Journal of Craniomandibular Function, 02/2019

Functional diagnostic examinations such as clinical functional analysis and manual structural analysis ('orthopedic tests') allow the dentist to establish a structured diagnosis. Previously, the process of correlating findings with the appropriate diagnoses was guided by human thought processes alone. The experimental diagnostic randomized controlled trial (RCT) in this study investigated whether computer-aided diagnosis (CADx) of temporomandibular disorders (TMD) offers quality advantages over traditional diagnosis (TRAD). Subjects and methods: Thirty-nine 5th-year dental students (examiners) at a university in Hamburg, Germany, received joint training in the diagnosis of TMD by clinical functional analysis and manual structural analysis ('orthopedic tests'). This study is based on anonymized data from 10 patients who were consecutively recruited at a specialized temporomandibular joint (TMJ) treatment center. The examiners were randomly allocated to two groups. Each examiner established a structured diagnosis through a traditional diagnostic method and by computer-aided diagnosis (CMDfact 4 functional diagnostics software) of five cases, each using the AB/BA crossover design. The diagnoses established by each individual examiner were then compared with the corresponding reference diagnoses (gold standard) and with those of the other examiners. Results: Cohen's kappa coefficient analysis showed that median agreement with the reference diagnoses was significantly higher (P 0.001) with computer assistance (median 0.692) than without it (0.553). Fleiss' kappa showed that the median interexaminer consistency of diagnoses was significantly higher (P 0.001) with computer assistance (0.497) than with traditional diagnostic methods alone (0.271). Likewise, the number of false-positive and false-negative diagnoses was significantly lower with computer assistance (P 0.001). Conclusions: This study determined that dentists who are less experienced and not specialized in dental functional diagnostics achieve a significantly better and more consistent diagnostic quality with computer assistance by means of the system used in this study. Therefore, it seems advisable to extend computer-aided diagnostics to further functional examination techniques (condylar position analysis and jaw motion analysis). Keywords: computer-aided diagnostics, temporomandibular disorders (TMD), clinical functional analysis, manual structural analysis, orthopedic tests, randomized controlled trial (RCT), diagnostic classification, CMDfact

The therapeutic products presented in this article can be helpful in expanding the range of treatment options for temporomandibular dysfunction (TMD) patients. It is very important that a careful approach is taken regarding the use of medical indication(s), that there is good patient training in the use of the therapeutic agents, and that regular monitoring of treatment successes takes place. In any case, what still remains to be considered is whether there could be an indication for any further components of a multimodal and interdisciplinary therapy, as is often the case with patients with TMD symptoms. Keywords: TMD, biofeedback, oral splints, extraoral devices, training device

The impetus to write this article came from the author's collaboration in drafting the S3 Guideline on Bruxism Diagnosis and Treatment (Register Number 083-027) as a representative of the German Central Association of Physiotherapists (ZVK). None of the physical therapy and bruxism-related studies found in the literature searches for guideline preparation provided scientific evidence as to whether any of the identified physical therapy approaches for bruxism were effective. Nevertheless, this article aims to give physiotherapists a practical concept, with guidance on how to recognize and assess the signs and symptoms of parafunctional activities in bruxers and on developing a treatment plan addressing their therapeutic consequences. Further topics discussed include the question of how temporomandibular dysfunction (TMD) and bruxism are related, the evaluation of treatment success, and factors influencing treatment outcome. Keywords: temporomandibular dysfunction (TMD), bruxism, awake bruxism, relaxation, self-management, physical therapy

Both functional and esthetic solutions pose a daily challenge to prosthetic restorative dentistry. One reason for this is that the model situation mounted in the articulator shows only an approximation of the patient's clinical situation. Approaches that address this problem are therefore called for. This article focuses on the transfer of the models to the articulator in a realistic way, and presents the development of the functional analytical method with the PlaneSystem. The capture of patient-specific details by analog means (eg, head posture, facial proportions, physiognomy map, model analysis, model orientation, movement recording, joint mechanics, mandible position in the physiological unmanipulated centric position) and by digital means (eg, facial scan, 3D analysis, photographic documentation, digital video technology [DVT]) and the transfer of these data to the articulator form the basis for this procedure. The occlusal plane and the asymmetries are likewise measured individually on each patient and transferred to the articulator in the same way as the vertical dimension of occlusion (VDO) and the mandibular alignment. All information collected can then be integrated into a digital workflow, so that reference can be made to entirely virtual solutions. This article describes the necessity that gave rise to this system and the individual development stages, and outlines the potential this method offers the dental prosthetics team. Keywords: occlusal plane, articulator, mandibular position, maxillary position, PlaneFinder, centric, functional analysis, bite registration, vertical dimension of occlusion (VDO), dental technology-related analysis