A comparison of ICAGD (immediate complete anterior guidance development) to mock ICAGD for symptom reductions in chronic myofascial pain dysfunction patients

Structured critical analysis correction of a systematic review

OBJECTIVE

: Systematic reviews (SRs) are an increasingly important format in the scientific literature. Commentaries on improvements to the SR format have focused on methodological quality, but a greater concern is a frequent lack of critical analysis. A structured critical analysis (SCA) was described as a solution to this deficiency.

METHODS

: Recommendations and conclusions of a recent SR were analyzed with a SCA to address common problems previously reported with the SR format.

RESULTS

: Errors in the component studies and their interpretation by the SR that led to erroneous recommendations were presented. The 5-part SCA provided comprehensive analysis that corrected the SR, which had accepted the component study conclusions verbatim.

CONCLUSION

: The SCA is a logical approach to provide critical thinking in SRs to ensure appropriate conclusions. This is especially important, as many SRs report contradictory evidence. Also, the reader can use the SCA format to better understand existing literature.

A retrospective five-year survey on the treatment outcome of disclusion time reduction (DTR) therapy in treating temporomandibular dysfunction patients

OBJECTIVE

To assess the five-year long-term quality of life of patients who were treated with Disclusion Time Reduction Therapy (DTR).

METHODS

Thirty occluso-muscular disorder patients responded to two questionnaires about their symptom intensities, frequencies, and pain levels that were given to the patients before DTR therapy and five years after. Both surveys were subjected to the Wilcoxon signed-rank test to compare differences in the reported intensities, frequencies, and pain levels.

RESULTS

A statistically significant reduction was found between the pre- and five-year post-DTR treatment intensities, frequencies, and pain scores (p < 0.05).

CONCLUSION

The chronic pain intensity and frequency observed in patients with occluso-muscular disorders can be markedly reduced by Immediate Complete Anterior Guidance Development (ICAGD)/DTR therapy, while improving the patient's overall long-term quality of life. Many pre-ICAGD/DTR daily chronic and painful, occluso-muscular symptoms were no longer present years after undergoing ICAGD/DTR treatment.

Sequential digital occlusal analysis in patients with skeletal Class III malocclusion with orthognathic surgery: Surgery-first vs orthodontic-first approach

INTRODUCTION

This study compared changes in occlusal characteristics in patients with skeletal Class III malocclusion with surgery-first approach (SFA) and those with orthodontic-first approach (OFA) through digital occlusal analysis.

METHODS

In this prospective study, 90 consecutive subjects were divided into control, OFA, and SFA groups (30 per group). Force discrepancy, occlusal time, tooth contact, center of force, and force-time graph pattern were calculated for all samples using the T-Scan III system. Between-group differences were analyzed using a 1-way analysis of variance and generalized estimating equations. These parameters were calculated at the following time points: preoperatively, 1-month postoperatively (T1), 4-months postoperatively, and 1-year postoperatively (T3).

RESULTS

No significant differences were observed in the parameters between the experimental groups. The force discrepancy of the OFA and SFA groups decreased, approaching the value of controls at T3. The occlusal time significantly increased at T1 and progressively decreased at T3. The initial contact and maximum force were most frequently observed on molars, and its maximum force significantly decreased by 5.72% and 7.40% in the OFA and SFA groups at T3, respectively. The number of tooth contact was significantly reduced at T1 and gradually increased at T3. Moreover, after surgery, the force-time graph pattern was normalized, and the center of force tended to be more centric; however, the most frequent trajectory revealed premature contact during closing.

CONCLUSIONS

No significant difference was found in all parameters between the OFA and SFA groups. Occlusion deteriorated at 1 month postoperatively but gradually improved at 1 year postoperatively, approaching the controls.

A Multi-Center Disclusion Time Reduction (DTR) Randomized Controlled Occlusal Adjustment Study Using Occlusal Force and Timing Sensors Synchronized with Muscle Physiology Sensors

