Journal of Craniomandibular Function, 01/2019

This article is based on a keynote lecture given by the author on the occasion of the 50th Annual Conference of the German Society of Craniomandibular Function and Disorders on "The Future of Function" held in Bad Homburg, Germany. The topic was set by the Society's Executive Board. The author took up the challenge this posed, and sketched out aspects that could define the future contents and focus of functional diagnostics and therapy. Keywords: functional diagnostics, functional therapy, digitalization

The objective of this randomized clinical trial (RCT) was to compare conventional occlusal splint therapy with the RehaBite (Dentrade International, Cologne, Germany) device-supported sensorimotor training program of physiotherapy home exercises for the treatment of temporomandibular joint (TMJ) pain and tempormandibular disorders (TMD). A total of 45 women (aged 18 to 45 years) with acute or acute-persistent Graded Chronic Pain Scale (GCPS) grade I or II myofascial TMD pain were included in the study. Twenty-three subjects received RehaBite therapy and the other 22 received occlusal splint therapy. Masticatory muscle activity at a submaximal clenching force of 100 Newtons (N) and at maximum voluntary clenching (MVC) in the intercuspal position (ICP) was measured by force-controlled electromyography (EMG) before the start of a 3-month treatment period (T0) and repeated after 2 weeks (T1), 6 weeks (T2), and 3 months (T3) of treatment. In addition to jaw opening measurements and muscle palpation, patient-reported data on the following variables were collected on each sampling date: characteristic pain intensity (CPI) as measured on the GCPS form, pain location, ease of handling, and therapeutic efficacy. Significant pain reduction was observed in both groups, but the degree of reduction was significantly larger in the RehaBite group. Likewise, jaw opening increased in both groups but to a greater degree in the RehaBite group. Conversely, the occlusal splint group performed better in the ease of handling and therapeutic efficacy assessments by the patients (subjective measures). A statistically significant difference between normalized EMG activity during submaximal clenching (100 N) from T0 to T3 was only observed in the RehaBite group. Analysis of the change in normalized EMG activity during MVC in the ICP from T0 to T3 showed a significant increase in activity in both the masseter and anterior temporal muscles in the RehaBite group, but only in the masseter muscles in the occlusal splint group. Since the therapeutic effects of the two methods are comparable, the home exercise program can be recommended as an alternative or supplement to occlusal splint therapy for the treatment of myofascial TMD.

Objectives: The aim of this randomized controlled trial was to evaluate the impact of facebow registration on the occlusal parameters and oral health-related quality of life (QHRQoL) when remounting complete dentures (CDs). Materials and methods: Thirty-two patients with new CDs were included. Intraoral pin registration with gothic arch tracing was performed to record the horizontal jaw relation. CDs were duplicated into two cast models, followed by mounting each pair of cast models into an articulator according to a mean setting (Group 1) and using a facebow (Group 2). Occlusal static contact points and the number of teeth in contact were evaluated by a computer program (laboratory results). CDs were adjusted according to the randomization protocol of Group 1 and Group 2. After 3 (T1) and 84 (T2) days, the clinical static contact points and teeth in contact were counted. Statistical analyses were performed using the F-test and the bootstrapping method. Questionnaires of the German version of the Oral Health Impact Profile (OHIP-G49) were distributed before the remounting procedure at T0, and at T1 and T2. Results: Laboratory: The mean number of occlusal contact points was 6.06 (Group 1: mean setting) and 7.23 (Group 2: facebow), P = 0.13. The number of teeth with at least one occlusal contact was significantly higher in Group 2 (P = 0.027). Clinic: The mean number of teeth with at least one clinical contact point was slightly significantly higher in Group 1 (7.13 compared with 5.31 in Group 2; P = 0.042). Mean values of the OHIP-G49 sum scores decreased in both groups, from T0 (Group 1: 48.56; Group 2: 45.46) to T1 (Group 1: 31.43; Group 2: 43.20), and to T2 (Group 1 29.06; Group 2: 29.40), with a significant reduction in Group 1 from T0 to T1 (P = 0.012). Conclusions: Differences in occlusion occur when an arbitrary facebow is used, compared with a mean setting, when changing the vertical dimension in the articulator when remounting CDs. With regard to oral health-related quality of life (OHRQoL), patients clearly benefit from a remounting procedure. Keywords: complete denture, facebow, occlusion, oral health-related quality of life, remounting procedure, RCT

In functional diagnostics, dentists gather numerous findings by performing different functional examinations and tests, and establish as differentiated a diagnosis as possible by arranging the individual pieces to produce an overall picture. In this respect, functional diagnostics is basically medical data processing. However, because one cannot 'see' the functional disorder itself, the clinician must gather and evaluate special findings in order to capture the functional situation. As this process generates many individual pieces of data, it is very useful to transfer the data to a digital information processing system. This has given rise to an emerging field of digital dental functional diagnostics which, like digital dentistry for the fabrication of dental restorations, exploits the considerable benefits of digitalization. This article describes the current status and implementation in individual examinations of digital dental functional diagnostics and the options gained from this approach. Keywords: articulator programming, centric relation records, condylar position analysis, clinical functional analysis, functional jaw movement analysis, manual structural analysis, temporomandibular disorders (TMD), tests for orthopedic cofactors, tests for psycho

A case report is presented about a patient with multiple advanced periodontal recessions and an Angle Class II/1 dentition with an open bite, whereby a combined periodontal/prosthetic concept was applied based on the existing dentition. An interdisciplinary approach using orthodontic procedures as a treatment option was considered but not accepted by the patient16. Therefore, the jaw position was first stabilized by means of direct composite restorations based on the existing Angle Class II in centric jaw relation and increased vertical dimension. After a 6-month adaptation period, the successive transfer of the jaw position held in this way to indirectly produce restorations took place. In the posterior region, minimally invasively prepared partial crowns (occlusal onlays) made of pressed ceramics were used, and in the anterior region veneers were made using the sandwich technique with pressed ceramic and feldspar ceramics. After 3 years of function, the hard and soft tissue ratios are non-inflammatory and stable. No discomfort is experienced in the temporomandibular joint (TMJ) area. The patient is completely satisfied with the result. Keywords: Angle Class II/1, implants, sinus lift, tunneling, multiple recessions, bite elevation, erosion, disc displacement, vertical dimension of occlusion (VDO)