Kieferorthopädische Behandlung erwachsener Patienten-Beraten und Überwachen

Zusammenfassung Die Beratung und Betreuung von erwachsenen Patienten sollte dem Prinzip der partnerschaftlichen Kommunikation und Interaktion folgen und den Erwachsenen in den Stand setzen, eigenständig in Kenntnis der Vorteile und Nachteile einer kieferorthopädischen Behandlung zu entscheiden und einsichtig am Prozedere der Behandlung nach Maßgabe der vom Patienten zu erbringenden Leistungen zu partizipieren.

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Summary Advising and taking care of adult patients should be a principle of partnership communication. The adult must be informed as to the nature of the orthodontic treatment planned, the advantages and disadvantages. Thereby the patient is in a position to make a decision and is aware of the degree of participation needed to ensure a successful outcome of treatment.

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Résumé Lors de la consultation et du traitement de patients adultes, il est nécessaire qu'il s'établisse un contact et un engagement réciproques. Ceci permettrait aux patients de se décider en toute indépendance, en connaissant les avantages et désavantages d'un traitement orthodontique et en prenant une part active au traitement.

     

Anterior disk displacement of the temporomandibular joint

Summary In order to examine the diagnostic significance of typical clinical symptoms in temporomandibular joint (TMJ) disorders for diagnosis of anterior disk displacement, clinical findings were compared with the degree of disk displacement in 84 TMJs of 59 patients with TMJ disorders, who were examined clinically and by means of magnetic resonance imaging (MRI). The control group consisted of 31 subjects with no TMJ symptoms. No significant correlation between the degree of anterior disk displacement and palpation pain of the masticatory muscles or clicking/crepitus of the TMJ could be found. Joint clicking was observed in 65% of patients with TMJ symptoms in normal disk position (NDP). The percentage of joint clicking was almost the same in patients with anterior disk displacement with reposition (ADWR) (68%). There were significant correlations between active mouth opening and disk position as well as between a history of pain and disk position. Patients with NDP and ADWR had almost identical mouth opening values: 48 (±5) mm and 46 (±5) mm respectively. In contrast to these groups the mean values decreased significantly to 42 (±6) mm in patients with anterior disk displacement without reposition (ADWOR). There were no significant correlations between occlusal findings (centric relation and habitual relation, early occlusal contacts, abrasion facets) and disk position when viewed either collectively or individually.

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Anteriore Verlagerung des Discus articularis des Kiefergelenkes

Zusammenfassung Zur Überprüfung der Wertigkeit typisch klinischer Symptome für Funktionsstörungen zur Diagnose von Diskusverlagerungen wurden 84 Kiefergelenke von 59 Patienten mit Funktionsstörungen und 31 Kiefergelenke von klinisch asymptomatischen Probanden mittels Magnetresonanztomographie (MRT) untersucht und die einzelnen klinischen Befunde der Art der Diskusvergerung gegenübergestellt. Zwischen dem Grad der anterioren Diskusverlagerung und einem positiven Palpationsbefund der Kaumuskulatur, einem Palpationsschmerz der Kiefergelenke und dem Auftreten von Gelenkgeräuschen ergaben sich keine signifikanten Beziehungen. Bei funktionsgestörten Patienten zeigte sich mit 65% bei normaler Diskusposition (NDP) fast ebenso oft ein Gelenkknacken wie bei Patienten mit anteriorer Diskusverlagerung mit Reposition (VMR, 68%). Signifikante Beziehungen bestanden zwischen aktiver Mundöffnung und Diskusposition sowie anamnestisch angegebenen Schmerzen und Diskusposition. Während bei NDP- und VMR-Patienten mit 48 (±5) mm und 46 (±5) mm ähnlich hohe Mundöffnungswerte vorlagen, nahmen diese bei Patienten mit anteriorer Diskusverlagerung ohne Reposition (VOR) auf 42 (±6) mm signifikant ab. Okklusale Befunde (Differenz zwischen zentrischer und habitueller Okklusion >2 mm, vorzeitige okklusale Kontakte, Auftreten von Schliffacetten) zeigten in ihrer Gesamtheit wie auch in der Einzelbetrachtung keine signifikanten Beziehungen zur Diskusposition. Die Ergebnisse zeigen, daß für die Diagnostik von Funktionsstörungen allgemein als bedeutend anerkannte klinische Symptome in bezug auf die Art und das Vorliegen einer anterioren Diskusverlagerung allein keine sichere Aussage zulassen. Dies betrifft besonders die anteriore Diskusverlagerung ohne Reposition. Gleichzeitig wird die Zuverlässigkeit der MRT für die klinisch oft schwierige Diagnostik der Bestimmung der Diskusverlagerung bei Patienten mit Funktionsstörungen des Kausystems bestätigt.

