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The minimally invasive restoration of tooth wear using indirect restorations is challenging, but with the right techniques, it is now possible to achieve amazingly natural and gentle results. In this article, our multicenter working group from Munich and Hamburg describes the procedure and illustrates it with a specific treatment case-we hope you enjoy reading it.

The minimally invasive restoration treatment of tooth wear using indirect restorations is challenging, but is now possible in a surprisingly natural and gentle way using appropriate techniques. In this article, our multicenter working group from Munich and Hamburg describes the procedure and illustrates it using a specific treatment case – we hope you enjoy reading it.

Occlusal onlays are particularly gentle forms of preparation for restorations of posterior teeth that are severely damaged by tooth wear. In order to achieve the required preparation shape quickly and predictably, PD Dr. Ahlers and Prof. Dr. Edelhoff have developed special techniques and innovative preparation instruments adapted to them. The practical procedure for using these instruments is described in a specialist article in the journal ZWP. You can download it here.

The Fifth German Oral Health Study reveals a marked decrease in caries incidence and an enhanced retention of teeth among the elderly in Germany, indicating a shift towards enduring dental preservation, frequently employing fixed prostheses or implants. Germany stands at the forefront of global dental health, although there is an increasing awareness of issues related to erosion, attrition, and abrasion that compromise dental hard tissues. Restorative methodologies have transitioned from subtractive techniques to more defect-oriented and additive strategies, prioritizing the conservation of dental hard tissues. Occlusal onlays emerge as a sophisticated, minimally invasive treatment alternative, particularly efficacious in reconstructing severely eroded occlusal surfaces, thus playing a crucial role in maintaining dental integrity. The present article delineates this innovative treatment modality, elucidating the procedural nuances with detailed illustrations and utilizing specially designed preparation instruments.

The German Oral Health Study DMS V shows a significant decline in the incidence of tooth decay in Germany. The number of remaining teeth in old age has increased, indicating a trend towards tooth preservation, often supported by implants. Despite this positive development, there are concerns about tooth structure damage due to biocorrosion, attrition and abrasion, which have different defect morphologies. Restorative treatment concepts for this have differentiated: instead of predominantly subtractive methods, less invasive, defect-oriented approaches are now preferred, and new forms of preparation contribute to tooth preservation. This article highlights the principles of minimally invasive treatment using occlusal onlays to reconstruct damaged occlusal surfaces. These modern techniques make it possible to preserve tooth structure while achieving functional and esthetic results. Learn in this training article how you can optimize your treatment results through the targeted preparation of such occlusal onlays.

The adhesive technique and translucent restorative materials have changed the treatment of fixed restorations. Modern technologies enable the use of new polymer materials. These offer innovative possibilities for the pre-treatment of dentures. In addition, there are now new types of ceramics that make metal-free restorations possible. As a result, treatment concepts in fixed prosthetics have changed considerably. Because there are so many new restorative materials, it is sometimes difficult to keep track of them all. This article deals with the latest developments in fixed prosthetics. It provides guidance on material selection for different dental treatments.

Certain situations require treatment with restoration of the tooth contours, the tooth volumes and the corrected (re-)adjustment of the temporomandibular joints to a physiological position. Such treatments are rare and extremely difficult because they require the complete – and correct – adjustment of the jaw position in a single step, without overloading the body’s ability to adapt. This is all the more challenging if those affected have an increased sensitivity to changes in tooth contact or tend to clench their teeth tightly. The appropriate approach was developed around the 2000s in Hamburg, Munich and elsewhere. One approach is to recontour all teeth that are in non-occlusion in a physiological jaw joint position in one step using indirect restorations – and then to replace these in groups with prepared dental ceramic restorations in a later step. The results of a study on the durability of this material from the treatment of PD Dr. Ahlers and his team have now been published in the prestigious journal Quintessence International. You can legally download here.

