Stomatognathic Function Research Articles

Orthodontic management of obstructive sleep-disordered respiratory disorders

Through his/her knowledge of cranio-facial growth, the orthodontist plays a leading role within the multidisciplinary team that tracks and treats sleep-disordered breathing (SDB) in children. Correction of craniofacial risk factors (maxillary deficiency and retrognathia) is commonly used by practitioners alongside orthodontic treatment such as OMA and RME in the optimal conditions afforded by childhood growth. Myofunctional therapies are performed to restore correct stomatognathic function and play a central role in the management of SDB in children. The orthodontist is therefore a key player in the medical treatment chain of these children.

Effect of Short-Term Forward Head Posture Correction for Masseter Muscle Activity and Temporomandibular Joint Function for People with Upper Cross Syndrome

Background. In 1996, meta-analysis of studies was performed and it showed the connections between head posture changes and temporomandibular joint (TMJ) dysfunctions (Harrison et al., 1996), but the abnormalities of the mandibular usually were treated as the only pathology leading to poor clinical effect (Lee et al., 2017). Supposedly, occlusion problems are related not only to the position of the jaw and skull, but also to the shoulder and spine, which act as a biomechanical chain (Moreno, Aranza, 2013; Shousha et al., 2018). There is a lack of evidence how head posture correction changes stomatognathic system functions, that is why our study aimed to determine if a short-term head posture correction affects the system. Research aim. Determine the effect of short-term forward head posture correction for temporomandibular joint (TMJ) function. Research methods. Evaluation of posture, TMJ range of motion, jaw opening stereotype. Research results. After a short-term head posture correction, head inclination angle alteration was as follows: ScapularR = 5.65°, ScapularL = 3.9°. Jaw opening alteration was ScapularR 15.09 mm, ScapularL 15.58 mm. The difference between mandibular deviations decreased to ScapularR 0.32 mm; ScapularL 1.60 mm. Deviation during jaw opening reduced ScapularR 2.06 mm; ScapularL 2.38 mm. Conclusion. Short-term head posture correction signifcantly reduced head inclination angle, mandibular opening movement amplitude and deviation from the centre line in individuals with upper cross syndrome and asymmetric scapular position.Keywords: temporomandibular joint, head posture, upper cross syndrome.

Application of digital mandibular movement record and masticatory muscle electromyography in the evaluation of stomatognathic function in patients with mandibular tumor

To study the clinical characteristics of mandibular movement and masticatory muscle function in preoperative and postoperative patients with unilateral mandibular tumors in the region of mandibular body and ramus by combining digital mandibular movement records with electromyography, and to preliminarily explore the relationship and mechanism between movement and masticatory muscle function. Six preoperative patients with tumor in unilateral body and ramus of mandible were included, and three postoperative patients with unilateral segmental resection and reconstruction of mandibular bone were included. The mandibular movement recording system and surface electromyography system were used to collect the movement trajectory of the patients' mandibular marginal movement and chewing movement, and the surface electromyography of bilateral masseter and temporalis was recorded concurrently. The surface electromyography of bilateral masseter and temporalis was collected when the patients were at relaxation and at maximal voluntary clenching (MVC). The motion trajectory was observed on the digital virtual model, and the motion amplitude and direction of mandibular marginal movements were analyzed. The characteristics of masticatory electromyogram (EMG) activity in affected and unaffected sides at relaxation, MVC and bilateral mastication were analyzed, and the asymmetry indexes and activity indexes were calculated. The preoperative mean maximum opening of the patients was (35.20±6.87) mm. Three patients had mild mouth opening limitation, and all the patients' mouth opening trajectory was skewed to the affected side. During lateral movements, the mean range of motion of the affected side [(10.34±1.27) mm] and that of the healthy side [(6.94±2.41) mm] were significantly different. The maximum opening of the postoperative patients was (30.65±17.32) mm, and the mandibular marginal movement characteristics were consistent with those of the patients before surgery. During MVC in the preoperative patients, the median EMG activities of the masseter muscle [44.20 (5.70, 197.90) μV] and the temporalis muscle [42.15 (22.90, 155.00) μV] on the affected side were slightly lower than those of the masseter [45.60 (7.50, 235.40) μV] and the temporalis muscle [63.30 (44.10, 126.70) μV] on the healthy side. In the postoperative patients, individualized changes occurred. Some patients suffered from weakened electromyographic activity on the affected side, while some other ones showed hyperelectromyographic activity on the affected side. Both benign and malignant tumors as well as their surgery can cause abnormal mandibular movements and change of electromyographic activity of bilateral masseter and temporalis muscles.

