Objective: The aim of the present randomized controlled trial was to investigate whether a self-managed home exercise program is equivalent to relaxation splint therapy in terms of pain reduction during the initial phase of treatment of temporomandibular disorders (TMD). Materials and methods: 32 patients were enrolled in the study and randomly assigned to relaxation splint or home exercise therapy groups, respectively. The former group received relaxation splints fabricated to the patient’s jaw position in habitual occlusion with anterior-canine guidance and occlusal surface adjustment. The home exercise group was given a copy of the ‘Oral Physiotherapy’ DVD and instructed to perform the exercises demonstrated on the DVD three times a day. Results: After 4 weeks of treatment, both groups showed significant improvement in the outcome measures of pain, performance impairment, and number of sites with pain on palpation. The target of at least 30% pain reduction was achieved by 62.5% of patients in the relaxation splint group and by 68.8% of those in the home exercise group. Comparative analysis showed no clinically significant difference between the two groups (P > 0.05) and no inferiority of the instructional DVD compared with splint therapy for any of the outcome measures. Conclusion: The findings demonstrate that self-management of TMD pain by means of home physiotherapy exercises is as effective as relaxation splint therapy. Keywords: clinical trial, temporomandibular disorders, TMD, relaxation splint, physiotherapy, self-management

Aims: To estimate the association between signs of temporomandibular disorders (TMD) and symptoms of posttraumatic stress disorder (PTSD) in a representative sample from the general population of northeastern Germany. Methods: Signs of TMD were assessed with a clinical functional analysis that included palpation of the temporomandibular joints (TMJs) and masticatory muscles. PTSD was assessed with the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, ed 4. The change-inestimate method for binary logistic regression models was used to determine the final model and control for confounders. Results: After the exclusion of subjects without prior traumatic events, the sample for joint pain consisted of 1,673 participants with a median age of 58.9 years (interquartile range 24.8), and the sample for muscle pain consisted of 1,689 participants with a median age of 59.1 years (interquartile range 24.8). Of these samples, 84 participants had pain on palpation of the TMJ, and 42 participants had pain on palpation of the masticatory muscles. Subjects having clinical PTSD (n = 62) had a 2.56-fold increase in joint pain (odds ratio [OR] = 2.56; 95% confidence interval [CI]: 1.14 to 5.71, P = .022) and a 3.86-fold increase (OR = 3.86; 95% CI: 1.51 to 9.85, P = .005) in muscle pain compared to subjects having no clinical PTSD. Conclusion: These results should encourage general practitioners and dentists to acknowledge the role of PTSD and traumatic events in the diagnosis and therapy of TMD, especially in a period of international migration and military foreign assignments. Keywords: chronic pain, orofacial pain, population, posttraumatic stress disorder, temporomandibular disorder

Especially before orthodontic or dental restorative treatment, patients should be screened for temporomandibular dysfunction. A short clinical screening battery of six tests requiring a simple 'Yes' or 'No' response was developed based on Krogh and Poulsen's method for initial functional diagnosis of the masticatory system. Ahlers and Jakstat confirmed the scientific reliability of the new screening instrument. Establishing the presence or absence of physiological centric relation is an important element of this test, and is the basis of further restorative and orthodontic treatment decision making. Keywords: cotton roll test, physiological centric relation, physiology and functional pathology of the masticatory system, short screening for temporomandibular disorders

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

Generell wird angenommen, dass die Eckzahnführung einer Gruppenführung oder einer balancierten Okklusion bezüglich der Vermeidung traumatisierender Faktoren im Bereich der Molaren überlegen ist. Hierfür liefern epidemiologische Studien über nicht kariöse Zahnhalsdefekte einige Anzeichen. Allerdings gibt es keine Langzeitstudien mit eindeutigen Aussagen. Zudem machen Front-Eckzahnführungen laut epidemiologischen Studien nur ungefähr ein Viertel der möglichen Führungsmuster in der dynamischen Okklusion aus. Die Überlegenheit bestimmter okklusaler Kontaktsituationen (Höcker-Fossa-Verzahnung und Dreipunktabstützung) ist hinsichtlich klinischer Parameter bisher unbewiesen. Die Kaueffektivität gestaltet sich bei Totalprothesenträgern mit verschiedenen gelenkbezüglichen okklusalen Konzepten nicht signifikant unterschiedlich. Wie bei anderen Okklusionskonzepten ist das Vorhandensein oder Fehlen einer front-eckzahngeführten dynamischen Okklusion ebenfalls nicht mit der Ausprägung von Symptomen kraniomandibulärer Dysfunktionen assoziiert. Jedoch scheint bei Vorhandensein dieses Okklusionsmusters gegenüber anderen wie der Gruppenführung die Ausprägung nicht kariöser Zahnhalsdefekte geringer zu sein. Auch wenn es keinen wissenschaftlichen Beweis für die Über-legenheit eines bestimmten okklusalen Konzeptes in puncto verbesserter stomatognather Funktion gibt, sind zum Schutz von Restaurationen front-eckzahngeführte Okklusionsmuster bei komplexen prothetischen Versorgungen empfehlenswert. Ebenso sollte bei kieferorthopädischen und prothetischen Rehabilitationen im jugendlichen Gebiss eine eckzahngeschützte Okklusion angestrebt werden, während ältere Patienten wahrscheinlich eher eine Gruppenführung als dynamisches Okklusionskonzept vertragen. Keywords: Front-Eckzahnführung, Laterotrusion, Okklusion, Zahnführungsmuster, Okklusionskonzept, kraniomandibuläre Dysfunktion

