International Journal of Computerized Dentistry, 03/2015

Mandibular movement recording has long been established as the method for the physiological design of indirect dental restorations. Condylar movement recording is the basis for individual, patient-specific programming of partially or fully adjustable articulators. The settings derived from these recordings can generally be used in both traditional mechanical and electronic virtual articulators. For many years, condylar movement recordings have also provided useful information about morphological conditions in the temporomandibular joints (TMJs) of patients with masticatory system dysfunction based on the recorded movement patterns. The latest clinical application for recorded jaw-motion analysis data consists of functional monitoring of the patient as a diagnostic and surveillance tool accompanying treatment. Published parameters for the analysis of such recordings already exist, but a standardized and practicable protocol for the documentation and analysis of such jaw-movement recordings is still lacking. The aim of this article by a multicenter consortium of authors is to provide an appropriate protocol with the documentation criteria needed to meet the requirements for standardized analysis of computer-assisted recording of condylar movements in the future. Parole chiave: diagnosis, mandibular condyle, mandibular movement recordings, range of motion, reference standards, temporomandibular joint

Analysis of temporomandibular joint (TMJ) function using condylar path tracings is a challenge in functionally oriented dentistry. In most cases, reference points on the skin surface over the TMJ region are defined as "arbitrary", "individual" or "kinematic" condylar hinge axis points, which are displayed as "condylar paths" in motion. To what extent these reference points represent the actual condylar paths in each individual patient is ultimately unclear because the geometric relationship of the actual condyle to the selected reference point is usually unknown. Depending on the location of the point on the condyle and the centers of rotation of mandibular movement, these trajectories can vary greatly during combined rotational and sliding movements (eg, opening and closing movements of the mandible); this represents a grid of points located in the vicinity of the TMJ. To record the actual condylar path as the movement trajectory of a given point (eg, the condylar center), technological solutions are needed with which to link the tracing technology with the appropriate imaging technology capable of scanning the condyle, including the points of interest, and displaying them in real dynamic motion. Sicat Function (Sicat, D-Bonn) is such a solution. Sicat Function links cone beam computed tomography (CBCT) scans (made using the Galileos CBCT scanner; Sirona, Bensheim, Germany) with ultrasound-based, three-dimensional (3D) functional jaw movement recordings of the mandible (made using the JMT+ Jaw Motion Tracker; Sicat, Bonn, Germany). Digital images of the dental arches acquired with the intraoral scanner Cerec system (Sirona) can also be superimposed. This results in the generation of a 3D model of the bony mandible, including the TMJ, which reproduces the 3D real dynamic movement of the condyles simultaneously with that of the condylar paths at defined points (with the condylar centers being a particular point of interest). Sicat Function is an integrated, digital 3D solution for additional instrumental and imaging diagnosis of temporomandibular joint dysfunction (TMD). The primary indication for Sicat Function is persistent, arthrogenic TMD complaints that require additional studies for evaluation of bony structural components of the TMJ. Parole chiave: Sicat Function, cone beam computed tomography (CBCT), functional analysis, condyle movement, TMJ diagnosis, TMD

Nowadays, CAD/CAM software is being used to compute the optimal shape and position of a new tooth model meant for a patient. With this possible future application in mind, we present in this article an independent and stand-alone interactive application that simulates the human chewing process and the deformation it produces in the food substrate. Chewing motion sensors are used to produce an accurate representation of the jaw movement. The substrate is represented by a deformable elastic model based on the finite linear elements method, which preserves physical accuracy. Collision detection based on spatial partitioning is used to calculate the forces that are acting on the deformable model. Based on the calculated information, geometry elements are added to the scene to enhance the information available for the user. The goal of the simulation is to present a complete scene to the dentist, highlighting the points where the teeth came into contact with the substrate and giving information about how much force acted at these points, which therefore makes it possible to indicate whether the tooth is being used incorrectly in the mastication process. Real-time interactivity is desired and achieved within limits, depending on the complexity of the employed geometric models. The presented simulation is a first step towards the overall project goal of interactively optimizing tooth position and shape under the investigation of a virtual chewing process using real patient data (Fig 1). Parole chiave: CAD/CAM, Cerec, chewing, deformable model, substrate

Incisors can sometimes become discolored due to trauma. In most cases, the trauma involves complicated fractures of dentin and enamel that necessitates immediate restorative treatment. In some cases, the trauma is minor and does not involve any structural damage to the tooth. In these cases, the pulp tissue reacts to the trauma, causing discoloration. In the following two cases involving anterior teeth, there were no changes visible at the apex of the incisor. We assumed that the pulp tissue remained vital to some degree and was able to react in several ways to the trauma. In both cases, we saw a change in color of a central incisor, combined with an irregularity in the position of the anterior teeth. The patients involved both explicitly wished to alter the color of the darker incisor in order to restore the harmony of their smiles. Parole chiave: non-invasive veneers, IPS e.max CAD, Cerec Esthetic

Abrasion and erosion are two increasingly common indications for dental treatment. Thanks to modern digital technologies and new restorative materials, there are novel therapeutic approaches to restoring such losses of tooth structure in a virtually non-invasive manner. The case study in this article demonstrates one such innovative approach. The patient's severely abraded natural dentition was restored in a defect-driven, minimally invasive manner using high-performance composite materials in the posterior region, and the "sandwich technique" in the anterior region. The restorations were milled on an optimized milling machine with milling cycles adapted for the fabrication of precision-fit restorations with thin edges. Parole chiave: bite raising, CAD/CAM, complex rehabilitation, high-performance composite, non-invasive, ultra-thin occlusal veneers, virtual articulation