Effects of Parkinson's disease on molar bite force, electromyographic activity and muscle thickness of the masseter, temporal and sternocleidomastoid muscles: A case-control study.

Parkinson's disease is a neurological disorder that promotes motor changes in the body. The aim of this study was to investigate the impairment of the stomatognathic function regarding molar bite force, electromyographic activity and thickness of the craniocervical muscles in patients with Parkinson's disease in comparison with those in asymptomatic controls. Twenty-four subjects were divided into two groups, a Parkinson's disease group (n=12) and a control group (n=12). The subjects were evaluated on the basis of molar bite force, electromyographic activity (rest, right and left laterality, protrusion, maximum voluntary contraction) and thickness (rest and maximum voluntary contraction) of the right and left temporal (anterior portion), masseter and sternocleidomastoid muscles. The results were submitted to a multivariate analysis of variance (MANOVA) to compare the means of the two independent groups, considering diagnosis of Parkinson's disease and craniocervical muscles as independent variables. For the post hoc comparisons, Bonferroni correction was used (P<0.05). Parkinson's disease group presented lower mean values both sides for maximal molar bite force, significant increases in the electromyographic activities during mandibular tasks, lower mean thickness values of the masseter and sternocleidomastoid muscles, and higher mean thickness values of the temporalis muscles (anterior portion). The results suggest that patients with Parkinson's disease may present functional changes of the stomatognathic system, related to bite force, electromyographic activity and thickness of the craniocervical muscles. The greater temporal muscle thickness in Parkinson's disease patients may compromise their daily life activities, especially with respect to chewing and nutrition.

Improvement of Open Bite and Stomatognathic Function in an Axenfeld- Rieger Syndrome Patient by Orthodontic Sectional Arch Mechanics: Clinical Considerations and the Risk of Orthodontic Tooth Movement.

Orthodontists need to understand the orthodontic risks associated with systemic disorders. Axenfeld-Rieger syndrome (ARS) is a rare autosomal dominant disorder with genetic and morphological variability. The risks of orthodontic treatment in ARS patients have been unclear. Here we describe the correction of an anterior open bite in a 15-year-old Japanese female ARS patient by molar intrusion using sectional archwires with miniscrew implants. An undesirable development of external apical root resorption (EARR) was observed in all intrusive force-applied posterior teeth during the patient's orthodontic treatment, suggesting that ARS patients have a higher risk of EARR than the general population.

Development and evaluation of a jaw-tracking system for mice: reconstruction of three-dimensional movement trajectories on an arbitrary point on the mandible

BackgroundMastication is one of the most fundamental functions for the conservation of life. The demand for devices for evaluating stomatognathic function, for instance, recording mandibular movements or masticatory muscle activities using animal models, has been increasing in recent years to elucidate neuromuscular control mechanisms of mastication and to investigate the etiology of oral motor disorders. To identify the fundamental characteristics of the jaw movements of mice, we developed a new device that reconstructs the three-dimensional (3D) movement trajectories on an arbitrary point on the mandible during mastication.MethodsFirst, jaw movements with six degrees of freedom were measured using a motion capture system comprising two high-speed cameras and four reflective markers. Second, a 3D model of the mandible including the markers was created from micro-computed tomography images. Then, the jaw movement trajectory on the certain anatomical point was reproduced by integrating the kinematic data of the jaw movements with the geometric data of the mandible.ResultsThe 3D movements at any points on the mandible, such as the condyle, molar, and incisor during mastication, could be calculated and visualized with an accuracy > 0.041 mm in 3D space. The masticatory cycle was found to be clearly divided into three phases, namely, the opening, closing, and occlusal phases in mice.ConclusionsThe proposed system can reproduce and visualize the movements of internal anatomical points such as condylar points precisely by combining kinematic data with geometric data. The findings obtained from this system could facilitate our understanding of the pathogenesis of eating disorders or other oral motor disorders when we could compare the parameters of stomatognathic function of normal mice and those of genetically modified mice with oral behavioral dysfunctions.

