The Open Dentistry Journal




ISSN: 1874-2106 ― Volume 14, 2020
RESEARCH ARTICLE

Coronal Restorations and Temporomandibular Joint (TMJ) Dysfunction: A Survey Among General Practitioners of the Town of Abidjan



Marie C. Avoaka-Boni1, *, Wendpoulomdé A. D. Kaboré2, Stéphane X Djolé1, Alain A. Kouadio3
1 Department of Conservative Dentistry and Endodontics, Félix Houphouët Boigny University, 22 BP: 612 Abidjan 22, Ivory Coast
2 Department of Conservative Dentistry and Endodontics, Research Center of Health Sciences, Joseph KI-ZERBO University, 03 BP 7021 Ouagadougou 03, Burkina Faso
3 Department of Prosthodontics, Félix Houphouët Boigny University, 22 BP: 612 Abidjan 22, Ivory Coast

Abstract

Background:

The paper surveyed the knowledge of general practitioners to coronal restorations and temporomandibular dysfunction. The specific aim of this study was to evaluate the knowledge and therapeutic approaches of the general practitioners in terms of restoring occlusion, aesthetics and function after restorative treatments in other to make recommendations to prevent potential dysfunction of the temporomandibular joint.

Methodology:

A cross sectional descriptive survey was used. It was carried out on 86 dentists out of the entire population size of 152 dentists practicing within Abidjan’s center municipality, randomly selected from the database provided by the National College of Dental Surgeons of Ivory Coast. A structured questionnaire was administered to collect data, which was subsequently collated and analysed.

Results:

The majority of the practitioners (95.4%) knew how to diagnose TMJ dysfunction. The etiological factors were stress for 55.2% of the practitioners and amalgam overhang for 49.4% of them. The precautions used to avoid TMJ disorders consisted of good control of the occlusion after having performed a restoration (55%) and taking into account the occlusal morphology (32%) at the time of shaping. Fifty-four percent of the practitioners systematically reevaluated the restorations undertaken.

Conclusion:

Impairment of occlusion results in improper muscular responses and leads to changes in pressure at the level of the temporomandibular joint. This study revealed that the general practitioners of the town of Abidjan have a good level of knowledge of the consequences of poorly carried out restorations on the initiation of masticatory apparatus disorders.

Keywords: Coronal restorations, Dental occlusion, Disorders, Temporomandibular joint, Recommendations, Ivory Coast, Survey.


Article Information


Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 443
Last Page: 448
Publisher Id: TODENTJ-13-443
DOI: 10.2174/1874210601913010443

Article History:

Received Date: 21/09/2019
Revision Received Date: 29/10/2019
Acceptance Date: 03/12/2019
Electronic publication date: 31/12/2019
Collection year: 2019

© 2019 Avoaka-Boni et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* * Address correspondence to this author at the Department of Conservative Dentistry and Endodontics, Research Center of Health Sciences, Joseph KI-ZERBO University, 03 BP 7021 Ouagadougou 03, Burkina Faso; Tel: +22670211283; E-mail: dr_kabor@yahoo.fr





