@phdthesis{Held2024, author = {Held, Helena}, title = {The effectiveness of non-occlusal therapies in relation to the chronicity of temporomandibular disorders: a systematic review with meta-analysis}, doi = {10.25972/OPUS-34799}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-347990}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Background: That a differentiated treatment of subjects with low and high levels of disabling pain might be necessarily has only been suspected but not sufficiently confirmed so far. Furthermore, the effectiveness of extraoral therapy methods for TMD is still controversial in the literature. The present work could make an important contribution to this. Objectives: Five systematic reviews with meta-analysis were conducted to investigate the efficacy of extraoral therapies (acupuncture, laser, medication, psychosocial interventions, and physiotherapy) in the treatment of TMD in relation to the degree of chronicity of pain. Literature sources: With this objective, the databases Pubmed/MEDLINE, EMBASE, Cochrane Library, Livivo, OpenGrey, drks.de, Clinicaltrials.gov. were searched. Criteria for the selection of suitable studies: Adults suffering from painful TMD and treated with either acupuncture, laser, medication, psychosocial interventions, or physiotherapy. The studies were then examined for evidence in the subjects' characteristics suggesting that they were suffering from chronic TMD in terms of pain dysfunction. These included a high score on the GCPS, resistance to undergone treatments, multilocular pain, depression, and regular use of pain medication. The effectiveness of the five interventions was then differentiated according to the suspected degree of chronicity. Effectiveness was assessed by the following outcomes: patient- related current pain intensity, MMO, pain on palpation, temporomandibular joint sounds, depression, and somatization. Study evaluation: After the assessment of the studies, the quality assessment (Risk of Bias Tool of the Cochrane Institute) and the extraction of the data were conducted. After that five meta-analyses were carried out for each of the five interventions using the Review Manager of the Cochrane Institute (RevMan 5.3) Results: Acupuncture and dry needling were statistically significantly more effective in providing short-term pain relief compared to the control group in patients with low disability pain (p=0.04) and (p=0.02), respectively. Acupuncture or dry needling did not show a significant result in the improvement of MMO in the short-term period. Laser therapy is more effective in relieving pain (p<0.0001) and functional outcomes (p=0.03) in the short term compared to placebo for low disability pain. Botulinum toxin (p=0.003) and NSAIDs (p=0.03) showed significantly better short-term improvement in pain intensity for high disability pain. Low disability pain is significantly better treated by psychosocial interventions than by other treatments in terms of long-term pain relief (more than 12 months) (p=0.02). Patients with high disability pain had significantly lower depression scores after psychosocial interventions than after other treatments (p=0.008). Physiotherapy showed a statistically significant short-term analgesic effect in patients with high disability pain compared to placebo (p=0.04). Manual Therapy (MT) showed a statistically significant short-term analgesic effect in high disability pain compared to the control group (p=0.01). Patients with low disability pain showed a statistically significant short-term pain-relieving effect with the single intervention of MT in combination with exercise compared to the control groups (p=0.003). A statistically significant result in the improvement of MMO was found in the short-term period in low disability pain for the single interventions of physiotherapy (p=0.008) and physiotherapy in combination with another treatment compared to other treatments (p=0.03), MT compared to the control group (p=0.03) and physiotherapy compared to splint therapy (p=0.03). Clinical conclusion: Individual interventions of the five extraoral therapies confirm the hypothesis that painful TMDs respond differently to established therapies depending on the degree of chronic pain-related disability and that the prognosis of therapy is significantly influenced by the degree of chronic pain- related disability of the condition, according to the GCPS. Registration number of the review at PROSPERO: CRD42020202558 Keywords: meta-analysis, systematic review, temporomandibular disorders, extra oral therapy, acupuncture, laser, medication, psychosocial interventions, physiotherapy, low disability, high disability, pain, chronification}, subject = {Metaanalyse}, language = {en} } @article{KunzStellzigEisenhauerBoldt2023, author = {Kunz, Felix and Stellzig-Eisenhauer, Angelika and