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The RNO, is defined as a part of medicine that operates in stomatology occlusal plane as a guide to a harmonious development of the face, chewing facilitating bilateral and alternating. (Planas, 1997). It works through selective grinding on the occlusal platform, providing an increased number of dental contacts.
Purpose: To evaluate the effects of the Neuro-Rehabilitation occlusion in patients with chronic facial palsy by observing the decrease of the symptoms of masticatory dysfunction.
Methods: a selection of sixty-five patients with facial palsy (PFP 65) and idiopathic chronic trauma of the Otorhinolaryngology sector facial nerve disorders at UNIFESP.
Patients were of both genders, aged between 18 and 60. They were analyzed according to the criteria of inclusion and exclusion, resulting in forty-three patients.
However, due to problems inherent in research, a group of fourteen patients were randomized (sub-divided) into two groups: control and treatment.
The visual analog scale was used at the first consultation to patients in the control and treatment group.
All patients underwent a dental cleaning in order to blind the study. Seven patients belonged to the control group for three months per sequence, the VAS was performed in both groups. The control group was later reunited with the treatment group after three months of control period, increasing the number of patients who were examined in extracts, with similar features in a prognostic factor.
Control group
First visit- visual analogue scale and dental cleaning - Day 1
Second visit, after a month, a new visual analog scale. Day-30
Third-visit -one months after a new visual analogue scale Day 60 patient was a three visits with an interval of one month, performing a repeat procedure.
Treatment group The researchers applied the technique of Rehabilitation and Neuro Occlusal gnathostatic models that were made before and after treatment to count the dental contacts.
First query - visual analogue scale and dental cleaning, preparation of initial models gnatostaticos and intervention- Day 1
Second-query-after a month, a new visual analogue and intervention. Day 30
Third query- -after a month, a new visual analogue and intervention Day 60
Last query -after a month a new visual analogue scale and making models gnathostatic finals. Day 90 The treatment group had one month to see changes in oral functions, but for estatistic effects was computed only de first andy the last visit the number of the dental contact and the VAS. Day 90 Upon completion of the study patients continued to receive care in the ambulatory clinic of the university, but the attendance for this research was terminated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Visual Analog Scale (VAS) | Placebo Comparator | Initial consultation, dental cleaning and performing the visual analog scale. Consultation three months after achieving "visual analog scale" final
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| Occlusal adjustment | Experimental | In all consultations, was performed VAS and occlusal adjustment. Three sessions of intervention are doing. The Gnathostatic models were performed in the first and last query. To reach a terminal axis of rotation of the jaw the patient to perform the act of swallowing for 3 times, and after palpation of the muscles, masseter and temporal on both sides and compared with the marks of carbon found in the teeth and started the adjustment following the rules of Guichet with a cylindrical drill with a thin cut.. The rules to guide the occlusal adjustment selective grinding were in this sequence: Occlusal adjustment to the centric relation: with sliding towards anterior; with sliding towards the medium line; with sliding opposite to the medium line; No sliding. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| occlusal adjustment. | Procedure | It prompted the patient to perform the act of swallowing for 3 times to reach a terminal axis of rotation of the jaw and from this to start. Will be held palpation of the muscles, masseter and temporal on both sides and compared with the marks of carbon found in the teeth. After starts the adjustment following the rules of Guichet with a cylindrical drill with a thin cut . basic principles 1 Occlusive stress maximum distribution in centric relation 2 The occlusive strengths should by the teeth's major axis.3 When the contact is surface to surface, it must be exchanged to another surface point. 4 Once the stability to the centric relation is achieved, it should be kept. The rules to guide the occlusal adjustment selective grinding . |
| Measure | Description | Time Frame |
|---|---|---|
| The Visual Analog Scale for Pain Was Used to Grade Discomfort in Chewing After the Installation of Facial Paralysis. Level Zero is the Lack of Discomfort and 10 is the Maximum Degree of Discomfort. | It is a scale-shaped ruler, which is associated with faces used to grade the degree of pain for patients, before and after treatments, or just graduating pain and its severity for the patient (Souza, 2002). Patients were asked to fill the VAS with the following questions.
