Pages 7-15, Language: German, EnglishKordaß, Bernd
This article is based on a keynote lecture given by the author on the occasion of the 50th Annual Conference of the German Society of Craniomandibular Function and Disorders on "The Future of Function" held in Bad Homburg, Germany. The topic was set by the Society's Executive Board. The author took up the challenge this posed, and sketched out aspects that could define the future contents and focus of functional diagnostics and therapy.
Keywords: functional diagnostics, functional therapy, digitalization
Digital extra printPages 17-29, Language: German, EnglishRauer, Ann-Kristin / Giannakopoulos, Nikolaos-Nikitas / Hellmann, Daniel / Hugger, Sybille / Schmitter, Marc / Schindler, Hans-Jürgen / Hugger, Alfons
Eine vergleichende klinische PilotstudieDas Ziel der vorliegenden randomisierten klinischen Studie war es, bei Patienten mit schmerzhafter Myoarthropathie (MAP) eine konventionelle Okklusionsschienentherapie und ein physiotherapeutisches Heimübungsprogramm mit Hilfe des Therapiegerätes RehaBite (Dentrade International e.K., Köln) miteinander zu vergleichen. Hierfür wurden 45 Patientinnen im Alter zwischen 18 und 45 Jahren mit akuten oder akut-persistierenden myofaszialen Schmerzen des Kausystems (Graduierung chronischer Schmerzen [GCS] I und II) in die Studie aufgenommen. Es wurden 23 Patientinnen mit RehaBite behandelt, während bei 22 Patientinnen eine Okklusionsschiene eingegliedert wurde. Über einen Therapiezeitraum von drei Monaten wurde zunächst eine kraftkontrollierte elektromyographische Ausgangsmessung (T0) bei submaximalen Kräften von 100 Newton (N) sowie bei maximalen Kräften in habitueller Okklusion durchgeführt. 14 Tage sowie sechs Wochen nach Therapiebeginn erfolgten Kontrollen (T1 und T2). Drei Monate (T3) nach Beginn wurde die Messung wiederholt. Zusätzlich wurden bei jedem Untersuchungstermin die Schmerzstärke (mittels GCS-Bogen) und -lokalisation erfasst, eine Beurteilung der Handhabung und des Therapieeffektes sowie Kieferöffnungsmessungen und Muskelpalpationen durchgeführt.
In beiden Gruppen zeigte sich eine signifikante Schmerzreduktion, wobei RehaBite die Schmerzen deutlicher reduzierte. Die Kieferöffnung vergrößerte sich in beiden Kohorten, allerdings deutlicher in der RehaBite-Gruppe. Bei der Beurteilung der Handhabung sowie bei der Wahrnehmung des subjektiven Therapieeffektes schnitt dagegen die Okklusionsschiene signifikant besser ab. Bei der normierten EMG-Aktivität der submaximalen Kräfte von 100 N zeigten sich nur in der RehaBite-Gruppe statistisch signifikante Unterschiede zwischen T0 und T3. Die normierte EMG-Aktivität bei maximaler Kraftentfaltung in habitueller Okklusion erhöhte sich in der RehaBite-Gruppe sowohl für den M. masseter als auch für den M. temporalis anterior statistisch signifikant zwischen T0 und T3, während sie sich in der Okklusionsschienen-Gruppe nur für den M. masseter statistisch signifikant erhöhte.
Aufgrund der ähnlichen therapeutischen Wirkung beider Therapiemittel können Patienten mit myofaszialen Schmerzen des Kausystems Heimübungen alternativ oder in Kombination mit einer Okklusionsschiene empfohlen werden.
Keywords: Elektromyographie, Funktionstherapie, Craniomandibuläre Dysfunktion, RehaBite, Okklusionsschiene, Physiotherapeutische Heimübungen
Pages 31-45, Language: German, Englishvon Stein-Lausnitz, Manja / Peroz, Ingrid / Helm, Iven / Ruge, Sebastian / Kordaß, Bernd / Beuer, Florian / Sterzenbach, Guido
Objectives: The aim of this randomized controlled trial was to evaluate the impact of facebow registration on the occlusal parameters and oral health-related quality of life (QHRQoL) when remounting complete dentures (CDs).
Materials and methods: Thirty-two patients with new CDs were included. Intraoral pin registration with gothic arch tracing was performed to record the horizontal jaw relation. CDs were duplicated into two cast models, followed by mounting each pair of cast models into an articulator according to a mean setting (Group 1) and using a facebow (Group 2). Occlusal static contact points and the number of teeth in contact were evaluated by a computer program (laboratory results). CDs were adjusted according to the randomization protocol of Group 1 and Group 2. After 3 (T1) and 84 (T2) days, the clinical static contact points and teeth in contact were counted. Statistical analyses were performed using the F-test and the bootstrapping method. Questionnaires of the German version of the Oral Health Impact Profile (OHIP-G49) were distributed before the remounting procedure at T0, and at T1 and T2.
Results: Laboratory: The mean number of occlusal contact points was 6.06 (Group 1: mean setting) and 7.23 (Group 2: facebow), P = 0.13. The number of teeth with at least one occlusal contact was significantly higher in Group 2 (P = 0.027). Clinic: The mean number of teeth with at least one clinical contact point was slightly significantly higher in Group 1 (7.13 compared with 5.31 in Group 2; P = 0.042). Mean values of the OHIP-G49 sum scores decreased in both groups, from T0 (Group 1: 48.56; Group 2: 45.46) to T1 (Group 1: 31.43; Group 2: 43.20), and to T2 (Group 1 29.06; Group 2: 29.40), with a significant reduction in Group 1 from T0 to T1 (P = 0.012).
Conclusions: Differences in occlusion occur when an arbitrary facebow is used, compared with a mean setting, when changing the vertical dimension in the articulator when remounting CDs. With regard to oral health-related quality of life (OHRQoL), patients clearly benefit from a remounting procedure.
Keywords: complete denture, facebow, occlusion, oral health-related quality of life, remounting procedure, RCT
Pages 49-73, Language: German, EnglishAhlers, M. Oliver / Jakstat, Holger A.
Status of computer-aided diagnostic data processing and integrated evaluationIn 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
Pages 75-90, Language: German, EnglishEgger, Sven / Berg, Christian
A case report is presented about a patient with multiple advanced periodontal recessions and an Angle Class II/1 dentition with an open bite, whereby a combined periodontal/prosthetic concept was applied based on the existing dentition. An interdisciplinary approach using orthodontic procedures as a treatment option was considered but not accepted by the patient16. Therefore, the jaw position was first stabilized by means of direct composite restorations based on the existing Angle Class II in centric jaw relation and increased vertical dimension. After a 6-month adaptation period, the successive transfer of the jaw position held in this way to indirectly produce restorations took place. In the posterior region, minimally invasively prepared partial crowns (occlusal onlays) made of pressed ceramics were used, and in the anterior region veneers were made using the sandwich technique with pressed ceramic and feldspar ceramics. After 3 years of function, the hard and soft tissue ratios are non-inflammatory and stable. No discomfort is experienced in the temporomandibular joint (TMJ) area. The patient is completely satisfied with the result.
Keywords: Angle Class II/1, implants, sinus lift, tunneling, multiple recessions, bite elevation, erosion, disc displacement, vertical dimension of occlusion (VDO)