Die Reliabilität der Vermessung der Bewegungskapazität des Unterkiefers mit dem Lineal

Ziel dieser Studie war es, die Unterschiede der Reliabilität der Bewegungskapazität des Unterkiefers bei verschiedenen Untersucher- und Probandengruppen über einen Zeitraum von 3 Monaten mit dem Lineal darzustellen. Die Vermessung wurde bei 85 konsekutiv rekrutierten Probanden (Durchschnittalter: 39,8 ± 17,8 Jahre, 60 % weiblich, 56 mit kraniomandibulärer Dysfunktion) durchgeführt. Die Untersuchergruppe setzte sich aus einer Gruppe unerfahrener Studierender der Zahnmedizin, einer Gruppe von 6 erfahrenen, kalibrierten Zahnärzten und einem weiteren erfahrenen, kalibrierten Zahnarzt zusammen. Die Schneidekantendistanzen bei Mundöffnung, die Frontzahnstufen und die Laterotrusionsbewegungen der Probanden wurden in zwei separaten Sitzungen vermessen. In der ersten Sitzung nahmen alle drei Untersuchergruppen die Vermessungen vor, zum zweiten Zeitpunkt nur ein erfahrener Zahnarzt. Die Reliabilität wurde durch die Intra-Klassen-Korrelation berechnet. Die aktive und passive Schneidekantendistanz, sowie der Overjet und der Overbite wurden mit exzellenter Reliabilität vermessen. Die Laterotrusionsbewegungen zeigten sowohl rechts- als auch linksseitig gute bis exzellente Übereinstimmungen. Bei keiner Untersuchergruppe konnten statistisch signifikante Unterschiede zwischen der gesunden Probandengruppe und der Gruppe mit kraniomandibulären Dysfunktionen festgestellt werden. Die Ergebnisse dieser Arbeit zeigen, dass die Vermessung der Bewegungskapazität des Unterkiefers mit dem Lineal, sowohl untersucher- als auch probandenunabhängig über einen mittellangen Zeitintervall von 3 Monaten, eine reliable Prozedur ist und demzufolge als Grundlage für die Diagnosebildung zuverlässig genutzt werden kann.:1 Einführung 1 2 Aufgabenstellung 8 3 Literaturübersicht 10 3.1 Prävalenz von RDC-TMD-Diagnosen bei Probanden mit CMD 10 3.2 Messinstrumente 12 3.3 Normwerte der Bewegungskapazität 12 3.4 Reliabilität 15 3.4.1 Interrater-Reliabilität der Bewegungskapazität 15 3.4.2 Intrarater-Reliabilität der Bewegungskapazität 18 3.5 Fazit der Literaturrecherche 19 4 Material und Methoden 20 4.1 Verwendete Materialien 20 4.2 Probanden 20 4.2.1 Probanden der Kontrollgruppe 21 4.2.2 Probanden der Gruppe kraniomandibuläre Dysfunktion (“CMD“) 21 4.2.3 Prävalenz der Diagnosen des RDC/TMD bei Probanden mit kraniomandibulärer Dysfunktion 22 4.3 Untersucher 22 4.4 Versuchsdurchführung 23 4.5 Statistische Auswertung 26 4.5.1 Berechnung der Reliabilität 26 4.5.2 Vergleich der Reliabilität 26 4.5.3 Berechnung des Goldstandards 26 4.5.4 Nullhypothesen 27 5 Ergebnisse 28 5.1 Durchschnittswerte 28 5.2 Reliabilitäten 29 5.2.1 Untersucherbezogener Vergleich der Reliabilität 29 5.2.2 Probandenbezogener Vergleich der Reliabilität 38 6 Diskussion 47 6.1 Gegenstand der Untersuchung 47 6.2 Methodische Stärken und Schwächen der Studie 47 6.2.1 Generalisierbarkeit 47 6.2.2 Genauigkeit der klinischen Untersuchung 48 6.3 Vergleich und Interpretation der Daten 48 6.3.1 Prävalenz der RDC/TMD-Diagnosen bei Patienten mit CMD 48 6.3.2 Durchschnittswerte 49 6.3.3 Untersucherbezogener Vergleich der Reliabilität 50 6.3.4 Probandenbezogener Vergleich der Reliabilitäten 53 6.4 Ausblick 54 7 Schlussfolgerung 56 8 Zusammenfassung 57 9 Literaturverzeichnis 60 10 Anhang 66 Eigenständigkeitserklärung 83 Publikationen 84 Danksagung 8

Relationship between Age-Dependent Body Constitution and Temporomandibular Joint Sounds in Adolescents

To date, risk factors for temporomandibular joint (TMJ) sounds are still not completely understood, and anatomical factors are suspected to influence their occurrence. This study aimed to evaluate the impact of body constitution on temporomandibular joint sounds of adolescents. 10- to 18-year-old participants of the LIFE Child Study were examined for TMJ sounds, and physical parameters such as body height, body weight, and general laxity of joints were measured. Odds ratios (OR) for associations of TMJ sounds and standard deviation scores (SDS) of body height and body weight were calculated by using binary logistic regression, including cofactors such as age and number of hypermobile joints. The OR for TMJ sounds and SDS of body height was 1.28 (95% confidence interval (CI) 1.06; 1.56) in females when the age-adjusted height value was above 0. SDS of body weight indicated significant ORs for TMJ sounds in males with values of 0.81 (95% CI 0.70; 0.94). No correlation was detected for SDS values and TMJ crepitus. Tall female adolescents seem to be more prone to TMJ clicking sounds, while their occurrence seems less likely in male adolescents with higher body weight

