Pages 15-28, Language: English, Germande Holanda, Thiago Azário / de Almeida, Rita de Cássia Costa Ribeiro / Silva, Alexandre Emídio Ribeiro / Damian, Melissa Feres / Boscato, Noéli
A retrospective cohort study utilizing cone beam computed tomographyPurpose: This retrospective cohort study in an asymptomatic nonpatient population evaluated the prevalence of specific morphologic changes usually associated with the presence of degenerative joint diseases (DJDs) using cone beam computed tomography (CBCT) and examined the associations between DJD and age, sex, and number of teeth present. Materials and methods: CBCT images (268 temporomandibular joints [TMJs]) of 134 asymptomatic patients were studied. Patient data were obtained from clinical records, and calibrated examiners interpreted the CBCT images. The presence or absence of traditional radiographic signs of DJD (erosion, generalized sclerosis, osteophytes, and subchondral cysts) in the condyle and articular eminence of each TMJ were evaluated. The data were submitted to bivariate (chisquare and Fisher exact tests) and multivariate (Poisson regression) analyses (α = 0.05).
Results: The sample was primarily composed of males (52.24%) and individuals aged ≥ 61 years (55.64%); 61.94% were partially edentulous with ≤ 12 teeth in the oral cavity. The most common DJD diagnoses were mandibular condyle osteophytes (30.22%) and erosion (12.69%), followed by articular eminence erosion (8.58%) and mandibular condyle subchondral cysts (7.09%). The bivariate analysis showed a statistically significant association between females and subchondral cysts (P = 0.007), between edentulous individuals and subchondral cysts (P = 0.008), and between individuals with ≤ 12 teeth and mandibular condyle erosion (P = 0.005). In the adjusted Poisson regression analysis, a significant association was found between DJD and sex (P = 0.015).
Conclusion: Despite the limitations of this study, the results show a high prevalence of morphologic changes usually associated with the presence of DJD in asymptomatic subjects. Osseous TMJ abnormalities were present mostly in females, individuals with a lower number of teeth, and older individuals. (Originally published in Int J Prosthodont 2018;
31:4:321–326.)
Pages 29-40, Language: German, EnglishKrause, Matthias / Dörfler, Hans Martin / Kruber, Daniel / Hümpfner-Hierl, Heike / Hierl, Thomas / Lethaus, Bernd
Minimally invasive procedures such as arthroscopy and arthrocentesis are therapeutic options for internal derangement (ID) of the temporomandibular joint (TMJ). This article describes the results of a pilot study of a digital surgical template designed to facilitate these procedures.
Materials and methods: Divisible, patient-specific digital templates were designed using cone beam computed tomography (CBCT) and optical facial scan data, then 3D printed and tested in a first clinical trial on three patients who underwent template-guided minimally invasive temporomandibular joint surgery (MITMJS) consisting of arthroscopy (three TMJs) or arthrocentesis (three TMJs).
Results: The template design and clinical use proceeded as planned. All templates showed excellent fit and provided direct access to the upper joint space. No complications were observed for any of the surgeries.
Conclusions: Template guidance can facilitate MITMJS. Divisibility is an important design feature, making it possible to remove or reposition the template during surgery, if necessary. The proposed inhouse workflow results in low-cost production.
Keywords: surgical template, computer-assisted surgery, minimally invasive temporomandibular joint surgery
Pages 41-52, Language: German, EnglishPlaster, Udo
Part 2: Occlusal plane and maxillomandibular relationship: Transferring analog information to the digital worldThe first article in this series described the development of a new method of dental functional analysis called the PlaneSystem (Zirkonzahn, Gais, Italy), which enables the exact transfer of clinical parameters from the patient's mouth to the articulator. Among the issues discussed was the context of the need out of which this system emerged. Background knowledge of the stages of research and development promotes a deeper understanding of the topic at hand, a major focus of which is the tapping into a wealth of patient-specific data collected by the analog route (including information on head posture; facial proportions; the physiognomic map; analysis of the study model; orientation of the study model; jaw movement recording; joint mechanics; and the non-manipulated, physiologic position of the mandible in centric relation). The new system registers the individual patient's occlusal plane and asymmetries as well as the vertical dimension of occlusion (VDO) and mandibular alignment, and accurately transfers this positional information to the articulator. This article, the second in the series, focuses on the digital processes involved in this process. All physically collected patient data can be integrated into the digital workflow and referenced to purely virtual solutions. Mandibular movements can be recorded and transferred to a physical or virtual articulator using the JMAnalyser+ (Zebris Medical GmbH, Isny, Germany) interface integrated into the PlaneSystem. This allows for the reconstruction of dynamic contact relationships relative to the referenced position of the maxilla.
