Occlusion, TMDs, and dental education

3D Technology Development and Dental Education: What Topics Are Best Suited for 3D Learning Resources?

The aim of this study is to identify topics (knowledge and skills) from the dental curricula that would benefit from having a 3D learning resource using an exploratory sequential design method. The first phase targeted stakeholders from a Scottish dental school. Seven focus groups and three interviews disclosed 97 suitable topics for 3D technology development. These results were used to construct a survey that was sent to final year dental students, newly dental graduates and academics from three Scottish universities. The survey asked participants to rank each item based on the perceived benefit that a 3D learning resource would have for dental education. Results revealed that detailed anatomy of the temporomandibular joint, dental anaesthesiology, dental clinical skills techniques, dental occlusion and mandibular functioning were top priorities. Gender differences only appeared in relation to ‘Extraction techniques: movements and force’ (p < 0.05), this topic was considered to be more beneficial by females than by males. No statistical difference was found when comparing results of graduates with undergraduates. These results serve as a starting point when developing a new 3D technology tool for dental education, considering users demands and perceived needs has the potential to benefit dental students and dental education directly.

The teaching of temporomandibular disorders and orofacial pain at undergraduate level in Brazilian dental schools

Objectives

Evaluate the way the topics for the study of pain mechanisms in general, and Orofacial Pain (OFP) and temporomandibular disorders (TMDs) more specifically, are addressed in undergraduate courses curricula, and also to verify the existence of specialist OFP/TMD teachers in Brazilian dental schools.

Methods

Between July 2010 and January 2011, course Coordinators/Directors of all dental schools duly registered at the Ministry of Education were invited to answer a questionnaire on topics related to OFP/TMD teaching in their institutions.

Results

Fifty-three dental schools representatives answered the questionnaire. The study of pain mechanisms was found to cover an average of less than 10% of the courses' total time. Pharmacology, Endodontics and Physiology were identified as the departments usually responsible for addressing pain mechanisms in dental courses. Psychosocial aspects were found to occupy a very small proportion in the syllabi, while most of the content referred to biological or somatic aspects. OFP/TMD is addressed by a specific department in only 28.4% of the participating dental schools, while in most cases (46.3%), OFP/TMD is under the responsibility of the Prosthodontics department. Only 38.5% of respondents indicated that they had a specialist OFP/TMD teacher in their Schools.

Conclusion

Among the Brazilian dental schools participating in the study, the teaching of OFP/TMD was found to be insufficient, segmented or with an extremely restricted focus. This initial assessment indicates that Curricular Guidelines for the study of OFP/TMD at undergraduate dental schools should be developed and implemented to facilitate their appropriate inclusion into the curricula and in specific pedagogical projects.

Occlusal stability

Occlusion is the foundation for clinical success in fixed, removable, and implant prosthodontic treatment. Understanding those principles is critical when restoring a patient's occlusion. Many philosophies, devices, and theories of occlusion have evolved based on anecdotal clinical observations and applied geometric perceptions. The literature has reported these classic and contemporary occlusal concepts. As evidence-based dentistry emerged, it championed scrutiny of previously held beliefs, resulting in the abandonment of many pragmatic, yet beneficial occlusal procedures. The impetus toward scientific discovery, whereby factual information might be universally applied in dental education and clinical practice, has renewed interest in occlusal studies.

Evaluation of relapse after orthodontic therapy combined with orthognathic surgery in the treatment of skeletal class III

INTRODUCTION

Multidisciplinary treatment of skeletal malocclusion by orthognathic surgery in addition to orthodontics is a routine strategy believed to offer good functional and esthetic outcomes. Postoperative relapse is, however, a problem. The present study was conducted to analyze the stability of outcomes achieved by surgical treatment of skeletal class III patients in terms of the rate and extent of relapses.

PATIENTS AND METHODS

A total of 30 patients who had undergone orthodontic treatment combined with orthognathic surgery were included. The primary inclusion criterion was a skeletal class III treated by mandibular setback (Obwegeser/Dal Pont) surgery alone or combined with maxillary advancement (Le Fort I) surgery. Analysis was based on one preoperative and two postoperative cephalograms per patient.