1. INTRODUCTION

The aim of dental restorations is to reconstitute the initial morphology of the teeth so as to allow them to again assume their various functions in the masticatory apparatus. They are an important component of daily practice and represent 40% of the procedures performed [1Avoaka-Boni MC, Djolé XS, Gnagne-Koffi NDY, Koffi AFE, Koné Kane A, Mansilla EC. Place des restaurations coronaires foulées dans le traitement des dents délabrées: Enquête auprès des praticiens de la ville d’abidjan. Rev Col Odonto-Stomatol Afr Chir Maxillofac 2017; 24: 5-9.]. They involve the use of various entities such as composite materials with adhesive systems, amalgams, and glass-ionomer cements that should allow re-establishment of function and occlusion [2Orthlieb JD, Darmouni L, Pedinielli A, Jouvin Darmouni J. Fonctions occlusales: Aspects physiologiques de l’occlusion dentaire humaine. EMC – Odontologie 2013; 28-160-B: 1-10.]. Occlusion must be controlled and the normal function needs to be reestablished by a proper fit [3Imfeld T, Krejci I, Lussi A, Lutz F, Mörmann WH. Médecine dentaire restauratrice: Lignes directrices relatives à la qualité. Swiss Dental J SSO 2015; 125: 1039-51.]. When occlusion is not reestablished, dysfunc- tion can occur, particularly repeated fracture of obturations, occlusal trauma, enhanced looseness of the teeth, movement or dislocation of teeth, attrition of the hard dental tissues and of the restorations [3Imfeld T, Krejci I, Lussi A, Lutz F, Mörmann WH. Médecine dentaire restauratrice: Lignes directrices relatives à la qualité. Swiss Dental J SSO 2015; 125: 1039-51., 4Schiffman E, Ohrbach R. Executive summary of the diagnostic criteria for temporomandibular disorders for clinical and research applications. J Am Dent Assoc 2016; 147(6): 438-45.
[http://dx.doi.org/10.1016/j.adaj.2016.01.007] [PMID: 26922248]
]. Such dysfunction can also manifest as disorders of the masticatory muscles or of the Temporo mandibullary Joint (TMJ) [5Dym H, Israel H. Diagnosis and treatment of temporomandibular disorders. Dent Clin North Am 2012; 56(1): 149-161, ix.
[http://dx.doi.org/10.1016/j.cden.2011.08.002] [PMID: 22117948]
]. Dental occlusion plays a major role in the functions of the masticatory apparatus [6Manfredini D. Occlusal equilibration for the management of temporomandibular disorders. Oral Maxillofac Surg Clin North Am 2018; 30(3): 257-64.
[http://dx.doi.org/10.1016/j.coms.2018.04.002] [PMID: 29858130]
, 7Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am 2013; 57(3): 465-79.
[http://dx.doi.org/10.1016/j.cden.2013.04.006] [PMID: 23809304]
]. Indeed, it influences the mandibular posture at rest, the mandibular kinetics, mastication, swallowing, the loads applied to the TMJ, and the trajectories play a major role during Maximized Intercuspal Occlusion (MIO) [8Manfredini D, Castroflorio T, Perinetti G, Guarda-Nardini L. Dental occlusion, body posture and temporomandibular disorders: Where we are now and where we are heading for. J Oral Rehabil 2012; 39(6): 463-71.
[http://dx.doi.org/10.1111/j.1365-2842.2012.02291.x] [PMID: 22435603]
]. As stated by Orthlieba et al. (2016) [9Orthlieb JD, Ré JP, Jeany M, Giraudeau A. Articulation temporo-mandibulaire, occlusion et bruxisme. Rev Stomatol Chir Maxillofac Chir Orale 2016; 117(4): 207-11.
[PMID: 27523443]
], the TMJ and dental occlusion are “linked, for better or for worse” even if a direct correlation between all TMJ and occlusion is still controversial.

In light of this, it struck us that it would be important to evaluate the level of knowledge and the approaches of general practitioners of the town of Abidjan in terms of the quality of occlusion control after restorative treatment in order to be able to make recommendations to prevent potential TMJ disorders.

2. METHODOLOGY

2.1. Setting, Period, Population and Type of Study

This was a cross-sectional descriptive survey that took place at Abidjan in Ivory Coast from February to April 2014. It involved administering a structured questionnaire to 86 dentists selected independently of gender, and all of them were registered with the National College of Dental Surgeons of Ivory Coast. They were randomly selected. The sample size of 86 practitioners was used out of the population of 152. The respondents included dentists of less than 5 years practice experience, practicing both in private and in public facilities, within Abidjan center municipality. These localities were chosen because they have a high concentration of practitioners or representative of the dentists that practice in Ivory Coast. Dentists in training were not included.

2.2. Execution of the Survey

A survey form was designed with relevant and adequate requirements of the study, with three sections. The first was in regard to socio-professional data (the type of practice, the number of years of experience). The second section evaluated the knowledge of the practitioners regarding TMJ disorders (the manifestations, the causes, the treatment), and the third evaluated the precautions taken when carrying out direct restorations (means of prevention). The survey then included self-administration of the questionnaires. The survey form was dropped off at the dental practice by the surveyor and filled out by the dentist. After manual inspection of the data to verify the forms had been filled out, analysis of the data was carried out using Microsoft Office Word version 2013 and Epi-info version 6.01 (Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America) software. The results obtained were presented as tables using Excel and Word 2013 software with Windows XP professional.

