Can an NTI-tss device be effective as a first-line therapy in patients with TMD myofascial pain?

This study was conducted to evaluate whether integrating a nociceptive trigeminal inhibition-tension suppression system (NTI-tss) device with first-line therapy of myofascial pain, which includes guidance, assurance, counselling and behavioural changes, would be more effective in alleviating symptoms. This randomised controlled clinical trial included 40 patients who were clinically diagnosed with myofascial pain according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients were randomly divided into two groups: the first group comprised patients who received guidance, assurance, counselling and behavioural changes; an NTI-tss device was integrated to this protocol in the second group. Both groups exhibited reduction in pain levels and improvement of jaw function compared with baseline values, but the difference was not significant. Both groups demonstrated improvements in 6 weeks; however, the integration of NTI-tss device into the therapy protocol did not provide any additional benefit in relieving symptoms of myofascial pain.

Does the use of soft or hard splints affect the short-term outcome of temporomandibular joint arthrocentesis?

Arthrocentesis is an effective treatment modality for temporomandibular joint (TMJ) disc displacement without reduction (DDw/oR), especially in patients who do not respond to non-surgical methods, and is nowadays regarded as a first-line treatment. Soft and hard stabilizing splints have also been used to treat TMJ disorders, but no data are available regarding the use of splints following arthrocentesis. The aim of this study was to compare the effect of the use of soft or hard stabilizing splints versus no appliance following TMJ arthrocentesis on the prognosis of the treatment. Forty-five patients with DDw/oR were included in the study. Pain was measured on a visual analog scale, and maximal mouth openings, lateral jaw movements and tenderness were recorded before arthrocentesis. Following arthrocentesis hard splints were fabricated for 22 patients, soft splints for 9 patients, and 14 patients without any splint served as controls. All the measurements were repeated 1 day, 1 month, 3 months and 6 months after arthrocentesis. Improvement in mouth opening was significant as well as decrease in pain in all groups regardless of the use of splints (P<0.05). Arthrocentesis alone is a successful procedure in the treatment of DDw/oR; the use of splints as an additional therapy does not affect the short-term prognosis.

Is there a greater mandibular movement capacity towards the left? Verification of an observation from 1921.

In 1921, the German dentist Hans Wertheim reported that more individuals were able to shift the mandible more towards the left than to the right. This study analyses the deviation from symmetrical mobility of the lower jaw in either direction. Using a millimetre ruler, maximum jaw opening (MJO), maximum left laterotrusion (MLL), and maximum right laterotrusion (MRL) were recorded in 141 healthy individuals and in 141 patients with temporomandibular disorders (TMDs). For both sexes, the mean maximum movements to the left and to the right were greater in the healthy group as compared with the TMD group. Healthy subjects as well as patients were able to move the mandible more to one side. Only a minority had identical values for MLL and MRL. The majority of healthy individuals and TMD patients could move more to the left (P < 0.001). In the healthy group, the mean ratio between MJO and MLL was 5.0, and 5.5 between MJO and MRL. In the TMD group, the corresponding values were 4.6 and 6.1. The mean absolute difference between MLL and MLR (in mm) was 1.24 [95% confidence interval (CI): 0.99; 1.49] among healthy females, and 2.09 (95% CI: 1.52; 2.66) among healthy males. In the TMD group, the corresponding values were 2.62 (95% CI: 2.21; 3.04) and 2.83 (95% CI: 1.67; 4.00), respectively. From the results of our study we conclude that moderate deviations from symmetric movements (mean: 1.2 mm for women, 2.1 mm for men) appear to be the norm even in healthy individuals.

Five-year retrospective evaluation of temporomandibular joint arthrocentesis.

