Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-05-24T21:11:50Z No. of bitstreams: 1 Fernanda Cordeiro da Silva.pdf: 1698143 bytes, checksum: 5188d9f0e1735fda1e319f632fa9f199 (MD5) / Made available in DSpace on 2016-05-24T21:11:50Z (GMT). No. of bitstreams: 1 Fernanda Cordeiro da Silva.pdf: 1698143 bytes, checksum: 5188d9f0e1735fda1e319f632fa9f199 (MD5) Previous issue date: 2015-12-17 / Cerebrovascular Accident (Stroke) is an important aggravation to the health of the global population, which causes motor impairments that could compromise the masticatory muscles. The objective of this study was to evaluate complete hemiparesis, originating from a Stroke, which may cause greater orofacial compromise, altering the electromyographic activity and the force of the masticatory muscles associated to the temporomandibular dysfunction when compared to incomplete hemiparesis. Hemiparetic post-stroke individuals aged between 18 and 75 years of age were evaluated. The sample was divided into two groups: the Complete Hemiparetic group containing 29 individuals and the Incomplete Hemiparetic group containing 21 individuals. All of the groups were submitted to evaluation to diagnose TMD through RDC/TMD, bite force through the Kratos® Dynamometer and electromyography of the masticatory muscles employing a 4-channel electromyography of the EMG System®. The results obtained were computed and the statistical analysis was made using the significance of 95% (p<0.05), where the significant statistical difference was observed in the TMD between the complete and incomplete hemiparetic group (p=0,01). However, regarding the bite force in the intergroup and/or intragroup, a statistical difference was not observed. As to the function of the upper limb, evaluated by SSQOL, and its relation to oral health, evaluated by OHIP-14, it was possible to observe the statistically significant correlation in the domains of Physical Pain, Functional Limitation, Psychological Discomfort, Physical Incapacity, Social Incapacity, Social Disadvantage and Psychological Incapacity. In all the domains stated above, the correlations were negative. Regarding the electromyography, a statistical significant difference was observed during rest, in the intergroup evaluation, both on the right side (p=0.005) and on the left (p=0.005). A negative correlation was verified, of moderate magnitude (-0.643) (p=0.02), among the electromyographic signals at rest and the male individuals that did not present TMD in the complete hemiparetic group. As to the time of injury, a negative correlation was also observed, of moderate magnitude (-0.663) (p=0.00) between the time of injury and the electromyographic signal in individuals without TMD also in the complete hemiparetic group, which allowed us to complete the relation between the TMD, time of injury and EMG in hemiparetic individuals with stroke, except for bite force which did not show a relation with hemiparesis. Finally, the orofacial function needs to be better understood, because it aggregates immeasurable value to the rehabilitation of these individuals. / O Acidente Vascular Encefálico é um importante agravo à saúde da população mundial, que cursa com prejuízos motores que podem comprometer os músculos mastigatórios. O objetivo deste estudo foi avaliar se a hemiparesia completa, proveniente de um AVE, pode causar maior comprometimento orofacial, alterando a atividade eletromiográfica e a força dos músculos mastigatórios associado à disfunção temporomandibular quando comparada à hemiparesia incompleta. Foram avaliados indivíduos hemiparéticos pós-ave com idade entre 18 a 75 anos. A amostra foi dividida em dois grupos, sendo: Hemiparéticos Completos contendo 29 indivíduos e hemiparéticos incompletos contendo 21 indivíduos. Todos os grupos foram submetidos à avaliação para diagnóstico da DTM através do RDC/TMD, força de mordida através do Dinamômetro da Kratos® e eletromiografia dos músculos mastigatórios empregando-se um eletromiógrafo de 4 canais da EMG System®. Os resultados obtidos foram computados e análise estatística realizada utilizando nível de significância de 95% (p<0,05), onde se observou diferença estatisticamente significante na DTM entre os hemiparéticos completos e incompletos (p=0,01). No entanto quanto a FM não foi observada diferença estatística intergrupos e/ou intragrupos. Quanto à função do membro superior, avaliada pelo SSQOL, e sua relação com a saúde oral, avaliada pelo OHIP-14, foi possível observar correlação estatisticamente significativa nos domínios Dor Física, Limitação Funcional, Desconforto Psicológico, Incapacidade