Bruksizm Hastalarında Splint Tedavisinin Serebral Gösterimi; Bir Fonksiyonel Manyetik Rezonans Görüntüleme Deneyi

Amaç: Çalışmanın amacı bruksimin etiyolojisinin santral sinir sistemi kaynaklı olduğu görüşünden yola çıkarak Nociceptive Trigeminal Inhibition Tension Suppression System NTI-tss okluzal splint tedavisinin beyin merkezlerinde meydana getireceği olası değişiklikleri gözlemlemektir. Ayrıca bruksizmi olan hastalar ve sağlıklı bireyler arasında diş sıkma fonksiyonu sırasında kortekste oluşan aktivite farklarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Çalışmaya Kırıkkale Üniversitesi Diş Hekimliği Fakültesi Ağız Diş ve Çene Radyolojisi Anabilim Dalına çeşitli şikayetlerle başvuran 15 bruksizmi olan ve 15 bruksizmi olmayan kontrol grubu toplam 30 birey katılmıştır. Bruksizm varlığının belirlenmesinde 2013 yılında uluslar arası otörler tarafından düzenlenen kriterler kullanılmıştır. Her katılımcı için diş sıkma ve dinlenme görevleri sırasında fonksiyonel manyetik rezonans görüntüleme ile beyin aktivitesi incelendi. Data analizi için BrainVoyager QX 2.8 programı kullanılmıştır. Bu proje Kırıkkale Üniversitesi Etik kurulu Karar no: 02/04 tarafından onaylanmıştır.Bulgular: Sağlıklı bireyler ile bruksizmi olanlar arası diş sıkma görevi sırasında beyinde meydana gelen aktivasyon ortalaması karşılaştırıldığında bruksizm grubunda inferior parietal lob Brodmann 39 ve 40 ve dorsal posterior cingulate area Brodmann 31 bölgelerinde hipoaktivasyon gözlenmiştir. Splint kullanımı öncesi ve sonrası gruplar analiz edildiğinde 11 günlük splint kullanımı sonrasında aktivitede artış kümesi izlendi; kontrol grubu ile bruksizm grubu arasında anlamlı bir fark bulunmamıştır.Sonuç: Bir nörogörüntüleme tekniği olan fMRI tekniği yardımı ile bruksizm hastalarında serebral korteksin belirli bölgelerinde aktivasyonda azalma izlenmiştir. 11 günlük splint kullanımının bu bölgelerde BOLD sinyalini artırdığı saptandı. Bu çalışmanın bulgularının bruksizmin etiyolojisi ve etkin tedavisinin netleşmesine yardım edeceğini düşünmekteyiz

Anahtar Kelimeler:

Bruksizm, fMRI, Manyetik rezonans görüntüleme, Çiğneme, Okluzal splint

Cerebral Representation of Splint Therapy in Bruxism Patients; An Functional Magnetic Resonance Imaging Experiment

Objective: The aim of this study was to investigate the effects of the novel Nociceptive Trigeminal Inhibition Tension Suppression System NTI-tss splint therapy in bruxism patients based on the view that the etiology is derived from central nerveous system. It was also aimed to evaluate the differences in cortical activity between bruxism patients and healthy subjects during the clenching function.Material and Methods: A total of 30 volunteers 15 bruxist and 15 healthy attending the KırıkkaleUniversity Faculty of Dentistry for various dental reasons were included in the study. For the diagnosis of bruxism, the criteria determined by an international consensus in 2013 were used. Brain activity was examined by functional magnetic resonance imaging during tooth clenching and rest tasks for each participant with the BrainVoyager QX 2.8 statistical data analysis program. This protocol was approved by the ethics committee of the medical faculty of Kırıkkale University, Turkey 02/04 .Results: When the average rate of brain activity in healthy subjects and bruxism patients was compared, hypoactivation was observed during the clenching task in the inferior parietal lobe Brodmann 39 ve 40 and dorsal posterior cingulate area Brodmann 31 . The group analysis between pre- and post- treatment groups revealed one activation cluster in the post-treatment group that may indicate increased activation in the mentioned cortical areas after 11 nights of NTI-tss splint therapy. When control group compared with post- treatment group no differences observed.Conclusion: With the aid of a neuroimaging technique, the decrease in activation in certain areas of the cerebral cortex in patients with bruxism. Our findings indicate that wearing the NTI-tss splint for 11 nights increased BOLD in the mentioned cortical area. These results might improve the understanding and physiological handling of sleep bruxism

Keywords:

