Occlusal Abnormalities Research Articles

Bio‐psycho‐social assessment of occlusal dysaesthesia patients

Dentists occasionally experience occlusal dysaesthesia (OD) patients, who complain of bite discomfort without evident occlusal abnormalities. It is suggested that this condition is related to somatosensory abnormalities of the trigeminal system and/or psychological problems such as somatoform disorders. The aim of this study was to investigate the characteristics of OD with a bio-psycho-social approach. Twelve OD patients (10 women, two men; mean age 54.7 years) and twelve healthy volunteers (10 women, two men; mean age 54.8 years) were selected. They were assessed using (i) interdental thickness discrimination ability test using 2-, 5- and 10-mm-thick standard blocks and 12 test blocks that were thinner or thicker than the corresponding standard block and (ii) psychological tests: General Health Questionnaire (GHQ60) and Profile of Mood States (POMS) brief-form. There was no significant difference in the interdental thickness discrimination ability between OD patients and controls (mixed-model anova, P=1.000). Regarding psychological tests, there were no significant differences between OD patients and controls in the total scores for either GHQ60 (P=0.143) or POMS brief-form (P=0.319) (Wilcoxon's test). However, OD patients showed significant differences from controls in several subscales, that is, 'somatic symptoms' (P=0.039) and 'severe depression' (P=0.039) for GHQ60 and 'depression-dejection' (P=0.014) and 'vigour' (P=0.008) for POMS brief-form (Wilcoxon's test). These results suggest there is no difference in interdental thickness discrimination ability between OD patients and normal controls, but OD patients tend to score higher on psychosomatic distress.

Negative self-perception of smile associated with malocclusions among Brazilian adolescents

This study estimated the prevalence of negative self-perception of smile because of occlusion abnormalities and investigated their association according to standard clinical criteria. The sample consisted of 1290 randomly selected Brazilian adolescent boys and girls aged 12-16 years. The outcome of interest was dissatisfaction with smile, and data were collected using a standardized questionnaire. Occlusion characteristics were assessed using the dental aesthetic index (DAI). The other study variables were gender, age, and use of dental services. A chi-square test and Poisson multiple regression were used for statistical analysis. Of the 1290 students interviewed and examined, 539 (41.8 per cent) were dissatisfied with their smile; of these, 373 (69.2 per cent) assigned their dissatisfaction to the presence of an occlusal abnormality, and 166 (30.8 per cent) reported reasons other than occlusal abnormalities for their negative self-perception of their smile. In multivariate analysis, the following variables were associated with the outcome of interest: maxillary anterior irregularity [prevalence ratio (PR) = 1.40; 95 per cent confidence interval (CI) = 1.29-1.80], incisal spacing (PR = 1.37; 95 per cent CI = 1.19-1.57), vertical open bite (PR = 1.34; 95 per cent CI = 1.15-1.55), mandibular anterior irregularity (PR = 1.29; 95 per cent CI = 1.14-1.46), permanent anterior teeth missing (PR = 1.21; 95 per cent CI = 1.05-1.39), and incisal diastema (PR = 1.14; 95 per cent CI = 1.01-1.31). The negative self-perception of smile was statistically associated with severity of occlusal disorders according to the DAI scores, which suggests that self-perception should be used together with standard clinical criteria when decisions about orthodontic treatments are made in public health care systems.

Orthodontic treatment in adult with type I temporomandibular dysfunction : A case report

The relationship between occlusion and TMJ has been the subject of considerable controversy. It is widely believed that the TMJ signs and symptoms such as Joint pain, clicking, locking and headaches are secondary to abnormalities of occlusion, with actual derangement being uncommon. This case report is to put forward the hypothesis that, type I TMD is often due primarily to occlusal interferences for which orthodontic treatment is generally effective. This case report underlines the significance of fixed orthodontic appliance along with the anterior bite plane splint used in correction of type I TMD.

