The history of the concepts in treating craniomandibular dysfunctions using occlusal appliances. A review

Objectives: The knowledge of the history of occlusal appliances and their treatment ideas help benchmark therapy concepts of today and in the future. Material and methods: The history of occlusal appliances was systematically reviewed. We analyzed 25 electronic data bases and additionally bibliographic catalogs by hand. Entirely 176 papers were included. Results: First appliances, made of wood or alloys, were only used to fix bone fractures. Later, appliances made of caoutchouc were added covering the entire dental arch. It was not until 1901 that occlusal appliances were systematically inserted to treat parafunctions. At that time, occlusal dysbalances were considered to be responsible for tooth lost (Alveolar pyorrhea) and furthermore, in the years 1920 to 1930, for dysfunctions of the tube, for vertigo and bad hearing (Costen syndrome). After the Second World War the dentists included the phenomena of stress in their treatment concepts and they considered more and more internal derangement of the temporomandibular joint as topic, which had to be treated by splints. The material of the appliances changed from natural rubber to acrylic resin materials, which offered the possibility to construct appliances in manifold ways. Conclusions: Beside appliances like the Michigan splint, that covered all teeth of the dental arc, concepts with reduced occlusal contact in anterior area (e.g.: jig-splints) or, posterior area (e.g.: pivot splints) were developed. Clinical relevance: Meanwhile a wide range of concepts and types of appliances were propagated, however, a final evidence based concept is still lacking

Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home-CARE (Home Monitoring in Cardiac Resynchronization Therapy) study

Aim To investigate whether diagnostic data from implanted cardiac resynchronization therapy defibrillators (CRT-Ds) retrieved automatically at 24 h intervals via a Home Monitoring function can enable dynamic prediction of cardiovascular hospitalization and death. Methods and results Three hundred and seventy-seven heart failure patients received CRT-Ds with Home Monitoring option. Data on all deaths and hospitalizations due to cardiovascular reasons and Home Monitoring data were collected prospectively during 1-year follow-up to develop a predictive algorithm with a predefined specificity of 99.5%. Seven parameters were included in the algorithm: mean heart rate over 24 h, heart rate at rest, patient activity, frequency of ventricular extrasystoles, atrial–atrial intervals (heart rate variability), right ventricular pacing impedance, and painless shock impedance. The algorithm was developed using a 25-day monitoring window ending 3 days before hospitalization or death. While the retrospective sensitivities of the individual parameters ranged from 23.6 to 50.0%, the combination of all parameters was 65.4% sensitive in detecting cardiovascular hospitalizations and deaths with 99.5% specificity (corresponding to 1.83 false-positive detections per patient-year of follow-up). The estimated relative risk of an event was 7.15-fold higher after a positive predictor finding than after a negative predictor finding. Conclusion We developed an automated algorithm for dynamic prediction of cardiovascular events in patients treated with CRT-D devices capable of daily transmission of their diagnostic data via Home Monitoring. This tool may increase patients’ quality of life and reduce morbidity, mortality, and health economic burden, it now warrants prospective studies

Meloxicam medication reduces orthodontically induced dental root resorption and tooth movement velocity: a combined in vivo and in vitro study of dental-periodontal cells and tissue

Non-steroidal anti-inflammatory drugs (NSAID) are used to alleviate pain sensations during orthodontic therapy but are also assumed to interfere with associated pseudo-inflammatory reactions. In particular, the effects of partially selective COX-2 inhibition over the constitutively expressed COX-1 (11:1) on periodontal cells and tissue, as induced by the NSAID meloxicam, remain unclear. We investigate possible adverse side-effects and potentially useful beneficial effects during orthodontic therapy and examine underlying cellular and tissue reactions. We randomly assigned 63 male Fischer344 rats to three consecutive experiments of 21 animals each (cone-beam computed tomography; histology/serology; reverse-transcription quantitative real-time polymerase chain reaction) in three experimental groups (n = 7; control; orthodontic tooth movement [OTM] of the first/second upper left molars [NiTi coil spring, 0.25 N]; OTM with a daily oral meloxicam dose of 3 mg/kg). In vitro, we stimulated human periodontal ligament fibroblasts (hPDL) with orthodontic pressure (2 g/cm(2)) with/without meloxicam (10 mu M). In vivo, meloxicam significantly reduced serum C-reactive protein concentration, tooth movement velocity, orthodontically induced dentine root resorption (OIRR), osteoclast activity and the relative expression of inflammatory/osteoclast marker genes within the dental-periodontal tissue, while presenting good gastric tolerance. In vitro, we observed a corresponding significant decrease of prostaglandin E-2/interleukin-6/RANKL(-OPG) expression and of hPDL-mediated osteoclastogenesis. By inhibiting prostaglandin synthesis, meloxicam seems to downregulate hPDL-mediated inflammation, RANKL-induced osteoclastogenesis and, consequently, tooth movement velocity by about 50%, thus limiting its suitability for analgesia during orthodontic therapy. However, its protective effects regarding OIRR and good tolerance profile suggest future prophylactic application, which merits its further investigation

