Harald Tschernitschek

The Functional Relationship Between the Craniomandibular System, Cervical Spine, and the Sacroiliac Joint: A Preliminary Investigation

ABSTRACT The hypothesis of a functional coupling between the muscles of the craniomandibular system and the muscles of other body areas is still controversial. The purpose of this pilot study was to examine whether there is a relationship between the craniomandibular system, the craniocervical system and the sacropelvic region. To test this hypothesis, the prevalence and localization of dysfunction of the cervical spine and the sacroiliac joint were examined in a prospective, experimental trial. Twenty healthy students underwent an artificial occlusal interference, which caused an occlusal interference. The upper cervical spine (C0-C3) and the sacroiliac joint were examined before, during and after this experimental test. The primary outcome with these experimental conditions was the occurrence of hypomobile functional abnormalities. In the presence of occlusal interference, functional abnormalities were detected in both regions examined and these changes were statistically significant. The clinical implications of these findings may be that a complementary examination of these areas in CMD patients could be useful.

Asymptomatic Cervical Spine Dysfunction (CSD) in Patients with Internal Derangement of the Temporomandibular Joint

ABSTRACT Patients with temporomandibular disorders (TMDs) frequently show symptoms related to the cervical spine. It is however unknown whether patients with TMD who have no symptoms in the neck region often have signs of cervical spine dysfunction (CSD) and whether there is a predominant localization of these asymptomatic CSDs. In a prospective and controlled examiner-blinded clinical trial, the prevalence and localization of asymptomatic CSD in patients with TMD was examined. Thirty patients with internal derangement of the temporomandibular joint but without any neck problems were compared with 30 age and gender matched healthy controls. Significantly more asymptomatic dysfunctions of the vertebral joints and increased muscle tenderness were found in the patient group. The difference between patients and nonpatients for vertebral joint dysfunction and muscle tenderness was greatest in the upper cervical spine. These findings support the thesis that a complementary examination of this area should be performed, even when TMD patients do not report any neck problems.

Medical and Physical Therapy of Temporomandibular Joint Disk Displacement without Reduction

ABSTRACT The objective of this study was to determine the influence of medical and physical therapy on long-term treatment outcome in 72 patients with anterior disk displacement without reduction. Patients were treated solely with occlusal splints (group I), with splints and supplementary medical therapy (group II), with splints and physical therapy (group III) or with splints, medical, and physical therapy (group IV). After therapy, the maintenance of improvement was objectively and subjectively assessed with an extensive clinical examination and a postal questionnaire. The percentage of pain free patients after therapy was 76% in group I, 88% in group II, 43% in group III, and 65% in group IV. There was a statistically significant higher increase of maximum jaw opening after therapy in group II than in the control groups (p<0.05). The improvement in mouth opening came to 9.7 mm in group I, 14.5 mm in group II, 7.3 mm in group III, and 11.2 mm in group IV. Medical therapy seems to have a positive influence on the treatment outcome of patients with anterior disk displacement without reduction.

Surface quality achieved by polishing and by varnishing of temporary crown and fixed partial denture resins.

STATEMENT OF PROBLEM Studies have suggested that coating a temporary restoration with varnish material could replace time-consuming polishing procedures needed for achieving an optimally smooth surface. PURPOSE This study examined the surface roughness of acrylic resins after having been polished or coated with different varnish materials. MATERIAL AND METHODS A total of 360 cylindrical specimens were fabricated from 9 brands of resin. One surface on each specimen was machined flat and subsequently either polished with rubber polishers or coated with 1 of 9 varnishes. Selected specimens were subjected to thermal cycling (5 degrees C to 55 degrees C, 2000 cycles). Surface quality was assessed by means of a profilometer and by SEM examination. RESULTS Polished specimens had average surface roughness values (Ra) of 0.8 microm; differences in roughness between materials were small, but statistically significant. Type of coating had a significant influence on surface quality. Depending on the combination of materials used, the coating produced both smoother and rougher surfaces than polishing (0.4 microm < Ra < 4.6 microm). Five coatings were deemed not to be clinically applicable because of poor wetting properties. Thermal cycling did not significantly influence surface quality, but caused minute cracks in the cyanoacrylate coating. CONCLUSION In regard to surface quality and applicability, the use of varnishes on temporary restorations is not advisable.

Radiographic inspection of dental castings

Abstract Underdimensioning may adversely affect the clinical use of a crown or bridge. Insufficient dimensions may be due to inadequate modelling or deficiencies caused by the casting process. The dimensions of cast objects are measured mechanically using a calliper. This method has often proved to be insufficient in detecting areas of too small dimensions. This paper presents a non-destructive method of inspecting dental castings using radiography. The occlusal thickness of a random sample of 150 crowns made during regular clinical treatment in our department was inspected mechanically and radiographically. We found that 19% of the crowns were only 0.1 mm thick or less at the thinnest spot, 18% were between 0.1 and 0.2 mm and 9% were between 0.2 and 0.3 mm. In comparison to mechanical examination, radiographic inspection usually showed smaller values.

The Effects of Seasonal Changes on Temporomandibular Disorders

Abstract The aim of our study was the evaluation of seasonal influences on development and evolution of temporomandibular disorders (TMD). In a retrospective study based on data from 1997 and 1998, we analyzed the monthly number of patients at the Department of Prosthodontics. The total number of first time examinations during these two years was 11,747. Nine hundred and sixty-one (961) patients showed symptoms frequently found in TMD. These patients were submitted to a special TMD diagnosis based on the criteria of a validated craniomandibular index questionnaire. In 568 patients (group A1), a TMD was confirmed, in the other 393 patients (group A2), the disorder could not be confirmed. Dividing up the numbers of patients into summer and winter half years, we found statistically significant relationships between patient numbers and season in TMD patients (A1) as well as in all patients (group B). The distribution of the monthly numbers of TMD patients with its maximum in winter, however, was characteristically different from that of all patients with the maximum in summer. The number of TMD patients per month was significantly correlated to the mean daily sunshine duration per month. Parallels could be drawn to seasonal variations of symptoms in Seasonal Affective Disorders (SAD). As the mechanisms which influence the emergence of psychologically impacted disease in TMD patients might be comparable to SAD, we propose that a similar therapy may be applied.