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Wissenschaftliche Artikel über bruxane

Die Klinische Studie der LMU München mit bruXane 2020

Diese Studie der LMU München bestätigt die Effektivität von bruXane. 

Abstract:

Objectives

The purpose of the present study was to analyze treatment outcome with a full-occlusion biofeedback (BFB) splint on sleep bruxism (SB) and TMD pain compared with treatment with an adjusted occlusal splint (AOS).

Materials and methods

Forty-one patients were randomly allocated to a test (BFB) or a control (AOS) group and monitored over a 3-month period. Output variables were frequency and duration of bruxing events (bursts) and various pain symptoms.

Results

The BFB group showed a statistically significant reduction in the frequency and duration of bursts and a statistically significant improvement in the patients’ global well-being and the facial muscle pain parameter. After the treatment was stopped, the BFB group showed a statistically significant reduction in the average and maximum duration but no statistically significant change in the frequency of bursts.

Conclusions

The tested BFB splint is highly effective in reducing SB at the subconscious level, i.e., without waking the patient, and in achieving improvements in global pain perception. The results suggest that the BFB splint also provides a better treatment option for bruxism-related pain than an AOS. However, further research is needed, and specifically studies with a larger patient population displaying higher levels of pain at baseline.

Clinical relevance

By reducing burst duration and therefore the pathological load on the masticatory apparatus, the BFB splint reduces TMD and bruxism-related symptoms and improves patients’ physical well-being. In the long term, this could prevent damage to the TMJ. This study confirms the effectiveness and safety of this splint.

Hier finden Sie den vollen Studienbericht. 

Interne bruXane Studie 2020

Interne bruXane Studie mit 57 Probanden zur Wirksamkeit von bruXane.

Hoeffler

In der Ausgabe 2017;9(3) des CMF (Journal of Craniomandibular Function) ist ein Artikel "Therapie des Bruxismus mit Biofeedbackapparatur" von Dr. med.dent. Klaus-R. Hoeffler erschienen. Sie können den Artikel auf der Quintessence-Homepage erwerben oder kostenfrei über diesen Link downloaden.

Imhoff

Neue Therapieansätze bei kraniomandibulärer Dysfunktion, B. Imhoff et al., wissen kompakt, Heft 1/2019

Therapieoptionen bei Wach- und Schlafbruxismus. M. Lange. wissen kompakt February 2018, Volume 12, Issue 1, pp 39-52.

Abstract:

 Für Patienten mit einer kraniomandibulären Dysfunktion (CMD) gibt es eine Reihe bewährter Therapieansätze. Die eingesetzten Maßnahmen richten sich nach der Befundkonstellation unter Berücksichtigung der Risikofaktoren. Neben Aufklärung und Beratung steht die Therapie mit Okklusionsschienen (Typ Michigan) als Goldstandard in der Regel im Mittelpunkt der zahnärztlichen Therapie. In den letzten Jahren sind eine Reihe neuer Therapiemittel und -konzepte publiziert worden, sowohl in Bezug auf Therapiekonzepte als auch in Form neuer Behandlungsmittel. Ziel ist eine Verbesserung der Behandlungsergebnisse und das Aufzeigen alternativer Behandlungsmethoden. Dieser Artikel informiert über bruXane® (Fa. bruXane GmbH, Marburg, Deutschland) als neue orale Schiene, GrindCare® (Fa. Sunstar Deutschland GmbH, Schönau, Deutschland) als elektronische Hilfe zur Unterbrechung von Parafunktionen, RehaBite® (Fa. Dentrade e. K., Köln, Deutschland) als muskelrelaxierendes Trainingsgerät, RelaxBogen® (Fa. RelaxBogen GmbH, Hameln, Deutschland) und Cerezen® (Fa. Renew Health Ltd., Garrycastle, Athlone, Irland) als extraorale Behandlungsgeräte, Botulinumtoxin-Injektionen sowie über Multi-Schienen-Konzepte und modifizierte Trainingspläne für Eigenübungen der Patienten. Diese Auflistung erhebt keinen Anspruch auf Vollständigkeit.

