SciencePages 277-293, Language: English, German
Aim: To evaluate the impact of localized and widespread pain on the outcome of oral appliance treatment of headache frequency and intensity in patients with temporomandibular disorders (TMD).
Materials and methods: The present multicenter study comprised 65 myofascial TMD patients diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain site drawings were completed at baseline. All patients received oral appliance treatment. Treatment outcome was followed up and analyzed (chi-square test, Mann-Whitney U test, Wilcoxon signed-rank test) for two pain profiles, being localized pain (face and head, n = 26) and widespread pain (pain sites also outside face and head, n = 39) at 6 and 10 weeks, and 6 and 12 months.
Results: At baseline, there were no differences in frequency of headache between the pain profile groups. Headache frequency decreased significantly within both groups (localized pain P = 0.008, widespread pain P < 0.001) during follow-up, with no differences between the groups. The intensity of headache differed significantly between the groups at baseline (P = 0.002). During follow-up, the decrease of headache intensity was statistically significant within both groups (localized pain P = 0.007, widespread pain P < 0.001), with no difference shown between groups at 6 weeks and 12 months. At the 6-week follow-up, 52% of all patients showed a 30% reduction of headache intensity; at the 12-month follow up, a 30% reduction was observed in 54% of the patients.
Conclusion: The present study indicates that oral appliance treatment has a similar positive effect on headache frequency and intensity, regardless of whether the myofascial TMD pain is localized or widespread.
Keywords: TMD, headache, localized pain, widespread pain, oral appliance treatment
SciencePages 295-317, Language: English, German
Introduction: This article reports the results of a comprehensive systematic review and meta-analysis of the effect of occlusal splints (OSs) on active maximum mouth opening (AMMO) in patients with temporomandibular disorders (TMD).
Methods: Multiple databases (PubMed/MEDLINE, EMBASE, Cochrane Library, LIVIVO, OpenGrey, DRKS, and ClinicalTrials.gov) plus additional literature were searched for relevant randomized clinical trials (RCTs) using OSs to treat adults with painful TMD. AMMO was assessed after 6 and 12 months of treatment, and OS therapy was compared with no treatment, other active treatments (OATs), and/or placebo splints. The Cochrane Collaboration’s tool for assessing risk of bias was used to assess study quality. The threshold for statistical significance of correlations detected by meta-analysis was P ≤ 0.05.
Results: The use of OSs did not increase AMMO significantly more than no treatment (P = 0.28) or placebo splints (P = 0.76). OS therapy was significantly inferior to OATs (P = 0.02 for short-term effect, P = 0.01 for medium-term effect). In 18 of the 21 included studies, OSs increased AMMO slightly but not significantly more than no treatment (P = 0.28) or placebo splints (P = 0.76).
Conclusions: OSs made no significant contribution to improving AMMO. Therefore, OATs should be used in patients with limited jaw opening.Registration: This study was registered in the PROSPERO database under ID number CRD42019123169.
Keywords: temporomandibular disorders (TMD), systematic review, meta-analysis, adults, pain propagation, occlusal splints, pain chronification
SciencePages 319-335, Language: English, German
Aim: The aim of the present study was to evaluate the number, strength, and position of occlusal contacts shown using an intraoral scanner (IOS) and a digital occlusal analysis system (T-Scan) compared with the current gold standard using occlusal foil (OF).
Materials and methods: Occlusal contacts were analyzed for 75 volunteers using OF in maximum intercuspation (MI). The contact points obtained using the IOS were evaluated using a screenshot from Zirkonzahn.Modellier CAD software. Finally, the volunteers were asked to bite on the sensor sheet of the T-Scan system. For the evaluation of these data, the contact points of the OF and the IOS were graded as light, medium, and strong. Furthermore, the positions of the contact points were analyzed for the anterior region (premolars and molars). Parametric statistical tests were applied to analyze the differences among the three methods.
Results: The mean number of all contact points was similar: 29 ± 8 with the OF, 30 ± 12 with the IOS, and 24 ± 10 with the T-Scan. However, results were different in terms of the grading of the strength of contact points: mean number of light contacts: 8 ± 4 OF vs 17 ± 8 IOS and 17 ± 6 T-Scan; medium contacts: 12 ± 5 OF vs 8 ± 4 IOS and 5 ± 4 T-Scan; and strong contacts: 9 ± 5 OF vs 6 ± 6 IOS and 4 ± 2 T-Scan. The positions of the occlusal contact points were also different.
Conclusion: The data sets showed that there were differences in the distribution of occlusal contact points evaluated using the OF, the IOS, and the T-Scan system. Although the number of detected occlusal contacts was similar, different occlusal contact protocols were determined by the three different methods.(Original article published in Int J Comput Dent 2020;23:
Keywords: occlusal contacts, intraoral scanner, T-Scan, occlusal foil, contact strength
Case ReportPages 337-354, Language: English, German
Adjusted occlusal splints (AOS) have a wide range of indications in the treatment of functional disorders of the craniomandibular system. Simulation splints add a fully anatomically modeled occlusal appliance to the armamentarium of AOS that enables clinical testing of proposed changes in vertical dimension of occlusion and/or jaw position in complex cases, even during mastication, without the need for invasive tooth preparation. As such, they fill a gap at the decision crossroads between functional therapy and more far-reaching restorative treatment. The present case report describes the integration of simulation splints in treatment based on the example of a temporomandibular dysfunction patient with myopathy, arthropathy, and occlusopathy. The special feature of this case was that 2 years after the successful initial treatment, the patient had a recurrence of temporomandibular joint arthrosis that no longer responded to treatment with conventional equilibration splints. Only the daytime use of a fully anatomical simulation splint, in addition to wearing the positioning splint at night, was able to stabilize this situation and improve the patient’s well-being in the long term. Hence, this approach achieved the goals of pain reduction, improvement of mandibular mobility, and rehabilitation of restricted masticatory function without invasive procedures. Adjuvant physiotherapy had a supportive effect. The present case report demonstrates the use of a fully anatomical simulation splint at the crossroads between classical functional therapy and irreversible restorative treatment.
Keywords: Simulation splint, functional therapy, arthritis, chewing function