Evaluation of cervical posture following rapid maxillary expansion: a review of literature

Cranio-cervical posture and rapid palatal expansion therapy

Objective:

Connections between craniocervical posture (CCP) and changes in teeth position have already been demonstrated; however, the defined pathway of relationship is still not clear. The aim of this study was to evaluate CCP modifications after rapid maxillary expansion therapy using rapid palatal expansion therapy (REP)/McNamara appliances.

Materials and Methods:

A consecutive series of 35 subjects, aged between 6 and 14 years, with no prior history of orthodontic treatment, and requiring skeletal expansion of the upper arch, were selected and analyzed. All patients were treated with REP or Mcnamara appliance: the active phase of 15 days and retaining phase of 6 months. Cephalometric analysis was carried out before (T0) and after (T1) orthodontic therapy evaluating changes in the craniofacial area and those related to CCP. The obtained data were statistically analyzed for the pre-post changes.

Results:

No statistically significant difference emerged indicating a modification in the CCP measured at T0 and T1 (P > 0.05). Patients treated with the McNamara appliance, compared to those treated with REP, showed a higher value of the angle OPT ^ Ver (P = 0.021), and a lower measure of the angles CVT^EVT (P = 0.035) and EVT^Ver (P = 0.023). Furthermore, patients treated with REP showed a higher hyoid angle value than those treated with McNamara (P = 0.047).

Conclusion:

This study did not reveal any relationship between the application of palatal expansion therapy and changes in CCP.

Efficacy of elastodontic devices in overjet and overbite reduction assessed by computer-aid evaluation

BACKGROUND

This study aimed to verify the efficacy of two elastodontic devices in overjet (OJ) and overbite (OB) reduction during treatment with the Equilibrator Series II (Eptamed) and Occlus-o-Guide (Sweden & Martina) devices.

METHOD

Sixty patients aged 7-15 years were enrolled in the study, and were divided into test and control groups. The test group included 30 patients (14 males, 16 females; mean age, 10.66 ± 2.12 years) treated with the EQ (Equilibrator) Series II. The control group included 30 patients (15 males, 15 females; mean age, 10.76 ± 2.52 years) treated with the Occlus-o-Guide. The two groups exhibited the same orthodontic features. The orthodontic criteria were: skeletal and dental class II malocclusion (divisions 1 and 2); and the presence of OJ and OB. Evaluation of OJ and OB was performed at two timepoints: T0 (before starting therapy) and T1 (after 1 year).

RESULTS

At T0, OJ and OB were similar for the two groups; however, at T1, both OJ and OB were significantly lower with the Eptamed device compared to the Occlus-o-Guide device (p = 0.0019).

CONCLUSIONS

Elastodontic devices improve orthodontic outcomes by aiding orthodontic patient management, diagnosis, and treatment planning, reducing the risk relapse acting on the whole organism and the rehabilitation of the tongue.

Standard Correction of Vision Worsens EMG Activity of Pericranial Muscles in Chronic TMD Subjects

Recent studies showed an evident correlation between the stomatognathic system and the visual system. These results suggest that subjects who are affected by both temporomandibular (TMD) disorders and refractive disorders present with altered control of pericranial musculature tone and higher open-eye electromyographic (EMG) values. The objective of this work was to evaluate the effects of standard vision correction on EMG in subjects suffering from TMD compared with application of the same vision treatments to non-TMD subjects. 40 subjects were enrolled in this study. The test group included 20 myopic subjects and also included patients with TMD. The control group included 20 healthy myopic subjects. All of the participants underwent a complete ocular examination and a sEMG analysis. The results showed that TMD subjects with vision disorders that are corrected with standard glasses present EMG values that are significantly higher than those presented by non-TMD subjects with vision disorders and standard glasses. Infact, in TMD subjects, eye correction did not have a positive effect on the stomatognathic or pericranial musculature.

Management of OSAS: The ELIBA® Device Can Help the Patient?

Obstructive sleep apnea syndrome (OSAS) is one of the most challenging diseases to treat in medicine. Here, the authors describe a case of OSAS treated with a lingual elevator of Balercia (ELIBA®). The patient, a forty-five-year-old Caucasian male, had a chief complaint of numerous episodes of nocturnal apnea. After several visits with specialists, a polysomnographic examination was performed, in which the patient's apnea hypopnea index (AHI) was 30.4, and a lingual elevator was prescribed. The lingual elevator helped to keep the patient's tongue in the correct position and prevented the tongue from reverting back to the soft tissue spaces in the mouth. After six months of treatment with the lingual elevator and dietary adjustments, the patient's AHI decreased to 11.6. This simple yet customizable approach is a comfortable and easy option for patients to reduce night apnea episodes.

