Pages 7-25, Language: English, GermanGouw, Simone / de Wijer, Anton / Creugers, Nico / Kalaykova, Stanimira
Bruxismus ist ein verbreitetes Phänomen, bei dem es zur wiederholten Aktivierung der Kaumuskeln kommt. Mehrere internationale Leitlinien empfehlen Muskeldehnungsübungen bei muskuloskeletalen Störungen. Solche Übungen könnten auch bei der Behandlung der für Bruxismus verantwortlichen Kaumuskelaktivität wirksam sein. Die meisten Studien zu Muskeldehnungsübungen beschäftigen sich jedoch schwerpunktmäßig mit deren Einfluss auf die Leistungsfähigkeit (Bewegungsumfang, Koordination, Muskelkraft) der Extremitäten- oder Rumpfmuskulatur von Gesunden oder Patienten mit Sportverletzungen. Die Dehnung der menschlichen Kaumuskulatur sowie Nicht-Dehnungsübungen im Rahmen der Behandlung von (Schlaf-)Bruxismus wurden dagegen bislang nur in wenigen Studien untersucht. Dieser Artikel bietet ein Review der Literatur zu Muskeldehnungsübungen und deren möglicher Rolle bei der Behandlung von Schlafbruxismus oder seinen Folgen für das muskuloskeletale System.
Keywords: Bruxismus, Muskeldehnung, Kaumuskeldehnungsprotokoll
Pages 27-40, Language: English, GermanGautsch, Andreas / Ratzmann, Anja / Bernhardt, Olaf
A systematic review of the literature and critical analysis of the national and international literatureBackground: Sleep bruxism (SB) and obstructive sleep apnea (OSA) are closely associated. Scores of occlusal splints are prescribed around the world for the management of bruxism and the symptoms associated with it. This prompted Gagnon et al1 to conduct a pilot study in 2004 investigating the effects of an occlusal splint adjusted in centric occlusion on different OSA variables. The investigators observed some differences in OSA variables, but none were statistically significant. Furthermore, the study had a low level of evidence.
Aim: The objective of this review, conducted as part of a Master's thesis, was to systematically evaluate the national and international literature on this subject and derive conclusions for dental practice.
Methods: Systematic searches of the Cochrane, PubMed, LIVIVO (formerly MEDPILOT), and TRIP medical databases and of various publishing company databases and national and international sleep medicine association journal databases were conducted and supplemented by manual searches of the cited references to identify potentially suitable studies. The identified studies were analyzed for design, methodological quality, and level of evidence (Oxford Centre for Evidence-Based Medicine criteria), and were evaluated and discussed.
Results: Currently, there is insufficient evidence to support the hypothesis that the use of a monomaxillary occlusal splint provokes the aggravation of clinical symptoms and the escalation of diagnostically relevant parameters in OSA patients. In addition to design weaknesses and methodological differences, another main limitation of the three thematically relevant and hitherto published studies is that the number of cases studied was too small to draw any statistically reliable conclusions.
Conclusions: In view of the close association between SB and OSA and the trends identified in the available studies, it still seems wise to review the medical history before prescribing an occlusal splint to determine whether the patient has OSA. A positive history of snoring, pauses in breathing during sleep, daytime tiredness, micro-sleep, sleep laboratory testing or the use of a positive airway pressure (PAP) device for respiratory ventilation should prompt the dentist to refer the patient to a sleep laboratory for polysomnography (PSG) to test for OSA. If the diagnosis is confirmed by a sleep medicine specialist, it is recommended that a portable device is used to monitor sleep-related parameters with the occlusal splint in place.
Keywords: apnea/hypopnea index (AHI), history, occlusal splint therapy, sleep bruxism (SB), obstructive sleep apnea (OSA)
Pages 41-51, Language: English, GermanKubein-Meesenburg, Dietmar / Dathe, Henning / Witt, Daniela / Fanghaenel, Jochen / Kirschneck, Christian / Krohn, Sebastian
Um die Funktion des Kiefergelenks veranschaulichen zu können, wurde auf Basis von Messwerten humaner Kiefergelenke ein Modell zur Simulation der Kiefergelenksfunktion konstruiert und CAD/CAM-gefertigt. Es zeigt sich, dass sich die Oberflächen des Os temporale und auch die des Kondylus mit wenigen Parametern als Teilflächen von Rotationskörpern darstellen lassen. Kondylus und Os temporale erlauben im konstruierten Modell praktisch alle Zuordnungen zueinander, eine Variation der Kondylenachsen aller Funktionen sowie die Herstellung naturnaher Disci, wie auch pathologischer Variationen. Durch die gute Visualisierbarkeit bietet sich das Modell für Lehrzwecke an. Wissenschaftlich lassen sich funktionelle Szenarien vergleichen und bewerten. Hierzu zählen zum Beispiel Diskus-Funktionen und -Variationen sowie -Rotationen, -Verschiebungen und -Verschraubungen, die dann zu MRT-Befunden und pathologischen Erscheinungen in Bezug gesetzt werden können.
Keywords: Kiefergelenk, Simulation, Biomechanik, Kiefergelenksfunktion, Kiefergelenksmodell
Pages 53-60, Language: English, GermanWeisskircher, Hans-Werner
The occlusal splint as a tried and tested treatment method for temporomandibular dysfunction (TMD) can pose a challenge to dentists in clinical practice in the case of certain positional anomalies of the jaw and teeth, especially with regard to the correct functional design. This article describes a case-based reasoning approach, which, via simple adjustments made to the occlusal splint in a patient with Angle Class II Division 2 malocclusion, resulted in the rapid success of treatment. In this article, possible factors for the occurrence and successful treatment of TMD with joint sounds are briefly discussed in the context of this dysgnathia case.
Keywords: occlusal splint, Angle Class II Division 2 malocclusion, malocclusion, joint sounds, case-based reasoning
Pages 61-71, Language: English, GermanRaff, Alexander
The functional analysis of mandibular movement patterns based on electronic records (electronic axiography or condylography) is not covered by the 2012 revision of the German Dental Fee Schedule (GOZ). The only change from GOZ 1988 is that the old service item 806 was renumbered 8060 and limited to the application of mechanical recording systems. The description was otherwise left unchanged. A separate service item, 8065, was added with a similar description, but intended to cover the use of electronic registration systems. Apart from the distinction between mechanical and electronic recording systems, both services thus remain almost unchanged in the revised GOZ 2012 compared to the GOZ 1988. Furthermore, the descriptions of both service items unequivocally limit the scope of the items to the movement record intended for programming articulators. This is sufficient and useful for restorative applications. However, the methods for the functional evaluation of mandibular movement patterns that have arisen in recent years are not reflected in these two items. At the same time, however, these methods are well founded in the scientific literature and have now also been described in the Guideline (S2k) "Instrumental Functional Analysis in Dentistry"1. Dentists in Germany are required by law to practice dentistry according to the current state of the art, but they cannot do so based solely on the service items listed in the GOZ. § 6.1 of GOZ 2012 therefore explicitly stipulates that those dental services not listed as independent service items can be billed according to the type, cost, and time input involved and the degree of difficulty of comparable services (referred to as "analogous services"). With reference to the example of functional mandibular movement analysis, the present article describes the legal and technical background of the GOZ items as well as the consequences for their implementation in clinical practice.
Keywords: temporomandibular dysfunction (TMD), analysis of mandibular movements, recording of mandibular movement, clinical functional analysis, Dental Fee Schedule (GOZ), analogous billing