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Sagl B, Schmid-Schwap M, Piehslinger E, Yao H, Rausch-Fan X, Stavness I. The effect of bolus properties on muscle activation patterns and TMJ loading during unilateral chewing. J Mech Behav Biomed Mater 2024; 151:106401. [PMID: 38237207 DOI: 10.1016/j.jmbbm.2024.106401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
Mastication is a vital human function and uses an intricate coordination of muscle activation to break down food. Collection of detailed muscle activation patterns is complex and commonly only masseter and anterior temporalis muscle activation are recorded. Chewing is the orofacial task with the highest muscle forces, potentially leading to high temporomandibular joint (TMJ) loading. Increased TMJ loading is often associated with the onset and progression of temporomandibular disorders (TMD). Hence, studying TMJ mechanical stress during mastication is a central task. Current TMD self-management guidelines suggest eating small and soft pieces of food, but patient safety concerns inhibit in vivo investigations of TMJ biomechanics and currently no in silico model of muscle recruitment and TMJ biomechanics during chewing exists. For this purpose, we have developed a state-of-the-art in silico model, combining rigid body bones, finite element TMJ discs and line actuator muscles. To solve the problems regarding muscle activation measurement, we used a forward dynamics tracking approach, optimizing muscle activations driven by mandibular motion. We include a total of 256 different combinations of food bolus size, stiffness and position in our study and report kinematics, muscle activation patterns and TMJ disc von Mises stress. Computed mandibular kinematics agree well with previous measurements. The computed muscle activation pattern stayed stable over all simulations, with changes to the magnitude relative to stiffness and size of the bolus. Our biomedical simulation results agree with the clinical guidelines regarding bolus modifications as smaller and softer food boluses lead to less TMJ loading. The computed mechanical stress results help to strengthen the confidence in TMD self-management recommendations of eating soft and small pieces of food to reduce TMJ pain.
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Affiliation(s)
- Benedikt Sagl
- Center for Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria.
| | - Martina Schmid-Schwap
- Division of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
| | - Eva Piehslinger
- Division of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
| | - Hai Yao
- Department of Bioengineering, Clemson University, 29634, Clemson, SC, United States; Department of Oral Health Sciences, Medical University of South Carolina, 29425, Charleston, SC, United States
| | - Xiaohui Rausch-Fan
- Center for Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, SK S7N 5C9 Saskatoon, Saskatchewan, Canada
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Besirevic-Bulic F, Schmid-Schwap M, Kundi M, Sagl B, Piehslinger E. Wear Management of Colored Foils for the Assessment of Sleep Bruxism Patterns-A Prospective, Randomized Crossover Study. Diagnostics (Basel) 2023; 13:diagnostics13020172. [PMID: 36672982 PMCID: PMC9858571 DOI: 10.3390/diagnostics13020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
The assessment of bruxism relies on clinical examinations, questionnaires, and polysomnography. The additional use of colored foils (BruxChecker®) could enable a more precise evaluation of bruxing patterns. To assess differences between use of the foils during stress periods or just on consecutive nights and to determine a reasonable duration of using the foils, 28 patients were classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and were randomly assigned to wearing the 12 foils for six consecutive nights (alternately in the upper and lower jaw; "consecutive") or six nights within one month following days of high stress ("stress") in a crossover design. The sizes of the attrition areas were measured with ImageJ. Stress was evaluated using the Perceived Stress Scale. The Stress Coping Questionnaire (SVF-120) was used for assessing habitual stress coping strategies. Areas of attrition increased significantly from day 1/2 to 5/6, both for the upper and lower jaw. Molars in the mandible had significantly larger attrition areas than in the maxilla. No significant differences were detected between "consecutive" and "stress" phases. The foils were suitable for differentiating teeth more or less affected by bruxism and were able to show that areas of attrition increased with days, indicating that some adaptation takes place and several days of wearing the foils are required to show the full picture. However, no differences between low/moderate- and high-stress phases were detected.
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Affiliation(s)
- Ferida Besirevic-Bulic
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
- Correspondence:
| | - Martina Schmid-Schwap
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Benedikt Sagl
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Eva Piehslinger
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
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Sagl B, Schmid-Schwap M, Piehslinger E, Rausch-Fan X, Stavness I. The effect of tooth cusp morphology and grinding direction on TMJ loading during bruxism. Front Physiol 2022; 13:964930. [PMID: 36187792 PMCID: PMC9521318 DOI: 10.3389/fphys.2022.964930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022] Open
Abstract
Increased mechanical loading of the temporomandibular joint (TMJ) is often connected with the onset and progression of temporomandibular joint disorders (TMD). The potential role of occlusal factors and sleep bruxism in the onset of TMD are a highly debated topic in literature, but ethical considerations limit in vivo examinations of this problem. The study aims to use an innovative in silico modeling approach to thoroughly investigate the connection between morphological parameters, bruxing direction and TMJ stress. A forward-dynamics tracking approach was used to simulate laterotrusive and mediotrusive tooth grinding for 3 tooth positions, 5 lateral inclination angles, 5 sagittal tilt angles and 3 force levels, giving a total of 450 simulations. Muscle activation patterns, TMJ disc von Mises stress as well as correlations between mean muscle activations and TMJ disc stress are reported. Computed muscle activation patterns agree well with previous literature. The results suggest that tooth inclination and grinding position, to a smaller degree, have an effect on TMJ loading. Mediotrusive bruxing computed higher loads compared to laterotrusive simulations. The strongest correlation was found for TMJ stress and mean activation of the superficial masseter. Overall, our results provide in silico evidence that TMJ disc stress is related to tooth morphology.