The preparation of veneers aims to be as minimally invasive as possible in the enamel alone. Studies from Galip Gürel’s working group in Istanbul have shown that this increases the durability of (ceramic) veneers by a factor of 10. For a long time, it was questionable how this goal could be achieved. As early as 1995, Natress et al. were able to show that there is a general risk of overpreparation, particularly in the cervical area, and that too little space is created in the incisal area.

A new study from Hamburg, Leipzig and Munich has now shown that compliance with preparation depths depends largely on the instruments used. Preparation instruments with depth markers are significantly more likely to prevent overpreparation. The study is “Editor’s Pick” No. 1 in the Journal of Prosthetic Research!!!

Dental functional diagnostics is information management. It is therefore not surprising that specialists have been working on improving the overview of findings and the transparency of their evaluation through the use of computer systems from an early stage. These systems are now ready for practical use and an initial study has demonstrated their efficiency. This article describes the application of individual modules and the advantages that digitization offers in each case.

While caries is decreasing as a result of good prevention, the incidence of tooth wear is increasing – especially in young adults. Various diagnostic schemes have been proposed in the past to identify those affected. Of these, only the Tooth Wear Evaluation System (TWES) provided for a multi-stage examination consisting of basic diagnostics and extended diagnostics.

An update was recently published for this , the TWES 2.0. This is initially intended to identify conspicuous patients by means of tooth wear screening. A detailed tooth wear status is then determined for these patients. This records the degree of wear of each individual tooth, signs of pathological tooth wear and indications of the cause of wear.

This article describes the practical procedure for digitally recording and evaluating the findings using special software (CMDbrux) and the treatment based on this using a comprehensive patient case from the treatment of PD Dr. Ahlers.

Tooth wear is increasing in incidence, especially in young patients. The causes are either mechanical and/or chemical. In the case of significant or extreme tooth wear, the vitality or preservation of the affected teeth is jeopardized. Pathological tooth wear also impairs esthetics, function and phonetics and/or causes pain. Early detection of increased tooth wear is therefore important. Until now, the standard for this was the Tooth Ware Evaluation System (TWES). This has been revised in recent years for the needs of dental practices and is now available in an updated version, TWES 2.0. You can find the original publication here.

In functional diagnostics, dentists collect numerous findings as part of individual functional examinations and organize them into an overall picture that is as differentiated as possible. In this respect, functional diagnostics is essentially medical data processing. The special feature here is that the functional disorder itself cannot be “seen”, which is why special findings and their evaluation are required in order to record the functional situation. Due to the large amount of individual information generated in this process, it makes perfect sense to transfer it to digital information processing systems. In addition to the digital fabrication of dental restorations, this is an area of dentistry that benefits considerably from digitization. This article shows the current status and describes the implementation for the individual examinations and the resulting options.

Bruxism is now recognized as an independent entity alongside CMD. Bruxism itself is apparently a normal bodily function. However, if it is too intense, bruxism becomes pathological for the various tissues of the masticatory organ. The GrindCare system was developed to dampen excessive bruxism in such cases, without the use of muscle relaxant medication. Until now, it was unclear how the GrindCare System should be used. An international working group from the Netherlands, Germany and Denmark has now developed a consensus for this – and published it at the highest level.

The adhesive technique and translucent restorative materials have changed the treatment of fixed dentures, and modern technologies enable the use of new polymer materials. These offer innovative possibilities for the pre-treatment of dentures. In addition, there are now new types of ceramics that make metal-free restorations possible. As a result, treatment concepts in fixed prosthetics have changed dramatically, and because there are so many new restorative materials, it is sometimes difficult to keep track of them all. This article deals with the latest developments in fixed prosthetics. It provides guidance on material selection for different dental treatments.

Electronic computer-assisted registration has become established for instrumental movement recording for articulator programming. Beyond this area of application, instrumental computer-assisted movement recording in protrusion, laterotrusion and also without tooth contact has now been introduced as the basis for functional movement analysis. The scientific basis for this has been developed over several years and the procedure is now suitable for practical use. The latest article in the leading online dental journal Quintessenz News describes how the diagnostic procedure can also be implemented digitally in practice.