Utilization of dental services and health literacy by older seniors during the COVID-19 pandemic

Background: This study aimed to investigate the utilization of dental services by older seniors during the COVID-19 pandemic and to evaluate their ability of finding, understanding, and using information on COVID-19. Methods: At the end of February 2021, a survey addressing demographic characteristics of the participants, (pain-associated) utilization of dental services, worries regarding a potential COVID-19 infection, the individual use of protective masks, and difficulties regarding the access to information on COVID-19 (by using the modified European Health Literacy Questionnaire [HLS-EU-Q16]) was developed. It was sent to all patients of the Dental Clinic of University of Leipzig who were either 75, 80, or 85 years old (n = 1228). Participation was voluntarily and anonymously; questionnaires had to be returned within six weeks, no reminders were sent. Results: Of the 439 replies (response rate 35.7%), twelve were excluded from data extraction due to disinterest, dementia, or lack of age information. Of the older seniors, 81.5% (n = 348) had utilized at least one dental examination and 54.2% of the dentulous patients (n = 199) had attended at least one dental hygiene appointment within the past year. Up to 55.8% of all participants said it was "difficult" or "very difficult" to find, understand, and use information on COVID-19, especially when judging reliability of information presented in the media, which was especially true for seniors with assigned care levels presenting odds ratios up to 5.30. Conclusions: The investigation revealed a frequent utilization of dental services by older seniors during the COVID-19 pandemic. However, the older seniors encountered difficulties finding, using, and understanding information about COVID-19. Keywords: COVID-19; geriatric dentistry; gerodontology; health literacy; older seniors; utilization

Combination of Digital and Conventional Workflows in the CAD/CAM-Fabrication of an Implant-Supported Overdenture

Completely digital workflows for the fabrication of implant-supported removable restorations are not yet common in clinical dental practice. The aim of the current case report is to illustrate a reliable and comfortable workflow that reasonably merges conventional and digital workflows for the CAD/CAM-fabrication of implant-supported overdentures. The 53-year old patient was supplied with a digitally processed complete denture in the upper jaw and, simultaneously, with an overdenture supported by four interforaminal implants in the lower jaw. The overdenture included a completely digitally processed and manufactured alloy framework that had been fabricated by selective laser sintering. The case report indicates that digital manufacturing processes for extensive and complex removable restorations are possible. However, as it is currently not yet possible to digitally obtain functional impressions, future developments and innovations might focus on that issue

Cross-Contamination Risk of Dental Tray Adhesives: An In Vitro Study

Background: The aim of this study was to investigate the risk of cross-contamination in dental tray adhesives with reusable brush systems. Methods: Four dental tray adhesives with different disinfectant components were examined for risk as a potential transmission medium for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Streptococcus oralis, and Candida albicans. Bacterial and fungal strains were mixed with artificial saliva. The contaminated saliva was intentionally added to tray adhesive liquid samples. At baseline and up to 60 min, 100 microliters of each sample were collected and cultivated aerobically on Columbia and Sabouraud agar for 24 or 48 h, respectively. Results: At baseline, contamination with Staphylococcus aureus and Candida albicans could be identified in three out of four adhesives. In the subsequent samples, low counts of up to 20 colony-forming units per milliliter could be observed for Staphylococcus aureus. All other strains did not form colonies at baseline or subsequently. Adhesives with isopropanol or ethyl acetate as disinfectant additives were most effective in preventing contamination, while adhesives with hydrogen chloride or acetone as a disinfectant additive were the least effective. Conclusion: Within 15 min, the tested adhesives appeared to be sufficiently bactericidal and fungicidal against all microorganisms tested

Effects of storage and toothbrush simulation on Martens hardness of CAD/CAM, hand-cast, thermoforming, and 3D-printed splint materials

Objectives To investigate Martens hardness parameters of splint materials after storage in liquids and toothbrush simulation. Materials and methods Ten specimens per material and group were fabricated (hand-cast CAST, thermoformed TF, CAD/CAM-milled CAM, 3D-printed PS, PL, PK, PV), stored in air, water, coffee, red wine, and cleaning tablets and investigated after fabrication, 24 h, 2- and 4-week storage or toothbrushing. Martens hardness (HM), indentation hardness (HIT), indentation modulus (EIT), the elastic part of indentation work (ηIT), and indentation creep (CIT) were calculated (ISO 14577-1). Statistics: ANOVA, Bonferroni post hoc test, between-subjects effects, Pearson correlation (α = 0.05). Results HM varied between 30.8 N/mm2 for PS (water 4 weeks) and 164.0 N/mm2 for CAM (toothbrush). HIT values between 34.9 N/mm2 for PS (water 4 weeks) and 238.9 N/mm2 for CAM (toothbrush) were found. EIT varied between 4.3 kN/mm2 for CAM (toothbrush) and 1.8 kN/mm2 for PK (water 2 weeks). ηIT was found to vary between 16.9% for PS (water 4 weeks) and 42.8% for PL (toothbrush). CIT varied between 2.5% for PL (toothbrush) and 11.4% for PS (water 4 weeks). The highest impact was identified for the material (p ≤ 0.001). Conclusions Storage and toothbrushing influenced Martens parameters. The properties of splints can be influenced by the choice of materials, based on different elastic and viscoelastic parameters. High HM and EIT and low CIT might be beneficial for splint applications. Clinical relevance Martens parameters HM, EIT, and CIT might help to evaluate clinically relevant splint properties such as hardness, elasticity, and creep

