Introduction Developmental dysplasia of the hip has since 1953 in Sweden most commonly been treated with the von Rosen splint. Over time, different types of splints have been developed, one of which is the Orebro splint. In some countries it is advised to have long-term follow-ups with radiological exams of patients treated with a splint. In Orebro, there is currently no mandatory follow-up after treatment with the Orebro splint. Aim The aims were to investigate how many children, despite treatment with the Orebro splint, developed dysplasia in the adolescence period, to study the hip function in children treated with the Orebro splint and investigate if there were any differences in treatment outcomes between males and females. Methods All children born between 2000 and 2012, treated with the Orebro splint, were eligible for inclusion. The outcome measures for quality of life and hip function were EQ-5D-Y-VAS and CHOHES score. The outcome measures for the pelvic radiological exams were Acetabular Index and Center Edge angle. Results Data from 46 patients were collected, 7 males and 39 females. 5,3% of the patients showed residual dysplasia. Both males and females showed overall good results in the radiological images, the surveys, and the clinical exams. The results did not show significant differences between the genders. Conclusion Even though our participants reported an overall good quality of life, our results showed some cases of residual dysplasia. However, the small sample size makes it difficult to assess whether the Orebro splint is equal to other splints regarding treatment outcomes.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

O uso de novas tecnologias na odontologia, como a técnica CAD/CAM, promete ser uma opção relevante no que diz respeito à confecção das placas oclusais, empregadas no tratamento de disfunções temporomandibulares. O objetivo desta pesquisa foi desenvolver uma técnica para desenho e confecção de placas oclusais pelo método CAD/CAM, em impressora 3D, e verificar seus resultados clínicos no tratamento de pacientes com disfunções temporomandibulares. Para o desenho das placas foi desenvolvida uma metodologia de desenho digital (CAD), utilizando o software Meshmixer® (Autodesk, USA), e de registro das relações maxilo-mandibulares. A partir dessa metodologia iniciou-se um estudo clínico randomizado comparativo entre as placas CAD/CAM produzidas em impressora 3D e placas produzidas convencionalmente em laboratório. O estudo foi realizado em duas etapas, 18 pacientes foram avaliados de acordo com os critérios de inclusão e exclusão. Na Etapa 1 (n=18) foram realizados testes técnicos comparativos das duas placas em relação à dor, por meio da Escala Visual Analógica; atividade muscular; ajuste interno; báscula; conforto; tempo de instalação; pontos de contato oclusal. Todos os pacientes da amostra utilizaram os dois tipos de placas. Na Etapa 2, estes pacientes foram divididos randomicamente em dois grupos para o estudo clínico randomizado (estudo cego): Grupo IMP (n=9) (placas impressas) e grupo LAB (n=9) (placas convencionais laboratoriais). Os grupos foram avaliados após 1 mês de uso, por meio dos Questionários, RDC/TMD, SF-36, escala visual de dor EVA, e pelos pontos de contato oclusais. Os dados foram avaliados estatisticamente usando os testes de Wilcoxon, de Mann-Whitney, e de Kruskal-Wallis nas análises quantitativas; os testes Qui-Quadrado e Exato de Fisher, nas variáveis categóricas. Os resultados mostraram que houve diferenças significativas (P-valor<0.05) nas avaliações para conforto, ajuste interno e tempo de confecção das placas, a favor das placas impressas. Nas demais avaliações, os grupos foram equivalentes (não- significantes). Concluiu-se que foi possível desenvolver uma técnica para desenho e confecção de placas oclusais pelo método CAD/CAM, em impressora 3D, e que o desempenho clínico foi equivalente entre as placas convencionais e impressas, sendo que estas se mostraram superiores quanto ao conforto e quanto à adaptação da superfície interna da placa, mostrando ser este um método possível e viável economicamente. / The use of new technologies in dentistry, as the CAD/CAM technique, promises to be a relevant option concerning the manufacture of occlusal splints for temporomandibular disorders treatment. The aim of this research was to develop a technique for design and manufacture occlusal splints using the CAD/CAM method and 3D printer and verify the clinical results in the treatment of temporomandibular disorders patients. It was developed a technique for occlusal splint design a using the software Meshmixer® (Autodesk, USA) and a technique to register the jaws relationship. From this method, it was started a Randomized Clinical Trial (RCT) to compare splints made through the CAD/CAM technique and others made conventionally in a dental