Unlike caries, craniomandibular dysfunctions cannot be seen. As in periodontology, it is therefore not possible to assess the situation visually alone. Optimized diagnostic recording systems combine easy and error-avoiding recording with high informative value. This task is ideal for digital information systems.

For such systems to become established in practice, they must offer added value. Corresponding software (CMDfact) offers medical added value and uses modern software modules to integrate information from various functional analysis examinations (manual structural analysis, instrumental functional movement analysis) into the information base. This makes diagnoses increasingly accurate.

The article in the ZWR shows how this works and also shows how the same information is also used in patient communication.

The German Oral Health Study DMS V shows a significant decline in the incidence of tooth decay in Germany. The number of remaining teeth in old age has increased, indicating a trend towards tooth preservation, often supported by implants. Despite this positive development, there are concerns about tooth structure damage due to biocorrosion, attrition and abrasion, which have different defect morphologies. Restorative treatment concepts for this have differentiated: instead of predominantly subtractive methods, less invasive, defect-oriented approaches are now preferred, and new forms of preparation contribute to tooth preservation. This article highlights the principles of minimally invasive treatment using occlusal onlays to reconstruct damaged occlusal surfaces. These modern techniques make it possible to preserve tooth structure while achieving functional and esthetic results. Learn in this training article how you can optimize your treatment results through the targeted preparation of such occlusal onlays.

The cranial transfer of the upper jaw position using an arbitrary facebow is a procedure that was developed some time ago. Until now, however, there has been a lack of evidence-based proof that the procedure offers a measurable advantage compared to transferring the upper jaw position based solely on the orientation of the upper jaw position using mean values and, above all, proof that this effect is confirmed in larger groups of test subjects. A multi-center study by the Universities of Hamburg, Leipzig and Munich has now been able to show that transferring the upper jaw position using an arbitrary face bow leads to a significantly more reproducible and correct fitting of the upper jaw model than fitting according to mean values alone using classic orientation aids – and this in 38 test subjects! The study was published in one of the world’s twenty leading dental journals following an anonymous review process.

There has been a great deal of uncertainty since the ruling by the Munich Higher Regional Court in 2017. In the ruling, the Higher Regional Court determined that CMD screening must be carried out regularly before dental prostheses are fitted. This has obviously alarmed a wide range of people: An article that PD Dr. Ahlers had already published in the special issue “Funktion” of Quintessenz in 2015 has now been reprinted independently by the Berlin dentists’ newsletter. In it, the CMD short findings according to Ahlers and Jakstat are explained, the study for its introduction is explained and the resulting evaluation is described.

The recording of functional analysis findings using software (CNMDfact) is now standard, as is the assignment of findings to diagnoses. This has become an integral part of everyday clinical practice. What our working group wanted to find out was: Does this type of evaluation of findings also influence the quality of diagnoses? It’s not so easy to clarify this properly, because you need “real” cases – which we obtained anonymously and consecutively from practice – OK. Then you need suitable test subjects – that’s more difficult, because dentists don’t have time and are biased. Dentistry students at the end of their studies would therefore be perfectly suited: alert, open-minded, not biased. The only thing missing was a suitable test design, which Kai Becker determined – and implemented.

The result was that the quality of computer-assisted diagnoses is significantly better than with the traditional approach – with fewer false positive diagnoses. We had not expected the latter. Conclusion: Computer-assisted diagnostics with CMDfact is therefore the new “state of the art”…

Occlusal onlays are a comparatively new type of restoration for restoring occlusal surfaces in cases of tooth wear. They extend less cervically and are therefore much less invasive. In combination with new high-strength dental ceramics (LS2), they enable tooth-coloured atraumatic restoration of the tooth contours and stabilization of the function of the craniomandibular system. The usual preparation instruments are less suitable for this purpose. The CMD Center Hamburg-Eppendorf(PD Dr. Ahlers) and the LMU Munich (Prof. Dr. Edelhoff) have therefore developed new strategies and suitable instruments. The article in the long-established ZWR – Das Deutsche Zahnärzteblatt illustrates both.

