<p>Within the ambulance care in Uppsala County a vacuum splint is used to immobilize fractures on extremities. The research available on which method of immobilizing to prefer during pre-hospital treatment is limited.</p><p> </p><p>The purpose of this pilot study was to examine the perceptions of the ambulance personal in Uppsala County on the issue of usability of SAM-splint and vacuum splint when immobilizing extremities. The project was also aimed at researching if SAM-splint could be seen as an alternative or a complement to vacuum splint, and to get an apprehension on any evident differences in patients’ perceived pain when treated with the two different approaches.</p><p> </p><p>A descriptive comparative study was carried out. All patients, regardless of age and sex, with the need of immobilizing supposed fractures, were included.  Patients with suspected femur fracture, collum fracture, or where pre-hospital care was not possible or in question, was excluded. The collection of data was done using a questionnaire designed by the students responsible for the project. The ambulance personal completed the questionnaire after having concluded the treatment.</p><p> </p><p>The result showed that all patients with fractures to their extremities were immobilized. There were no evident differences in how the personal experienced the application of the two methods of immobilizing, but rather they were generally both perceived as easy to use. In Uppsala, where the paramedics had access to both SAM-splint and vacuum splint, the SAM-splint was the predominant choice.</p><p> </p><p>Based on this pilot study it can be established that the ambulance personal experienced the methods for immobilizing as easy in the event of fractures to the extremities. The SAM-splint is to be seen as a complement to the vacuum splint. Any difference in perceived patient rated pain connected to the different methods of immobilizing was not to deduce.</p> / <p>Inom ambulanssjukvården i Uppsala län används vakuumsplint för immobilisering av extremitetsfrakturer. Forskning och kunskap om vilken immobiliseringsmetod som är att föredra vid prehospital handläggning av extremitetsfrakturer är begränsad.</p><p><strong> </strong></p><p>Syftet med detta pilotprojekt var att i Uppsala län undersöka ambulanspersonalens uppfattning om användarvänligheten av vakuumsplint och SAM-splint vid immobilisering. Målet med projektet var även att ta reda på om SAM-splint kunde ses som alternativ eller komplement till vakuumsplintar samt om det fanns några uppenbara skillnader i patientskattad smärta mellan de olika immobiliseringsmetoderna.<strong> </strong></p><p><strong> </strong></p><p>En deskriptiv komparativ studie genomfördes där alla patienter oavsett ålder och kön i behov av immobilisering av misstänkta extremitetsfrakturer inkluderas. Patienter med misstänkt femurfraktur, collumfraktur eller där prehospital immobilisering ej varit möjlig eller aktuell exkluderades. Insamling av data har skett med hjälp av ett frågeformulär utformat av projektansvariga studenter. Frågeformuläret besvarades av vårdansvarig ambulanspersonal efter avslutat vårdtillfälle.</p><p> </p><p>Resultatet visade att samtliga patienter med extremitetsfrakturer immobiliserades. Det fanns ingen uppenbar skillnad gällande personalupplevd applicering mellan de olika immobiliseringsmetoderna utan generellt uppfattades de enkla att använda. I Uppsala där ambulanspersonalen hade tillgång till både SAM-splint och vakuumsplint valdes övervägande SAM-splint.</p><p><strong> </strong></p><p>Med detta pilotprojekt som grund kan sägas att ambulanspersonalen ansåg att immobiliseringsmetoderna var enkla att använda vid extremitetsfrakturer. SAM-splint kan ses som komplement till vakuumsplinten. Någon skillnad i patientskattad smärta mellan de båda immobiliseringsmetoderna framkom ej.</p>

Within the ambulance care in Uppsala County a vacuum splint is used to immobilize fractures on extremities. The research available on which method of immobilizing to prefer during pre-hospital treatment is limited.   The purpose of this pilot study was to examine the perceptions of the ambulance personal in Uppsala County on the issue of usability of SAM-splint and vacuum splint when immobilizing extremities. The project was also aimed at researching if SAM-splint could be seen as an alternative or a complement to vacuum splint, and to get an apprehension on any evident differences in patients’ perceived pain when treated with the two different approaches.   A descriptive comparative study was carried out. All patients, regardless of age and sex, with the need of immobilizing supposed fractures, were included.  Patients with suspected femur fracture, collum fracture, or where pre-hospital care was not possible or in question, was excluded. The collection of data was done using a questionnaire designed by the students responsible for the project. The ambulance personal completed the questionnaire after having concluded the treatment.   