Bruxism, fMRI, Magnetic resonance imaging, Mastication, Occlusal splint,

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Macaluso G, Guerra P, Di Giovanni G, Boselli M, Parrino L, Terzano M. Sleep bruxism is a disorder related to periodic arousals during sleep. Journal of Dental Research 1998;77(4):565-73.
Manfredini D, Landi N, Romagnoli M, Bosco M. Psychic and occlusal factors in bruxers. Australian Dental Journal 2004;49(2):84-9.
Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism in the general population. Chest Journal 2001;119(1):53-61.
Jaffee MS, Bostwick JM. Buspirone as an antidote to venlafaxine-induced bruxism. Psychosomatics 2000;41(6):535.
Raigrodski AJ, Mohamed SE, Gardiner DM. The effect of amitriptyline on pain intensity and perception of stress in bruxers. Journal of Prosthodontics 2001;10(2):73-7.
Lobbezoo F, Ahlberg J, Glaros A, Kato T, Koyano K, Lavigne G, de Leeuw R, Manfredini D, Svensson P, Winocur E. Bruxism defined and graded: An international consensus. Journal of Oral Rehabilitation 2013;40(1):2-4.
Glaros A, Owais Z, Lausten L. Reduction in parafunctional activity: A potential mechanism for the effectiveness of splint therapy. Journal of Oral Rehabilitation 2007;34(2):97-104.
Kato T, Rompre P, Montplaisir J, Sessle B, Lavigne G. Sleep bruxism: an oromotor activity secondary to micro- arousal. Journal of Dental Research 2001;80(10):1940-4.
Bracco P, Anastasi G, Piancino MG, Frongia G, Milardi D, Favaloro A, Bramanti P. Hemispheric prevalence during chewing in normal right-handed and left-handed subjects: A functional magnetic resonance imaging preliminary study. CRANIO 2010;28(2):114-21.
Quintero A, Ichesco E, Myers C, Schutt R, Gerstner G. Brain activity and human unilateral chewing an fMRI study. Journal of Dental Research 2013;92(2):136-42.
Tamura T, Kanayama T, Yoshida S, Kawasaki T. Functional magnetic resonance imaging of human jaw movements. Journal of Oral Rehabilitation 2003;30(6):614-22.
Wong D, Dzemidzic M, Talavage TM, Romito LM, Byrd KE. Motor control of jaw movements: An fMRI study of parafunctional clench and grind behavior. Brain Research 2011;1383:206-17.
Takada T, Miyamoto T. A fronto-parietal network for chewing of gum: a study on human subjects with functional magnetic resonance imaging. Neuroscience letters 2004;360(3):137-40.
Takahashi T, Miyamoto T, Terao A, Yokoyama A. Cerebral activation related to the control of mastication during changes in food hardness. Neuroscience 2007;145(3):791-94.
Rushworth MF, Nixon PD, Renowden S, Wade DT, Passingham RE. The left parietal cortex and motor attention. Neuropsychologia 1997;35(9):1261-73.
Byrd K, Romito L, Dzemidzic M, Wong D, Talavage T. fMRI study of brain activity elicited by oral parafunctional movements. Journal of Oral Rehabilitation 2009;36(5):346-61.
Behr M, Hahnel S, Faltermeier A, Bürgers R, Kolbeck C, Handel G, Proff P. The two main theories on dental bruxism. Annals of Anatomy-Anatomischer Anzeiger 2012;194(2):216-9.
Hellmann D, Giannakopoulos N, Blaser R, Eberhard L, Rues S, Schindler H. Long‐term training effects on masticatory muscles. Journal of Oral Rehabilitation 2011;38(12):912-20.
Sessle B, Adachi K, Avivi-Arber L, Lee J, Nishiura H, Yao D, et al. Neuroplasticity of face primary motor cortex control of orofacial movements. Archives of oral Biology 2007;52(4):334-7.
Lickteig R, Lotze M, Lucas C, Domin M, Kordaß B. Changes in cortical activation in craniomandibular disorders during splint therapy-A single subject fMRI study. Annals of Anatomy-Anatomischer Anzeiger 2012;194(2):212-5.
Lavigne GJ, Huynh N, Kato T, Okura K, Adachi K, Yao D, et al. Genesis of sleep bruxism: Motor and autonomic-cardiac interactions. Archives of Oral Biology 2007;52(4):381-4.
Fink GR, Frackowiak RS, Pietrzyk U, Passingham RE. Multiple nonprimary motor areas in the human cortex. Journal of Neurophysiology 1997;77(4):2164-74.
Yao D, Yamamura K, Narita N, Martin RE, Murray GM, Sessle BJ. Neuronal activity patterns in primate primary motor cortex related to trained or semiautomatic jaw and tongue movements. Journal of Neurophysiology 2002;87(5):2531-41.
Iida T, Overgaard A, Komiyama O, Weibull A, Baad- Hansen L, Kawara M, Sundgren PC, List T, Svensson P. Analysis of brain and muscle activity during low‐level tooth clenching-a feasibility study with a novel biting device. Journal of Oral Rehabilitation 2014;41(2):93-100.