Long-term survival of monolithic tooth-supported lithium disilicate crowns fabricated using a chairside approach: 15-year results

Objectives To investigate the clinical performance of chairside fabricated tooth-supported posterior single crowns from lithium disilicate ceramic. Materials and methods Thirty-four crowns (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein) were inserted between 2006 and 2007 and again evaluated after 15 years. Survival and success rates were calculated according to Kaplan–Meier, and the quality of the crowns was evaluated by using modified United States Public Health (USPHS) criteria. Results Twenty-two crowns were available for recall; six patients were defined as dropouts. The mean observation period was 15.2 years (± 0.2). Six failures occurred (1 technical/5 biological) resulting in a survival rate of 80.1%. The success rate was 64.2%. The roughness of the crowns increased (p = 0.021) and the majority of adhesive gaps were discolored (p = 0.001) in comparison to baseline. The color, tooth, and crown integrity remained stable over the follow-up period (p ≥ 0.317). Conclusion The fabrication of tooth-supported lithium disilicate crowns using a chairside approach yielded acceptable long-term survival and success rates. Due to discoloration, the long-term use of dual-cure self-adhesive resin cements might result in unpleasing esthetic results. Clinical relevance The performance of posterior lithium disilicate single crowns revealed excellent to good clinical quality and an acceptable number of events after 15 years of clinical service

Prevalence of temporomandibular disorders and bruxism in seniors

Background Information on the prevalence of temporomandibular disorders (TMD) or possible/probable bruxism in seniors is heterogeneous and sparse. Objectives To elucidate the prevalence of TMD and possible/probable bruxism in German adults aged 60 years and older. Methods Participants of the Interdisciplinary Longitudinal Study of Adult Development and Aging (ILSE) born between 1950–1952 (C1) and 1930–1932 (C2) were examined in 2014–2016 (fourth wave). The participants were surveyed and clinically examined by one calibrated examiner. Two questions of the Patient Health Questionnaire (PHQ) were utilised to evaluate self-reported bruxism. The clinical examination included signs of probable bruxism and the RDC/TMD examination protocol. Results Data from 191 participants were available. No RDC/TMD diagnosis was made in 83.2%. Of the participants, 15.2% received a single diagnosis and 1.6% multiple diagnoses that included disc displacements (9.4%) and degenerative joint diseases (8.9%). A total of 24.7% reported bruxism that included self-reported awake bruxism in 11.9% and sleep bruxism in 16.2%. Wear was clinically identified in 27.2% of the participants. No sex-related differences were observed. Significant differences were detected for probable bruxism between C1 (14.1%) and C2 (54.3%). Conclusion In the German population aged 60 years and older, the prevalence of TMD is 16.8%. TMD is characterised by temporomandibular joint disorders, including disc displacements and degenerative joint disorders. Bruxism was observed in a quarter of the old population

Identifying the concepts contained in outcome measures of clinical trials on four internal disorders using the international classification of functioning, disability and health as a reference

Objectives: To systematically identify and compare the concepts contained in outcome measures of clinical trials on chronic ischemic heart disease, diabetes mellitus, obesity and obstructive pulmonary disease, including asthma using the International Classification of Functioning, Disability and Health (ICF) as a reference. Methods: Randomized controlled trials between 1993 and 2003 were located in MEDLINE and selected according predefined criteria. The outcome measures were extracted and the concepts contained in the outcome measures were linked by so called “linking rules” to the ICF. Results: 166 trials on chronic ischemic heart disease, 227 trials on diabetes mellitus, 428 trials on obesity and 253 trials on obstructive pulmonary disease were included. 10 different health status questionnaires were extracted in chronic ischemic heart disease, 19 in diabetes mellitus, 47 in obesity, 39 in obstructive pulmonary disease. Across conditions at least 75% (range: 75-92%) of the extracted concepts could be linked to the ICF. In diabetes mellitus and obesity the most used ICF- categories were ‘general metabolic functions’ (b540), in obstructive pulmonary disease ‘respiratory functions’ (b440) and in chronic ischemic heart disease ‘heart functions’ (b410). Conclusions: In all four health conditions the majority of studies were drug trials focusing on clinically relevant parameters and not on functioning. The ICF provides a useful reference to identify and quantify the concepts contained in outcome measures used in clinical trials