Alterations in Surface Electromyography Are Associated with Subjective Masticatory Muscle Pain

Background

Tenderness of masseters and temporalis can be considered a relevant tool for diagnosis of myo-type craniofacial pain disorders, but a limit of pain score systems is that they are based on subjective pain perception. Surface electromyography (sEMG) is a noninvasive and reliable tool for recording muscle activity. Therefore, we investigated whether a correlation exists between tenderness on masseters and temporalis, assessed by subjective pain scale, and muscles activity, evaluated by sEMG, in patients with painful temporomandibular disorder (TMD) and concurrent tension-type headache (TTH).

Methods

A cross-sectional study on fifty adult volunteer patients with TMD and TTH, who underwent tenderness protocol according to Diagnostic Criteria for TMD (DC/TMD) guidelines, was conducted followed by sEMG recording of temporalis and masseters. Pearson's correlation was performed to investigate the correlation between muscular activity and subjective pain scores.

Results

An overall moderate correlation between muscle tenderness and sEMG values (y = 1 + 1.2 · x; r² = 0.62; p < 0.0001), particularly in the temporalis, was observed. Segregation of data occurred according to tenderness and sEMG values. At the highest pain score, the mean sEMG absolute value was higher at the temporalis than the masseters.

Conclusions

Our study provides evidence that subjective pain perception can be objectively quantified at a magnitude proportional to pain severity. At greater tenderness scores, higher sEMG activity at the level of temporalis could help discriminate clinically prevalent TTH versus prevalent TMD. sEMG confirms to be an accurate tool to reliably objectify the subjective perception of pain. When combined with clinical evaluation and patients' symptoms, sEMG increases diagnostic sensitivity in the field of myo-type craniofacial pain disorders. This trial is registered with NCT02789085.

A Device Improves Signs and Symptoms of TMD

Background

Temporomandibular joint dysfunction (TMD) therapy remains an open challenge for modern dentistry. Herein, we propose a new neuromuscular lingual device able to reduce signs and symptoms of TMD in female patients with chronic orofacial pain.

Methods

50 females with myofascial TMD according to RDC/TMD were randomly assigned to study (n = 25) and control groups (n = 25). At T0, both groups received sEMG/KNG and pain evaluation by the VAS scale. The study group received the ELIBA device (lingual elevator by Balercia) constructed under ULF-TENS (ultra-low-frequency transcoutaneous electrical nervous stimulation). Subjects were instructed to use ELIBA at least for 16 h/day. After 6 months (T1), both groups underwent to sEMG/KNG and VAS revaluation.

Results

T1 study group compared to controls showed a significant reduction in total (p < 0.0001) and mean (p < 0.0001) sEMG values, as well as a significant increase in both maximum vertical mouth opening (p=0.003) and maximum velocity in mouth opening (p=0.003) and closing (p < 0.0001). Interestingly, a significant reduction in pain measured by VAS (p < 0.0001) was reported.

Conclusions

After 6 months, the ELIBA device is able to significantly reduce TMD-associated myogenous pain and to promote the enhancement of sEMG/KNG values.

Practical Implications

ELIBA can be considered as a new device, potentially useful for head-neck pain relief in patients suffering from chronic TMD. In addition, its use promotes a muscles relaxation inducing freeway space increase. This characteristic makes it particularly useful for rehabilitation of patients with not enough space for construction of conventional orthotics or neuromuscular bites.

Relationship between craniocervical posture and skeletal class: A statistical multivariate approach for studying Class II and Class III malocclusions

Objective: To investigate the relationships between craniocervical posture and skeletal Class in cephalometric radiographs of adult subjects.Methods: Sixty-five cephalometric radiographs were classified after Delaire, as skeletal Class II and III. The craniocervical posture was evaluated using the variables proposed by Solow (1976) and Rocabado (1983). In order to test the null hypothesis (absence of an association between craniocervical posture and skeletal Class), uni- and multivariate statistical protocols were carried out.Results: Skeletal Class II presented a more posterior rotation of the ramus in relation to the cranium and a more extended head than skeletal Class III. Additionally, significant correlations were observed in Class II individuals between the rotation of mandibular ramus and cervical lordosis, as well as between rotation of mandibular ramus and craniocervical posture.Discussion: The findings of this research may help to understand the contradictory results described in clinical literature about the effect of skeletal class on craniocervical posture.

Orthodontic management by functional activator treatment: a case report

Background

Managing orthodontic treatment is often very difficult for the orthodontist. Many devices are used during the orthopedic phase of orthodontic treatment, always with different functions. We describe a case of orthodontic management treated with the Equilibrator O.S.A. device (equilibrator designed by Ovidi, Santi, and Aprile for Eptamed SRL; Cesena, Italy; www.eptamed.com).

