Download Medicina i tehnika 12.- 15. 5. 2010. FUNCTIONAL DISORDERS OF

Medicina i tehnika
12.- 15. 5. 2010.
FUNCTIONAL DISORDERS OF THE STOMATOGNATHIC SYSTEM
14.05.2010. - 9.00-16.00 hall Brijuni
Organizaton:
School of Dental Medicine University of Zagreb i
Croatian Academy of Medical Sciences (AMZH)
Organized by: prof. dr. sc. Melita Valentić-Peruzović
Program:
8:00 - 9:15
9.15 - 9.45
9.45 - 11.45
11.45 - 12.15
12. 15 - 12.45
12.45 - 13.15
13.15 -13.45
13.45 -14.15
14.15.- 14.45
Oppening
FUNCTIONAL DISORDERS OF THE STOMATOGNATHIC SYSTEM
prof. dr. sc. Melita Valentić-Peruzović
OCCLUSO-POSTURAL SEMEIOTICS - prof. dr Tullio Toti, (Milano)
THE ROLE OF THE POSTURE IN THE FUNCTIONAL DISORDERS OF
BIOMECHANICAL SYSTEMS - dr.sc.Stanislav Peharec
NOVEL DENTAL RADIOLOGICAL TEHNIQUES -prof. dr. sc. Miljenko Marotti
DYAGNOSTICS OF FUNCTIONAL DISORDERS AND TREATMENT
MODALITIES - doc. dr. sc. Iva Alajbeg
PSYCHOLOGICAL AND PSYCHIATRIC FACTORS OF TEMPOROMANDIBULAR
DISORDER - prof. dr. sc. Danijel Buljan
THE INFLUENCE OF ARITCULATORY AND RESONANT DISORDERS TO
PHONATORY MECHANISMS - prof.dr.sc. Santa Večerina-Violić
THE IMPORTANCE OF PREVENTION FROM FUNCTIONAL DISORDERS OF
STOMATOGNATHIC SYSTEM IN YOUNG’S DURING THEIR SPORT’S
ACTIVITIES - prof. dr. sc. Vjekoslav Jerolimov,
Demonstration:
14.45 – 15.30 EMG supported diagnostics – demonstration - dr.sc. Davor Illeš
14.45 – 15.30 Accelerometry - demonstration and application possibilities - mr.sc. Ivica
Pelivan
Croatian dental chamber evaluates this symposia with 8 points.
FUNCTIONAL DISORDERS OF THE STOMATOGNATHIC SYSTEM – AN INTRODUCTION
prof.dr.sc. Melita Valentić-Peruzović
School of Dental Medicine, University of Zagreb
Functional disorders of the stomatognathic system are complex and it is well known, that
they can be under multiple influences from different factors in subject’s life. In some cases
they are recognisable and clearly determined, but also they can be accompanied by less
known and less defined signs and symptoms. Because of those factors, it is very important
to carefuly and thoroully analyse all objective and subjective elements. It is known that
temporomandibular disorder (TMD), after the dental pain (pulpal and periodontal pain) is
the most frequent cause for patients to visit the dental office. Therefore it is a frequent and
very serious problem for the clinitian, and it requests a systematic and serious approach.
Pain can be the effect of the overstimulation of neuromuscular system. Such behaviour
could be the result of different couses- such as malocclusion, bruxism (stressed clenching of
teeth), muscular spasm, intracapsular inflamation (provoked by micro or macro-trauma).
Stress and systemic factors coud have an important role in the chronic flow of disorders.
In the dental medicine, TMD is mostly evaluated according to some generall parameters,
such as the range of jaw movements, joint sounds, teeth sensitivity, TMJ palpation and
muscle pain. About 60% of patients with acute disfunction complain on painfull sensitivity
around the TMJ skin projection. The usuall approach is to implement, as the first stage, an
clinical functionall analisys, and thereafter some kind of instrumental analysis, mostly
computerised methods such as electromyography, electrosonography, electrokinetic and
axiographic recordings, to achieve more objective and precise diagnosis, and to plann as
well as to control the course of therapy.
Key words: functional disorder, TMD, pain, signs and symptoms, acute and chronic disorder
OCCLUSO-POSTURAL SEMEIOTICS
prof.dr. Tullio Totti,
University Vita Salute San Raffaele di Milano, Italy
The lesson will give a short historical escursus about the philosophy of the multidisciplinary
approach to the dysfunctional patient.
