We'd like to understand how you use our websites in order to improve them. Register your interest. The previous consensus document, approved in a similar meeting in was acknowledged and regarded as valid and widely utilized in controversies Medical and Legal, Insurances Companies, etc. PURPOSE: The goal of this meeting was an adjournment of that document with present state of the art evidence-based literature and experience. A thesis supporting a correlation between posture and occlusion was opposed to an oppositional position on the lack of a correlation the pro and con positions.
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Language: English Italian. Among the various treatment options currently indicated for the temporomandibular joint disorders TMD tackle an important role is played by occlusal devices which can be used in an individualized and or universal. To assess the applicability and efficacy was carried out a preliminary study on a sample of 50 patients selected according to the criteria RDC-TMD and divided in random into two groups, the patient group PG , treated with the device, and a control group CG does not undergo any treatment.
The two groups were evaluated according to an analysis of segmentation by comparing the clinical data. Were considered some aspects of the application of the device using a self-evaluation questionnaire administered to the PG. Considerations derived from this initial application are: none of the 25 patients in the sample PG has worsened the initial situation.
The patients in the CG have all been included in the multidisciplinary treatment program. The findings of our preliminary study are favorable to this new device occlusion, however, requires further verification in time and on a sample of patients numeroso. Le considerazioni che derivano da questa prima applicazione sono: nessuno dei 25 pazienti del campione PG ha peggiorato la situazione iniziale. I pazienti in CG sono stati tutti inseriti nel programma di trattamento multidisciplinare.
I risultati del nostro studio preliminare sono favorevoli sul nuovo dispositivo occlusale. Si richiedono comunque, ulteriori verifiche nel tempo e su un campione numerico maggiore. The indications and efficacies of therapies for temporomandibular joint disorders TMDs are currently a study topic of great importance.
The treatment models applied today are directly related to the symptoms, the time over which they have developed, and some of the factors affecting these symptoms and their development. Moreover, the data emerging from studies have demonstrated the possibility of treating patients with TMDs using conservative methods that are chosen and individualized over time for each patient and altered appropriately for any changes in their lifestyle.
The purpose of this study was to evaluate a new type of occluding device that is ready-to-used. The technical, mechanical, physical, and construction characteristics of this device, the Universal Neuromuscular Immediate Relaxing Appliance UNIRA by Rampello , are presented herein, along with the outcome of preliminary trials in several patients compared with a control group.
A cohort of patients with temporomandibular articulation pathologies were observed at the Service of Clinical Gnathology of the Head-Neck Department of the Umberto I Polyclinic in Rome, between January and May The cohort in the present study was thus divided into two groups using the following inclusion and exclusion criteria:.
Articular pathologies of systemic nature e. Absence of more than six teeth three in the inferior arch and three in the superior arch necessary for the correct function of the splint.
Of the remaining 66, 16 declined to be part of the study. The selected sample of 50 was divided randomly into two subgroups: the patient group PG and the control group CG. Subjects in the PG, who were fitted with the UNIRA splint, comprised a consecutive series of 25 patients 20 women and 5 men; age 20—46 years old, average Subjects in the CG comprised 25 patients 22 women and 3 men; age 20—45 years old, average Before describing the treatment method used for the clinical study, it is important to explain the design of the project and the realization of the UNIRA dental appliance.
The majority of occlusive immediate splints used for TMD therapy are designed to resist the occlusive forces determined by the strength of the vertical muscles masseters, internal pterygoids and temporal. We believe that in order to obtain a complete functional recovery and pain relief, it is necessary to establish the balance of all masticatory and facial muscles.
Thus, we have designed a new splint that acts not only on the vertical muscles, but also on the horizontal muscles, improving the connection between the tongue, the hyoid bone, and the rachis. The design of the UNIRA is the result of a combination of clinical considerations associated with the following technical prerequisites: small dimensions and reduced trauma, good comfort, easily managed, and low economic and biological cost.
It was decided that the expansion, thickness, and general structure of this appliance must have a good retention and be firm. Thus, a polyvinyl polypropylene material was chosen, which is biocompatible, nontoxic, hypoallergenic, and has a hardness of about 60—70 Shore, in accordance with European Union directives Class 1a CE.