The result showed that all patients with fractures to their extremities were immobilized. There were no evident differences in how the personal experienced the application of the two methods of immobilizing, but rather they were generally both perceived as easy to use. In Uppsala, where the paramedics had access to both SAM-splint and vacuum splint, the SAM-splint was the predominant choice.   Based on this pilot study it can be established that the ambulance personal experienced the methods for immobilizing as easy in the event of fractures to the extremities. The SAM-splint is to be seen as a complement to the vacuum splint. Any difference in perceived patient rated pain connected to the different methods of immobilizing was not to deduce. / Inom ambulanssjukvården i Uppsala län används vakuumsplint för immobilisering av extremitetsfrakturer. Forskning och kunskap om vilken immobiliseringsmetod som är att föredra vid prehospital handläggning av extremitetsfrakturer är begränsad.   Syftet med detta pilotprojekt var att i Uppsala län undersöka ambulanspersonalens uppfattning om användarvänligheten av vakuumsplint och SAM-splint vid immobilisering. Målet med projektet var även att ta reda på om SAM-splint kunde ses som alternativ eller komplement till vakuumsplintar samt om det fanns några uppenbara skillnader i patientskattad smärta mellan de olika immobiliseringsmetoderna.   En deskriptiv komparativ studie genomfördes där alla patienter oavsett ålder och kön i behov av immobilisering av misstänkta extremitetsfrakturer inkluderas. Patienter med misstänkt femurfraktur, collumfraktur eller där prehospital immobilisering ej varit möjlig eller aktuell exkluderades. Insamling av data har skett med hjälp av ett frågeformulär utformat av projektansvariga studenter. Frågeformuläret besvarades av vårdansvarig ambulanspersonal efter avslutat vårdtillfälle.   Resultatet visade att samtliga patienter med extremitetsfrakturer immobiliserades. Det fanns ingen uppenbar skillnad gällande personalupplevd applicering mellan de olika immobiliseringsmetoderna utan generellt uppfattades de enkla att använda. I Uppsala där ambulanspersonalen hade tillgång till både SAM-splint och vakuumsplint valdes övervägande SAM-splint.   Med detta pilotprojekt som grund kan sägas att ambulanspersonalen ansåg att immobiliseringsmetoderna var enkla att använda vid extremitetsfrakturer. SAM-splint kan ses som komplement till vakuumsplinten. Någon skillnad i patientskattad smärta mellan de båda immobiliseringsmetoderna framkom ej.

Obstructive sleep apnoea (OSA) is a common disorder characterized by repetitive closure of the upper airway during sleep and associated with significant adverse health effects including hypertension, heart disease and stroke. Current treatment with continuous positive airway pressure (CPAP) is highly effective but reduced compliance levels have resulted in suboptimal outcomes. Oral appliances such as mandibular advancement splints (MAS) are an alternative treatment and have potential advantages including greater patient compliance, comfort and portability. Although they have been shown to be successful across all categories of OSA severity, overall they are less effective than CPAP. A key limitation to its more widespread use has been the inability to predict which patients will be a treatment success. Prediction of treatment outcome would greatly enhance both MAS utilization and overall OSA management. However, little is known about the mechanisms of action of MAS therapy and a more detailed understanding is likely to improve patient selection and outcome. The aim of this thesis is to improve the prediction of treatment outcome through improved understanding of the mechanisms and site(s) of action of MAS therapy during sleep, through extrapolating this knowledge into daytime prediction tests and by developing prediction equations which can be tested prospectively. The work in this thesis presents novel ideas and findings. It is the first to examine and find that MAS therapy improves upper airway collapsibility during sleep. The site(s) of upper airway collapse was also examined and found to predict treatment outcome. Primary oropharyngeal collapse during sleep predicted treatment success and this was extrapolated into a simple daytime test hypothesized to reflect oropharyngeal function. These primary oropharyngeal collapsers were found to have characteristic awake flow-volume curves and this was then studied prospectively. Cephalometric X-rays and anthropomorphic measurements were also evaluated to formulate prediction equations for treatment outcome with MAS. These new findings together with their implications for clinical practice and future research are then summarized. It is concluded, however, that although many advancements have been made, the mechanisms of MAS action and prediction of treatment outcome remain incompletely understood reflecting the complex pathophysiology of the upper airway.