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Affiliation(s)
- Benedikt Sagl
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- *Correspondence: Benedikt Sagl,
| | - Martina Schmid-Schwap
- Division of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Eva Piehslinger
- Division of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Xiaohui Rausch-Fan
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
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Sagl B, Schmid-Schwap M, Piehslinger E, Kundi M, Stavness I. Effect of facet inclination and location on TMJ loading during bruxism: An in-silico study. J Adv Res 2022; 35:25-32. [PMID: 35024193 PMCID: PMC8721353 DOI: 10.1016/j.jare.2021.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/14/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Sheds new light on the important potential connection between tooth grinding and temporomandibular joint loading Demonstrates a larger effect of grinding inclination than grinding position on TMJ loading Creates a novel computer simulation of TMJ disc stress during dynamic tooth grinding tasks Uses state-of-the-art in silico methods for a highly multidisciplinary investigation, which is not feasible in vivo Presents a tracking simulation approach to work around the highly complicated recording of masticatory muscle EMG acquisition
Introduction Functional impairment of the masticatory region can have significant consequences that range from a loss of quality of life to severe health issues. Increased temporomandibular joint loading is often connected with temporomandibular disorders, but the effect of morphological factors on joint loading is a heavily discussed topic. Due to the small size and complex structure of the masticatory region in vivo investigations of these connections are difficult to perform. Objectives We propose a novel in silico approach for the investigation of the effect of wear facet inclination and position on TMJ stress. Methods We use a forward-dynamics tracking approach to simulate lateral bruxing on the canine and first molar using 6 different inclinations, resulting in a total of 12 simulated cases. By using a computational model, we control a single variable without interfering with the system. Muscle activation pattern, maximum bruxing force as well as TMJ disc stress are reported for all simulations. Results Muscle activation patterns and bruxing forces agree well with previously reported EMG findings and in vivo force measurements. The simulation results show that an increase in inclination leads to a decrease in TMJ loading. Wear facet position seems to play a smaller role with regard to bruxing force but might be more relevant for TMJ loading. Conclusion Together these results suggest a possible effect of tooth morphology on TMJ loading during bruxism.
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Affiliation(s)
- Benedikt Sagl
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Martina Schmid-Schwap
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Eva Piehslinger
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Kundi
- Institute of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, SK S7N 5C9 Saskatoon, Saskatchewan, Canada
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Sagl B, Schmid-Schwap M, Piehslinger E, Rausch-Fan X, Stavness I. An in silico investigation of the effect of bolus properties on TMJ loading during mastication. J Mech Behav Biomed Mater 2021; 124:104836. [PMID: 34544017 DOI: 10.1016/j.jmbbm.2021.104836] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
Mastication is the motor task with the highest muscle activations of the jaw region, potentially leading to high temporomandibular joint (TMJ) loading. Since increased loading of the TMJ is associated with temporomandibular disorders (TMD), TMJ mechanics during chewing has potential clinical relevance in TMD treatment. TMD self-management guidelines suggest eating soft and small pieces of food to reduce TMJ pain. Since TMJ loading cannot be measured in vivo, due to patient safety restrictions, computer modeling is an important tool for investigations of the potential connection between TMJ loading and TMD. The objective of this study is to investigate the effect of food bolus variables on mechanical TMJ loading to help inform better self-management guidelines for TMD. A combined rigid-body-finite-element model of the jaw region was used to investigate the effect of bolus size, stiffness, and position. Mandibular motion and TMJ disc von Mises stress were reported. Computed mandibular motion generally agrees well with previous literature. Disc stress was higher during the closing phase of the chewing cycle and for the non-working side disc. Smaller and softer food boluses overall lead to less TMJ loading. The results reinforce current guidelines regarding bolus modifications and provide new potential guidelines for bolus positioning that could be verified through a future clinical trial. The paper presents a first in silico investigation of dynamic chewing with detailed TMJ stress for different bolus properties. The results help to strengthen the confidence in TMD self-management recommendations, potentially reducing pain levels of patients.