lab. The study was performed in two steps, 18 patients were selected based on the inclusion/exclusion criteria. In Step 1 (n=18) patients were comparatively evaluated, using both splints, in relation to pain, using the visual analog scale; internal adjustment of the splint; patients comfort; time spent to deliver the appliance and occlusal contacts pattern. In Step 2, these patients were allocated in two groups (n=9 each group) randomly to the RCT be performed (blind study): Group IMP - printed splints and Group LAB (conventional lab splints). Both groups were assessed after 1 month using the splint using RDC/TMD and SF-36 questionnaires, the visual analog scale for pain, and occlusal contacts pattern. The data were statistically evaluated using Wilcoxon, Mann-Whitney, and Kruskal-Wallis test for qualitative analyses and Qui-square and Fisher´s exact tests for categorical variables. The results showed significant statistical differences (p-value<0.05) in favor of printed occlusal splints, related to patients\' comfort, internal adjustment, and time spent to deliver the appliance. All other assessments were equivalents (not significant). It was concluded that it was possible to develop a technique to design and manufacture occlusal splints using CAD/CAM and 3D printer, and furthermore the clinical performance was equivalent comparing conventional and printed occlusal splints, being the printed splints superior to conventional splints in relation to comfort and internal adjustment, proving this is a possible and economically viable method.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Objetivo: Avaliar por meio do estudo fotoelástico qualitativo as tensões geradas no longo eixo dos implantes e interimplantes nas regiões cervical, média e apical quando submetidos a diferentes carregamentos com ou sem interposição de placa oclusal plana. Método: Foram confeccionados quatro modelos fotoelásticos, com dois implantes hexágono externo (Neodent) localizados no espaço correspondente ao segundo pré-molar e segundo molar inferiores. Em cada modelo, foram instaladas supraestruturas metálicas parafusadas sobre os implantes. Os modelos fotoelásticos foram posicionados no polariscópio circular para distribuição das franjas isocromáticas em torno dos implantes e áreas interimplantes. Registros fotográficos foram obtidos antes e após a aplicação dos diferentes tipos de carregamento: 1- 30kg sem placa; 2- 30kg com placa; 3- 60kg sem placa; 4- 60kg com placa; 5- 90kg sem placa; 6- 90kg com placa. Resultados: Após as análises, observou-se a presença de tensão nos modelos sem a aplicação de carga oclusal após a aplicação do torque (20Ncm). A diminuição na magnitude de tensão com a aplicação da placa oclusal plana se tornou mais evidente após a aplicação de carga de 60kg. De modo geral, a maior magnitude de tensão se deu na região cervical para as áreas interimplantares e na região apical ao redor dos implantes, havendo uma diminuição de 57,77% entre as três magnitudes de cargas aplicadas após utilização da placa. Conclusões: Assim, os dados obtidos deste estudo demonstraram que a melhor distribuição de tensões nos implantes foi obtida com a interposição da placa oclusal plana, a partir da aplicação de carga de 60kg, com diminuição de 66,66%. / Aim: To assess using qualitative photoelastic studies the tensions generated in the long axis of the implants and interimplants in the cervical, middle and apical regions when subjected to different loads with or without interposition of occlusal splint flat. Methods: Four photoelastic models were fabricated with two external hexagon implants (Neodent) located in the space corresponding to the second premolar and molar inferiors. In each model, screw-retained metal superstructures were installed on the implants. Photoelastic models were positioned in the circular polariscope for distribution of isochromatic fringes around the implants. Photographic records were obtained before and after application of different types of loading: 1- 30kg without plate; 2- 30kg with plate; 3- 60kg without plate; 4- 60kg with plate; 5- 90kg without plate; 6- 90kg with plate. Results: After the analysis, the presence of tension in the models without the application of occlusal load after torque application (20Ncm) was observed. The decrease in stress with the application of the occlusal splint flat became more evident after the application of 60kg load. Generally, the major stress magnitude occurred in the cervical region for interimplant areas and in the apical region around implants, with a decrease of 57,77%, between the three magnitudes of loads applied after use of plate. Conclusions: The data obtained in this studies demonstrate that the best stress distribution in the implants is obtained by interposing occlusal splint flat, with the application of a 60kg load, and a decrease of 66,66%.