Immobilisation has been one of the common forms of treatments for orthopaedic injuries and diseases. Immobilisation of injured limbs using dynamic splinting is routinely recommended by clinicians for fast healing as it promotes blood flow and provides the require stability. There are several dynamic splints available in the market that make use of different materials and mechanical elements. This research was set out to investigate the applicability of Magneto-Rheological(MR) fluids for the development of a smart fabric for orthopaedic splints. The fabric would be woven with hollow fibres containing MR fluid, which will change stiffness in an applied magnetic field. The concept was tested by measuring changes in the stiffness of silicone tubings in two different diameters filled with MR fluid, under different magnetic flux densities. The corresponding changes in stiffness of a preliminary fabric specimen built with woven tubings and cast liner was also investigated. The magnetic field was created after a set of detailed experimental and numerical analyses (Finite Element Method). It was found that although the electromagnets are much more versatile and easier to control for a required magnitude of magnetic flux density, they were found to be unsatisfactory due to their weight, bulk, and substantial requirement of batterie power. Permanent magnets offered a much better solution. After detailed preliminary analyses, an array of 21 neodymium magnets was chose for the experiments, which provided the required magnitude and uniformity of the magnetic field. The specimens were loaded in steps by small weights, and the resulting deflection was measured using an optical deformation analysis system. The equivalent Young’s modulus was found to increase from 16 MPa to 122 MPa under an average magnetic flux density of 0.0139 Tesla, which is an in- crease of 70%. A finite-element (FE) model of the single tubing test set up was developed and validated against the experimental results. The FE analysis was extended to the fabric specimens. The difference between the experimental and numerical results for the single tubing was as small as 2.5%, and 9.2% for the fabric. Furthermore, a preliminary numerical model and analysis of the hand was developed, which set the basis in the development of a further numerical analysis in the final development of the fabric. Upon the completion of the tests and simulation, it was concluded that a woven fabric made up of hollow fibres containing MR fluid can be an effective dynamic splint over a small area such as the wrist. However a fully functional product would require further research.