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Affiliation(s)
- Benedikt Sagl
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria.
| | - Martina Schmid-Schwap
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Eva Piehslinger
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Xiaohui Rausch-Fan
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, SK S7N 5C9 Saskatoon, Saskatchewan, Canada
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Sagl B, Besirevic-Bulic F, Schmid-Schwap M, Laky B, Janjić K, Piehslinger E, Rausch-Fan X. A Novel Quantitative Method for Tooth Grinding Surface Assessment Using 3D Scanning. Diagnostics (Basel) 2021; 11:1483. [PMID: 34441417 PMCID: PMC8392501 DOI: 10.3390/diagnostics11081483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/27/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
Sleep bruxism is an oral parafunction that involves involuntary tooth grinding and clenching. Splints with a colored layer that gets removed during tooth grinding are a common tool for the initial diagnosis of sleep bruxism. Currently, such splints are either assessed qualitatively or using 2D photographs, leading to a non-neglectable error due to the 3D nature of the dentition. In this study we propose a new and fast method for the quantitative assessment of tooth grinding surfaces using 3D scanning and mesh processing. We assessed our diagnostic method by producing 18 standardized splints with 8 grinding surfaces each, giving us a total of 144 surfaces. Moreover, each splint was scanned and analyzed five times. The accuracy and repeatability of our method was assessed by computing the intraclass correlation coefficient (ICC) as well reporting means and standard deviations of surface measurements for intra- and intersplint measurements. An ICC of 0.998 was computed as well as a maximum standard deviation of 0.63 mm2 for repeated measures, suggesting an appropriate accuracy of our proposed method. Overall, this study proposes an innovative, fast and cost effective method to support the initial diagnosis of sleep bruxism.
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Affiliation(s)
- Benedikt Sagl
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (B.L.); (K.J.); (X.R.-F.)
| | - Ferida Besirevic-Bulic
- Division of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (F.B.-B.); (M.S.-S.); (E.P.)
| | - Martina Schmid-Schwap
- Division of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (F.B.-B.); (M.S.-S.); (E.P.)
| | - Brenda Laky
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (B.L.); (K.J.); (X.R.-F.)
| | - Klara Janjić
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (B.L.); (K.J.); (X.R.-F.)
| | - Eva Piehslinger
- Division of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (F.B.-B.); (M.S.-S.); (E.P.)
| | - Xiaohui Rausch-Fan
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (B.L.); (K.J.); (X.R.-F.)
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Eder J, Szomolanyi P, Schmid-Schwap M, Bristela M, Skolka A, Pittschieler E, Piehslinger E, Trattnig S. Early diagnosis of degenerative changes in the articular/fibrocartilaginous disc of the temporomandibular joint in patients with temporomandibular disorders using delayed gadolinium-enhanced MRI at 3 Tesla - preliminary results. Magn Reson Imaging 2019; 67:24-27. [PMID: 31843417 DOI: 10.1016/j.mri.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) is a quantitative method for assessment of glycosaminoglycan content in connective tissues. We hypothesize that the early diagnosis of degenerative changes in the temporomandibular joint could be diagnosed using dGEMRIC technique. PURPOSE To test the compositional MRI technique, dGEMRIC, at 3 Tesla to diagnosis early the degenerative changes in the fibrocartilaginous disc of the temporomandibular joint (TMJ) in patients with temporomandibular disorders (TMD) and to compare the dGEMRIC index of patients to the healthy volunteers. METHODS Six volunteers (two men, four women; 20.8÷28.1 years) and eleven patients (22 TMJs, seven women, four men; 24÷54 years) were recruited for this prospective trial. Only patients with no morphological abnormality on MRI and without disc dislocations were included. Volunteers were used as a control group. The PD-weighted FSE sequence and the 3D GRE (DESS) sequence protocols were performed for morphological assessment. The Inversion recovery (IR) sequence was performed for T1 relaxation time measurements and intra-venous (IV) contrast agent administration was used according to the dGEMRIC protocol. T1 maps were calculated offline and ROIs were drawn on TMJ discs by a specialist trained in TMD disorders. Statistical evaluation was performed by ANOVA and correlations were calculated. RESULTS The difference between the dGEMRIC values in the TMJ articular discs of the patients and the volunteers was statistically significant (P = .019). After contrast agent administration the T1 values dropped in both groups. In patient group was the T1 drop stronger (-54% from initial pre-contrast value), while in control group was the T1 drop less pronounced (-46% from initial pre-contrast value). CONCLUSIONS dGEMRIC seems to be a useful, compositional, quantitative method, suitable also for small joints, such as the articular disc of the TMJ. The results of the dGEMRIC index in the articular disc of the TMJ imply a lower GAG content in patients with TMJ disorders.