Über diesen Link erhalten Sie kostenfrei die komplette Veröffentlichung.

Lange

Therapieoptionen bei Wach- und Schlafbruxismus. M. Lange. wissen kompakt February 2018, Volume 12, Issue 1, pp 39-52.

Abstract:

Im zahnärztlichen Alltag wird man vor allen Dingen mit vermutlichen Folgeerscheinungen übermäßiger Bruxismusaktivität, wie Schäden an den Zähnen, den Restaurationen, dem Zahnersatz und Zahnhalteapparat, Kopfschmerzen oder kraniomandibulären Dysfunktionen, konfrontiert. Da gegenwärtig keine kausal wirkende Bruxismustherapie bekannt ist, zielt die Behandlung je nach Leitsymptom in erster Linie auf den Schutz der Zähne und der Restaurationen, die Minderung der Bruxismusaktivität und die Schmerzlinderung. Basierend auf dem aktuellen Stand der Wissenschaft werden im Folgenden Behandlungsmöglichkeiten vorgestellt, die, basierend auf einer soliden Diagnostik, nahtlos in den Praxisalltag integrierbar sind. Neben den klassischen Maßnahmen wie Beratung und Information, Verhaltenstherapie, Biofeedback, Schienentherapie sowie pharmakologische Intervention wird eine Übersicht über die Prävention und Behandlung des Abrasionsgebisses gegeben.

Über diesen Link erhalten Sie kostenfrei die komplette Veröffentlichung.

S3 Leitlinie Bruxismus und Artikel Lange 2019

Erstmals wurde 2019 eine S3-Leitlinie “Diagnostik und Behandlung des Bruxismus“ federführend durch die DGFDT und DGZMK sowie 30 weiteren Fachgesellschaften und Institutionen veröffentlicht. Als häufige Auslöser für Bruxismus werden psychologische Faktoren wie emotionaler Stress, Angststörungen, Schlafstörungen etc. beschrieben. Als Behandlungsmethoden werden auch Biofeedback und Physiotherapie empfohlen.
Die komplette Leitlinie finden sie hier zum Download.

In seinem Artikel “Meilenstein zum Umgang mit Bruxismus” (Der Freie Zahnarzt
July 2019, Volume 63, Issue 7–8, pp 64–69) erläutert Dr. Lange die Leitlinie und beschreibt auch bruXane als Behandlungsmethode. Einen Abstract zum Artikel sowie Kauflink finden sie hier.

Wissenschaftliche Studien über Bruxismus, Zähneknirschen und Biofeedback

Die folgenden unabhängigen, wissenschaftlichen Studien über Bruxismus präsentieren Untersuchungsergebnisse zu den in bruXane verwendeten Behandlungsmethoden Schienentherapie und Biofeedback.

GU 2015: Diese chinesische Studie mit 24 Probanden (leichte Knirscher) zeigt: die Biofeedbacktherapie ist eine wirksame und bequeme Behandlung für Knirscher

Efficacy of biofeedback therapy via a mini wireless device on sleep bruxism contrasted with occlusal splint: a pilot study. Gu W, Yang J, Zhang F, Yin X, Wei X, Wang C. J Biomed Res. 2015 Apr;29(2):160-8. 

Biofeedbacktherapie unter Verwendung einer Oberkieferschiene mit integriertem Drucksensor und externem Vibrationsmodul am Handgelenk führt zu signifikanten Abnahmen der Dauer und Häufigkeit der Knirschereignisse.