After some technical tests including compression, torsion, traction, and cut executed in the laboratory, and from an analysis of similar commercially available devices and the results of a first-phase clinical study with different prototypes over a 2-year period, a first set of UNIRA splints with a thickness of 3 mm in the occlusive active portion and 2 mm in the other parts was constructed, and used in the present study. The so-called active parts are:. Two lateral genal shields that are vertical and symmetric, and have a right- and left-of-oval form.
Two interocclusive levels with a roughly triangular form, but with round angles; also right and left symmetric. Palatal arch linking the two horizontal, triangular, occlusive levels passing near the palatal vault. An arched string connecting the two lateral shields placed in the vestibular fornix inferior and front.
Two small vertical and semilunar wings that are detachable at the lower part in a right angle from the two occlusive horizontal levels, encircling the mouth on the molar and premolar teeth Figs. It is also important to note that the connecting parts have an effect upon the tissues that they come into contact with, but for the present description we preferred to divide the different parts of the splint into active and stabilizing.
The two lateral genal shields balance and equilibrate the perioral muscles horizontal and stabilize the splint horizontally. The two triangular interocclusive and horizontal parts increase the vertical dimension and space the teeth.
Indeed, they equilibrate the vertical muscles, protecting the teeth and the temporomandibular structures from inadequate parafunctional forces. They also function to stabilize the vertical parts. Particularly novel in the present model is the palatal arch, which commences from the internal superior pole of the two horizontal interocclusive levels and continues crosswise to encircle the palatine vault at the back of the tongue. It has various functions: 1 it links elements 1 and 2, 2 it retains the entire splint, opposing its expulsion from the mouth sagittally, and 3 it induces postural tongue rehabilitation and, as a consequence, rehabilitation of the lower jaw, the hyoid bone, and the cervical column, aiding the correct head posture.
The front lower string, the front arch, is positioned in the lower vestibular fornix, between the front lower teeth and the lower lip, linking the lateral 1 and 2 elements to stabilize and retain the splint sagittally. The two small semilunar wings help the retention and intra-oral stabilization of the splint, in order to maintain the two interocclusive levels firm between the antagonist teeth. The surfaces of all described elements are smooth, and thus should cause no trauma.
Only the surfaces of the two interocclusive levels could eventually develop small holes or retentions, or become rough. No other form of therapy was used during the treatment period 0. The patients provided informed consent to participate in this study, agreeing to use the UNIRA splint. All of the patients were aware of the trouble afflicting them and so were able to obtain a real perception of the problem, thus assuring us of the best possible compliance. Patients were examined every 25 days during the study period.
This is a quantitative analysis that utilizes periodic comparison of mill metric values of mouth-opening fluidity, symmetry, and absence of pain during mandibular movements. To reduce interexamination variability, all of the patients i. The pain levels were measured for the PG at two time intervals: before therapy, and at the end of therapy T1.
For the CG, examinations were carried out at the beginning of the study period and then again after 4 months T1. A segmentation analysis between the two groups was carried out for results obtained before and after the therapy.
They were evaluated as follows:. Considering the innovation of this appliance and as part of the evaluation of its clinical effectiveness, the level of comfort while wearing the splint was evaluated by asking the patients to respond to a set of easily understood questions:.
Did the splint cause any problems in your mouth? Did you have any problems with the appliance? This question was designed to ascertain whether the patients had any problems inserting or removing the UNIRA from the mouth, and to assess its wearability. Given your initial condition, would you chose to use this appliance? This question allowed us to assess the level of patient satisfaction with the treatment. Absence of real changes in the teeth at the three levels of space perceptible by the patient and the doctor.
The main findings of this study are presented in Table 3. The application time for the remaining 20 patients ranged from 2 to 3 months. These patients had an end-of-study mouth opening of 40 mm. No change was observed in muscular pain in 14 out of the 15 CG patients who initially reported this symptom Table 4 ; only 1 CG patient noted any improvement.
In one of the remaining two, migraines became worse, while the condition of the other slightly improved, achieving a high VAS score of 40— Overall, there was no significant variation in migraine symptoms between the two groups. In the CG, those who presented with cervical pain experienced no change in their symptoms throughout the study period. No change in this symptom was observed in the remaining two patients. The ATM noises experienced by 14 patients in the CG improved during the study period in only 1 patient, while for the remaining 13 patients the symptom was unchanged.