3. RESULTS

3.1. Socio-professional Characteristics of those Surveyed

Of the 152 dentists questioned, 86 completed the question- naires, amounting to a participation rate of 56.6% and a sex ratio of 1.68. Of the surveyed practitioners, 49.5% practiced in the private sector while 50.5% practiced in the public sector. Practitioners with more than 10 years of experience (48%) were the most represented (Table 1). The majority (89.7%) participated in continued post-university training.

3.2. Knowledge Regarding TMJ Disorders

The majority of the practitioners (95.4%) knew how to diagnose a TMJ disorder, although the frequency of the diag- nosis was 59% for those who had encountered it only a handful of times (Table 2). The reported clinical signs were: joint pain according to 76% of the practitioners, joint noise according to 64.4%, and muscle pain for 69.9% of them (Table 3). The etiological factors noted by the practitioners were stress for 52% and overhanging amalgams for 49.4% of them (Table 4). For the practitioners, the treatment of TMJ disorders amounted to selective grinding (70.1%) and wearing a mouthguard (65.5%). Medication-based therapies with myorelaxants were also used (Table 5). In case of pain at the level of the TMJ following coronal restorations, 54% of the practitioners pro- ceeded with correction and reevaluation. Nonetheless, 65.5% of the practitioners revealed that they referred patients to a specialist in this area, an occlusodontist or a maxillofacial surgeon.

Table 1
How long the dentists had been in practice.


Table 2
The frequency at which TMJ disorders were diagnosed by the practitioners.


Table 3
Manifestations of TMJ disorders according to the practitioners.


Table 4
The etiological factors for TMJ disorders according to the practitioners.


Table 5
Treatment of TMJ disorders according to the practitioners.


3.3. Quality of the Protocol for Carrying out a Restoration

The proportion of the practitioners who used clinical methods that consisted of an evaluation of the joint of the patient by asking them to clench their teeth until they achieved optimal comfort was 5.7%. The vast majority (94.3%) always used articulating paper to adjust the Maximal Intercuspal Occlusion (MOI). Most of the surgeons (82.8%) noted that they carried out the polishing of amalgam restorations in a subsequent session. The precautions used to avoid TMJ disorders comprised taking into account the occlusal morphology at the time of shaping of the restorations for 32% of them and rigorous control of the occlusion after having undertaken the restoration for 55%. The proportion of practitioners who systematically reevaluated the restoration in another session was 54%.

4. DISCUSSION

The repartition according to the type of practice, allowed us to show that the two sectors of practice were represented nearly equally, that is to say, 49.5% of the practitioners were in the private sector and 50.5% in the public sector, with a sex ratio of 1.68. Nearly all took part in continued training (89.7%). The sample was representative of all years of experience brackets and the most active categories were those that had more than 10 years of experience (48%). Similar results have been reported by other studies. Indeed, Kaboré et al. in 2015 [10Kaboré WAD, Bane K, Fall M, Niang SO, Faye B. Problèmes terminologiques et facteurs étiologiques des lésions dentaires non carieuses. Enquête auprès de chirurgiens-dentistes burkinabè. Rev. Col. Odonto-Stomatol. Afr. Chir. Maxillo-fac 2015; 22: 5-10.] and Fall et al. [11Fall M, Ouédraogo Y, Millogo M, Diarra AA, Ouattara S, Konsem T. Prise en charge de l’édentement unitaire dans les cabinets dentaires de la ville de Ouagadougou. Rev Col Odonto-Stomatol Afr Chir Maxillofac 2018; 25: 46-51.] in 2018, in Burkina Faso, also reported the same trends in terms of the public sector and continued post-university training. However, these authors had a high level (40%) of young practitioners in their sample, that is to say, practitioners who had been in practice for less than 10 years. The work by Ndiaye et al. [12Ndiaye ML, Lecor PA, Soumboundou S, Niang SO, Gueye PD, Touré B. Attitudes et connaissances des chirurgiens-dentistes sénégalais sur la radioprotection. Rev CAMES SANTE 2017; 5: 88-93.] in 2017 in Senegal and of Udoye et al. (2013) [13Udoye CI, Sede MA, Jafarzadeh H, Abbott PV. A survey of endodontic practices among dentists in Nigeria. J Contemp Dent Pract 2013; 14(2): 293-8.
[http://dx.doi.org/10.5005/jp-journals-10024-1316] [PMID: 23811662]
] in Nigeria also reported a predominance of males in the dental profession and a larger proportion in private practice.

