Journal of Craniomandibular Function, 03/2017

The purpose of this article is to review the pain literature in order to gain beneficial information from articles about thera- peutic failure among patients with chronic orofacial pain. A PubMed search (July 2017) yielded 17 relevant citations: most articles related to psychosocial aspects, pharmacological management, and surgical procedures. Neglect of psychosocial assessment may have disadvantageous consequences for diagnosis and therapy. Finding the right medication and dosage may be a challenge for therapists, while surgical interventions require a strict indication. Additional causes for therapeutic failure are an exclusive focus on somatic complaints, a strong emphasis on imaging, and ignorance of the principles of evidence-based medicine. The consequence of deficiencies in medical and dental education may be diagnostic and therapeutic arbitrariness, which is associated with an increased risk of failure. Patient-related factors for failure may be interindividual variation, somatic comorbidity, negative psychosocial influences, and lack of adherence to therapy. Keywords: chronic pain, diagnosis, evidence-based dentistry, medical education, PubMed, treatment failure

Aim: To demonstrate whether a correlation exists between the occurrence of mandibular lateral translation during the symmetric movements (ΔY-MLT) in mandibular dynamics and the different skeletal classes in humans. The main goal was to evaluate whether a correlation exists between the occurrence of mandibular lateral translation (ΔY-MLT) in protrusion/retrusion (P/R) and open/close (O/C) movements at different levels of severity and the subjects' skeletal classes. The secondary goal was to test the concordance between the maximum ΔY-MLT values in reference to four different cutoffs (0.65, 0.70, 0.75 and 0.80 mm). Materials and methods: A total of 108 subjects - 216 temporomandibular joints (TMJs) - who underwent a condyl-ography performed to obtain a functional diagnosis before dental rehabilitation were retrospectively selected by our research group to detect the occurrence of ΔY-MLT during symmetric movements. The condylographic tracings were analyzed in both sides (216 TMJs): two for P/R and two for O/C. The maximum ΔY-MLT value occurring in one side was taken out of both tracings. The cephalometric tracing executed to define the individual sagittal intermaxillary skeletal relationship was retrospectively retrieved and also included in the study. To test the correlation among the risk of presenting a pathological level of ΔY-MLT in both P/R and O/C movements, a chi-square test was performed for each skeletal class, using the abovementioned cutoffs. Conclusions: The repeated measures carried out for each patient were highly correlated, confirming the accuracy of the electronic-assisted condylography. Patients belonging to different skeletal classes did not show statistical differences in terms of ΔY-MLT average value in P/R and O/C. However, the multivariate analysis highlighted that skeletal class II showed a higher risk of presenting a pathological value in O/C compared to the risk for skeletal class I. During P/R movements, a higher level of risk exists for subjects belonging to skeletal class I. Moreover, this latter subgroup showed a high probability of presenting a pathological or borderline level in both types of symmetric movements at any cutoff, while the skeletal class II subjects have a major probability of presenting this complex pathological/altered profile only in the case of the larger width of lateral translation (0.8 mm). Keywords: temporomandibular disorders, temporomandibular joint dysfunction, internal derangement, computerized jaw tracking, skeletal classes

The two case studies in this article show the effect on bruxism of a novel biofeedback splint (bruXane). A pressure sensor, vibration module, and data storage module to record bruxing events are integrated into a maxillary occlusal splint worn, as a rule, at night. When bruxing occurs, the pressure sensor triggers a motor that generates a vibrating sensation in the maxilla and, simultaneously via bone conduction, a buzzing sound. As a result of this biofeedback, the wearer's bruxing is interrupted or reduced and a positive, therapeutic effect on bruxism is achieved. With it, tendentially, a longer-term learning process leading to less bruxing appears to occur. Concurrently, the readable bruxing data enables conclusions to be drawn about the causes and types of bruxism that is occurring. Keywords: bruxism, electromyography, craniofacial pain, contingent electrical stimulation, biofeedback, TMD, bruXane, occlusal splint

The further development of the principles of functional diagnostics also concerns the inclusion and integration of the issues in this dentistry sector with those of other medical sectors such as orthopaedic or psychosomatic medicine. Some scientific studies are now available that underscore the significance of appropriate tests for identifying any existing co-factors from these sectors of medicine. 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 services not listed therein as independent 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"). With reference to the example of tests for the determination of orthopaedic co-factors relating to a dysfunction of the stomatognathic system, this article describes the legal and functional background to the GOZ fees, and the consequences for their implementation in clinical practice. Keywords: temporomandibular dysfunction (TMD), tests for determining orthopaedic co-factors, clinical functional analysis, Dental Fee Schedule (GOZ), analogous billing