Quando os componentes do sistema estomatognático sofrem alterações na forma, estrutura e/ou função de uma das partes, também ocorrem modificações estruturais e fisiológicas para a absorção ou compensação das resultantes criadas. Assim, uma criteriosa reabilitação deste tipo de paciente envolve procedimentos fundamentais, como: correta orientação do plano oclusal, determinação da dimensão vertical de oclusão adequada e a relação maxilo-mandibular estável e saudável, sendo que a não observação destes aspectos pode levar ao fracasso da reabilitação protética. O objetivo do presente caso é relatar o planejamento pré-cirúrgico e a reabilitação protética de um paciente edêntulo com atrofia severa dos maxilares e sinais e sintomas de Desordens Temporomandibulares, que foi submetido à terapia com aparelhos oclusais planos e lisos para restabelecimento das relações côndilo-fossa, maxilo-mandibular e da atividade muscular e, posterior reabilitação oral com próteses totais fixas implantossuportadas,onde a determinação da relação maxilo-mandibular foi realizada pela técnica do registro intraoral, com um período de proservação de 24 meses.

When the shape, structure, and/or function of one of the parts of the components of the stomatognathic system change, structural and physiological changes also occur to absorb or compensate the consequent loads. Hence, an insightful rehabilitation of this type of patient involves essential procedures, such as: correct orientation of the occlusal plane, determination of the vertical dimension of occlusion, and a stable and healthy maxillomandibular relationship, since the nonobservance of these aspects may result in prosthodontic rehabilitation failure. The objective of the present case study is to report the preoperative planning and prosthodontic rehabilitation of an edentulous patient with severe maxillary atrophy and signs and symptoms of temporomandibular disorders. The patient underwent flat occlusal plane splint therapy to reestablish the condyle-fossa and maxillomandibular relationships and muscle activity, followed by prosthodontic rehabilitation with implant-supported complete dentures. The maxillomandibular relationship was determined by the intraoral tracing technique, with a 24-month follow-up.

O objetivo deste estudo foi avaliar por meio de eletrognatografia computadorizada (K6-I Diagnostic System, Myotronics-Noromed Inc., Tukwila, EUA) o padrão dos movimentos mandibulares de 16 pacientes reabilitados com dentaduras completas, livres de alterações funcionais do sistema estomatognático. Os pacientes foram instruídos a utilizar um aparelho intra-oral de cobertura oclusal plana adaptado na prótese usual superior e então reabilitados com novas próteses preservando a existência de um espaço funcional livre de 3 mm. Após 60 dias promoveu-se um aumento da dimensão vertical de oclusão e as próteses inferiores assim modificadas foram utilizadas por mais 60 dias. Os resultados foram submetidos ao Teste de Tukey e ao Teste de Friedman, dependendo da variável em estudo, ambos com 5% de significância. Constatou-se decréscimo significante do espaço funcional livre quando compararam-se a primeira e a última avaliações. Não foram encontradas diferenças durante abertura e fechamento. Concluiu-se que a presença de um espaço funcional livre ao final do tratamento vem comprovar a importância de sua existência na manutenção do equilíbrio do sistema mastigatório, admitindo-se que ocorre o reposicionamento postural.

This study investigated, through computerized electrognathographic evaluations (K6-I Diagnostic System, Myotronics-Noromed Inc., Tukwila, USA), the mandibular movement pattern of 16 patients rehabilitated with complete dentures presenting no symptoms of stomatognathic functional alterations. The patients were instructed to wear an intra-oral appliance for occlusal plane coverage over their usual superior denture and were then rehabilitated with new dentures preserving a free-way space of 3 mm. After sixty days, the occlusal vertical dimension was increased and the modified inferior dentures were used for another 60 days. The obtained results were submitted to the Tukey Test and to the Friedman test, depending on which variable was under consideration, both at a significance level of 5%. The data revealed a significant decrease in free-way space when the first and the last evaluations were compared. No significant differences were found during opening and closing. It was concluded that the presence of a free-way space at the end of the treatment confirms the importance of its existence for maintaining the balance of the masticatory system, assuming the occurrence of a postural repositioning.

The centric relation is a mandibular position that determines a balance relation among the temporomandibular joints, the chew muscles and the occlusion. This position makes possible to the dentist to plan and to execute oral rehabilitation respecting the physiological principles of the stomatognathic system. The aim of this study was to investigate the reproducibility of centric relation records obtained using two techniques: Dawson's Bilateral Manipulation and Gysi's Gothic Arch Tracing. Twenty volunteers (14 females and 6 males) with no dental loss, presenting occlusal contacts according to those described in Angle's I classification and without signs and symptoms of temporomandibular disorders were selected. All volunteers were submitted five times with a 1-week interval, always in the same schedule, to the Dawson's Bilateral Manipulation and to the Gysi's Gothic Arch Tracing with aid of an intraoral apparatus. The average standard error of each technique was calculated (Bilateral Manipulation 0.94 and Gothic Arch Tracing 0.27). Shapiro-Wilk test was applied and the results allowed application of Student's t-test (sampling error of 5%). The techniques showed different degrees of variability. The Gysi's Gothic Arch Tracing was found to be more accurate than the Bilateral Manipulation in reproducing the centric relation records.