SciencePages 9-23, Language: English, GermanLauenstein, Niklas D. / Becker, Giuliana M. / Bernhardt, Olaf
A follow-up studyAim: The objective of the present study was to investigate the effect of biofeedback treatment, administered via contingent electrical stimulation (CES) with the GrindCare 4 device (market launch in 2016), on bruxism activity and orofacial pain in patients with temporomandibular disorders (TMD) and bruxism.
Materials and methods: Twenty-six participants were enrolled in this follow-up study. The first 13 (group 1) completed a 21-day study protocol. The next 13 (group 2) were assigned a 42-day protocol, which 10 participants completed successfully. The study was conducted in three phases. In phase 1 (pretreatment), participants received baseline functional status (Research Diagnostic Criteria for Temporomandibular Disorders [RDC/TMD] questionnaire and clinical examination) and bruxism status examinations (Lange & Bernhardt Bruxism Status screener) and were then supplied with study information and a GrindCare 4 device, with oral and written instructions for its use. Per protocol, participants were directed to use the device without biofeedback on the first 4 or 7 nights, respectively, for a baseline measurement of jaw muscle contraction frequency. In phase 2 (treatment), they were to activate the device’s biofeedback mode and administer themselves after 2 to 4 weeks, respectively, of CES treatment. In phase 3 (posttreatment), group 1 and 2 participants used GrindCare 4 without biofeedback on 3 or 7 nights, respectively, for follow-up measurement and evaluation of jaw muscle contraction frequency, followed by a second functional status assessment (RDC/TMD questionnaire and clinical examination).
Results: A significant reduction of bruxism events was only achieved after 4 weeks of CES (42-day study protocol): compared with pretreatment measurements (baseline), the number of bruxism events was 40% lower after 4 weeks of treatment and 32% lower during posttreatment follow-up. The number of painful palpation sites decreased significantly in both groups (21-day arm: P = 0.010; 42-day arm: P = 0.035). However, no significant change in pain intensity was detected.
Conclusions: A 2-week CES intervention appears to be insufficient because a reduction of bruxism events only occurred after a longer treatment duration. The reduction of bruxism events achieved by 4 weeks of CES persisted into the posttreatment follow-up phase, suggestive of a potential learning effect. No evidence was found of a reduction of bruxism symptoms. At the time of publication, the manufacturer had withdrawn the study device from the market for modification. Further controlled studies with larger cohorts are needed to verify these results. A longer treatment duration and follow-up would be advisable.
Keywords: temporomandibular disorders (TMD), sleep bruxism, myofascial pain, biofeedback
SciencePages 25-34, Language: English, GermanManfredini, Daniele / Lombardo, Luca / Visentin, Alessandra / Arreghini, Angela / Siciliani, Giuseppe
An electromyographic studyAims: To assess the correlation between tooth wear and sleep-time masseter muscle activity (sMMA) in a group of healthy young adults who underwent home electromyographic/electrocardiographic (EMG/ECG) recordings with a portable device.
Methods: A total of 41 healthy volunteers (23 women, 18 men; mean age 28.8 years, range 25 to 40) with good natural dentition underwent a 2-night in-home evaluation with a portable device that allowed a simultaneous sleep-time recording of EMG signals from both masseter muscles and heart rate. The number of sleep bruxism (SB) episodes per sleep hour (SB index); the number of phasic, tonic, and mixed sMMA events per hour; and the total number of sMMA events per night were calculated. All individuals also underwent an assessment of tooth wear on digital casts with the adoption of a six-degree rating scale. Correlations between sMMA variables and tooth wear were assessed using the Pearson test. The null hypothesis was that correlation between the two conditions would not be significant.
Results: On average, the SB index was 4.5 ± 2.6, while the total number of sleep-time masseter contractions was 97.2 ± 55.2. Of those contractions, almost 60% were phasic. Average tooth wear was 1.5 ± 0.7, with the canines and mandibular incisors showing the highest wear scores. For all pairwise analyses, correlation values were not significant (P values 0.11 to 0.69), with r values ranging from 0.064 to 0.253.
