Abstracts
Purpose
to establish the relationship between the presence of temporomandibular disorders and variability of vertical dimension of occlusion aged between 7 and 12 years.
Methods
it was analyzed 96 children and adolescents of Rogacionista Institute in Sao Paulo, Brazil. The diagnostic investigation of temporomandibular disorders was through Helkimo index and subsequent clinical examination. To measure the data on the vertical dimension were employed distances labial - corner of his eye and nose base - ment. To compare the mean values of anthropometric measurements between genders and the groups with and without TMD, we used analysis of variance (ANOVA) complemented by least significance diference test.
Results
the vertical dimension of occlusion showed distinct measures in children and adolescents in all age groups studied, significant changes were observed for this measure at ages 10 and 12 years of both genders.
Conclusion
we can conclude that in this sample there was a direct relationship between TMD and DVO, positive correlation between the measures lip commissure – corner of eye and nasium - mentum in females and significant changes in the vertical dimension of occlusion at the ages of 10 and 12 years for both sexes.
Temporomandibular Joint; Temporomandibular Joint Disorders; Vertical Dimension; Dental Occlusion; Child
Objetivo
verificar se existe relação entre a presença de disfunção temporomandibular (DTM) relacionada à variabilidade da dimensão vertical de oclusão em crianças e adolescentes na faixa etária de 7 a 12 anos.
Métodos
foram avaliadas 96 crianças e adolescentes do Instituto Rogacionista em São Paulo. A pesquisa diagnóstica da disfunção temporomandibular foi por meio do Índice de Helkimo e exame clínico posterior. Para a mensuração dos dados referentes à dimensão vertical foram empregadas as distâncias comissura labial - canto externo do olho e base do nariz – mento. A comparação dos valores médios das medidas antropométricas entre os gêneros e os grupos com e sem disfunção temporomandibular foi realizada empregando-se a análise de variância (ANOVA) complementada pelo teste least significance diference.
Resultados
a dimensão vertical de oclusão demonstrou medidas distintas nas crianças e adolescentes em todas as faixas etárias avaliadas, foram observadas alterações significantes dessa medida nas idades de 10 e 12 anos de ambos os gêneros.
Conclusão
pode -se concluir que na amostra estudada houve relação direta entre a presença de DTM e Dimensão vertical de oclusão (DVO), correlação positiva entre as medidas comissura labial – canto do olho externo e Násio – Mento no sexo feminino e alterações significantes na dimensão vertical de oclusão nas idades de 10 e 12 anos para ambos os sexos.
Articulação Temporomandibular; Transtornos da Articulação Temporomandibular; Dimensão Vertical; Oclusão Dentária; Criança
INTRODUCTION
Centric occlusion is characterized by maximum intercuspation. When within the pattern of normality, the entire stomatognathic system responds adequately, with muscles, bones and joints functioning correctly11 . Knelbeman S. Method for determining vertical dimension. Patent Storm. 2006;1:14-8.. When the proper balance occurs between the positioning of the teeth and the forces of elevation, contraction and resting of the muscles, the temporomandibularjoint (ATM) performs optimally22 . Spers F. Occlusion the new millennium: the controversy continuous. Spears Perspect. 2007;3(2):64-9.,33 . Ciavarella D, Parziale V, Mastrovincenzo M, et al. Condylar Position Indicator and T-Scan system II in clinical evaluation of temporomandibular intracapsular disease. J Craniomaxillofac Surg. 2012;40(5):449-55..
The vertical dimension of occlusion (VDO) is the main determinant in the
establishment of occlusal and facial balance. A number of studies have
demonstrated that any change in VDO can compromise the activity of the hyoid and
digastric muscles, predisposing individuals to temporomandibular disorder
(TMD)44 . Al-Ninri KS. Vertical Changes in class II division I maloclussion
afterpremolar extraction. The Angle Ortho. 2008;76(1):52-8.
5 . Ohnuki Y, Kawai N, Tanaka E, Langenbach GE, Tanne K, Saeki Y.
Effects of increased occlusal vertical dimension on daily activity and myosin
heavy chain composition in rat jaw muscle. Arch Oral Biol.
