Journal of Craniomandibular Function, 03/2015

In the wake of the Proplast/Teflon scandal of the early 1990s, which seriously discredited joint endoprostheses made from alloplastic materials, doctors have been clearly reluctant for a long time about the indications for alloplastic temporomandibular joint (TMJ) replacements (disk replacement, hemiarthroplasty, and total joint replacements). Today, with the availability of sophisticated systems - either as stock prostheses or as customized CAD-based systems - the focus of surgical interest is again on total alloplastic joint reconstruction. This article provides an overview of the contraindications, risks, and perioperative and postoperative complications associated with the total replacement of the TMJ with autologous or alloplastic materials. Colleagues who work in the field of functional diagnostics frequently assume an important part in the decision-making process for invasive surgical treatments. It is therefore important for them to know the potential complications and risks of total alloplastic TMJ replacement, as presented in this article. Keywords: alloplastic joint replacement, alloplastic materials, risks, complications, contraindications, autologous joint replacement, hemiarthroplasty, prosthesis infection, TMJ prosthesis

Biomechanical or muscular disorders are often the cause of temporomandibular disorders (TMDs) and may be treated with physiotherapy (PT). This study was part of a PhD thesis1 investigating whether PT shows therapeutic success in TMD patients and whether it is an economic means of treatment. PT treatments were selected and adjusted to last for 15 to 20 min (German statutory health insurance). Questionnaires for pain localization (SL-NRS)2 before and after PT were completed by 807 TMD patients (P-Practice group), blinded to the examiners. These questionnaires were compared with those of control groups (N = 450) at the end of the study. Also investigated was whether TMD patients only suffer from symptoms of the chewing system or are also affected by complaints of the cervical spine region (CSR) and the sacroiliac joint (SIJ), and whether this pain can be reduced by PT. Patients in the P-Practice group (N = 807; average age 43 years) experienced an improvement of 65.8% in the pain indication from the first to the final treatment dates of a treatment series. To find out whether TMD patients with a pain indication of ≥ 5 experience a comparable change through PT, 319 of the 807 P-Practice group patients were observed separately. Of this P-Practice group ≥ 5 (N = 319), 85.58% indicated an improvement - 2 points from 10 could be realized in the median of the general pain indication - from the time before and after one therapy unit. As additional values, the median in the head and jaw area on both sides showed an even clearer improvement of 3 points in the SL-NRS, compared to the total P-Practice group (N = 807). The same result was obtained for the CSR (P 0.001). This shows that the CSR and TMD should not be viewed in an isolated manner. With TMD patients, good to very good results were achieved with PT and/or manual therapy of 15 to 20 min per prescription. With TMD pain patients (N = 319), in particular, PT/manual therapy was highly effective, economical, and useful. Keywords: pain, pain localization, pain intensity, pain scale, numerical rating scale, physical therapy, manual therapy, temporomandibular joint disorder, TMJ

The increasing use of computer-assisted design and manufacturing (CAD/CAM) systems in prosthetic dentistry has led to the question of how to precisely record, digitize, and integrate the individual patient-specific dynamics of jaw motion captured by mechanical articulators into the analogous digital workflow. It is expedient to incorporate optoelectronic systems for jaw movement tracking in the digital workflows for virtual articulator systems. The dental scan data is captured and exported to the software, which calculates and displays the movements of the mandible. Computerized occlusal analysis technologies have opened up a variety of new analytical possibilities. Additional measurement data, such as electrical muscle activity, can be integrated into the digital workflow. By synchronizing EMG masseter muscle activity with the dental scan data, the user obtains information on the temporal sequence of jaw movement and high or low forces over time. This information is not only useful for the assessment of dynamic occlusion but also for functional analysis and dental prosthetic design. Keywords: virtual articulator, virtual occlusion, muscle activity, EMG, occlusal contacts

Bruxism is defined as a diurnal or nocturnal parafunctional activity involving grinding, gnashing or clenching of the teeth, accompanied by hyperactivity of the masticatory musculature. It is associated with occlusal trauma, abrasion, attrition and abfraction of hard tooth structures, cervical defects, tooth migration, and the etiology of temporomandibular disorders (TMDs). The evaluation of the individual masticatory movement pattern is decisive for the assessment of "pathological" influences of occlusion and the long-term stability and quality of occlusal rehabilitation, both in reconstructive dentistry and orthodontics. The involuntary and incalculable forces acting particularly during nocturnal parafunctional activity are difficult to reproduce or record in everyday clinical practice. The aim of this article is to present the BruxChecker (Scheu Dental) and evaluate existing dental literature on this topic. The BruxChecker is a simple diagnostic tool that facilitates the recording and evaluation of patients' parafunctional activity patterns. It enables the visualization of static and dynamic occlusal contacts, the identification of physiological or unphysiological tooth contacts, and the classification and differentiation of the dynamic occlusal scheme. The assessment of these patterns in the context of occlusion diagnostics enables the development of a precise, personalized treatment plan for each patient based on his or her respective current bruxism pattern. Keywords: BruxChecker, bruxism, clenching, grinding, occlusion, temporomandibular disorder (TMD), temporomandibular system (TMS)