Biomedical subjects

E Piehslinger

Publications and source records attributed to E Piehslinger.

At least 19 recordsLinked to original sources

PubMed2002

Effectiveness of exercise therapy in patients with myofascial pain dysfunction syndrome.

UNLABELLED: Twenty consecutive patients suffering from myofascial pain dysfunction (MPD) were assigned to a waiting-list, serving as a no-treatment control period. Inclusion criteria were: (i) pain in the temporomandibular region for at least 3 months, (ii) no evidence of internal derangement or osteoarthritis and (iii) symptoms of postural dysfunction. Treatment consisted of active and passive jaw movement exercises, correction of body posture and relaxation techniques. The following main outcome measures were evaluated: (i) pain at rest, (ii) pain at stress, (iii) impairment, (iv) mouth opening at base-line, before and after treatment and at 6-month follow-up. All patients completed the study and no adverse effects occurred. During control period no significant changes occurred. After treatment six patients had no pain at all (chi-square: P < 0.01) and seven patients experienced no impairment (chi-square: P < 0.005). Pain at stress, impairment and incisal edge clearance improved significantly (Wilcoxon test P < 0.001). This result did not change until follow up, except pain at stress, which further improved significantly (Wilcoxon test P < 0.03). At follow up 16 patients experienced no pain at all, 13 patients were not impaired and only three patients had a restricted mouth opening, in contrast to 12 before treatment (chi-square test P < 0.001). CONCLUSION: Exercise therapy seems to be useful in the treatment of MPD Syndrome.

Adult↗

PubMed2001

[Treatment strategy in functional temporomandibular joint changes].

In the management of functional disturbances of the stomatognathic system symptomatic and causal therapeutic methods can be distinguished. Symptomatic therapy encompasses medication, physical methods (heat, cold, radiation, TENS) in combination with physiotherapy and emergency splint. After one or two weeks of symptomatic therapy the patient should be free of pain allowing precise diagnostic procedures followed by causal therapy managing muscular problems, joint pathology and occlusal disturbances. Splint therapy is used to establish a therapeutic joint position according to articulator mounting. After splint therapy prosthodontic and/or orthodontic treatment is needed to restore occlusion. Interdisciplinary management in the therapy of functional disturbances of the stomatognathic system is of utmost importance due to the relationship between chewing muscles, neck muscles and body posture. In addition to splint therapy, physiotherapy, logopedic therapy, myofunctional therapy, psychologic and psychiatric intervention is performed.

Combined Modality Therapy↗

PubMed2001

Effectiveness of exercise therapy in patients with internal derangement of the temporomandibular joint.

This study intended in evaluating the effectiveness of exercise therapy in patients with craniomandibular disorders (CMD). Twenty consecutive patients suffering from CMD with anterior disc displacement without reduction consulting a CMD service were included in the study if they met following criteria: (i) pain in the temporomandibular region, (ii) reduced incisal edge clearance (<35 mm), (iii) magnet resonance imaging confirmed anterior disc displacement without reduction and (iv) evidence of postural dysfunction. All patients were assigned to a waiting list, serving as a no-treatment control period, according to a before-after trial. The treatment consisted of active and passive jaw movement exercises, correction of body posture and relaxation techniques. A total of 18 patients completed the study, no adverse effects occurred. Following main outcome measures were evaluated: (1) pain at rest (2) pain at stress (3) impairment (4) mouth opening at base-line, before and after treatment and at 6 month follow-up. As a result of treatment pain, impairment and mouth opening improved significantly more than during control period (paired samples t-test P < 0.05). After treatment four patients had no pain at all (chi-square: P < 0.05) and only seven patients revealed an impaired incisal edge clearance after treatment. (chi-square Test, P < 0.001). At follow up, seven patients had no pain and experienced no impairment. Exercise therapy seems to be useful in the treatment of anterior disc displacement without reduction.

Adult↗

PubMed2001

An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis.