Física, Incapacidade Social, Desvantagem Social e Incapacidade Psicológica. Em todos os domínios citados acima, as correlações foram negativas. Em relação à eletromiografia, foi observada diferença estatisticamente significativa durante o repouso, na avaliação intergrupos, tanto no lado direito (p=0,005) como no esquerdo (p=0,005). Verificou-se uma correlação negativa, de moderada magnitude (-0,643) (p=0,02), entre os sinais eletromiográficos em repouso e os indivíduos do sexo masculino que não apresentaram DTM no grupo de hemiparéticos completos. Quanto ao tempo de lesão, também foi observada uma correlação negativa, de moderada magnitude (-0,663) (p=0,00) entre o tempo de lesão e o sinal eletromiográfico em indivíduos sem DTM também no grupo dos hemiparéticos completos, o que nos permitiu concluir que existe relação entre DTM, tempo de lesão e EMG nos indivíduos hemiparéticos pós-acidente vascular encefálico, com exceção da FM que não mostrou relação com a hemiparesia. Por fim, a função orofacial precisa ser melhor compreendida, pois agregará valor imensurável na reabilitação destes indivíduos.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-16T21:50:43Z No. of bitstreams: 1 Yasmin El Hage.pdf: 1970287 bytes, checksum: a115ee670601d955883a00022faa7af9 (MD5) / Made available in DSpace on 2018-07-16T21:50:43Z (GMT). No. of bitstreams: 1 Yasmin El Hage.pdf: 1970287 bytes, checksum: a115ee670601d955883a00022faa7af9 (MD5) Previous issue date: 2016-12-12 / Introduction: Temporomandibular dysfunction (TMD) is a complex multifactorial dysfunction commonly associated with other conditions such as cervical spine disorders. Although there is evidence of the correlation between a TMD and neck dysfunctions, treatment approaches address local and direct. Since TMD etiology is multidimensional, the present study hypothetize that a cervical and thoracic approach could reduce the signs and symptoms of TMD. Purpose: To evaluate the effects of a manual therapy protocol applied to the cervical and thoracic region on the signs and symptoms of TMD, as well as the temperature of the temporomandibular joint (TMJ), masticatory and cervical muscles. Methods: 30 subjects with a diagnosis of TMD according to RDC/TMD classified as severe or moderate, according to the Fonseca’s Anamnestic Index (FAI) were randomized into two groups: experimental (miofacial release and joint mobilization) and placebo ultrassound. The interventions were performed twice a week, 8 sessions total. Volunteers were assessed for TMD severity by FAI; Pain in TMJ and masticatory muscles, using a Numerical Pain Scale (END); Mandibular range of motion (ROM), through pachymetry; Level of pain and craniofacial dysfunction, according to the Craniofacial Pain and Dysfunction Index (CF-IDD); Cervical dysfunction level, according to Neck Disorders Index (NDI); Regarding the surface temperature of the TMJ and the anterior temporal muscles, masseter and upper trapezius, under pre and post intervention conditions, and under a 30 days follow-up. The study was approved by the Ethics and Research Committee of Universidade Nove de Julho and is registered in Clinical Trials under the number NCT02822469.Statistical analysis: Data distribution was normal. ANOVA was performed followed by Tukey's multiple comparison for group versus time interaction. The category changes between the moments and the groups were analyzed following a contingency table using the proportional comparison test for each category. The level of significance of 5% was considered. Results: Of the 186 volunteers screened, only 28 complete the study. No statistically significant difference was found between groups for any of the variables studied. Conclusion: The proposed treatment protocol applied to the thoracic and cervical region did not alter pain, ROM, TMD severity, cervical dysfunction level and superficial temperature of the TMJ and the masseter, anterior temporal and upper trapezius muscles in patients with severe and/or moderate TMD. / Introdução: Disfunção temporomandibular (DTM) é uma disfunção complexa e multifatorial comumente associada à outras condições como desordens da coluna cervical. Apesar de haver evidências da correlação entre a DTM e disfunções cervicais, as propostas de tratamento incluem abordagem local e direta. Uma vez que a etiologia da DTM é multidimensional, o presente estudo hipotetiza que uma abordagem cervical e torácica poderia reduzir os sinais e sintomas de DTM. Objetivo: Avaliar os efeitos de um protocolo de terapia manual aplicado sobre a região cervical e torácica sobre os sinais e sintomas da DTM, bem como