Jakstat, Holger A.

Objectives: To evaluate the survival rate of minimally invasive semipermanent occlusal polymethyl methacrylate (PMMA) onlays/veneers in previous temporomandibular disorder (TMD) patients with severe tooth wear and with a loss of vertical dimension after up to 7 years. Method and materials: This case series was designed as a follow-up evaluation with consecutive patient recruitment. All patients bearing the indication for this kind of rehabilitation were treated by the same clinician using the same adhesive methodology. The study included 22 patients (3 men/19 women), with a mean ± SD age of 50.7 ± 11.6 years. Controls followed within the first 4 weeks (and subsequently as required). Failure criteria included damage by fracture, chipping, and retention loss. Survival rates were determined based on the Kaplan–Meier analysis. Results: 328 semipermanent occlusal/incisal veneers were included (142 maxillary/186 mandibular teeth). Almost 80% of the restorations were in place and in function when starting the follow-up treatment after 180 days; failures predominantly occurred within the first 3 to 6 months but proved reparable. Depending on the patients’ priorities, scheduled replacements followed successively, and more than 65% did not show repair or any renewal needs for more than 360 days. Conclusion: Within the limitations of this study the survival rates of occlusal veneers made of PMMA were sufficiently high to allow for consecutive treatment of the respective teeth by means of permanent restorations while preserving the restored vertical dimension. In patients with severe tooth wear and a TMD history, semipermanent restorative therapy with occlusal PMMA onlays/veneers would seem a noteworthy option. Keywords: attrition, case series, occlusal onlays, occlusal veneers, open bite, oral rehabilitation, polymethyl methacrylate, temporomandibular disorder (TMD), tooth wear, vertical dimension, wax-up

Anders als Karies kann man Funktionsstörungen im Kauorgan bzw. craniomandibuläre Dysfunktionen (CMD) nicht sehen. Die Untersuchung erfordert daher spezielle funktionsanalytische Befunde, die in der Summe als Funktionsdiagnostik bezeichnet werden. Dabei bauen verschiedene funktionsanalytische Untersuchungen stufenweise aufeinander auf und ergeben in der Summe ein Gesamtbild in Form einer möglichst differenzierten Diagnose. Funktionsdiagnostik ist daher im Grunde eine medizinische Datenverarbeitung. Aufgrund der Vielzahl der Einzelinformationen drängt sich hierbei die Erfassung der Befunde mittels entsprechender Software geradezu auf – man muss sie nur kennen und nutzen. Dieser Beitrag erläutert hierfür den aktuellen Stand und beschreibt die einzelnen Untersuchungen sowie ihre Auswertung im Zusammenhang.

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

In functional diagnostics, dentists gather numerous findings by performing different functional examinations and tests, and establish as differentiated a diagnosis as possible by arranging the individual pieces to produce an overall picture. In this respect, functional diagnostics is basically medical data processing. However, because one cannot 'see' the functional disorder itself, the clinician must gather and evaluate special findings in order to capture the functional situation. As this process generates many individual pieces of data, it is very useful to transfer the data to a digital information processing system. This has given rise to an emerging field of digital dental functional diagnostics which, like digital dentistry for the fabrication of dental restorations, exploits the considerable benefits of digitalization. This article describes the current status and implementation in individual examinations of digital dental functional diagnostics and the options gained from this approach. Keywords: articulator programming, centric relation records, condylar position analysis, clinical functional analysis, functional jaw movement analysis, manual structural analysis, temporomandibular disorders (TMD), tests for orthopedic cofactors, tests for psycho

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 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, diagnostic classification, CMDfact

Mandibular movement recording has long been established as the method for the physiological design of indirect dental restorations. Condylar movement recording is the basis for individual, patient-specific programming of partially or fully adjustable articulators. The settings derived from these recordings can generally be used in both traditional mechanical and electronic virtual articulators. For many years, condylar movement recordings have also provided useful information about morphological conditions in the temporomandibular joints (TMJs) of patients with masticatory system dysfunction based on the recorded movement patterns. The latest clinical application for recorded jaw-motion analysis data consists of functional monitoring of the patient as a diagnostic and surveillance tool accompanying treatment. Published parameters for the analysis of such recordings already exist, but a standardized and practicable protocol for the documentation and analysis of such jaw-movement recordings is still lacking. The aim of this article by a multicenter consortium of authors is to provide an appropriate protocol with the documentation criteria needed to meet the requirements for standardized analysis of computer-assisted recording of condylar movements in the future. Keywords: diagnosis, mandibular condyle, mandibular movement recordings, range of motion, reference standards, temporomandibular joint

