here - Voigts Spinal Solutions

EFFECTS OF THE ATLASPROFILAX® THERAPY ON
SYMPTOMS RELATED TO TMJ DYSFUNCTION, BRUXISM
AND DENTAL MID=LINE RELATIONSHIP.
Study by Dra.
Victoria Eugenia
Gutiérrez Navas
Dra. Gutiérrez Navas studied dentistry and orthodontistry at the Santo Tomas
de Aquino University in Bucaramanga, Colombia. She specialised in aesthetic
dentistry as well as TMJ rehabilitation and handling. Dra. Gutiérrez is a
medical auditor and has a postgraduate in Orthodontics at USTA University
according to the MEAW Japanese orthodontic approach.
Dra. Gutiérrez is an author of several articles:
MANUAL DE SUSTENTO TEORICO PARA LAS HISTORIAS CLINICAS, CAPRECOM
E.P.S. February 1996 (Theoretical support manual for clinical records)
MANUAL DE BIOSEGURIDAD EN ODONTOLOGIA,Bucaramanga, Octubre de 1996
(Biosecurity in Odontology)
REVISTA ORTOUSTA 2002;2:101-103 Efectividad de los magnetos en el tratamiento de
Maloclusión clase II. Bucaramanga, Diciembre 2002 (Effectivness of magneto-therapy in
maloclusion treatment class II)
REVISTA ORTOUSTA 2003;3:13-19. Uso de implantes como anclaje en el movimiento
dental Ortodóncico. Bucaramanga, Diciembre 2003 (Using implants as orthodontic
anchorage in the tooth movement)
REVISTA USTASALUD ODONTOLOGIA 2006;5:85-73. Morfología Craneofacial en Padres
de Niños con Paladar Hendido.( Craniofacial Morphology in Parents of Children with Cleft
Palate.)
In 2012 Dr. Gutierrez specialised in the Swiss AtlasPROfilax® method that
combines and complements her professional work in the field of dentistry and
orthodontics.
Several studies report a close relationship
between the cervical spine and the craniomandibular complex, both capable of being
reciprocally influenced.
INTRODUCTION
>Aldana PA, Báez RJ, Sandoval CC,
Vergara NC, Cauvi LD, Fernández-de-laReguera A. Asociación entre
maloclusiones y posición de la cabeza
y el cuello. Int J. Odontoestomatol.
2011, 5(2):119-125
>Sonneesen L, Kjaer I. Cervical column
morphology in patients with skeletal
Class III malocclusion and mandibular
overjet. Am J Orthod tofacial Orthop.
2007, 132:427.e7.e12)
>Armijo-olivo S, Rappoport K, Fuentes
J, Gadotti IC, Major PW, Warrren S, et
al. Head and Cervical Posture in
patients with temporal disorders. J
Orofacial Pain.2011;25:199-209
Altered posture of the head and neck may cause
or predispose painful conditions which alter the
biomechanics and muscle balance of the
craniocervical region.
A forward head posture.
Extension of the upper cervical spine (C1-C3).
accompanied with flexion of the lower
cervical spine (C4-C7).
Center of gravity of the head moves and the
spine supports a larger weight.
Miyawaki S, Tanimoto Y, Inoue M, Sugawara Y, Fujiki T, Takano-Yamamoto T. Condylar motion in
patients with reduced anterior disc displacement. J Dent Res. 2001;80:1430–1435
The jaw muscles.are part of the muscle chain that
allows the individual to remain standing with an erect
head .
When postural changes occur, muscle
contractions at the stomatognathic system
change mandibular position, which tries to adapt due
its need to operate.
Aldana PA, Báez RJ, Sandoval CC, Vergara NC, Cauvi LD, Fernández-de-la-Reguera A. Asociación entre maloclusiones y posición de
la cabeza y el cuello. Int J. Odontoestomatol. 2011, 5(2):119-125.