2009;54(8):783-9.-66 . Krey KF, Dannhauer KH. Morphometric analysis of facial profile in
adults. J Orofac Orthop. 2008;69(6):424-36.. The analysis of VDOis all the
more important in the pediatric population, as young patients are in the growth
phase, with all joint structures, bone bases and apical bases undergoing
development. However, few papers offer clinical protocols or standard measures
of VDOfor children and adolescents in specific age groups77 . Misch CE. Guidelines for maxillary incisal edge position-a pilot
study: the key is the canine. J Prost. 2008;17(2):130-4.
8 . Cutbirth ST. Increasing vertical dimension: considerations and
steps in reconstruction of the severely worn dentition. Pract Proced Aesthet
Dent. 2008;20(10):619-26.-99 . Geerts GA, Stuhlinger ME, Nel DG. A comparison of the accuracy of
two methods used by pre-doctoral students to measure vertical dimension. J
Prosthet Dent. 2004;91(1):59-66..
Geerts99 . Geerts GA, Stuhlinger ME, Nel DG. A comparison of the accuracy of two methods used by pre-doctoral students to measure vertical dimension. J Prosthet Dent. 2004;91(1):59-66. measured VDOin children and adolescents using a digital caliper. The author states that this fast, noninvasive, low-cost method offers good reliability and no risk to the patient and is therefore considered the gold standard for this type of measure.
A change in VDO is accompanied by the most varied types of changes in one’s bite.
Such changes can cause pathogenic muscle and joint development indicative of
TMD44 . Al-Ninri KS. Vertical Changes in class II division I maloclussion
afterpremolar extraction. The Angle Ortho. 2008;76(1):52-8.,1010 . Torii K, Chiwata I. Occlusal adjustment using the bite
plate-induced occlusal position as a reference position for temporomandibular
disorders: a pilot study. Head Face Med. 2010;6:5.,1111 . Manfredini D, Castroflorio T, Perinetti G, Guarda- Nardini L.
Dental occlusion, body posture and temporomandibular disorders: where we are now
and where we are heading for. J Oral Rehabil.
2012;39(6):463-71.. TMD is a term applied to
functional abnormalities in the temporomandibular jointand associated
structures11 . Knelbeman S. Method for determining vertical dimension. Patent
Storm. 2006;1:14-8.,1212 . Marini I, Gatto MR, Bonetti GA. Effects of superpulsed low-level
laser therapy on temporomandibular joint pain. Clin J Pain.
2010;26(7):611-6.,1313 . Andrade TNC, Frare JC. Estudo comparativo entre os efeitos de
técnicas de terapia manual isoladas e associadas à laserterapia de baixa
potência sobre a dor em pacientes com disfunção temporomandibular. Rev Gauch
Odontol. 2008;56 (3):287-95.. The signs of this disorder are joint noises and
limited range of motion or deviation during mandibular function, whereas the
symptoms include pain in the pre-auricular region, temporomandibular jointand/or
muscles of mastication55 . Ohnuki Y, Kawai N, Tanaka E, Langenbach GE, Tanne K, Saeki Y.
Effects of increased occlusal vertical dimension on daily activity and myosin
heavy chain composition in rat jaw muscle. Arch Oral Biol.
2009;54(8):783-9.,66 . Krey KF, Dannhauer KH. Morphometric analysis of facial profile in
adults. J Orofac Orthop. 2008;69(6):424-36.,1414 . Frare JC, Nicolau RA. Análise clínica do efeito da
fotobiomodulação laser (GaAs – 904 nm) sobre a disfunção temporomandibular. Rev
Bras Fisioter. 2008;12(1):37-42.
15 . Okson JP. Tratamento das desordens temporomandibulares e oclusão.
Rio de Janeiro-RJ: Ed. Elsevier; 2008.-1616 . Carrasco TG, Mazzetto MO, Mazzetto RG, Mestriner W. Low intensity
laser therapy in temporomandibular disorder: a phase II double – blind study. J
Craniomandibular Pract. 2008;26(4):274-81..
