Title Kliničko istraživanje kretnji i položaja donje čeljusti ultrazvučnim postupkom Title (english) Clinical study of movements and positions of lower jaw with ultrasonic method Author Samir Čimić Mentor Sonja Kraljević-Šimunković (mentor)Committee member Adnan Ćatović (predsjednik povjerenstva)Committee member Melita Valentić-Peruzović (član povjerenstva)Committee member Robert Ćelić (član povjerenstva)Committee member Tomislav Badel (član povjerenstva)Committee member Sunčana Simonić Kocijan (član povjerenstva)Granter University of Zagreb Defense date and country 2014-09-09, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616.31 - Stomatology Abstract Kinematika donje čeljusti posebno je zanimljivo područje u znanstvenom i kliničkom smislu. Temeljem novih spoznaja i primjenom suvremene metodologije može se utjecati na unapređenje uvriježenog načina rada. Istraživanje je podijeljeno u tri dijela u kojima su sva mjerenja učinjena korištenjem ultrazvučnog uređaja za snimanje i analizu kinematike donje čeljusti, sa šest stupnjeva slobode. Cilj prvog dijela (N=104) bilo je utvrđivanje vrijednosti kuta nagiba kondilne staze, imedijatnog pomaka u stranu, Bennettovog kuta, kuta incizijskog vođenja, kuta lateralnog prednjeg vođenja i pomaka iz okluzije centrične relacije u maksimalnu interkuspidaciju, te utvrđivanje razlika između različitih skupina ispitanika (prema British Standard Instituteu i klasifikaciji po Angleu). Kod klase I, II/1 i II/2 po Angleu nisu utvrđene razlike prosječnih vrijednosti postavki artikulatora putem KTS sustava. Kod klase III po Angleu su utvrđene u prosjeku niže vrijednosti kuta incizijskog vođenja, kuta lateralnog prednjeg vođenja i kuta nagiba kondilne staze, te su za pacijente s Angle klasom III sugerirane niže vrijednosti prosječnih postavki tih parametara artikulatora. U svih ispitanika imedijatni pomak u stranu je iznosio 0 mm. Ako je imedijatni pomak u stranu definiran kao trenutni pomak ne treba ga očekivati kod ljudi sa zdravim TMZ. Prosječna vrijednost Bennettovog kuta iznosila je 8°, bez razlika prema klasama okluzije. Utvrđena je prosječna vrijednost pomaka iz okluzije centrične relacije u maksimalnu interkuspidaciju od 0,68 mm, uz najčešći anteroinferiorni smjer. Podudaranje okluzije centrične relacije i maksimalne interkuspidacije utvrđeno je u manje od 10% ispitanika. Svrha drugog dijela istraživanja bila je analiza ponovljivosti određivanja centrične relacije kod ispitanika s dislokacijom diska s redukcijom, i ispitanika sa zdravim TMZ. Svim ispitanicima su određena tri registrata centrične relacije metodom vođenja brade, te su mjerene razlike položaja kondila. Statistička obrada nije utvrdila razliku između dvije promatrane skupine. Drukčiji pristup pacijentima s dislokacijom diska s redukcijom prilikom određivanja centrične relacije ne može se preporučiti. U treći dio istraživanja uključeno je 15 ispitanika kojima su napravljene po dvije stabilizacijske udlage; jedna korištenjem KTS sustava individualizacije artikulatora, a druga prijenosom obraznim lukom uz prosječne postavke artikulatora. Statističkom obradom nije utvrđena značajna razlika u preciznosti između dvije metode. Ipak, granični rezultati sugeriraju prijenos obraznim lukom uz individualizaciju vrijednosti artikulatora kao precizniju metodu.
Abstract (english) Objective: Lower jaw kinematics is an interesting area, both in scientific and clinical applications. Improvements of the common methods can result from application of modern technology and new achievements. The present study consisted of three different parts. The objective of the first part of the study (N=104) was to determine values of the sagittal condylar inclination, immediate side shift, Bennett angle, incisal guide angle, lateral anterior guidance angle, slide from centric occlusion to intercuspal position, and to determine variations between different groups of participants (British Standards Institution's incisal classification and Angle's classification). The purpose of the second part of the investigation was to study the reproducibility of the centric relation records between participants with disc displacement with reduction, and participants with healthy temporomandibular joints. The purpose of the third part of the study was to determine precision between two methods of bite splint fabrication: KTS system and average facebow transfer with average values of the articulator settings.
Methods: All measuremets were performed using an ultrasonic device for jaw kinematics measurements and analysis with six degrees of freedom. In the second part of the study three centric relation records using the chin point guidance technique were determined for each subject, and variations between condylar positions were measured. The third part of the study involved 15 participants, who received two stabilization splints; one was made with the KTS system of the articulator settings, and the second one with an average facebow transfer and average values of the articulator settings. Precision of these two methods was tested.
Results: Angle class I, II/1 and II/2 showed no difference in average values of the articulator settings with the KTS system. Angle class III group showed lower values for the sagittal condylar inclination, incisal guidance angle and lateral anterior guidance angle. The average value for the Bennett angle was 8°, consistent for all occlusion types. All the participants showed 0 mm for the immediate side shift. The obtained average value for centric occlusion to intercuspal position slide was 0.68 mm, with anteroinferior direction being the most frequent. An identical position for centric occlusion and intercuspal position was determined in less than 10% of the subjects. In the second part of the study, no statistically significant differences were determined between the two groups. The third part of the study showed no statistically significant difference in precision between the two studied methods.
Conclusion: Results suggest lower values for the sagittal condylar inclination, incisal guidance angle and lateral anterior guidance angle for average articulator settings in patients with Angle class III. Differences in Bennett angle values in different occlusion types are not
expected. If the immediate side shift is defined as an „immediate“ movement, it should not be expected in subjects with healthy temporomandibular joint. Results of the present study suggest that during centric relation recording in patients with disc displacement with reduction a different approach than usual cannot be recommended. Although there was no difference in precision between the two studied methods, the results suggested facebow transfer with individual articulator settings as the most precise method for the bite splint fabrication.
Keywords
donja čeljust
kinematika
kut nagiba kondilne staze
Bennettov kut
imedijatni pomak u stranu
kut incizijskog vođenja
kut lateralnog prednjeg vođenja
okluzija centrične relacije
artikulator
centrična relacija
dislokacija diska
udlaga
Keywords (english)
mandible
temporomandibular joint
malocclusion
Angle class I
malocclusion
Angle class II
dental articulators
Language croatian URN:NBN urn:nbn:hr:127:580866 Study programme Title: dental medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2017-03-15 11:08:10
