This document summarizes the current state of knowledge regarding intraoral appliances used to treat temporomandibular disorders (TMDs). It discusses what is known about how these appliances work, their various designs, and the mechanisms by which they may provide relief from TMD pain and dysfunction. However, the evidence from clinical trials supporting their use is still limited. More research is needed to determine which appliance designs are best suited for specific TMD diagnoses and whether long-term wear provides ongoing benefits or risks changes to occlusion. Overall, oral appliances are considered a reasonable first-line treatment option for managing TMD pain when used appropriately.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Lecture 12 general considerations in treatment of tmdLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name 12 general considerations in the treatment of TMJ
Al Azhar University Gaza Palestine
Dr. Lama El Banna
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Lecture 12 general considerations in treatment of tmdLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name 12 general considerations in the treatment of TMJ
Al Azhar University Gaza Palestine
Dr. Lama El Banna
68.Dr. Afreen Kauser; Dr. Rahul VC Tiwari; Dr. Ankita Khandelwal; Dr. Heena Tiwari; Dr. Sourabh Ramesh Joshi; Dr. Fawaz Abdul Hamid Baig; Dr. Anil Managutti. "Preference Of Orthodontic Treatment Versus Orthognathic Surgery In Class Iii Malocclusion Cases: A Research Survey". European Journal of Molecular & Clinical Medicine, 8, 1, 2021, 1271-1276.
68.Dr. Afreen Kauser; Dr. Rahul VC Tiwari; Dr. Ankita Khandelwal; Dr. Heena Tiwari; Dr. Sourabh Ramesh Joshi; Dr. Fawaz Abdul Hamid Baig; Dr. Anil Managutti. "Preference Of Orthodontic Treatment Versus Orthognathic Surgery In Class Iii Malocclusion Cases: A Research Survey". European Journal of Molecular & Clinical Medicine, 8, 1, 2021, 1271-1276.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. Intraoral appliances for temporomandibular disorders: what we know and
what we need to know. Harold F. Menchel, Charles S. Greene, Kevin D.
Huff. Front Oral Maxillofac Med 2021;3:6
Guided by,
Dr. Tushar Tanwani, Professor and HOD
Dr. Gaurav Tripathi, Reader
Dr. Gaurav Agrawal, Reader
Dr. Ankita Piplani, Reader
Dr. Sudeepti Soni, Reader
Dr. Vikas Agrahari, Senior Lecturer
Dr. Rajeev Shrivastava, Senior Lecturer
Dr. Pooja Agrawal, Senior Lecturer
Dr. Megha Sahu, Senior Lecturer
Dr. Pramod Singhroul, Senior Lecturer
Dr Anukriti Chandra, Senior Lecturer
Presented by
Dr. Susovan Giri
2. INTRODUCTION
Oral appliances (OAs) have been used by many dentists over the past century to treat various forms
of temporomandibular disorders (TMDs).
Consequently, we find ourselves today in the situation of knowing some things about OAs, including
how they can be designed, when they might best be used, and what kind of clinical results are likely
to be obtained under various conditions.
Favorable outcomes of decreased pain and improved mouth opening are the most commonly reported
results from both academic studies as well as clinical experiences.
3. Also, the long-term impact of continuous OA wear remains a subject of
deep controversy because such wear may produce major changes in
occlusal and craniomandibular relationships.
Furthermore, because there are so many physical designs of OAs, it is not
clear which kind is most appropriate for treating any particular TMD
condition as defined within the Diagnostic Criteria for
Temporomandibular Orders (DC/TMD)
4. As concerns the DC/TMD diagnoses, there is a case to made from the
current evidence that OAs may be most effective in management of two
common TMD conditions: (I) regional myofacial pain; and (II)
inflammatory TM joint disease, especially the pain associated with
degenerative joint disease (DJD)
OAs are a reasonable therapeutic modality because they provide a
conservative and relatively reversible treatment approach that is non-
pharmaceutical, with minimal adverse effects when used with accepted
appliance designs and protocols.
They do not typically require invasive treatment, and they generally do not
produce permanent anatomic changes in the stomatognathic system.