The new textbook on dental functional diagnostics and therapy by Dr. Jürgen Dapprich describes its expansion of the diagnostic procedure to include new orthopaedic examination techniques. PD Dr. Ahlers was commissioned by the editors of ZMK to review the book and describes the individual chapters and their contents.

Previous research determined the relevance of masticatory performance with regard to nutritional status, cognitive functions, or stress management. In addition, the measurement of masticatory efficiency contributes to the evaluation of therapeutic successes within the stomatognathic system. However, the question remains unanswered as to what extent modern techniques are able to reproduce the subtle differences in masticatory efficiency within various patient groups. The purpose of this review is to provide an extensive summary of the evaluation of masticatory performance by means of a color-changeable chewing gum with regard to its clinical relevance and applicability. You can download a private copy from this site of the authors.

Previously, there were only 2 now outdated scientific bulletins on instrumental functional analysis from the former AFDT. In the meantime, the state of the art and science has developed further and, in 2011, the DIMDI criticized the lack of a guideline for the orientation of the public. Under the leadership of the DGFDT, such a guideline has now been developed and published in coordination with 12 other specialist societies.

Due to the high level of international interest, an English translation has been produced from donations and the guideline has therefore been published bilingually in this article for the guidance of the public in Germany and internationally.

Scientific communication of the German Society for Functional Diagnostics and Therapy (DGFDT) in the DGZMK, the German Society for Prosthetic Dentistry and Biomaterials (DGPro), the German Society for Oral and Maxillofacial Surgery (DGMKG), the Working Group for Maxillofacial Surgery (AGKi), the German Society for Orthodontics (DGKFO) and the German Society for Dental, Oral and Maxillofacial Medicine (DGZMK), published in the German Dental Journal, DZZ

Craniomandibular dysfunction (CMD) is one of the more common conditions in dentistry. They occur in all dental practices, so it is helpful to be able to identify affected patients by simple means. The first stage of diagnostics consists of identifying patients who are conspicuous by means of CMD screening. Based on Krogh-Poulson’s suggestions, the authors have developed and scientifically investigated the CMD short findings. The article describes the basic principles and the practical procedure for this examination.

Functional diagnostic measures are carried out in stages. If CMD is suspected, the clinical functional analysis forms the basis. The concept of evaluating the clinical functional analysis in such a way that a diagnosis can already be made on its basis is new. The principles of evaluation have now been transferred to computer-aided systems, which help to assign the individual findings to the appropriate diagnoses. The same data can also be used for new patient consultation systems and in expert systems for therapy planning, which put the local practitioner in the same situation of collegial coordination as should be the case at specialized centers. The article presents the aim of the study, its implementation and evaluation as well as its consequences and gives an outlook on future developments.

Restorative final treatment after functional therapy is indicated within narrow limits. This article describes these in detail as well as the alternatives. These include orthodontic or conventional restorative treatment procedures (with long-term temporaries and crowns), or minimally invasive prepared restorations (“table-tops”) as well as non-invasive forms of restoration available (“reduction onlays” or “reduction veneers”). This article in the special issue “Function” of Quintessenz, which has already been described by a third party as a “basic article”, describes the background, indications, forms of treatment and the practical procedure.

In the rehabilitation of functionally impaired patients in dental practice, too little attention has so far been paid to the assessment of functionally impaired chewing ability as a central task of the masticatory organ. The article therefore presents three selected measurement methods (classic comminution test, color mixing test, color change test).
Various evaluation methods exist for all test methods, which are described. There is also an assessment of the advantages and disadvantages and existing obstacles that have so far made practical application difficult.

The DIMDI had long called for the development of a guideline for instrumental functional analysis. This is now available at level S2k. It was developed by a group of specialist societies with the leading participation of four authors, including PD Dr. M. Oliver Ahlers.