Ziel dieser Studie war es, die Unterschiede der Reliabilität der Bewegungskapazität des Unterkiefers bei verschiedenen Untersucher- und Probandengruppen über einen Zeitraum von 3 Monaten mit dem Lineal darzustellen. Die Vermessung wurde bei 85 konsekutiv rekrutierten Probanden (Durchschnittalter: 39,8 ± 17,8 Jahre, 60 % weiblich, 56 mit kraniomandibulärer Dysfunktion) durchgeführt. Die Untersuchergruppe setzte sich aus einer Gruppe unerfahrener Studierender der Zahnmedizin, einer Gruppe von 6 erfahrenen, kalibrierten Zahnärzten und einem weiteren erfahrenen, kalibrierten Zahnarzt zusammen. Die Schneidekantendistanzen bei Mundöffnung, die Frontzahnstufen und die Laterotrusionsbewegungen der Probanden wurden in zwei separaten Sitzungen vermessen. In der ersten Sitzung nahmen alle drei Untersuchergruppen die Vermessungen vor, zum zweiten Zeitpunkt nur ein erfahrener Zahnarzt. Die Reliabilität wurde durch die Intra-Klassen-Korrelation berechnet. Die aktive und passive Schneidekantendistanz, sowie der Overjet und der Overbite wurden mit exzellenter Reliabilität vermessen. Die Laterotrusionsbewegungen zeigten sowohl rechts- als auch linksseitig gute bis exzellente Übereinstimmungen. Bei keiner Untersuchergruppe konnten statistisch signifikante Unterschiede zwischen der gesunden Probandengruppe und der Gruppe mit kraniomandibulären Dysfunktionen festgestellt werden. Die Ergebnisse dieser Arbeit zeigen, dass die Vermessung der Bewegungskapazität des Unterkiefers mit dem Lineal, sowohl untersucher- als auch probandenunabhängig über einen mittellangen Zeitintervall von 3 Monaten, eine reliable Prozedur ist und demzufolge als Grundlage für die Diagnosebildung zuverlässig genutzt werden kann.

Objective: We aim to improve our understanding of sleep physiology by describing the changes in mandibular position during sleep in normal subjects. Methods: We developed a novel method for mapping mandibular position simultaneously in three dimensions (anteroposterior, vertical and lateral) using magneto-resistive sensors strategically placed around 3 different moving joints on an external apparatus attached to the head and mandible. Spherical coordinates derived from these sensors provided information of jaw position in each of the three measurement planes. We assessed changes in jaw position in twelve healthy subjects (6 male, 6 female) aged (mean ± SD) 23 ± 7 years, Body Mass Index 22.5 ± 3.4 kg/m2, and with nasal resistance 3.24 ± 0.67 cmH2O/L/s by recording mandibular position simultaneously with overnight sleep polysomnography. Results: Jaw position was significantly influenced by sleep stage (p<0.001). The transition from wake to light sleep (stage one) was accompanied by significant jaw closure and jaw protrusion (p<0.05). As non-rapid-eye-movement (NREM) sleep deepened from stages 1 through slow wave sleep (SWS), vertical jaw opening (p<0.05) and posterior jaw movement progressively increased (p<0.05). REM sleep was associated with the greatest degree of jaw opening of all sleep stages (p<0.05). Lateral jaw position was not significantly different between sleep stages. Conclusion: This study describes, for the first time, an accurate method of measuring changes in mandibular position during sleep in all three dimensions. The observed changes during sleep in healthy subjects suggest a simultaneous modulation of upper airway muscular tone, which may be important in the understanding of upper airway occlusion in Obstructive Sleep Apnea. / Thesis (Master, Physiology) -- Queen's University, 2008-08-29 14:27:57.726

Ziel dieser Studie war es, die Unterschiede der Reliabilität der Bewegungskapazität des Unterkiefers bei verschiedenen Untersucher- und Probandengruppen über einen Zeitraum von 3 Monaten mit dem Lineal darzustellen. Die Vermessung wurde bei 85 konsekutiv rekrutierten Probanden (Durchschnittalter: 39,8 ± 17,8 Jahre, 60 % weiblich, 56 mit kraniomandibulärer Dysfunktion) durchgeführt. Die Untersuchergruppe setzte sich aus einer Gruppe unerfahrener Studierender der Zahnmedizin, einer Gruppe von 6 erfahrenen, kalibrierten Zahnärzten und einem weiteren erfahrenen, kalibrierten Zahnarzt zusammen. Die Schneidekantendistanzen bei Mundöffnung, die