Comparação clínica entre diferentes técnicas para registro de relação central em indivíduos edêntulos
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Data
2020-08-27
Autores
Ervolino, Isabela Caroline de Sousa [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
As reabilitações protéticas baseadas em técnicas adequadas podem promover um melhor desempenho, conforto e longevidade à prótese, com o intuito de restabelecer o equilíbrio muscular e articular com o seu uso. Uma das etapas da reabilitação é o registro da relação central (RC) do indivíduo. Para que este registro seja feito, a literatura descreve diversas técnicas aplicáveis, partindo de métodos fisiológicos, guiados ou gráficos. Infelizmente, não existe um consenso se diferentes técnicas para registro da RC oferecem resultados semelhantes. Diante disto, o objetivo deste estudo foi comparar a semelhança entre diferentes técnicas para registro da RC em indivíduos edêntulos, levando em consideração a posição condilar em relação à cavidade glenóide no sentido anteroposterior e o tempo para realização de cada registro, adotando-se uma técnica inicial como controle (técnica do arco gótico extra oral) e uma posição fixada em articulador como referência. Foram incluídos no estudo 12 voluntários (2 homens e 10 mulheres, idade média de 68,58 anos) desdentados bimaxilares usuários de prótese total insatisfatória, considerando critérios de inclusão específicos. Diferentes técnicas foram analisadas pelo posicionamento em um articulador personalizado para mensurar movimentos no sentido anteroposterior, sendo elas: arco gótico extra oral (AGEO), deglutição (D), manipulação frontal associada ao levantamento da língua (MFLL) e arco gótico intra oral (AGIO). Todos os registros foram realizados pelo mesmo operador no mesmo período do dia, com intervalo de 30 minutos entre cada registro e o tempo para realização de cada técnica foi mensurado. Os dados relacionados à confiabilidade das técnicas e o tempo de realização das mesmas foram submetidos à Análise de Variância um fator, seguido do teste de Tukey. Todas as análises foram realizadas com significância de 5%. Considerando as medidas da posição condilar do lado direito, houve diferença estatística (P < 0,05) no registro da técnica D em relação ao registro de AGEO, onde a mandíbula posicionou-se mais anteriorizada. No lado esquerdo, não houve diferença estatística entre os grupos. O registro das técnicas MFLL e AGIO não mostrou diferença estatisticamente significativa em comparação à técnica AGEO em relação a posição de registro da RC em ambos os lados. Em relação ao tempo para realizar cada registro, as técnicas AGEO e AGIO apresentaram diferenças significativas em relação as técnicas D e MFLL, despendendo maior tempo. Pode-se concluir que a técnica D apresentou maior diferença quando comparada às técnicas MFLL e AGIO sobre a posição condilar, onde esta posicionou-se retruída. Os registros de AGEO, MFLL e AGIO não apresentaram diferenças significativas, bem como entre as técnicas D e AGEO. Considerando-se semelhança posição condilar em cada técnica registrada e tempo para execução, as técnicas MFLL mostrou-se adequada, por promover menor tempo clínico ao paciente durante o registro e ser estatisticamente semelhante ao controle. A técnica D também mostrou-se interessante, apresentando-se semelhante ao controle, com erro padrão equilibrado e fisiologicamente confortável ao paciente.Mais estudos precisam ser realizados sobre o comportamento das estruturas do sistema estomatognático quanto quando ao registro de posição condilar protruido ou retruido a longo prazo.