Mandibular deviations during opening and
closing, are manifestations of inflammation
or impaired balance and position of the
temporomandibular complex.
This may be the result of changes in head
position.
>Capursso U. Postural and
respiratory factors of the condylar
position in the Temporomandibular
Joint. Revista Romana de
Stomatologie.2007;13(3)) .
>Celic R, Jerolimov V, Zlataric DK,
Klaic B. Measures of Mandibular
Movements in Patients with
Temporal Disorders and
Asymptomatic Subjects. Coll
Antropol; 2003: 27(2):43-49
TILT AND
ROTATION OF
THE ATLAS
The importance of clinical examination and non-surgical
treatment to control pain and dysfunction.
The limited effect the maxillomandibular appliances like
plates, splints, orthodontic treatment, etc. can have.
Physical therapy in association with other treatment
methods may be helpful in relieving musculoskeletal pain
and improve movement.
>American Society of Temporomandibular
Joint
Surgeons.
Guidelines for Diagnosis and
Management of Disorders Involving
the Temporo-mandibular Joint and
Related
Musculo-skeletal
Structures.2001.
http://astmjs.org/final%20guideline
s-04-27-2005.pdf (Mayo 2013)
>Koul R. Orthodontic implications of
growth and differently enabled
mandibular movements for the
temporal
joint.
Seminars
in
Orthodontics.2012;18(1):73-91
Orthodontic therapy should be addressed to achieve structural
balance to facilitate physiological adaptation and rehabilitation
of patients affected by TMJD.
Note that in the head there are three joints:
the craniocervical joint, craniomandibular
joint (TMJ) and tooth joint, which should be
treated harmoniously together.
The study arises from the need to treat TMJ
Dysfunctions by means of using alternatives.
OBJECTIVE OF
THE STUDY
> Goring H. Estudio suizo
Posición viciosa del atlas con
rotación e inclinación a la
izquierda. Crones Croatian
Federation.
www.atlasprofilax.la
AtlasPROfilax® is a natural therapy developed to
permanently correct the wrong angle of rotation of
the first cervical vertebra or "atlas".
It helps in correcting the cervical curve, the position
of the head and the spatial relationship of the jaw
and the rest of the body.
The goal was to describe the effect of AtlasPROfilax®
therapy on symptoms associated with TMJD, bruxism
and
mandibular
deviations
in
maximum
intercuspation and openness, in a cohort of patients.
Type of study
Descriptive observational study
MATERIALS AND
METHOD USED
Universe and Sample
Excluded were:
Patients with total superior or inferior
UNIVERSE: 223 patients to
whom the AtlasPROfilax® methodprothesis, because of intraoral or eviction
movement.
was applied.
Patients with thrush or any soft tissue injury
pain that could affect the mouth opening.
SAMPLE: 151 patients that assist
as the control session 30 or 40
days after the Atlasprofilax
application.
SUB-SAMPLE: 71
patients (Photographic
measurement of middle
odontal line)
Sociodemographic:
• Age.
• Gender.
Clinic: taken directly from the patient
VARIABLES
• The presence or absence of temporomandibular dysfunction (TMD).
• In patients with TMJ symptoms related to noise, jump, pain or lockjaw before
and after the therapy was analysed.
• The presence of bruxism both before and after therapy.
• Perception of relief felt by the patient after treatment, which was quantified
on a scale from 0 to 100% and qualitative relief Yes or No.
Obtained from photographic analysis
• Magnitude in millimeters of midline deviation; variables that were taken
immediately before, after and in the monthly control.
• The difference between the midline deviation at occlusion and opening at each
of those times.
For the collection of clinical data:
Taken from the medical history and from sociodemographic variables, TMJD
and articular symptoms as well identified from the perceptions reported by
the patient.
PROCEDURE
For the information obtained from the pictures:
The patient was placed in a sitting position without a back rest, keeping a
natural posture with feet flat on the floor and knees at a 90 degree angle.