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Affiliation(s)
- Jaryna Eder
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria.
| | - Pavol Szomolanyi
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Dubravska cesta 9, 84219 Bratislava, Slovakia
| | - Martina Schmid-Schwap
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Margit Bristela
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Astrid Skolka
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Elisabeth Pittschieler
- Private practice for orthodontics and craniomandibular disorders, Reichsratsstraße 5/4a1010, Vienna, Austria
| | - Eva Piehslinger
- Division of Prosthodontics, University Clinic of Dentistry Vienna, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Siegfried Trattnig
- High-Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; CD Laboratory for Molecular Clinical MR Imaging, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Sagl B, Schmid-Schwap M, Piehslinger E, Kundi M, Stavness I. A Dynamic Jaw Model With a Finite-Element Temporomandibular Joint. Front Physiol 2019; 10:1156. [PMID: 31607939 PMCID: PMC6757193 DOI: 10.3389/fphys.2019.01156] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/28/2019] [Indexed: 12/22/2022] Open
Abstract
The masticatory region is an important human motion system that is essential for basic human tasks like mastication, speech or swallowing. An association between temporomandibular disorders (TMDs) and high temporomandibular joint (TMJ) stress has been suggested, but in vivo joint force measurements are not feasible to directly test this assumption. Consequently, biomechanical computer simulation remains as one of a few means to investigate this complex system. To thoroughly examine orofacial biomechanics, we developed a novel, dynamic computer model of the masticatory system. The model combines a muscle driven rigid body model of the jaw region with a detailed finite element model (FEM) disk and elastic foundation (EF) articular cartilage. The model is validated using high-resolution MRI data for protrusion and opening that were collected from the same volunteer. Joint stresses for a clenching task as well as protrusive and opening movements are computed. Simulations resulted in mandibular positions as well as disk positions and shapes that agree well with the MRI data. The model computes reasonable disk stress patterns for dynamic tasks. Moreover, to the best of our knowledge this model presents the first ever contact model using a combination of EF layers and a FEM body, which results in a clear decrease in computation time. In conclusion, the presented model is a valuable tool for the investigation of the human TMJ and can potentially help in the future to increase the understanding of the masticatory system and the relationship between TMD and joint stress and to highlight potential therapeutic approaches for the restoration of orofacial function.
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Affiliation(s)
- Benedikt Sagl
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Martina Schmid-Schwap
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Eva Piehslinger
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Michael Kundi
- Institute of Environmental Health, Medical University of Vienna, Vienna, Austria
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
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Lilaj B, Dauti R, Agis H, Schmid-Schwap M, Franz A, Kanz F, Moritz A, Schedle A, Cvikl B. Comparison of Bleaching Products With Up to 6% and With More Than 6% Hydrogen Peroxide: Whitening Efficacy Using BI and WI D and Side Effects - An in vitro Study. Front Physiol 2019; 10:919. [PMID: 31543822 PMCID: PMC6728628 DOI: 10.3389/fphys.2019.00919] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/05/2019] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to evaluate the effect of bleaching agents containing different concentrations of hydrogen peroxide (HP) on color-change and on enamel-surface in bovine teeth. Furthermore the influence on cell viability and proliferation was investigated. Two hundred and forty teeth were randomly assigned into four groups (home bleaching ≤6%, in-office bleaching ≤6%, in-office bleaching > 6% HP, and control group). Bleaching was performed after artificial staining and the bleached index (BI) as well as the whiteness index (WID) was measured at several time points. Chemical analysis for HP concentrations and the pH of the bleaching products was done. Furthermore, enamel surfaces of randomly selected specimens were analyzed using scanning electron microscopy (SEM) and cytotoxicity of the tested bleaching products was evaluated in vitro using dental pulp cells (DPCs) and L929 cells. A statistically significant whitening effect was observed in almost all products. As expected all investigated products resulted in decreased cell viability, however, with different values of LC50 (median lethal concentration). SEM analysis showed an analog of enamel alterations with decreasing pH, increasing exposure time, and increasing HP concentration. Bleaching agents containing a low HP concentration are considered to be effective and to have less damaging effects on enamel and tested cells.