Conclusion: The null hypothesis of an absence of correlation between tooth wear and sMMA could not be rejected, implying that tooth wear cannot be used as an indicator of ongoing SB or sMMA. Future studies taking into account the multifaceted nature of tooth wear and the complex natural course of sleep phenomena are encouraged to investigate the issue further, at the individual level. J Oral Facial Pain Headache 2019;33:199–204. doi: 10.11607/ofph.2081
Keywords: electromyography, masticatory muscles activity, sleep bruxism, tooth wear
SciencePages 35-46, Language: English, GermanPeroz, Ingrid / Roneh, Ehssan
Ziel: Durch eine kontrollierte, klinische Studie soll die zentrische Kieferrelation (CR) vor und nach einer Physiotherapieanwendung bei Patienten mit Myalgie und funktionsgesunden Probanden verglichen werden.
Material und Methode: 22 Patienten mit einer Myalgie entsprechend der Diagnostic Criteria for Temporomandibular Disorders wurden in die Studie aufgenommen. Fünf Probanden wiesen keine Symptome einer CMD auf. Alle Studienteilnehmer wurden auf einen Orthas Stuhl gesetzt. Die CR wurde mithilfe des elektronischen Stützstiftsystems Intraoral Process Registration (IPR) mit drei unterschiedlichen Methoden bestimmt. a) der Adduktionspunkt vor einer Deprogrammierung (AP), b) der Adduktionspunkt nach einer Deprogrammierung durch Bewegungen auf dem Drucksensor (APD) und c) die handgeführte Kieferrelation (CRM). Direkt nach der ersten IPR-Messung erhielten die Teilnehmer eine Physiotherapieanwendung. Danach folgte eine zweite IPR-Messung. Als Maß für die Übereinstimmung zwischen den Ergebnissen der IPR-Messungen wurde Cronbachs α bestimmt. Mittels t-Test wurden die Differenzen zwischen den Positionen der Kieferrelation bei Patienten mit Myalgie und funktionsgesunden Probanden vor und nach Physiotherapie verglichen. Die physiotherapeutische Intervention beinhaltete manuelle Techniken wie Massage, Dehnung und Mobilisation des Weichgewebes sowie die Mobilisierung der Kiefergelenke und der oberen Kopfgelenke.
Ergebnisse: Der Grad der Übereinstimmung der Registriermethoden variierte in einem akzeptablen Maß für den Adduktionspunkt nach Deprogrammierung (0,65 ≤ α ≤ 0,99). Für die Wiederholbarkeit des Adduktionspunkts vor Deprogrammierung und die Handführung war die Übereinstimmung exzellent (0,79 ≤ α ≤ 0,99). Bei Patienten mit Myalgie differierte die zentrische Kieferrelation vor und nach Physiotherapie nicht signifikant (p > 0,05). Bei den funktionsgesunden Probanden lag der Adduktionspunkt nach Deprogrammierung nach Physiotherapie signifikant anteriorer (p = 0,001).
Schlussfolgerungen: Eine einzige Physiotherapieanwendung kann die Kieferrelation bei Patienten mit Myalgie nicht beeinflussen.
Keywords: Kieferrelationsbestimmung, Entspannung, Manualtherapie, IPR, Gothischer Bogen, Deprogrammierung
Pages 47-63, Language: English, GermanRaff, Alexander
Bimaxillary splints are oral appliances with a number of established dental indications, and their names vary depending on the indication (eg, anti-snoring splint, sleep apnea appliance, and positioning splint versus simulation splint). These treatment appliances are an integral part of modern dentistry and are recognized in various guidelines and scientific publications. Nevertheless, they are not yet included in Germany’s official Dental Fee Schedule (GOZ), and several new resolutions on this subject have been passed in recent months. The aim of the present article is to present and discuss these guidelines and resolutions in the scope of a critical discourse.
Keywords: occlusal splints, bimaxillary positioning splints, mandibular protrusion splints, bimaxillary simulation splints, sleep apnea, snoring, arthropathy