Objective—To perform a Randomized Controlled Trial (RCT) Disclusion Time Reduction (DTR) study at five Dental Colleges, using intraoral sensors and muscular electrodes. Methods and Materials—One hundred students were randomly assigned to a treatment group to receive the ICAGD coronoplasty, or a control group that received tooth polishing. All subjects answered symptom questionnaires: Beck Depression Inventory-II, Functional Restrictions, and Chronic Pain Symptom and Frequency. Subjects self-reported after ICAGD or placebo at 1 week, 1 month, 3 months, and 6 months. The Student’s t-Test analyzed the measured data. The Mann–Whitney U Test analyzed the subjective data (Alpha = 0.05). Results—The Disclusion Times, BDI-II scores, and Symptom Scales were similar between groups prior to treatment (p > 0.05). At 1 week, all three measures reduced in the treatment group, continuing to decline over 6 months (p < 0.05), but not for the controls (p > 0.05). Symptom Frequency, Functional Restrictions, and Pain Frequencies were higher in the treated group (p < 0.05), but declined after ICAGD compared to the control group (p < 0.05). Conclusions—ICAGD reduced Pain, Functional Restrictions, Symptom Frequency, and Emotional Depression within 1 week, which continued for 6 months. The tooth polishing did not initiate a placebo response.

Botulinum toxin type A for controlling bruxism assessed with computerized occlusal analysis: A pilot study

Objective: To assess botulinum toxin-A (BTX-A) on mandibular movements and bite force (BF%) in bruxism.Methods: Ten bruxers were divided into 2 groups based on BF% imbalance (G1: >10%, G2: <10%). BTX-A 140U was total injected into the masseter and temporalis muscles. A T-Scan® recorded BF%, occlusion time (OT), right, left, and protrusive disclusion time (DT) before administering BTX-A, as well as 15, 45, 90, and 120 days after injection.Results: The Friedman and Wilcoxon tests found significant differences in BF% in G1 subjects at 15 days (p = 0.028 s), OT at 90 (p = 0.043 s), and 120 (p = 0.027 s) days, DTR at 90 (p = 0.046 s) and 120 (p = 0.028 s) days, DTL at 15 (p = 0.043 s) and 90 (p = 0.027 s) days, and DTP 45_-90 days (p = 0.043 s).Conclusion: BTX-A induced BF% starting at 15 days post-injection and influenced lateralities later.

Systematic review versus structured critical analysis

Objective: This analysis discusses common problems with systematic reviews (SRs) and presents a novel solution, the structured critical analysis (SCA) that can be incorporated into a SR or used as an alternative literature review design.Methods: A cross-sectional survey of current SRs related to interdisciplinary restorative dentistry was obtained by evaluating 100 current SRs for their self-reported methodological quality and its effect on scientific validity.Results: The preferred reporting items for systematic reviews and meta-analyses protocol (PRISMA) was used in 99/100 SRs, but only 8/100 reported a low risk of bias. High statistical heterogeneity precluding meta-analysis was found in 44/100 SRs. Only 94 paragraphs/100 SRs provided critical analysis.Discussion: Significant problems were found with current SRs that can compromise their reliability as the premier level of evidence for clinical science research. The reader must be aware of these deficiencies to correctly interpret the SR and cannot rely on the format alone.

Modifications in Class I and Class II Div. 1 malocclusion during orthodontic treatment and their association with TMD problems

Objective: To observe changes in tooth movements of patients with Class I and Class II malocclusion during the first 6 months of orthodontic treatment and to investigate the relation between TMJ problems and these changes. Methods: The sample was comprised of 63 individuals (20 control, 25 Class I malocclusion, 18 Class II Div. 1 malocclusion). Occlusion analysis was performed through T-Scan® record and chewing pattern examination before and after the 6-month period. The existence of TMD was evaluated using joint vibration analysis (JVA). Patients with malocclusion had active fixed orthodontic treatment. Results: Disclusion time reduced in the patients group during the treatment period. No association was observed between the first 6-month period of the orthodontic treatment and TMD. Discussion: It is suggested that occlusion analyses should be done before any orthodontic treatment, and disclusion time should be minimized as much as possible.

A digital poll of dentists testing the accuracy of paper mark subjective interpretation

AIMS

The aim of this study was to test subjective interpretation accuracy via digital polling of a large group of dentists to determine whether dentists can reliably interpret occlusal forces by visually assessing articulating paper markings.

METHODS

One hundred fifty-two dentists selected the most forceful occlusal contact in five occlusal-view photographs of articulating paper marks that were compared against T-Scan® relative occlusal levels of the same tooth contacts.

RESULTS

The mean correct response was a mere 13.13% correct (86.87% incorrect). Random chance was calculated at 16.7% correct. The cuspid contacts were the least often chosen as the most forceful contact. The Mann-Whitney U test found a significant difference between choosing the anterior teeth vs. posterior teeth. onclusions: Subjective interpretation is an inaccurate method for determining high force occlusal contacts. The reported low correct percentage fell below random chance, suggesting that dentists are unable to detect high occlusal force from looking at articulating paper marks.