Abstract:

The putative causes of bruxism are multifactorial and there are no definite measures for bruxism management. The aim of this study was to evaluate the efficacy of biofeedback therapy on sleep bruxism, compared with occlusal splint. Twenty-four volunteers with sleep bruxism were divided into two groups: the GTB group that were treated with biofeedback therapy (n  = 12) and the GTO group that were treated with occlusal splint (n  = 12). A mini pressure sensor integrated with a monitoring circuit by use of a maxillary biofeedback splint was fabricated. To foster the relaxation of the masticatory muscles and the nervous system, the wireless device received signals from bruxism events and vibrations alerted the bruxer when the threshold was exceeded. Total episodes and average duration of bruxism events during 8 hours of sleep were analyzed with the monitoring program (TRMY1.0). After 6 and 12 weeks, the episodes (P  =  0.001) and duration (P < 0.05) in the GTB group declined dramatically. In contrast, there were no significant differences in the GTO group after the treatment (P > 0.05). Furthermore, the episodes had significant differences between the GTB group and the GTO group after the same period of treatment (P  =  0.000). The results suggest that biofeedback therapy may be an effective and convenient measure for mild bruxers, when compared with occlusal splint therapy. The mini wireless biofeedback method may be of value for the diagnosis and management of bruxism in the future.

Quelle des Abstracts: https://www.ncbi.nlm.nih.gov/pubmed/25859272

Turk 1993: Biofeedback und Schienentherapie in Kombination zeigen die beste Wirkung.

Effects of intraoral appliance and biofeedback/stress management alone and in combination in treating pain and depression in patients with temporomandibular disorders. Turk DC, Zaki HS, Rudy TE. J Prosthet Dent 1993;70:158-164

Abstract:

To assess the differential efficacy of two commonly used treatments for temporomandibular disorders (TMD), intraoral appliances (IAs) andbiofeedback (BF), separately and in combination, two studies were conducted. The first study directly compared IA treatment, a combination ofbiofeedback and stress management (BF/SM), and a waiting list control group in a sample of 80 TMD patients. Both treatments were determined to be equally credible to patients, ruling out this potential threat to the validity of the results obtained. The results demonstrated that the IA treatment was more effective than the BF/SM treatment in reducing pain after treatment, but at a 6-month follow-up the IA group significantly relapsed, especially in depression, whereas the BF/SM maintained improvements on both pain and depression and continued to improve. The second study examined the combination of IA and BF/SM in a sample of 30 TMD patients. The results of this study demonstrated that the combined treatment approach was more effective than either of the single treatments alone, particularly in pain reduction, at the 6-month follow-up. These results support the importance of using both dental and psychologic treatments to successfully treat TMD patients if treatment gains are to be maintained.

Quelle des Abstracts: http://www.ncbi.nlm.nih.gov/pubmed/8371179

Pierce 1988: Im Gegensatz zu anderen Methoden können sowohl Biofeedback als auch Schienentherapie die Knirschaktivität reduzieren. bruXane ist eine Kombination von beidem.

A Comparison of Different Treatments for Nocturnal Bruxism. C.J. Pierce and E.N. Gale. J DENT RES 1988 67: 597

Abstract:

One hundred bruxers were evaluated for bruxing activity before, during, and after treatment with a portable electromyograph (EMG). A six-month post-treatment follow-up of bruxing activity was obtained. Experimental treatment groups consisted of diurnal biofeedback, nocturnal biofeedback, massed negative practice, and splint therapy. A no-treatment control group was included. The comparative efficacy of treatments was determined by analyses of variance. Both EMG-measured frequency of bruxing episodes and duration of bruxing activity decreased significantly for nocturnal biofeedback and splint therapy treatments but not for massed negative practice, diurnal biofeedback (relaxation), or the no-treatment control group. The two-week treatment effects were transient, and bruxing activity generally returned to baseline levels when treatment was withdrawn. These findings are consistent with the findings of previous researchers with regard to nocturnal biofeedback and splint therapy but differ from previous findings for massed negative practice therapy. Über diesen Link erhalten Sie die komplette Veröffentlichung: http://www.ncbi.nlm.nih.gov/pubmed/3170898 

Jadidi 2008: Biofeedback kann Knirschaktivität reduzieren.

Effect of conditioning electrical stimuli on temporalis electromyographic activity during sleep. F. JADIDI, E. CASTRILLON & P. SVENSSON. Journal of Oral Rehabilitation 2008 35; 171-183.