Keywords: occlusal plane, articulator, mandibular position, maxillary position, PlaneFinder, centric, functional analysis, bite registration, vertical dimension of occlusion (VDO), dental technology-related analysis
Pages 53-64, Language: German, EnglishRaff, Alexander
Auch in der Funktionsdiagnostik und -therapie kommt es seit einigen Jahren zunehmend zu Auseinandersetzungen hinsichtlich der gebührenrechtlichen Einordnung verschiedener Untersuchungs- und Behandlungsverfahren. Dies liegt darin begründet, dass die von der Bundesregierung zuletzt 2012 überarbeitete Gebührenordnung für Zahnärzte (GOZ) generell gültig ist und Zahnärzte verpflichtet, ihre Leistungen ausnahmslos nach dieser zu berechnen (§1 GOZ), solange nicht durch das Gesetz etwas anderes bestimmt ist. Da die Funktionsdiagnostik und -therapie nach Vorgabe Sozialgesetzbuch V § 28 (2) 8 nicht zum Leistungsumfang der vertragszahnärztlichen Leistung zählt, betrifft dies alle Patienten mit funktionsdiagnostischem Behandlungsbedarf. Diese Regelung ist an und für sich eindeutig. Problematisch ist die Berechnung funktionsanalytischer und -therapeutischer Maßnahmen dennoch, weil die Gebührenordnung ein tabellarisches Gebührenverzeichnis enthält, das auch und gerade in diesem Bereich unvollständig ist. Diese Besonderheit ist rein formal bereits daran erkennbar, dass in der Gebührenordnung in §6 (1) eine Regelung enthalten ist, die ausdrücklich vorsieht, nicht im Gebührenverzeichnis enthaltene selbstständige Leistungen entsprechend bzw. analog anderer, im Gebührenverzeichnis der Gebührenordnung enthaltenen Leistungen zu berechnen ("Analogberechnung"). Der Verordnungsgeber vermeidet so eine allfällige periodische zeitnahe Aktualisierung der Gebührenordnung und ermöglicht durch die Analogberechnung dennoch die im Zahnheilkundegesetz geforderte Behandlung nach dem aktuellen Stand der Wissenschaft. Als Orientierung für Zahnärzte, welche nicht im Gebührenverzeichnis der GOZ enthaltene Leistungen selbstständig und daher auf dem Weg der Analogberechnung abrechnen, gibt die Bundeszahnärztekammer eine "Analogliste" heraus. Diese wird durch halbjährliche Überarbeitungen aktuell gehalten, enthält aber keine inhaltlichen Erläuterungen. Diese Aufgabe erfüllt ausführlich u. a. "Der Kommentar BEMA + GOZ"1 , ein seit Jahrzenten eingeführter unabhängiger Abrechnungskommentar, der auch bei Zahnärztekammern und Gerichten anerkannt ist. Dessen Mitherausgeber berichtet nachfolgend, inwieweit die Kondylenpositionsanalyse ein selbstständiges Verfahren darstellt und wie die Leistung zu berechnen ist.
Keywords: craniomandibuläre Dysfunktion (CMD), instrumentelle Funktionsanalyse, Kondylenpositionsanalyse, Gebührenordnung, GOZ, Gebührenverzeichnis, Analogberechnung
Pages 65-72, Language: German, EnglishPeroz, Ingrid / Hugger, Alfons
Consensus on craniomandibular function and therapy-based learning objectives in the context of prosthetic dentistryCraniomandibular function is an interdisciplinary area of study designed to provide students with a good knowledge of complex physiological, pathophysiological, and medical principles as well as knowledge and proficiency in the use of articulators and in the simulation of mandibular movements. Due to changes to Germany's Dental Licensure Act (AOZ), preclinical dental technology-related course contents will be cut back in the near future. The German Society of Craniomandibular Function and Disorders (DGFDT) therefore launched a consensus-building process in collaboration with representatives of the prosthodontic faculties of German universities with the aim of elaborating a list of essential Craniomandibular Function-Based Learning Objectives (CFLO) and competence levels for preclinical and clinical dental education. The National Competence-Based Learning Objectives for Dental Education (NCLO) should be revised to include the consensus-based CFLO.
Keywords: learning objectives, craniomandibular function and therapy, occlusion, dental education