records from 2005-2018, and functional outcomes were evaluated based on the development of complications at clinical follow up. Patients were categorised into three treatment groups: conservative (management with soft diet, analgesia, and monitoring), closed (management with intermaxillary fixation), and open reduction and internal fixation (ORIF). A total of 358 patients were included with a median age of 33 years (mean 38), and a male:female ratio of 2.7:1. A total of 72 patients (20%) were treated conservatively, 177 (49%) were treated with closed management, and 109 (31%) with ORIF. The ORIF group demonstrated better outcomes than the closed group in terms of reduced protrusive and lateral excursive movements, and temporomandibular joint (TMJ) pain; and in terms of occlusal derangement when compared with the conservative group. The ORIF group had poorer outcomes than both the closed and conservative groups in terms of maximum mouth opening, and temporary facial nerve injury occurred in 5/109 (5%) and condylar resorption in 2/109 (2%) of patients in the ORIF group. There was no incidence of permanent facial nerve injury, Frey syndrome, or paraesthesia of the auricular nerve. The trend that favours ORIF can be justified, as it offers improved functional outcomes in severe or displaced condylar fractures. However, this must be evaluated against the risk of potential surgical complications. Careful case selection is therefore necessary to optimise management of these injuries.

Changes in mandibular and articular dynamics associated with surgical versus nonsurgical treatment of mandibular condylar fractures: a systematic review with meta-analysis.

The aim of this study was to evaluate the mandibular and articular dynamics and the presence of complications associated with surgical or nonsurgical treatments of condylar fractures. Clinical trials that compared open reduction internal fixation and maxillomandibular fixation in patients with condylar fractures were included. We performed an electronic search of PubMed, Scopus, Cochrane Library, Web of Science, and LILACS (Latin American and Caribbean Health Sciences) databases starting from February 2017 and updated in January 2019 and found 467 articles. We evaluated methodologic quality by using the criteria from Cochrane's Collaboration Tool. After independent screening of abstracts, we assessed the full texts of 88 articles; 9 studies were included for qualitative synthesis; but only 8 were included for the meta-analysis. Four studies were considered to have high risk of bias, and 5 were considered to have low risk. The risk ratio (RR=0.20; 95% confidence interval [CI] 0.13-0.32) was observed for complications. The quality of evidence, using GRADE software, was considered low for maximum mouth opening and protrusive movement and moderate for lateral excursion movement and complications. This review suggested that open reduction internal fixation and maxillomandibular fixation are effective. However, surgical treatment presented higher objective parameters. Nonsurgical treatment presented a high index of complications, such as malocclusion, pain and deviation.

Evaluation of the Effect of Bioresorbable Plates and Screws in the Treatment of Condylar Fractures, Assisted by Digital Preoperative Planning

Although bioresorbable materials have begun to be applied in the clinic, they are used primarily in children with fractures; thus, there are few reports of their application for treatment of condylar fractures. This study evaluated the effect of the application of bioresorbable plates and screws for patients with condylar fractures, assisted by digital preoperative planning. This was a prospective interventional study. The sample was composed of 46 patients treated at the School of Stomatology of the China Medical University (Shenyang, China) from October 2016 through May 2018 for condylar fractures alone or in combination with other facial fractures. All patients underwent confirmatory preoperative computed tomography (CT) to obtain Digital Imaging and Communications in Medicine (DICOM) format data for preoperative designing. By digital designing, the authors confirmed operative plans for each patient. All 46 patients underwent bioresorbable osteosynthesis and underwent repeat CT on postoperative day 3. Postoperative clinical assessments included postoperative positions of the fracture segments, maximal mouth opening, lateral excursion movements, occlusal status, and patient satisfaction. These variables were used to assess postoperative efficacy. The sample was composed of 46 patients who had open reduction with internal fixation on 52 sides. At the 3-month follow-up visit, the proportions of patients who were satisfied with the results and who achieved stable occlusion, appropriate maximal mouth opening, and flexible lateral excursion movement were 97, 100, 66, and 95%, respectively. One patient sustained postoperative displacement of a condylar fracture fragment, as confirmed by repeated CT. He was lost to follow-up at 3months postoperatively. The results of this study suggest that open reduction treatment of condylar fractures implanted with bioresorbable materials in combination with digital preoperative designing is an effective method for managing patients in clinical practice.