Abstract:

Inhibitory reflexes during voluntary contractions are well described; however, few studies have attempted to use such reflex-mechanisms to modulate electromyographic (EMG) activity in jaw-closing muscles during sleep. The aim was to apply a new intelligent biofeedback device (Grindcare(R)) using electrical pulses to inhibit EMG activity in the temporalis muscle during sleep. Fourteen volunteers participated who were aware of jaw-clenching activity as indicated by complaints from sleep partner, soreness or pain in the jaw-muscle upon awakening and tooth wear facets. The EMG activity was recorded from the temporalis muscle, online analysed and the frequency content determined using a signal recognition algorithm. Based on specific individual parameters for pattern recognition, an electrical square-wave pulse train, which was adjusted to a clear, but non-painful intensity (range 1-7 mA) was applied through the EMG electrodes, if jaw-clenching activity was detected. All volunteers had baseline EMG recordings for five to seven consecutive nights, followed by 3-weeks EMG recordings with the feedback turned on, 2 weeks without the feedback and finally 3 weeks with the biofeedback on. There were no session effects on the average duration of sleep hours (P = 0.626). The number of EMG episodes/hour sleep was significantly reduced during the two sessions with biofeedback (54 +/- 14%; 55 +/- 17%, P < 0.001) compared with baseline EMG activity and the session without biofeedback. The present study suggests that biofeedback with electrical pulses does not cause major disruption in sleep and is associated with pronounced reduction in temporalis EMG activity during sleep.

Über diesen Link erhalten Sie die komplette Veröffentlichung: http://www.ncbi.nlm.nih.gov/pubmed/18254794

Watanabe 2001: Vibration als Biofeedback kann Knirschaktivität und Folgesymptome reduzieren.

A vibratory stimulation-based inhibition system for nocturnal bruxism : a clinical report. Watanabe T, Baba K, Yamagata K, Ohyama T, Clark GT J Prostet Dent 2001;85:233-235

Abstract:

For the single subject tested to date, the bruxism-contingent vibratory-feedback system for occlusal appliances effectively inhibited bruxism without inducing substantial sleep disturbance. Whether the reduction in bruxism would continue if the device no longer provided feedback and whether the force levels applied are optimal to induce suppression remain to be determined.

Quelle des Abstracts: http://www.ncbi.nlm.nih.gov/pubmed/11264929

Feehan 1989: Akustisches Biofeedback kann Knirschaktivität und Folgesymptome reduzieren.

The reduction of bruxism using contingent EMG audible biofeedback: a case study. Feehan M. and Marsh N. J Behav Ther Exp Psychiatry. 1989 Jun;20(2):179-83.

Abstract:

This report describes the use of EMG biofeedback to reduce bruxism in an 18-year-old woman. The behaviour was severe and not responsive to standard dental treatment. In addition to psychometric measures of affective status, objective measures of both the frequency and intensity of bruxing incidents were made, and a 4-week intervention conducted. On the bruxing and affective measures significant improvements were noted, as were reductions in associated pain and dysfunction.

Quelle des Abstracts: http://www.ncbi.nlm.nih.gov/pubmed/2584401

Clarke 1977: Akustisches Biofeedback kann Gesichtsschmerzen reduzieren.

The treatment of myofascial pain-dysfunction syndrome using the biofeedback principle. Clarke NG, Kardachi BJ. J Periodontol. 1977 Oct;48(10):643-5

Abstract:

Facial pain is a relatively common sequel to bruxism and the biofeedback principle was used on seven subjects experiencing this syndrome. The results obtained were satisfactory and support the concept that the etiology of the M.P.D. syndrome is psychophysiological. This study showed that biofeedback is both a logical and appropriate form of treatment. However, the result with subject 7 indicates that not all patients are willing to wear the equipment but conselling and empathy probably form an equally satisfactory form of treatment.

Über diesen Link erhalten Sie die komplette Veröffentlichung: http://www.ncbi.nlm.nih.gov/pubmed/269245

Kardachi 1977: Akustisches Biofeedback kann Knirschaktivität reduzieren. Es ist wichtig, dass der Biofeedbackreiz zeitgleich mit der zu behandelnden Aktivität (Knirschen) startet und stoppt.