This retrospective study is aimed to evaluate the long-term outcome of arthrocentesis for the treatment of temporomandibular joint (TMJ) internal derangements, and to document the impact of patient, time and symptom-related factors on the outcome of the procedure. Thirty-four patients (48 joints) who underwent TMJ arthrocentesis were included in this study. The scores for preoperative maximal mouth opening, and VAS scores for pain and dysfunction were compared with the follow-up scores obtained by the questionnaire and clinical examination. Several factors that may affect the long-term outcome of arthrocentesis are further evaluated. Statistical evaluation of the baseline and follow-up data was made by linear regression analysis and paired t-test. The mean follow-up period was 22 months. There was a significant (P< 0.001) increase in the maximal mouth opening (MMO) postoperatively that held during the longer term follow-up period. The pain and dysfunction levels at the follow-up were significantly (P< 0.001) lower than the preoperative values. Twenty-six per cent of patients were pain free and also showed a total relief in dysfunction at the follow-up. Although both preoperative and follow-up pain scores were higher in patients with bruxism, there was not a significant difference in the outcome when compared with non-bruxers. However, there was a greater reduction in dysfunction with improvement in MMO in non-bruxers. The duration of symptoms before arthrocentesis has not been found to affect the outcome. Also, there were no significant differences between the results of follow-up when comparing the shorter follow-up time results (<20 months) and longer term results. Arthrocentesis for the treatment of TMJ internal derangements offers favourable long-term stable results with regard to increasing maximal mouth opening, and reducing pain and dysfunction.

Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements.

PURPOSE: This study was designed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate (SH) into the upper joint space in the treatment of temporomandibular joint (TMJ) internal derangements. PATIENTS AND METHODS: Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material. The patients' complaints were limited mouth opening, TMJ pain and tenderness, and joint noises during function. Patients were randomly divided into 2 groups in which only arthrocentesis was performed in 1 group and arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in the other group. Both groups contained patients with disc displacement with reduction and with closed lock. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, on postoperative day 1, and at 1, 2, 3, 4, 5, 6, 9, 12, 18, and 24 months postoperatively. Intensity of TMJ pain, jaw function, and clicking sounds in the TMJ were assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit. RESULTS: Both techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise. CONCLUSIONS: Although patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone.

Effect of arthrocentesis and sodium hyaluronate injection on nitrite, nitrate, and thiobarbituric acid-reactive substance levels in the synovial fluid.

OBJECTIVE: To evaluate the effect of arthrocentesis and sodium hyaluronate (SH) injections on nitrite, nitrate, and thiobarbituric acid-reactive substance (TBA-RS) levels in temporomandibular joint internal derangements. STUDY DESIGN: Arthrocentesis was performed on 10 patients, and 15 patients received a supplemental injection of SH after arthrocentesis. All these patients received an SH injection 15 days after the first intervention. The synovial fluid samples were obtained before arthrocentesis on the first appointment and before the SH injection 15 days later. Nitrite and nitrate levels were measured with a highly sensitive and specific chemiluminescence detection method, and the concentration of lipid peroxidation products was assessed by means of the thiobarbituric acid reaction. RESULTS: Symptomatic improvement was seen in both groups. Nitrite, nitrate, and TBA-RS levels only decreased significantly (P <.05) with a supplemental SH injection after arthrocentesis. CONCLUSIONS: Intra-articular injections of SH may reduce nitrite, nitrate, and TBA-RS levels that play a role in the pathogenesis of various temporomandibular disorders.

Disturbances in oral and dental structures in patients with pediatric lymphoma after chemotherapy: a preliminary report.

OBJECTIVE: The purpose of this study was to evaluate the effects of chemotherapy on oral and dental structures and craniofacial growth in 30 survivors of childhood lymphoma. STUDY DESIGN: Eruption status, root malformations, premature apexification, agenesis, crown anomalies, soft tissue abnormalities, gingival and periodontal status, enamel defects and discolorations, and craniofacial growth status of the subjects were documented and compared with findings in 20 healthy children who served as controls. RESULTS: Statistically significant (P < .05) differences between the study and control groups were found for plaque index, enamel hypoplasias, discolorations, and agenesis. CONCLUSIONS: The results of the study suggest that antineoplastic therapy and/or childhood cancer can result in a higher prevalence of various malformations in teeth. Children treated in the early years of their lives displayed the most severe dental defects, suggesting that immature teeth are at a greater risk of developmental disturbances than fully developed teeth.

Mandibular soft tissue mass as the initial presentation of Burkitt's lymphoma.

A six-year-old girl was evaluated for an intraoral mass of 5 months duration, which had been treated with antibiotics in a district hospital. Extraoral examination showed a firm, non-tender swelling at the angular region of the left mandible with regional lymphadenopathy. Intraoral examination revealed a mass extending from the left mandibular primary first molar to the retromolar region, interfering normal occlusion. The mass was painful and firm, peduculated and reddish in appearance. The remainder of the oral examination was unremarkable. Panoramic radiograph and CT scan showed a large multilocular radiolucency beginning from the bud of second premolar, extending to the mandibular ramus that displaced the bud of second molar. Incisional biopsy of the intraoral mass was performed and the result was reported as Burkitt's lymphoma. The child was treated with chemotherapy and radiation, with recurrence.