Syfte Syftet med föreliggande studie var att undersöka böjhållfastheten på 3D-printat material avsett för stabiliseringsskenor som är tillverkade i olika vinklar och både före och efter polering. Material och Metod Totalt framställdes 50 rektangulära provkroppar i vinklarna 0°, 25°, 45°, 75° och 90° med måtten 64 x 10 x 4,5 mm av Keysplint Hard och hälften polerades med Otec poleringsmaskin. Alla provkroppar utsattes för ett trepunktsböjhållfasthetstest med Instron 4465 med en lasthastighet på 5 mm/min till fraktur och värdena dokumenterades i Bluehill-mjukvara. Resultatet analyserades med One-Way ANOVA, Tukey s’ test och signifikansnivån sattes till α = 0,05. Resultat Enligt resultat från programmet SPSS (IBM® SPSS® Statistics powerful statistical software platform) observerades högst böjhållfasthet i den 3D-printade gruppen vid 25° som var polerad, vilket innebar en signifikant skillnad mellan denna grupp (25°) och de övriga grupperna (p&lt;0,05). Statistisk påvisades inga signifikanta skillnader mellan de andra grupper oavsett om det var opolerade och polerade provkroppar printade i vinklarna 0॰, 45॰, 75॰,90॰ (p&gt;0,05). Slutsats Inom ramen för studiens begränsningar kan följande slutsats dras: Printningsvinkel och polering påverkar böjhållfastheten hos 3D-printad polymer. En printningsvinkel på 25॰ i kombination med polering ger högst böjhållfasthet. En printningsvinkel på 0॰ger numeriskt lägst böjhållfasthet. Mer omfattande studier beträffande olika printningvinklar, olika printningsmaterial (resin) och 3D-printrar och dess inverkan på böjhållfastheten krävs för att säkerställa resultaten. / Aim The purpose of this in vitro study was to investigate the flexural strength of 3D-printed material intended for stabilization splints that are manufactured at different angles, both before and after polishing. Material and Method A total of 50 rectangular specimens at angles of 0°, 25°, 45°, 75° and 90° with dimensions of 64 x 10 x 4.5 mm were produced by Keysplint Hard and half were polished with the Otec polishing machine. All specimens were subjected to three-point flexural strength test using the Instron 4465 at a loading rate of 5 mm/min to fracture and the values were documented in Bluehill software. The result was analyzed with One-Way ANOVA, Tukey's test and the significance level was set at α = 0.05. Results According to results from the software SPSS (IBM® SPSS® Statistics powerful statistical software platform), the highest flexural strength was observed in the 3D-printed group at 25° that was polished, which means a significant difference between this group (25°) and the other groups (p&lt;0.05). Statistically, no significant differences were detected between the other groups regardless of whether they were unpolished and polished specimens printed at angles 0°, 45°, 75°, 90° (p&gt;0.05). Conclusion Within the limitations of the study, the following conclusion can be drawn: Printing angle and polishing affect the flexural strength of 3D-printed polymer. A printing angle of 25° in combination with polishing gives the highest flexural strength. A printing angle of 0° gives the numerically lowest flexural strength. More extensive studies regarding different printing angles, different printing materials (resin) and 3D-printers and the effect on the flexural strength are required to ensure the results.

No description available.

O objetivo deste estudo foi verificar o efeito da placa oclusal rígida em pacientes com DTM crônica, como tratamento único ou associado à terapia prévia. Foram selecionados pacientes diagnosticados com DTM de acordo com o protocolo para pesquisa Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) os quais foram distribuídos em 2 grupos experimentais. O primeiro foi tratado apenas com placa oclusal rígida (POR) (GP, n=20), e o segundo (GTP, n=17), recebeu terapia prévia com fonoaudiólogo, em 12 sessões de 45 minutos, e após três meses de finalização deste tratamento, foram submetidos ao tratamento com POR, assim como GP. As avaliações destes pacientes aconteceram em três momentos, antes do tratamento (T1), 3 meses após a instalação e ajuste da placa (T2) e 4 meses após a instalação e ajuste da placa (T3). O grupo GTP foi submetido a uma avaliação a mais (TS) que foi realizada antes da instalação da placa oclusal rígida, ou seja, após três meses de término do tratamento fonoaudiológico. O grupo controle pareado por gênero e idade foi formado por 20 pacientes sem sinais e sintomas para DTM segundo RDC/TMDO e estes foram submetidos às mesmas avaliações em um único momento. As avaliações realizadas foram: RDC/TMD, ProDTMmulti (grau de severidade dos sinais e sintomas) e AMIOFE (avaliação miofuncional orofacial), algometria, força de mordida e eletromiografia