Journal of Craniomandibular Function, 02/2017

This article describes the role of the dentist in the recognition of obstructive sleep apnea syndrome (OSAS), and in the management of this condition by advancing the mandible with a mandibular advancement device (MAD). OSAS is characterized by recurrent obstruction of the upper airway. The opening of this blockage is often accompanied by loud snoring noises, resulting in the patient awakening. MADs are recommended for the treatment of mild to moderate OSAS. The goal of MAD treatment is to expand the upper airway and reduce its tendency to become obstructed. In addition to recognizing OSAS and performing a thorough dental examination before treatment, MAD selection, fabrication, and adaptation are some of the main responsibilities of the dentist. Once the patient has become accustomed to the MAD, a sleep study (polysomnography) should be performed to objectively evaluate the efficacy of the MAD. The physician and dentist should also regularly check to monitor the effectiveness of the MAD, to identify potential side effects, and to evaluate the patient's adherence to treatment (compliance). Keywords: obstructive sleep apnea syndrome, OSAS, snoring, diagnosis, treatment

Over the past 20 years, occlusal guidance patterns have been investigated using various approaches with regard to their significance for masticatory function. These patterns undoubtedly require reevaluation with respect to more traditional occlusal concepts. Anterior/canine-guided occlusion, for instance, does not have the highest prevalence among laterotrusive tooth guidance patterns and therefore cannot be regarded as a dominant occlusal pattern. With this occlusal pattern, however, the prevalence of noncarious cervical defects seems to be lower than with other occlusal patterns, such as group guidance. The absence of anterior/canine-guided occlusion is not associated with the occurrence of temporomandibular dysfunction (TMD). As a result, occlusal rehabilitation on the basis of this occlusal guidance pattern does not constitute a variation of TMD therapy, nor does it serve to prevent TMD. For any necessary treatment with prosthetic restorations, the patient's already existing occlusal guidance pattern should primarily be taken into account. In order to protect posterior restorations, anterior/canine-guided occlusal patterns are nevertheless to be recommended in the case of complex prosthetic restorations. Keywords: anterior/canine guidance, laterotrusion, occlusion, temporomandibular dysfunction

Dentists working in the specialized field of functional diagnostics and functional therapy need to bear in mind that different pain symptoms and/or syndromes involving the mouth, jaw, and face often coexist and affect each other. Painful muscle- and joint-related temporomandibular disorders (TMDs), for example, may occur concomitantly with certain types of headaches. A specific case history and evaluation is therefore crucial in these patients. In the case described in this article, the patient presented with dull, pressing bilateral pain in the masseter muscle region and neck muscles that had persisted for about 6 years. In addition, unilateral headaches causing severe pain and occurring several times a day in attacks lasting for a brief period of time to several minutes started in the last several days before presentation. These symptoms were accompanied by eye redness and hypersensitivity to noise and light. The general history, specific history, and clinical examination findings suggested the coexistence of myogenous TMD and cluster headache (CH) of the trigeminal autonomic cephalalgia (TAC) type, as defined by the International Headache Classification. This constellation of diagnoses required an interdisciplinary, multistage treatment approach. The coordinated integration of specialists from four disciplines resulted in satisfactory long-term remission from pain via a combination of pain treatment, physiotherapy, psychotherapy, and dental splint therapy. The appropriate diagnosis and treatment as well as the current literature are discussed in this case study article. Keywords: temporomandibular disorders (TMDs), trigeminal autonomic cephalalgia (TAC), chronic pain

Condylar fractures are the type of jaw fractures that occur most frequently. Complications such as abnormal or malfunctional occlusion can arise from the treatment of condylar fractures. These, in turn, can cause severe symptoms that may require corrective surgery. The etiology of this postoperative complication has not yet been fully clarified; one possible cause is considered to be the protrusive traction of the masticatory musculature. In the case reported here, the patient presented with a lateral open bite and limited mouth opening after the repositioning of a unilateral fracture of the mandibular condyle. Bilaterally, the muscles of mastication were prominently developed. Imaging procedures revealed a postoperative anterior condylar position. The patient had a forced bite, probably of muscular origin, and received multimodal treatment based on an occlusal splint with an anterior jig and botulinum toxin injections. The lateral open bite was slightly reduced, and mouth opening was still slightly limited after injection of the toxin. A few days after the use of the anterior jig, the lateral open bite was closed, and a normal range of mouth opening was achieved. This multimodal therapy could be a possible strategy for the correction of post-interventional malocclusion resulting from a mandibular neck fracture. Keywords: condylar fracture, mandibular neck, lateral open bite, malocclusion, limited mouth opening, masseter muscle hypertrophy, occlusal splint, anterior jig, botulinum toxin

The further development of the principles of functional diagnostics frequently also has an effect on new diagnostic instrumental procedures. Diagnostic occlusal indicator splints for the visual analysis of occlusal parafunctions are an example of this. These were developed to record the intensity and distribution of tooth contacts over time throughout the period of splint wearing, and to enable their objective visual evaluation at a later date. The list of service items contained in the German Dental Fee Schedule (GOZ) were hardly altered with regard to functional diagnostics by the GOZ fee reform in 2012, so that they differ very little from the previous version of 1988. Consequently, in this regard the GOZ is outdated, and since dentists in Germany are required by law to practice dentistry according to the current state of science, they cannot do so based solely on the service items listed in the GOZ. The legislator is aware of this problem and has, therefore, included the possibility in the new GOZ of invoicing those dental independent services not listed in the fee code as analogous service items according to the type of service, cost, and time input involved, as well as the degree of difficulty of comparable services (referred to as "analogous services"). On the basis of the example of diagnostic occlusal indicator splints and their evaluation, this article describes the legal and functional background to the GOZ fees, and the consequences for their implementation in clinical practice. Keywords: occlusal parafunctions, diagnostic occlusal indicator splints, dental fee schedule (GOZ), analogous services