The Use of Biofeedback to Control Bruxism. Kardachi BJ, Clarke NG. J Periodontol. 1977 Oct; 48(10):639-42.

Abstract:

A highly significant reduction in bruxism has been obtained using a biofeedback system. The concept that the etiology of bruxism is related to emotional stress is supported as biofeedback has been successful in controlling other stress-related parameters. The form of biofeedback used as an audible tone derived from amplified electromyographic data, relayed to the subject via an earpiece. Future work will be concerned with learning potential and the control of parafunctional activity; further investigation into the correlation between E.E.G. patterns and masticatory E.M.G. activity is necessary.

Über diesen Link erhalten Sie die komplette Veröffentlichung: http://www.ncbi.nlm.nih.gov/pubmed/269244

Rugh 1981: Akustisches Biofeedback kann die Dauer einzelner Knirschereignisse reduzieren. Wir haben die Erfahrung gesammelt, dass bruXane sowohl die Dauer als auch die Anzahl der Knirschereignisse reduziert.

Temporal analysis of nocturnal bruxism during EMG feedback. Rugh JD, Johnson RW. J Periodontol. 1981 May;52(5):263-5.

Abstract:

Several studies have demonstrated that nocturnal bruxism and related symptoms can be relieved through nocturnal electromyogram (EMG) feedback. The effects, however, are not always long lasting and the mechanism of suppression is not understood. It was the object of this study to examine more closely the manner in which nocturnal feedback works in suppressing bruxism. Chart recordings were made of nocturnal masseter EMG activity in five bruxism subjects. Baseline recordings were made in the subject's home followed by 10 or more nights of feedback treatment. Treatment involved sounding a 300 mW tone when EMG activity exceeded about 20 micro V for more than 1 second. All subjects showed a decrease in the duration of bruxism. The decrease in bruxism was due to a reduction in the duration of bruxism episodes rather than a change in the number of episodes, i.e. rather than reducing the probability of an event starting, nocturnal feedback appears to simply suppress the activity once it is initiated. This provides little evidence of learning.

Über diesen Link erhalten Sie die komplette Veröffentlichung: http://www.ncbi.nlm.nih.gov/pubmed/6941011

Dubé 2004: Sowohl okklusale als auch palatinale Schienen können nächtliche Knirschaktivität reduzieren. bruXane nutzt beide Techniken.

Quantitative Polygraphic Controlled Study on Efficacy and Safety of Oral Splint Devices in Tooth-grinding Subjects. C. Dubé, P.H. Rompré, C. Manzini, F. Guitard, P. de Grandmont and G.J. Lavigne. J DENT RES 2004 83: 398.

Abstract:

The efficacy of occlusal splints in diminishing muscle activity and tooth-grinding damage remains controversial. The objective of this study was to compare the efficacy and safety of an occlusal splint (OS) vs. a palatal control device (PCD). Nine subjects with sleep bruxism (SB) participated in this randomized study. Sleep laboratory recordings were made on the second night to establish baseline data. Patients then wore each of the splints in the sleep laboratory for recording nights three and four, two weeks apart, according to a crossover design. A statistically significant reduction in the number of SB episodes per hour (decrease of 41%, p = 0.05) and SB bursts per hour (decrease of 40%, p < 0.05) was observed with the two devices. Both oral devices also showed 50% fewer episodes with grinding noise (p = 0.06). No difference was observed between the devices. Moreover, no changes in respiratory variables were observed. Both devices reduced muscle activity associated with SB.

Über diesen Link erhalten Sie die komplette Veröffentlichung: http://www.ncbi.nlm.nih.gov/pubmed/15111632

Harada 2006: Knirscherschienen alleine haben lediglich zu einer kurzfristigen Reduktion geführt.