Ten-year Clinical Trends among 575 Consecutive Oral Cancer Patients at Tokyo Dental College Oral Cancer Center.

The facilities comprising Tokyo Dental College (TDC) -the college itself and its medical institutions at Suidobashi, Ichikawa, and Chiba - have been officially recognized as a center for treating oral cancer. The TDC Oral Cancer Center (OCC) was established on April 1, 2006. It provides comprehensive medical care, including that aimed at recovery of postoperative function, such as restoration of stomatognathic function, dysphagia therapy, and placement of maxillary prostheses. The purpose of this study was to investigate patient trends at TDC-OCC over the 10 years following its establishment in order to determine how the safe and high-quality cancer care already provided might be even further improved. Oral cancer patients attending TDC-OCC between April 2007 and March 2017 were investigated. Clinical information was obtained from medical records and analyzed, including that on patient numbers, age, sex, primary site of tumor, clinical stage, and surgery provided. There were 758 new cases, and the number of new cases showed an annual increase. Among the total number of new patients, 575 (75.9%) represented primary cases. The number of operations also showed an increase, which correlated with the increase in the number of patients. The incidence in oral cancer has increased in several countries, including Japan. Oral cancer can be observed macroscopically and touched. In contrast to with cancers at many other sites, and despite various diagnostic devices for early detection having been developed, however, cases are often advanced when first encountered. Many advanced cases were treated at TDC-OCC, and the number of reconstructive operations following progressive cancer also increased over time.

Pressure and resistance of the lips in subjects with and without occlusal change

ABSTRACT Objective: to evaluate the resistance and pressure of the lips in Class I, II and III Angle’s malocclusion subjects, in comparison to reference values and relate them with gender and age. Methods: a quantitative, descriptive and cross-sectional study. Participants included 40 subjects, 20 women and 20 men, average age 26.3 years, separated by occlusal classification. The volunteers answered on the self-reported performance of the stomatognathic functions and were submitted to the evaluation of the mobility and posture of the lips. Pressure and resistance were measured with the Iowa Oral Performance Instrument (IOPI) and the results compared to the reference values described in the instrument´s manual. The data were analyzed descriptively and, for inferential analysis, Pearson's Chi-Square test was used. The significance level was considered 5%. Results: a decrease in pressure and resistance values wasobserved in all patients, including Angle’s class I group. There was an inverse relationship between the age of the subjects and the values of pressure of lips with statistical significance (p = 0.02). In general, women had lower pressure values than men. Conclusion: all study subjects had lower pressure of the lips than the reference values described in the literature.

Anterior open bite due to temporomandibular joint osteoarthrosis with muscle dysfunction treated with temporary anchorage devices

Skeletal Class II high-angle open bite is often accompanied by osteoarthrosis of the temporomandibular joint (TMJ-OA). This type of malocclusion is challenging to correct, and it has been reported that patients with TMJ-OA treated with orthognathic surgery often experience skeletal relapse and a poor prognosis. This case report describes the treatment of a 25-year-old woman with retrognathia and TMJ-OA, whose masseter and temporal muscle activities were weak. Temporary anchorage devices were placed in the maxilla and the mandible, and the first molars were intruded. We used improved superelastic nickel-titanium alloy wires with tip-back bends for both arches, and intermaxillary elastics were used to upright the molars. After treatment, intrusion of the maxillary and mandibular first molars, counterclockwise rotation of the mandible, and improvement of occlusion and profile had been achieved. The patient's condyles were repositioned into ideal positions, and masticatory muscle activity was augmented and balanced. After 2years of retention, the mandibular and condylar positions were stable, and acceptable occlusion was maintained without recurrence of TMJ symptoms; harmonious activity of the masticatory muscles was retained. The findings of this case report suggest that molar intrusion using temporary anchorage devices for a patient with severe anterior open bite and TMJ-OA may be useful for improving stomatognathic function, occlusion, and facial esthetics.