sobre a temperatura da articulação temporomandibular (ATM), músculos mastigatórios e cervicais. Metodologia: 30 sujeitos com diagnóstico de DTM conforme o RDC/TMD, classificada como grave ou moderada, de acordo com o Índice Anamnésico de Fonseca (IAF) foram randomizados em 2 grupos: experimental (liberação miofascial e mobilização articular) e ultrassom placebo. As intervenções foram aplicadas 2 vezes por semana, totalizando 8 sessões. Os sujeitos foram avaliados quanto à gravidade da DTM, pelo IAF; dor na ATM e nos músculos mastigatórios, utilizando a escala numérica de dor (END); amplitude de movimento mandibular (ADM), por meio da paquimetria; nível de dor e disfunção craniofacial, de acordo com o Índice de Dor e Disfunção Craniofacial (IDD-CF); nível de disfunção do cervical, conforme o Índice de Disfunção Cervical (NDI); e quanto a temperatura da superfície da ATM e dos músculos temporal anterior, masseter e trapézio superior, nas condições pré intervenção, pós intervenção e follow-up após 30 dias do término do protocolo. O estudo foi aprovado pelo comitê de ética e cadastrado no clinical trials sob o número NCT02822469. Análise estatística: Os dados apresentaram distribuição normal e foram analisados utilizando a ANOVA seguido de comparação múltipla de Tukey para a interação grupo versus momento. As mudanças de categorias entre os momentos e os grupos foram analisadas seguindo uma tabela de contingência por meio do teste de comparação de proporções para cada categoria. Considerou-se o nível de significância de 5%. Resultados: Dos 186 voluntários triados, apenas 28 completaram o estudo. Não foi encontrada diferença estatisticamente significante entre os grupos para nenhuma das variáveis estudadas. Conclusão: O protocolo de tratamento proposto, aplicado sobre a região torácica e cervical não alterou a dor, ADM, gravidade da DTM, nível de disfunção cervical e temperatura superficial da ATM e dos músculos masseter, temporal anterior e trapézio superior em pacientes com DTM grave e moderada.

The presented master’s thesis deals with the problem of the application of total endoprosthesis (TEP) during temporomandibular joint (TMJ) replacement. The implantation of TEP occurs due the severe TMJ disease (arthrosis, ankylosis, cancer) or its macrotrauma. Condylar prosthesis is fixed during the implantation by self-tapping screws to the mandible. This fixation causes a change of stress-strain behaviour of mandible, TEP and fixation screws. In the thesis is performed the stress-strain analysis by using computational modeling in use the finite element method (FEM). Analysis is performed for six different screws positions (the number of screws is unchanged) and for a variable the static friction coefficient (in range 0.1 to 0.11) between condylar prosthesis (CP) and fossa prosthesis (FP). Altogether, 36 variants of computational models were created. The stress strain analysis detected a substantial influence of the static friction coefficient value to final results of displacements, contact pressure on the articulation surface between the CP and the FP and also to von Mises stress of the CP. A substantial influence of different screws position is detected for von Mises stress in the screws and for von Mises strain in the cortical and spongious bone tissue.

Title: Voice controlled electronic health record in dentistry Author: MUDr. Radek Hippmann Department: Department of paediatric stomatology, Faculty hospital Motol Supervisor: Prof. MUDr. Taťjana Dostalová, DrSc., MBA Supervisor's e-mail: Tatjana.Dostalova@fnmotol.cz This PhD thesis is concerning with development of the complex electronic health record (EHR) for the field of dentistry. This system is also enhanced with voice control based on the Automatic speech recognition (ASR) system and module for speech synthesis Text-to- speech (TTS). In the first part of the thesis is described the whole issue and are defined particular areas, whose combination is essential for EHR system creation in this field. It is mainly basic delimiting of terms and areas in the dentistry. In the next step we are engaged in temporomandibular joint (TMJ) problematic, which is often ignored and trends in EHR and voice technologies are also described. In the methodological part are described delineated technologies used during the EHR system creation, voice recognition and TMJ disease classification. Following part incorporates results description, which are corresponding with the knowledge base in dentistry and TMJ. From this knowledge base originates the graphic user interface DentCross, which is serving for dental data...