A Case Report of Bilateral Brodie Bite in Early Mixed Dentition Using Bonded Constriction Quad-helix Appliance

Brodie bite is a comparatively rare type of malocclusion found in primary and mixed dentition. It not only adversely affects chewing and muscle functions, but also impairs normal growth and development of the mandible. This report describes the therapeutic results of a patient with bilateral Brodie bite in early mixed dentition after using a bonded constriction quad-helix appliance. The patient, a boy aged 9 years and 2 months, first visited our hospital after occlusal abnormality in the molar region was detected at a local dental clinic. Case analysis resulted in a diagnosis of bilateral Brodie bite with slight mandibular retrognathism. Treatment objectives were to reduce the arch width of the maxillary dentition and expand the mandibular arch in order to establish and stabilize molar occlusion and to achieve a Class I molar relation and appropriate overbite and overjet. Treatment comprised covering the occlusal surface of the maxillary molars with resin and attaching a bonded constriction quad-helix appliance joined with a 0.040-inch quad-helix wire. A bi-helix appliance was also fixed to the mandibular dentition. Brodie bite visibly improved after 5 months. Cervical headgear was then fitted and the patient observed until eruption of the permanent dentition was complete. Class I molar relation was achieved after 2 years and 6 months, although spacing remained in the maxillary and mandibular dentitions. Treatment of bilateral Brodie bite in mixed dentition by means of a bonded constriction quad-helix appliance attached to the maxillary dentition enabled effective bite opening and reduction in the width of maxillary arch independent of the patient's cooperation, providing good therapeutic outcome in a short time period.

OLIGODONTIA OF PERMANENT DENTITION :A CASE REPORT

The present report highlights a case where a patient presented with midline diastema in the lower arch due to missing mandibular incisors and the esthetic and occlusal problems associated with permanent teeth Oligodontia. Congenitally missing teeth is the condition of having one or more missing teeth which cannot be observed clinically or in radiographic images. However, the prevalence of oligodontia in permanent teeth is reported to be 0.14%. There have been reports showing absence of maxillary lateral incisors, premolars, unilateral absence of mandibular incisors but agenesis of bilateral mandibular central incisors is not well documented in the literature. The early orthododntic intervention may eliminate some of the periodontal and restorative problems that could arise in these patients as adults. The aim of this case report is to document a case of congenitally missing permanent teeth along with other occlusal abnormalities and to discuss its clinical implications and management.

EFFECTS OF CONSANGUINEOUS MARRIAGES ON ORAL AND CRANIOFACIAL STRUCTURES: A STUDY ON DENTAL PATIENTS IN NORTH INDIA

Background: Consanguinity describes a relationship between two people who share an ancestor, or share blood. These consanguineous marriages are a major risk to the health of offsprings till the extent that they can cause various craniofacial abnormalities, orofacial pigmentations and other abnormal birth defects. We conducted a study on patients visiting a dental college in North India to accesses the possible deleterious effects of consanguineous marriages on oral and craniofacial structures. Methodology: The study group comprised of all the patients visiting outpatient department of Kotiwal Dental college and Research centre, Moradabad in North India from March 2009 to February 2010. 200 patients showed positive history of consanguinity. They were carefully evaluated and all the diagnostic information was noted. Results: 66 out of 200 patients had systemic disorders like cardiovascular, pulmonary and renal disturbances. 56 patients had orofacial manifestations like orofacial pigmentations, craniofacial syndromes and occlusal abnormalities with or without systemic disorders. Conclusion:The prevalence of consanguineous marriages is still high. Consanguineous marriages are a major risk to the health of offsprings till the extent that they can cause various craniofacial abnormalities, orofacial pigmentations and other abnormal birth defects. They increase the autosomal recessive conditions through the expression of recessive deleterious alleles, especially in the offspring of first degree cousins.