Frontzahnstufen und die Laterotrusionsbewegungen der Probanden wurden in zwei separaten Sitzungen vermessen. In der ersten Sitzung nahmen alle drei Untersuchergruppen die Vermessungen vor, zum zweiten Zeitpunkt nur ein erfahrener Zahnarzt. Die Reliabilität wurde durch die Intra-Klassen-Korrelation berechnet. Die aktive und passive Schneidekantendistanz, sowie der Overjet und der Overbite wurden mit exzellenter Reliabilität vermessen. Die Laterotrusionsbewegungen zeigten sowohl rechts- als auch linksseitig gute bis exzellente Übereinstimmungen. Bei keiner Untersuchergruppe konnten statistisch signifikante Unterschiede zwischen der gesunden Probandengruppe und der Gruppe mit kraniomandibulären Dysfunktionen festgestellt werden. Die Ergebnisse dieser Arbeit zeigen, dass die Vermessung der Bewegungskapazität des Unterkiefers mit dem Lineal, sowohl untersucher- als auch probandenunabhängig über einen mittellangen Zeitintervall von 3 Monaten, eine reliable Prozedur ist und demzufolge als Grundlage für die Diagnosebildung zuverlässig genutzt werden kann.:1 Einführung 1 2 Aufgabenstellung 8 3 Literaturübersicht 10 3.1 Prävalenz von RDC-TMD-Diagnosen bei Probanden mit CMD 10 3.2 Messinstrumente 12 3.3 Normwerte der Bewegungskapazität 12 3.4 Reliabilität 15 3.4.1 Interrater-Reliabilität der Bewegungskapazität 15 3.4.2 Intrarater-Reliabilität der Bewegungskapazität 18 3.5 Fazit der Literaturrecherche 19 4 Material und Methoden 20 4.1 Verwendete Materialien 20 4.2 Probanden 20 4.2.1 Probanden der Kontrollgruppe 21 4.2.2 Probanden der Gruppe kraniomandibuläre Dysfunktion (“CMD“) 21 4.2.3 Prävalenz der Diagnosen des RDC/TMD bei Probanden mit kraniomandibulärer Dysfunktion 22 4.3 Untersucher 22 4.4 Versuchsdurchführung 23 4.5 Statistische Auswertung 26 4.5.1 Berechnung der Reliabilität 26 4.5.2 Vergleich der Reliabilität 26 4.5.3 Berechnung des Goldstandards 26 4.5.4 Nullhypothesen 27 5 Ergebnisse 28 5.1 Durchschnittswerte 28 5.2 Reliabilitäten 29 5.2.1 Untersucherbezogener Vergleich der Reliabilität 29 5.2.2 Probandenbezogener Vergleich der Reliabilität 38 6 Diskussion 47 6.1 Gegenstand der Untersuchung 47 6.2 Methodische Stärken und Schwächen der Studie 47 6.2.1 Generalisierbarkeit 47 6.2.2 Genauigkeit der klinischen Untersuchung 48 6.3 Vergleich und Interpretation der Daten 48 6.3.1 Prävalenz der RDC/TMD-Diagnosen bei Patienten mit CMD 48 6.3.2 Durchschnittswerte 49 6.3.3 Untersucherbezogener Vergleich der Reliabilität 50 6.3.4 Probandenbezogener Vergleich der Reliabilitäten 53 6.4 Ausblick 54 7 Schlussfolgerung 56 8 Zusammenfassung 57 9 Literaturverzeichnis 60 10 Anhang 66 Eigenständigkeitserklärung 83 Publikationen 84 Danksagung 85

Due to the complex nature of jaw movements, three-dimensional (3D) movement recording provide information about the jaw movement capacity. The aim of the present report was to test the reliability of measuring lower jaw movements using a 3D movement recording system and to calculate the lower jaw movement volume. Lower jaw movements, recorded by 3D optoelectronic movement analysis system (MacReflex®) was compared with reference values from a digital caliper. Pre-tests were performed to develop a software to calculate the lower jaw movements in separate dimensions and its volume. Pilot tests with two test persons followed to register the lower jaw movements and calculate lower jaw movement volume. The results indicate low reliability of lower jaw movements measured by movement recording system compared with reference values from digital caliper, reflected by delta values (D = max-min). The values from the movement recording system indicate high variability reflected by higher levels of standard deviation for movement recorded values compared with digital caliper and by percentage values calculated from the differences between mean values of movement recording and digital caliper. The calculated lower jaw movement volume was 10.3 cm3 and 17.2 cm3 for the test persons, respectively. Conclusively, the results imply that further testing of the method is needed with larger series and test-retest reliability analysis to evaluate the possibility to improve accuracy of tracing jaw movements with recording device. The 3D-movement recording system together with the software could be used for calculation of lower jaw movement volume but its accuracy could not be validated.