Title: Possibilities of physiotherapy interventions in patients with temporomandibular disorders - a systematic review. Objective: The aim of the diploma thesis is based on the analysis of available literature fulfilling the selection criteria to evaluate the most effective therapeutic intervention within the competence of a physiotherapist for the predetermined evaluation parameter in patients with myogenic temporomandibular disorder. Methods: This diploma thesis is processed in the form of a systematic review. Auitable literature was searched in the various a database including Scopus, PubMed, Web of Science a PEDro. Based on the criteria, a total of 390 articles were found, including 271 randomized clinical trials obtained after removal of duplicates. An abstract was screened on these selected studies to identify suitable ones. Subsequently, 97 studies remained for further investigation, of which a total of 18 studies were suitable for inclusion in this work. The first part of the thesis contains theoretical information related to this topic. In the second part of the thesis, an analysis of suitable studies is performed, followed by the results of this analysis and then a discussion, which is focused on each of the research questions. Results: A total of 18 randomized controlled clinical trials...

Thesis (Ph. D.)--Joint Program in Oceanography/Applied Ocean Science and Engineering (Massachusetts Institute of Technology, Dept. of Biology; and the Woods Hole Oceanographic Institution), 2007. / Includes bibliographical references. / The North Atlantic right whale, Eubalaena glacialis, one of the most critically endangered whales in the world, is subject to high anthropogenic mortality. Vessel-whale collisions and entanglement in fishing gear were indicated in 27 (67.5%) of the 40 right whales necropsied between 1970 and December 2006. Of those, at least 9 deaths (22.5%) resulted from blunt contact with a vessel. To reduce the likelihood of fatal collisions, speed restrictions are being considered for vessels traversing critical habitat, although the effects of speed on collision outcomes have not been specifically evaluated from a biomechanics perspective. The ultimate goal of a larger collaborative project is to evaluate the efficacy of speed restrictions for reducing blunt collision mortality using a multi-scale finite element model. Complete, transverse fracture of the right whale mandible, an injury seen only in right whales killed by vessels, is used as a proxy for mortality in the model. Vital for that model are the material properties and biomechanical behavior of the right whale mandible. Here, the internal structure and physical properties of right whale jawbone tissue are reported. The average apparent densities, 0.4258 g/cc ±0.0970 and 1.2370 g/cc ±0.0535 for trabecular and cortical bone respectively, indicate that the bone is of relatively low density. Average ash content for trabecular bone (64.38% ±1.1330) is comparable with values from other species, indicating that low density results from a reduction of bone mass, not mineralization. Mechanical properties of right whale bone (Young's modulus of elasticity and Poisson's ratio) were determined via uniaxial compression testing. / (cont.) These data are incorporated into the finite element model simulating different loading conditions (e.g. vessel speeds) that likely lead to mandibular failure and thereby mortality from blunt vessel collisions. Model results (e.g. risk of fracture) are used to determine the effect of speed restrictions on collision outcomes. / by Regina Campbell-Malone. / Ph.D.

The functioning of maxillofacial complex as a one unit is an important condition of fulfilling several functions connected with this area of human body. A maxillofacial region and other parts of the body are connected through occlusion, one of the basic characteristics of which is occlusal plane. According to the number of researchers, 3D orientation of occlusal plane, its shape and possible deformation can have an influence on other anatomic structures via a system of a complex neuromuscular reactions. This theory assumes that the adjustment of occlusal plane inclination causes redistribution and redirection of the chewing forces in the adjacent structures which will subsequently manifest itself in the adjustment of the tension of different muscles. Aim The aim of an experimental part of the research was to define the influence of occlusal plane inclination on the function of maxillofacial region with the focus of jaw joints and chewing muscles. The next goal was to determine the figures of sagittal and frontal inclination of occlusal plane which can be considered as physiological. Patients and Methods The research was based on the examination of 87 people of both genders, different age groups with a complete set of teeth and without chronic diseases. The participants were divided in two groups...