| Day 1 (Day 91 for Treatment participants first receiving Placebo) |
| Brand Carbon Count on Gnathostats Models | Only in the treatment group were done gnatostatic models.The models were placed occluding brought with carbon, using the willis compass to keep occluding the posterior base of the model which are aligned with the rear. A model of the teeth was made to measure the occlusion of the teeth (i.e., the amount of contact between the upper and lower mandibles), and used carbon to count the the number of dental contacts, through the brand carbon made on the model, The dental contacts were counted in the models before and after treatment. The models are made in the first and last query. | Day 01 and after 90 days of treatment (Day 180 for Treatment participants first receiving Placebo) |
| Measure | Description | Time Frame |
|---|---|---|
| Visual Analog Scale | It is a scale-shaped ruler, which is associated with faces used to grade the degree of pain for patients, before and after treatments, or just graduating pain and its severity for the patient (Souza, 2002). Patients were asked to fill the VAS with the following questions. Do you chew well? How would you classify your chewing at the moment? If you have no trouble chewing, the rating is zero. If you have any discomfort when you chew, your reference level is five. If the discomfort is intense, its reference level is ten. The greater the discomfort, the greater the scale. |
| Measure | Description | Time Frame |
|---|---|---|
| Correlation Between the Increase of the Number of Dental Contact Points and the Improvement in the Subjective Evaluation Measured Through the Visual Analogic Scale . | The correlation between the increase of the number of the dental contacts and the VAS evaluation final result from chronic peripheral facial paralysis patients, according to control and treated groups by the neuro occlusal rehabilitation technic. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Rosana Q Costa, master | Federal University of São Paulo | Principal Investigator |
| Rosana Q Costa, Investigator | Federal University São Paulo | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Federal University of São Paulo | São Paulo | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20572435 | Background | Rahal A, Goffi-Gomez MV. Clinical and electromyographic study of lateral preference in mastication in patients with longstanding peripheral facial paralysis. Int J Orofacial Myology. 2009 Nov;35:19-32. | |
| 10838864 | Background | Martin E. [Neuro-occlusal rehabilitation and selective grinding: results after 1 year]. Orthod Fr. 2000 Jan;71(1):57-60. French. |
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Some patients were excluded because they did not agree to be randomized, others could not be present at every visit, or were co-interventions.
There was a selection of sixty-five patients with traumatic and idiopathic palsy of the Otorhinolaryngology UNIFESP, between June 2008-March 2009, according to the criteria of inclusion and exclusion, resultram forty-four, of whom 30 did not participate, resulting in 14.
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| ID | Title | Description |
|---|---|---|
| FG000 | Placebo Then Treatment | Participants recived, Dental cleaning and performing the visual analog scale, durant tree visits. At first visit was doing Dental cleaning and visual analog scale and after 90 days was doing another visual analog scale. Participants who recieved Placebo later recieved Treatment as described for The experimental-Occlusal Adjustment Arm. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| 01-90 |
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| Visual analog scale. | Behavioral | Visual analog scale-Graduation was held on the visual analogue scale in the first and last query to measure discomfort chewing.Graduation was held on the visual analogue scale .in the first and last query to measure discomfort chewing. After graduating dental cleaning was performed, with the purpose of blinding the study, Dental Cleaning.With engine using low speed, brushes, and prophylactic paste is carried out dental cleaning in the teeth of all patient. Dental Cleaning.With engine using low speed, brushes, and prophylactic paste is carried out dental cleaning in the teeth of all patient. |
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| After 90 days of treatment (Day 180 for Treatment participants first receiving Placebo) |
| Day 01 and after 90 days of treatment (Day 180 for Treatment participants first receiving Placebo) |
| Correlation Between the Increase of the Number of Dental Contact Points and the Improvement in the Subjective Evaluation Measured Through the Visual Analogic Scale Whithout the Outlier. | The correlation between the increase of the number of the dental contacts and VAS evaluation final result from chronic peripheral facial paralysis patients. On this measure was excluded one outlier patient whose facial paralysis appeared in her childhood. Observing the outlier patient, it was carried out a new scatterplot, ignoring her. | Day 01 and after 90 days of treatment (Day 180 for Treatment participants first receiving Placebo) |
| 1341730 | Background | Planas P. [Equilibrium and neuro-occlusal rehabilitation]. Orthod Fr. 1992;63 Pt 2:435-41. French. |
| 5293022 | Background | Planas M. [Neuro-occlusal rehabilitation: NOR]. Orthod Fr. 1971;42:333-47. No abstract available. French. |
| 3862802 | Background | Christensen LV, Radue JT. Lateral preference in mastication: an electromyographic study. J Oral Rehabil. 1985 Sep;12(5):429-34. doi: 10.1111/j.1365-2842.1985.tb01548.x. |
| FG001 |
| Experimental-Occlusal Adjustment |
Participants recived, Dental cleaning, occlusal adjustment, and visual analog scale and gnathostatic models in the first visit. After three times, consecutively, one visit a month, the intervention was performed. At the first visit and after 90 days, visual analog scale, and gnathostatic models, were performed. |
| COMPLETED |
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| NOT COMPLETED |
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| 91-180 |
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Only on the treatment group was done the brand carbon count models, and gnatostatic models.