Boldt, Julian}, title = {Applications of artificial intelligence in orthodontics — an overview and perspective based on the current state of the art}, series = {Applied Sciences}, volume = {13}, journal = {Applied Sciences}, number = {6}, issn = {2076-3417}, doi = {10.3390/app13063850}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-310940}, year = {2023}, abstract = {Artificial intelligence (AI) has already arrived in many areas of our lives and, because of the increasing availability of computing power, can now be used for complex tasks in medicine and dentistry. This is reflected by an exponential increase in scientific publications aiming to integrate AI into everyday clinical routines. Applications of AI in orthodontics are already manifold and range from the identification of anatomical/pathological structures or reference points in imaging to the support of complex decision-making in orthodontic treatment planning. The aim of this article is to give the reader an overview of the current state of the art regarding applications of AI in orthodontics and to provide a perspective for the use of such AI solutions in clinical routine. For this purpose, we present various use cases for AI in orthodontics, for which research is already available. Considering the current scientific progress, it is not unreasonable to assume that AI will become an integral part of orthodontic diagnostics and treatment planning in the near future. Although AI will equally likely not be able to replace the knowledge and experience of human experts in the not-too-distant future, it probably will be able to support practitioners, thus serving as a quality-assuring component in orthodontic patient care.}, language = {en} } @phdthesis{Obid2023, author = {Obid, Nada}, title = {EMG activity of masticatory muscles of patients with different bruxism grades during tasks with submaximal controlled force}, doi = {10.25972/OPUS-34588}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-345883}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {The main objective of this study was to test whether subjects with different degrees of bruxism differ regarding EMG parameters and whether CES intervention affects those parameters. The hypothesis was that CES influences EMG parameters and after its' cessation, all EMG parameters return to baseline (exposure-response relationship). For this purpose, forty subjects were examined, 16 men and 24 women, matched for age and gender and assigned randomly in the intervention (N=20) and control group (N=20). The procedure was as follows: 1-week inactive GC (N=40), 2 weeks inactive/active GC (N=20/N=20), 2 weeks inactive GC (N=40). Each interval was followed by a surface EMG recording from eight muscle parts (right and left anterior -, medial -, and posterior masseter and right and left anterior temporalis) under force-controlled feedback (BiteFork®) with three submaximal bite forces. The resulting EMG activity is expressed as RMS \% MVC and RMS at MVC. The statistics is performed with t-test, one-way rmANOVA, and Friedman rmANOVA on ranks, according to the distribution of the data. The significance level was set at p≤0.05. The results generated from the within-groups and between-groups comparison were mostly not statistically significant and could therefore not offer clinically relevant conclu-sions. However, it cannot be excluded that a higher submaximal bite force and an extended intervention interval would have rendered different outcomes. The insufficient study sample resulted in a low observed power which makes the findings prone to Type II er-ror. It can be concluded that this study did not find any substantiating differences be-tween the EMG values of participants with various bruxism activity and that CES could not influence the studied EMG parameters in the two weeks intervention time. Our hypothesis which supposes that subjects with high and low bruxism activity differ in RMS \% MVC could not be verified. However, with the gained knowledge, it is recom-mended to further elaborate a definite bruxism diagnosis by using portable EMG devices.}, subject = {Bruxismus}, language = {en} } @article{SchneiderHoehneSchneideretal.2022, author = {Schneider, Sonja Jasmin Maria and H{\"o}hne, Christian and Schneider, Martin and Schmitter, Marc}, title = {Photoacoustic tomography versus cone-beam computed tomography versus micro-computed tomography: Accuracy of 3D reconstructions of human teeth}, series = {PloS One}, volume = {17}, journal = {PloS One}, number = {12}, doi = {10.1371/journal.pone.0274818}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-301437}, year = {2022}, abstract = {Objectives In this in-vitro study, teeth were imaged using photoacoustic tomography (PAT), cone-beam computed tomography (CBCT), and micro-computed tomography (μ-CT). The study had aim: to identify