Introduction: Due to potentially severe sequelae (impaired growth, condylar resorption, and ankylosis) early diagnosis of chronic rheumatic arthritis of the temporomandibular joint (TMJ) and timely onset of therapy are essential. Aim: Owing to very limited evidence the aim of the study was to identify and discuss controversial topics in the guideline development to promote further focused research. Methods: Through a systematic literature search, 394 out of 3771 publications were included in a German interdisciplinary guideline draft. Two workgroups (1: oral and maxillofacial surgery, 2: interdisciplinary) voted on 77 recommendations/statements, in 2 independent anonymized and blinded consensus phases (Delphi process). Results: The voting results were relatively homogenous, except for a greater proportion of abstentions amongst the interdisciplinary group (p < 0.001). Eighty four percent of recommendations/statements were approved in the first round, 89% with strong consensus. Fourteen recommendations/statements (18.2%) required a prolonged consensus phase and further discussion. Discussion: Contrast-enhanced MRI was confirmed as the method of choice for the diagnosis of TMJ arthritis. Intraarticular corticosteroid injection is to be limited to therapy refractory cases and single injection only. In adults, alloplastic joint replacement is preferable to autologous replacement. In children/adolescents, autologous reconstruction may be performed lacking viable alternatives. Alloplastic options are currently still considered experimental.

Objectifs : L’objectif principal de cette étude était de décrire les caractéristiques des patients atteints d’arthrite juvénile idiopathique (AJI) qui ont fréquenté la nouvelle clinique dentaire spécialisée de l’articulation temporo-mandibulaire (ATM) développée au Centre hospitalier universitaire (CHU) Sainte-Justine. L’objectif secondaire visait à établir un portrait des ressources actuellement disponibles dans les hôpitaux pédiatriques canadiens pour les patients ayant un diagnostic d’AJI avec atteinte de l’ATM. Méthodes : Une collecte de données rétrospective des patients vus à la clinique spécialisée du CHU Sainte-Justine a été effectuée à partir des dossiers informatiques des patients. Les données comprenaient le sexe, l’âge, la spécialité du dentiste qui a vu le patient, le référent, le diagnostic, le type d’AJI, l’atteinte et la localisation à l’ATM, les symptômes, les plaintes signalées par le patient, le type d’imagerie utilisé, les traitements reçus et autres. Pour la deuxième partie de l’étude, des questionnaires ont été envoyés aux départements de rhumatologie et de médecine dentaire des 13 hôpitaux pédiatriques canadiens. Résultats : 86 patients atteints d’AJI de la clinique spécialisée ont été inclus, dont 42 % avaient une atteinte de l’ATM. L’imagerie panoramique était l’imagerie la plus prescrite chez les patients atteints d’AJI (91 %). Sept hôpitaux ont été inclus dans la deuxième partie de l’étude. Deux hôpitaux avaient une clinique spécialisée de l’ATM. Les réponses transmises entre les départements du même hôpital ne concordaient pas concernant les types d’imageries et de dentistes spécialistes accessibles. Conclusion : Les données des patients du CHU Sainte-Justine ne présentent pas d’écarts significatifs avec celles de la littérature. Les résultats des sondages montrent que peu d’hôpitaux pédiatriques canadiens disposent d’une clinique spécialisée de l’ATM pour l’AJI et que les rhumatologues ne semblent pas au fait de la prise en charge des patients atteints d’AJI par les différents dentistes spécialistes. / Objectives: The primary objective was to describe the characteristics of patients with juvenile idiopathic arthritis (JIA) in a newly developed specialized temporomandibular joint (TMJ) dental clinic at the Centre hospitalier universitaire (CHU) Sainte-Justine. The secondary objective aimed to describe a current portrait of the resources available in Canadian pediatric hospitals for JIA patients with TMJ involvement. Methods: A retrospective data collection of patients seen in the CHU Sainte-Justine specialized clinic was done from patient computer records. The data included sex, age, specialty of the dentist seen by the patient, referral source, diagnosis, JIA type, damage and location at the TMJ, symptoms, complaints reported by the patient, type of imaging used, treatments received and other. For the second part of the study, questionnaires were sent to the departments of rheumatology and dentistry of 13 Canadian pediatric hospitals. Results: A total of 86 JIA patients from the specialized clinic were included, of which 42% had TMJ involvement. The panoramic radiograph was the most prescribed imaging in patients with JIA (91%). A total of seven hospitals were included in the second part of the study. Two hospitals surveyed had a specialized TMJ clinic. Many results regarding the types of imaging and dental specialists accessible did not agree between the rheumatology and dentistry questionnaires within the same hospital. Conclusion: Most data from the CHU Sainte-Justine is consistent with findings in the literature. Results from surveys show that few Canadian pediatric hospitals have a specialized TMJ clinic for JIA and rheumatologists seem to lack understanding in the management of patients with JIA by different dental specialists.