Funções estomatognáticas e queimaduras em face e/ou pescoço: revisão sistemática da literatura

Objetivo: Descrever as alterações nas funções do sistema estomatognático de indivíduos que sofreram queimaduras em face e/ou pescoço. Método: Trata-se de uma revisão sistemática da literatura. A pesquisa foi realizada por meio da Biblioteca Virtual em Saúde (BVS) e busca manual, utilizando-se os descritores: queimadura (burn), deglutição (deglutition), mastigação (mastigation), respiração (respiration), fala (speech), sucção (sucking, suction). Foram selecionados artigos publicados entre 2008 e 2018 que descreveram funções estomatognáticas após queimaduras em face e/ou pescoço. Para análise, foram extraídas informações quanto ao número de participantes, sexo, idade, etiologia e grau da queimadura, superfície corporal queimada e características de funções estomatognáticas pós-queimadura. Resultados: Dos 377 artigos identificados nas bases de dados, oito foram selecionados. Além destes, três foram selecionados por meio de busca manual, totalizando a inclusão de 11 artigos. A maioria dos participantes era do sexo masculino, com idade entre dois e 85 anos. Foram descritas queimaduras com superfície corporal queimada entre cinco e 80%, de primeiro a terceiro grau, sendo a maioria queimadura térmica. Seis artigos descreveram alteração na deglutição, cinco relataram alteração na respiração, três na articulação da fala, dois na mastigação e dois referiram comprometimento da mímica facial. Nenhum citou alteração na sucção. Conclusão: As alterações no sistema estomatognático decorrentes de queimaduras em face e/ou pescoço mais descritas na literatura analisada foram relacionadas à deglutição e à respiração, especialmente devido a edema pós-queimadura e restrição de mobilidade causada por hipercicatrização. Alterações na fala, mastigação e mímica facial também foram observadas.

Oral Diffuse Large B-Cell Lymphoma with Plasmablastic Differentiation in an HIV-Negative Patient

A 52-year-old man was admitted to the oral diagnoses department for evaluation of a painless facial swelling for 4 months. A physical examination revealed dysphagia and facial asymmetry in the left jaw. In an intraoral exam, an expansive and necrotic lesion limiting stomatognathic function was observed. The radiographic aspect confirmed a primary soft tissue lesion with osteolytic capacity. Incisional biopsy and the microscopy showed diffuse small cell proliferation, with nuclear hyperchromatism, high mitotic activity, and clear perinuclear space, associated with large cells, with clear cytoplasm resembling macrophages, in a connective tissue stroma, resembling a “starry sky”. Immunohistochemical analysis revealed positivity for CD38, CD138, weak for CD20, and negative for CD79, CD19, CD10, CD3, CAM5.2, CK (LMH), PAX, TDT, and AE1AE3. With diagnosis of diffuse large B-cell lymphoma with plasmablastic differentiation, the patient was evaluated for human immunodeficiency virus, with negative results. The patient died after the first chemotherapy cycle.

Tongue pressure and endurance in patients with Class II and Class III malocclusion

ABSTRACT Objective: to evaluate pressure and endurance exerted by the tongue and their association with malocclusion, gender and age in orthognathic surgery candidates. Method: a cross-sectional, descriptive observational study, performed with 34 subjects, i.e., 18 women and 16 men, in the average age 28.7 years, sorted by Angle’s classification. Self-reported complaint of tongue mobility and stomatognathic functions was assessed and the evaluation of tongue mobility carried out. Tongue pressure and endurance were measured with the Iowa Oral Performance Instrument (IOPI). The data were analyzed descriptively and, for inferential analysis, the Pearson Chi-Square test was used. A 5% significance level was considered. Results: the assessed pressure and tongue endurance values of patients with malocclusion were lower than the reference ones, indicating a statistical significance in class II female patients. There was an association between inadequate pressure and tongue endurance in women with class II malocclusion. Pressure and tongue endurance in females were slightly higher than in males and a gradual decrease in averages of pressure and tongue endurance with advancing age was seen. Conclusion: pressure and tongue endurance values in women presented with class II malocclusion were lower than the reference ones, an association between inadequate pressure and tongue endurance being found.