This Master's Project deals with creation of virtual Splint (Orthopedic plate) model and with placement of virtual Splint model onto 3D Bone model. It handles with creating of interpolation curves in 3D (especially Subdivision method) and motion along a curve. This work is only in Czech.

Introduction : Plusieurs effets secondaires sont associés au traitement de l’apnée obstructive du sommeil (AOS) par appareil d’avancement mandibulaire (AAM). Pour minimiser leur occurrence, plusieurs professionnels préconisent l’utilisation d’une attelle de repositionnement matinal (ARM) malgré le manque d’évidences valides soutenant cette approche. Objectifs : L’objectif principal de cette étude pilote randomisée contrôlée est d’évaluer l’utilisation d’une ARM comme moyen d’atténuer les effets secondaires à court terme associés au traitement par AAM. Méthode : 9 sujets souffrant d’AOS nécessitant un traitement par AAM ont été inclus et assignés aléatoirement au groupe témoin (n=5) et au groupe traitement (n=4). Tous les participants ont été traités avec un AAM fabriqué sur mesure et ajustable (SomnoDent Flex, SomnoMed, USA). Les sujets du groupe traitement ont également reçu une qu’ils devaient porter 1 heure le matin suivant le retrait de leur AAM. La participation comprenait 6 visites échelonnées sur une période approximative de 8 mois durant lesquelles plusieurs variables ont été évaluées, notamment les changements occlusaux, les effets secondaires et l’adhérence au traitement. Résultats : Des tendances de réduction des surplombs horizontaux et verticaux, de la distance intermolaire maxillaire et de la longueur d’arcade totale supérieure ont été observées uniquement au sein du groupe témoin (p=0,063). Six mois suivant la fin de la période de titration, les problèmes masticatoires étaient plus fréquemment rapportés dans le groupe témoin. 60% des sujets traités uniquement avec un AAM en rapportaient sur une base hebdomadaire comparativement à ceux recevant conjointement une ARM, où la survenue était rare, voire absente. Conclusion : Nos résultats suggèrent que l’ajout d’une ARM pourrait être bénéfique au traitement de l’AOS par AAM en réduisant la survenue de certains effets secondaires à court terme. D’autres études bien construites sont nécessaires pour confirmer nos observations. / Introduction: There are several side-effects associated with mandibular advancement devices (MAD) used to treat obstructive sleep apnea (OSA). Despite the lack of evidence supporting their use, some providers advocate the use of morning repositioning splints (MRS) to minimize these side effects. Objectives: The main objective of this randomized controlled pilot study is to evaluate MRS-use as a means of mitigating MAD-associated short-term side-effects. Methods: 9 subjects with OSA requiring MAD-use were included in this study and were randomized into a control group (n=5) and a treatment group (n=4). All participants were treated with a customized adjustable MAD (SomnoDent Flex, SomnoMed, USA). Subjects in the treatment group also received an MRS that was to be used every morning for 1 hour after removal of their MAD. Follow-up consisted of 6 appointments over approximately 8 months. During this time, variables including occlusal changes, side effects and treatment adherence were evaluated. Results: A tendency for overjet and overbite reduction as well as maxillary intermolar distance reduction and superior arch length shortening were observed in the control group only (P=0.063). Six months after completion of MAD titration, masticatory problems were more frequently reported by subjects in the control group. 60% of these subjects reported masticatory problems on a weekly basis whereas subjects in the treatment group never or rarely reported these issues. Conclusion: Our results suggest that MRS-use can minimize short-term side effects associated with MADs used to treat OSA. Additional, well-constructed, studies are needed to confirm these findings.