PENTAX Optio camera brand Dinecorp M40 8.0 Megapixels and 3x optical
zoom, 6.3 mm-18,9mm, located on an adjustable to the height of the
patient's mouth, at a distance of 33 cm tripod, was used.
The patient’s position of the head was not corrected at the time of the shot,
allowing angulation or tilting the same as the tendency of the patient.
Coefficient of Correlation
Midline deviation in occlusion
•
•
•
Before
Right after
1 Month after
0.96
0.96
0.97
Midline deviation in opening
•
Before
0.95
•
After
0.97
•
1 Month after
0.95
In the photographic analysis the distance between the
dental midlines top and bottom in both closed and
opened intercuspation were measured. The
correlometer of Bimler was used. Measurements at two
different times were made by the same orthodontist
with 15 days difference between measurements to
match coherence. Deviation from the midline in
occlusion - deviation of the midline on opening in three
stages. The midline line distance difference in occlusion
and opening were calculated in millimeters (mm).
STATA Corporation
The AtlasPROfilax® method seeks the correct repositioning of the atlas (C1) vertebra
using pressure and a controlled vibration stimulus to the short muscles of the neck
that mitigates existing contractures. It is a safe treatment.
Usually, the therapy is performed only once in life. The approximate length of the
appointment is 45 minutes including the history, kinesiological tests, anthropometric
measurements and application itself.
The procedure is performed with the patient in a sitting
position, using the AtlasPROfilax® Wellnessvib in adults
and in children AtlasPROfilax® Babyvib manufactured by
Automation and HC Ingenierie SA, ZI in Bovery D
CH'1868 Collombey and approved in Colombia with
INVIMA register # 2011000975.
Göring H. Estudio suizo Posición viciosa del atlas con rotación e inclinación a la izquierda. Crones Croatian Federation . // www.atlasprofilax.la
Information was collected on a tool. It was systematised in Excel.
The database was debugged. The information was processed in
STATA 9.0. Results are presented in text, tables and graphs.
STATISTICAL
ANALYSIS
Univariate
• Summary measurements for Qualitative variables:
proportions were calculated. Measurements for
Quantitative: measurements of central tendency (mean
and median) and dispersion (standard deviation, range,
percentiles).
Bivariate
• TMD was associated with socio demographic variables:
• Qualitative: Chi2 or Fisher's exact test.
• Quantitative: Student's t test or Wilcoxon rank test.
• TMJD related symptoms before and one month were
compared:
• McNemar test.
• The difference of the deviations from the midline before
• and after and monthly were monitored and correlated
with the presence of TMJD
• t Test of Student or the Wilcoxon rank test.
For all analyses a significance level
of α (alpha) ≤ 0.05 was considered:
>Microsoft Excel 5.0. Microsoft
Corporation, 1997
>STATA Corporation
>Pagano M, Gauvreau K.
Fundamentos de Bioestadística. Ed.
Thomson Learning; 2001. p. 259 321
ETHICAL
CONSIDERATIONS
Ministry of Health. Resolution No. 008430
(Oct 4/1993) Bogota (Colombia)
This research was welcomed with established ethical
principles in resolution 1993 008430, while preserving the
principles of beneficence, autonomy, confidentiality, privacy
of information.