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-16T19:54:41Z No. of bitstreams: 1 Ana Paula Amaral.pdf: 2693688 bytes, checksum: 6f8e156a2426045e9230b1f6a49d5722 (MD5) / Made available in DSpace on 2018-07-16T19:54:42Z (GMT). No. of bitstreams: 1 Ana Paula Amaral.pdf: 2693688 bytes, checksum: 6f8e156a2426045e9230b1f6a49d5722 (MD5) Previous issue date: 2016-12-12 / Temporomandibular dysfunction is defined as a group of heterogeneous alterations that affect the temporomandibular joint, affecting important functional and anatomical elements, characterizing itself as a complex and multifactorial disease. His doctoral thesis was divided into four studies with the following objectives: Article 1 (protocol) and Article 4: to evaluate the influence of non-specific mandibular mobilization on mandibular opening movements and lateral excursions in women with TMD by means of pachymetry and the three-dimensional kinematic analysis of movement, as well as assessing pain intensity, functionality and quality of life; Article 2: identify if manual therapy is effective in treating TMD, as well as assess the accuracy of tools that are used to evaluate the rehabilitation of patients with TMD; Article 3: investigate the immediate effect of nonspecific mandibular mobilization on the range of motion in individuals with temporomandibular dysfunction. Thus we obtained as a result and conclusion: Article 2: manual therapy is effective in the treatment of TMD mainly in the reduction of muscular pain and to improve the ROM. The visual analogue scale (VAS) and clinical evaluation using RDC / TMD are the most used tools to evaluate the effects of Manual Therapy; Article 3: Nonspecific mandibular mobilization led to an immediate increase in maximal vertical mandibular movement, as well as increases in right and left lateral excursion in individuals with and without TMD; Article 4: Non-specific mandibular mobilization decreases pain intensity and influences the clinical improvement of the mandibular opening amplitude measured by pachymetry, but does not influence the functionality, quality of life and trajectory of the mandibular movements of patients with temporomandibular dysfunction. / A disfunção temporomandibular é definida como um grupo de alterações heterogêneas que afetam a articulação temporomandibular, acometendo importantes elementos funcionais e anatômicos, caracterizando-se assim como uma doença complexa e multifatorial. Essa tese de doutorado foi dividida em quatro estudos com os seguintes objetivos: Artigo 1 (protocolo) e Artigo 4 : avaliar a influência da mobilização mandibular inespecífica, sobre os movimentos mandibulares de abertura e excursões laterais, em mulheres com DTM, por meio da paquimetria e da análise cinemática tridimensional do movimento, bem como avaliar a intensidade da dor, a funcionalidade e a qualidade de vida; Artigo 2: identificar se a terapia manual é eficaz no tratamento para DTM, bem como avaliar a acurácia das ferramentas que são utilizadas para avaliar a reabilitação dos pacientes com DTM; Artigo 3: investigar o efeito imediato da mobilização mandibular inespecífica, na amplitude de movimento em indivíduos com disfunção temporomandibular. Assim obtivemos como resultado e conclusão: Artigo 2: a terapia manual é eficaz no tratamento da DTM principalmente na diminuição da dor muscular e para melhorar a ADM. A escala visual analógica (EVA) e avaliação clínica com o uso do RDC/TMD são as ferramentas mais utilizadas para avaliar os efeitos da Terapia Manual; Artigo 3: A mobilização mandibular inespecífica levou a um aumento imediato do movimento mandibular vertical máximo, bem como aumentos na excursão lateral direita e esquerda em indivíduos com e sem DTM; Artigo 4: A mobilização mandibular inespecífica diminui a intensidade de dor e influencia na melhora clínica da amplitude de abertura mandibular mensurada pela paquimetria, porém não influencia na funcionalidade, na qualidade de vida e na trajetória dos movimentos mandibulares de pacientes com disfunção temporomandibular.