Signs and symptoms of TMDare found in all age groups. However, the prevalence of this disorder is considered low among children and increases with age in adolescence and early adulthood1717 . Motta LJ, Guedes CC, De Santis TO, Fernandes KP, Mesquita-Ferrari RA, Bussadori SK. Association between parafunctional habits and signs and symptoms of temporomandibular dysfunction among adolescents. Oral Health Prev Dent. 2013;11(1):3-7.,1818 . Motta LJ, Martins MD, Fernandes KP, Mesquita-Ferrari RA, Biasotto-Gonzalez DA, Bussadori SK. Craniocervical posture and bruxism in children. Physiother Res Int. 2011;16(1):57-61.. Since the temporomandibular jointundergoes remodeling in adolescence, there is a need for the direct, accurate evaluation of dental conditions, the temporomandibular joint and associated neuromuscular apparatus in this period of life1717 . Motta LJ, Guedes CC, De Santis TO, Fernandes KP, Mesquita-Ferrari RA, Bussadori SK. Association between parafunctional habits and signs and symptoms of temporomandibular dysfunction among adolescents. Oral Health Prev Dent. 2013;11(1):3-7.. As TMD can arise at the onset of craniofacial growth, a high percentage of adolescents exhibit signs and symptoms of this disorder1818 . Motta LJ, Martins MD, Fernandes KP, Mesquita-Ferrari RA, Biasotto-Gonzalez DA, Bussadori SK. Craniocervical posture and bruxism in children. Physiother Res Int. 2011;16(1):57-61.,1919 . Egermark-Eriksson I, Carlsson GE, Magnusson T. A 20-year longitudinal study of subjective symptoms of temporomandibular disorders from childhood to adulthood. Acta Odontol Scand. 2001;59(1):40-8..
Epidemiological studies have reported an increase in signs and symptoms of TMDin children beginning at six years of age through to adolescence, when the prevalence of this disorder is similar to that found in adults88 . Cutbirth ST. Increasing vertical dimension: considerations and steps in reconstruction of the severely worn dentition. Pract Proced Aesthet Dent. 2008;20(10):619-26.,99 . Geerts GA, Stuhlinger ME, Nel DG. A comparison of the accuracy of two methods used by pre-doctoral students to measure vertical dimension. J Prosthet Dent. 2004;91(1):59-66.. Moreover, characteristics of malocclusion are believed to predispose individuals to signs and symptoms of TMDand are also related to a reduction in VDO99 . Geerts GA, Stuhlinger ME, Nel DG. A comparison of the accuracy of two methods used by pre-doctoral students to measure vertical dimension. J Prosthet Dent. 2004;91(1):59-66..
Considering the numerous factors that may affect the temporomandibular joint, the aim of the present study was to determine a possible association between TMDand variability in VDOamong children and adolescents aged seven to 12 years.
METHODS
The present observational, cross-sectional study was carried out in compliance with the guidelines of Resolution 196/96 of the Brazilian National Board of Health and received approval from the Human Research Ethics Committee of the Universidade Nove de Julho (Brazil) under process number 249781/2009. The parents/guardians of the participants were duly informed regarding the objectives and procedures of the study and agreed to the participation of their child or adolescent by signing a statement of informed consent.
Among the 105 children enrolled at the Rogationist Institute in the city of Sao Paulo (Brazil), 48 fulfilled the eligibility criteria and participated in the study. The inclusion criterion was the presence of four erupted permanent first molars without carious lesions. The exclusion criteria were neurological problems and past or current history of orthodontic or orthopedic treatment of the jaws.
The investigation of TMDwas performed using the Helkimo Index, followed by a clinical exam involving an extraoral and intraoral inspection of the teeth and bite, palpation of the trapezius, sternocleidomastoid, temporal, masseter, digastricand medial pterygoid muscles, palpation of the temporomandibular joints and an analysis of mandibular movement with the aid of a digital caliper for measures of maximum mouth opening and lateral movements.
A clinical examination was performed for the measurement of data referring to VDO. For such, the child remained seated under natural light, with the head aligned with the body and gaze fixed on a predetermined point. The following measures were performed during centric occlusion using a digital caliper (Mytutoyo):2020 . Thilander B, Rubio G, Pena L, de Mayorga C. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development. Angle Orthod. 2002;72(2):146-54.
1 – distance from lip commissure to outer corner of eye (LC – CE);
2 – distance from base of nose (nasium) to chin (mentum) (Na – Me).
The data were tabulated and submitted to statistical tests. Descriptive statistics (mean and standard deviation) were used for the characterization of the sample. Analysis of variance (ANOVA) complemented by the least significant difference (LSD) test was used for the comparison of mean anthropometric measures between genders and groups with and without TMD. The level of significance was set to 5%.
