Ricerca traslazionale dell'analisi digitalizzata delle forze occlusali applicata al paziente con disfunzione temporomandibolare

TRANSLATIONAL RESEARCH OF DIGITAL ANALYSIS OF OCCLUSAL FORCES APPLIED TO THE PATIENT WITH TEMPOROMANDIBULAR DYSFUNCTION ABSTRACT AIM: To date, with the term "Temporomandibular Dysfunction" we indicate a set of pathological pictures involving ATM, masticatory muscles and related structures. In the current state of knowledge, the etiopathogenesis of these dysfunctions is not yet fully clarified. The researchers agree that a series of factors influence the course and constitute the "pattern". Between them, the scientific research has focused its attention on the "occlusal factor", which is still the most controversial and debated today. For his study he focused in particular on the analysis of the occlusal contacts analyzed by number and distribution by using conventional non-digital methods. No study has ever been able to clarify whether certain alterations in the distribution of occlusal contacts detectable on dysfunctional patients were prior or subsequent to the onset of dysfunction and what its role was. The continuous development of technologies in the biomedical field, has made available to researchers a digitized tool, the T-Scan III, able to analyze the occlusal contacts from the point of view of the force that is expressed on them and of their behavior over time. The purpose of this work is to perform a translational research on the digitized analysis of the occlusal forces applied to the patient with temporomandibular dysfunction to evaluate the possibility of its use to support the clinician both during the diagnostic evaluation and in the control phase. MATERIALS AND METHODS: The research is divided into four different phases with a progressive deepening in the evaluation of the data detected by means of the tool. In a first phase, data were compared to 28 healthy subjects with those coming from tests carried out on 35 patients with a diagnosis of temporomandibular dysfunction formulated according to the diagnostic criteria DC / TMD. After this phase, the number of patients under examination was expanded to 160. In the second phase the research was carried out to bring out possible relationships between a given pattern of occlusal forces and a given clinical picture. In the third phase, the occlusal force patterns detected before and after treatment with occlusal splints were compared. Finally, the possible correlation between the distribution of occlusal forces and the three main symptoms associated with dysfunction was studied: cervicalgia, headache, joint pain. The analysis of the occlusal forces was carried out by evaluating the following parameters: percentage of the force referred to the single dental element, to the side (right and left), to the sector (posterior and anterior); behavior of the COF (Center of Occlusal Forces); trend of the black line; occlusiontime (OT); the disclusiontime (DT). RESULTS: The analysis of results highlighted the differences between healthy subjects and dysfunctional patients both from the point of view of the model of distribution of occlusal forces and from the point of view of the behavior of the COF. In the subsequent study phases it was found that there are differences in tendencies that can correlate a given model of force distribution and a given clinical picture. In the research phase on the relationship between occlusal forces and symptoms, it was possible to observe a predictable behavior between occlusal force and symptom intensity evaluated according to the VAS scale. The phase of the research carried out on patients treated with splint, has shown that the evaluation of the forces allows detecting changes in the course of treatment.