Particular attention will be given to the definition of “dysfunctional patient” in order to
identify all the signs, that sometimes are not evident but that can bring us to interpret a
clinical case.
The medical procedure, used at the O.U. of Dentistry at Scientific Universitary Institute San
Raffaele in Milan (Italia) would be explained, as well as how to discriminate cases of dental
clinic pertinence from others which have to be referred to other specialists.
This procedure allowes to obtaine the rate of the solved dysfunctional cases to the 82%, and
that’s because the cases analyzed are only of dental clinic pertinence.
More over the results of two different researches will be explained:
The first deals with the postural adaptations due to an experimental induction of a
precontact in voluntary patients in the occlusal class I and without occlusal or articular
problems.
The second due to postural adaptations after extraction of the elements 1.8, 2.8, 3.8, 4.8.
At the end, the three clinical cases will be presented supplied with photographical
demonstration of the application of the clinical prosthetic procedure of the school of
Occluso Postural Semeiotics.
( Semiotics (from the greek word σημεῖον semeion, which means "sign" and tekhne, "art") is
the discipline that studies signs )
Key words: disfunction, postural adaptation, interferences, semeiotics
THE ROLE OF THE POSTURE IN THE FUNCTIONAL DISORDERS OF BIOMECHANICAL
SYSTEMS
dr.sc. Peharec Stanislav,
Polyclinic for Physical Medicine and Rehabilitation, Pula
Laboratory for Biomechanical Research
Posture or body position is the term which denotes interrelationship between diferent parts
of the body in different positions and their space maintainance. So we can separate the
posture during the upright position of the body, during the sitting position or lying down.
A proper postural organisation is presented through the balanced and harmonious
relationship of the certain body parts, which enables harmonious movements and protects a
body from possible deformations or damages.
It is an oppinion that every working performance has its own optimal posture. Significant
departure from the optimal postural organisation can lead to the esthetic differences, can
change muscle efficacy, evoke different musculo-skeletal and neurological disorders.
The improper postural organisation can be connected with pain in the cervical, thoracal or
lumbal part of the spine.
A head posture certainly is an object of scientific interest and the results of the
interrelations of the posture, malocclusion and pain in the head and neck are still
contradictory. Some studies have found positive correlation between maloclusion and
improper postural organisation, pain in the soulder muscles, neck and also headache.
Also, it is known the connection between the TMD and head and neck position. Some
studies had noticed biomechanical connection between the head and neck position and
dentofacial structures. The posture of head and neck is considered normal when a vertical
line drawn from occiput to thoracal kyphosis is 6 cm frpm the neck.
The application of the postural position in diagnostic purposes nowadays is implemented
into a clinical protocol. For that reason it was necessary to develop methods for the
measurements of the postural organisation. It is of great importance that differences in the
posture could be measurable in the course of the treatment.
The evaluation of the posture is important for the definition of the treatment plan, and it
should be provided at the first clinical appointment.
Key words: posture of the head and neck, postural organisation, clinical protocol,
diagnostics.
NOVEL DENTAL RADIOLOGICAL TEHNIQUES
prof.dr.sc. Miljenko Marotti, prof.dr.sc. Ivan Krolo, dr.med Dijana Podoreški
Deparment of Radiology, University Hospital Sestre milosrdnice, Zagreb, Croatia
Complex anatomical configuration of the temporomandibular joint, was the reason for
developing standardized radiographic techniques which would provide accurate anatomical
images.
Tomography provides excellent bony details but no information of the soft tissue
component of the joint. This technique is useful in demonstrating suspected hypoplasia,
hypertrophy or malformation of the condyles, in the case of maxillofacial trauma with
fracture description, infections and tumors.
Artrography is performed to determine the status of the condyle-disk-glenoid fossa and
eminence relationship with regard to the closed and open mouth position.
Computerized tomography (CT) is superior to conventional radiography and conventional
tomography for evaluating internal derangements of temporomandibular joint, trauma,
degenerative processes and tumors. CT demonstrated good evaluation of soft tissue and
excellent evaluation of bony structures.