RESULTS
Among the 48 children and adolescents evaluated, 15 (31%) were male and 33 (69%) were female. Mean age was 9.8 ± 1.56 years. The diagnostic exams revealed what 35 (72.9%) of the participants exhibited TMDand 13 (27.2%) did not have the disorder. Considering all ages, mean LC-CE distance was 59.30 ± 4.52 mm and mean Na-Me distance was 61.39 ± 4.48 mm. Table 1 displays the descriptive statistics for LC-CEand Na-Me at all ages analyzed.
Stratifying the data by age, the minimum LC-CE distance was 52.30 mm at nine years of age and maximum LC-CE was 70.20 mm at 12 years of age. Minimum Na-Me distance was 56.70 mm at seven years of age and maximum Na-Me was 68.70 mm at 11 years of age (Table 2).Pearson’s correlation was significant (0.47) for the correlation between the LC-CEand Na-Me measures.
Table 3 displays the results of the comparison of measures using the paired t-test for all ages together and separately. A statistically significant difference between LC-CEand Na-Me was found at 10 years of age. Moreover, the p-value was precisely 0.05 at 12 years of age, which can also be considered statistically significant. No significant differences were found for the other ages.
Stratifying by gender, the correlation between LC-CEand Na-Me was non-significant for the male gender (p = 0.60959), but significant for the female gender (p=0.01126) (Table 4).
A statistically significant difference in mean VDO was found between participants with and without TMD in both genders (Table 5).
DISCUSSION
The results of the present study demonstrate different measures of VDOin all age groups analyzed(7 to 12 years). Significantly significant changes in VDOwere found in both genders at 10 and 12 years of age, which is likely due to the instability in growth that occurs when the VDO increases due to the eruption of the permanent premolars and second molars caused by active bone apposition and reposition2121 . Sant’Ana, E. Avaliação comparativa do padrão de normalidade do perfil facial em pacientes Brasileiros leucodermas e em Norte-Americanos. Rev Dent Press Ortodon Ortop Facial. 2009;14(1):80-9..
There is no consensus in the literature on the relation of VDO measures in the deciduous and mixed dentition phases2121 . Sant’Ana, E. Avaliação comparativa do padrão de normalidade do perfil facial em pacientes Brasileiros leucodermas e em Norte-Americanos. Rev Dent Press Ortodon Ortop Facial. 2009;14(1):80-9.,2222 . Chaves TC, Oliveira AS, Grossi DB. Principais instrumentos para avaliação da disfunção temporomandibular, parte II: critérios diagnósticos; uma contribuição para a parte clínica e de pesquisa. Fisio e Pesq. 2008;15(1):101-6.. In adults, however, this distance should have the same proportion as the LC-CE for facial balance and so that the muscles can function correctly, thereby avoiding future problems with malocclusion2323 . Fonseca DM, Bonafante G, Valle AL, Freitas SFT. Diagnóstico pela anamnese da disfunção craniomandibular. RGO. 1994;42(1):23-8.,2424 . Strajnić L, Stanisić-Sinobad D, Marković D, Stojanović L. Cephalometric indicators of the vertical dimension of occlusion. Coll Antropol. 2008; 32(2):535-41..
In the present study, the smallest LC-CE distance was 47.40 mm at nine years of age and the largest was 70.20 mm at 12 years of age, whereas the smallest Na-Me distance was 52.30 mm at seven years of age and the largest was 68.70mm at 11 years of age. As each 3 mm in change in VDOleads to an approximate change of 0.8 mm in the central relation,2020 . Thilander B, Rubio G, Pena L, de Mayorga C. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development. Angle Orthod. 2002;72(2):146-54. it is important to maintain the ideal VDOin accordance with age for a correct central relation, thereby avoiding problems with the occlusion and temporomandibular joint, as such problems can cause changes in the muscles and joints indicative of TMD33 . Ciavarella D, Parziale V, Mastrovincenzo M, et al. Condylar Position Indicator and T-Scan system II in clinical evaluation of temporomandibular intracapsular disease. J Craniomaxillofac Surg. 2012;40(5):449-55.,1111 . Manfredini D, Castroflorio T, Perinetti G, Guarda- Nardini L. Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading for. J Oral Rehabil. 2012;39(6):463-71.,2121 . Sant’Ana, E. Avaliação comparativa do padrão de normalidade do perfil facial em pacientes Brasileiros leucodermas e em Norte-Americanos. Rev Dent Press Ortodon Ortop Facial. 2009;14(1):80-9.,2222 . Chaves TC, Oliveira AS, Grossi DB. Principais instrumentos para avaliação da disfunção temporomandibular, parte II: critérios diagnósticos; uma contribuição para a parte clínica e de pesquisa. Fisio e Pesq. 2008;15(1):101-6..