Posttraumatic Temporomandibular Joint Ankylosis in Adults

Ankylosis of the temporomandibular joint (TMJ) is a severe disorder that leads to jaw function impairment and restricted mouth opening. Management of TMJ ankylosis poses a challenge to surgeons concerned because of the high rate of recurrence. The surgical approach to TMJ ankylosis can be performed according to different techniques and modalities. This report presents a case of a bilateral posttraumatic TMJ ankylosis that showed limited mouth opening (27 mm) along with dental occlusion abnormalities, and both TMJs showed severe fibro-osseous ankylosis. Bilateral gap arthroplasty was performed, and passive interincisal mouth opening of at least 47 mm was achieved after 15 days of physiotherapy. Eight months later, bilateral split ramus osteotomy was performed to correct the residual retrognathia and malocclusion. The outcome of the patient's treatment was satisfactory. Wide gap arthroplasty if followed by vigorous physiotherapy may be sufficient in treating TMJ ankylosis and prevent recurrence in adults.

Abnormalities of microcirculation in dentoalveolar complex after direct occlusal restorations

Nowadays, the role of occlusion in etiology and pathogenesis of the inflammation in periodontal tissues have not still become clear and considered as biomechanics and articulation. Physiologically, masticatory pressure stimulates metabolic processes in periodontal tissues. Occlusal overloading leads to periodontal damages. The aim of this study is to reveal abnormalities of microcirculation in periodontal tissues and pulp after direct occlusal restorations. A total of 62 participants, 18–35 years old, with direct occlusal restorations were investigated. The functional analysis included the examination of diagnosis models in articulator PROTAR-evo VII and instrumental analysis with the use of ARCUS DIGMA system. The evaluation of microcirculation was made by the laser Doppler flowmetry (LDF). RESULTS: The intensity of the periodontal tissues microcirculation in teeth with fillings on occlusal surfaces and teeth-antagonists significantly increases by 10–14% (p < 0.001). The intensity of a pulp microcirculation in the teeth with fillings on occlusal surfaces and teeth-antagonists significantly increases by 43–54% (p < 0.05). Thereby, in conditions of occlusal contacts abnormalities, reaction of microcirculation in periodontal tissues and pulp denote the chronic inflammation. At the initial stage clinical presentations are usually absent.

Ocorrência de mordida aberta anterior e hábitos bucais deletérios em crianças de 4 a 6 anos

OBJETIVO: verificar a ocorrência de mordida aberta anterior e de hábitos orais deletérios em crianças de quatro a seis anos de idade. MÉTODOS: foram avaliadas 266 crianças de quatro a seis anos incompletos, de ambos os gêneros, na cidade de Suzano - São Paulo. As avaliações constaram de aplicação de ficha de avaliação para detecção de ocorrência de hábitos bucais deletérios aos responsáveis e da realização de exame clínico constituído por avaliação da oclusão das crianças. RESULTADOS: verificou-se que 221 crianças (83,1%) apresentaram pelo menos um hábito bucal deletério, sendo o mais frequente o uso de mamadeira 167 (75,6%). A ocorrência simultânea de hábitos deletérios e alterações de oclusão dentária foi observada em 119 crianças (44,1% da amostra) e nestas, a maior prevalência foi a presença da mordida aberta anterior, presente em 89 (79,8%). CONCLUSÃO: a mordida aberta anterior (MAA) foi a alteração oclusal mais prevalente nas crianças, havendo associação estatisticamente significante entre hábitos orais deletérios, como uso de mamadeira, chupeta e ocorrência de bruxismo e presença de mordida aberta anterior.

Risk Indicators for Signs and Symptoms of Temporomandibular Dysfunction in Children

The aim of this study was to determine the risk indicators for signs and symptoms of temporomandibular dysfunction (TMD) in children between 4 and 12 years of age. One hundred six patients were assessed for the following variables: (1) signs and symptoms of TMD (deviation when opening mouth, joint noises, limitation of movement, pain in the mandible or during movement), (2) dentition and occlusal abnormalities, and 3) habits (pacifier sucking, nonnutritive sucking, finger sucking, nail biting, and teeth grinding (bruxing). Multivariate logistic regression was performed with the level of significance set at P < 0.05. The prevalence of at least one sign or symptom of TMD in the present sample was 12.26% (n = 13). Only bruxing (P = 0.01, odds ratio 6.08, CI 1.51-24.51) and posterior crossbite (P = 0.03, odds ratio 5.74, CI, 1.18-27.85) achieved statistical significance in the multivariate regression model and were considered risk indicators for signs and symptoms of TMD. Children with bruxing or clenching habits and those with posterior crossbite have a greater likelihood of developing signs and symptoms of TMD.