The present study, although limited to the practitioners of the town of Abidjan, has allowed occlusion to be recognized as one of the foremost concerns of general practitioner dentists who perform restorative dentistry on a daily basis. Indeed, poorly suited restoration materials can impair occlusion and mandibular kinetics [14Gnauck M, Magnusson T, Ekberg E. Knowledge and competence in temporomandibular disorders among Swedish general dental practitioners and dental hygienists. Acta Odontol Scand 2017; 75(6): 429-36.
[http://dx.doi.org/10.1080/00016357.2017.1331373] [PMID: 28554268]
]. Conservative materials present great variability and they present different mechanical properties in terms of hardness [15Khosravani MR. Mechanical behavior of restorative dental composites under various loading conditions. J Mech Behav Biomed Mater 2019; 93: 151-7.
[http://dx.doi.org/10.1016/j.jmbbm.2019.02.009] [PMID: 30798181]
], roughness [16Poggio C, Dagna A, Chiesa M, Colombo M, Scribante A. Surface roughness of flowable resin composites eroded by acidic and alcoholic drinks. J Conserv Dent 2012; 15(2): 137-40.
[http://dx.doi.org/10.4103/0972-0707.94581] [PMID: 22557811]
] and elasticity modulus [17de Andrade GS, Tribst JP, Dal Piva AO, et al. A study on stress distribution to cement layer and root dentin for post and cores made of CAD/CAM materials with different elasticity modulus in the absence of ferrule. J Clin Exp Dent 2019; 11(1): e1-8.
[http://dx.doi.org/10.4317/jced.55295] [PMID: 30697387]
]. Additionally, some recently introduced conservative materials such as fiber reinforced composites [18Scribante A, Vallittu PK, Özcan M. Fiber-Reinforced Composites for Dental Applications. BioMed Res Int 2018; 20184734986
[http://dx.doi.org/10.1155/2018/4734986] [PMID: 30515400]
] or CAD/CAM restoratives [19Ahlholm P, Lappalainen R, Lappalainen J, Tarvonen PL, Sipilä K. Challenges of the direct filling technique, adoption of cad/cam techniques, and attitudes toward 3d printing for restorative treatments among finnish dentists. Int J Prosthodont 2019; 32(5): 402-10.
[http://dx.doi.org/10.11607/ijp.6343] [PMID: 31486810]
] present different hardness and flexural properties if compared with conventional conservative materials, thus leading to different possibilities of correlation with TMJ. For this reason, the knowledge about this topic has to be constantly updated.