The Focus of this study is to present Pro-Active approach and its use in pediatric occupational therapy. The main goal is to find out the effect of the Pro-active approach to neurorehabilitation on function capability of children with spastic quadruparesis form of cerebral palsy. In the first part is presented an overview of the issue of the Pro-active approach, which is made on the basis of a literature search. Nine patients participate in this study. The pro-active approach was applied to all of them. The first case study acted as a pre- research, she had 4 months of therapy with 25 therapies. The other 8 case studies took place for 5-weeks, with occupational therapy 3 times a week. Participants were assessed with the Pediatric Evaluation of Disability Inventory (PEDI), measurement of active and passive range of motion in joints at upper extremity and spasticity. Evaluation of model activities was also included. Comparison of initial and control assessment showed an improvement in all measured score. 6 participants had better score in PEDI. For most participants was the range of active and passive motion increase. The degree of spasticity remained unchanged, but the spasticity angle improved. This study confirms that Pro-active approach has a positive effect on functional capabilities of...

Die vorliegende Arbeit fasst 4 Studien zusammen, die konservative Behandlungsstrategien und Folgeerscheinungen an Kiefergelenken mit bestehender Diskusverlagerung (DV) ohne Reposition evaluieren. Studie 1 beurteilt die Therapie mit Äquilibrierungsschienen in Form einer Anwendungsbeobachtung. Die Schmerzsymptomatik und die Kieferöffnungsweite werden über einen Beobachtungszeitraum von 13 Monaten positiv beeinflusst. Studie 2 zeigt als randomisierte, kontrollierte Doppelblindstudie, dass sich die Symptomatik der DV ohne Reposition sowie der aktivierten Arthrose während eines Beobachtungszeitraums von 4 Monaten signifikant verbessert, unabhängig von der durchgeführten Therapie bzw. der Behandlung mit einem Placebogerät. Somit erzielt die Pulsierende Signaltherapie keinen spezifischen therapeutischen Effekt. Die Studie 3 beurteilt die Kaueffektivität bei vorliegender DV ohne Reposition im Vergleich zu einer Kontrollgruppe. Die Kaueffektivität nimmt in Abhängigkeit von der Dauer des Krankheitsbildes deutlich zu, erreicht jedoch nicht die Effizienz der gesunden Vergleichsgruppe. Die Studie 4 stellt eine MRT-gestützte Nachuntersuchung von Patienten mit DV ohne Reposition dar. Das Krankheitsbild geht mit deutlichen degenerativen Veränderungen der Gelenkstrukturen einher, die sich aber über einen Beobachtungszeitraum von ca. 2 Jahren hinweg nicht signifikant verändern. Entzündungszeichen nehmen jedoch signifikant ab und die Translationsbewegung der Kondylen verbessert sich. Die DV ohne Reposition kann somit als Krankheitsbild mit morphologischen Veränderungen und funktionellen Beeinträchtigungen gewertet werden, dessen subjektive Beschwerden sich auch ohne Intervention verbessern. Morphologische Veränderungen unterliegen sich selbst limitierenden Adaptationsmechanismen. / This work presents four studies dealing with disk displacement without reduction, its treatment and long-term effects. Study 1 evaluates the treatment effects of stabilization splints. The study has a prospective follow-up design. Thirteen months after the baseline examination pain relieves and mouth opening reached a significant larger extend. Study 2 is randomised controlled and double blinded and evaluates pulsed electromagnetic fields (PEMF) as a new conservative treatment method. After a period of 4 months the pain relieves significantly and mouth opening is significantly larger in patients with anterior disk displacement or activated arthrosis, independent to active or mock treatment. PST has no specific effect on disk displacement without reduction or activated arthrosis. Study 3 tests the chewing efficiency of patients with disk displacement without reduction in comparison to a control trial. The chewing efficiency improves according to the time since onset of the disorder but is nevertheless reduced compared to a control group without TMJ-disorders. Study 4 is a MRI-controlled study, evaluating morphologic changements. Over an average time of 2 years no significant ongoing of degenerative changements accur, only high signal areas disappear and the translation of the condyle improves significantly. Anterior disk displacement is therefore a TMJ-disorder accompanied by limitation of joint function and degenerative changements of joint structures, which improve without treatment and can be interpreted as a self limiting adaptative process.