Magnetic resonance (MR) has shown exquisite soft tissue contrast and provides a view of
the structures of temporomandibular joint which cannot be differentiated by conventional
radiography, conventional tomography and computerized tomography. MR of
temporomandibular joint can distinguish internal anatomical features of the joint to a
degree that no other imaging procedure can match. An image of the articular disk without
contrast media as well an image of the posterior band has made the magnetic resonance the
golden standard of temporomandibular joint imaging
Key words:.dental radiological techniques, acuracy, evaluation, golden standard
DYAGNOSTICS OF FUNCTIONAL DISORDERS AND TREATMENT MODALITIES
doc.dr.sc. Iva Alajbeg
School of dental Medicine University of Zagreb
The effectiveness and success of diagnosis and treatment of TMD lie in the ability of the
clinician to establish the proper diagnosis. The basis represents clinical functional analysis.
It usually begins with the detailed history of illness followed by clinical examination of
masticatory muscles, examination of temporomandibular joints and assessment of occlusal
complex. Pain is certainly the most common complaint. Sounds within the joint, although
very common in the general population, have no clinical significance in the absence of pain.
The next important symptom is limited function of the lower jaw, which implies a limited
range of movements in all directions. Procedures that are recommended for the treatment
of temporomandibular disorders vary greatly and have a wide range of modalities, and can
be generally categorized into two groups: definitive treatment and supportive therapy.
While the definitive treatment refers to methods directed at controlling or eliminating the
etiologic factors of the disorder, while supportive therapy refers to treatment methods
directed toward alleviating the symptoms. The most common dental treatment is the use of
stabilization occlusal splint.
Key words: clinical functional analisis, signs and symptoms, diagnostics, supportive therapy,
definitive treatment
PSYCHOLOGICAL AND PSYCHIATRIC FACTORS OF TEMPOROMANDIBULAR DISORDER
Danijel Buljan
Department of Psychiatry, University Hospital Sestre milosrdnice, Zagreb, Croatia
Temporomandibular disorder (TMD) is an umbrella term covering a series of pathologic
conditions which can have similar signs and symptoms and which lead to an imbalance in
the normal functioning of stomatognatic system. Temporomandibular disorders are defined
as a group of orofacial disorders with pain in the preauricular area, jaw joints (TMJ) or
masticating muscles with limitations in range and deviations of lower jaw’s movement as
well as TMJ sounds during mastication. When the pathophysiologic factor is known, the pain
is conventionally classified as “specific” and when it is unknown it is called “nonspecific”,
psychogenic, idiopathic, conversive or euphemistic atypical pain. Nonspecific pain of the
TMD is very often a symptom of a psychiatric disorder, for example depression with somatic
symptoms, hypochondria, psychosis or is classified in the group of somatoform psychiatric
disorders according to contemporary classification systems, e.g. the American Psychiatric
Association’s DSM-IV (7) and the International Classification of Diseases (ICD-10).
TMD affects 12% of overall population. Psychological-psychiatric problems prevail among
patients with TMD, anxious-depressive disorder is found in 50%, while depression in 32.1%
of patients. Patients with psychiatric problems are 4.5 times more prone to TMD than
individuals without psychiatric problems and vice versa.
TMD is connected with numerous etiologic factors, which renders early and precise
diagnosis as well as efficient therapy more difficult. Five main factors are usually listed as
connected to TMD: trauma, occlusion, habits (parafunctional activities, such as chewing a
piece of gum, chewing on one side, teeth clenching, bruxism), deep pain stimulus,
psychological problems connected with emotional stress, and psychiatric disorders.
Psychological and psychiatric factors of TMD are the focus of this paper.
Treating nonspecific, psychogenic pain disorders is not possible without a holistic,
integrative, interdisciplinary team approach of psychiatrists, psychologists, physiologists,
neurologists and sometimes even neurosurgeons. Cognitive-behavioral psychotherapy is
prevalent as well as techniques of alleviating anxiety and stress (autogenic training),
physiologic therapy, EMG biofeedback methods and psychopharmacotherapy.
Key words: TMD, pain disorder, “nonspecific pain”, psychotherapy, psychopharmacotherapy.
THE INFLUENCE OF ARITCULATORY AND RESONANT DISORDERS TO PHONATORY
MECHANISMS
Prof.dr.sc. Santa Večerina Volić
Medical Faculty, University of Zagreb
Voice is the result of all morphological, dynamic, acoustiuc and vibratory processes in the
whole vocal tract. It means that the final product- voice is the result of not only laryngeal
and vocal folds acitivity, but also of the activitiy of articulatory and resonant cavities. In
pathological vocal folds changes, we are faced with compensatory hyprekinesis in which all
muscles of vocal tract are involved including those for articulatory and resonant
mechanisms. And vice versa in articulatory and resonant disordeser voice disorders and
vocal patghology could also develop. Thus, vocal tract should be considered, analyzed and
investigated as the unique functional entity.