de superfície dos músculos masseter e temporal. Os dados obtidos foram tabulados e a análise estatística realizada pelo programa BioEstat 5.0. Após o teste de normalização, a estatística não-paramétrica foi aplicada por meio dos testes Kruskal-Wallis e Friedman para amostras independentes e pareadas, respectivamente. Os resultados mostraram que o tratamento com placa oclusal rígida como tratamento único ou associada a tratamento prévio com fonoaudiólogo, proporciona melhora da sintomatologia dolorosa em longo prazo (T2 e T3) mesmo em pacientes com DTM crônica. Os escores para AMIOFE foram significantes apenas para as avaliações de mobilidade, função e o escore total para o grupo que recebeu tratamento com fonoaudiólogo e exercício miofuncional orofacial. O GP não demonstrou resultados estatisticamente significantes para esta avaliação. Os índices eletromiográficos, POC masseter, ASSIM e ATTIV foram analisados após a normalização dos dados e foi possível perceber maior simetria após os tratamentos propostos (GP e GTP), no entanto, esta diferença foi significativa apenas para o índice POC masseter para GTP e ATTIV para GP (p<0,05). Em suma, é possível concluir que os dois tratamentos foram efetivos para diminuição dos sinais e sintomas e melhora da função do sistema mastigatório em pacientes com DTM crônica, em longo prazo. De uma maneira geral, houve diferença significativa entre GP e GTP apenas para a avaliação do protocolo AMIOFE, onde o grupo que recebeu tratamento fonoaudiológico prévio apresentou resultados significativos / The aim of this study was to verify the effect of hard occlusal splint (HOS) in patients with chronic TMD, as a single treatment or associated with previous therapy. Patients diagnosed with TMD were selected according to the protocol for Research Diagnostic Criteria for Temporomandibular Disorder (RDC / TMD), which were distributed in two experimental groups. In the first group, patient was treated with only HOS (GP, n = 20), and in the second one (GTP, n = 17) received prior therapy with a phonoaudiologist in 12 sessions of 45 minutes and after three months of the end of this treatment, they were submitted to treatment with POR, as well as GP. The evaluations of these patients were performed in three moments, before the treatment (T1), 3 months after the installation and adjustment of the HOS (T2) and 4 months after the installation and adjustment of HOS (T3). The GTP had one more evaluation (TS) that was performed before HOS, that is, after three months of phonoaudiology therapy. The control group was performed by 20 patients with no signs and symptoms for TMD according to RDC / TMD, matched by gender and age with experimental groups. They were submitted as the same evaluations that experimental group in one moment (T1) and received no treatment. The evaluations were: palpation pain, ProDTMmulti protocol (degree of severity of signs and symptoms), AMIOFE protocol (orofacial myofunctional evaluation), difficulty chewing questionnaire, algometry, bite force and surface electromyography of the masseter and temporal muscles. The data obtained were tabulated and the statistical analysis performed by the BioEstat 5.0 program. After the normalization test, the nonparametric statistic was applied through the Kruskal-Wallis and Friedman tests for independent and paired samples, respectively. The results showed that treatment with HOS as a single treatment or associated with previous treatment with a speech pathologist, provides an improvement in long-term painful symptoms (T2 and T3) even in patients with chronic TMD. AMIOFE scores were significant only for assessments of mobility, function, and total score for the group receiving orofacial myofunctional exercise (GTP). The GP did not show statistically significant results for this evaluation. The electromyographic indices, POC masseter, ASIM and ATTIV were analyzed after normalization of the data and it was possible to perceive greater symmetry after the proposed treatments (GP and GTP), however, this difference was only significant for the POC masseter index in GTP and ATTIV in GP (p <0.05). In conclusion, both treatments were effective in reducing signs and symptoms and improving the function of the masticatory system in patients with chronic TMD in the long term. In general, there was a significant difference between GP and GTP only for the evaluation of the AMIOFE protocol, where the group that received orafacial myofunctional therapy had significant results