5. While additional therapeutic modalities such as physiotherapy, cognitive
behavioral therapy, patient education, and pharmacotherapy all play
important roles in the non-surgical management of TMDs, OAs should
definitely be considered among the pragmatic first line therapeutic options
that may be prescribed by orofacial pain specialists as well as by
appropriately trained general dentists.
6. What does the recent literature say about
the value of OAs?
Unfortunately, to date, there is only weak to moderate evidence from
randomized clinical trials (RCTs), meta-analyses, and systematic reviews to
support the use of OAs for TMD pain management.
However, the main weakness in the current evidence base is due in large
part to the continuing decades old controversy about what OAs are intended
to do.
More than likely, they are type of conservative therapy within the
biopsychosocial model of TMD therapy meant to manage pain and
dysfunction in TMD patients. These patients have multifactorial
contributing etiologic issues including both Axis I (biophysical) and Axis II
(psychosocial) DC/TMD categories of susceptibility and perpetuating
factors.
7. Nevertheless, some clinicians believe that OAs should be regarded as
devices that are intended as a preliminary or diagnostic step prior to
definitive dental therapy.
Within that conceptual framework, an OA is used to modify joint position
and anatomy, evaluate vertical dimension of occlusion, “deprogram” the
patient so that irreversible occlusal modification can be performed in “phase
II” treatment, or other mechanistic protocols with minimal consideration for
psychosocial contributions
8. Probable mechanisms of OA therapy
Based on current understanding of the multifactorial etiology for TMD signs and
symptoms, some probable mechanisms for the observed positive effect of OA
therapy may be the following:
Reduced joint loading
OAs decrease mechanical stress and joint inflammation by changing the load
applied to the TMJs. In fact, there are a number of studies in vivo, in vitro,
and based on computer modeling that consistently show reduced force to
TMJs with OAs, particularly regarding OAs with posterior occlusal support .
Since mechanical stress on joints has been shown to cause inflammation, it
therefore could be inferred that OAs reducing joint load should result in
decreased inflammation.
9. Behavioral changes may explain both muscular and joint responses to
wearing an OA
Associated behavioral changes may explain both muscular and joint
responses to OA therapy.
Furthermore, Findings from PSG sleep lab studies indicate that that OAs may
reduce bruxism on a short-term basis.
OAs change proprioception, which increases brain modulation of muscle
activity for 2–6 weeks as a protective mechanism to something foreign.
During this time, especially when augmented with other interventions like
cognitive behavior therapy, counseling, anti-inflammatory medications, and
physiotherapy, one might expect to see a variety of positive responses as
TMD signs and symptoms improve.
10. Placebo effect
As a general medical patient management consideration, it has been
suggested that the placebo effect of an intervention has a significant positive
effect on the outcome and can often persuade the clinician that both the
diagnosis and treatment are correct.
Furthermore, patients who have been effectively treated with OA therapy
tend to depend on long-term wear of the OA to prevent pain from recurring;
there is, however, no evidence to support this strong patient belief.
It is not clear from the literature on OAs whether patients with certain TMD
diagnoses should continue OA wear after their symptoms have abated. One
study showed that after patients ceased OA wear for 15 days after 6 months
of night wear that their pain recurred
11. Regression to the mean
Clinical experience and many no-treatment observational studies suggest
that levels of chronic pain with no objective disease findings tend to
reduce without therapy over time to about 50% of maximum levels,
which may be due to psychological or physical adaptation or both. In
medical pain management, this is commonly referred to as “regression to
the mean”.
12. Most common OA designs
OAs can be directive or non-directive (permissive) in design.
With a directive OA there are usually tooth indentations or “guides” on the
cameo occluding surface of the OA to hold the opposing teeth in a given
position depending on the treatment philosophy of the dentist .
With non- directive OAs, the biting surface is relatively flat relative to the
occlusal plane and allows freedom of excursive movement without eccentric
interference.
13.
14. In general, the most commonly used OAs can be grouped into five
categories.
OAs of each type are fabricated by a variety of materials according to
clinician preference and perceived patient comfort .
Some examples include hard polymethylmethacrylate acrylic, hard and soft
thermoplastic materials of varying thicknesses that may or may not be
laminated with hard acrylic, milled resin, and even cast metal. Anecdotally,
the more rigid the OA is, the more predictable the outcome.
