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

Bone quality, quantity and metabolism in terms of dental implantation

The present paper provides an introduction to regular bone structure in the face area which is considered a precondition of successful implantation. The specific properties of the jaw bones have to be observed in this context. Bone is the largest calcium storage, forms part of the supporting tissue and displays distinctive plasticity and adaptability. Thus, an adequate, differentiated composition and metabolism are required. The bone matrix consists of organic and inorganic structures. The cells, osteoblasts, osteoclasts and osteocytes are responsible for bone formation, resorption and metabolism and, thus, for remodeling processes (formation and resorption) which permanently occur in bone tissue. Periosteum and endosteum form a functional unit with bone tissue itself and exercise protective, nutritive and growth functions

Morphofunctional aspects of dental implants

Although oral implantology is among the most beneficial developments of modern dentistry, the widely spread opinion that the long-term outcome of implants is superior to that of natural teeth has been refuted. To evade uncritical extractions, the morphofunctional properties of natural teeth and implant-supported restorations are compared from a proprioceptive and occlusal trauma perspective. The periodontal ligament of natural teeth provides the central nerve system with feedback for sensory perception and motor control. Conversely, the lack of such proprioception causes lower tactile sensitivity and less coordinated masticatory muscle activity in implant-borne restorations and makes them more prone to occlusal overload and possible subsequent failure. Moreover, occlusal anomalies may be conducive to parafunctional activity, craniomandibular disorder, tinnitus, and headache. Oral implantology, therefore, has to take appropriate account of occlusal conditions and the biomechanical and neuromuscular aspects of masticatory function. (C) 2011 Published by Elsevier GmbH

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

Cellular response to orthodontically-induced short-term hypoxia in dental pulp cells

Orthodontic force application is well known to induce sterile inflammation, which is initially caused by the compression of blood vessels in tooth-supporting apparatus. The reaction of periodontal ligament cells to mechanical loading has been thoroughly investigated, whereas knowledge on tissue reactions of the dental pulp is rather limited. The aim of the present trial is to analyze the effect of orthodontic treatment on the induction and cellular regulation of intra-pulpal hypoxia. To investigate the effect of orthodontic force on dental pulp cells, which results in circulatory disturbances within the dental pulp, we used a rat model for the immunohistochemical analysis of the accumulation of hypoxia-inducible factor-1 alpha in the initial phase of orthodontic tooth movement. To further examine the regulatory role of circulatory disturbances and hypoxic conditions, we analyze isolated dental pulp cells from human teeth with regard to their specific reaction under hypoxic conditions by means of flow cytometry, immunoblot, ELISA and real-time PCR on markers (Hif-1 alpha, VEGF, Cox-2, IL-6, IL-8, ROS, p65). In vivo experiments showed the induction of hypoxia in dental pulp after orthodontic tooth movement. The induction of oxidative stress in human dental pulp cells showed up-regulation of the pro-inflammatory and angiogenic genes Cox-2, VEGF, IL-6 and IL-8. The present data suggest that orthodontic tooth movement affects dental pulp circulation by hypoxia, which leads to an inflammatory response inside treated teeth. Therefore, pulp tissue may be expected to undergo a remodeling process after tooth movement