Dores miofasciais mastigatórias (DMF) frequentemente encontram-se associadas com cefaleia. Porém, é incerto se esta relação acontece com cefaleias primárias ou secundárias. O objetivo do presente estudo foi descrever as características da cefaleia secundária à DMF considerada como tal aquela que melhorou após o tratamento da DMF. O efeito de diferentes tipos de tratamento na melhora da cefaleia associado à DMF, e o impacto da presença da cefaleia na melhora da intensidade de dor facial e limiar de dor à pressão (LDP) também foram avaliados. A amostra foi composta por adultos com DMF segundo o RDC/TMD, com (n=60) e sem (n=20) queixa de cefaleia. Os 60 participantes com cefaleia foram divididos em 2 grupos (1a e 1b). O grupo 1a recebeu tratamento que envolvia orientações para mudanças de hábitos. Os grupos 1b e 2 (sem cefaleia), além das orientações, receberam placa oclusal. O período de acompanhamento foi de 5 meses, com avaliações no início, após 2 meses e ao final do 5o mês. As intensidades das dores faciais e da cefaleia (EAV), além do limiar de dor a pressão (LDP) dos músculos temporal anterior, masseter e antebraço, foram analisados. ANOVA de medidas repetidas, teste de Friedman e de Wilcoxon foram usados para as comparações intra e intergrupos considerando um nível de significância de 5%. Ocorreu uma redução significativa da intensidade e frequência da cefaleia em ambos os grupos. A média inicial foi de 7,55 ± 2,24 para o grupo 1a e de 6,52 ± 1,63 para o grupo 1b. Ao final essa média foi, respectivamente, 3,13 ± 2,19 e 2,5 ± 2,33. Não houve diferença entre os grupos. Houve também uma redução na frequência da cefaleia entre o início e o final do tratamento nos grupos 1a e 1b, porém sem diferença entre os grupos. Ocorreu uma redução na intensidade da dor facial em todos os grupos. A média inicial foi de 6,34 ± 2 no grupo 1a, 6,14 ± 1,94 para o grupo 1b e 4,77 ± 1,57 para o grupo 2. Ao final os valores foram, respectivamente 1,66 ± 1,29, 2,3 ± 2,53 e 2,17 ± 1,17 e sem diferença entre os grupos. Houve um aumento no LDP para o temporal anterior no grupo 1b (p=0,01) e para o masseter no grupo 2 (p=0,01). Na comparação intergrupos, houve diferença entre o grupo 1a e 2 no acompanhamento de 2 meses para o temporal anterior (p=0,02). Conclui-se que o tratamento da DMF é eficaz na melhora da cefaleia secundária a DTM, independente do uso da placa oclusal, e que esta cefaleia tem como principais características a duração maior que 4 horas, localização bilateral e qualidade de pressão/peso. / Masticatory myofascial pain (MMF) is often associated with headache. Nevertheless, it is unclear whether this relationship occurs with primary or secondary headaches. The purpose of this study was to describe the characteristics of headache attributed to MMF, considered as such, one that improved after treatment of muscle condition. The effect of different treatments types in the improvement of headache associated with MMF, and the impact of the presence of headache on the improvement of facial pain intensity were also evaluated. The sample was comprised of MMF adults according to the RDC / TMD, with (n = 60) and without (n = 20) headache complaints. The 60 subjects with headache were divided into two groups (1a and 1b). The first group received only counseling for behavioral changes. Groups 1b and 2 (without headache), besides counseling, also received occlusal splint. Evaluations were done at baseline, 2 months and after the end of the 5th month. The intensities of facial pain and headache (VAS), and the pressure pain threshold (PPT) of the anterior temporalis, masseter and forearm were recorded. Repeated measures ANOVA, Friedman test and Wilcoxon test were used for comparisons within and between groups considering a 5% significance level. There was a significant reduction in headache intensity and frequency in both groups. The baseline mean was 7.55 ± 2.24 for the group 1a and 6.52 ± 1.63 for group 1b. In the final evaluation these values was respectively, 3.13 ± 2.19 and 2.5 ± 2.33. There was not difference between groups. There was also a reduction in headache frequency between baseline and final evaluation in groups 1a and 1b. There was a reduction in facial pain intensity in all groups. The baseline mean was 6.34 ± 2 in group 1a, 6.14 ± 1.94 for group 1b and 4.77 ± 1.57 for group 2. In the final evaluation these values were 1.66 ± 1.29, 2.3 ± 2.53 and 2.17 ± 1.17 with no difference between groups. There was an increase in the anterior temporalis PPT values for the group 1b (p = 0.01) and the masseter in group 2 (p = 0.01). The between groups comparison showed differences between the group 1a and 2 in the 2 months evaluation for anterior temporalis (p = 0.02). It is concluded that MMF treatment is effective in the improvement of headache attributed to TMD, regardless of the use of occlusal splint. Indeed the main characteristics of this headache were the long duration (more than 4 hours), bilateral location and pressure/tight quality.