Treatment of temporomandibular disorder using occlusal splint

Background : Patient suffering from occlusal abnormality is usually detected months or even years when the acute patient visits a dentist, and generally the patient does not receive direct treatment upon his complaints since minimum information is available on this type of treatment. In general, the dentist provides medication only or conducts incorrect selective grinding where in fact, the patient does not feel better from the previous conditions. Purpose : The objective of this study is to discuss the treatment on the dysfunctional temporomandibular joint followed by orofacial pain caused by occlusal disorder using occlusal splint. Case : In this case, a forty three years old male having trouble with the joint on the left jaw followed by orofacial pain caused by occlusal disorder. Case Management : Initial treatment with occlusal splint makes the patient comfortable and recovers from his complaints since the patient could restructure the chewing muscles. This treatment will be more successful if the dentist has the knowledge to use and choose occlusal splint method properly. Occlusal Splint could be used as a supporting therapy and consideration as one of the therapies to avoid the unwanted side effects. The use of occlusal splint is meant as an alternative of the main therapy in overcoming the problem of occlusal splint. Conclusion : Finally, therapy with occlusal splint is very effective as an alternative treatment to handle the dysfunction of temporomandibular joint caused by occlusion.

The oral health of children in a rural area of the Lao People's Democratic Republic

The lack of information on oral health in Laos makes it difficult to estimate the need and methods for preventing oral disease. This study identified problems concerning the oral health of Lao children. The study subjects were 59 school children who lived in Pakkading District. Dental caries, gingivitis malocclusions, temporomandibular joint (TMJ) disorders, dental plaque, and calculus were examined. We observed an average of 1.6 decayed, missing, and filled teeth (DMFT) and 4.1 decayed and filled deciduous teeth (dft) per child. 25.4% had gingivitis scores from 16 to 20 on the papillary, marginal, and attached (PMA) index; 29.6% had one or more occlusal abnormality; and 0% had signs of TMJ disorders. 93.5% of the children had at least one buccal or lingual tooth surface with plaque covering more than two thirds of the surface; 32.6% had dental calculus. Oral health promotion programs for children should prioritise prevention and treatment of caries. It is likely that the high rate of gingivitis in Lao children is due mainly to unsuccessful plaque control in daily life. In addition to descriptive epidemiological studies of dental diseases in other areas, the influence of sociological and behavioural factors on oral health should be analyzed epidemiologically to promote child health.

Etiopathogenesis of disk displacement of the temporomandibular joint: A review of the mechanisms

Disk displacement of the temporomandibular joint (TMJ) is a clinically important condition, showing a high prevalence in both patient and non-patient populations. Despite its clinical importance, there is incomplete understanding of the etiopathogenic mechanisms leading to disk displacement. A number of possible risk factors have been identified. This article analyzes the etiopathogenesis from both the clinical and the biomechanical viewpoints and also reviews the literature on the association between disk displacement and the main risk factors (i.e., trauma, altered disk shape and/or dynamic properties, occlusal abnormalities, steepness of the articular eminence, hyperactivity of the lateral pterygoid muscle, joint hypermobility, etc.). According to our interpretation of available data, an impairment of joint lubrication may be a common finding in cases of disk displacement, thus suggesting the need for future studies addressing both local and systemic neuroendocrine aspects influencing the friction coefficient of the TMJ. A full comprehension of the etiopathogenesis of disk displacement is far from being achieved, and clinicians must take into account this consideration when treating patients with temporomandibular disorders.