Tissue reaction to three subcutaneously implanted local hemostatic agents.

Soft tissue response to three subcutaneously implanted local hemostatic agents; oxidised regenerated cellulose (Surgicel), gelatin sponge (Spongostan) and collagen sponge (Hemostagen) were evaluated histopathologically 7, 14, 21, 30 and 45 days following their implantation in rats. The results showed that all materials were well tolerated by soft tissues. These materials neither seemed to impair nor contribute to wound healing.

Postoperative pain control by single doses of piroxicam administered sublingually and aspirin.

The objective of this study is to evaluate and compare the analgesic efficacy of Piroxicam Fast Dissolving Dosage Formulation (FDDF) administered sublingually either preoperatively or postoperatively with that of aspirin and placebo. Hundred patients, undergoing surgical removal of mandibular third molars were given sublingually either piroxicam FDDF 40 mg or placebo or aspirin 500 mg according to a double blind experimental model. Pain scores and pain relief was recorded hourly for six hours following the operation. Rescue analgesics used during the trial and overall assessment of the drug were recorded at the end of six hours. Scores were evaluated statistically by student t test. Piroxicam FDDF was significantly (p < 0.05) more effective than aspirin and placebo for all variables, and less rescue analgesics were required in patients receiving piroxicam preoperatively. It was concluded that single doses of piroxicam FDDF administered sublingually either preoperatively or postoperatively appeared to be effective analgesic for the control of pain after third molar surgery with no side effects.

Long-term evaluation of recombinant human bone morphogenetic protein-2 induced bone formation with a biologic and synthetic delivery system.

The efficacy of microspheres made of polylactic acid polyglycolic acid copolymer mixed with blood clot as a delivery system for recombinant human bone morphogenetic protein-2 (rhBMP-2) was evaluated and the long term behaviour of rhBMP-2 in rats was studied. Twenty micro grams of rhBMP-2 in 200 microliter carrier (blood coagulum and polylactic acid polyglycolic acid porous microspheres) were implanted subcutaneously over both sides of the chest muscles in 40 5-week-old male Long Evans rats. The control group were implanted with carrier alone. Specimens were retrieved after 3 days and weekly for 9 weeks. Outcome was measured by signs of bone formation on low power radiographs, and signs of bony growth on histological examination. There were no signs of foreign body or inflammatory reactions to the carrier in either group. In the experimental group signs of bone formation had started to appear by the end of the first week, and there was a gradual increase in both radio-opacity and size during the observation period. Histologically the bony growth was beginning to mature by 4 weeks and was fully mature by 7-9 weeks. In contrast there was no sign of cartilage or bone formation in the control group and the carrier had resorbed by 4-6 weeks. It is concluded that rhBMP-2 implanted in a carrier consisting of blood clot and porous microspheres made of polylactic acid polyglycolic acid induces rapid proliferation of mesenchymal cells that lead to formation of cartilage and bone by 7 days which had matured by 9 weeks. rhBMP-2 in this carrier may be useful clinically because of its capacity to induce early formation of bone.

Serum alkaline phosphatase, calcium, and phosphate levels following clinical use of natural coral. Case reports.

Measurement of alkaline phosphatase enzymatic activity is the most commonly used serum marker to assess bone formation. In this present study serum alkaline phosphatase, calcium, and phosphate were measured in 12 patients where natural coral was implanted in surgical bony defects. Blood samples were obtained preoperatively which served as control, and at 1, 7, 15, and 30 days. No statistically significant increase in serum alkaline phosphatase, calcium, and phosphate was observed.

Bone reaction to subperiosteally implanted hydroxyapatite/collagen/glycosaminoglycans and coral in the guinea pig.

Tissue reactions and new bone formation at 30, 60, and 90 days after the subperiosteal implantation of hydroxyapatite/collagen/glycosaminoglycans and blocks of coral in 18 guinea pigs were evaluated histologically with the use of polarized light and light microscopy. Animals implanted with coral showed new bone formation at each time interval and resorption of coral was observed. Histopathologic evaluation of hydroxyapatite/collagen/glycosaminoglycans implants revealed no evidence of new bone formation and the hydroxyapatite particles were surrounded by fibrous connective tissue.