Prosthetic rehabilitation based on appropriate techniques can promote better performance, comfort and longevity to the prosthesis, in order to restore muscle and joint balance with its use. One of the stages of rehabilitation is the registration of the individual's central relationship (CR). For this record to be made, the literature describes several applicable techniques, starting from physiological, guided or graphic methods. Unfortunately, there is no consensus on whether different techniques for recording CR offer similar results. In view of this, the aim of this study was to compare the similarity between different techniques for recording CR in edentulous individuals, taking into account the condylar position in relation to the glenoid cavity in the anteroposterior direction and the time to perform each record, adopting a technique initial as a control (extra oral gothic arch technique) and a position fixed on the articulator as a reference. Twelve volunteers (2 men and 10 women, mean age 68.58 years) were included in the study, toothless bimaxillary users of unsatisfactory complete dentures, considering specific inclusion criteria. Different techniques were analyzed by positioning in a personalized articulator to measure movements in the anteroposterior direction, namely: extra oral gothic arch (AGEO), swallowing (D), frontal manipulation associated with tongue lifting (MFLL) and intra oral gothic arch (AGIO ). All records were made by the same operator at the same time of the day, with an interval of 30 minutes between each record and the time to perform each technique was measured. The data related to the reliability of the techniques and the time they were performed were submitted to one-way analysis of variance, followed by the Tukey test. All analyzes were performed with a 5% significance level. Considering the measurements of the condylar position on the right side, there was a statistical difference (P <0.05) in the registration of technique D in relation to the registration of AGEO, where the mandible was positioned more anteriorly. On the left side, there was no statistical difference between the groups. The registration of the MFLL and AGIO techniques showed no statistically significant difference compared to the AGEO technique in relation to the CR registration position on both sides. Regarding the time to perform each record, the AGEO and AGIO techniques showed significant differences in relation to the D and MFLL techniques, spending more time. It can be concluded that technique D presented a greater difference when compared to the techniques MFLL and AGIO on the condylar position, where it was retracted. The records of AGEO, MFLL and AGIO showed no significant differences, as well as between the techniques D and AGEO. Considering the similarity of the condylar position in each registered technique and time for execution, the MFLL techniques were shown to be adequate, as they promote less clinical time for the patient during registration and are statistically similar to the control. Technique D was also interesting, being similar to the 16 control, with balanced standard error and physiologically comfortable to the patient. More studies need to be carried out on the behavior of the structures of the stomatognathic system regarding the recording of protruded or retracted condylar position at long term.
Prosthetic rehabilitation based on appropriate techniques can promote better performance, comfort and longevity to the prosthesis, in order to restore muscle and joint balance with its use. One of the stages of rehabilitation is the registration of the individual's central relationship (CR). For this record to be made, the literature describes several applicable techniques, starting from physiological, guided or graphic methods. Unfortunately, there is no consensus on whether different techniques for recording CR offer similar results. In view of this, the aim of this study was to compare the similarity between different techniques for recording CR in edentulous individuals, taking into account the condylar position in relation to the glenoid cavity in the anteroposterior direction and the time to perform each record, adopting a technique initial as a control (extra oral gothic arch technique) and a position fixed on the articulator as a reference. Twelve volunteers (2 men and 10 women, mean age 68.58 years) were included in the study, toothless bimaxillary users of unsatisfactory complete dentures, considering specific inclusion criteria. Different techniques were analyzed by positioning in a personalized articulator to measure movements in the anteroposterior direction, namely: extra oral gothic arch (AGEO), swallowing (D), frontal manipulation associated with tongue lifting (MFLL) and intra oral gothic arch (AGIO ). All records were made by the same operator at the same time of the day, with an interval of 30 minutes between each record and the time to perform each technique was measured. The data related to the reliability of the techniques and the time they were performed were submitted to one-way analysis of variance, followed by the Tukey test. All analyzes were performed with a 5% significance level. Considering the measurements of the condylar position on the right side, there was a statistical difference (P <0.05) in the registration of technique D in relation to the registration of AGEO, where the mandible was positioned more anteriorly. On the left side, there was no statistical difference between the groups. The registration of the MFLL and AGIO techniques showed no statistically significant difference compared to the AGEO technique in relation to the CR registration position on both sides. Regarding the time to perform each record, the AGEO and AGIO techniques showed significant differences in relation to the D and MFLL techniques, spending more time. It can be concluded that technique D presented a greater difference when compared to the techniques MFLL and AGIO on the condylar position, where it was retracted. The records of AGEO, MFLL and AGIO showed no significant differences, as well as between the techniques D and AGEO. Considering the similarity of the condylar position in each registered technique and time for execution, the MFLL techniques were shown to be adequate, as they promote less clinical time for the patient during registration and are statistically similar to the control. Technique D was also interesting, being similar to the 16 control, with balanced standard error and physiologically comfortable to the patient. More studies need to be carried out on the behavior of the structures of the stomatognathic system regarding the recording of protruded or retracted condylar position at long term.
Descrição
Palavras-chave
Relação Central, Registro da Relação Maxilomandibular, Articuladores Dentários, Reabilitação bucal, Arcada Edêntula, Mouth rehabilitation