Five PG patients presented with DDwR; over the study period, two of these improved, while this symptom remained unchanged in the remaining three patients. The number of patients reporting to be stressed in the CG increased from 14 to 15 during the study period.
The number of patients in the PG who clench their teeth decreased from 18 to 11 over the study period. The symptom of bruxism also improved in the PG in three cases during the study period, remaining unchanged in the other four patients who reported this symptom initially. A segmentation analysis of the findings at T1 for the two groups is presented below.
The answers to the three appliance evaluation questions presented to the PG patients were as follows:. Question 1 Did the splint caused you any problems in your mouth? Question 2 Did you have any problems with the appliance? Question 3 Given your initial condition, would you chose to use this appliance?
We have been treating diseases of the stomatologic apparatus for the past 25 years at our center, and we are continually striving to develop diagnostic and therapeutic strategies that will provide more rapid, comfortable, and less expensive ways of treating our patients.
Following this logic, treatment strategies have advanced over the years, allowing us to be consistently up-to date, both clinically and as regards the literature. Patients with TMDs are treated with a combination of occlusive, conservative, behavioral, and physiotherapy solutions, involving cooperation between disciplines and practitioner multidiscipline training.
Patients with structural and nonreversible diseases of the osteoarticular components are seen, following diagnosis, by a maxillofacial surgeon, who will apply the correct therapy. Only three of the PG patients experienced no change as a result of using the splint.
These three patients were submitted to a diagnostic reevaluation, and a more therapeutic program more appropriate to their specific pathology was provided.
Following the study period, the CG patients were all entered into a therapeutic multidisciplinary program. The findings regarding improvement of cervical pain are not conclusive, and it is necessary to further analyze this problem.
The main limit of this device appears to be mechanical. There are issues with dental anchorage, since there are no supporting elements. It may sometimes be impossible to place the palatal spring optimally in jaws that are particularly arched or particularly low, or those with a large arch. Furthermore, this splint is often prescribed for those patients with particularly dysfunctional and painful forms of the disease who have a characteristic tensive musculature, in whom immediate control of pain is necessary.
Finally, the sample number of this study is low; further studies are required with a larger sample. The benefits of the UNIRA are its immediacy of use by the doctor, the low cost of the appliance, the ease of control by the patient and doctor, the reduction of the sometimes long waiting times in public health systems when it is important to treat the patients as soon as possible.
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Language: English Italian. Among the various treatment options currently indicated for the temporomandibular joint disorders TMD tackle an important role is played by occlusal devices which can be used in an individualized and or universal. To assess the applicability and efficacy was carried out a preliminary study on a sample of 50 patients selected according to the criteria RDC-TMD and divided in random into two groups, the patient group PG , treated with the device, and a control group CG does not undergo any treatment. The two groups were evaluated according to an analysis of segmentation by comparing the clinical data. Were considered some aspects of the application of the device using a self-evaluation questionnaire administered to the PG.
A new aid in TMD Therapy: the Universal Neuromuscular Immediate Relaxing appliance “UNIRA”
Skip to content 1 info the7psy. Facebook Twitter Pinterest Instagram. Management of temporomandibular joint degenerative disorders with human amniotic membrane: Hypothesis of action Guarda-Nardini L. Guarda-Nardini L. Personality traits are potentially associated with the presence of chronic temporomandibular joint pain in patients without effusion as determined by T-2 weighted magnetic resonance.
The aim of this investigation was to perform a review of the literature dealing with the issue of relationships between dental occlusion , body posture and temporomandibular disorders TMD. A search of the available literature was performed to determine what the current evidence is regarding: i The physiology of the dental occlusion—body posture relationship, ii The relationship of these two topics with TMD and iii The validity of the available clinical and instrumental devices surface electromyography, kinesiography and postural platforms to measure the dental occlusion—body posture—TMD relationship. The available posturographic techniques and devices have not consistently found any association between body posture and dental occlusion. This outcome is most likely due to the many compensation mechanisms occurring within the neuromuscular system regulating body balance.