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Affiliation(s)
- Bledar Lilaj
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Rinet Dauti
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Hermann Agis
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Martina Schmid-Schwap
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Alexander Franz
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Fabian Kanz
- Center for Forensic Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Moritz
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Schedle
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Barbara Cvikl
- Department of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Department of Conservative Dentistry, Sigmund Freud University, Vienna, Austria
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Bristela M, Skolka A, Eder J, Szomolanyi P, Weber M, Piehslinger E, Schmid-Schwap M, Trattnig S. T2 mapping with 3.0 T MRI of the temporomandibular joint disc of patients with disc dislocation. Magn Reson Imaging 2019; 58:125-134. [DOI: 10.1016/j.mri.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/11/2018] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
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Sagl B, Schmid-Schwap M, Piehslinger E, Kronnerwetter C, Kundi M, Trattnig S, Stavness I. In vivo prediction of temporomandibular joint disc thickness and position changes for different jaw positions. J Anat 2019; 234:718-727. [PMID: 30786005 DOI: 10.1111/joa.12951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 12/31/2022] Open
Abstract
Temporomandibular joint disorders (TMD) are common dysfunctions of the masticatory region and are often linked to dislocation or changes of the temporomandibular joint (TMJ) disc. Magnetic resonance imaging (MRI) is the gold standard for TMJ imaging but standard clinical sequences do not deliver a sufficient resolution and contrast for the creation of detailed meshes of the TMJ disc. Additionally, bony structures cannot be captured appropriately using standard MRI sequences due to their low signal intensity. The objective of this study was to enable researchers to create high resolution representations of all structures of the TMJ and consequently investigate morphological as well as positional changes of the masticatory system. To create meshes of the bony structures, a single computed tomography (CT) scan was acquired. In addition, a high-resolution MRI sequence was produced, which is used to collect the thickness and position change of the disc for various static postures using bite blocks. Changes in thickness of the TMJ disc as well as disc translation were measured. The newly developed workflow successfully allows researchers to create high resolution models of all structures of the TMJ for various static positions, enabling the investigation of TMJ disc translation and deformation. Discs were thinnest in the lateral part and moved mainly anteriorly and slightly medially. The procedure offers the most comprehensive picture of disc positioning and thickness changes reported to date. The presented data can be used for the development of a biomechanical computer model of TMJ anatomy and to investigate dynamic and static loads on the components of the system, which could be useful for the prediction of TMD onset.
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Affiliation(s)
- Benedikt Sagl
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Martina Schmid-Schwap
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Eva Piehslinger
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Claudia Kronnerwetter
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
| | - Michael Kundi
- Institute of Environmental Health, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria.,CD Laboratory for Clinical Molecular MR Imaging, Medical University of Vienna, Vienna, Austria
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
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Eder J, Tonar Z, Schmid-Schwap M, Bristela M, Skolka A, Traxler H, Piehslinger E, Egerbacher M, Trattnig S, Witter K. Regional Collagen Fiber Network in the Articular Disc of the Human Temporomandibular Joint: Biochemical 3-Tesla Quantitative Magnetic Resonance Imaging Compared to Quantitative Histologic Analysis of Fiber Arrangement. J Oral Facial Pain Headache 2018; 32:266-276. [DOI: 10.11607/ofph.1879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Bristela M, Schmid-Schwap M, Eder J, Reichenberg G, Kundi M, Piehslinger E, Robinson S. Magnetic resonance imaging of temporomandibular joint with anterior disk dislocation without reposition - long-term results. Clin Oral Investig 2016; 21:237-245. [PMID: 27083157 PMCID: PMC5203833 DOI: 10.1007/s00784-016-1800-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/01/2016] [Indexed: 11/23/2022]
Abstract
Objectives Anterior disk dislocation (ADD) without reposition in the temporomandibular joint (TMJ) may be associated with morphological changes in the retrodiscal region of the bilaminar zone presenting as pseudo-disk (PD). The present study was initiated to investigate the development of retrodiscal fibrosis in a period of 4–8 years and to assess if patients with a PD show differences in the clinical and radiologic findings versus patients without a PD. Materials and Methods In a retrospective follow-up study of 33 consecutive patients with ADD without reposition in one or both TMJs, a clinical and MRI-supported evaluation was conducted 4 to 8 years after baseline diagnosis. Results In 45 % of the TMJs with ADD without reposition, a PD could be identified. Twenty-one of 31 patients who showed pain at the baseline examination (VAS mean 56 ± 38) were pain free. The mouth opening capacity (MO) of the mandible could be increased in 80 %. There were no statistical significant differences between patients with or without PD in these clinical features. The MRI parameters effusion and translation showed a statistical tendency for more improvement in the group with PD (p = 0.061, 0.064). Conclusion In about half of the patients, a structure corresponding to a pseudo-disk developed during follow-up. Pain and the mouth opening capacity improved in all patients independent of the development of a PD. Clinical Relevance Detection of a PD during follow-up of patients with ADD without spontaneous reposition does neither predict favorable nor worse therapy response and clinical course.
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Affiliation(s)
- M Bristela
- Department of Fixed and Removable Prosthodontics, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria.
| | - M Schmid-Schwap
- Department of Fixed and Removable Prosthodontics, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
| | - J Eder
- Department of Fixed and Removable Prosthodontics, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
| | | | - M Kundi
- Institute of Environmental Health, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Wien, Austria
| | - E Piehslinger
- Department of Fixed and Removable Prosthodontics, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
| | - S Robinson
- Diagnostic Center Urania, Laurenzerberg 2, 1010, Vienna, Austria
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Abstract
This retrospective series was intended to determine whether morphological disk findings in open and closed mouth magnetic resonance imaging (MRI) may be correlated with the time curves in axiography. In this series, 45 temporomandibular joints of 33 patients were subjected to a retrospective evaluation. Magnetic resonance images obtained with closed and open mouth and joint movements assessed by electronic axiography were analyzed. Disk morphology in MRI was classified as normal, partly flattened, partly thickened, or completely thickened. For the axiographic tracings, time curves of the free movements of the respective joint were developed and evaluated. Data obtained were analyzed for any potential correlation using scatter plots and discriminance analysis. No correlation between these data was found suggesting that the axiographic time curves do not provide for any conclusions with regard to disk morphology. Apart from patient history and a thorough clinical evaluation, recording of jaw movements, but also using MRI continues to be of particular value in the diagnostic assessment of anterior disk displacement.