Key words: voice, phonatory mechanisms, aritculatory and resonant disorders
THE IMPORTANCE OF PREVENTION FROM FUNCTIONAL DISORDERS
STOMATOGNATHIC SYSTEM IN YOUNG’S DURING THEIR SPORT’S ACTIVITIES
OF
prof.dr.sc. Vjekoslav Jerolimov
School of dental Medicine University of Zagreb
Orofacial injuries are common in sporting activities, depending on type of sport and many
other factors. Temporomandibular injuries and disorders have been found in 2 – 6 % of all
orofacial injuries cases, and they are the result of macrotraumas and microtraumas of the
mandible, the temporomandibular joint and adjacent anatomic structures. The results of
such traumas are of different symptomatology and can lead to a temporary or permanent
cessation of sporting activity.
Most injuries in sports, including orofacial and temporomandibular disorders, are
predictable and therefore preventable. Measures for preventing orofacial injuries and
temporomandibular disorders in sporting activities include various types of protection
appliances: extraoral, interdental (intraoral) and combined mouth and teeth protectors.
Interdental sports guards (mouthguards) can be stock or ready-made, mouth-formed or
custom-made mouthguards. These mouthguards, mutually different in quality, play a very
important role in prevention of orofacial and temporomandibular tissue injuries. Use of
mouthguards significantly reduces the number of orofacial tissue injuries, and also reduces
the severity of sustained injuries. Sports injuries, including those to orofacial and
temporomandibular area, regardless of whether they are incurred in recreational or
competitive sport, require multidisciplinary approach, both in diagnostics and treatment
and in implementation of prevention measures. Sports physicians, coaches, sports officials,
parents and athletes themselves, should also be permanently educated on the exceptional
importance of prevention measures, thus making the role of dentist in sport unavoidable.
Key words: sport’s injury, orofacial injury, micro-and macrotrauma, mouthguards
DEMONSTRATIONS OF THE DIAGNOSTIC METHODS
A. EMG supported diagnostics – demonstration
dr.sc.Davor Illeš
School of dental Medicine University of Zagreb
Electromyography (surface electromyography) can be used for action potential recording
and analysis in a certain masticatory system. Analysis of unction is usually done for
maseteric, temporal and mouth opening muscles (digastric). Recorded action potentials can
explain: disturbances in functional symmetry between muscles of the left and right side,
disturbances in inervation and function, analysis of reflex motions which originate in
masticatory system eg. „silent period “.
Demonstration will be preformed usin 8 channel EMG device called Miodent 8 (6 chanes are
reserved for EMG signal and 2 for audio signal). Device has been developed especially for
recording action potentials in dentistry. Movements of maximal opening, clenching and
maximal laterotrusion will be recorded. Recording will be analyzed using mean voltage,
MVC and indexes of asymmetry.
Significance of recorded results will be discussed in light of different occlusal parameters,
for instance in fully edentate mouth or partially dentate jaws.
B. Accelerometry - demonstration and application possibilities
mr.sc.Ivica Pelivan,
School of Dental Medicine University of Zagreb
Recently mandibular movements are in the centre of research because of other functions of
the masticatory system. Moreover, we cannot ignore the impact of occlusion and
temporomandibular joint kinematics on the mandible, as well as the impact of head position
on the kinematic properties of the jaw. Previous research has been focused on dynamic
properties of the masticatory system mainly by use of different optoelectronic methods, and
without investigation of the influence of head position and/or body posture on kinematic
properties of the jaw. Exploring the possibilities of applying accelerometry in this research
filed has led to interesting insights on the kinematics of the masticatory systems. One of
these insights is influence of head position on the mandibular kinematics which will be
demonstrated. The opening-closing mandibular motion will be analyzed using two tri-axial
accelerometers at three different head positions: flexed head position, extended head
position and the position in which the Frankfort plane is parallel to the absolute horizontal
plane. These three different head position lead to changes in muscular tension of infrahyoid
and suprahyoid muscles changing direction of their actions and the path of mandibular
movements.