A previous study demonstrated that changes in the bite of more than or less than 2 mm can cause a 50% interincisal increase during intercuspation and a 40% increase in the resting position2323 . Fonseca DM, Bonafante G, Valle AL, Freitas SFT. Diagnóstico pela anamnese da disfunção craniomandibular. RGO. 1994;42(1):23-8., which can impair facial esthetics1919 . Egermark-Eriksson I, Carlsson GE, Magnusson T. A 20-year longitudinal study of subjective symptoms of temporomandibular disorders from childhood to adulthood. Acta Odontol Scand. 2001;59(1):40-8.. Deficiencies in VDOcan also have an negative impact on facial attractiveness and the development of malocclusions2222 . Chaves TC, Oliveira AS, Grossi DB. Principais instrumentos para avaliação da disfunção temporomandibular, parte II: critérios diagnósticos; uma contribuição para a parte clínica e de pesquisa. Fisio e Pesq. 2008;15(1):101-6..
A statistically significant association between VDOand age was found in both genders and an association was found with TMDin 35 children (72.91% of the sample). Moreover, children with TMD demonstrated greater variations in VDOin comparison to those without TMD. This variation ranged from 52 to 70 mmin children and adolescents with TMD and 56.1 to 65.70 mm among those without the disorder.
As the temporomandibular jointundergoes constant remodeling in adolescence, high prevalence rates of signs and symptoms of TMD are found in this age group2222 . Chaves TC, Oliveira AS, Grossi DB. Principais instrumentos para avaliação da disfunção temporomandibular, parte II: critérios diagnósticos; uma contribuição para a parte clínica e de pesquisa. Fisio e Pesq. 2008;15(1):101-6.,2323 . Fonseca DM, Bonafante G, Valle AL, Freitas SFT. Diagnóstico pela anamnese da disfunção craniomandibular. RGO. 1994;42(1):23-8.. The present data are in agreement with these findings, as 72.91% of the sample exhibited signs and symptoms of TMD. The results underscore the importance of an early diagnosis to impede the progress of the disorder and limit the harm caused to the stomatognathic system. On the other hand, the fact that the temporomandibular jointundergoes constant remodeling in childhood and adolescence may imply that TMDis not related to changes in VDO. A previous longitudinal study involving children treated with orthodontics/orthopedics of the jaws (which sometimes increases the VDO)followed up for a 30-year period concluded that one cannot affirm whether the treatment had a beneficial or harmful effect on the presence of TMD2424 . Strajnić L, Stanisić-Sinobad D, Marković D, Stojanović L. Cephalometric indicators of the vertical dimension of occlusion. Coll Antropol. 2008; 32(2):535-41..
The current consensus is that determinant factors of functional changes in the stomatognathic system are those that have a negative impact on the balance among the bite, muscles of mastication and temporomandibular jointand that TMD may be caused by occlusal macro-traumas and micro-traumasthat affect chewing function and cause functional asymmetry of the stomatognathic system99 . Geerts GA, Stuhlinger ME, Nel DG. A comparison of the accuracy of two methods used by pre-doctoral students to measure vertical dimension. J Prosthet Dent. 2004;91(1):59-66.,2525 . Lucena LBS, Kosmisky M, Costa LJ, Góes PSA. Validation of the portuguese version of theRDC/TMD axis II questionnaire. Braz Oral Res. 2006; 20(4):312-7.,2626 . Dworkin SF, Huggins KH, Leresche L, von Korff M, Howard J, Truelove E, et al. Epidemiology of signs and symptoms in temporomandibular disordens: clinical signs in case and controls. J Am Dent Assoc. 1990;120(3):273-81.. A number of studies have demonstrated that there is no standardized method for the detection of TMD. One should also bear in mind that individual variation is an important factor to the development of TMD. In a recent systematic review involving 37 papers, the craniomandibular index was used in one paper, the Research Diagnostic Criteria for Temporomandibular Disorders was used in nine, a clinical patient-history protocol was used in 21 papers and Helkimodisorder index was used in six papers2727 . Moyers RE. Etiologia da Maloclusão. In: Moyers, RE. Ortodontia. 4. ed. Rio de Janeiro: Guanabara Koogan. 1991. p. 212-37..