Unter dem Begriff der kraniomandibulären Dysfunktion (CMD) wird ein äußerst komplexes Krankheitsbild zusammengefasst, das sehr vielfältige und zum Teil außerhalb der Zahnmedizin liegende Risikofaktoren aufweisen kann. Gleiches gilt für die Krankheitssymptome, die von Kopf- und Gesichtsschmerzen, Kiefergelenksproblemen und Tinnitus bis hin zu Halswirbelsäulenproblemen reichen können. Aus Sicht der Zahnmedizin sind okklusale Interferenzen, die zu Kaufunktionsstörungen führen, der Hauptrisikofaktor für CMD. Ziel der Schienentherapie ist es, derartige Störungen zu erkennen und mit okklusalen Schienen auszugleichen. Keywords: Kraniomandibuläre Dysfunktion (CMD), physiologisches Zentrikregistrat, Schienentherapie, Aufbissbehelfe, Reflexschienen, Michigan-Schienen, Positionierungsschienen, Dekompressionsschienen

Temporomandibular disorder (TMD) is the collective term for a number of functional disorders of the head and neck region. The main symptoms of TMD are pain and dysfunction of the muscles of mastication and/or temporomandibular joints (TMJs). The etiology of TMD is now believed to be multifactorial due to the heterogeneity of TMDs. The dental occlusion is suspected to be an etiologic factor. Originally described as playing a role ranging from a primary causative factor to a cofactor, it is now considered to play a rather insignificant part in the development of dysfunction in the temporomandibular system. Aim: To investigate the relationship between occlusal parameters and the signs and symptoms of TMDs in population- based subjects. General occlusion-related variables as well as static and dynamic contact relationships in the posterior region were analyzed for this purpose. Materials and methods: Five hundred and fifty eight subjects aged 20 to 49 years with at least 20 remaining teeth were evaluated for contact relationships between the dental arches in static and dynamic occlusion and for malocclusion (project affiliated with the Study of Health in Pomerania baseline study, SHIP0). Clinical TMJ function analysis was also performed on each subject. Bivariate relationships were examined using the chi-square test, correlation analysis, and multivariate models. Results: Of all the subjects, 5.7% had pure anterior canine guidance and 4.2% had hyperbalancing occlusal contact. Occlusal guidance patterns were not associated with TMD signs and symptoms. Likewise, no occlusal parameter was associated with signs and symptoms of TMDs (self-reported pain). Patients with no occlusal contact or only unilateral occlusal contact in the posterior region (3.6%) showed a tendency for a higher rate of tenderness of the TMJ (P = 0.055). Those with an inverted maxillary central incisor exhibited a significantly higher rate of TMJ tenderness (P = 0.02) and a tendency for a higher rate of tenderness of the masticatory muscles (P = 0.065). The following associations were found for tenderness of the TMJ (results adjusted for age, sex, and marital status; significance level P = 0.05): vertical bite/Angle Class II/2 malocclusion (cover bite): odds ratio (OR) = 2.3 (1.4-3.8); no occlusal contact or only unilateral occlusal contact in the posterior region: OR = 3.9 (1.3-11.3); bruxism: OR = 1.6 (0.9-2.7). Reciprocal clicking of the TMJ (TMJ sounds) was significantly associated with a loss of posterior support (right side: P = 0.021; left side: P = 0.041). These associations were no longer significant in the multivariate analysis of the longitudinal data. Conclusions: Subjects with a loss of posterior support due to missing teeth or the absence of occlusal contact in maximum intercuspation had a higher incidence of TMJ sounds and tenderness. Angle Class II/2 malocclusion (cover bite) in the maxillary anterior region was associated with tenderness on palpation of the TMJ and masticatory muscles. Except for cover bite, there was a low prevalence of all occlusal parameters with significant associations with TMD signs and symptoms. Although cross-sectional data analysis revealed associations between TMD and occlusal factors, causality of these relationships cannot be assumed. Keywords: etiology, occlusion, temporomandibular disorder (TMD)