Pages 9-20, Language: English, German
Objective: This study of orofacial pain patients aimed to investigate the relationship of the degree of preexisting depression with pain distribution and a modified Ransford score (MRS).Materials and methods: Patients with non-odontogenic orofacial pain were consecutively recruited on first presentation at the University of Heidelberg University Clinic for Prosthodontics. All participants completed the Patient Health Questionnaire 9 (PHQ-9) for depression severity and the new pain drawings (PDs) from the DC/TMD. The PDs were rated in terms of dermatomal pain distribution (DPD) and MRS. Nonparametric statistics were used to analyze the data (significance level: P ≤ 0.05).Results: A total of 218 patients (average age: 41.9 years, n = 50 male) were included in the final study. The DPD analysis showed that 56% of patients (n = 122) had pain extending beyond dermatome C4. PHQ-9 scores (mean with standard deviation) were 8.23 ± 6.73 in males and 7.82 ± 6.25 in females. Increased PHQ-9 scores of ≥ 10 points, which indicate a high probability of moderate to severe depression, were detected in 73 (33.5%) patients overall. Compared with females, males with a higher PHQ-9 score had significantly less localized pain (c22(1) = 4.118, P = 0.042). Patients with a higher PHQ-9 score did not have significantly higher MRS values than those with a lower PHQ-9 score (P = 0.109, Mann-Whitney U test).Conclusion: Based on the available data, it seems that the DPD and MRS of patients’ PDs are not valid predictors of the severity of depression.
Keywords: pain drawing, orofacial pain, dermatomes, depressive disorder
Pages 31-49, Language: English, German
The human temporomandibular joints are characterized by an extraordinary mobility when compared with those of other species. This mobility allows the mandible to carry out a wide range of movements with a considerable amount of interindividual variability, as is reflected during chewing. The mandible can be compared to a marionette: it is attached to the skull and the hyoid bone via muscles and ligaments – the ‘threads’ – that is operated and controlled by the central nervous system (the ‘puppeteer’).
Keywords: biologic evolution, form and function, musculoskeletal system, movement, mandible, mandibular condyle, temporomandibular joint
Pages 51-65, Language: English, German
Objective: The aim of the present study was to compare three systems for transferring the position of the maxilla to the articulator and the centric mounting of the mandible with the intraoral situation.Material and methods: Three identical model pairs from 20 patients were transferred to the articulator using Reference AB (Gamma) and Arcus (KaVo) facebows and the esthetically oriented HeadLine transfer bow, and mounted in centric condylar position (CCP) with the help of a bite registration record. Results: The required reduction of the vertical dimension of occlusion was achieved by lowering the upper part of the articulator until interocclusal tooth contact was shown to be significantly lower (P < 0.05) with the HeadLine system after model mounting with a bite registration record than with the skull-related systems. In the horizontal plane, the first centric contact point of the systems in relation to the skull was approximately identical to the situation on the patient, while the HeadLine system led to significant changes in the position of the models in both the horizontal and sagittal planes. Conclusion: The use of a bite registration record in CCP with the HeadLine system leads to a change in the jaw-closing radius, which does not correspond to the patient situation.
Keywords: articulator, facebow, arbitrary facebow transfer, centric condylar position (CCP), Arcus facebow, HeadLine system, Reference AB facebow, arbitrary hinge axis, rotation center
Pages 67-77, Language: English, German
The recent amendment of the German Habilitative Services Prescription Directive for Dentists changes the rules governing the prescription of habilitative services and devices in statutory health insurance (SHI)-accredited dental care. The main change is the scrapping of the average-case limit, which in the past made prescribing more sessions than the average-case limit subject to evaluation and approval by the SHI provider. What is also new is the introduction of a blank prescription policy, which allows physiotherapists to shape the habilitative treatment plan as they deem necessary. This article describes the background of the directive, what has changed, and what deficits remain.
Keywords: Habilitative Services Prescription Directive, physiotherapy, manual therapy