the best wavelength for PAT images to determine the accuracy of the three imaging methods, and to determine whether PAT images of teeth can achieve acceptable reconstruction quality. Methods Nineteen human mandibular single-rooted incisors were extracted from patients with trauma or periodontitis. To determine the best wavelength for acquiring photoacoustic images, all 19 teeth were scanned in vitro with PAT, using different laser wavelengths between 680 and 960 nm. The images were analyzed using image analysis software. To assess the accuracy of PAT and compare it with the accuracy of CBCT, each tooth was also scanned in vitro using CBCT and the reference standard technique of μ-CT. Subsequently, three different three-dimensional models, one for each imaging technique, were created for each tooth. Finally, the three different three-dimensional models acquired for the same tooth were matched and analyzed regarding volume and surface. Results The highest quality tooth images were achieved using the 680 nm wavelength, which showed the best contrast ratio. The full geometry of the dental root (μ-CT compared with PAT) could be visualized with relative standard deviations of 0.12 mm for the surface and -7.33 mm3 for the volume (n = 19). The full geometry of the dental root (μ-CT compared with CBCT) could be visualized with relative standard deviations of 0.06 mm for the surface and -14.56 mm3 for the volume (n = 19). The difference between the PAT-μ-CT group and CBCT-μ-CT group regarding the total average of the root surface area was not significant (p>0.06). Conclusion Images, which were acquired using PAT at 680nm showed the best contrast ration, enabling the identification of dentin, cementum and the dental pulp. No significant differences were found between the PAT-μ-CT group and CBCT-μ-CT group regarding the total average of the RSA and the total volume. Thus, three-dimensional reconstructions based on in-vitro PAT are already of acceptable reconstruction quality.}, language = {en} } @article{FadilliogluKanusMoehleretal.2022, author = {Fadillioglu, Cagla and Kanus, Lisa and M{\"o}hler, Felix and Ringhof, Steffen and Schindler, Hans J. and Stein, Thorsten and Hellmann, Daniel}, title = {Influence of controlled masticatory muscle activity on dynamic reactive balance}, series = {Journal of Oral Rehabilitation}, volume = {49}, journal = {Journal of Oral Rehabilitation}, number = {3}, doi = {10.1111/joor.13284}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-262436}, pages = {327 -- 336}, year = {2022}, abstract = {Background The influence of the stomatognatic system on human posture control has been investigated under static conditions, but the effects on dynamic balance have not yet been considered. Objective Investigating the influence of different functional stomatognatic activities (jaw clenching (JAW), tongue pressing (TON) and habitual jaw position (HAB)) on postural performance during a dynamic reactive balance task. Methods Forty-eight physically active and healthy adults were assigned to three groups differing in oral-motor tasks (JAW, TON or HAB). Dynamic reactive balance was assessed by an oscillating platform which was externally perturbed in four directions. Performance was quantified by means of Lehr's damping ratio. Mean speeds of the selected anatomical regions (head, trunk, pelvis, knee and foot) were analysed to determine significant performance differences. Results The groups differed significantly in balance performance in direction F (i.e., forwards acceleration of the platform). Post hoc tests revealed that the JAW group had significantly better performance compared with both the HAB and TON groups. Better performance was associated with a decreased mean speed of the analysed anatomical regions. Conclusion JAW can improve dynamic reactive balance but the occurrence of positive effects seems to be task-specific and not general. TON seems not to have any observable effects on dynamic reactive balance performance, at least when evaluating it with an oscillating platform. JAW might be a valuable strategy which could possibly reduce the risk of falls in elderly people; however, further investigations are still needed.}, language = {en} } @article{LinzFaberSchmidetal.2022, author = {Linz, Christian and Faber, Julian and Schmid, Reiner and Kunz, Felix and B{\"o}hm, Hartmut and Hartmann, Stefan and Schweitzer, Tilmann}, title = {Using a 3D asymmetry index as a novel form for capturing complex three-dimensionality in positional plagiocephaly}, series = {Scientific Reports}, volume = {12}, journal = {Scientific Reports}, doi = {10.1038/s41598-022-24555-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300427}, year = {2022}, abstract = {Positional plagiocephaly (PP) is the most common skull deformity in infants. Different classification systems exist for graduating the degree of PP, but all of these systems are based on two-dimensional (2D) parameters. This limitation leads to several problems stemming from the fact that 2D parameters are used to classify the three-dimensional (3D) shape of the head. We therefore evaluate existing measurement parameters and validate a newly developed 3D parameter for quantifying PP. Additionally, we present a new classification of PP based on a 3D parameter. 