Complete Denture Treatment With a Flat Ridge Using Semi-adjustable Articulator

Background: Complete denture is a removable denture replacing all the missing teeth and tissue in the upper jaw and lower jaw. The purpose of making complete denture is to improve the function of chewing, aesthetic functions and maintaining patient's oral health. Complete edentulous ridge will causes resorption, until it become flat. A flat ridge is associated with difficulties in providing successful dentures. Purpose: This case report aims to reported the treatment of complete edentulous maxillary and mandibular with a flat ridge using semi-adjustable articulator. Case(s): A 63-year-old male patient visited the Prosthodontic Clinic of Dentistry Faculty, Airlangga University with complete edentulous maxillary and mandibular, also flat ridge in his mandibular. Case Management: This case is using semi-adjustable articulator (Stratos 300). Some accessories in Stratos 300 were used in this case, such as centric tray to help determine the height of bite, gnathometer M to help the process of functional impression and bite block, also tooth arrangement with 2D templates. Conclusion: The use of semi-adjustable articulator (Stratos 300) could restore stomatognathic function in accordance with patient’s condition.

Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment.

: This study was conducted to identify variables associated with mouth breathing diagnosis in children, based on multidisciplinary domains. 119 children, six to 12 years old, underwent anamnesis, speech therapy (orofacial structures and stomatognathic functions), otorhinolaryngologic (OTRL) with clinical and endoscopic examinations, dental (occlusion) and physiotherapy (body posture and nasal patency) assessments. Nasal patency was evaluated using Peak Nasal Inspiratory Flow (PNIF) and the Nasal Obstruction Symptom Evaluation (NOSE) scale. A multiple logistic regression was performed considering breathing mode as the dependent variable and the co-variables from each multidisciplinary assessment as associated variables. Association with MB diagnosis was found in each professional domain with: nasal obstruction report (Odds ratio - OR=5.55), time of pacifier use (OR=1.25), convex facial type (OR=3.78), obtuse nasal angle (OR=4.30), half-open or open lip posture (OR=4.13), tongue position on the mouth floor (OR=5.88), reduced hard palate width (OR=2.99), unexpected contraction during mastication (OR=2.97), obstructive pharyngeal tonsils (OR=8.37), Angle Class II malocclusion (OR=10.85) and regular gingival maintenance (OR=2.89). We concluded that a multidisciplinary diagnosis is important, given that each evaluation domain, including OTRL, dental and speech therapy, presented variables associated with MB diagnosis. Body posture and nasal patency variables were not associated with MB.

Dental considerations and the role of prosthodontics and maxillofacial prosthetics in facial transplantation

BackgroundFacial transplantation (FT) is a challenging reconstructive endeavor that requires the expertise of a multidisciplinary team. The specific role of maxillofacial prosthodontists has not yet been reported in detail. MethodsThis review considers the contributions of prosthodontists throughout the FT process, from patient selection and dental evaluation to long-term dental rehabilitation of the transplant patient postoperatively. Moreover, considerations of dental management are evaluated. ResultsIn the almost 40 FT reported in the literature, the most consistently documented contribution by prosthodontists is the fabrication of a donor mask to maintain donor integrity. Though infrequently reported, prosthodontists have the potential to plan and perform a variety of dental procedures and follow-up plans. ConclusionsWhen applicable, facial transplant teams are tasked with providing optimal stomatognathic function and dental occlusion to recipients with severe facial disfigurement. The maxillofacial prosthodontist’s contribution is crucial to the long-term dental restoration of the edentulous facial transplant candidate, in addition to the fabrication of the donor mask which fulfills the team’s ethical responsibilities. Practical ImplicationsMaxillofacial prosthodontists play a pivotal role in facial transplantation, particularly when jaw segments are intended for transplantation.

Recent Advances in Surgical Treatments for Growing Patients with Cleft

Cleft lip and palate is the most common teratologic condition of oromaxillofacial units, probably associated with genetic and environmental causes. The goal of cleft surgery is to optimize facial esthetics and stomatognathic function while minimizing growth disturbances from surgical intervention. In this article, the author suggests the recent surgical strategies that minimize cleft nasal deformity and midfacial skeletal constriction. From the author's surgical experiences and literature reviews, only considerate surgeries would achieve functional improvement and facial esthetics in patients with cleft lip and palate.

