Open AccessPages 191-210, Language: English, GermanNeff, Andreas
In the wake of the Proplast/Teflon scandal of the early 1990s, which seriously discredited joint endoprostheses made from alloplastic materials, doctors have been clearly reluctant for a long time about the indications for alloplastic temporomandibular joint (TMJ) replacements (disk replacement, hemiarthroplasty, and total joint replacements). Today, with the availability of sophisticated systems - either as stock prostheses or as customized CAD-based systems - the focus of surgical interest is again on total alloplastic joint reconstruction. This article provides an overview of the contraindications, risks, and perioperative and postoperative complications associated with the total replacement of the TMJ with autologous or alloplastic materials. Colleagues who work in the field of functional diagnostics frequently assume an important part in the decision-making process for invasive surgical treatments. It is therefore important for them to know the potential complications and risks of total alloplastic TMJ replacement, as presented in this article.
Keywords: alloplastic joint replacement, alloplastic materials, risks, complications, contraindications, autologous joint replacement, hemiarthroplasty, prosthesis infection, TMJ prosthesis
Pages 211-230, Language: English, GermanStelzenmüller, Wolfgang / Kopp, Stefan / Čelar, Aleš / Lisson, Jörg
Part 1 - numerical rating scaleBiomechanical or muscular disorders are often the cause of temporomandibular disorders (TMDs) and may be treated with physiotherapy (PT). This study was part of a PhD thesis1 investigating whether PT shows therapeutic success in TMD patients and whether it is an economic means of treatment. PT treatments were selected and adjusted to last for 15 to 20 min (German statutory health insurance). Questionnaires for pain localization (SL-NRS)2 before and after PT were completed by 807 TMD patients (P-Practice group), blinded to the examiners. These questionnaires were compared with those of control groups (N = 450) at the end of the study. Also investigated was whether TMD patients only suffer from symptoms of the chewing system or are also affected by complaints of the cervical spine region (CSR) and the sacroiliac joint (SIJ), and whether this pain can be reduced by PT. Patients in the P-Practice group (N = 807; average age 43 years) experienced an improvement of 65.8% in the pain indication from the first to the final treatment dates of a treatment series. To find out whether TMD patients with a pain indication of ≥ 5 experience a comparable change through PT, 319 of the 807 P-Practice group patients were observed separately. Of this P-Practice group ≥ 5 (N = 319), 85.58% indicated an improvement - 2 points from 10 could be realized in the median of the general pain indication - from the time before and after one therapy unit. As additional values, the median in the head and jaw area on both sides showed an even clearer improvement of 3 points in the SL-NRS, compared to the total P-Practice group (N = 807). The same result was obtained for the CSR (P < 0.001). This shows that the CSR and TMD should not be viewed in an isolated manner. With TMD patients, good to very good results were achieved with PT and/or manual therapy of 15 to 20 min per prescription. With TMD pain patients (N = 319), in particular, PT/manual therapy was highly effective, economical, and useful.
Keywords: pain, pain localization, pain intensity, pain scale, numerical rating scale, physical therapy, manual therapy, temporomandibular joint disorder, TMJ
Pages 231-248, Language: English, GermanRuge, Sebastian / John, Diana / Kordaß, Bernd
The increasing use of computer-assisted design and manufacturing (CAD/CAM) systems in prosthetic dentistry has led to the question of how to precisely record, digitize, and integrate the individual patient-specific dynamics of jaw motion captured by mechanical articulators into the analogous digital workflow. It is expedient to incorporate optoelectronic systems for jaw movement tracking in the digital workflows for virtual articulator systems. The dental scan data is captured and exported to the software, which calculates and displays the movements of the mandible. Computerized occlusal analysis technologies have opened up a variety of new analytical possibilities. Additional measurement data, such as electrical muscle activity, can be integrated into the digital workflow. By synchronizing EMG masseter muscle activity with the dental scan data, the user obtains information on the temporal sequence of jaw movement and high or low forces over time. This information is not only useful for the assessment of dynamic occlusion but also for functional analysis and dental prosthetic design.
Keywords: virtual articulator, virtual occlusion, muscle activity, EMG, occlusal contacts
Pages 249-259, Language: English, GermanGreven, Markus / Onodera, Kanji / Sato, Sadao
Bruxismus beschreibt die nächtliche oder bei Tage ausgeführte Parafunktion; Zähneknirschen, -beißen oder -pressen, begleitet von extrem hoher mastikatorischer Muskelaktivität. Er wird mit okklusalen Traumata, Abrasion, Attrition, Abscherungen von Zahnhartsubstanz, Zahnhalsdefekten, Zahnwanderungen oder der Entstehung von kraniomandibulären Dysfunktionen in Verbindung gebracht. Die Beurteilung der Bewegungen im Einzelfall ist entscheidend für Einschätzung "pathologischer" Einflüsse der Okklusion und für die Langzeitstabilität und -qualität okklusaler Rehabilitationen - rekonstruktiv und kieferorthopädisch. Die unbewussten und nicht kalkulierbaren Kräfte, die insbesondere während nächtlicher parafunktioneller Aktivität entstehen, sind im klinischen Alltag schlecht reproduzierbar oder erfassbar. Das Ziel dieses Artikels ist es den BruxChecker vorzustellen und die vorhandene Literatur auszuwerten. Es ist ein simples diagnostisches Werkzeug, um parafunktionelle Muster von Patienten auf einfache Art und Weise zu erfassen und zu beurteilen. Der BruxChecker visualisiert statische und dynamische okklusale Kontakte, erlaubt die Identifizierung physiologischer oder unphysiologischer Zahnkontakte und eine Klassifizierung und Differenzierung des okklusalen dynamischen Schemas. Die Beurteilung dieser Muster im Rahmen einer Okklusionsdiagnostik ermöglicht es, basierend auf dem aktuellen Bruxismusmuster, einen exakten, patientenindividuellen Behandlungsplan zu erstellen.
Keywords: BruxChecker, Bruxismus, Knirschen, Pressen, Okklusion, CMS, CMD