SciencePages 277-293, Language: English, GermanDoepel, Marika / Le Bell, Yrsa / Liljeström, Marjo-Riitta / Vahlberg, Tero / Nilner, Maria
Ziel: Ziel war es, den Einfluss von lokalisiertem bzw. ausgebreitetem Schmerz auf die Kopfschmerzhäufigkeit und -intensität nach Behandlung mit Aufbissbehelfen bei CMD-Patienten zu untersuchen.
Material und Methode: Diese multizentrische Studie schloss 65 Patienten mit der CMD-Diagnose myofaszialer Schmerz gemäß den Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) ein. Zu Beginn der Untersuchung (Baseline) wurden Schmerzzeichnungen erstellt. Alle Patienten erhielten eine Behandlung mit Aufbissbehelfen. Die Therapieresultate wurden nach 6 und 10 Wochen sowie 6 und 12 Monaten kontrolliert und für zwei Schmerzprofile – lokalisierter Schmerz (Gesicht und Kopf, n = 26) und ausgebreiteter Schmerz (auch außerhalb von Kopf und Gesicht liegende Schmerzstellen, n = 39) – analysiert (Chi-Quadrat-Test, Mann-Whitney-U-Test, Wilcoxon-Vorzeichen-Rang-Test).
Ergebnisse: Bei Studienbeginn bestanden bezüglich der Kopfschmerzhäufigkeit keine Unterschiede zwischen den Schmerzprofil-Gruppen. Die Kopfschmerzhäufigkeit nahm über den Beobachtungszeitraum in beiden Gruppen signifikant ab (lokalisierter Schmerz: p = 0,008, ausgebreiteter Schmerz: p < 0,001), ohne signifikante Unterschiede zwischen beiden Gruppen. Die Intensität des Kopfschmerzes war bei Studienbeginn zwischen beiden Gruppen signifikant verschieden (p = 0,002). Während der Nachbeobachtung war in beiden Gruppen eine signifikante Abnahme der Kopfschmerzintensität (lokalisierter Schmerz: p = 0,007, ausgebreiteter Schmerz: p < 0,001) zu beobachten, die nach 6 Wochen und 12 Monaten keine Unterschiede zwischen den Gruppen aufwies. Bei der Untersuchung nach 6 Wochen wurde bei 52 % aller Patienten eine Reduktion der Kopfschmerzintensität um 30 % beobachtet, während sich nach 12 Monaten bei 54 % der Patienten eine Reduktion um 30 % fand.
Schlussfolgerung: Diese Studie zeigt, dass die Behandlung mit Aufbissbehelfen unabhängig davon, ob lokalisierter oder ausgebreiteter myofaszialer CMD-Schmerz vorliegt, eine vergleichbare positive Wirkung auf die Kopfschmerzhäufigkeit und -intensität hat.
Keywords: CMD, Kopfschmerz, lokalisierter Schmerz, ausgebreiteter Schmerz, Aufbissbehelfe
SciencePages 295-317, Language: English, GermanStimmer, Magdalena / Giannakopoulos, Nikolaos Nikitas / Held, Helena / Schindler, Hans Jürgen / Roldán-Majewski, Carolina
Partial results of a systematic review and meta-analysisIntroduction: This article reports the results of a comprehensive systematic review and meta-analysis of the effect of occlusal splints (OSs) on active maximum mouth opening (AMMO) in patients with temporomandibular disorders (TMD).
Methods: Multiple databases (PubMed/MEDLINE, EMBASE, Cochrane Library, LIVIVO, OpenGrey, DRKS, and ClinicalTrials.gov) plus additional literature were searched for relevant randomized clinical trials (RCTs) using OSs to treat adults with painful TMD. AMMO was assessed after 6 and 12 months of treatment, and OS therapy was compared with no treatment, other active treatments (OATs), and/or placebo splints. The Cochrane Collaboration’s tool for assessing risk of bias was used to assess study quality. The threshold for statistical significance of correlations detected by meta-analysis was P ≤ 0.05.