210 patients with PP and 50 patients without PP were included in this study. Existing parameters (2D and 3D) and newly developed volume parameters based on a 3D stereophotogrammetry scan were validated using ROC curves. Additionally, thresholds for the new 3D parameter of a 3D asymmetry index were assessed. The volume parameter 3D asymmetry index quantifies PP equally as well as the gold standard of 30° diagonal difference. Moreover, a 3D asymmetry index allows for a 3D-based classification of PP. The 3D asymmetry index can be used to define the degree of PP. It is easily applicable in stereophotogrammetric datasets and allows for comparability both intra- and inter-individually as well as for scientific analysis.}, language = {en} } @article{WinterSchulzSchmitteretal.2022, author = {Winter, Anna and Schulz, Stefan M. and Schmitter, Marc and Brands, Roman C. and Straub, Anton and K{\"u}bler, Alexander and Borgmann, Anna and Hartmann, Stefan}, title = {Oral-health-related quality of life in patients with medication-related osteonecrosis of the jaw: a prospective clinical study}, series = {International Journal of Environmental Research and Public Health}, volume = {19}, journal = {International Journal of Environmental Research and Public Health}, number = {18}, issn = {1660-4601}, doi = {10.3390/ijerph191811709}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-288141}, year = {2022}, abstract = {Medication-related osteonecrosis of the jaw (MRONJ) represents an adverse side effect of antiresorptive and antiangiogenic medications. It is associated with impaired quality of life, oral health, and oral function and can be classified into various stages. The purpose of this prospective clinical study is to evaluate the impact of stages I and II MRONJ on oral-health-related quality of life (OHRQoL) and related parameters. Patients' OHRQoL, satisfaction with life, oral discomfort, and oral health were assessed using the German version of the Oral Health Impact Profile (OHIP-G49), visual analog scales (VAS), and Satisfaction with Life Scale (SWLS) at baseline (T0), 10 days (T1), and 3 months after treatment (T2) in 36 patients. Data were analyzed using Kolmogorov-Smirnov test, two-way mixed ANOVAs, and follow-up Mann-Whitney U tests. The impact of treatment effects on the original seven OHIP domain structures and the recently introduced four-dimensional OHIP structure were evaluated using linear regression analysis. Thirty-six patients received surgical MRONJ treatment. Before treatment, patients' perceived OHRQoL, oral discomfort, oral health, and satisfaction with life were negatively affected by MRONJ. Surgical treatment significantly improved OHRQoL and related parameters (all p ≤ 0.012). This improvement was greater in patients with higher impairment at T0. OHRQoL and oral restrictions were still impaired after treatment in patients who needed prosthetic treatment. The four-dimensional structure revealed valuable information beyond the standard seven OHIP domains. Increased awareness of MRONJ risks and an interdisciplinary treatment approach for MRONJ patients are needed.}, language = {en} } @article{SchmitterBoemickeBehnischetal.2022, author = {Schmitter, Marc and B{\"o}micke, Wolfgang and Behnisch, Rouven and Lorenzo Bermejo, Justo and Waldecker, Moritz and Rammelsberg, Peter and Ohlmann, Brigitte}, title = {Ceramic crowns and sleep bruxism: first results from a randomized trial}, series = {Journal of Clinical Medicine}, volume = {12}, journal = {Journal of Clinical Medicine}, number = {1}, issn = {2077-0383}, doi = {10.3390/jcm12010273}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-301480}, year = {2022}, abstract = {Background: This randomized clinical trial was conducted to assess whether sleep bruxism (SB) is associated with an increased rate of technical complications (ceramic defects) in lithium disilicate (LiDi) or zirconia (Z) molar single crowns (SCs). Methods: Adult patients were classified as affected or unaffected by SB based on structured questionnaires, clinical signs, and overnight portable electromyography (BruxOff) and block randomized into four groups according to SB status and crown material (LiDi or Z): LiDi-SB (n = 29), LiDi-no SB (n = 24), Z-SB (n = 23), and Z-no SB (n = 27). Differences in technical complications (main outcome) and survival and success rates (secondary outcomes) one year after crown cementation were assessed using Fisher's exact test with significance level α = 0.05. Results: No technical complications occurred. Restoration survival rates were 100\% in the LiDi-SB and LiDi-no SB groups, 95.7\% in the Z-SB group, and 96.3\% in the Z-no SB group (p > 0.999). Success rates were 96.6\% in the LiDi-SB group, 95.8\% in the LiDi-no SB group (p > 0.999), 91.3\% in the Z-SB group, and 96.3\% in the Z-no SB group (p ≥ 0.588). Conclusions: With a limited observation time and sample size, no effect of SB on technical complication, survival, and success rates of molar LiDi and Z SCs was detected.