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Schmid-Schwap M, Bristela M, Pittschieler E, Skolka A, Szomolanyi P, Weber M, Piehslinger E, Trattnig S. Biochemical analysis of the articular disc of the temporomandibular joint with magnetic resonance T2 mapping: a feasibility study. Clin Oral Investig 2013; 18:1865-71. [PMID: 24306680 DOI: 10.1007/s00784-013-1154-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Symptoms of temporomandibular joint (TMJ) dysfunction can seriously compromise patients' quality of life. The aim of our study was to use magnetic resonance imaging (MRI) T2 mapping of the articular disc to determine whether T2 mapping of the TMJ disc is feasible in routine clinical imaging and to assess the normal T2 relaxation time distribution within the TMJ. METHODS Included were ten asymptomatic volunteers without pain, any mouth-opening limitations, or any clicking phenomena. MR imaging was performed on a 3-T MR scanner using a flexible, dedicated, eight-channel multielement coil. T2 mapping was performed in the oblique sagittal plane. The regions of interest (ROIs) for the T2 relaxation time maps of the disc were selected manually. RESULTS The mean values for ROIs ranged between 22.4 and 28.8 ms, and the mean for all ROIs was 26.0 ± 5.0 ms. Intraclass correlation (ICC) for interobserver variability was 0.698, and ICC for intraobserver variability was 0.861. There was no statistically significant difference between raters (p = 0.091) or sides (p = 0.810). CONCLUSION The T2 mapping technique enables ultrastructural analysis of the composition of TMJ disc. This biochemical technique is feasible in vivo, as shown in our study, when a high-field (3 T) MR and a dedicated TMJ coil are used. CLINICAL RELEVANCE T2 mapping as a biochemical technique, together with morphological MRI, may help to gain more insights into the physiology and into the pathophysiology of the articular disc in the TMJ noninvasively and in vivo.
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Affiliation(s)
- Martina Schmid-Schwap
- Department of Prosthodontics, Bernhard Gottlieb University of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria,
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Schmid-Schwap M, Bristela M, Kundi M, Piehslinger E. Sex-specific differences in patients with temporomandibular disorders. ACTA ACUST UNITED AC 2013; 27:42-50. [PMID: 23424719 DOI: 10.11607/jop.970] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To explore potential differences in characteristics of patients that might account for sex-specific differences in temporomandibular disorders (TMD). METHODS A total of 502 patients presenting with TMD during 2000 to 2002 at the Outpatient Unit for Functional Disorders of the Medical University of Vienna underwent detailed evaluation of their medical history and assessment of clinical findings. The data obtained were assessed for sex-specific differences by analysis of variance and multiple regression. RESULTS Overall, 404 females (mean age ± SD: 40 ± 16 years; range 12 to 96 years) and 98 males (mean age 41 ± 16 years; range 16 to 78 years) were included. Their rating of their pain on a visual analog scale (VAS) showed a significantly higher pain intensity for females than for males (P = .004). Clinical assessment showed a significantly lower degree of mouth opening for females than for males (P < .001). While no sex-specific differences were noted for clicking phenomena of the temporomandibular joint (TMJ) and for the bite class of the patients, bite anomalies were significantly more frequent in male patients (P = .03). Palpation of masticatory muscles and the TMJ revealed significantly higher tenderness on palpation in female as compared to male patients (P = .001). Grouping by clicking, crepitation, and bruxism also showed greater pain (VAS) and more tenderness on palpation in females versus males. Females also showed peaks of prevalence of TMD in the age group below 25 years and in the group 55 to 60 years, whereas males had a more even age distribution. No external factors, such as exposure to stress, were found that moderated the sex difference. CONCLUSION Female TMD patients showed greater pain and muscle tenderness on palpation as compared to male TMD patients. They also showed a different age distribution of prevalence of TMD. These results were independent of subjective symptoms, clinical findings, and external factors.
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Affiliation(s)
- Martina Schmid-Schwap
- Department of Prosthodontics, Bernhard-Gottlieb University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.