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| ID | Title | Description |
|---|---|---|
| BG000 | Control Group-visual Analog Scale (EVA), Dental Cleaning | Dental cleaning and performing the visual analog scale. At first visit was doing Dental cleaning and visual analog scale and after 90 days was doing another visual analog scale. |
| BG001 | Treatment Group-EVA,Dental Cleaning,Occlusal Adjustment. | Dental cleaning, occlusal adjustment, and visual analog scale and gnathostatic models was doing in the intervention group, at the first visit and after 90 days, visual analog scale, and gnathostatic models. |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | The patient's age affects the prognosis, the sample should be as uniform as possible. | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Cause of facial paralysis | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | The Visual Analog Scale for Pain Was Used to Grade Discomfort in Chewing After the Installation of Facial Paralysis. Level Zero is the Lack of Discomfort and 10 is the Maximum Degree of Discomfort. | It is a scale-shaped ruler, which is associated with faces used to grade the degree of pain for patients, before and after treatments, or just graduating pain and its severity for the patient (Souza, 2002). Patients were asked to fill the VAS with the following questions.
| All participants were treated by intention to treat. | Posted | Mean | Standard Deviation | units on a scale | Day 1 (Day 91 for Treatment participants first receiving Placebo) |
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| Primary | Brand Carbon Count on Gnathostats Models | Only in the treatment group were done gnatostatic models.The models were placed occluding brought with carbon, using the willis compass to keep occluding the posterior base of the model which are aligned with the rear. A model of the teeth was made to measure the occlusion of the teeth (i.e., the amount of contact between the upper and lower mandibles), and used carbon to count the the number of dental contacts, through the brand carbon made on the model, The dental contacts were counted in the models before and after treatment. The models are made in the first and last query. | Posted | Mean | Standard Deviation | number of dental contacts | Day 01 and after 90 days of treatment (Day 180 for Treatment participants first receiving Placebo) |
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| Secondary | Visual Analog Scale | It is a scale-shaped ruler, which is associated with faces used to grade the degree of pain for patients, before and after treatments, or just graduating pain and its severity for the patient (Souza, 2002). Patients were asked to fill the VAS with the following questions. Do you chew well? How would you classify your chewing at the moment? If you have no trouble chewing, the rating is zero. If you have any discomfort when you chew, your reference level is five. If the discomfort is intense, its reference level is ten. The greater the discomfort, the greater the scale. | Posted | Mean | Standard Deviation | units on a scale | After 90 days of treatment (Day 180 for Treatment participants first receiving Placebo) |
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| Other Pre-specified | Correlation Between the Increase of the Number of Dental Contact Points and the Improvement in the Subjective Evaluation Measured Through the Visual Analogic Scale . | The correlation between the increase of the number of the dental contacts and the VAS evaluation final result from chronic peripheral facial paralysis patients, according to control and treated groups by the neuro occlusal rehabilitation technic. | Posted | Number | correlation coefficient | Day 01 and after 90 days of treatment (Day 180 for Treatment participants first receiving Placebo) |
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| Other Pre-specified | Correlation Between the Increase of the Number of Dental Contact Points and the Improvement in the Subjective Evaluation Measured Through the Visual Analogic Scale Whithout the Outlier. | The correlation between the increase of the number of the dental contacts and VAS evaluation final result from chronic peripheral facial paralysis patients. On this measure was excluded one outlier patient whose facial paralysis appeared in her childhood. Observing the outlier patient, it was carried out a new scatterplot, ignoring her. | Posted | Number | correlation coefficient | Day 01 and after 90 days of treatment (Day 180 for Treatment participants first receiving Placebo) |
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Visual Analog Scale, Dental Cleaning | Dental cleaning and performing the visual analog scale. At first visit was doing Dental cleaning and visual analog scale and after 90 days was doing another visual analog scale. | 0 | 7 | 0 | 7 | 0 | 7 |
| EG001 | Visual Analog Scale,Dental Cleaning,Occlusal Adjustment. | Dental cleaning, occlusal adjustment, and visual analog scale and gnathostatic models was doing in the intervention group, at the first visit. After 90 days, visual analog scale, and gnathostatic models, was doing again. | 0 | 14 | 0 | 14 | 0 | 14 |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dra Rosana de Queiroz Costa | Master-Pos graduação em Otorrinolaringologia | 55___11___98579-8799 | rosanaqueiroz@msn.com |
| ID | Term |
|---|---|
| D005155 | Facial Nerve Diseases |
| D005157 | Facial Pain |
| D005158 | Facial Paralysis |
| D001733 | Bites and Stings |
| D008310 | Malocclusion |
| ID | Term |
|---|---|
| D009059 | Mouth Diseases |
| D009057 | Stomatognathic Diseases |
| D003389 | Cranial Nerve Diseases |
| D009422 | Nervous System Diseases |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010243 | Paralysis |
| D011041 | Poisoning |
| D064419 | Chemically-Induced Disorders |
| D014947 | Wounds and Injuries |
| D014076 | Tooth Diseases |
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| ID | Term |
|---|---|
| D019558 | Occlusal Adjustment |
| ID | Term |
|---|---|
| D009971 | Orthodontics, Corrective |
| D009970 | Orthodontics |
| D003813 | Dentistry |
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| Male |
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| Idiopatic |
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| Equivalence |
The comparison among the groups, from the results obtained by the Visual Analog Scale (VAS), was done through analysis of variance models (ANOVA) with two factors. |
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