Botulinum toksin u liječenju temporomandibularnih poremećaja

master's thesis

• Title (english): Botulinum toxin in the treatment of temporomandibular disorders
• Author: Ivan Orabović
• Mentor: Ema Vrbanović (mentor)
• Granter: University of Zagreb; School of Dental Medicine; Zagreb
• Defense date and country: 2023-07-10, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine

Abstract

Temporomandibularni poremećaji (TMP) najčešći su kronični bolni poremećaji orofacijalne regije nakon bolova uzrokovanih zubima. Mogu zahvaćati temporomandibularni zglob (TMZ) i/ili žvačne mišiće, a dijele se u bolna stanja te stanja bez boli. Budući da su to višečimbenični poremećaji koji imaju svoju somatsku i psihološku komponentu, liječenje je kompleksno i dugotrajno. Za liječenje TMP-a uglavnom se primjenjuju neinvazivne metode poput: okluzijskih udlaga, farmakoterapije, kineziterapije te kognitivno-bihevioralne terapije. Iako su takve metode uglavnom uspješne, kod nekih pacijenata ponekad daju ograničene rezultate što dovodi do potrage za novim, alternativnim terapijskim mogućnostima poput botulinum neurotoksina (BoNT). BoNT bakterijski je proteinski toksin dobiven iz roda Clostridium botulinum koji se u medicinske terapijske svrhe koristi već preko 30 godina. U dentalnoj medicini razmatra se uloga BoNT-a kao glavnog ili dodatnog terapijskog sredstva u bolnim mišićnim stanjima (mialgija), intraartikularnim poremećajima (pomak diska) te parafunkcijskim navikama poput bruksizma. Smatra se kako bi BoNT u liječenju kronične boli mogao imati trojnu ulogu: 1.) blokadom otpuštanja neurotransmitera acetilkolina iz živčanih završetaka motornih neurona uzrokuje reverzibilnu paralizu mišića, 2.) smanjenjem otpuštanja medijatora boli na periferiji ima antinociceptivni učinak te 3.) djelovanjem na spinalnoj razini ostvaruje svoje centralno djelovanje. Iako recentna literatura pokazuje blagotvorni utjecaj botulinum neurotoksina na navedena patološka stanja, potrebna su daljnja kvalitetna i dobro koncipirana istraživanja kako bi se utvrdio točan terapijski učinak kao i sami protokol aplikacije botulinum neurotoksina, te eventualno proširile indikacije njegove primjene u dentalnoj medicini.

Abstract (english)

Temporomandibular disorders (TMD) are the most common chronic pain disorders of the orofacial region after pain caused by teeth. They can affect the temporomandibular joint (TMJ) and/or masticatory muscles, and they are divided into painful and painless conditions. The treatment is sometimes complex and long-term since these are multifactorial disorders with somatic and psychological components. The main treatment methods of TMD are non-invasive methods such as occlusal splints, pharmacotherapy, kinesitherapy, and cognitive-behavioral therapy. Although these methods are generally successful, they provide limited results in some patients, leading to the search for new, alternative therapeutic options such as botulinum neurotoxin (BoNT). BoNT is a bacterial protein toxin obtained from the Clostridium botulinum, which has been used for medical purposes for over 30 years. BoNT, as a therapeutic option in dental medicine, is considered in painful muscle conditions (myalgia), intra-articular disorders (disc dislocation), and parafunctional habits such as bruxism. It is believed that BoNT can have a triple role in the treatment of chronic pain: 1) it causes reversible muscle paralysis by blocking the release of the neurotransmitter acetylcholine from the nerve endings of motor neurons, 2) it has an antinociceptive effect by reducing the release of pain mediators in the periphery, and 3) it achieves its central action by acting on the spinal level. Although recent literature shows the beneficial effect of botulinum neurotoxin on the aforementioned pathological conditions, further high-quality and well-designed research is needed to determine the exact therapeutic effect as well as the botulinum neurotoxin application protocol, and possibly expand the indications for its use in dental medicine.

• Keywords: temporomandibularni poremećaji; botulinum toksin; bruksizam; žvačni mišići
• Keywords (english): temporomandibular disorders; botulinum toxin; bruxism; masticatory muscles
• Language: croatian
• URN:NBN: urn:nbn:hr:127:779781
• Study programme: Title: dental medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-07-05 06:42:14