Search for candidate chromosomes that specify mesiodistal tooth crown length of the mandibular first molar using MSM, C57BL/6J and their consomic mice

Tooth size directly affects abnormalities in dental occlusion, and is decided by genetic and environmental factors. Malalignment of teeth occurs as a result of discrepancies in jaw bone and tooth size. In this study, F2 mice acquired by crossing C57BL/6J (B6) strain having large mesiodistal tooth crowns and MSM strain having small mesiodistal crowns were used to conduct quantitative trait locus (QTL) analysis and to identify chromosomes involved in determining mesiodistal tooth size. Analysis revealed that the QTL responsible for tooth size could be mapped chromosomes 3 and 17 in mice. Therefore, we measured mesiodistal crown length of the first molar of the mandible, and analyzed candidate chromosomes that decide the size of teeth in vivo using consomic mice between B6 and MSM strains. Mesiodistal crown length was largest in consomic mice of B6-Chr.3 MSM , thus some genes for mesiodistal crown development may be located on chromosome 3.

Long-Term Treatment Effectiveness of Molding Helmet Therapy in the Correction of Posterior Deformational Plagiocephaly: A Five-Year Follow-Up

To evaluate the long-term effectiveness of helmet therapy in the correction of deformational plagiocephaly and to assess the early occlusal abnormalities seen in these patients. A prospective study with blinded measurements. Twenty-eight patients with deformational plagiocephaly who were treated with molding helmet therapy with at least 5 years of follow-up. The average length of molding helmet treatment was 6.2 months. At the time of this follow-up evaluation, the mean interval since completing the molding helmet therapy was 5.6 years. Anthropometric measurements of cranial asymmetry included cranial vault asymmetry (CVA), orbitotragial depth asymmetry (OTDA), and cranial base asymmetry (CBA). A dental examination was also performed. At the completion of therapy, the most improvement was seen in the measurement of CBA, followed by CVA and OTDA. However, in evaluating the long-term stability of molding treatment, OTDA tended to continue improving after the initial treatment, while CBA and CVA appeared to regress, although none of the changes reached statistically significant levels. In dental measurements, all the dental midline and chin deviations were toward the unaffected side with respect to occipital deformation. This study demonstrated that helmet remodeling with the dynamic orthotic cranioplasty band is effective in the correction of cranial asymmetry, with some nonstatistically significant changes in long-term cranial vault symmetry. Dental observations indicated the possibility of occlusal abnormalities that may affect dental, especially orthodontic, diagnosis and treatment planning.

Familial Lambdoid Craniosynostosis Between Father and Son

Lambdoid craniosynostosis is an uncommon condition, with an incidence of 1 per 33,000 live births. Its etiopathology remains controversial. Although many forms of syndromic and nonsyndromic craniosynostosis demonstrate an inherited pattern, few articles have reported lambdoid craniosynostosis in the same family. In this article, we report lambdoid synostosis in a father and son. A case review is performed. A full-term male infant was delivered by cesarean delivery because of failure to progress. He presented at 3 years of age with right unilateral lambdoid craniosynostosis with facial asymmetry and lateral deviation of his jaw, with occlusal abnormality. At presentation, the father reported skull surgery during his infancy for unilateral lambdoid craniosynostosis. Review of the computed tomographic scan of the child demonstrated a plagiocephalic appearance of the calvarium with frontal bossing and a fusion of the lambdoid suture on the right sides. The brain parenchyma showed no abnormality. The review of his father's surgical record from 33 years ago and of his computed tomographic scan ordered by our team confirmed the diagnosis of previous lambdoid craniosynostosis. Only 2 previous cases of familial isolated lambdoid craniosynostosis have been previously described in literature. Although the genetic basis has been established for many types of craniosynostosis, the etiopathogenesis of isolated lambdoid synostosis has not yet been established. We report the third case of inherited unilateral lambdoid craniosynostosis. The genetic pathogenesis of lambdoid craniosynostosis will be discussed.

Awareness of Malalignment and Malocclusion in Children and Their Guardians

We conducted a survey on the awareness of abnormalities of dentition and occlusion in 1,904 children (0-15 years old) and their guardians (parents, grandmothers, grandfathers and siblings) on their initial visit to the Department of Pediatric Dentistry, Chiba Hospital, Tokyo Dental College. The location and type of abnormality for which the children and their guardians most commonly sought treatment were crowding of the upper and lower anterior teeth and inverted occlusion. The most common initial triggers for concern were "guardians noticed abnormalities themselves". It seems logical that where malocclusions that children and guardians can easily notice for themselves are present, they are likely to make an early visit to a clinic in the hope of improving the abnormality. We suggest that further effect is made to educate guardians of children with abnormalities of dentition and occlusion on the importance of obtaining treatment.