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Bristela M, Skolka A, Schmid-Schwap M, Piehslinger E, Indra A, Wewalka G, Stauffer F. Testing for aerobic heterotrophic bacteria allows no prediction of contamination with potentially pathogenic bacteria in the output water of dental chair units. GMS Krankenhhyg Interdiszip 2012; 7:Doc12. [PMID: 22558046 PMCID: PMC3334951 DOI: 10.3205/dgkh000196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Currently, to our knowledge, quality of output water of dental chair units is not covered by specific regulations in the European Union, and national recommendations are heterogeneous. In Germany, water used in dental chair units must follow drinking water quality. In the United States of America, testing for aerobic heterotrophic bacteria is recommended. The present study was performed to evaluate whether the counts of aerobic heterotrophic bacteria correlate with the presence of potentially pathogenic bacteria such as Legionella spp. or Pseudomonas aeruginosa. Methods: 71 samples were collected from 26 dental chair units with integrated disinfection device and 31 samples from 15 outlets of the water distribution pipework within the department were examined. Samples were tested for aerobic heterotrophic bacteria at 35°C and 22°C using different culture media and for Legionella spp. and for Pseudomonas aeruginosa. Additionally, strains of Legionella pneumophila serogroup 1 were typed with monoclonal antibodies and representative samples of Legionella pneumophila serogroup 1 were typed by sequence based typing. Results: Our results showed a correlation between different agars for aerobic heterotrophic bacteria but no correlation for the count of aerobic heterotrophic bacteria and the presence of Legionella spp. or Pseudomonas aeruginosa. Conclusion: Testing for aerobic heterotrophic bacteria in output water or water distribution pipework within the departments alone is without any value for predicting whether the water is contaminated with potentially pathogenic bacteria like Legionella spp. or Pseudomonas aeruginosa.
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Affiliation(s)
- Margit Bristela
- Bernhard Gottlieb University Clinic of Dentistry, Department of Fixed and Removable Prosthodontics, Medical University Vienna, Austria
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Schmid-Schwap M, Rousson V, Vornwagner K, Heintze SD. Wear of two artificial tooth materials in vivo: A 12-month pilot study. J Prosthet Dent 2009; 102:104-14. [DOI: 10.1016/s0022-3913(09)60118-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schmid-Schwap M, Franz A, König F, Bristela M, Lucas T, Piehslinger E, Watts DC, Schedle A. Cytotoxicity of four categories of dental cements. Dent Mater 2009; 25:360-8. [DOI: 10.1016/j.dental.2008.08.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 07/15/2008] [Accepted: 08/13/2008] [Indexed: 11/16/2022]
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Schmid-Schwap M, Drahanowsky W, Bristela M, Kundi M, Piehslinger E, Robinson S. Diagnosis of temporomandibular dysfunction syndrome—image quality at 1.5 and 3.0 Tesla magnetic resonance imaging. Eur Radiol 2009; 19:1239-45. [DOI: 10.1007/s00330-008-1264-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 10/31/2008] [Accepted: 11/12/2008] [Indexed: 10/21/2022]
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Schmid-Schwap M, Franz A, Krainhöfner M, König F, Krennmair G, Schedle A. Cytotoxic effects of veneer composite materials. INT J PROSTHODONT 2007; 20:596-598. [PMID: 18069367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The aim of this study was to evaluate 4 veneer composites-Signum+EM, Gradia Enamel E3, Sinfony E3, and SR Adoro S1-in a standardized test at 2 different conditions. For each composite, 2 groups of specimens (added to cultures immediately after preparation [ie, fresh] or after 7 days of incubation in cell culture medium) were added to L-929 fibroblast cultures for 72 hours. All composites showed reduced cell numbers compared to glass controls. Fresh specimens of Signum+EM exhibited the least cytotoxicity, followed by Gradia Enamel E3 and Sinfony E3 and then SR Adoro S1. For specimens with 7-day incubation, 3 of the composites (Signum+EM, Sinfony E3, and Gradia Enamel E3) showed similarly low cytotoxicity, while cytotoxic results with SR Adoro S1 were significantly higher. With low in vitro toxicity values in conjunction with good mechanical properties, veneer composites appear to offer an interesting alternative for prosthetic rehabilitation.
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Affiliation(s)
- Martina Schmid-Schwap
- Bernhard Gottlieb University Clinic of Dentistry, Department of Prosthodontics, Medical University of Vienna, Austria
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Krennmair G, Krainhöfner M, Schmid-Schwap M, Piehslinger E. Maxillary sinus lift for single implant-supported restorations: a clinical study. Int J Oral Maxillofac Implants 2007; 22:351-8. [PMID: 17622000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate single-tooth implant-supported restorations placed in conjunction with several methods of maxillary sinus augmentation. MATERIALS AND METHODS A retrospective review was conducted of all consecutively treated patients who received single-implant tooth rehabilitation in combination with sinus augmentation. Implant survival rate and peri-implant conditions, such as marginal bone resorption (mm), pocket depth (mm), Plaque and Bleeding Indices, and Periotest values, were compared for the different augmentation procedures. RESULTS Fifty-one patients were treated with 54 screw-type single implant-supported restorations in the posterior maxilla in combination with isolated sinus floor augmentation. Depending on the residual ridge height and the intended augmentation height, sinus lift elevation was performed either in a 1-stage lateral approach (25 patients, 28 implants), in a 2-stage lateral approach (12 patients, 12 implants), or with the osteotome technique (14 patients, 14 implants). The predominant use of long implants provided for a favorable implant-crown ratio (> 1.0) and produced an overall clinical survival rate of 100% over the observation period (44.5 +/- 22.7 months), with no differences between the augmentation procedures and implant types used. The most frequent site for single-tooth replacement in combination with sinus floor augmentation was the first molar region (61%). Implants with wider diameters (94% 2 4.3 mm) were used in this region. The most frequent intraoperative complication was tearing of the sinus membrane (58%) as a result of the restricted access for the lateral 1- or 2-stage approach, and the most frequent prosthetic complication was crown loosening. CONCLUSION On the basis of this retrospective review, the following was observed: (1) Successful function and excellent peri-implant parameters may be anticipated for single implant-supported restorations placed in conjunction with sinus elevation procedures. (2) Clinical and radiographic examinations demonstrated similar conditions for single-tooth restorations despite the use of different surgical approaches to sinus augmentation. (More than 50 references).