Historischer Rückblick der Entwicklung und Indikationsstellungen von Aufbissbehelfen/Schienen in der Zahnheilkunde

Einführung: Publikationen zur Geschichte von Aufbissbehelfen und historische Publikationen über Aufbissbehelfe wurden anhand einer strukturierten Literatursuche recherchiert. Methode: Es wurden eine breite Auswahl an Datenbanken, Katalogen und Bibliographien elektronisch und per Hand Recherche herangezogen. Insgesamt wurden 181 Literaturstellen ausgewertet. Ergebnisse: Zunächst wurden Schienen aus Holz oder Metall im Wesentlichen nur zur Frakturbehandlung eingesetzt. Später kamen Kautschukschienen dazu, die auch schon die Zahnreihen umfassten. Erst ab der Jahrhundertwende, ab ca. 1901, wurden Aufbissbehelfe gezielt zur Therapie von Dysfunktionen eingegliedert. Eine fehlerhafte Okklusion wurde in der Folgezeit als entscheidende Ursache von Zahnverlust (Alveolar Pyorrhöe, Karolyi-Effekt) sowie in den 20er und 30er Jahren als Ursache für Störungen der Funktion von Tuben, Hörminderung sowie Schwindel angesehen (Costen Syndrom). Nach 1945 rückten Okklusionsstörungen in Kombination mit Stressphänomenen in den Vordergrund der Therapiekonzepte sowie Therapien von Dysfunktionen des Kiefergelenks wie Diskusverlagerungen. Da Kunststoff statt Kautschuk zur Schienenherstellung genutzt werden konnte, eröffneten sich vielseitige Gestaltungsmöglichkeiten von Aufbissbehelfen. Neben Schienen, die die gesamte Zahnreihe bedeckten (z.B. Michiganschiene) wurden Konzepte mit im Aufbiss reduzierten Kontaktflächen im Front- (z.B. Jig-Schienen) wie auch im Seitenzahngebiet (z.B. Pivot-Schienen) entwickelt. Schlussfolgerungen: Der Nachweis der Effizienz einer Schienentherapie ist aber bei vielen Konzepten unbefriedigend. Werden Schienen als temporäreres Hilfsmittel zur Therapie kraniomandibulärer Störungen verstanden und eingesetzt, können sie, im Sinne einer „Krücke“, dem Patienten helfen über den akuten Beschwerdeschub hinweg zu kommen. Inwieweit sich durch Schienen die neuromuskulären Funktionsmuster des Patienten nachhaltig verändern, ist zurzeit Gegenstand intensiver Forschung. Es gibt Belege, dass sich auch kurative Wirkungen durch Aufbissbehelfe erzielen lassen

Reference genes for valid gene expression studies on rat dental, periodontal and alveolar bone tissue by means of RT-qPCR with a focus on orthodontic tooth movement and periodontitis

