Journal of Craniomandibular Function, 03/2020

Background: The number of occlusal contacts per tooth, reproducibility, and repeated usage of the digital T-Scan III System (TS) with Sensor foil (SF) are compared in vivo with Hanel foil (HF). Materials and methods: The static occlusion of 20 volunteers (average age: 25 years) with complete natural dentition without reconstructions or temporomandibular disorders (TMDs) was tested using HF, and compared with those tested using TS (with SF). To test intraexaminer reliability, the contacts by the TS and HF were evaluated twice, with an interval of 6 months. Reproducibility was tested by using five different HFs or SFs in two volunteers. For the TS stress test, one foil was used twice in three volunteers. Results: Intraexaminer reliability was excellent. Overall, HF showed significantly more contacts (P = 0.001), especially in posterior teeth (P = 0.002); SF revealed significantly more contacts in anterior teeth (P = 0.003). Repeated assignment of occlusal contacts was reliable for HF but not for SF. The number of contacts was significantly less in the second usage of the same SF (P = 0.001). Conclusion: SF should not be used for occlusal analysis or occlusal adjustment. Keywords: occlusion, T-Scan, Hanel foil (HF), Sensor foil (SF), occlusal analysis, occlusal equilibration, occlusal indicator

Dass die kausale Bedeutung okklusaler Interferenzen verworfen wird, kann die Folge einer irrigen Auffassung von okklusalen Interferenzen und Funktionsstörungen, wie craniomandibulären Dysfunktionen (CMD) sein. Die Mehrheit der Forscher misst oder bestimmt okklusale Abweichungen auf eine Art und Weise, die nicht dem von vielen klinisch tätigen Zahnärzten angewendeten Interferenz- Konzept entspricht. Interferenzen sind praktisch allgemein erworbene Risikofaktoren und das Ergebnis einer weichen Ernährung sowie minimalen funktionellen Zahnverschleißes. Beim Studiendesign von Untersuchungen zur Okklusion muss das Fehlen interferenzfreier Subpopulationen berücksichtigt werden. Studien, die keinen Zusammenhang zwischen der Okklusion und CMD nachweisen können, unterliegen einer methodischen Verzerrung ("Bias") nicht nur bezüglich okklusaler Abweichungen, sondern vermutlich hinsichtlich der Natur von CMD, da die grundlegende Annahme ist, dass CMD eine selbstlimitierende Schmerzstörung darstellt. Die Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) blenden mehrere mit Pathofunktionen assoziierte Befunde und Beschwerden aus, die nach klinischer Auffassung jedoch häufig auf Schmerzerkrankungen vorausdeuten. Schmerzfreie Patienten, unter dem Risiko stehend, Schmerzpatienten zu werden, werden nach den RDC/TMD als gesund klassifiziert. Randomisierte klinische Studien, in denen die kausale Rolle der Okklusion unter der Annahme getestet wurde, dass okklusale Interferenzen Risikofaktoren darstellen, waren bislang nicht in der Lage, die Okklusion aus dem Ursachenkomplex von Funktionsstörungen auszuschließen. Die Beseitigung des okklusionsbedingten Risikos bleibt, sofern eine adäquate Kosten-Nutzen-Relation gegeben ist, eine valide Therapie. Keywords: okklusale Interferenz, Funktionsstörung, Paradigmen

Aim: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. Materials and Methods: A questionnaire with 31 statements regarding jaw exercises was constructed. 14 international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from "strongly agree" to "strongly disagree." The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts' earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement. Results: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality. Conclusion: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function. (Original article published in J Oral Facial Pain Headache 2019; 33:389–398. doi: 10.11607/ofph.2359) Keywords: Delphi technique, dentistry, jaw exercises, orofacial pain, physical treatment

Das Thema Okklusion spielt in der Zahnmedizin eine tragende Rolle. Voraussetzung für eine gemeinsame Sprache unter den zahnärztlichen Akteuren ist aber eine einheitliche Nomenklatur. Am Beispiel des Ausdrucks zentrale Okklusion wird gezeigt, dass wichtige Fachtermini oftmals nicht einheitlich definiert sind und dass Inhalte bestehender Definitionen den sich in der Natur darbietenden Ist-Zuständen widersprechen. Die Vorgabe von reißbrettartig festgelegten Soll-Zuständen führt in der Zahnärzteschaft jedoch zu Verwirrung. Daher ist es wichtig, sich bei der klinischen Entscheidungsfindung stets von biologischen Grundsätzen und aktuellen wissenschaftlichen Erkenntnissen leiten zu lassen. Keywords: Definition, Kondylen, maximale Interkuspidation, Okklusion, Terminologie

While the incidence of caries is decreasing due to good prevention, the incidence of tooth wear is increasing, especially in young adults. Over the years, a variety of diagnostic schemes have been proposed to identify tooth wear patients. Of these, only the Tooth Wear Evaluation System (TWES) provided a multi-stage examination consisting of a basic and an extended diagnostic module. An updated version, TWES 2.0, was recently released. The first module, Tooth Wear Screening, serves to identify patients with relevant findings. The second module, Tooth Wear Status, consists of a comprehensive charting procedure in patients with positive screening results, including tooth wear severity grading for each individual tooth, signs and symptoms indicative for pathological tooth wear, and the causes of the tooth wear. This article explains the practical procedure for digitally recording and interpreting the corresponding findings using special software (CMDbrux) and the resultant treatment based on an actual case example. Keywords: tooth wear, Tooth Wear Screening, Tooth Wear Status, Tooth Wear Evaluation System (TWES) 2.0, bruxism, CMDfact, CMDbrux, minimally invasive restoration

Further development of the foundations of the specialty of Craniomandibular Function and Disorders has in some cases made it necessary to redefine the positions of systematized entities of this specialty that had previously been relegated to other positions or causal contexts. Consequently, the first AWMF Guideline on Bruxism Diagnosis and Treatment was published on 2 May 2019 (Register No. 083-027) by the German Society of Craniomandibular Function and Disorders (DGFDT), together with the German Society of Dental, Oral and Craniomandibular Sciences (DGZMK) as well as around three dozen professional societies. The guideline, which was assigned an S3 ranking (reflecting the highest stage of development), recognizes bruxism as a potentially independent disease entity, placing it on a similar footing with craniomandibular dysfunction. The Bruxism Screening Index (BSI), an instrument for the diagnosis of bruxism, was developed by a DGFDT working group based on the current literature, parallel to the S3 Guideline. Restructuring of the specialty in this manner has led to a need for changes in the billing of bruxism diagnostic services. These aspects are discussed in this article. Keywords: craniomandibular dysfunction (CMD), bruxism, Bruxism Screening Index (BSI), clinical functional analysis, German Dental Fee Schedule, GOZ, analogous billing