Clinical protocol for occlusal adjustment: Rationale and application

BACKGROUND

Occlusal adjustment can optimize the result of orthodontics, orthognathic surgery, and comprehensive restoration, and resolve adverse forces to the dentition that affect the entire masticatory system. Mounted diagnostic casts and computerized occlusal analysis offer complementary advantages for evaluating occlusal problems. Predictable occlusal adjustment is facilitated by precise, measured documentation of occlusal force by computerized occlusal analysis.

CLINICAL PRESENTATION

A conservative, structural correction of a pronounced, chronic occlusal problem by additive and subtractive occlusal adjustment was performed after a previous failed occlusal adjustment. The patient's chief concerns were significant anterior teeth fremitus in maximum intercuspation and "pain in the teeth and a poor bite" after 30+ adjustments over 2.5 years.

CLINICAL RELEVANCE

Confirmation of specific criteria for a therapeutic occlusion resolved the anterior teeth fremitus and uneven bite. Traumatic occlusal contact on posterior teeth may elicit protective mandibular repositioning affecting anterior teeth relationships and should be considered during comprehensive diagnosis.

Disclusion time reduction therapy in treating occluso-muscular pains

Disclusion time reduction (DTR) is an objective treatment protocol using T-Scan III (digital analysis of occlusion) and electromyography for treating occlusally activated orofacial pains. Chronic occluso-muscle disorder is a myogenous subset of temporomandibular disorder symptoms. These muscular symptoms are induced within hyperactive masticatory muscles due to prolonged disclusion time, occlusal interferences, and occlusal surface friction that occur during mandibular excursive movements. This case report describes a patient treated by DTR therapy, whereby measured pretreatment prolonged disclusion time was reduced to short disclusion time using the immediate complete anterior guidance development enameloplasty, guided by T-Scan occlusal contact time and force analysis synchronized with electromyographic recordings of four masticatory muscles.

Treatment of frictional dental hypersensitivity (FDH) with computer-guided occlusal adjustments

OBJECTIVE

To verify the efficacy of treating dentin/dental hypersensitivity (DH) to Cold Ice Water Swish testing before and after subjects undergo the Immediate Complete Anterior Guidance Development (ICAGD) computer-guided occlusal adjustment.

METHODS

One hundred chronically dysfunctional patients with known cold sensitivity swished ice water intraorally to elicit a DH response scored on a Visual Analog Scale (VAS). The subjects then underwent the ICAGD coronoplasty, which was followed by a second ice water swish scored with a second VAS. The pre to post ICAGD Disclusion Time values and VAS scores were statistically evaluated by the Wilcoxon Signed Rank for Paired Difference test. The subjects were divided into subgroups with DH sensitivities <4 and ≥4, and analyzed. Limitations were as follows: abfractions were not quantified, dysfunctional symptom resolution was not determined, each subject was their own control, one clinician administered all ice water tests, and protrusive excursions were not included.

RESULTS

Disclusion Time reductions from ICAGD were significant (2.11-0.55 s. p = 0.0000). The DH score changes showed highly significant decreases from pre to post ICAGD (p < 0.0001).

CONCLUSIONS

A partial etiology for cold tooth sensitivity exists, resultant from prolonged occlusal surface excursive movement frictional contacts. This cold sensitivity can be lessened with measured, computer-guided occlusal adjustments.

The effect of disocclusion time-reduction therapy to treat chronic myofascial pain: A single group interventional study with 3 year follow-up of 100 cases

PURPOSE

The purpose of this study is to evaluate the longevity of reduced disclusion time in treating and removing myofascial pain dysfunction symptoms following the T-Scan-based, immediate complete anterior guidance development (ICAGD) coronoplasty. This measured occlusal adjustment has been shown to reduce the muscle hyperactivity of myofascial pain.

METHODS

Myofascial pain symptomatic patients were recruited as per the diagnostic criteria for temporomandibular disorders (TMDs), including the clinical protocol and assessment instruments outlined by the international RDC/TMD consortium network (version: January 20, 2014) to assess the efficacy of reduced disclusion time in left and right lateral excursions to resolve the myofascial pain symptoms. As per the inclusion and exclusion criteria, 100 cases were treated with ICAGD in three visits, each 1 week apart. Recall disclusion time measurements were recorded every 3 months over 3 years. The RDC/TMD questionnaire was used for symptom assessment at every recall visit. ICAGD brought pretreatment prolonged disclusion time down to <0.4 s, as quantified from T-Scan force and time data records, while the subjects were assessed for symptom relief. The Wilcoxon signed-rank test was used for statistical analysis (P < 0.05).

