Journal of Craniomandibular Function, 01/2023

Aims: To test whether standardized palpation around the lateral pole of the condyle can influence mechanical sensitivity and unpleasantness and evoke referred sensations/pain in healthy individuals. Methods: Palpometers (0.5, 1.0, and 2.0 kg) with spherical extensions were applied around the lateral pole of the condyle in relaxed and protruded positions of the mandible for 2, 5, and 10 s in 30 healthy participants. Mechanical sensitivity, unpleasantness, and referred sensations/pain were assessed using a 0 to 100 numeric rating scale (NRS) for each palpation. The NRS scores were compared using ANOVA and the McNemar test. Results: Participants reported significantly higher mechanical sensitivity and unpleasantness scores for the 2.0-kg stimulus compared with the 0.5- and 1.0-kg stimuli for a duration of 2, 5, and 10 s (mean NRS > 50; p < 0.001). Application of a 1.0-kg stimulus was significantly different from the 0.5- and 2.0-kg stimuli applied for 5 s (mean NRS < 50; p < 0.001). One-third of participants reported referred sensations/pain. Conclusion: Application of a 2.0-kg stimulus around the lateral pole of the condyle is painful and unpleasant regardless of the duration of palpation. Application of a 1.0-kg stimulus for 5 s was found to be nonpainful and not unpleasant in healthy participants. Thus, this study supports the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) recommendation for standardized examination of the temporomandibular joint and indicates that referred sensation/pain is a common finding in healthy individuals. Keywords: DC/TMD, lateral pole of the condyle, mechanical sensitivity, palpation, referred sensation/pain

The present case report describes a rare case of a lateral and anterior open bite caused by a right trigeminal nerve paresis due to compression of the trigeminal ganglion by a meningioma. Based on the initial diagnosis of TMD, the patient was treated conservatively (also with occlusal splints) for over a year without success, although sensory deficits in the face and tongue, wave-like pain, and a continuous increase in pain symptoms were observed simultaneously. This case report emphasizes the importance of carefully taking the medical history in cases of unclear orofacial pain, supplemented by a clinical examination in which all symptoms and signs can be systematically identified and assigned to a diagnosis. Keywords: lateral open bite, meningioma, malocclusion, numbness, chewing difficulties

A 34-year-old patient presented at a dental practice with feelings of tension and pain in the area of the masticatory muscles. After a detailed clinical examination, temporomandibular disorder (TMD) was diagnosed (pain in the masticatory muscles) and occlusal splint treatment was chosen to achieve rapid pain reduction. With the help of a digital workflow and the associated possibilities of a digital splint design and computer-aided manufacturing, an occlusal splint could be delivered to the patient in a time- and cost-efficient manner. Within only a few days of wearing the splint, the patient reported a significant reduction in symptoms, with the complete absence of symptoms after 7 days. The digital workflow presented here enabled timely, individualized, and targeted care of the patient. Keywords: temporomandibular dysfunction, bruxism, digital splint design, 3D printing materials, digital dentistry, CAD/CAM design

A case report is presented of a patient with: multiple carious lesions presenting periodontal recessions; tooth loss; tooth wear; and severe myopathy in the area of the masticatory muscles (mylohyoid muscle on the right; masseter muscle, superficial part on both sides), atlanto-occipital region (deep neck muscles), shoulder and neck muscles, as well as an Angle class II classifcation with a tendency to anterior and lateral open bite. Given advanced periodontal attachment loss (especially in the maxillary posterior region), periodontal surgery (root top resection 15 – right maxillary second premolar ), and implantological and functional pretreatment using an occlusal splint combined with physiotherapy were carried out. Initially, an interdisciplinary approach was applied, and orthodontic measures (intrusion and gap closure of the anterior mandible) were carried out. The splint treatment was performed at the beginning of orthodontic treatment until the muscles were symptom free, as well as after completion with subsequent adjustment of the splint. After the completion of the splint treatment, the jaw position was stabilized using CAD/CAM long-term provisionals based on the existing Angle Class II classification in centric jaw relation and reduced vertical dimension of occlusion. After a 6-month adaptation period, the jaw position thus maintained was successively transferred to indirectly manufactured dentures. In the posterior region, minimally invasively prepared partial crowns (occlusal onlays) made of lithium-disilicate ceramic were used. In the anterior region, veneers were fabricated using the sandwich technique, comprising pressed ceramic and feldspathic ceramic. Keywords: Angle class II, division 1, implant, walking bleach, sandwich technique, lowering of the vertical dimension of occlusion (VDO), orthodontic gap closure, compensatory supraeruption of the mandibular anterior teeth, myopathy, cervical spine, syndrome, loss of VDO