A cirurgia ortognática é o procedimento cirúrgico que visa a correção das deformidades dentofaciais esqueléticas e pode levar a diminuição dos movimentos mandibulares, dor e edema. Uma possibilidade de tratamento para essas consequências é a fototerapia com laser de baixa potência. O objetivo deste estudo foi realizar uma avaliação longitudinal dos movimentos mandibulares, dor e edema em pacientes submetidos à cirurgia ortognática bimaxilar, após fototerapia com laser de baixa potência (LLLT). Foram avaliados 30 pacientes, divididos em grupo laser (n=15) e grupo controle (n=15) de modo aleatório. O grupo laser recebeu laserterapia pós-operatória por 19 sessões. O grupo controle recebeu placebo de laserterapia. Os grupos foram comparados quanto aos movimentos mandibulares - abertura máxima, lateralidade e protrusão máxima, dor - escala visual analógica, edema - medidas entre pontos cefalométricos, em um período de 60 dias após a cirurgia. Foram aplicados testes estatísticos para comparação entre os grupos (p<0,05). Houve diferença significante para abertura máxima, lateralidade e protrusão máxima nos períodos de 14 a 60 dias para a maioria das comparações. Foi verificada diferença significante para dor pós-operatória na maioria das comparações, nos períodos 24 h a 5 semanas, sendo que grupo laser atingiu o valor 0, 2 semanas antes. Ocorreu redução do edema, sem diferença estatisticamente significante para maioria das mensurações. Com base neste estudo, foi possível concluir que após a fototerapia com laser de baixa potência (LLLT) houve um ganho nos valores de todos os movimentos mandibulares, não houve diferença significante para ocorrência de edema e houve uma diminuição da ocorrência de dor. / The orthognathic surgery is the surgical procedure that aims to correct skeletal dentofacial deformities and can lead to decrease in jaw movements, pain and edema. A possible treatment for these consequences is the low-power laser phototherapy. The aim of this study was a longitudinal evaluation of jaw movements, pain and edema in patients undergoing orthognathic surgery bimaxillary after lowlevel laser light therapy (LLLT). We evaluated 30 patients divided into laser group (n=15) and control group (n=15) randomly. The laser group received postoperative laser therapy for 19 sessions. The control group received laser therapy placebo. The groups were compared regarding jaw movements - maximum aperture, laterality and maximum protrusion, pain - visual analog scale, edema - measured between cephalometric points in a period of 60 days after surgery. Statistical tests were applied to compare the groups (p <0.05). There was a significant difference for maximum aperture, laterality and maximum protrusion in periods of 14 to 60 days for most comparisons. There was a significant difference in postoperative pain in most comparisons, in the periods 24 h to 5 weeks, and laser group reached the value 0 a 2 weeks before. There was a reduction of edema, with no statistically significant difference for most measurements. Based on this study, it was concluded that after phototherapy with low power laser (LLLT) there was a gain in the amount of all mandibular movements, there was no significant difference in the occurrence of edema and there was a decrease in the occurrence of pain.

A cirurgia ortognática é o procedimento cirúrgico que visa a correção das deformidades dentofaciais esqueléticas e pode levar a diminuição dos movimentos mandibulares, dor e edema. Uma possibilidade de tratamento para essas consequências é a fototerapia com laser de baixa potência. O objetivo deste estudo foi realizar uma avaliação longitudinal dos movimentos mandibulares, dor e edema em pacientes submetidos à cirurgia ortognática bimaxilar, após fototerapia com laser de baixa potência (LLLT). Foram avaliados 30 pacientes, divididos em grupo laser (n=15) e grupo controle (n=15) de modo aleatório. O grupo laser recebeu laserterapia pós-operatória por 19 sessões. O grupo controle recebeu placebo de laserterapia. Os grupos foram comparados quanto aos movimentos mandibulares - abertura máxima, lateralidade e protrusão máxima, dor - escala visual analógica, edema - medidas entre pontos cefalométricos, em um período de 60 dias após a cirurgia. Foram aplicados testes estatísticos para comparação entre os grupos (p<0,05). Houve diferença significante para abertura máxima, lateralidade e protrusão máxima nos períodos de 14 a 60 dias para a maioria das comparações. Foi verificada diferença significante para dor pós-operatória na maioria das comparações, nos períodos 24 h a 5 semanas, sendo que grupo laser atingiu o valor 0, 2 semanas antes. Ocorreu redução do edema, sem diferença estatisticamente significante para maioria das mensurações. Com base neste estudo, foi possível concluir que após a fototerapia com laser de baixa potência (LLLT) houve um ganho nos valores de todos os movimentos mandibulares, não houve diferença significante para ocorrência de edema e houve uma diminuição da ocorrência de dor. / The orthognathic surgery is the surgical procedure that aims to correct skeletal dentofacial deformities and can lead to decrease in jaw movements, pain and edema. A possible treatment for these consequences is the low-power laser phototherapy. The aim of this study was a longitudinal evaluation of jaw movements, pain and edema in patients undergoing orthognathic surgery bimaxillary after lowlevel laser light therapy (LLLT). We evaluated 30 patients divided into laser group (n=15) and control group (n=15) randomly. The laser group received postoperative laser therapy for 19 sessions. The control group received laser therapy placebo. The groups were compared regarding jaw movements - maximum aperture, laterality and maximum protrusion, pain - visual analog scale, edema - measured between cephalometric points in a period of 60 days after surgery. Statistical tests were applied to compare the groups (p <0.05). There was a significant difference for maximum aperture, laterality and maximum protrusion in periods of 14 to 60 days for most comparisons. There was a significant difference in postoperative pain in most comparisons, in the periods 24 h to 5 weeks, and laser group reached the value 0 a 2 weeks before. There was a reduction of edema, with no statistically significant difference for most measurements. Based on this study, it was concluded that after phototherapy with low power laser (LLLT) there was a gain in the amount of all mandibular movements, there was no significant difference in the occurrence of edema and there was a decrease in the occurrence of pain.