Use of a sibilant phoneme registration protocol to prevent upper airway collapse in patients with TMD

Abstract

Patients with temporomandibular dysfunction (TMD) require antero-posterior (AP) correction of mandibular position inter alia. Determination of the limit of the AP correction using a sibilant phoneme registration (SPR) protocol is essential in not increasing muscular tonus. The aim of this study is to investigate the effect of a SPR protocol on the upper airway. Using acoustic pharyngometry data, mean airways of 46 adults undergoing treatment for TMD were reconstructed in 3-D and analyzed using finite element analysis and principal components analysis. When the mean baseline functional residual capacity (FRC) airway was compared to the mean collapsed residual volume (RV) airway, a 25% reduction in the 3-D upper airway was demonstrable (p < 0.01). When the mean baseline FRC airway was compared to the mean airway with SPR (FRC-SPR), a 12% increase was found at the oropharyngeal junction of the 3-D airway, but this finding failed to reach statistical difference. Similarly, when the mean FRC-SPR airway was compared to the mean RV-SPR airway, the amount of collapse was reduced to 16% but again no statistical difference was found. In contrast, when the mean RV airway was compared to the mean RV-SPR airway, a 15-18% increase was found (p< 0.05). It is concluded that the use of a SPR protocol may be useful in improving upper airway RV in patients, during treatment for TMD.

On the Etiology and Significance of Palatal and Mandibular Tori

“…The osteogenic periosteum of the palatal vault (the midpalatal suture) would be stretched intermittently, and this tension would lead to new bone formation localized to the midline, being the epicenter of force distribution, and thereby precipitating the torus palatinus. This osteogenic model is in accord with the notion of sutural homeostasis, 6 and follows also from the functional matrix hypothesis. 11 Thus, undifferentiated stem cells would undergo mechanotransduction and differentiate locally into osteoblasts.…”

“…Second, the spatial matrix hypothesis might explain the occurrence of the symptoms of TMD, which often includes clenching, bruxism, grinding and tooth wear (facets). We believe that these parafunctional habits are secondary to, or in some way compensatory for, a compromised upper airway space, 2,5,6 which may have other presenting symptoms, such as morning headaches, snoring and obstructive sleep apnea at night, etc. Preliminary evidence of this behavioral response is beginning to emerge (Simmons and Prehn,7 Abstract 0668) supporting this view.…”

Biomimetic Oral Appliance Therapy in Adults with Severe Obstructive Sleep Apnea

“…BOAT differs from the conventional MADs as it aims to remodel the upper airway through combined maxillo-mandibular correction with or without primary mandibular repositioning. Therefore, a bite registration was obtained in the upright-sitting position with the jaw posture corrected in the antero-posterior and vertical axes specific for each subject, using a sibilant phoneme registration protocol or 'phonetic bite' [8]. Upper and lower polyvinylsiloxane impressions were also obtained.…”

Effect of an intra-oral nasal dilation appliance on 3-D nasal airway morphology in adults

“…Thus, PCA is the determination of axes that account for the maximal variance. If PCA is applied, the two most significant modes can be used for classification/diagnostic purposes [14].…”

“…The products and ratios can be resolved for individual landmarks within the configuration, and these can be linearized using a loglinear scale. For ease of interpretation, a pseudo-color-coded scale can be deployed to provide a graphic display of size change [14].…”