When dysfunction manifest, the clinical signs most often reported by the practitioners were joint pain (76%) followed by cracking joint (64.4%) and muscle pain (69.9%). The etiological factors put forward were overhanging restorations for 49.4% of them. The objective of any occlusal restoration is to optimize masticatory function and to maintain dental health [20Donovan TE, Marzola R, Murphy KR, et al. Annual review of selected scientific literature: A report of the committee on scientific investigation of the american academy of restorative dentistry. J Prosthet Dent 2018; 120(6): 816-78.
[http://dx.doi.org/10.1016/j.prosdent.2018.09.010] [PMID: 30545471]
]. Occlusion is always involved to a certain degree in daily dental treatments [2Orthlieb JD, Darmouni L, Pedinielli A, Jouvin Darmouni J. Fonctions occlusales: Aspects physiologiques de l’occlusion dentaire humaine. EMC – Odontologie 2013; 28-160-B: 1-10.]. By systematic screening, odontologists need to know how to recognize occlusion impairments, so as to at least avoid generating then by iatrogenic procedures [2Orthlieb JD, Darmouni L, Pedinielli A, Jouvin Darmouni J. Fonctions occlusales: Aspects physiologiques de l’occlusion dentaire humaine. EMC – Odontologie 2013; 28-160-B: 1-10.]. Sudden occlusal changes can occur over the course of a restorative treatment with amalgam or composite resins that can lead to an overbite or an underbite [21Mehta NR, Correa LP. Oral appliance therapy and temporomandibular disorders. Sleep Med Clin 2018; 13(4): 513-9.
[http://dx.doi.org/10.1016/j.jsmc.2018.08.001] [PMID: 30396445]
]. When they are not tolerated, these changes in occlusion can lead to ineffective sensorimotor regulation [22Cortese S, Mondello A, Galarza R, Biondi A. Postural alterations as a risk factor for temporomandibular disorders. Acta Odontol Latinoam 2017; 30(2): 57-61.
[PMID: 29248939]
, 23Wieckiewicz M, Boening K, Wiland P, Shiau YY, Paradowska-Stolarz A. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain 2015; 16: 106-17.
[http://dx.doi.org/10.1186/s10194-015-0586-5] [PMID: 26644030]
]. Occlusal surfaces, due to their shape, constitute the working part of a tooth. Occlusal and root morphologies affect the functional ergonomics [2Orthlieb JD, Darmouni L, Pedinielli A, Jouvin Darmouni J. Fonctions occlusales: Aspects physiologiques de l’occlusion dentaire humaine. EMC – Odontologie 2013; 28-160-B: 1-10.]. Each tooth has an essential functional and stabilizing role. The occlusal morphology of human teeth comprises convex shapes, elevations that are cusp-shaped or that have free edges. The cusp shape constitutes the ergonomic response to the physiological requirements. The morphology has a direction and needs to be respected, restored, or reconstructed [24Türp JC, Schindler H. The dental occlusion as a suspected cause for TMDs: Epidemiological and etiological considerations. J Oral Rehabil 2012; 39(7): 502-12.
[http://dx.doi.org/10.1111/j.1365-2842.2012.02304.x] [PMID: 22486535]
, 25Fougeront N. Neurophysiologie de l’occlusion: Des sciences fondamentales à la pratique clinique. Actual Odontostomatol (Paris) 2018; 290: 1-13.
[http://dx.doi.org/10.1051/aos/2018043]
]. When the occlusal alignment is perturbed, so are the abilities of the manducatory apparatus, which is harmful to the various structures [26Pontons-Melo JC, Pizzatto E, Furuse AY, Mondelli J. A conservative approach for restoring anterior guidance: A case report. J Esthet Restor Dent 2012; 24(3): 171-82.
[http://dx.doi.org/10.1111/j.1708-8240.2011.00483.x] [PMID: 22691078]
, 27Shah N, Melo L, Reid WD, Cioffi I. Masseter deoxygenation in adults at risk for temporomandibular disorders. J Dent Res 2019; 98(6): 666-72.
[http://dx.doi.org/10.1177/0022034519837249] [PMID: 30946624]
, 22Cortese S, Mondello A, Galarza R, Biondi A. Postural alterations as a risk factor for temporomandibular disorders. Acta Odontol Latinoam 2017; 30(2): 57-61.
[PMID: 29248939]
]. Such one-off occlusal anomalies (one or two teeth), having appeared or worsened recently, can be corrected by a straightforward equilibration of the first intention with the aim of immediate optimization of occlusal functions [28Oltramari-Navarro PV, Yoshie MT, Silva RA, et al. Influence of the presence of temporomandibular disorders on postural balance in the elderly. CoDAS 2017; 29(2): e20160070-.
[http://dx.doi.org/10.1590/2317-1782/20172016070] [PMID: 28198949]
, 29Clauzade M. L’occlusion dentaire. Rev d’Orthodontie Clin 2015; 12: 2-16.
[http://dx.doi.org/10.1051/roc/20151202]
]. MAD can be clinically characterized by pain at the level of the TMJ and/or at the level of the masticatory muscles, as shown in this study. It can radiate to the eyes, the face, the shoulders, the neck, or the back. The patient may also state that they have headaches and otalgia [30Abduo J, Tennant M, McGeachie J. Lateral occlusion schemes in natural and minimally restored permanent dentition: A systematic review. J Oral Rehabil 2013; 40(10): 788-802.
