SciencePages 193-204, Language: English, GermanRuge, Sebastian / Kordaß, Bernd
Bei der Verwendung von CAD/CAM-Verfahren für die Herstellung von Zahnersatz und Aufbissschienen stellt sich schnell die Frage, wie realitätsgetreu die Okklusion virtuell dargestellt werden kann. Bei herkömmlichen Verfahren mit Abformungen, Gipsmodellen, Artikulatoren und manuellen Kontrollmöglichkeiten wie Kontaktpapier, sind die Fehlerquellen und -ketten bekannt und mitunter auch die Kompensation dieser gut diskutiert. Noch sehr neuartig und zum Teil ungewohnt stellt sich die Situation in digitalen Workflows dar, die analoge Schritte enthalten können, aber auch beispielsweise Intraoralscans und elektronische Bewegungsaufzeichnungen.Ein Aspekt, der bei digitalen Verfahren sofort auffällt, sind Durchdringungen von Ober- und Unterkiefer. Diese entstehen aus dem Problem heraus, dass die Realität des variablen, physiologischen Kausystems nur annähernd digitalisiert werden kann und weil jedes Messsystem typischerweise Messfehler erzeugt. Ziel dieses Beitrags ist es, die Einflüsse aufzuzeigen und zu diskutieren. Manche Fehler werden erst in der digitalen Welt aufgedeckt. Die virtuellen Möglichkeiten bieten neue Sichtweisen, die erst noch erforscht und verstanden werden müssen.
Keywords: Okklusion, virtueller Artikulator, Intraoralscan, Bewegungsaufzeichnung
SciencePages 205-222, Language: English, GermanTuch, Greta Kira Kristina / Teschke, Marcus / Schön, Andreas / Linsen, Sabine Swantje Margarete
Objectives: Total alloplastic temporomandibular joint replacement (TMJR) requires detachment of the masseter muscle and often resection of the coronoid process. The present study investigated masticatory muscle activity and maximum voluntary clenching (MVC) force after insertion of a unilateral TMJR.
Materials and methods: Muscle activity of the masseter and temporalis anterior muscles (surface electromyographic – sEMG) and MVC as well as muscle symmetry (POC) were determined on both sides preoperatively (T0) and 1-year postoperatively (T3).
Results: 28 patients (18 females, 10 males; aged 47.25 ± 17.54 years) with preservation of the mandibular angle (MA) (n = 15) and with resection of the MA (n = 10) were studied. In patients with MA, muscle activity increased bilaterally at a constant POC from T0 to T3. In patients without MA, activity increased contralaterally in both muscles. Ipsilaterally, muscle activity increased in the temporalis muscle and remained constant in the masseter muscle. POC showed an increase in the temporalis muscle and a decrease in the masseter muscle. Both groups showed an increase in MVC ipsilaterally and a constant MVC contralaterally.
Conclusion: The anterior fibers of the temporalis muscle were preserved despite resection of the coronoid process. Reattachment of the masseter muscle was likely. In the group with resection of the MA, residual activity/the mimic muscles were probably derived ipsilaterally.
Keywords: TMJR, temporomandibular joint replacement, resection, maximium voluntary clenching force, masticatory muscles, muscle activity, sEMG, muscle symmetry, reattachment
SciencePages 223-238, Language: English, GermanAlmeida de Melo, Laércio / Bezerra de Medeiros, Annie Karoline / Pinto Campos, Maria De Fátima Trindade / Bastos Machado de Resende, Camila Maria / Seabra Barbosa, Gustavo Augusto / Oliveira de Almeida, Erika
A systematic reviewAim: To evaluate the effectiveness of manual therapy in the treatment of myofascial pain related to temporomandibular disorders.
Methods: Randomized clinical trials were searched in the Cochrane Library, MEDLINE, Web of Science, Scopus, LILACS, and SciELO databases using the following keywords: temporomandibular joint disorders; craniomandibular disorders; myofascial pain syndromes; myofascial pain; exercise therapy; myofunctional therapy; physical therapy modalities; clinical trial; prospective studies; and longitudinal studies. Studies using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and manual therapy for myofascial pain were included. All studies were evaluated using the Cochrane Risk of Bias tool.
Results: Five studies were included in the present review. Of 279 total patients, 156 were treated with manual therapy only or manual therapy with counseling. Manual therapy was efficient for pain relief in all studies evaluated; however, manual therapy was not better than counseling or botulinum toxin.
Conclusions: Manual therapy was better than no treatment in one study and better than counseling in another study; however, manual therapy combined with counseling was not statistically better than counseling alone, and manual therapy alone was not better than botulinum toxin. Manual therapy combined with home therapy was better than home therapy alone in one study. Further studies are required due to the inconclusive data and poor homogeneity found in this review.
Keywords: exercise therapy, myofascial pain, myofascial pain syndromes, systematic review, temporomandibular joint disorders
Case ReportPages 239-260, Language: English, GermanSchunke, Stefan / Steubesand, Uta / Hellmann, Daniel / Micarelli, Costanza / Gintaute, Aiste
Casts mounted in the articulator should depict the patient’s clinical situation as accurately as possible. The more precise the match, the fewer functional and esthetic problems can be expected later on. Currently, a great variety of options are available on the dental market for transferring the patient’s situation into the articulator with reference to the cranium. Common methods of mounting are average value-based mounting (Bonwill) using arbitrary or localized axes, esthetic mounting using bite registration records, and digital procedures. Furthermore, different systems are found within these defined categories, which has led to uncertainty over the years as to what the advantages and disadvantages or weaknesses of the individual methods might be. Questions also arise concerning the usefulness of the application in terms of time and cost management and the improvement to be made in the functional and esthetic quality of the final result. What is established, well-founded or even scientifically verified? People like to try out ‘newer,’ more up-to-date systems and to combine the ‘advantages’ of the different systems, ie, criticism of long-established and traditional systems is being voiced. The present article is based on practical experiences in everyday life. The aim is to demonstrate whether the supposed effectiveness of cranium-related systems is still state of the art. Can cranium-related mounting systems actually reflect the anatomy of billions of patients? Can a single system represent all these conditions? These and other questions are explored, not in a theoretical, scientific manner, but on the basis of established procedures in the dental laboratory. After all, this is ultimately where the restorations for our patients come from, not from the textbook.
Keywords: functional reference, esthetic reference, dentofacial analysis, esthetic plane, mobile table plane