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Affiliation(s)
- Gerald Krennmair
- University Professor and Clinical Lecturer, Dental School, University of Vienna, Austria.
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Schmid-Schwap M, Simma-Kletschka I, Stockner A, Sengstbratl M, Gleditsch J, Kundi M, Piehslinger E. Oral acupuncture in the therapy of craniomandibular dysfunction syndrome -- a randomized controlled trial. Wien Klin Wochenschr 2006; 118:36-42. [PMID: 16489524 DOI: 10.1007/s00508-005-0501-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 12/19/2005] [Indexed: 11/25/2022]
Abstract
CONTEXT Patients with disorders of the stomatognathic system describe pain and clicking phenomena as primary symptoms. Rapid improvement of the pain is required to ensure and maintain adequate patient compliance. OBJECTIVE The study was intended to assess the effects of acupuncture in patients with temporomandibular disorders as compared to placebo therapy (sham laser); the primary target parameter was the subjective pain sensation. DESIGN Randomized, placebo-controlled trial. PATIENTS AND METHODS 23 patients were enrolled and randomly assigned to one of the two groups. One group received acupuncture treatment according to the very-point technique, the other group received sham laser treatment. The following observer-blinded findings were evaluated before and after treatment: subjective pain, mouth opening, and muscular tenderness and pain on pressure. In addition, mandibular joint movement pathways were recorded using electronic axiography. OUTCOMES Improvements in pain scores (scale, 0-100) in the acupuncture group (19.1 +/- 11.9) were significant (p = 0.03) versus those in the placebo group (6.2 +/- 14.8). Mouth opening showed an insignificant trend towards improvement (p > 0.1) in the acupuncture (5.0 +/- 6.2 mm) versus the placebo group (1.0 +/- 4.7 mm), differences in tenderness and pain on pressure in neck and masticatory muscles were significant (p < 0,05) for most of the muscles having shown pretreatment tenderness or pain. The axiographic tracings were assessed for quality, symmetry and curve characteristics. Recordings of the opening and closing movement in the acupuncture group showed an increased frequency of improvements of curve characteristics as compared to the placebo group. The acupuncture group also showed an increased frequency of improvement in protrusion and retrusion movements, though no statistical significance could be obtained. CONCLUSION On the basis of the results of the present study, acupuncture may be recommended as acute treatment of craniomandibular disorders, but studies with larger numbers of patients as well as about long-term treatment outcomes should be conducted.
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Affiliation(s)
- Martina Schmid-Schwap
- Department of Fixed and Removable Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.
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Gsellmann B, Schmid-Schwap M, Piehslinger E, Slavicek R. Lengths of condylar pathways measured with computerized axiography (CADIAX) and occlusal index in patients and volunteers. J Oral Rehabil 1998; 25:146-52. [PMID: 9576600 DOI: 10.1046/j.1365-2842.1998.00198.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The lengths of the condylar pathways during protrusive and opening movements were investigated with computerized axiography in 100 individuals. Forty-two patients suffering from anterior disk displacement with reduction (ADD) in one or both temporomandibular joints (TMJ) and 28 patients with anterior overrotation clicking (AOC) of the TMJ were compared with 30 asymptomatic volunteers. Patients suffering from ADD showed significantly shorter tracings than did the two other groups. A significant difference of length of TMJ movement between men and women was found only in one group. The occlusal indices (OI) of the three groups were assessed and compared with each other. Here, a significant difference was found between volunteers and patients suffering ADD and between volunteers and patients with AOC. Between men and women a significant difference of the OI was found in the group with AOC, women presenting higher scores than men. Except for the group of patients with ADD, who showed shorter average lengths, volunteers as well as patients with AOC, were within the normal limits given in the literature for TMJ movement lengths recorded with axiography. The results of this examination therefore indicate that when considering movement length alone no discrimination between healthy and diseased TMJ can be made.
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Affiliation(s)
- B Gsellmann
- Department of Prosthodontics, Dental School, University of Vienna, Austria
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