Journal of Craniomandibular Function, 02/2018

The current controversy as regards the etiology of temporomandibular disorders (TMDs) is further complicated by discussions about the connections between etiology and treatment, together with questions about the ethics of irreversible treatment modalities. However, most dental treatments are irreversible, even in cases with unclear etiology. Therefore, the ethics of treatment cannot be based on etiology alone, but call for an understanding of the possibilities available to help patients with health problems in ways that are physiologically correct and economically viable. Keywords: ethics, etiology, evidence, irreversible treatment

Fully digital computer-aided design/computer-aided manufacturing (CAD/CAM) complete denture fabrication systems are currently marketed by four providers: Global Dental Science (AvaDent), Merz Dental (Baltic Denture System), Ivoclar Vivadent/Wieland Dental (Wieland Digital Dentures), and Whole You (Whole You Nexteeth). Both the clinical adaptation protocols and technical production steps vary from one system to another. Each system has its own workflows for occlusal plane determination and bite registration. Therefore, both the clinician and the dental technician must overcome an initial learning curve before CAD/CAM denture systems become more efficient than conventional dentures. The current standard occlusal concept for CAD/CAM complete dentures is the bilaterally balanced occlusion, but anterior/canine-guided occlusion can also be achieved by individualizing the specified tooth position. Since neither the clinical adjustment steps nor the technical finalization steps for CAD/CAM complete dentures are fully controllable yet, they are still not superior to remounted conventional complete dentures in terms of occlusal quality. For this reason, denture remounting must also be recommended for CAD/CAM fabricated dentures. Keywords: CAD/CAM dentures, complete dentures, occlusion, remounting

The influence of occlusal forces on cervical spine (CS) muscle activation was determined with the aid of electromyography (EMG). For the first time in this pilot study, the hypothesis was tested that maximal and submaximal bite forces have a significant influence on all physiological CS movements in temporomandibular dysfunction (TMD) patients and a control group. Twenty female subjects were divided into a TMD group (n = 10) and a control group (n = 10) on the basis of a validated questionnaire. The range of motion (ROM) of the CS (flexion/extension/rotation/lateral flexion) was measured using the WinSpine system. The biteFork system was used to evaluate occlusal forces by recording the forces acting on the molars 15/16 and 25/26. The CS mobility measurements were made at occlusal force percentages of 0%, 25%, and 30%. Evaluation was based on the differences in the ROM with and without biting movements. This was followed by a temporomandibular joint (TMJ) examination, including evaluation of the mandibular movement range. A significant difference was observed in the control group between rotation to the left at occlusal force percentages of 0% and 25% (P 0.05). In the TMD group, the difference between flexion at occlusal force percentages of 0% and 25% (P 0.05), extension at occlusal force percentages of 25% and 100% (P 0.05), and rotation to the left at occlusal force percentages of 25% and 100% (P 0.05) were found to be significant. On comparing the data between the groups, a significant difference was observed between flexion at occlusal force percentages of 0% and 25% (P 0.05), and rotation to the left at occlusal force percentages of 25% and 100% (P 0.05). The initial hypothesis that the bite force has a significant influence on all six CS movements cannot be confirmed, since only 1 in 12 movements under loading in the control group, and 5 in 12 movements in the TMD group showed significant differences compared to the healthy control group. Nevertheless, the results indicate a connection between the temporomandibular and the craniocervical systems on a neuromuscular level. Larger sample sizes, more homogeneous samples, and the use of additional measuring instruments would be beneficial for further studies. Keywords: temporomandibular dysfunction (TMD), cervical spine (CS), range of motion (ROM), submaximal occlusal force, maximal occlusal force

Patients with temporomandibular dysfunction (TMD) are often affected by muscular symptoms. In recent years, scientific opinion has frequently recommended collaboration with physiotherapists for TMD patients. The RelaxBogen was the result of such interdisciplinary collaboration between dentists and physiotherapists. It imitates a specific form of relaxation technique - based on the myofascial release technique - for the masseter and temporal muscles. This article describes two cases from a pilot study. The case studies were presented by the author as a lecture entitled "The RelaxBogen, a new method of treatment for bruxism and TMD - a pilot study" at the 2016 Annual Conference of the DGFDT. They demonstrate the possibilities offered by the RelaxBogen for treating myogenic TMD and headaches. After 3 months of wearing the device, patients reported considerably reduced headaches and pain on palpation. Apart from a reduction in the general pain level, pain reduction was also documented in the head/jaw, cervical spine, and neck areas. Keywords: TMD, bruxism, myalgia, headaches, myofascial pain