SciencePages 277-293, Language: English, GermanDoepel, Marika / Le Bell, Yrsa / Liljeström, Marjo-Riitta / Vahlberg, Tero / Nilner, Maria
Aim: To evaluate the impact of localized and widespread pain on the outcome of oral appliance treatment of headache frequency and intensity in patients with temporomandibular disorders (TMD).
Materials and methods: The present multicenter study comprised 65 myofascial TMD patients diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain site drawings were completed at baseline. All patients received oral appliance treatment. Treatment outcome was followed up and analyzed (chi-square test, Mann-Whitney U test, Wilcoxon signed-rank test) for two pain profiles, being localized pain (face and head, n = 26) and widespread pain (pain sites also outside face and head, n = 39) at 6 and 10 weeks, and 6 and 12 months.
Results: At baseline, there were no differences in frequency of headache between the pain profile groups. Headache frequency decreased significantly within both groups (localized pain P = 0.008, widespread pain P < 0.001) during follow-up, with no differences between the groups. The intensity of headache differed significantly between the groups at baseline (P = 0.002). During follow-up, the decrease of headache intensity was statistically significant within both groups (localized pain P = 0.007, widespread pain P < 0.001), with no difference shown between groups at 6 weeks and 12 months. At the 6-week follow-up, 52% of all patients showed a 30% reduction of headache intensity; at the 12-month follow up, a 30% reduction was observed in 54% of the patients.
Conclusion: The present study indicates that oral appliance treatment has a similar positive effect on headache frequency and intensity, regardless of whether the myofascial TMD pain is localized or widespread.
Keywords: TMD, headache, localized pain, widespread pain, oral appliance treatment
SciencePages 295-317, Language: English, GermanStimmer, Magdalena / Giannakopoulos, Nikolaos Nikitas / Held, Helena / Schindler, Hans Jürgen / Roldán-Majewski, Carolina
Partial results of a systematic review and meta-analysisIntroduction: This article reports the results of a comprehensive systematic review and meta-analysis of the effect of occlusal splints (OSs) on active maximum mouth opening (AMMO) in patients with temporomandibular disorders (TMD).
Methods: Multiple databases (PubMed/MEDLINE, EMBASE, Cochrane Library, LIVIVO, OpenGrey, DRKS, and ClinicalTrials.gov) plus additional literature were searched for relevant randomized clinical trials (RCTs) using OSs to treat adults with painful TMD. AMMO was assessed after 6 and 12 months of treatment, and OS therapy was compared with no treatment, other active treatments (OATs), and/or placebo splints. The Cochrane Collaboration’s tool for assessing risk of bias was used to assess study quality. The threshold for statistical significance of correlations detected by meta-analysis was P ≤ 0.05.
Results: The use of OSs did not increase AMMO significantly more than no treatment (P = 0.28) or placebo splints (P = 0.76). OS therapy was significantly inferior to OATs (P = 0.02 for short-term effect, P = 0.01 for medium-term effect). In 18 of the 21 included studies, OSs increased AMMO slightly but not significantly more than no treatment (P = 0.28) or placebo splints (P = 0.76).
Conclusions: OSs made no significant contribution to improving AMMO. Therefore, OATs should be used in patients with limited jaw opening.Registration: This study was registered in the PROSPERO database under ID number CRD42019123169.
Keywords: temporomandibular disorders (TMD), systematic review, meta-analysis, adults, pain propagation, occlusal splints, pain chronification
SciencePages 319-335, Language: English, GermanHeuser, Florian / Bourauel, Christoph / Stark, Helmut / Dörsam, Istabrak
Ziel: Das Ziel der Studie war es, die Anzahl, die Stärke und die Position von okklusalen Kontaktpunkten, die durch einen Intraoralscanner (IOS), ein digitales Messsystem (T-Scan) und den aktuellen Goldstandard – die Okklusionsfolie (OF) – erhoben wurden, zu vergleichen.
Material und Methoden: Die okklusalen Kontaktpunkte von 75 Teilnehmern wurden in maximaler Interkuspidation mithilfe der Okklusionsfolie analysiert. Die Auswertung der Kontaktpunkte, die mit dem Intraoralscanner erhoben wurden, erfolgte über einen Screenshot der CAD-Software von Zirkonzahn. Anschließend wurden die Teilnehmer gebeten, auf die Sensorfolie des T-Scan-Systems zu beißen. Zur Evaluierung der erhobenen Daten wurden die Kontakte der OF, des T-Scan und des IOS in je drei Stärken eingeteilt: leicht, mittel und stark. Des Weiteren wurde die Kontaktposition für den Frontzahn-, Prämolaren-, und Molarenbereich analysiert. Parametrische statistische Tests wurden angewendet, um die drei Methoden zu vergleichen.
Ergebnisse: Die durchschnittliche Anzahl aller ermittelten Kontakte war ähnlich. Es konnten 29 ± 8 mit der OF ermittelt werden. Mit dem IOS konnten 30 ± 12 Kontaktpunkte ermittelt werden. Mithilfe des T-Scan wurden 24 ± 10 Kontakte ermittelt. Bei der Kontaktstärke hingegen konnten Unterschiede gezeigt werden. An leichten Kontakten wurden durchschnittlich 8 ± 4 mit der OF, 17 ± 8 mit dem IOS und 17 ± 6 mit dem T-Scan ermittelt. Von den mittleren Kontakten wurden 12 ± 5 mit der OF, 8 ± 4 mit dem IOS und 5 ± 4 mit dem T-Scan ermittelt. An starken Kontakten waren 9 ± 5 mit der OF, 6 ± 6 mit dem IOS und 4 ± 2 mit dem T-Scan zu ermitteln. Die Position der okklusalen Kontaktpunkte zeigte ebenfalls Abweichungen.
Schlussfolgerung: Die Datensätze zeigten, dass es zu Unterschieden in der Verteilung der Okklusionskontakte unter Anwendung der OF, des IOS und des T-Scan kommt. Obwohl die Anzahl der erkannten Kontaktpunkte ähnlich war, wurden verschiedene Okklusionsprotokolle durch die drei Methoden ermittelt.
Keywords: okklusale Kontakte, Intraoralscanner, T-Scan, Okklusionsfolie, Kontaktstärke
Case ReportPages 337-354, Language: English, GermanKatzer, Lukasz / Roehl, Jakob C. / Ahlers, M. Oliver
Adjusted occlusal splints (AOS) have a wide range of indications in the treatment of functional disorders of the craniomandibular system. Simulation splints add a fully anatomically modeled occlusal appliance to the armamentarium of AOS that enables clinical testing of proposed changes in vertical dimension of occlusion and/or jaw position in complex cases, even during mastication, without the need for invasive tooth preparation. As such, they fill a gap at the decision crossroads between functional therapy and more far-reaching restorative treatment. The present case report describes the integration of simulation splints in treatment based on the example of a temporomandibular dysfunction patient with myopathy, arthropathy, and occlusopathy. The special feature of this case was that 2 years after the successful initial treatment, the patient had a recurrence of temporomandibular joint arthrosis that no longer responded to treatment with conventional equilibration splints. Only the daytime use of a fully anatomical simulation splint, in addition to wearing the positioning splint at night, was able to stabilize this situation and improve the patient’s well-being in the long term. Hence, this approach achieved the goals of pain reduction, improvement of mandibular mobility, and rehabilitation of restricted masticatory function without invasive procedures. Adjuvant physiotherapy had a supportive effect. The present case report demonstrates the use of a fully anatomical simulation splint at the crossroads between classical functional therapy and irreversible restorative treatment.
Keywords: Simulation splint, functional therapy, arthritis, chewing function