     

In-vitro Investigations on Suitability of Light-cured Resins for Interocclusal Splints

OBJECTIVE: It was the aim of the present study to investigate the material properties of different resins and their suitability for the fabrication of occlusal and intermaxillary splints. MATERIAL AND METHOD: We subjected auto-polymerized resins (Palapress, Orthocryl, Steady-Resin M) and light-polymerized resins (Acrylight, Primosplint, Triad TranSheet Colorless and Pink) to investigation. The Targis Power light oven was used to polymerize the light-cured resins. After the auto-polymerized resins had been mixed by hand and filled into the forms, they were polymerized for 15 minutes in a high-pressure polymerization machine (Palamat) at 2 bar. The parameters examined were flexural strength, water adsorption, and polymerization shrinkage. Tests carried out according to DIN EN ISO 1567 served to determine flexural strength, flexural modulus, and water adsorption. Polymerization shrinkage was determined via the buoyancy test. RESULTS: The resins' flexural strength ranged from 60 to 101 MPa. Flexural moduli lay between 1.3 and 5.3 GPa. The water adsorption noted in light-cured resins amounted to 2.1-4.6 mass percent. Palapress and Steady-Resin displayed the lowest water adsorption with 2.0 mass percent. The light-polymerized resins revealed significantly less shrinkage (p < 0.05) than the autopolymerized resins tested in this study. CONCLUSION: Our results demonstrate that the light-cured resins-with the exception of Acrylight -easily match and even exceed the material properties of the cold-polymerized resins regarding flexural strength, flexural modulus, water adsorption and polymerization shrinkage. The light-cured resins examined thus seem suitable for use as splint material.     

THE HSA: A FOCUS FOR ADVANCING PRIMARY PREVENTIVE DENTAL PROGRAMS

In conclusion, as community agencies under P.L. 93-641 embark upon the definition of health status goals, health system goals, and program implementation, dentists have the opportunity to clarify and assist in developing a vigorous approach to meeting dental health needs through primary prevention. Insofar as public health dentistry is able to provide technical assistance and leadership at the local HSA and SHPDA levels, the powerful tools for change embodied in this law can be a force for promoting the oral health of our population.     

Biomechanics of the mandible and growth extension

Background and objective

One way of determining the direction of growth of the mandible is to consider the temporomandibular joint and movement of the mandible as a four-joint gear system, regarding growth then as an extension of the gear system. Our aim was to examine any correlations between the type of biomechanical growth extension and change in the maxilomandibular relation after Class?II therapy.

Subjects and methods

A total of 130?lateral cephalograms??before and after orthodontic treatment??were available from 65?adolescent class?II patients with open bite or deep bite. The two lateral cephalograms from each patient were superimposed on the occlusal plane. Cephalometric values and the vertical base point deviation were determined from biomechanical analyses, together with three distances and three angles.

Results

No correlation between the cephalometric data and distances or angles were observed. Although there were no significant differences in the distances, we did note significant differences in all three angles (p?Conclusion If gear system extension during growth is considered, this can be interpreted as meaning that the occlusal plane of those patients with an initially open bite dropped during treatment, but that it rose in patients with an initially deep bite.     

Reference Values for Craniofacial Structures in Children 4 to 6 Years Old: Review of the Literature

This review article addresses the question as to what methods can be used to investigate cranial structure and growth development in children 4 to 6 years old, and what the relevant reference values are for this age group. We screened the literature for epidemiological, longitudinal and cross-sectional studies investigating healthy children 4 to 6 years old without abnormalities and orthodontic therapy. Radiographic cephalometry is a practical, valid tool for analyzing craniofacial structure and growth processes. But it has several disadvantages, including the use of ionizing radiation, measuring points that are difficult to locate, no means of radiographic enlargement without distorting reference values, and the data's two-dimensionality. Anthropometry is another procedure for creating reference values for the craniofacial structure in children. Its advantages over radiographic cephalometry include three-dimensional results and no radiation exposure. Moreover, it yields precise and valid results for a wide variety of potential applications.In addition to these procedures, there are other techniques with which cranial structure and growth development in children 4 to 6 years old can be investigated. Those reported in the literature in this connection include standardized photographs, the creation of computerized and magnetic resonance images, and investigations performed on dry skulls. In short, there is great demand nowadays for investigations aimed at developing reference values for Caucasian children 4 to 6 years old. Radiographic cephalometry and anthropometry are two very common methods. Anthropometry is expected to become increasingly important because it involves no exposure to radiation.     

Quantity and distribution of plaque in orthodontic patients treated with molar bands

Objective

The placement of orthodontic bands usually increases plaque accumulation due to numerous mechanical retention sites. The purpose of this investigation was to evaluate the amount and distribution pattern of biofilm in the oral (palatal and lingual) and interproximal regions surrounding orthodontic bands.

Materials and Methods

We evaluated the formation of biofilm on 32 orthodontic bands which had been placed intraorally for 6?C37?months. Two parameters were measured: the percentage of surface covered by biofilm (quantity) and the biofilm distribution pattern of accumulation. We measured these two parameters in four regions of interest: the mesial and distal interproximal regions, as well as the mesial and distal regions of the oral attachment.

Results

The quantity of biofilm formation was similar in all four regions of interest, ranging from 13.3% to 16.8%. In contrast to biofilm quantity, distribution patterns differed in the four regions. In the mesial and distal interproximal regions it appeared as extensive insular areas in 87.5% and 71.9%, respectively, whereas it appeared more often supragingival and linear in nature in regions adjacent to the oral attachment, i.e. in 65.6% and 68.8%, respectively.

Conclusion

Our results indicate that firstly, oral hygiene in the palatal and lingual regions of orthodontic bands seems as difficult as it is in the interproximal areas, thus requiring thorough hygiene in both areas. Secondly, orthodontic patients with a history of periodontal disease require special attention regarding the use of orthodontic bands.