Table 1. Description of the socio demographic variables analysed according
to TMJD before and one month after the treatment
VARIABLE
*Average (Standard Deviation)
TMD
TOTAL
RESULTS
WITH SYMPTOMS
MONTH
P
Yes
No
TREATMENT
TMD
151(100)
65 (43.1)
86 (56.9)
Age (years) *
50.3 ±17.5
49.2±15.4
51.2±19
0.5227**
53±13.4
Male
47(31.1)
13(27.7)
34(72.3)
0.010+
4 (8.5)
Female
104(68.9)
52(50)
52(50)
**Wilcoxon rank test
+
Chi2
Test
Gender
24 (23.1)
.025
.02
.015
0
.005
.01
Density
20 TMD
0
No
40
edad
60
With
TMD
1
80
100
.02
0
.01
Density
.03
.04
0
0
50
100
0
50
100
edad
Graphs by dtm
Figure 1. Distribution of age in all patients in the cohort
and according presence of TMD
®
Table 2. Description of
symptoms associated
with TMD before and
one month after
therapy AtlasPROfilax®
After 1
Month
Variables
Total
Before
Symptoms
151(100)
Articular noise
33(21.9)
33(50.8)
14(21.5)
<0.0001
Articular jump
29(19.2)
29(44.6)
12(18.5)
<0.0001
Articular pain
32(21.2)
32(49.2)
13(20)
<0.0001
Lockjaw in
opening
6(4)
6(9.2)
1 (1.5)
0.0243
Bruxism
11(7.3)
11(16.9)
4(6.2)
0.0082
Relief provided by
treatment (%)
NA
NA
72.8±37.9*
---
P**
65(43.1)
*Average (Estándar Deviation)
**McNemar Test
The symptoms were significantly reduced after the effect of AtlasPROfilax® therapy.
Noise, jump and joint pain reduced by more than half and bruxism in about 70%.
82.3% (51) of those suffering TMJD reported pain relief after therapy.
The average percentage of relief was 72.8 ± 37.9, with a median of 100%.
TMD
Variable
Table 3. Mean
differences deviation
from the midline at
maximum occlusion
and openness; before,
after and in the
monthly monitoring
analysed by level of
TMJD.
Yes
No
P
Difference midline occlusion and
opening BEFORE (mm)
-1.4±2.3*
-0.4±1.6
0.0395**
Difference midline occlusion and
opening AFTER (mm)
-1.4±2.3
-0.3±1.5
0.0110**
Difference midline occlusion and
opening 1 MONTH AFTER (mm)
-0.9±2.1
-0.3±1.5
0.1562+
*Average (Standard Deviation)
**Wilcoxon rank test
+ T Test
DISCUSSION
The aim of this study was to analyse
the effect of AtlasPROfilax® therapy
on symptoms associated with TMJD,
bruxism and the ratio of the
midlines in maximum opening and
closing, in a cohort of patients.
Alternative treatments performed
by
orthodontists,
for
these
alterations should not be limited to
the correction of tooth alignment
and occlusion control.
The orthodontist must know and even have
the
skills to
intervene
with
the
craniocervicofacial complex and the dental
complex in favour of more stable and holistic
treatments.
In this sense the AtlasPROfilax® therapy is an
alternative that allows an approach via the
cranio-cervical complex to effect the TMJ.
Based on the results of this study, this
therapy has potential impact on the
management of TMJD symptoms.
• Alpern M. TMJ Biocompatible orthodontic treatment. The Angle orthodontic 1992;62(4):299-302
• Atlas Clínico: Congruencia Cráneo-Cervico- Mandibular. Dr Mariano Rocabado Seaton
Values
In this work
50%
Warren & Fried
80%
Wadhwa & Kapila
2:1
Kuttila & col
confused by stress
Analysis of the presence of symptoms
before and after the AtlasPROfilax®
therapy by age.
Hormonal influence
.03
.02
.01
.03
0
50
With1 symptoms
100
0
50
100
50
100
edad
Graphs by sintoa
.02
Después
AfterTTO
therapy
.01
Density
>Kuttila M, Niemi PM, Kuttila S,
Alanen P, Le Bell Y. TMD treatment
need in relation to age, gender,
stress and diagnosis subgroup.
Journal of Orofacial Pain. 1998,
12(1):67-74
Con síntomas
Sin síntomas
0symptoms
No
0
>Wadhwa S, Kapila S. TMJ disorders:
future innovations in diagnostics
and therapeutics. Journal of Dental
Education. 2008; 72(8):930-947
0
>Warren
MP,
Fried
JL.
