Influence of tongue position on the determination of tooth shade

Statement of problem

Dentists frequently use electronic devices to determine tooth color. However, neither the instructions for these devices nor the accompanying brochures refer to the environmental conditions required at the point of measurement.

Evidence-based development of a diagnosis-dependent therapy planning system and its implementation in modern diagnostic software

The prerequisite for structured individual therapy of craniomandibular dysfunctions is differential diagnostics. Suggestions for the structured recording of findings and their structured evaluation beyond the global diagnosis of "craniomandibular disorders" have been published. Only this structured approach enables computerization of the diagnostic process. The respective software is available for use in practice (CMDcheck for CMD screening, CMDfact for the differential diagnostics). Based on this structured diagnostics, knowledge-based therapy planning is also conceivable. The prerequisite for this would be a model of achieving consensus on the indicated forms of therapy related to the diagnosis. Therefore, a procedure for evidence-based achievement of consensus on suitable forms of therapy in CMD was developed first in multicentric cooperation, and then implemented in corresponding software. The clinical knowledge of experienced specialists was included consciously for the consensus achievement process. At the same time, anonymized mathematical statistical evaluations were used for control and objectification. Different examiners form different departments of several universities working independently of one another assigned the theoretically conceiveable therapeutic alternatives to the already published diagnostic scheme. After anonymization, the correlation of these assignments was then calculated mathematically. For achieving consensus in those cases for which no agreement initally existed, agreement was subsequently arrived at in the course of a consensus conference on the basis of literature evaluations and the discussion of clinical case examples. This consensus in turn finally served as the basis of a therapy planner implemented in the above-mentioned diagnostic software CMDfact. Contributing to quality assurance, the principles of programming this assistant as well as the interface for linking into the diagnostic software are documented and also published here.     

Reproduction accuracy of articulator mounting with an arbitrary face-bow vs. average values—a controlled,randomized, blinded patient simulator study

Objectives

The benefit from positioning the maxillary casts with the aid of face-bows has been questioned in the past. Therefore, the aim of this study was to investigate the reliability and validity of arbitrary face-bow transfers compared to a process solely based on the orientation by means of average values. For optimized validity, the study was conducted using a controlled, randomized, anonymized, and blinded patient simulator study design.

Material and methods

Thirty-eight undergraduate dental students were randomly divided into two groups; both groups were applied to both methods, in opposite sequences. Investigated methods were the transfer of casts using an arbitrary face-bow in comparison to the transfer using average values based on Bonwill’s triangle and the Balkwill angle. The “patient” used in this study was a patient simulator. All casts were transferred to the same individual articulator, and all the transferred casts were made using type IV special hard stone plaster; for the attachment into the articulator, type II plaster was used. A blinded evaluation was performed based on three-dimensional measurements of three reference points.

Results

The results are presented three-dimensionally in scatterplots. Statistical analysis indicated a significantly smaller variance (Student’s t test, p < 0.05) for the transfer using a face-bow, applicable for all three reference points.

Conclusions

The use of an arbitrary face-bow significantly improves the transfer reliability and hence the validity.

Clinical relevance

To simulate the patient situation in an individual articulator correctly, casts should be transferred at least by means of an arbitrary face-bow.

     

Concept of computer-assisted clinical diagnostic documentation systems for the practice with the option of later scientific evaluations

Treatment data from practices and specialization centers, especially in the increasingly specialized areas which university clinics do not cover, are very important for evaluating the effectiveness and efficiency of dental examination and treatment methods. In the case of paper-based documentation, the evaluation of these data usually fails because of the cost it entails. With the use of electronic medical records, this expense can be markedly lower, provided the data acquisition and storage is structured accordingly. Since access to sensitive person-related data is simplified considerably by this method, such health data are protected, especially on the European level. Other than generally assumed, this protection is not restricted solely to the confidentiality principle, but also comprises the power of disposition over the data (data protection). The result is that from a legal point of view, the treatment data cannot be readily used for scientific studies, not even by dentists and physicians who have collected the data legally during the course of their therapeutic work. The technical separation of treatment data from the personal data offers a legally acceptable solution to this problem. It must ensure that a later assignment to individual persons will not be feasible at a realistic expense ("effective anonymization"). This article describes the legal and information technology principles and their practical implementation, as illustrated by the concept of a respective compliant IT architecture for the dentaConcept CMD fact diagnostic software. Here, a special export function automatically separates the anonymized treatment data and thus facilitates multicentric studies within an institution and among dental practices.     

Computer assistance in clinical functional analysis

The use of computers in the dental practice has been primarily restricted to the acquisition of billing data. Additional possibilities for use of PCs exist in diagnostic data acquisition and evaluation; clinical functional analysis seems a particularly suitable application. Such software is now available: CMDfact. Dentally, it is based on a previously developed and published examination and documentation system, the graphic user interface of which is used in the newly developed software. After the examination data have been acquired by mouse click or numerical entry, these are available for evaluation. A special function, the "Diagnosis pilot" is integrated to support the user. This helps in the assignment of the appropriate "Initial diagnoses", since it brings together the individually existing principal symptoms and suitable diagnoses for the initial diagnosis in question and also states which diagnoses "would be appropriate" for this, but are not available. With 3D animation, the software also helps the dentist to explain aspects of CMD to patients. The software also assists the dentist with a detailed multimedia help system, which provides context-sensitive help for every examination step. These help functions explain the sense of the relevant examinations, their performance and evaluation in the form of short texts and explanatory photographs and videos.