UNLABELLED: The background and purpose of this investigation was to evaluate the use of a treatment protocol which included active and passive jaw movements, manual therapy techniques, correction of body posture, and relaxation techniques for the treatment of temporomandibular joint (TMJ) osteoarthrosis (OA). Twenty consecutive patients suffering from TMJ OA participated in this study. INCLUSION CRITERIA: a. pain in the temporomandibular region; b. symptoms lasting at least three months; and c. radiologically proven OA. All patients were assigned to a waiting list, serving as a no treatment control period. Nineteen patients completed the study. No adverse effects occurred. During the control period (mean duration 35 days), the parameters did not change significantly. After treatment (mean duration 46 days) pain, impairment, and incisal edge clearance improved significantly (Wilcoxon test p < 0.001). At follow-up, pain and impairment were further reduced. The number of patients experiencing no pain at rest (80%), chi-square test p = 0.02) and stress (47%), chi-square test p = 0.03), and no impairment (37%), chi-square test p = 0.05) increased significantly. This therapeutic treatment protocol seems to be useful treatment for the symptoms of clinical dysfunction in OA of the TMJ.

Activities of Daily Living↗

PubMed2001

[Temporomandibular joint pain: radiological diagnosis].

Pain in the temporomandibular joint is often the result of internal derangement, other causes are traumatic, functional or inflammatory processes. Conventional radiography is indicated in case of suspected trauma or for specialised preoperative measurements to plan the treatment of various facial dysplasias. MRI and CT should be used in the context with the results of clinical investigation and of axiography to differentiate the various functional and morphological abnormalities of this joint.

Diagnosis, Differential↗

PubMed2000

Mandibular position at chin-point guided closure, intercuspation and final deglutition in asymptomatic and temporomandibular dysfunction subjects.

This study compared the mandibular position at chin-point guided jaw closure, intercuspation and final deglutition (position at the end of swallowing) in 159 asymptomatic subjects and 142 subjects with symptoms in the craniomandibular system. The symptomatic subjects were assigned to four groups showing an adapted centric posture, pain, luxation with reduction of the temporomandibular joint and pain with luxation and reduction. Computer equipment aided recording of hinge axis movements in three dimensions. While the three positions differed significantly in anterior-posterior direction on both sides and in inferior-superior direction on the right, a significant difference between asymptomatic and symptomatic subjects existed only in final deglutition on the left side and in the anterior-posterior location of the guided closure. Final deglutition did not coincide with the guided closure or the intercuspation in approximately 89%. A proportionally large standard deviation gave evidence against a strict relationship of the three positions in asymptomatic and symptomatic subjects. Because of this variability, final deglutition was not recommended for verification of centric relation or the intercuspal position.

Adolescent↗

PubMed2000

Exercise therapy for craniomandibular disorders.

OBJECTIVE: To evaluate the use of exercise therapy for the treatment of craniomandibular disorders (CMDs). DESIGN: Before-after trial. All patients were assigned to a waiting list, serving as a no-treatment control period. SETTING: Outpatient clinic for physical medicine and rehabilitation of the University of Vienna. PATIENTS: Thirty consecutive patients suffering from CMD with anteridr disc displacement with reduction who were consulting a CMD service. INCLUSION CRITERIA: (1) symptoms lasting at least 3 months, (2) pain in the temporomandibular region, (3) a positive axiography, and (4) evidence of postural dysfunction. Twenty-six patients completed the study; no adverse effects occurred. INTERVENTIONS: Active and passive jaw movement exercises, correction of body posture, and relaxation techniques. MAIN OUTCOME MEASURES: (1) Pain at rest, (2) pain at stress, (3) impairment, and (4) mouth opening at baseline, before and after treatment, and at 6-month follow-up. RESULTS: During the control period, no changes occurred. After the treatment, pain and impairment were significantly reduced (Wilcoxon test, p < .001). Four patients had a restricted mouth opening, in contrast to 15 before treatment (chi2 test, p < .005). Joint clicking vanished in 13.3% and was reduced in another 13.3% (chi2 test, p < .01). These results did not change until follow-up. Seventy-five percent of the patients were treated successfully. CONCLUSION: Exercise therapy seems to be useful in the treatment of anterior disc displacement with reduction.