TMD is a multifactor disorder with a psychogenic influence that affects quality of life2727 . Moyers RE. Etiologia da Maloclusão. In: Moyers, RE. Ortodontia. 4. ed. Rio de Janeiro: Guanabara Koogan. 1991. p. 212-37.and increases with age in adolescence and young adulthood2828 . Toscano P, Defabianis P Clinical evaluation of temporomandibular disorders in children and adolescents: a review of the literature. Eur J Paediatr Dent. 2009;10(4):188-92.. In a recent study, Pereira et al.2929 . Pereira LJ, Pereira-Cenci T, Del Bel Cury AA, Pereira SM, Pereira AC, Ambosano GM, Gavião MB. Risk indicators of temporomandibular disorder incidences in early adolescence. Pediatr Dent. 2010;32(4):324-8. evaluated risks for the development of TMDin adolescents and concluded that the gestational behavior of the mother, malocclusion, menarche and harmful oral habits were not associated with TMDand that gender alone was correlated with the incidence of TMDin 12-year-old patients.
Another study concluded that it is not possible to establish an association between TMDand orthodontic treatment, as occlusion may not be the main factor in the development of the disorder. In contrast, Laucis-Pinto3030 . Laucis-Pinto S, Diegues MB, Ferreira SLM, Simonato CASS. Bruxismo em odontopediatria e sua correlação com hábitos orais. Rev Paul Odontol. 2000; 22(5):10-8. and Bevilacqua3131 . Bevilaqua DG, et al. Atividade Eletromiográfica dos músculos masseter e temporal anterior de crianças com mordida cruzada posterior unilateral (MCPu). Rev. Bras. Fisioter. 2005;9(2):257-63. state that occlusion is indeed one of the etiological agents of TMD. In the present study, 12-year-old patients exhibited a statistically significant change in the difference between LC-CEand Na-Me measures, demonstrating a positive correlation between TMDandVDOin this age group.
For an effective diagnosis of TMD, it is important to evaluate all variables capable of influencing the harmony of the stomatognathic system, including the variability in VDO, to prevent this disorder and allow craniofacial growth and development within the patterns of normality. Further studies with a larger number of individuals in each age group are needed to establish the actual mean VDOin children and adolescent during craniofacial development.
CONCLUSION
In the present study, a direct association was found between TMD and VDO, with positive correlations between the lip commissure to outer corner of eye and the nasium to mentum in the female sex as well as significant changes in the vertical dimension of occlusion at 10 and 12 years of age in both genders.
REFERÊNCIAS
-
1Knelbeman S. Method for determining vertical dimension. Patent Storm. 2006;1:14-8.
-
2Spers F. Occlusion the new millennium: the controversy continuous. Spears Perspect. 2007;3(2):64-9.
-
3Ciavarella D, Parziale V, Mastrovincenzo M, et al. Condylar Position Indicator and T-Scan system II in clinical evaluation of temporomandibular intracapsular disease. J Craniomaxillofac Surg. 2012;40(5):449-55.
-
4Al-Ninri KS. Vertical Changes in class II division I maloclussion afterpremolar extraction. The Angle Ortho. 2008;76(1):52-8.
-
5Ohnuki Y, Kawai N, Tanaka E, Langenbach GE, Tanne K, Saeki Y. Effects of increased occlusal vertical dimension on daily activity and myosin heavy chain composition in rat jaw muscle. Arch Oral Biol. 2009;54(8):783-9.
-
6Krey KF, Dannhauer KH. Morphometric analysis of facial profile in adults. J Orofac Orthop. 2008;69(6):424-36.
-
7Misch CE. Guidelines for maxillary incisal edge position-a pilot study: the key is the canine. J Prost. 2008;17(2):130-4.