The effect of oral splint devices on sleep bruxism: a 6-week observation with an ambulatory electromyographic recording device. Harada T, Ichiki R, Tsukiyama Y, Koyano K. J Oral Rehabil. 2006 Jul;33(7):482-8

Abstract:

This study investigated the effect of stabilization splint (SS) and palatal splint (PS), which had the same design as SS except for the elimination of the occlusal coverage, on sleep bruxism (SB) using a portable electromyographic (EMG) recording system. Sixteen bruxers participated in this study. The EMG activities of the right masseter muscle during sleep were recorded for three nights each in the following five recording periods: before, immediately after, and 2, 4 and 6 weeks after the insertion of the splint. The crossover design, in which each splint was applied to each subject for 6 weeks with an interval of 2 months for a washout period, was employed in this randomized-controlled study. The number of SB events, duration and total activities of SB were analysed. The number of SB events before the insertion of splints (baseline) was 2.98 +/- 1.61 times h(-1). Both splints significantly reduced SB immediately after the insertion of devices (P < 0.05, one-way repeated-measures anova followed by Dunnett); however, no reduction was observed in 2, 4 or 6 weeks (P > 0.05). There was no statistical difference in the effect on SB between the SS and PS (P > 0.05, two-way repeated-measures anova). Both splints reduced the masseter EMG activities associated with SB; however, the effect was transient.

Über diesen Link erhalten Sie die komplette Veröffentlichung: http://www.ncbi.nlm.nih.gov/pubmed/16774505

Die folgenden Studien könnten Sie auch interessieren:

Carra 2012:

Sleep bruxism: a comprehensive overview for the dental clinician interested in sleep medicine. Carra MC1, Huynh N, Lavigne G. Dent Clin North Am. 2012 Apr;56(2):387-413. doi: 10.1016/j.cden.2012.01.003

Abstract:

Sleep bruxism (SB) is a common sleep-related motor disorder characterized by tooth grinding and clenching. SB diagnosis is made on history of tooth grinding and confirmed by polysomnographic recording of electromyographic (EMG) episodes in the masseter and temporalis muscles. The typical EMG activity pattern in patients with SB is known as rhythmic masticatory muscle activity (RMMA). The authors observed that most RMMA episodes occur in association with sleep arousal and are preceded by physiologic activation of the central nervous and sympathetic cardiac systems. This article provides a comprehensive review of the cause, pathophysiology, assessment, and management of SB.

Über diesen Link erhalten Sie die komplette Veröffentlichung: http://www.ncbi.nlm.nih.gov/pubmed/22480810

Lavigne 2008:

Bruxism physiology and pathology: an overview for clinicians. Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K. J Oral Rehabil 2008;35:476-494

Abstract:

Awake bruxism is defined as the awareness of jaw clenching. Its prevalence is reported to be 20% among the adult population. Awake bruxism is mainly associated with nervous tic and reactions to stress. The physiology and pathology of awake bruxism is unknown, although stress and anxiety are considered to be risk factors. During sleep, awareness of tooth grinding (as noted by sleep partner or family members) is reported by 8% of the population. Sleep bruxism is a behaviour that was recently classified as a 'sleep-related movement disorder'. There is limited evidence to support the role of occlusal factors in the aetiology of sleep bruxism. Recent publications suggest that sleep bruxism is secondary to sleep-related micro-arousals (defined by a rise in autonomic cardiac and respiratory activity that tends to be repeated 8-14 times per hour of sleep). The putative roles of hereditary (genetic) factors and of upper airway resistance in the genesis of rhythmic masticatory muscle activity and of sleep bruxism are under investigation. Moreover, rhythmic masticatory muscle activity in sleep bruxism peaks in the minutes before rapid eye movement sleep, which suggests that some mechanism related to sleep stage transitions exerts an influence on the motor neurons that facilitate the onset of sleep bruxism. Finally, it remains to be clarified when bruxism, as a behaviour found in an otherwise healthy population, becomes a disorder, i.e. associated with consequences (e.g. tooth damage, pain and social/marital conflict) requires intervention by a clinician.

Über diesen Link erhalten Sie die komplette Veröffentlichung: http://www.ncbi.nlm.nih.gov/pubmed/18557915