Adult↗

PubMed2000

Relationship between craniomandibular disorders and poor posture.

The purpose of this research was to show that a relationship between craniomandibular disorders (CMD) and postural abnormalities has been repeatedly postulated, but still remains unproven. This study was intended to test this hypothesis. Twenty-five CMD patients (mean age 28.2 years) were compared with 25 gender and age matched controls (mean age 28.3 years) in a controlled, investigator-blinded trial. Twelve postural and ten muscle function parameters were examined. Measurements were separated into three subgroups, consisting of those variables associated with the cervical region, the trunk in the frontal plane, and the trunk in the sagittal plane. Within these subgroups, there was significantly more dysfunction in the patients, compared to control subjects (Mann-Whitney U test p < 0.001, p < 0.05, p < 0.01). Postural and muscle function abnormalities appeared to be more common in the CMD group. Since there is evidence of the mutual influence of posture and the craniomandibular system, control of body posture in CMD patients is recommended, especially if they do not respond to splint therapy. Whether poor posture is the reason or the result of CMD cannot be distinguished by the data presented here.

Adult↗

PubMed1999

The incidence and influence of abnormal styloid conditions on the etiology of craniomandibular functional disorders.

This study aimed to examine the incidence and influence of craniomandibular functional disorders caused by abnormal styloid-stylohyoid chains. Seven hundred sixty-five patients with temporomandibular joint (TMJ) disorders were divided into two groups (with and without radiographically visible abnormal styloid conditions). In the group with abnormal stylohyoid conditions, the etiology of TMJ disorders was further subdivided into poly-, oligo- and monoetiological factors, and, after this classification, evaluated regarding a clear, possible or unlikely involvement of abnormal stylohyoid conditions in TMJ disorders. One hundred thirty-six out of 765 patients presented abnormal styloid-stylohyoid chains. One hundred five of the patients (77.2%) demonstrated polyetiological causes of TMJ symptoms with an unlikely involvement of the abnormal styloid-stylohyoid chain. Twenty-nine of the patients (21.3%) showed oligoetiological causes with possible involvement of the abnormal styloid-stylohyoid chain. In two patients (1.5%), the abnormal styloid conditions showed up as the only definite cause of TMJ symptoms (monoetiological). Detailed knowledge of variations and possible effects of suprahyoid structures is important for an accurate diagnosis of TMJ disorders. All in all, the incidence of a stylohyoid involvement in TMJ disorders is very low. However, after an initial subdivision into abnormal and normal stylohyoid conditions, the incidence of pathological stylohyoid chains gains significant importance in the etiology of TMJ disorders.

Calcinosis↗

PubMed1998

Lengths of condylar pathways measured with computerized axiography (CADIAX) and occlusal index in patients and volunteers.

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.

Adult↗

PubMed1997

Treatment of recurrent mandibular dislocation, Part I: Leclerc blocking procedure.

Nine patients with recurrent mandibular dislocation, who underwent the blocking procedure of Leclerc and Girard, as modified by Gosserez and Dautrey, are presented. The follow-up period range from 2.5 to 5 years. An axiographic study revealed significant postoperative limitation of translation of the condyle when opening, while maximal mouth opening as measured between the incisors, as well as translation of the condyle in protrusion and mediotrusion, showed no significant limitation. Long-term evaluation showed a high incidence of clicking and pain, not evident prior to surgery. The causes for recurrence in three cases were analysed.

Adolescent↗

PubMed1996

Mandibular reference position: chin-point guided closure vs. final deglutition.