Results: The use of OSs did not increase AMMO significantly more than no treatment (P = 0.28) or placebo splints (P = 0.76). OS therapy was significantly inferior to OATs (P = 0.02 for short-term effect, P = 0.01 for medium-term effect). In 18 of the 21 included studies, OSs increased AMMO slightly but not significantly more than no treatment (P = 0.28) or placebo splints (P = 0.76).
Conclusions: OSs made no significant contribution to improving AMMO. Therefore, OATs should be used in patients with limited jaw opening.Registration: This study was registered in the PROSPERO database under ID number CRD42019123169.
Keywords: temporomandibular disorders (TMD), systematic review, meta-analysis, adults, pain propagation, occlusal splints, pain chronification
SciencePages 319-335, Language: English, GermanHeuser, Florian / Bourauel, Christoph / Stark, Helmut / Dörsam, Istabrak
Aim: The aim of the present study was to evaluate the number, strength, and position of occlusal contacts shown using an intraoral scanner (IOS) and a digital occlusal analysis system (T-Scan) compared with the current gold standard using occlusal foil (OF).
Materials and methods: Occlusal contacts were analyzed for 75 volunteers using OF in maximum intercuspation (MI). The contact points obtained using the IOS were evaluated using a screenshot from Zirkonzahn.Modellier CAD software. Finally, the volunteers were asked to bite on the sensor sheet of the T-Scan system. For the evaluation of these data, the contact points of the OF and the IOS were graded as light, medium, and strong. Furthermore, the positions of the contact points were analyzed for the anterior region (premolars and molars). Parametric statistical tests were applied to analyze the differences among the three methods.
Results: The mean number of all contact points was similar: 29 ± 8 with the OF, 30 ± 12 with the IOS, and 24 ± 10 with the T-Scan. However, results were different in terms of the grading of the strength of contact points: mean number of light contacts: 8 ± 4 OF vs 17 ± 8 IOS and 17 ± 6 T-Scan; medium contacts: 12 ± 5 OF vs 8 ± 4 IOS and 5 ± 4 T-Scan; and strong contacts: 9 ± 5 OF vs 6 ± 6 IOS and 4 ± 2 T-Scan. The positions of the occlusal contact points were also different.
Conclusion: The data sets showed that there were differences in the distribution of occlusal contact points evaluated using the OF, the IOS, and the T-Scan system. Although the number of detected occlusal contacts was similar, different occlusal contact protocols were determined by the three different methods.(Original article published in Int J Comput Dent 2020;23:
245–255.)
Keywords: occlusal contacts, intraoral scanner, T-Scan, occlusal foil, contact strength
Case ReportPages 337-354, Language: English, GermanKatzer, Lukasz / Roehl, Jakob C. / Ahlers, M. Oliver
Adjusted occlusal splints (AOS) have a wide range of indications in the treatment of functional disorders of the craniomandibular system. Simulation splints add a fully anatomically modeled occlusal appliance to the armamentarium of AOS that enables clinical testing of proposed changes in vertical dimension of occlusion and/or jaw position in complex cases, even during mastication, without the need for invasive tooth preparation. As such, they fill a gap at the decision crossroads between functional therapy and more far-reaching restorative treatment. The present case report describes the integration of simulation splints in treatment based on the example of a temporomandibular dysfunction patient with myopathy, arthropathy, and occlusopathy. The special feature of this case was that 2 years after the successful initial treatment, the patient had a recurrence of temporomandibular joint arthrosis that no longer responded to treatment with conventional equilibration splints. Only the daytime use of a fully anatomical simulation splint, in addition to wearing the positioning splint at night, was able to stabilize this situation and improve the patient’s well-being in the long term. Hence, this approach achieved the goals of pain reduction, improvement of mandibular mobility, and rehabilitation of restricted masticatory function without invasive procedures. Adjuvant physiotherapy had a supportive effect. The present case report demonstrates the use of a fully anatomical simulation splint at the crossroads between classical functional therapy and irreversible restorative treatment.
Keywords: Simulation splint, functional therapy, arthritis, chewing function