RESULTS

Changes in the intensity of many symptoms from reducing the disclusion time to <0.4 s were statistically significant from treatment day 1, and onward through the 3-year period of observation (P < 0.05).

CONCLUSION

The results indicate that ICAGD reduces the musculoskeletal symptoms of myofascial pain, such that this methodology increases clinical therapeutic success.

Average chewing pattern improvements following Disclusion Time reduction

OBJECTIVES

Studies involving electrognathographic (EGN) recordings of chewing improvements obtained following occlusal adjustment therapy are rare, as most studies lack 'chewing' within the research. The objectives of this study were to determine if reducing long Disclusion Time to short Disclusion Time with the immediate complete anterior guidance development (ICAGD) coronoplasty in symptomatic subjects altered their average chewing pattern (ACP) and their muscle function.

METHODS

Twenty-nine muscularly symptomatic subjects underwent simultaneous EMG and EGN recordings of right and left gum chewing, before and after the ICAGD coronoplasty. Statistical differences in the mean Disclusion Time, the mean muscle contraction cycle, and the mean ACP resultant from ICAGD underwent the Student's paired t-test (α = 0.05).

RESULTS

Disclusion Time reductions from ICAGD were significant (2.11-0.45 s. p = 0.0000). Post-ICAGD muscle changes were significant in the mean area (p = 0.000001), the peak amplitude (p = 0.00005), the time to peak contraction (p < 0.000004), the time to 50% peak contraction (p < 0.00001), and in the decreased number of silent periods per side (right p < 0.0000002; left p < 0.0000006). Post-ICAGD ACP changes were also significant; the terminal chewing position became closer to centric occlusion (p < 0.002), the maximum and average chewing velocities increased (p < 0.002; p < 0.00005), the opening and closing times, the cycle time, and the occlusal contact time all decreased (p < 0.004-0.0001).

CONCLUSION

The average chewing pattern (ACP) shape, speed, consistency, muscular coordination, and vertical opening improvements can be significantly improved in muscularly dysfunctional TMD patients within one week's time of undergoing the ICAGD enameloplasty. Computer-measured and guided occlusal adjustments quickly and physiologically improved chewing, without requiring the patients to wear pre- or post-treatment appliances.

Electromyographic and patient-reported outcomes of a computer-guided occlusal adjustment performed on patients suffering from chronic myofascial pain

Objectives: Muscular hyperactivity is a potential source of symptoms in patients with temporal-mandibular disorders. An adequate occlusal adjustment may relieve such symptoms. This study aims to measure the effect of shortening the protrusive disclusion time (DT) and balancing the center of occlusal forces (COF) on the EMG recordings and assess the pain reported by chronic patients one month after the computer-guided occlusal adjustment. Study Design: The sample studied comprised 34 patients suffering from chronic facial pain in which the EMG activity of both masseters was recorded by electromyography. By selective grinding we alleviated all the occlusal interferences during the mandibular protrusion from the habitual closure position in order to establish an immediate posterior disclusion and an equilibration of the COF. Results: At follow-up 76.5% of the patients reported no facial pain. Moreover, the EMG activity and protrusive DT were significantly reduced, and occlusal and muscular function were significantly more symmetric than at baseline. Conclusions: According to this EMG study, this computer-guided occlusal adjustment is able to reduce the activity of the masseters and the self-reported muscular pain of patients one-month after treatment.

Key words:Myofascial pain, occlusal adjustment, electromyography, T-Scan III, occlusal interferences.

Occlusal adjustment for treating and preventing temporomandibular joint disorders

To assess the effectiveness of occlusal adjustment (OA) for treating temporomandibular disorders (TMD) in adults and preventing TMD. The Cochrane Controlled Trials Register, MEDLINE and EMBASE were comprehensively searched using the Cochrane methods. Reports and review articles were retrieved. Unpublished reports or abstracts were considered from the SIGLE database. All randomized or quasi-randomized controlled trials comparing OA with placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement. Data collection and analysis followed the Cochrane Oral Health Group's statistical guidelines. Results showed no difference between OA and control group in symptom-based outcomes for treatment or incidence of symptoms for prevention. There is no evidence that OA treats or prevents TMD. OA cannot be recommended for the management or prevention of TMD. Future trials should use standardized diagnostic criteria and outcome measures when evaluating TMD.