Kraniomandibuläre Dysfunktionen (CMD) gehören zu den häufigeren Erkrankungen in der Zahnheilkunde. Sie kommen in allen Zahnarztpraxen vor, so dass es hilfreich ist, betroffene Patienten mit einfachen Mitteln erfassen zu können. Die erste Stufe der Diagnostik besteht in der Identifikation entsprechend auffälliger Patienten mittels eines CMD-Screenings. Die Autoren haben hierfür ausgehend von Vorschlägen Krogh-Poulsons den CMD-Kurzbefund entwickelt und wissenschaftlich untersucht. Der Beitrag schildert die Grundlagen und das praktische Vorgehen bei dieser Untersuchung. Keywords: Kraniomandibuläre Dysfunktion (CMD), Basisdiagnostik, Screening, Spezifität, Sensitivität

Funktionsdiagnostische Maßnahmen erfolgen heute stufenweise. Bei begründetem Verdacht auf das Vorliegen einer kraniomandibulären Dysfunktion (CMD) bildet die klinische Funktionsanalyse das Fundament der Diagnostik-Kaskade. Wesentliche Bestandteile dieser Untersuchung sind seit Jahrzehnten bekannt. Neu ist das Niveau der zugrunde liegenden Evidenz, und ebenfalls neu ist das Konzept, die klinische Funktionsanalyse so auszuwerten, dass auf ihrer Grundlage bereits eine Diagnose gestellt werden kann. Seit den 1990er Jahren wird die klinische Funktionsanalyse fakultativ durch Zusatzuntersuchungen ergänzt, darunter Tests hinsichtlich der Beteiligung psychosomatischer und orthopädischer Einflüsse sowie die manuelle Strukturanalyse. Die Prinzipien der Auswertung wurden mittlerweile in computergestützte Systeme überführt, welche helfen, die individuellen Befunde dazu passenden Diagnosen zuzuordnen. Die gleichen Daten lassen sich zudem für neue Patientenberatungssysteme und in evidenzbasierten Expertensystemen zur Therapieplanung einsetzen. Absehbar ist daher, dass die Bedeutung der klinischen Funktionsanalyse eher noch zunehmen wird, weil softwaregestützte Diagnoseinstrumente in der Praxis die Auswertung der Befunde erleichtern. Sie ermöglichen es so, den Behandler in die gleiche Situation einer kollegialen Abstimmung zu versetzen, wie sie theoretisch an spezialisierten Zentren gegeben ist. Der Beitrag stellt das Ziel der Untersuchung, ihre aktuelle Durchführung und Auswertung sowie ihre Konsequenzen vor und gibt einen Ausblick auf künftige Entwicklungen. Keywords: Klinische Funktionsanalyse, Funktionsstatus, Diagnostik-Kaskade, computergestützte Befunderhebung, computergestützte Befundauswertung kraniomandibuläre Dysfunktion (CMD)

In der restaurativen Zahnmedizin sind die Aufzeichnung und Auswertung von Unterkieferbewegungen seit Langem eingeführt. Sie bilden die Grundlage für die patientengetreue Einstellung oder "Programmierung" individueller teil- oder volljustierbarer Artikulatoren in der Absicht, eine physiologische Adaptation auf zahnärztliche Restaurationen zu erreichen und diese möglichst optimal auf das individuelle Kausystem auszurichten. Die aus der Aufzeichnung resultierenden Einstelldaten sind grundsätzlich sowohl in klassischen mechanischen als auch in elektronischen virtuellen Artikulatoren verwendbar. Kondyläre Bewegungsaufzeichnungen werden außerdem dafür eingesetzt, bei Patienten mit Funktionsstörungen des Kauorgans aus den aufgezeichneten Bewegungsverläufen auf mögliche morphologische Veränderungen im Kiefergelenkbereich zu schließen. Darüber hinaus kann der klinische Nutzen von Bewegungsaufzeichnungen im diagnostischen und behandlungsbegleitenden Funktionsmonitoring der Patienten bestehen. Hierzu sind Kriterien für die Auswertung von Bewegungsaufzeichnungen sowie ein standardisiertes und praxistaugliches Protokoll zur Befundung und Auswertung publiziert worden. Keywords: Instrumentelle Bewegungsanalyse, Funktionsdiagnostik, kondyläre Bewegungsaufzeichnung, Artikulatorprogrammierung, Funktionsmonitoring