15. In general, the common appliance design categories are:
(I) Full-coverage flat plane stabilization appliance;
The Appliance With Centric and Eccentric Contacts
Marked. Note that the mandibular canine provides the
laterotrusive (LT) and protrusive (P) guidance. The posterior
portion of the appliance should reveal only centric relation
(CR) contacts. This appliance, however, also reveals
undesirable LT and mediotrusive (MT) posterior contacts.
These must be eliminated.
16. (II) Mandibular repositioning appliance;
(III) Anterior-only contact appliance;
(IV) Posterior bilateral platform appliance with no anterior contact;
(V) Neuromuscular full coverage appliances with joint position determined by
electronic instrumentation.
18. Full coverage flat plane hard stabilization
appliance (FP)
This is the most common full coverage OA with a flat occluding surface, and it
features equal bilateral contacts adjusted with or without anterior guidance. This
design has been proven to be the safest, especially for long term wear, providing
mechanical protection to the joints and avoiding permanent occlusal changes.
19. Example of lower adjusted flat plane full coverage hard acrylic OA. This example FP is
adjusted optimally to even bilateral contact (black marks) and shallow anterior guidance
including cuspid rise, protrusive, and cross-over adjusted in red. The crossover contacts keep
the upper cuspids from falling off the lingual of the OA as the contacts are transitioned to the
upper incisors. The minimum recommended thickness in the 2nd molar area is 1.5 mm to
assure minimum perforation when adjusting the OA. OA, oral appliance.
20. Mandibular repositioning OAs [anterior
repositioning appliances (ARAs)]
These appliances are also full coverage and usually fabricated for the
maxillary arch, but they can also be fabricated for the mandibular arch.
Mandibular versions tend to have excessive labial bulk and may result in
less patient compliance . There is a directive anterior ramp on the ARAs, but
the posterior surfaces are flat allowing some freedom of movement
(although less than a typical FP). The ramp on the anterior positions the
mandible into a protrusive position.
21. Maxillary anterior repositioning appliances ARA. This is a maxillary ARA adjusted to
even bilateral contact with the patient in a protrusive position. The ramp in the
anterior is added and retroclined to hold the patient in this position. There is some
freedom of movement. It is important that the patient have good posterior support and
even contact to minimize any trauma to the mandibular anterior teeth. ARA, anterior
repositioning appliance.
22. ARAs are indicated in patients with diagnosis of disc displacements with
reduction under certain conditions, such as disc displacements with
reduction with intermittent locking . In these patients, anecdotal
observations suggest that locking occurs most commonly upon awakening
from sleep. It also has been reported that ARAs can be helpful in
preventing clicking patients from progressing to disc displacement
without reduction in patients with increasing occasional locking. There is
a cautionary consensus that ARAs should be used short term to avoid
permanent occlusal changes (posterior open bite). ARAs, therefore, have
potential therapeutic advantages; however, there is no support for using
this protrusive position as a template for permanent occlusal therapy.
23.
24. Disc Displacement With Reduction. Note that during
opening the condyle passes over the posterior border
of the disc onto the intermediate area of the disc, thus
reducing the anterior displaced disc. This discal
movement can lead to momentary mechanical
catching or locking. When this is present, the
condition is called disc displacement with
intermittent locking.
25. Disc Displacement Without Reduction (Closed
Lock). Note that the condyle never assumes
a normal relationship on the disc, but instead
causes the disc to be maintained in front of the
condyle. This
condition limits the distance it can translate
forward.
26. Examples of occlusal changes associated with oral
appliances. (A) Anterior contacting appliance. This appliance
was worn for 4 years only during sleep. The opposing
adaptive occlusal changes are impressive.
27. Posterior contacting OA. This OA (Gelb appliance)
was worn in a 24-year-old woman for 2 years with
continuous wear (daytime and nighttime). Notice the
occlusal changes. OA, oral appliance.
28. Anterior only contacting OAs (ACs)
The configuration of anterior only contacting OAs (ACs) allows only the
anterior teeth to touch on a flat plane perpendicular to the ala-tragus line in a
sagittal view and the horizon in the frontal plane, or when facing the patient.