Condylar Fractures: Surgical Versus Conservative Management.

Background and Objectives:Condylar fractures can be treated with one of the two methods, including the conservative (closed reduction and immobilization) and/or surgical (open reduction and internal fixation) methods. Both these modalities of treatment have their indications and contraindications and merits and demerits. The present study was designed with the purpose of comparing the outcomes of surgical versus conservative management of moderately displaced subcondylar and condylar neck fractures.Materials and Methods:The present study included a total of 20 patients with moderately displaced condylar fractures in patients > 18 years of age who were randomly divided into nonsurgical and surgical group and were managed accordingly. In the present study, the outcomes of conservative versus surgical management of subcondylar and condylar neck fractures were discussed in terms of seven parameters, including the maximal interincisal mouth opening, protrusive and lateral excursive movements of the mandible, status of occlusion, deviation of mandible during mouth opening, pain (in terms of visual analog scale) and the height of ascending ramus (radiographically) which were measured and evaluated pre- and post-operatively at different intervals of time. The follow-up was done for a period of up to 6 weeks postoperatively.Statistical Analysis Used:Descriptive and analytical statistics were calculated using the Statistical Package for Social Sciences version 19. The Mann–Whitney U-test was used to assess the significance of the difference between the groups, whereas the Wilcoxon signed-rank test was used to assess the significance of the difference between the paired observations in each group.Results:Patients treated surgically showed better improvement in maximal interincisal mouth opening, lateral excursions with minimal deviation, early relief from pain, and restoration of height of the ramus with symmetry in comparison with the patients managed conservatively where prolonged periods of pain apart from obvious deviation and minimal restoration of height of the ramus was observed over a follow-up period of 6 weeks postoperatively. The results were also found to be statistically significant with the value of P < 0.05.Interpretation and Conclusion:Surgery is inarguably preferred over conservative management of moderately displaced condylar fractures as per the results of the present study. The present study provided valuable information and mandated further studies with larger sample sizes to come to definitive conclusions.

A Comparative Evaluation of Closed and Open Treatment in the Management of Unilateral Displaced Mandibular Subcondylar Fractures: A Prospective Randomized Study.

The aim of the study is to evaluate closed and open treatment in the management of unilateral displaced mandibular subcondylar fractures. Twenty patients with unilateral subcondylar fractures of the mandible were evaluated with degree of displacement of more than 20 degrees and ramal height shortening of more than 10 mm. They were informed of the need for 6-month follow-up. Patients were thoroughly informed, explaining the possible advantages and disadvantages of the open and closed treatment options. Radiographic parameters included the level of fracture, deviation of fragment, and ramal height shortening. Correct anatomical reduction is achieved by open treatment as compared with closed treatment. Regarding pain, mouth opening, and lateral excursion movement, statistically significant difference was found in both groups ( p < 0.01). In radiographic assessment of ramal height shortening and fracture displacement, statistically significant difference was found ( p < 0.01). And no significant complication is found in both treatment groups. The results of this study favor the open treatment for the management of displaced subcondylar fractures. However, the treatment results are also acceptable for closed group.

Evaluation of Total Alloplastic Temporomandibular Joint Replacement in TMJ Ankylosis.

Total joint reconstruction using autologous or alloplastic materials is one of the treatment options for the reconstruction of the affected joint in TMJ ankylosis. The clinical results of alloplastic TM joint replacement (Biomet Microfixation system) that was carried out for the treatment and reconstruction of TMJ ankylosis have been summarised. A retrospective analysis of eight cases clinically and radiographically diagnosed as TMJ ankylosis with minimal facial asymmetry presenting beyond the growth period and willing for at least 12months of follow-up who have been taken up for gap arthroplasty and reconstruction using Biomet Microfixation TMJ replacement system was carried out. Follow-up of these patients was carried out at regular intervals and assessed on the following criteria: maximal interincisal mouth opening, TM joint pain on the affected side (on VAS), lateral mandibular excursions to the unaffected side deviation on mouth opening, occlusal discrepancy and neuromotor deficit of peripheral branches of facial nerve. The mean maximal interincisal mouth opening pre-surgery and 1year post-surgery was 2 and 31.8mm, respectively. The mean lateral excursive movement to the unaffected side was found to be 5.5mm with mean deviation on mouth opening to be 4.6mm. No pain, occlusal discrepancy or neurological deficit existed at the end of 1year. Biomet Microfixation system is a viable treatment option for reconstruction of TMJ in cases of ankylosis with no major complications.