[http://dx.doi.org/10.1111/joor.12095] [PMID: 23981045]
]; which is also what practitioners have noted. Thus, while the symptoms of TMJ disorders can be unclear, they can be related to other pathologies [31Stechman-Neto J, Porporatti AL, Porto de Toledo I, et al. Effect of temporomandibular disorder therapy on otologic signs and symptoms: A systematic review. J Oral Rehabil 2016; 43(6): 468-79.
[http://dx.doi.org/10.1111/joor.12380] [PMID: 26749516]
-33Kharrat O, Zahar M, Aloulou I, et al. Rachialgies et dysfonction de l’appareil manducateur. Journal de Réadaptation Médicale: Pratique et Formation en Médecine Physique et de Réadaptation 2014; 34: 10-6.]; whence the importance of a rigorous analysis that leads to a positive diagnosis. For the practitioners, the treatment of TMJ disorders amounted to selective grinding (70.1%) and wearing an occlusal mouthguard (65.5%) in advanced cases. Indeed, a mouthguard provides pain relief by muscle relaxation and by repositioning of the condyles [34Buergers R, Kleinjung T, Behr M, Vielsmeier V. Is there a link between tinnitus and temporomandibular disorders? J Prosthet Dent 2014; 111(3): 222-7.
[http://dx.doi.org/10.1016/j.prosdent.2013.10.001] [PMID: 24286640]
, 28Oltramari-Navarro PV, Yoshie MT, Silva RA, et al. Influence of the presence of temporomandibular disorders on postural balance in the elderly. CoDAS 2017; 29(2): e20160070-.
[http://dx.doi.org/10.1590/2317-1782/20172016070] [PMID: 28198949]
]. This study has reported that the vast majority of the practitioners always used articulation paper (94.3%) to evaluate the TMJ and 82.8% polished the amalgam restoration that they had carried out at a prior appointment. Physiologically, the TMJ constitutes a reference mandibular position whereby the relationship of the teeth is characterized by a maximum of interarcade contacts [24Türp JC, Schindler H. The dental occlusion as a suspected cause for TMDs: Epidemiological and etiological considerations. J Oral Rehabil 2012; 39(7): 502-12.
[http://dx.doi.org/10.1111/j.1365-2842.2012.02304.x] [PMID: 22486535]
, 35Oliveira SSI, Pannuti CM, Paranhos KS, et al. Effect of occlusal splint and therapeutic exercises on postural balance of patients with signs and symptoms of temporomandibular disorder. Clin Exp Dent Res 2019; 5(2): 109-15.
[http://dx.doi.org/10.1002/cre2.136] [PMID: 31049212]
]. It should be noted that the term “intercuspation” comprises the notion of displacement; it hence signifies, not the position, but the movement of the mandible resulting in the maximal intercuspidal position [36Butts R, Dunning J, Perreault T, Mettille J, Escaloni J. Pathoanatomical characteristics of temporomandibular dysfunction: Where do we stand? (Narrative review part 1). J Bodyw Mov Ther 2017; 21(3): 534-40.
[http://dx.doi.org/10.1016/j.jbmt.2017.05.017] [PMID: 28750961]
, 37Jiménez-Silva A, Tobar-Reyes J, Vivanco-Coke S, Pastén-Castro E, Palomino-Montenegro H. Centric relation-intercuspal position discrepancy and its relationship with temporomandibular disorders. A systematic review. Acta Odontol Scand 2017; 75(7): 463-74.
[http://dx.doi.org/10.1080/00016357.2017.1340667] [PMID: 28641068]
]. The role of occlusion is, therefore, not trivial, and its regulation abides with definite rules. This is why in practice its control and its regulation need to be carried out with great thoroughness [38De Rossi SS, Greenberg MS, Liu F, Steinkeler A. Temporomandibular disorders: evaluation and management. Med Clin North Am 2014; 98(6): 1353-84.
[http://dx.doi.org/10.1016/j.mcna.2014.08.009] [PMID: 25443680]
, 39Racich MJ. Occlusion, temporomandibular disorders, and orofacial pain: An evidence-based overview and update with recommendations. J Prosthet Dent 2018; 120(5): 678-85.
[http://dx.doi.org/10.1016/j.prosdent.2018.01.033] [PMID: 29961622]
]. When the skills of the practitioner are insufficient, the patient needs to be referred to a specialist, as indicated by more than half of the practitioners.

CONCLUSION

This study has shown that the general practitioners of the town of Abidjan have a good level of knowledge of the consequences of poorly carried out restorations? Such occlusion impairments typically produce improper muscle responses and lead to changes in pressure at the level of the temporomandibular joint. Hence, the need to follow the procedures for restoration so as not to generate them. Re-establishment of occlusal function, just like the sealing of coronal obturations, is indispensable for the longevity of restorations and thereby contributes to maintaining good-oro-dental health.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable

HUMAN AND ANIMAL RIGHTS

No animals/humans were used for studies that are the basis of this research.

CONSENT FOR PUBLICATION

Not applicable.

AVAILABILITY OF DATA AND MATERIALS:

Not applicable.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

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