Object
Title: The influence of prosthetic procedures correcting the occlusion on the condition and symmetry of the masticatory muscle tone
Abstract:
Introduction The aim of this project was to evaluate the impact of prosthetic procedures designed to correct occlusal disorders that affect the condition and symmetry of masticatory muscle tone. The initial section of this monograph highlights the issues related to the etiological factors, their impact on the stomatognathic system (US), methods of assessment and the management of occlusal disorders. The ways of occlusion analysis were described, as well as the planning of the prosthetic reconstructions to provide the physiological tension on masticatory muscles to equal the load within the articular structures. Various methods of the occlusal analysis were shown using both, - traditional visual methods (with the use of occlusion recorders, i.e., wax plates, silicone masses, articulation papers and foils) as well as modern instrumental methods of occlusion analysis with the use of electronic devices for the detection and measurement of occlusal forces (T- Scan). Bearing in mind the constantly developing digitization of dentistry, new methods of taking digital impressions, occlusal analysis with the use of CAD (Computer Aided Design) technology, are also mentioned. Many authors confirm that the hyperactivity of stomatognathic system muscles is an important etiological factor responsible for the occurrence of the functional disorders of the masticatory organ. Howev ; er, there is still a lack of direct assessment of occlusal correction and their impact on the condition and symmetry of the masticatory muscle tone. Therefore, the results obtained in this study can complement the research conducted so far in the field of disorders of the masticatory system - both from the cognitive and practical point of view. Aims The aim of the study was to prove the effectiveness of procedures correcting the occlusion by selective grinding of premature occlusal contacts (group I) and the reconstruction of tooth crowns using a composite material (group II) through the results of electromyographic testing. The conducted research is to answer the following specific questions: 1. Will the selective grinding of premature occlusal contacts and the composite reconstruction of the tooth crowns have a positive effect on the reduction of masticatory muscle activity? 2. Will the applied prosthetic methods result in achieving masticatory muscle tension symmetry? The key in the comparative assessment was the verification of the level of electrical activity of the masseter muscles before and after the prosthetic correction of occlusion disorders and the determination of their asymmetry index. In the case of corrective procedures, the restoration of the correct function of the masticatory muscles and thus the improvement of the dynamics of mandibular mov ; ements was assessed. Material and methods The study involved 100 patients of both sexes, aged 20 to 42 years, who were admitted in a private dental office in Wolbrom for dental treatments between December 2019 and February 2021. The patients were divided into two groups of 50 people each. Assignment to group I or II was randomized based on observed occlusal disorders during the clinical trial. In the first group, corrective procedures were performed in the form of selective grinding of premature contacts. In the second group the reconstructive procedures were performed to build up too low clinical crowns using composite material. The studies were carried out in accordance with the guidelines of the Bioethics Committee of the Regional Medical Chamber in Krakow, issued in the opinion number 310 / KBL / OIL / 2019 of December 10, 2019. The patients participating in the study were fully informed regarding the aim of the study, voluntary attendance policy, the method and scope of corrective procedures, contraindications for the performance and the possibility to leave the group at any stage of the project without giving a reason. All patients underwent a dental check-up, specialist dental examination as well as the supplementary tests such as: orthopantomogram, a test of electrical activity of masseter muscles. The subjective study was conducted on the basis of an ; author's own questionnaire, consisting of three parts. Part I provided information on general health. Part II included detailed questions about problems in the oral cavity and temporomandibular joints as well as questions about the headache, with the specific details about the location, duration, and intensity of the pain. Pain severity diagnostics were carried out based on the joint self-modified VAS and VNRS scales form. The last part - III included detailed questions about psycho-emotional factors such as, - stress and sleep disturbances. The dental check-up was carried out in order to assess teeth, periodontium and oral mucosa conditions. The examination of natural teeth was carried out in terms of both carious and non-carious defects. A detailed analysis of the consequences of traumatic occlusion on the mucosa of the tongue and cheeks as well as the presence of periodontitis was also carried out. In the case of any prosthetic restorations, their clinical value was assessed, especially in the areas supporting the height of the occlusion. The specialist dental examination included the extent of mandibular abduction and lateral mandibular movements, symmetry of mandible depression path, rest position distance, masseter muscle tone on palpation, sensitivity of their attachments and the presence of acoustic and pain symptoms in temporomandibular joints occurring ; idiopathically or on palpation and/or during mandibular movements. The measurements of the extent of mandibular adduction were made between incisal margins of the upper and lower central incisors using a caliper considering the incisors overlapping in case of scissors bite. The extent of lateral movements was referred to the centerline of upper and lower dental arch or in case of lack of their correspondence, to the median line of the upper arch. The path of vertical mandibular movement was assessed visually by placing a thin