Temporomandibular Joint Reconstruction in Patients With Autoimmune/Connective Tissue Disease

To evaluate clinical outcomes in patients with autoimmune or connective tissue (CT) disease undergoing temporomandibular joint (TMJ) reconstruction. Patients were divided into 2 groups based on type of TMJ reconstruction. Patients in group 1 (n=9) underwent autogenous reconstruction and had a diagnosis of rheumatoid arthritis (5), lupus arthritis (1), and psoriatic arthritis (3). Patients in group 2 (n=2l) had alloplastic reconstruction with a patient-fitted total joint prosthesis (TMJ Concepts, Ventura, CA) and had a diagnosis of rheumatoid arthritis (15), lupus (3), and psoriatic arthritis (3). Standardized clinical and radiographic examinations were performed before surgery, immediately after surgery, and at longest follow-up after surgery (T3). Group l showed no meaningful improvement in maximal opening without pain, a decrease in lateral excursions, minimal decrease in TMJ pain, and a 32% relapse of chin projection at point B at T3. Average postsurgery follow-up time was 58months. Postsurgical ankylosis was seen in 22% of patients. In contrast, group 2 showed a statistically meaningful decrease in subjective TMJ pain and lateral excursive movements and improvement in jaw function, diet, maximal incisal opening without pain, and only 5% showed a relapse at point B at T3. Average postsurgical follow-up in this group was 78months. Improved treatment outcomes were obtained with alloplastic TMJ total joint reconstruction compared with autogenous TMJ reconstruction in patients with autoimmune or CT disease.

Conservative oral rehabilitation of the bruxism patient with tooth wear

Tooth wear, a progressive but gradual loss of convexity on the cusp of the tooth, does not cause premature deterioration of the dentition. However, it may evolve into pathological wear if this normal wear becomes accelerated due to abnormal endogenous or exogenous factors. The pathological wear can lead to pathological changes of pulp, impaired function, occlusal disharmony and aesthetic problems. When treating patients with pathological wear, the cause of the wear must be analyzed, and each tooth should be diagnosed individually. Additionally, the loss of the vertical occlusal dimension, as well as the appropriateness of the space for restoration, should be evaluated. These procedures can prevent the progression of the wear, limit the range of any possible restoration, and finally, allow a clinician to establish a conservative treatment plan. This case report presents a patient with pathological wear caused by bruxism, and treated with monolithic zirconia fixed dental prostheses, so as to restore the lost guidance and the collapsed tooth shape; treatment was made with an occlusal adjustment of specific teeth, which showed interference during lateral excursive movement. As the result of the treatment, the functional movement of the mandible was freed, and the recurrence of tooth wear was prevented. The pathological wear displayed by this patient was successfully treated by this conservative method, as well as a limited range of restoration, all the while ensuring functionality and aesthetically satisfying results.

Full Mouth Reconstruction of a Patient with Worn Dentition: A Clinical Report

The attrition of anterior teeth leads to the loss of efficient anterior guidance, which protects posterior teeth from wear during lateral excursions. This clinical report describes a 48-year-old man with diagonal tooth wear and posterior mandibular tooth loss. The clinical diagnosis was based on a complete oral examination, photos, functional analysis of lateral excursion movements, general health condition and behavioral aspects such as diet and bruxism. A mandibular partial overlay denture was used to reestablish the occlusal plane after the decision of restoring the vertical dimension of occlusion (OVD) by anatomical landmarks and physiological measurements. Once the compatibility of new OVD was approved and accepted, and followed for six months, fixed implant and tooth supported restorations were fabricated.A satisfactory clinical result was achieved by restoring OVD by 7 mm and avoiding advanced periodontal crown lengthening. Successful full mouth rehabilitation for a severely worn dentition can be achieved through good clinical management with long-term success to improve the quality of life.