Journal of Craniomandibular Function, 02/2014

Bruxism has been studied increasingly over the past decades. Nevertheless, many aspects of this disorder are still unclear. In this article, a concise overview is provided on the current insights into sleep and awake bruxism, especially related to its definition, epidemiology, etiology, consequences, assessment, differential diagnosis, and treatment. Keywords: bruxism, sleep, wakefulness, definition, epidemiology, etiology, consequences, assessment, differential diagnosis, treatment

Monotonous, long-lasting and low-intensity muscle contractions are considered a relevant physical risk factor for work-related muscle pain. There is some evidence that parafunction (bruxism) whilst awake is characterized by low-intensity and long-lasting muscle activity and that the masticatory muscles behave like the trapezius muscle during this type of contractions. Therefore, parafunction whilst awake has the potential but is not a sufficient cause to elicit masticatory muscle pain. This review briefly describes why parafunction whilst awake cannot cause by itself masticatory muscle pain by explaining analogies with work-related muscle pain, a condition that has been studied in great detail. Keywords: masticatory muscle pain, muscle pain, myofascial pain, bruxismus whilst awake, wake-time bruxism, bruxism

Patients, who present with a posterior position of the mandible, caused by a dental interference in the maxilla (single tooth retrusion, rotation, steep angulation of the entire incisor group, frontal deep bite, or an insufficient transversal dimension) often require raising their bites and decoupling of their occlusion by means of a splint. This allows the mandible to obtain an advanced position free of any dental interference. Passive splints of this kind do not change anything of the occlusally compromising situation, into which the patients are being forced, when they do not wear their splints temporarily. This unsatisfying situation can be altered when the equilibrating splint is combined with orthodontic screw segments. Thus, in a posterior forced bite, it is possible not only to advance the position of the mandible, but also improve the position of the interfering teeth from the beginning of treatment. Keywords: Equilibrating splint, orthodontic screw segments, posterior forced bite, craniomandibular dysfunction

After completion of functional therapy, irreversible and/or long-term secondary treatment procedures may be necessary to stabilize the jaw position achieved in functional therapy in individual patients when the post-treatment jaw position after functional therapy does not provide an even distribution of occlusal contacts, and long-term occlusal splint therapy is not an option. If indicated, options for second stage occlusal adjustment following functional therapy include orthodontic, surgical, and dental restorative treatments. In any case, the clinician must determine the desired vertical dimension of occlusion before starting second stage treatment. This paper presents cephalometric methods, as an alternative, and consideration of occlusal and material-specific factors for additive restoration or subtractive occlusal equilibration. Keywords: vertical dimension, cephalometrics, orthodiontic treatment, subtractive occluscal therapy, restorative therapy, repositioning onlays, disk-repositioning onlays