SciencePages 9-22, Language: English, GermanSerrano-Hernanz, Gema / Kothari, Simple Futarmal / Castrillón, Eduardo / Álvarez-Méndez, Ana María / Ardizone-García, Ignacio / Svensson, Peter
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
Case ReportPages 23-35, Language: English, GermanKares, Horst / Rauber, Nikolaus / Wagner, Michael / Schmitter, Marc / Kares-Vrincianu, Alexandra
Eine KasuistikDiese Kasuistik beschreibt den seltenen Fall eines seitlich und frontal offenen Bisses, ausgelöst durch eine Trigeminusparese rechts aufgrund einer Kompression des Ganglion trigeminale durch ein Meningeom. Der Patient wurde aufgrund der initialen Diagnose CMD über ein Jahr erfolglos konservativ (unter anderem mit Okklusionsschienen) behandelt, obwohl zeitgleich sensorische Defizite im Gesicht und auf der Zunge, wellenartig auftretende Schmerzen und ein kontinuierliches Ansteigen der Schmerzsymptomatik vorlagen. Dieser Patientenbericht unterstreicht bei unklaren Schmerzen im orofazialen Bereich die Bedeutung einer sorgfältigen medizinischen Anamnese, ergänzt durch eine klinische Untersuchung, bei der systematisch alle Symptome und Zeichen identifiziert und einer Diagnose zugeordnet werden können.
Keywords: seitlich offener Biss, Meningeom, Malokklusion, Taubheit, Kauschwierigkeiten
Case ReportPages 37-47, Language: English, GermanEffenberger, Susanne / Oberhofer, Fabian / Samadi, Mariam / Schwendicke, Falk
A case report 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
Case ReportPages 49-68, Language: English, GermanEgger, Sven / Greven, Markus / Berg, Christian
A case report 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