補綴歯科治療に簡易精神療法を導入した症例

A 50-year-old male with a history of schizophrenia is reported. He had severe periodontal disease and visited the clinic complaining of occlusal abnormality due to buccally inclined maxillary right first and second molars. Occlusion was steadied to the utmost using a removable splint, and approach based on brief psychotherapy was applied for his gaining an understanding of prosthetic therapy. The patient was successfully desensitized to occlusal abnormality by the splint. Furthermore, the patient was consistently treated with acceptance, support and reassurance for his complaints; for example, prosthetic appliances were selected with forethought, and thereby favorable results were obtained. Introduction of brief psychotherapy in prosthetic therapy provided understanding and satisfaction of the therapy to the patient.

The relationship of occlusal disharmonies and symptoms of temporomandibular disorders

The influence of occlusal condition on the onset of temporomandibular disorder (TMD) has been strongly debated for many years and is still the source of controversy. Until 1980s, the occlusal factors such as the presence of uncured malocclusions, discrepancies between intercuspal position (ICP) and retruded contact position (RCP) greater than two millimeters, occlusal abnormality, particularly mediotrusion and retrusion, and loss of posterior teeth were considered the primary causes ofTMD. The objective of our study was to find correlation of occlusion disharmonies (difference between ICP and RCP) and present sings and symptoms of TMD. The study involved 60 subjects between 18 and 26 years of age who were divided in two groups. The study group consisted of 30 subjects between 18 and 26 years of age with sings and symptoms of temporomandibular disorders (TMD). TMD was confirmed according to Helkimo index. An average value of Helkimo index in this group was 1. The control group included 30 subjects between 20 and 25 years of age without TMD sings and symptoms. An average value of Helkimo index in this group was 0. The function analysis of cinematic centers position in RCP and ICP was performed in each subject using the computer pantograph Arcus-Digma (KaVo EWL GmbH, Leutkirch, Germany). The results of our study showed that the translation tracing of cinematic points from RCP to ICP was significantly different in TMD subjects and asymptomatic group (p > 0.16). In addition, the study revealed that 53.4% of subjects with sings and symptoms of temporomandibular disorders had marked translation in the lower temporomandibular joint (0.61-1.2 mm) what directed to intracapsular disorders. The results of our study suggested significant difference of RCP and ICP between subjects with sings and symptoms of the temporomandibular disorders and subjects without sings and symptoms.

A Study Using the Interdental Thickness Discrimination Test at Three Different Degrees of Mouth Opening: Reproducibility and Gender Differences in Young Adults

Purpose: This study gathered basic information on the ability of healthy dentate individuals to discriminate interdental thicknesses in order to diagnose patients without evident occlusal abnormalities who complain about bite discomfort.Materials and Methods: Twenty healthy dentate adults participated in the study. The interdental thickness discrimination test was performed at the maxillary and mandibular central incisors with 2-, 5-, and 10-mm thick standard blocks. A test block with a different thickness from that of the corresponding standard block was tested after the application of the standard block. The subjects were then asked to answer whether the test block felt thicker or thinner than the standard block. The number of wrong answers was statistically analyzed. The measurement was repeated three times on different days.Results: There was no statistical difference in the number of wrong answers among the measurements on three different days. There were statistically significant differences in the number of wrong answers between the 2- and 10-mm, and 5- and 10-mm thicknesses (p<0.05, ANOVA). Significantly more wrong answers were observed for the test blocks that were thicker than the standard block compared to those that were thinner (p<0.05, ANOVA). There were significant differences between females and males in the distribution of wrong answers for the thinner test blocks (2- and 5-mm thicknesses) (p<0.01, ridit analysis).Conclusion: There was reproducibility of the interdental thickness discrimination test and a gender difference in the thickness discrimination ability in the healthy dentate adults who participated in this study.