Objectives: To obtain valid results in relative gene/mRNA-expression analyses by RT-qPCR, a careful selection of stable reference genes is required for normalization. Currently there is little information on reference gene stability in dental, periodontal and alveolar bone tissues of the rat, especially regarding orthodontic tooth movement and periodontitis. We therefore aimed to identify the best selection and number of reference genes under these experimental as well as physiological conditions. Materials and methods: In 7 male Fischer344-rats the upper left first and second molars were moved orthodontically for 2 weeks and in 7 more animals additionally subjected to an experimental periodontitis, whereas 7 animals were left untreated. Tissue samples of defined size containing both molars (without crowns) as well as the adjacent periodontal and alveolar bone tissue were retrieved and RNA extracted for RT-qPCR analyses. Nine candidate reference genes were evaluated and ranked according to their expression stability by 4 different algorithms (geNorm, NormFinder, BestKeeper, comparative Delta C-q). Results: PPIB/YWHAZ were the most stabile reference genes for the combined dental, periodontal and alveolar bone tissue of the rat overall, in untreated animals and rats with additional periodontitis, whereas PPIB/B2M performed best in orthodontically treated rats with YWHAZ ranking third. Gene-stability ranking differed considerably between investigated groups. A combination of two reference genes was found to be sufficient for normalization in all cases. Conclusions: The substantial differences in expression stability emphasize the need for valid reference genes, when aiming for meaningful results in relative gene expression analyses. Our results should enable researchers to optimize gene expression analysis in future studies by choosing the most suitable reference genes for normalization. (C) 2015 Published by Elsevier GmbH

Interactive effects of periodontitis and orthodontic tooth movement on dental root resorption, tooth movement velocity and alveolar bone loss in a rat model

Background: Many adult orthodontic patients suffer from chronic periodontitis with recurrent episodes of active periodontal inflammation. As their number is steadily increasing, orthodontists are more and more frequently challenged by respective treatment considerations. However, little is currently known regarding interactive effects on undesired dental root resorption (DRR), tooth movement velocity, periodontal bone loss and the underlying cellular and tissue reactions. Material and methods: A total of 63 male Fischer344 rats were used in three consecutive experiments employing 21 animals each (A/B/C), randomly assigned to 3 experimental groups (n = 7, 1/2/3), respectively: (A) CBCT; (B) histology/serology; (C) RT-qPCR (1) control: (2) orthodontic tooth movement (OTM) of the first/second upper left molars (NiTi coil spring, 0.25 N); (3) OTM with experimentally induced periodontitis (cervical silk ligature). After 14 days of OTM, we quantified blood leukocyte level, DRR, osteoclast activity and relative gene expression of inflammatory and osteoclast marker genes within the dental-periodontal tissue as well as tooth movement velocity and periodontal bone loss after 14 and 28 days. Results: The experimentally induced periodontal bone loss was significantly increased by concurrent orthodontic force application. Periodontal inflammation during OTM on the other hand significantly augmented the extent of DRR, relative expression of inflammatory/osteoclast marker genes, blood leukocyte level and periodontal osteoclast activity. In addition, contrary to previous studies, we observed a significant increase in tooth movement velocity. Conclusions: Although accelerated tooth movement would be favourable for orthodontic treatment, our results suggest that orthodontic interventions should only be performed after successful systematic periodontal therapy and paused in case of recurrent active inflammation. (C) 2016 Elsevier GmbH. All rights reserved

Morphometric characteristics of anencephalic skulls – A comparative study

Anencephaly is the most severe form of a neural tube defect resulting from the incomplete occlusion of the anterior neuropore in the fourth week of development and associated with a severely underdeveloped brain mass. As desmal ossification of the neurocranium is induced by the presence of soft tissues (brain), no bone develops as direct consequence of the missing brain. The cranial base, by contrast, is formed by chondral ossification, which is genetically determined, and thus present also in anencephaly. Morphometric characteristics of anencephalic skulls, however, have not yet been investigated in sufficient detail before. In this study we therefore comparatively assessed macroscopic morphological-anatomical and cephalometric CT data on structures and dimensions of 11 macerated anencephalic and 4 normal neonatal skulls highlighting skeletal morphological differences. The most striking results were the missing skullcap and the greatly changed morphology of the existing skull bones, which were reduced in size. The parameters of the skull base, the transverse orbital diameter and maxillary width were significantly smaller in anencephalic skulls. The morphology of the viscerocranium appeared similar to that of normal neonatal skulls. The results of this study can be used in diagnosis and skeletal classification for anencephaly. This can help identify bones that are incomplete, fragmented and taphonomically altered, which is often the case in historical and forensic studies. (C) 2020 Elsevier GmbH. All rights reserved

Home Monitoring: clinical significance

Detection of atrial high-rate events by continuou