metal belt between the upper incisors that served as a symmetric reference point, considering the division of the path into three segments. The examination of occlusal conditions including the assessment of the occlusal height, and the opposing teeth contact in central occlusion that is maximal intercuspal position, distal mandibular contact position and in freedom in centric. Long centric occlusion was examined during anterior, anterolateral, and lateral mandibular movements. The muscles examined on palpation, comparatively on the right and left side, were assessed on the basis of pain occurrence, hypertension and hypertrophy. The intraoral and extraoral examination was carried out, and while performing the intraoral examination the special emphasis was laid on the muscle’s attachments examination. Masseter muscles, temporal muscles, both ; bellies of the biventer muscles, mouth floor muscles as well as medial pterygoid and lateral pterygoid were assessed in indirect tests. The temporomandibular joints examination involved simultaneous palpation in central occlusion and mandibular movements. In orthopantomogram the number of endodontically treated teeth were assessed as well as root structure abnormalities, unerupted teeth location, pathologies within the maxillary sinus and mandibular bones region. The next stage of the occlusal examination was an instrumental analysis performed on the casts in the articulator. The transfer of the spatial relation of the occlusal surface of the upper arch to the hinge axis of the temporomandibular joint was performed with the use of the facial arch. The dislocation of the posterior teeth during protrusive movements (incisal guidance) and the displacement of the posterior teeth during lateral movements (canine guidance) were examined. The electromyographic testing of masseter muscle activity was done using the 4-channel Electromyography MyoPlus 4Pro with bipolar surface electrodes with a constant distance between poles covered with AgCl. Electrical potentials were recorded during the 10-second examination, separately in the resting position of the mandible, and in the central occlusion. The dental check-up, specialist dental examination of the masticatory organ, ma ; sseter muscles and temporomandibular joints pain intensification and masseter muscles electrical activity were evaluated twice, that is, before the prosthetic treatment began, and 7 days after the last correction of occlusal disorders. In the treatment process, there were two prosthetic treatment methods used in patients with occlusal disorders: selective grinding of premature occlusal contacts and the reconstruction of tooth crowns with the use of a composite material. In the case of measure giving the constant results, statistical analysis was based on traditional methods of calculation: mean values, standard deviation, minimal values, maximal values, standard error of the mean, variance analysis for dependent variables and post-hoc Tukey test for dependent variables being the statistical significance measure. To compare the dependence between the results obtained in consecutive clinical tests, the non-parametric ANOVA test was used. For statistical studies special computer software Statistica ver. 13.3 was used. Results In assessment of clinical parameters carried out during consecutive tests of masticatory organ activity, a significant improvement was observed in patients belonging to both groups. The mean value of the electrical potentials obtained in the control study (7 days after correction) in the first group (grinding) in the resting position proves t ; hat the activity of the examined muscles decreased by 5.12 μV for the left side and 3.95 μV for the right side, which is 51 % of the output on the left and 45% on the right. The mean value of electric potentials obtained in the first group (grinding) in the central occlusion also decreased by 37.62 μV for the left side and 43.69 μV for the right side, which is 39% of the base value on the left side and 42% on the right. Similarly for the second group (reconstruction), the results of the control test are as follows: the mean value of electrical potentials in the rest position decreased by 3.47 μV for the left side and 4.65 μV for the right side, which is 45% of the initial value on the left side and 51% on the right. The mean value of the potentials obtained in the second group (reconstruction) in the central occlusion also decreased by 32.69 μV for the left side and 39.05 μV for the right side, which is 35% of the base value on the left side and 39% on the right side. The results indicate that the parameters assessing the activity of stomatognathic system, mandible adduction path, lateral movements symmetry, muscle and temporomandibular pain, obtained in the follow-up in both groups were satisfactory. From the point of etiological factors, the correction of occlusal disorders is therefore a very important aspect of achieving the symmetry of muscle activity combin ; ed with the elimination of the load on the joint structures. Conclusions The detailed analysis of the test’s results can allow for the drawing of some meaningful conclusions that can be implemented in clinical practice to effectively use prosthetic procedures to correct the condition and tension of the masticatory muscles: 1. The selective grinding of premature occlusal contacts and the composite reconstruction of tooth crowns cause the reduction of electrical activity of the masticatory muscles both, in the resting position and in the central occlusion. 2. After occlusal correction, bilateral symmetry of the electric potentials of masticatory muscles was obtained, ensuring the physiological load on the periodontal tissues, the proper function of the neuromuscular system and the improvement of the patients' neurobehavioral attitude.
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Rada Dyscypliny Nauki medyczne
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Jan 3, 2024
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Nov 20, 2023
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http://dl.cm-uj.krakow.pl:8080/publication/4993
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