Este trabalho teve por objetivo avaliar o efeito do tratamento com placa interoclusal estabilizadora como terapia única ou pós terapia miofuncional orofacial prévia em portadores de disfunção temporomandibular articular (Grupos II e III) associada ou não ao diagnóstico de DTM muscular (Grupo I) de acordo com Research Diagnostic Criteria for TMD (RDC/TMD), a fim de determinar os efeitos desta terapia para a redução dos sinais e sintomas de DTM, como também melhora no limiar de dor à pressão com algômetro, dor à palpação, redução da dor subjetiva pela VAS e alteração da atividade muscular avaliada através da eletromiografia. A amostra foi composta por 33 pacientes, do sexo feminino com idade entre 18 a 45 anos que já haviam sido submetidos, há menos de 12 meses, à Terapia Miofuncional Orofacial (TMO), ou não, e que apresentavam indicação para complementar o tratamento por meio do uso de placa. Os indivíduos foram divididos em dois grupos, Grupo T (n = 21), grupo que passou por tratamento prévio com TMO e Grupo P (n = 12), grupo que não se submeteu a terapias prévias. Ambos os grupos foram tratados com placa interoclusal estabilizadora com guias (protrusiva e canina) e acompanhamento por 120 dias. Todos os sujeitos foram avaliados antes da instalação do dispositivo interoclusal (A1) e após os 120 dias de uso (A2). Os resultados mostraram que: houve aumento significante nas medidas de movimentos excursivos quanto ao movimento de protrusão para o Grupo P, entretanto, para os outros movimentos os grupos se comportaram de maneira semelhante; houve redução significante em relação ao aspecto subjetivo da dor por meio da VAS nos dois grupos estudados, sem diferença entre eles; não se observou diferença entre os grupos em relação à alteração do limiar de dor com algômetro; para o ProDTMmulti; foi observado uma diminuição na presença de sinais e sintomas para a maioria dos parâmetros avaliados e um decréscimo na severidade de dor articular e dor muscular apenas para o grupo P e na sensibilidade dentária e plenitude apenas para o grupo T e ruídos articulares para os dois grupos. Não houve mudanças na atividade muscular avaliada por meio de eletromiografia de superfície. / This study aimed to evaluate the effect of the treatment with stabilization splint as a single therapy or after prior orofacial myofunctional therapy in TMJ patients (Groups II and III) with or without the diagnosis of myofascial pain (Group I) according to Research Diagnostic Criteria for TMD (RDC / TMD) in order to determine the effects of this therapy to reducing TMD signs and symptoms, as well as improvement in pain threshold algometer pressure, pain to palpation, reduction of subjective pain by VAS and changes in muscle activity assessed by electromyography (EMG). A total of 33 patients, female, aged from 18 to 45, were divided into two groups: T Group (n = 21), a group that underwent to prior therapy (Orofacial Myofunctional Therapy-OMT) and P Group (n = 12), a group that hadnt undergone to prior therapies. Both groups were treated with stabilization splint with guides (canine and protrusive) and were evaluated before (A1) and after (A2) the splint therapy (120 days). The results showed that there was a significant increase in measures on protrusive movement for Group P, however, for the other movements the groups behaved similarly; there was significant reduction in relation to the subjective aspect of pain by VAS in both groups, without differences between them; there wasnt any differences between groups regarding the change in pain threshold by algometer; for ProDTMmulti, a decrease was observed in the presence of signs and symptoms for most of the evaluated parameters and a decrease in the severity of joint pain and muscle pain only to the P Group; tooth sensitivity and fullness only to the T Group; and joint sounds to both groups. There werent changes in muscle activity assessed by surface electromyography (EMG).