The study investigated two mandibular positions based upon computerized axiography recordings of hinge axis movements of 262 subjects. Next to the well-known guided closure position RP (reference position by chin-point guidance), the position of final deglutition (FD) was quantified. FD represented the hinge axis position at the end of the swallowing movement. The results elicited average linear distances of 0.32 +/- 0.43 mm on the right and 0.33 +/- 0.40 mm on the left side between both positions in the sagittal plane. The average distance in the frontal plane was 0.02 mm (right) and 0.04 mm (left). Approximately 46 per cent of FD recordings were found anterior and inferior to RP, and showed significant difference to posterior and anterior-superior FD recordings. The replicability of both positions was tested on 53 subjects and averaged 0.04 mm (FD) and 0.09 mm (RP). Average deviations of repeated recordings within the subject ranged from 0.07 to 0.47 mm (FD) and 0.07 to 0.57 mm (RP) for each spatial direction. The results of this study showed a relative coincidence of an average FD and RP Variation of FD in anterior inferior direction questioned the clinical reliability of FD to reassure the guided closure position.

Adolescent↗

PubMed1995

Computer simulation of occlusal discrepancies resulting from different mounting techniques.

The effect of arbitrary mounting of maxillary casts on occlusal relationships was investigated in this study. Maxillary casts of 31 volunteers were mounted on an articulator by use of two split cast bases. This mounting was done first with the arbitrary face bow and second with a hinge bow. Three reference points were defined and measured on each maxillary cast with a three-dimensional digitizer. The measurements were taken from the arbitrarily mounted cast and from the cast mounted according to the hinge axis. Opening and closing movements that were transferred according to the hinge axis. Opening and closing movements that were transferred from the articulator to the mouth of the patient were simulated by a computer based on measurements of the reference points. The results revealed that the use of an arbitrary face bow causes a deviation of the hinge-axis points from the precise axis of more than 5 mm in 77% of the cases. Resulting occlusal errors depended on the angles between the arbitrary and precise axes and the direction of the axis shifts. The occlusal error is roughly proportional to the shift or tilting of the hinge axis in millimeters or degrees. For a given deviation of the arbitrary and precise axes, the occlusal error is proportional to the record height. For a record height of 2 mm or more, an occlusal error of more than 0.1 mm will occur. An average occlusal error of more than 0.1 mm would most likely lead to the necessity of extensive selective grinding of occlusal discrepancies in the patient's mouth.

Adult↗

PubMed1995

Comparison of magnetic resonance tomography with computerized axiography in diagnosis of temporomandibular joint disorders.

This study compared the accuracy of two noninvasive methods, computerized axiography and magnetic resonance tomography (MRT), in diagnosing temporomandibular joint (TMJ) disorders. Forty-seven subjects underwent axiography and subsequent assessment of the TMJ by MRT. The statistical analysis referred to the correlations of the most relevant clinical diagnoses, i.e., no appreciable disease, disk displacement with reposition, disk displacement without reposition, morphologic alterations, and hypermobility of the condyle. In 70% of the disk-displacement-with-reposition and disk-displacement-without-reposition patient groups, axiography and MRT gave the same information. In other patient groups, the axiography findings agreed with the MRT findings in 45% of the cases. It was concluded that although a large percentage of morphologic alterations could be detected by MRT, axiography determined the dysfunctional dynamics more clearly.

Adolescent↗

PubMed1995

The effect of occlusal splint therapy on different curve parameters of axiographic TMJ tracings.

