SummaryIn 2013, consensus was obtained on a definition of bruxism as repetitive masticatory muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible and specified as either sleep bruxism or awake bruxism. In addition, a grading system was proposed to determine the likelihood that a certain assessment of bruxism actually yields a valid outcome. This study discusses the need for an updated consensus and has the following aims: (i) to further clarify the 2013 definition and to develop separate definitions for sleep and awake bruxism; (ii) to determine whether bruxism is a disorder rather than a behaviour that can be a risk factor for certain clinical conditions; (iii) to re-examine the 2013 grading system; and (iv) to develop a research agenda. It was concluded that: (i) sleep and awake bruxism are masticatory muscle activities that occur during sleep (characterised as rhythmic or non-rhythmic) and wakefulness (characterised by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible), respectively; (ii) in otherwise healthy individuals, bruxism should not be considered as a disorder, but rather as a behaviour that can be a risk (and/or protective) factor for certain clinical consequences; (iii) both non-instrumental approaches (notably self-report) and instrumental approaches (notably electromyography) can be employed to assess bruxism; and (iv) standard cut-off points for establishing the presence or absence of bruxism should not be used in otherwise healthy individuals; rather, bruxism­related masticatory muscle activities should be assessed in the behaviour’s continuum.

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Neuroanatomical interconnections and neurophysiological relationships between the orofacial area and the cervical spine have been documented earlier. The present single-blind study was aimed at screening possible correlations between clinical signs of temporomandibular disorders (TMD) and cervical spine disorders. Thirty-one consecutive patients with symptoms of TMD and 30 controls underwent a standardised clinical examination of the masticatory system, evaluating range of motion of the mandible, temporomandibular joint (TMJ) function and pain of the TMJ and masticatory muscles. Afterwards subjects were referred for clinical examination of the cervical spine, evaluating segmental limitations, tender points upon palpation of the muscles, hyperalgesia and hypermobility. The results indicated that segmental limitations (especially at the C0-C3 levels) and tender points (especially in the m. sternocleidomastoideus and m. trapezius) are significantly more present in patients than in controls. Hyperalgesia was present only in the patient group (12-16%).

An RCT comparing patientcentred outcome variables of guided surgery (bone or mucosa supported) with conventional implant placement Vercruyssen M, De Laat A, Coucke W, Quirynen M. An RCT comparing patientcentred outcome variables of guided surgery (bone or mucosa supported) with conventional implant placement. AbstractAim: To assess in a randomized study the patient-centred outcome of two guided surgery systems (mucosa or bone supported) compared to conventional implant placement, in fully edentulous patients. Material and Methods: Fifty-nine patients (72 jaws) with edentulous maxillas and/ or mandibles, were consecutively recruited and randomly assigned to one of the treatment groups. Outcome measures were the Dutch version of the McGill Pain Questionnaire (MPQ-DLV), the Health-related quality of life instrument (HRQOL), visual analogue scales (VAS), the duration of the procedure, and the analgesic doses taken each day. Results: Three hundred and fourteen implants were placed successfully. No statistical differences could be shown between treatment groups on pain response (MPQ-DLV), treatment perception (VAS) or number or kind of pain killers. For the HRQOLI-instrument, a significant difference was found between the Materialise Mucosa and Materialise Bone group at day 1 (p = 0.02) and day 2 (p = 0.01). For the duration of the surgery, a statistical difference (p = 0.005) was found between the Materialise mucosa and the Mental group, in favour of the first. Conclusion: In this study little difference could be found in the patient outcome variables of the different treatment groups. However there was a tendency for patients treated with conventional flapped implant placement to experience the pain for a longer period of time.

Pressure pain thresholds (PPTs) of the bilateral masseter and temporalis muscles were assessed over a single day and in between 2 days with the aid of an electronic algometer in 11 males and 11 females. Using a mixed model approach, covariance results were controlled for confounding of gender, day, time of the day and the within-session replications of the measurements. For every jaw muscle, the first PPT measurement of a session was markedly higher than the last one of that same session. Except for the right temporalis muscles, no significant systematic PPT differences could be observed between male and female subjects. The differences between morning and afternoon sessions were not significant for any of the muscles tested. Although the PPTs measured on the 1st day were systematically lower than those on the 2nd day for the left masseter and temporalis muscles, no significant difference between the time of the day could be observed when the values of the different muscles were grouped within a subject. Analysis of variance showed that the variability induced by the day or the time of the day was similar to the variability of the measurement itself. The inter-individual variability of PPTs was 2.3 to 9 x higher than the variability observed between trials, sessions or days. The results indicate that the PPT measurement will not be systematically influenced by the time of registration (morning/afternoon) or inbetween consecutive days. In addition, the important inter-individual differences favor the use of longitudinal within-subject studies.