Temporomandibular disorders are a group of conditions affecting the temporomandibular joints, the jaw muscles, and related structures. Patients with temporomandibular signs and/or symptoms frequently present with indications for prosthetic treatment. The management of these patients aims to achieve patient comfort, occlusal stability, and the complex restoration of the teeth. The goal of this review is to provide an overview of the relationship between prosthodontics and temporomandibular disorders and/or bruxism with a focus on the cause-and-effect implications and the strategies for planning prosthetic treatments in patients with temporomandibular disorders and/or bruxism.
Temporomandibular disorders (TMDs) are multi-factorial and polysymptomatic pathologies and their management must be customized for every patient. Numerous therapy techniques are available to treat temporomandibular disorders-related muscular discomfort and persistent orofacial pain. Botulinum toxin (BoNT) has emerged as a popular option for patients with myofascial TMD who do not completely recover from their condition after receiving conservative care and medication. A systematic search of the literature, from January 2000 until 1 April 2022, was performed in the MEDLINE (PubMed), Web of Science, and Lilacs databases. The following search terms combination: (temporomandibular disorders) OR (botulinum) OR (toxin) was employed. A total of 357 articles were initially found in the electronic search. After screening, 11 full-text articles satisfied the inclusion criteria. The Cochrane risk of bias tool (RoB 2) tool, which uses seven domains of bias to assess random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment of self-reported outcomes, blinding of outcome assessment of objective measures, incomplete outcome data, selective reporting, and other biases, was employed to analyze randomized controlled trials. The aim of this systematic review of randomized controlled trials is to provide an overview of the use of BoNT for TMDs by comparing the application of BoNT with other therapeutic approaches. BoNT-A could help patients that do not respond to conservative treatments. Low doses are recommended when BoNT-A is considered for persistent orofacial pain related to TMD. Future research should, however, conduct clinical trials with a stricter design. The results of BoNT-A could be confirmed by more randomized controlled trials with larger sample sizes, less bias, and longer follow-up times.
The use of reliable indices to evaluate the aesthetic outcomes in the aesthetic area is an important and objective clinical aid to monitor the results over time. According to the literature various indices were proposed to evaluate aesthetic outcomes of implant-prosthetic rehabilitation of the anterior area like Peri-Implant and Crown Index [PICI], Implant Crown Aesthetic Index [ICAI], Pink Esthetic Score/White Esthetic Score [PES/WES], and Pink Esthetic Score [PES] but none of them was related to prosthetic rehabilitation on natural teeth. The aim of this study is to verify the validity of PES/WES index for natural tooth-prosthetic rehabilitation of the anterior area. As secondary objective, we proposed to evaluate the long-term predictability of this clinical application, one of which is presented below, following the analysis of the most currently accepted literature.
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