Ankylosis Due Sequel Of Fracture Of The Mandibular Condyle: Case Report

The Ankylosis of the Temporomandibular joint (TMJ) is a disorder of craniofacial complex that results in the merger between the condyle and the mandibular fossa, causing partial or complete immobilization of the mandible. The etiological factors are local and systemic inflammation, infection in the area of TMJ, rheumatic diseases and neoplasms, having the trauma as the main etiologic factor. The traumas are responsible for 31% to 98% of cases of ankylosis. The diagnosis is made from the anamnesis and imaging scans (computed tomography) pointing to the union of joint components. The treatment of ankylosis is a big challenge due the high rate of recurrence that can be affected by factors such as type of ankylosis, surgical technique, age of the patient, post-operative physiotherapy and systematic follow-up of the patient. The various forms of treatment require careful analysis of type of ankylosis if it is intra or extra-articular, unilateral or bilateral and if it is bony or fibrous, There is no consensus in current literature regarding the best treatment. The aim of this work is to present through the report of a clinical case, a surgical treatment of Unilateral Temporomandibular joint Ankylosis, due to sequel of condylar fracture with re-establishment of the stomatognathic functions in postoperative follow-up.

Comparing masticatory performance between dentate individuals and removable denture wearers

Tooth loss replacement with dental prostheses aims to restore stomatognathic function, including masticatory performance. Masticatory performance is one of the factors that affect stomatognathic function and health in general. The aim of this study was to compare the masticatory performance of fully dentate subjects and removable denture wearers and determine which method is most suitable, whether using color-changeable chewing gum or gummy jelly. Subjects were classified into two groups: fully dentate (n=10) and removable denture groups (n=10). Masticatory performance was measured using color-changeable chewing gum with 30, 45 and 60 strokes and gummy jelly with 10, 20 and 30 strokes. A Mann-Whitney analysis was done to compare the masticatory performance of the fully dentate and removable denture groups. There was a significant difference (p<0.05) in masticatory performance between the two groups, both with chewing gum and gummy jelly. Spearman’s correlation was used to analyze the correlation between the chewing gum and gummy jelly measurements. Statistically, a significant correlation (P<0.05) was found between the color-changeable chewing gum and gummy jelly. A removable denture does improve masticatory performance, but it is not able to fully restore masticatory performance comparable to dentate individuals. Color-changeable chewing gum and gummy jelly can differentiate masticatory performance in fully dentate and removable denture groups.

Improvement in three-dimensional facial configuration and jaw motion following surgical orthodontic treatment of a case with jaw deviation

The establishment of normal stomatognathic function and an acceptable facial appearance is considered an important treatment goal in orthodontics. The patient, who demonstrated posterior crossbites and jaw deviation, underwent treatment with a combined orthodontic-surgical approach utilizing maxillary transverse distraction osteogenesis, Le Fort I osteotomy, and bilateral SSRO. The smoothness of the masticatory jaw-closing movement and three-dimensional facial configuration were compared pre- and post-treatment. Correction of the posterior crossbites enabled the patient to perform smoother jaw-closing movements during chewing. Additionally, asymmetry in the morphology of the chin, cheek, and lips was reduced. These favorable changes in masticatory jaw movement kinematics and three-dimensional evaluation of the face justify the application of surgical-orthodontic treatment to improve jaw function and facial appearance.

Oral rehabilitation with removable dental prosthesis in a six-year-old patient with hypohidrotic ectodermal dysplasia

Ectodermal dysplasia is an abnormality of the ectoderm and its derivatives, phenotypically expressed in males and genetically inherited from mothers. Objective: To report the efficacy of the prosthetics treatment of severe ectodermal dysplasia in a 6-year-old boy with hypohidrotic ectodermal dysplasia (HED). Case report: The boy had difficulty in speaking and eating and the condition also affected his self-esteem. Prosthetic treatments included the construction of acrylic custom trays, determination of the vertical dimension of occlusion (VDO), construction of upper and lower dentures, and palatal expansion procedure. Conclusion: Significant improvements in the patient’s stomatognathic function and self-esteem were evident.