This plane can be small with only the central incisors touching or may be
extended to the cuspids. These appliances have been reported to reduce
masseter hyperactivity when clenching
29. According to some advocates of this design, these OAs are proposed to be
more effective in the treatment of migraine and tension headache than
FPs. However, the overwhelming evidence is that there are no specific
TMD diagnoses that show improved outcomes with these appliances
The concept of how ACs may work is that the narrower the platform the
less elevator muscle activity can be generated., although other To date,
most studies show no additional benefit in comparing ACs with FPs.
Furthermore, headache studies have shown that there was minimal effect
in improvement of migraine headaches using ACs when compared to low
dose tricyclic antidepressant medication.
30. In addition, other studies have indicated that the lack of posterior support
with ACs may result in increased joint loading and an increase in joint
sounds . Given the current evidence, ACs should be used judiciously in
patients with overriding muscle pain and no joint pathology.
It should also be noted that up to one-third of clinically healthy and quiet
temporomandibular joints have disc displacements, so this fact should be
kept in mind whenever such appliances are being used.
31. Posterior contact appliances (PCA)
Historically, PCAs have been used in an effort to distract the joints
vertically, even though the mandible is a Class III lever which cannot be
distracted in that manner.
Dr. Harold Gelb has been credited with the concept that TMDs are best
managed by positioning the condyle at a specific radiographic point in the
glenoid fossa.
This position was accomplished using a mandibular appliance (MORA)
with occlusal coverage over the posterior teeth only.
While this concept may have provided relief for some patients, a common
complication with these appliances was that wearing them over extended
periods of time resulted in intrusion of the posterior dentition or possible
eruption of the open anterior bite.
32.
33. Neuromuscular OAs
Neuromuscular OAs are directive (anterior repositioning) and are usually
placed over the mandible following 30–45 minute of TENS stimulation.
Advocates believe that this leads to the mandible being in a directed
position where the patient has muscular relaxation determined by surface
EMG reading from the muscles of mastication. To date there is no research
support for the validity of this “myocentric” position. This device is
intended for more than just therapeutic use and is meant to determine jaw
position prior to occlusal therapy.
34. Common errors with the use of OAs
There are many controversies associated with the process of choosing a
particular OA, and clinical errors are often made in their use and application
The most common errors reported by expert clinicians working in orofacial
pain clinics is that patients present with ill-fitting OAs that are unstable, too
bulky, and poorly adjusted. Some of these appliances have poor retention or
are overly tight, creating pressure and tooth discomfort resulting in poor
patient acceptance
35. Thermoplastic materials are often used to fabricate OAs. While some
thermoplastic materials when laminated with hard acrylic may be rigid,
many thermoplastic materials used for OAs are resilient, even when
laminated with a rigid cameo shell. Other thermoplastic appliances are
fabricated in one uniform thickness of material that mimic the anatomy of
the underlying occlusal surfaces; due to the posterior envelope of
function, these thermoplastic appliances may be easily perforated in the
distal segments with normal wear and/or therapeutic adjustment.
36. standardized protocols to follow the patient for needed adjustments after
insertion (depending on diagnosis).
Many patients have simply had an OA inserted and then not been
followed up. In fact, based on the reports of many orofacial pain patients,
OAs are commonly inserted by dentists in some cases by dental
auxiliaries with a misunderstanding that they are accurate coming directly
from the laboratory. They often may not be refined clinically based on the
diagnosis for which they were fabricated.
37. Conclusions
The ultimate purpose of this paper was to present a current summary of how OAs
might be of clinical value for treating various TMD conditions within the DC/TMD
framework.
After reading the above review of the current evidence in relation to this issue, it
would be reasonable to conclude that the answer to that question remains somewhat
controversial, and thus is far from being perfectly clear.
Nevertheless, it also is reasonable to state that the position taken by some that OAs
are of no value at all for treating such patients is not correct. The combination of
positive clinical studies and extensive experience in both academic and private
clinical settings is more than enough to offset the cynical viewpoint that OAs are
simply worthless.
As reported above, most of the negative studies that appear to support that type of
negative conclusion are seriously flawed in terms of patient selection, diagnostic
confusion, poorly controlled conditions, and much more.