O objetivo deste estudo foi avaliar a eficácia da laserterapia de baixa intensidade associada ao uso da placa oclusal, como método de contribuição para o tratamento das DTMs intraarticulares e/ou musculares, por meio de exames clínicos e instrumentais. Foram selecionados 25 pacientes entre homens e mulheres, com idade média de 33,8 anos, encaminhados para tratamento da DTM na FORP/USP. Também foram selecionados 12 sujeitos assintomáticos para DTM, para compor o grupo controle. O diagnóstico da DTM foi realizado com o Research Diagnostic Criteria for Temporomadibular Disorders (RDC/TMD). Os pacientes foram divididos randomicamente em dois grupos: um grupo recebeu tratamento através de placa oclusal e o outro grupo, recebeu tratamento através de placa oclusal associada à laserterapia de baixa intensidade. As avaliações incluíram avaliação da oclusão funcional estática e dinâmica, medida dos movimentos mandibulares, dor à palpação e eletromiografia de superfície. Os pacientes também responderam um questionário de frequência e severidade dos sinais e sintomas de DTM (ProDTMMulti). A avaliação eletromiográfica foi realizada em várias atividades com e sem placa oclusal. As avaliações foram realizadas inicialmente (A1), antes do tratamento, e após a finalização do tratamento (A2). Os resultados mostraram uma significante melhora da dor relatada pelo pacientes e aumento da amplitude da abertura bucal em ambos os grupos, porém para o grupo que recebeu laser e placa, essa melhora foi mais acentuada. A atividade eletromiográfica foi reduzida durante a maioria dos testes realizados, porém não houve diferença estatística entre os grupos experimentais antes e após o tratamento, nem quando comparados com o grupo controle. Baseados nesses achados podese concluir que o tratamento com placa oclusal em associação à laserterapia promoveu melhora mais acentuada na sintomatologia dos pacientes e nos movimentos mandibulares em sujeitos com DTM. / The aim of this study was to evaluate the efficacy of low intensity laser therapy associated with the use of occlusal splint as a method of contribution to the treatment of intraarticular TMD and / or muscle, by clinical and instrumental exams. A total of 25 patients between men and women, mean age 33.8 years, were selected referred for treatment of TMD in FORP / USP. A control group of 12 subjects were also selected for asymptomatic DTM, to compose the control group. All subjects met the inclusion criteria. The diagnosis of TMD was conducted with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD). The patients were randomly divided into two groups: one group was treated by occlusal splints and the other group was treated by occlusal splint associated with low level laser therapy. The assessments included evaluation of functional occlusion static and dynamic, measurement of mandibular movements, pain on palpation and surface electromyography. Patients also answered a questionnaire about the frequency and severity of signs and symptoms of TMD (ProDTMMulti). The electromyographic evaluation was performed in various activities with and without occlusal splint. Evaluations were performed initially (A1) before treatment, and after completion of treatment (A2). The results showed a significant improvement in pain reported by patients and increased range of mouth opening in both groups, but the group that received laser and plate, this improvement was more pronounced. The electromyographic activity was reduced during most tests, but there was no statistical difference between the experimental groups before and after treatment, nor when compared with the control group. Based on these findings it can be concluded that treatment with occlusal splint in combination with laser therapy yielded more pronounced improvement in symptoms of patients and mandibular movements in subjects with TMD.