Journal of Craniomandibular Function, 03/2013

Personality traits and behavior can have a significant influence on the treatment success in patients with temporomandibular disorders (TMD). Chronic pain is an essential criterion in the evaluation of psychological assessment, according to the recommendations for the standardized diagnostic criteria of TMD. The aim of the study was to evaluate whether persistent pain can be applied as a diagnostic decision criterion for the evaluation of psychosocial assessment like depression, unspecific pain (somatization) and pain related disability, and to find out the correlation strength between pain, depression and somatization. In 402 patients with a TMD diagnosis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), pain intensity and disability were assessed using the Graded Chronic Pain Scale (GCPS), depression was assesssed using the German version of the Center for Epidemiological Studies Depression Scale ( ADS-L) and somatization (unspecific somatic complaints) was assessed using a complaints list (Beschwerdenliste, B-L). TMD patients with chronic pain have psychosocial impairments more often than patients with acute pain or without any pain. Therefore, psychosocial assessment should be applied regularly in the treatment of TMD patients with persistent or chronic pain. Keywords: persistent pain, temporomandibular disorders, depression, pain intensity, somatization

The international literature on the various methods of occlusal analysis is very inconsistent and does not allow a reliable assessment of reliability and validity. No method has been proven based on scientific evidence. Objective assessment criteria are lacking for the qualitative methods (articulating paper or film; analysis of wax or silicone bite registrations). Quantitative methods such as photo-occlusion and the Dental Prescale and T-Scan systems have yielded contradictory results, ranging from reports of good reproducibility to technical difficulties. Therefore, the validity of these methods is questionable at this time. Current trends in occlusal analysis include the use of virtual articulators, or the acquisition of a virtual 3D model of the tooth surfaces directly in the patient's mouth, and time-moment analysis of occlusal contacts. At the same time, the previous mechanical notions of transferable occlusal concepts are increasingly being questioned, and attempts are being made to assess the individual occlusal relationships in the context of the entire masticatory system in order to reach undisturbed function in the individual patient. Keywords: Occlusal contact, dental occlusion, instrumentation, methods, standards, T‑scan, virtual articulator

Digital analysis of the occlusal contacts can be performed with the T-scan device (T Scan III, TekScan, Boston, USA). However, the thickness of the interocclusal T-scan sheet (100 μm) may lead to a displacement of the mandible. Thus, the aim of this study was to investigate the impact of the T-scan sheet on the position of the mandibular condyles in maximum intercuspidation. Twenty dentate subjects with healthy jaw function were enrolled in the study. An ultrasonic axiography device was used to measure the position of the condyles. Ten 3D condyle positions in maximum intercuspidation of the teeth were recorded: first the reference position without the sheet, then 3 times without the sheet, 3 times with the sheet, and finally again 3 times without the sheet. There was a statistically significant difference (Wilcoxon matched pairs test) between the condyle positions with and without the interocclusally positioned T-scan sheet (P 0.0005). The T-scan device lead to a displacement of the condyles of about 1 mm mainly in ventral direction (P = 0.005). Thus, occlusal analysis is not performed in physiological, maximum intercuspidation. This has to be considered when interpreting the measured contact points. Keywords: occlusion, axiography, T-scan sheet, jaw motion, zebris, T-Scan III

For over 10 years, systematic additive occlusal therapy (SAOT) has played a valuable role as a component of an integrated approach to the diagnosis and treatment of temporomandibular dysfunction (TMD)1. SAOT is used as a therapeutic alternative to 24-hour splints, its occlusal approach being in accord with the rules of splint therapy. SAOT can be carried out by means of either a direct or an indirect procedure. Patients are able to find their own muscle-guided jaw relation and assess the effectiveness of this in terms of their symptoms. The procedure is reversible, since with correct handling the composite build-ups can be removed without damage to teeth or dental restorations. The practical implementation of SAOT is described, the indications, contraindications, and limitations of the technique are described, and the subsequent treatment is discussed. Keywords: TMD, canine guidance, functional therapy, occlusion, stepwise approach, systematic additive occlusal therapy, therapeutic jaw relation, 24-hour splint