-
8Cutbirth ST. Increasing vertical dimension: considerations and steps in reconstruction of the severely worn dentition. Pract Proced Aesthet Dent. 2008;20(10):619-26.
-
9Geerts GA, Stuhlinger ME, Nel DG. A comparison of the accuracy of two methods used by pre-doctoral students to measure vertical dimension. J Prosthet Dent. 2004;91(1):59-66.
-
10Torii K, Chiwata I. Occlusal adjustment using the bite plate-induced occlusal position as a reference position for temporomandibular disorders: a pilot study. Head Face Med. 2010;6:5.
-
11Manfredini D, Castroflorio T, Perinetti G, Guarda- Nardini L. Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading for. J Oral Rehabil. 2012;39(6):463-71.
-
12Marini I, Gatto MR, Bonetti GA. Effects of superpulsed low-level laser therapy on temporomandibular joint pain. Clin J Pain. 2010;26(7):611-6.
-
13Andrade TNC, Frare JC. Estudo comparativo entre os efeitos de técnicas de terapia manual isoladas e associadas à laserterapia de baixa potência sobre a dor em pacientes com disfunção temporomandibular. Rev Gauch Odontol. 2008;56 (3):287-95.
-
14Frare JC, Nicolau RA. Análise clínica do efeito da fotobiomodulação laser (GaAs – 904 nm) sobre a disfunção temporomandibular. Rev Bras Fisioter. 2008;12(1):37-42.
-
15Okson JP. Tratamento das desordens temporomandibulares e oclusão. Rio de Janeiro-RJ: Ed. Elsevier; 2008.
-
16Carrasco TG, Mazzetto MO, Mazzetto RG, Mestriner W. Low intensity laser therapy in temporomandibular disorder: a phase II double – blind study. J Craniomandibular Pract. 2008;26(4):274-81.
-
17Motta LJ, Guedes CC, De Santis TO, Fernandes KP, Mesquita-Ferrari RA, Bussadori SK. Association between parafunctional habits and signs and symptoms of temporomandibular dysfunction among adolescents. Oral Health Prev Dent. 2013;11(1):3-7.
-
18Motta LJ, Martins MD, Fernandes KP, Mesquita-Ferrari RA, Biasotto-Gonzalez DA, Bussadori SK. Craniocervical posture and bruxism in children. Physiother Res Int. 2011;16(1):57-61.
-
19Egermark-Eriksson I, Carlsson GE, Magnusson T. A 20-year longitudinal study of subjective symptoms of temporomandibular disorders from childhood to adulthood. Acta Odontol Scand. 2001;59(1):40-8.
-
20Thilander B, Rubio G, Pena L, de Mayorga C. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development. Angle Orthod. 2002;72(2):146-54.
-
21Sant’Ana, E. Avaliação comparativa do padrão de normalidade do perfil facial em pacientes Brasileiros leucodermas e em Norte-Americanos. Rev Dent Press Ortodon Ortop Facial. 2009;14(1):80-9.
-
22Chaves TC, Oliveira AS, Grossi DB. Principais instrumentos para avaliação da disfunção temporomandibular, parte II: critérios diagnósticos; uma contribuição para a parte clínica e de pesquisa. Fisio e Pesq. 2008;15(1):101-6.
-
23Fonseca DM, Bonafante G, Valle AL, Freitas SFT. Diagnóstico pela anamnese da disfunção craniomandibular. RGO. 1994;42(1):23-8.
-
24Strajnić L, Stanisić-Sinobad D, Marković D, Stojanović L. Cephalometric indicators of the vertical dimension of occlusion. Coll Antropol. 2008; 32(2):535-41.
-
25Lucena LBS, Kosmisky M, Costa LJ, Góes PSA. Validation of the portuguese version of theRDC/TMD axis II questionnaire. Braz Oral Res. 2006; 20(4):312-7.
-
26Dworkin SF, Huggins KH, Leresche L, von Korff M, Howard J, Truelove E, et al. Epidemiology of signs and symptoms in temporomandibular disordens: clinical signs in case and controls. J Am Dent Assoc. 1990;120(3):273-81.
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Funding: FAPESP process [2009/54628-5]
Publication Dates
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Publication in this collection
may-jun 2014
History
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Received
12 Feb 2013 -
Accepted
22 May 2013