RESULTS

We observed relapse (defined, in accordance with Proffit, as changes >2 mm or 2°) at a rate of 24% after bimaxillary procedures, compared to a lower rate of 21% after mandibular setback procedures only. The relapse rate was 21% among patients who had undergone upper-jaw surgery versus 27% among those who had undergone lower-jaw surgery, which was statistically significant.

CONCLUSION

The majority of patients exhibited stable treatment outcomes. Maxillary advancement procedures were found to be less susceptible to relapse-resulting in more stable outcomes-and mandibular setback distances correlated positively with the degree of the relapse. No statistically significant differences were observed between the procedures conducted in both jaws versus in the lower jaw only, or in the extent of upper-jaw repositioning.

Orthodontic and surgical treatment of a patient with Apert syndrome

The aim of this case report was to present the combined orthodontic and surgical treatment of a patient with Apert syndrome in an adult stage. A 15 years old male patient with Apert syndrome was concerned about the appearance of his face and malocclusion. His profile was concave with a retruded maxilla and prominent lower lip. He had an Angle class I molar relationship with a 9.5 mm anterior open bite. The amount of crowding was 20.4 mm in the maxilla and 6 mm in the mandible. Cephalometric analysis revealed a skeletal Class III relationship due to maxillary hypoplasia with a dolichofacial growth pattern. Orthodontic treatment and orthognathic surgery were planned for the patient. After 45 months of presurgical orthodontics, the patient underwent two surgeries sequentially. The first surgery was performed to advance the maxilla and the second surgery was performed to correct the mandibular rotation and increase the overbite at the time of removing halo device. The amount of maxillary advencement was 8 mm. Mandibula was moved 1.5 mm anteriorly and rotated 1° to 1.5° (SNB and facial depth) in a counterclockwise direction. After a relatively long treatment, an esthetically pleasing and functional occlusion and correction of the skeletal problem was achieved in this adult case.

A survey on German dentists regarding the management of craniomandibular disorders

The purpose of the present investigation was to identify the most frequent therapies and, in particular, the prescription patterns for occlusal splints for the management of craniomandibular disorders (CMDs) used by German general dentists and specialists. Additionally, the knowledge and opinion of the practising dentists were examined. All active members of the statutory dental insurance providers of the German North Rhine (n = 5,500) and the Westphalia-Lippe area (n = 4,984) were surveyed with a questionnaire by mail. Results indicated that occlusal splints were the first-choice therapy followed by physiotherapy and occlusal equilibration. In the preceding year, both general dentists and specialists made 30 occlusal splints on average. With regard to high-quality evidence-based recommendations, some statistically significant discrepancies between general dentists and specialists were detected. On the basis of the present data, it seems useful to consider intensifying the topic of CMDs and orofacial pain in future undergraduate dental curricula and in postgraduate training.

Bruxism physiology and pathology: an overview for clinicians

Awake bruxism is defined as the awareness of jaw clenching. Its prevalence is reported to be 20% among the adult population. Awake bruxism is mainly associated with nervous tic and reactions to stress. The physiology and pathology of awake bruxism is unknown, although stress and anxiety are considered to be risk factors. During sleep, awareness of tooth grinding (as noted by sleep partner or family members) is reported by 8% of the population. Sleep bruxism is a behaviour that was recently classified as a 'sleep-related movement disorder'. There is limited evidence to support the role of occlusal factors in the aetiology of sleep bruxism. Recent publications suggest that sleep bruxism is secondary to sleep-related micro-arousals (defined by a rise in autonomic cardiac and respiratory activity that tends to be repeated 8-14 times per hour of sleep). The putative roles of hereditary (genetic) factors and of upper airway resistance in the genesis of rhythmic masticatory muscle activity and of sleep bruxism are under investigation. Moreover, rhythmic masticatory muscle activity in sleep bruxism peaks in the minutes before rapid eye movement sleep, which suggests that some mechanism related to sleep stage transitions exerts an influence on the motor neurons that facilitate the onset of sleep bruxism. Finally, it remains to be clarified when bruxism, as a behaviour found in an otherwise healthy population, becomes a disorder, i.e. associated with consequences (e.g. tooth damage, pain and social/marital conflict) requires intervention by a clinician.