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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.