Introduction: L’arthrite juvénile idiopathique (AJI) est la maladie rhumatologique la plus répandue chez les enfants. Lorsque l’articulation temporo-mandibulaire est touchée, le processus inflammatoire peut causer une perturbation de la croissance cranio-faciale et une destruction du condyle, ce qui peut engendrer des difformités dentofaciales et des malocclusions dentaires. Des facteurs environnementaux, tels que les médicaments et les habitudes parafonctionnelles, ont le potentiel d’influencer la progression de la maladie et, par conséquent, jouer un rôle dans l’étiologie des malocclusions des patients avec AJI. Objectifs : L’objectif principal est de comparer la fréquence et la sévérité des malocclusions des patients avec et sans AJI. L’objectif secondaire est d’investiguer la relation entre la sévérité des malocclusions des patients avec AJI et leurs médicaments et habitudes parafonctionnelles. Méthodes: L’échantillon était divisé en deux groupes: AJI (n=30) et contrôle (n=30). Un questionnaire médical, un examen orthodontique et un examen radiologique ont été complétés pour chaque patient. Résultats : Par rapport au groupe contrôle, les enfants avec AJI avaient plus d’asymétries dentofaciales (p=0.009), de classe II canines (p=0.05) et molaires (p<0.001), de surplombs vertical > 3.5 mm (p=0.011) et horizontal > 5.0 mm (p=0.033) augmentés, des courbes de Spee (p=0.044), de Wilson (p=0.044) et de Monson (p=0.003) accentuées, de chevauchement incisif mandibulaire (p=0.042) et de manque transverse maxillaire (p<0.001). Les médicaments et les habitudes parafonctionnelles n’avaient pas d’impact sur les malocclusions. Conclusion : Les enfants avec AJI avaient des malocclusions plus sévères. Un diagnostic précoce et des traitements médicaux et orthodontiques opportuns sont essentiels pour prévenir les dommages irréversibles causés par la maladie. / Introduction: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease found in children. In cases affecting the temporomandibular joint (TMJ), the inflammatory process may cause disturbances in craniofacial growth and condylar destruction, both of which can lead to dentofacial deformities and dental malocclusions. Environmental factors such as medication and parafunctional habits have the potential to influence the disease progression and therefore play a role in the etiology of malocclusions of children with JIA. Objectives: The main objective of this study was to compare the frequency and the severity of malocclusions of patients with and without JIA. The secondary objective was to investigate the relationship between the severity of malocclusions of patients with JIA and their medication and parafunctional habits. Methods: The sample was divided into two groups: JIA (n=30) and control (n=30). A health questionnaire, an orthodontic examination, and radiographic records were completed for each patient. Results: Compared to the control group, children with JIA had more dentofacial asymmetry (p=0.009), Class II canine (p=0.05) and molar (p<0.001) relationships, increased overbite > 3.5 mm (p=0.011) and overjet > 5.0 mm (p=0.033), accentuated curves of Spee (p=0.044), Wilson (p=0.029) and Monson (p=0.003), lower incisor crowding (p=0.042) and maxillary transverse discrepancy (p<0.001). Medication and parafunctional habits did not influence malocclusions. Conclusion: Children with JIA have more severe malocclusions. An early diagnosis and timely medical and orthodontic treatment are crucial to prevent the irreversible damage caused by the disease.