Temporomandibular disorders and
hormones in women. Cell Tissues
Organs. 2001;169:187-192
Antes
TTO therapy
Before
Density
GENDER AND AGE
From 65 with TMJD, 52
(80%) were females.
Con síntomas
1
With
symptoms
síntomas
0
NoSin symptoms
.04
Female
0
50
100
edad
0
Age
SYMPTOMS
>Abou-Atme YS, Zawawi KH, Melis M.
Prevalence, intensity and correlation of different
TMJ symptoms in Lebanese and Italian
subpopulations. J
>Contemp Dent Pract 2006;7(4):71-78.
>Casanova-Rosado JF, Medina-Solis CE, VallejoSánchez AA, Casanova-Rosado A, HernándezPrada B et al. Prevalence and associated factors
for Temporomandibular disorders in a group of
Mexican adolescents and youth adults. Clin
Oral Investen:
>Sonnesen
L,
Bakke
M,
Solow
B.
Temporomandibular disorders in relation to
craniofacial dimensions, head posture and bite
forcé in children
selected for orthodontic treatment. European
Journal of Orthodontics. 2001; 23:179-|192.
>Manfredini D, Peretta R, Guarda-Nardini L,
Ferronato G. Predictive value of combined
clinically diagnosed bruxism and occlusal
features for
>TMJ Pain. Journal of craniomadibular practice.
2010;28(2): 1-9.
SYMPTOMS
TRABAJO
TMD
Prevalence
This study
43%
Abou-Atme
y col.
40-75%
CasanovaRosado y col.
Sonnesen y
col.
Manfredini y
col.
46%
Articular
noise
Articular
blockade
Articular
pain
Bruxism
22%
4%
General:21%
<30 years:
14.3%
7.3%
50%
5%
12.5%(Adoles
cents)
65%
WORKS
This study
PHOTOGRAPHIC
ANALYSIS
Armijo & al.
Lunes & al.
He photographed the position of the head and whole body
in the sagittal and frontal plane for the purpose of analyzing
the craniocervical posture and its relationship to TMJD.
S, Rappoport K,
Fuentes J, Gadotti IC, Major PW,
Warrren S, et al. Head and Cervical
>Lunes DH, Carvalho LCF, Oliveira
AS,
Bevilaqua-Grossi
D.
Craniocervical posture analysis in
patients
with temporoandibular
disorder. Rev Brasil Fisioter. 2009;
13(1):89-95.
Objective: measuring midline deviation in occlusion and
openness by using frontal photography as a strategy to
identify TMJD, when the head is in normal position.
Objective: To obtain the position of the head and cervical
spine in the sagittal plane according to the usual position of
the head, associating them with TMJD
>Armijo-olivo
>Posture in patients with temporal
disorders.
J
Orofacial
Pain.2011;25:199-209.
CARACTERISTICS
SUPPORT FOR THE
DENTAL MIDLINE
DIAGNOSIS BY
PHOTOGRAPHY
>Schmitter M, Kress B, Leckel M,
Henschel V, Ohlmann B, Rammelsberg
P. Validity of temporalmandibular
disorders examination procedure for
assessment of tempormandibular joint
status. Am J. Orthod Dentofacial
Orthop 2008; 133(6):796-803.
>Sora C, Jaramillo PM. Diagnóstico de
las asimetrías faciales y dentales.
Revista Facultad de Odontología
Universidad de Antioquia 2005; 16 (1
y2): 15-25.
>Hirschhaut
M,
Desordenes
temporomandibulares y dolor facial
crónico. Acta Odontológica Venezolana
1998;36(3).
According to data: measuring the deviation of the midlines in
photographs is a good marker to analyse the TMJ while showing that
the difference of the deviation is greater among people with TMJD.