}, language = {en} } @article{GloegglerHellmannVonMansteinetal.2021, author = {Gl{\"o}ggler, Julia C. and Hellmann, Daniel and Von Manstein, Maja and J{\"a}ger, Rudolph and Repky, Stefan and Beyersmann, Jan and Lapatki, Bernd G.}, title = {Motor learning might contribute to a therapeutic anterior shift of the habitual mandibular position—An exploratory study}, series = {Journal of Oral Rehabilitation}, volume = {48}, journal = {Journal of Oral Rehabilitation}, number = {8}, doi = {10.1111/joor.13183}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-262644}, pages = {891 -- 900}, year = {2021}, abstract = {Background Passive mandibular advancement with functional appliances is commonly used to treat juvenile patients with mandibular retrognathism. Objective The aim of this study was to investigate whether active repetitive training of the mandible into an anterior position would result in a shift of the habitual mandibular position (HMP). Methods Twenty adult healthy subjects were randomly assigned to one of two groups: a training group receiving six supervised functional training sessions of 10 min each and a control group without training. Bonded lateral biteplates disengaged occlusion among both groups throughout the 15-day experiment. Customised registration-training appliances consisted of a maxillary component with an anterior plane and a mandibular component with an attached metal sphere. Training sessions consisted of repeated mouth-opening/closing cycles (frequency: 30/min) to hit an anteriorly positioned hemispherical target notch with this metal sphere. The HMP was registered at defined times during the experiment. Results The HMP in the training group showed a statistically significant anterior shift of 1.6 mm (interquartile range [IQR]: 1.2 mm), compared with a significant posterior shift of -0.8 mm (IQR: 2.8 mm) in the control group (p < .05). Although the anterior shift among the training group showed a partial relapse 4 days after the first training block, it then advanced slightly in the 4-day interval after the second training block, which might indicate neuroplasticity of the masticatory motor system. Conclusions Motor learning by repetitive training of the mandible into an anterior position might help to improve the results of functional appliance therapy among patients with mandibular retrognathism.}, language = {en} } @article{BrandtLauerFehrenzetal.2021, author = {Brandt, Silvia and Lauer, Hans-Christoph and Fehrenz, Michael and G{\"u}th, Jan-Frederik and Romanos, Georgios and Winter, Anna}, title = {Ball versus Locator\(^®\) attachments: a retrospective study on prosthetic maintenance and effect on oral-health-related quality of life}, series = {Materials}, volume = {14}, journal = {Materials}, number = {4}, issn = {1996-1944}, doi = {10.3390/ma14041051}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-228909}, year = {2021}, abstract = {Locator\(^®\) and ball attachments are well-established systems to attach overdentures to two inter-foraminal implants. This study aimed to evaluate differences between the two systems regarding prosthetic maintenance and patients' oral-health-related quality of life (OHRQoL). Dental records of patients with a mandibular implant-retained overdenture were retrospectively analyzed. Prosthetic maintenance measures involving the denture suprastructure and attachment matrix and patrix were analyzed. Furthermore, the Oral Health Impact Profile-G14 (OHIP-G14) was used to evaluate OHRQoL. Results were analyzed by means of Kaplan-Meier analysis and Student's t- and log-rank tests. The records of 122 patients were evaluated. Kaplan-Meier survival analysis revealed a significant difference between ball attachments (Group B; n patients = 47) and Locator\(^®\) attachments (Group L; n patients = 75) regarding the occurrence of denture fractures (p < 0.001) and events affecting the matrix (p = 0.028) and patrix (p = 0.030). Group L had a significantly lower total OHIP-G14 score than Group B (p = 0.002). The most common maintenance events were matrix-related and denture relining for both attachment systems. Group B required more maintenance measures than Group L. Moreover, patients in Group L had better OHRQoL than patients in Group B.}, language = {en} }