Computerized axiography was used as an objective instrumental method of evaluating the response of patients with temporomandibular joint (TMJ) symptomatology to occlusal splint therapy. Diagnosis was performed in a standardized manner by systematically analyzing TMJ path tracings obtained by computerized axiography. Thirty-six patients were axiographed before and after therapy with full-arch occlusal stabilizing appliances, followed by assessing the effect of therapy on various path curve parameters. The data obtained for the patient group treated with splints was compared to that of six patients also axiographed, but left untreated for a period of six weeks before a second TMJ tracing was obtained. The results show that splints have a certain effect on reciprocal TMJ clicking (response rate 67%). Retral stability and path characteristics are also substantially improved (response rates 44% and 40%). Less influence was noted on hypomobile joint paths (response rate 29%), the quality of movements (response rate 28%) and Bennett angle values (response rate 23%). Patients with disk displacements without reduction were not treated with splints, they underwent surgery. Their results will be reported later. By contrast, TMJ tracings in the control group remained essentially unchanged.

Adolescent↗

PubMed1995

Computerized axiography for standardized evaluation of TMJ function and dysfunction.

Computerized axiography permits the recording of mandibular movement and offers analytic systems for evaluation. Data of both temporo-mandibular joints can be compared simultaneously in relation to changes in space and time [1]. The experienced dentist is able to detect early symptoms of disturbances in the stomatognathic system.

Cephalometry↗

PubMed1994

Orthopedic jaw movement observations. Part III: The quantitation of mediotrusion.

The objective of this series is to observe and analyze movements of the temporomandibular joint (TMJ). With the information from these studies, orthopedic standards for jaw movements will be established in further investigations according to the neutral-zero method used in general orthopedics. Any restricted range of motion can thus be defined as a deviation from these standards. Direct interpretation and objective evaluation of joint functions has major practical implications. With the aid of computerized axiography, mediotrusive movements of 48 asymptomatic volunteers and 66 jaw patients were evaluated. The movements performed were either free or guided. The mean curve lengths, as well as the Bennett angles at 3 mm and at the end point were recorded. An average group was defined, containing the values of 50% of all volunteers. The interquartile range was calculated for lengths of mediotrusive movements as well as for Bennett angles. The average range of free mediotrusive movement for female volunteers was 11.06-11.98 mm (mean 11.55 mm) on the right side and 10.47-11.75 mm (mean 11.24 mm) on the left side. Male volunteers showed an average range of 10.23-11.54 mm (mean 11.1 mm) on the right side and 10.24-11.73 mm (mean 11.12 mm) on the left side. The values for female patients amounted to 9.95-1.66 mm (mean 10.8 mm) on the right side and 9.75-11.28 mm (mean 10.55 mm) on the left side. The average range for male patients was 9.06-9.71 mm (mean 9.54 mm) on the right side and 9.17-10.23 mm (mean 9.73 mm) on the left side. The average range for Bennett angles at maximum excursion in free mediotrusive movement was between 0.41 and 5.89 degrees (mean 4.43 degrees) in the volunteers on the right side and between 2.45 and 10.07 degrees (mean 6.87 degrees), respectively, on the left side. The values for patients amounted to 0.19-12.65 degrees (mean 6.93 degrees), on the right side and 1.71-14.15 degrees (mean 6.73 degrees) on the left side.

Adolescent↗

PubMed1994

Recording orthopedic jaw movements. Part IV: The rotational component during mastication.

The recording and analysis of mastication provides information on neuromuscular engrams, and hence avoidance mechanisms. Avoidance mechanisms are pathologic movement patterns which are developed to avoid occlusal interferences during functional movements. Evaluation of hinge-axis rotation permits selective quantitative analysis of a complex movement pattern. The objective of this study was to determine the amount of hinge axis rotation in mastication using computerized axiography. Furthermore, the distance of the condyles from reference position (RP) at maximum rotation was evaluated and the chronological sequence of translation and rotation was investigated. The mean value for the rotational angle of the mandible (gamma) during mastication was 14.1 degrees in the volunteers and 13.44 degrees in the patients. The linear spatial distance from RP amounted to a mean of 6.57 mm on the right side and 6.21 mm on the left in the volunteers. In the patients, the measurements were 6.33 mm on the right side and 6.7 mm on the left. In most cases, maximum rotation did not correspond with maximum translation. The chronological sequence of maximum excursion was not constant.

Adolescent↗