Journal of Craniomandibular Function, 04/2020

Aim: To study the therapeutic effect of the RelaxBogen device on sleep bruxism (SB) and temporomandibular dysfunction (TMD)-related symptoms and pain of myogenic origin in a trial of RelaxBogen plus stabilization splint therapy (RB-SST) versus stabilization splint therapy alone (SST). Materials and methods: A single-blind, single-center randomized controlled trial of RB-SST versus SST (control) in 32 patients with SB and TMD symptoms, who were randomly assigned to treatment with either RB-SST or SST for a comparative efficacy analysis over a treatment duration of 8 weeks. All examinations were performed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) standards. Results: Analysis of Stelzenmüller’s Pain Location/Numeric Rating Scale Questionnaire (SL-NRS) responses and muscle palpation test findings revealed significant pain reduction in the jaw elevator muscles in the RB-SST group compared with the SST (control) group. The RB-SST patients also had less pain on mouth opening. Furthermore, the RelaxBogen device had a mitigating effect on headache in association with muscular TMD symptoms, commonly described as tension headache. Keywords: temporomandibular dysfunction, bruxism, jaw, headache, fascia, RelaxBogen, CMD, TMD, myalgia

Objective: The aim of this research was to assess the efficacy of stabilization splint (SS) therapy limited to myalgia compared with other treatments. Materials and methods: Systematic reviews (SRs) and meta-analyses (MAs) were searched electronically and manually from 1 January 2001 to 31 March 2019. The methodological quality of the retrieved articles was evaluated through the AMSTAR (Assessment of Methodological Quality of Systematic Reviews) method. Results: Only four articles were finally included: three SRs published in the same period (2001–2005), and a more recent MA (2014). Conclusion: SSs could determine a significant improvement in pain-related symptoms in patients affected by myofascial pain compared with minimal or no treatment. No statistically significant difference was detected when comparing oral splints with placebo or alternative treatments. However, splint therapy does not seem to be more effective than alternative treatments not involving reversible occlusal therapy; most effective seems to be SSs combined with other treatments. Keywords: occlusal splints, temporomandibular disorders, myalgia, masticatory muscles, systematic reviews, qualitative research, AMSTAR

Introduction: The fabrication of a stabilization (Michigan) appliance for edentulous patients suffering from temporomandibular disorders remains a challenge. This article describes a complete denture Michigan splint, where a maxillary removable denture and stabilization appliance was fabricated as one single piece. Case presentation: A 76-year-old edentulous female presented for replacement of her insufficient 20-year-old removable complete dentures. The patient was also diagnosed with arthralgia of the right temporomandibular joint and myofascial pain in the right masseter muscle. First, a new set of dentures was made with an increased occlusal vertical dimension of 2 mm to compensate for the current reduced vertical height. In an attempt to manage the temporomandibular pain, a single-piece maxillary complete denture splint was manufactured through CAM milling of a polymethyl methacrylate block. The denture splint was worn at night during sleep instead of the maxillary complete denture. It was tolerated well, and the temporomandibular pain had vanished 3 months later. Discussion: The complete denture Michigan appliance showed a perfect fit on the oral mucosa. Further advantages of this design were the avoidance of possible retention loss between a conventional splint and a complete denture, increased patient comfort, increased durability of the appliance, and reduced risk for systemic effects due to a lower residual monomer content. The presence of a digital data set allows for the making of a duplicate in an effective way if the denture splint is lost. Conclusion: Edentulous patients suffering from temporomandibular pain may benefit from a maxillary complete denture Michigan splint as an alternative to a stabilization splint placed on a complete denture. Keywords: complete denture, computer-aided design, temporomandibular disorders, edentulous jaw, occlusal splints

Clinical functional analysis (CFA) lays the groundwork for many diagnostic and therapeutic measures for craniomandibular dysfunction (CMD). Hence, Code 8000 of the German Dental Fee Schedule (GOZ) is central to billing for such functional analysis services. However, the principles for evidence-based practice of functional diagnostics have evolved substantially, which is rarely more evident than in GOZ Code 8000: 'Clinical functional analysis, including documentation.' The mismatch between the fee schedule specifications and current practice guidelines becomes particularly obvious when reading the procedural code description for CFA, which was taken from the former GOZ 1988 and adopted in the new and revised GOZ 2012, without updates or changes. Code 8000 states: “The service under no. 8000 also includes the following dental services: prophylactic, prosthetic, periodontal and occlusal examination, functional diagnosis of X-rays of the skull and cervical spine, and clinical reaction tests (such as a resiliency test and provocation test).” The German Dentistry Act requires dentists in Germany to practice dentistry according to current scientific evidence. However, it is difficult to reconcile best practice according to current scientific evidence with the outdated provisions of the GOZ. This article describes this problem in detail, based on the example of GOZ Code 8000. In the case of CFA, it is important to distinguish the exact scope of services included in GOZ Code 8000, since the field of dental functional diagnostics has undergone enormous scientific development and diversification in recent decades, yielding new and distinct services that must be billed separately. Keywords: clinical functional analysis (CFA), craniomandibular dysfunction (CMD), temporomandibular disorders (TMD), fee schedule, German Dental Fee Schedule (GOZ)