Case presentation

A healthy 10-year-old white boy presented with a skeletal class II, division 1 malocclusion, molar class II, exhibiting an overjet of 7 mm prior to treatment. For treatment, we only used the Equilibrator O.S.A. device.

Conclusions

We successfully treated an orthopedic/orthodontic case with a particular device that we describe here.

Accuracy of Different Modalities to Record Natural Head Position in 3 Dimensions: A Systematic Review

PURPOSE

Three-dimensional (3D) images are taken with positioning devices to ensure a patient's stability, which, however, place the patient's head into a random orientation. Reorientation of images to the natural head position (NHP) is necessary for appropriate assessment of dentofacial deformities before any surgical planning. The aim of this study was to review the literature systematically to identify and evaluate the various modalities available to record the NHP in 3 dimensions and to compare their accuracy.

MATERIALS AND METHODS

A systematic literature search of the PubMed, Cochrane Library and Embase databases, with no limitations on publication time or language, was performed in July 2015. The search and evaluations of articles were performed in 4 rounds. The methodologies, accuracies, advantages, and limitations of various modalities to record NHP were examined.

RESULTS

Eight articles were included in the final review. Six modalities to record NHP were identified, namely 1) stereophotogrammetry, 2) facial markings along laser lines, 3) clinical photographs and the pose from orthography and scaling with iterations (POSIT) algorithm, 4) digital orientation sensing, 5) handheld 3D camera measuring system, and 6) laser scanning. Digital orientation sensing had good accuracy, with mean angular differences from the reference within 1° (0.07 ± 0.49° and 0.12 ± 0.54°, respectively). Laser scanning was shown to be comparable to digital orientation sensing. The method involving clinical photographs and the POSIT algorithm was reported to have good accuracy, with mean angular differences for pitch, roll, and yaw within 1° (-0.17 ± 0.50°). Stereophotogrammetry was reported to have the highest reliability, with mean angular deviations in pitch, roll, and yaw for active and passive stereophotogrammetric devices within 0.1° (0.004771 ± 0.045645° and 0.007572 ± 0.079088°, respectively).

CONCLUSIONS

This systematic review showed that recording the NHP in 3 dimensions with a digital orientation sensor has good accuracy. Laser scanning was found to have comparable accuracy to digital orientation sensing, but routine clinical use was limited by its high cost and low portability. Stereophotogrammetry and the method using a single clinical photograph and the POSIT algorithm were potential alternatives. Nevertheless, clinical trials are needed to verify their applications in patients. Preferably, digital orientation sensor should be used as a reference for comparison with new proposed methods of recording the NHP in future research.

Dental Occlusion and Ophthalmology: A Literature Review

Stomatognathic system is strictly correlated to other anatomical regions; many studies investigated relationship between temporomandibular joint and posture, several articles describe cranio-facial pain from dental causes, such as trigger points. Until now less interest has been given to connections between dental occlusion and ophthalmology, even if they are important and involving. Clinical experience in dental practice claims that mandibular latero-deviation is connected both to eye dominance and to defects of ocular convergence. The trigeminal nerve is the largest and most complex of the twelve cranial nerves. The trigeminal system represents the connection between somitic structures and those derived from the branchial arches, collecting the proprioception from both somitic structures and oculomotor muscles. The intermedius nucleus of the medulla is a small perihypoglossal brainstem nucleus, which acts to integrate information from the head and neck and relays it on to the nucleus of the solitary tract where autonomic responses are generated. This intriguing neurophysiological web led our research group to investigate anatomical and functional associations between dental occlusion and vision. In conclusion, nervous system and functional pathways strictly connect vision and dental occlusion, and in the future both dentists and oculists should be more and more aware of this correlation for a better diagnosis and therapy.

Oropharyngeal airway changes after rapid maxillary expansion: the state of the art

The aim of this article is to elucidate the state of the art about how rapid maxillary expansion (RME) produces changes in the oropharyngeal airways in terms of CBCT (Cone Beam Computed Tomography) data during the growth period, according to the available literature. Electronic search was done from January 2009 to April 2014 on PubMed and Scopus databases; in addition manual search was conducted as well. According to keywords, seven papers were eligible for our purpose, but definitely five papers were selected in agreement with the inclusion/exclusion criteria. The current literature suggests that the potential relationship between RME and oropharyngeal airway changes is still unclear. In fact, although the pharyngeal airway changes after the rapid palatal expansion are evident clinically, current orthodontic literature does not provide conclusive evidence about the nature of this relationship.