This score is based on the statement by Sora and Jaramillo who
believe that the clinical evaluation of the deviation from the midline
in different positions, including opening and occlusion, is a strategy to
detect functional asymmetries related to TMJ disorders and
mandibular dynamics.
To Hirschhaut, it is normal that the midline is kept opening and closing,
but can move sideways and then return (deviation) or not (deflection).
In cases of subluxation, the interarticular disc is displaced and the
patient has, among other signs, deviation from the midline toward the
affected side.
Orthodontic treatment of patients with TMJD is complex
and requires a multidisciplinary approach; diagnosis and
conventional orthodontic treatment need to be modified.
THE TREAMENT
>Alpern M. TMJ biocompatible
orthodontinc treatment. The Angle
Orthodontic 1992; 62(4): 299-302.
>American
Society
of
Temporomandibular Joint Surgeons.
Guidelines
for
Diagnosis
and
Managment of Disorders Involving the
Temporomandibular Joint
and
Related
Musculoeskeletal
Structures.2001.
En
http://astmjs.org/final%20guidelines04-27-2005.pdf (Mayo 2013).
>gGrossi
DB,
Chaves
TC.
Physiotherpeutic
treatment
for
temporal disorders (TMD). Braz J Oral
Sci.2004;3(10): 492-497.
In the literature the interest of promoting less invasive
treatments for the management of TMJ disorders in
which physical therapy, postural changes, among others,
are presented as alternatives to control this dysfunction
is evident.
Research to assess the impact of these treatments
illustrate how the approach from this perspective is
underdeveloped by orthodontists.
Postural training should be used for the treatment of
TMJD because of the obvious link between TMJ disorders
and craniocervical posture.
STUDY
Nicolakis & al.
COMPARED
RESULTS
>Garcia de Paula e Silva FW,
Mussolino de Queiroz A, DíazSerrano KV. Alteraciones posturales
y su repercusión en el sistema
estomatognático. Acta Odontológica
Venezolana.2008 46(4):1-7
>Grossi
DB,
Chaves
TC.
Physiotherpeutic treatment for
temporal disorders (TMD). Braz J
Oral Sci.2004;3(10): 492-497
CHARACTERISTICS
They implemented a protocol based on passive movements,
correcting posture and relaxation techniques in 20 patients with
TMJ articular displacement and observed increase in mouth opening
and pain reduction and treatment effect.
Wright & al.
They selected 60 patients with TMJD and dysfunction of the
masticatory muscles. The aim was to assess the efficacy of postural
training and TMJD guidance. They took a group to which the two
interventions were offered while in the control group were offered
only guidelines; The results showed that 10% of individuals
undergoing TMJD related symptoms disappeared.
This study
In this study of 65 patients with TMJD, the AtlasPROfilax® therapy
relieved the symptoms related to: articular noise 29.3%, articular
jump 26.1% Articular Pain 29.2%, lockjaw on opening 7.7% and
Bruxism 10.7% of patients.
It is not a controlled trial (RCT).
LIMITATIONS
However, from this observational study, bases were set to
develop a study related to this intervention in order to
provide a higher level of evidence. This prospective
observational study comparing people with and without
TMJD provides analytical advances.
In assessing the effectivness of the therapy by only one
month after could lead to an underestimation of the
effectiveness of AtlasPROfilax® therapy. The reason is that
some patients may be at the stage of healing crisis or still
improving, because the process of adjustment and the
changes generated by the correct repositioning of the atlas
vertebra needs time, several months, up to 24.
The specialized orthodontist, interested in treating TMJD
must know and even have the skills to intervene with the
craniocervicofacial complex in addition to the dental one.
CONCLUSIONS AND
RECOMMENDATIONS
The AtlasPROfilax® therapy had effect on the symptoms
associated with TMJD, bruxism, and the relationship of dental
midlines but requires ECC tracked at three and six months to
continue evaluating the effectiveness of this therapeutic
alternative.