Surgical treatment of osteochondroma of the mandibular condyle in the adult. A 5-year follow-up.

Five adult patients with temporomandibular joint (TMJ) pain and impaired mandibular function and with clinical and radiographic features of unilateral osteochondroma of the mandibular condyle was included in a 5-year prospective follow-up study. All patients were surgically treated with condylectomy and reshaping of the condylar neck which was then positioned underneath the preserved TMJ disk. The yearly follow-up evaluations comprised measurements of maximum interincisal opening and protrusive movements, assessments of occlusion and TMJ pain as well as tomographic interpretation of recurrent growth. No patient showed recurrence of growth at the 5-year follow-up and mandibular function and occlusion was normalized in all patients. The results indicate that this conservative surgical approach can be recommended for treatment of osteochondroma of the mandibular condyle.

Brånemark System and ITI Dental Implant System for treatment of mandibular edentulism. A comparative randomized study: 3-year follow-up.

In a randomized prospective study, two implant systems were compared in forty consecutive patients treated for mandibular edentulism. The patients were randomly allotted for treatment by the Brånemark two-stage (submerged) system (BRS), or the ITI(R) one-stage (non-submerged) system. In all, 102 Brånemark selftapping implants and 106 ITI hollow screw implants were installed and all patients were treated with full bridges. Biological and prosthodontic parameters, complications, success rates, clinical efficacy, patient satisfaction and resource requirements were evaluated. No differences were found in plaque accumulation, bleeding or complications during the follow-up period. The BRS group showed deeper periimplant sulcus, less attached mucosa, larger bridge-mucosa distance and higher Periotest values. Prosthetic complications were not related to the configuration of the implant systems. After 3 years, the cumulative success rates were 97.9% and 96.8% for the Brånemark and ITI systems, respectively (difference not statistically significant). One implant in the BRS group had failed to osseointegrate at the time of abutment connection, and another was lost after 2 years due to progressive breakdown of bone. In the ITI group, three implants showed progressive bone loss after 1-3 years associated with periimplant infection. All 40 bridges were intact and remained stable throughout the study. There was general patient satisfaction, but about half the Brånemark patients reported difficulty in coping with the surgical procedures. Treatment time was similar for the two systems. It is concluded that both systems meet the current requirements for dental implant systems in the treatment of mandibular edentulism.

A comparison of discectomy and arthroscopic lysis and lavage for the treatment of chronic closed lock of the temporomandibular joint: a randomized outcome study.

PURPOSE: The study compared the efficacy of discectomy or arthroscopic lysis and lavage in patients with chronic closed lock of the temporomandibular joint (TMJ) in a prospective, randomized clinical trial. PATIENTS AND METHODS: Twenty-two patients with a clinical diagnosis of chronic closed lock were prospectively randomized to either discectomy or arthroscopic lysis and lavage. The individual outcome in each patient was evaluated with a visual analog scale for pain and a questionnaire concerning mandibular functional impairment. The clinical evaluation included measurement of maximum interincisal opening and protrusion, recording of clicking and crepitation, and palpation for tenderness of the TMJ and jaw muscles. Recordings were made before the operation (baseline) and at the 1-year follow-up. RESULTS: Twenty patients completed the study. Discectomy and arthroscopic lysis and lavage significantly reduced pain and improved mandibular function. Discectomy reduced pain somewhat more effectively than arthroscopic lysis and lavage. The clinical recordings at the 1-year follow-up indicated similarly good outcomes after both procedures. CONCLUSION: Both discectomy and arthroscopic lysis and lavage are effective surgical methods for treatment of chronic closed lock of the TMJ. Considering that arthroscopic lysis and lavage is a minimally invasive outpatient procedure, it should be used as the first choice in surgical treatment of this condition.

Direct oral microscopy and its value in diagnosing mucosal lesions: a pilot study.

OBJECTIVE: Clinical examination of the oral mucosa often leads to an uncertain diagnosis, and a supplementary biopsy with a histopathologic examination of the lesion is necessary to establish a definite diagnosis. However, the site for the biopsy is a subjective choice that sometimes raises doubts about its representativeness. So far, no simple and reliable method is available for selecting the most appropriate area for biopsy. STUDY DESIGN: In a prospective study, we performed direct oral microscopy (oral application of the colposcopy technique used in gynecology) in 35 patients with various clinical diagnoses, such as leukoplakia, oral lichenoid lesions, or suspected malignancy. First, the oral mucosa was examined with direct microscopy, and the most representative site, according to colposcopic criteria, was selected. Then, the mucosa was clinically inspected by an independent examiner. The best site for biopsy according to clinical criteria was noted, and any difference in biopsy sites was recorded. Biopsy specimens were taken from 2 of these sites. RESULTS: Twenty-nine patients (83%) showed changes in the vascular picture on microscopy, according to the colposcopy criteria. In 14 patients (40%), the biopsy sites identified by direct oral microscopy showed more advanced histologic signs than those selected by routine clinical examination (0.01 < P

Surgical treatment of temporomandibular joint luxation.

Eminectomy with or without diskectomy was performed in 19 patients with temporomandibular joint luxation. Three of them were long-standing luxations (duration between three months and one year). The remaining 16 patients had recurrent luxations. The follow-up period was three years. No complications such as infection or permanent palsy of the facial nerve occurred. However, transient palsy of the temporal branch of the facial nerve, which resolved within three months was seen in 4 patients (21%). After treatment two patients had recurrent luxations. In the remaining 17 patients, two developed painful clicking of one TMJ, requiring additional surgery (one patient had arthroscopic lysis and lavage and the other one diskectomy). If these two are also regarded as unsuccessful cases, the overall long-term success rate was 79%. A comparison of the subgroups who underwent eminectomy alone and eminectomy with diskectomy showed that all unsuccessful cases occurred in the former group.

Evaluation of single-tooth restorations on ITI dental implants. A prospective study of 29 patients.

From January 1992 to March 1997, a total of 30 ITI hollow cylinder implants were installed to replace lost single maxillary incisor teeth. Conical abutments with cemented all-ceramic crowns were used in 10 cases and the Octa-abutment with screw-retained metallo-ceramic crowns in 19 cases. One implant failed due to postoperative infection, and was extracted a month after installation. After a mean observation time of 3.4 years, the cumulative success rate is 96.7%. Only minor bone loss has occurred around the implants, and there have been no other complications to date. The implant system fulfills the requirements for good function and esthetics.

Implant treatment without bone grafting in severely resorbed edentulous maxillae.

PURPOSE: This article describes the surgical technique for implant treatment in severely resorbed edentulous maxillae without any alveolar reconstruction before or combined with implant placement. PATIENTS AND MATERIAL: Fifteen patients with severely resorbed edentulous maxillae were treated with osseointegrated implants and fixed dental prostheses. All patients were initially considered to be treated with bone grafting because of a lack of sufficient bone volume for conventional treatment. Preoperative radiographic examinations showed that the height of the alveolar crest was on average 7.4 mm at the 4-mm-width level (Classes V to VI). RESULTS: By fenestration of the maxillary sinus and uncovering the nasal floor, the maxillary bone could be visualized and used maximally for installation of implants. By angulation of the implants and permitting two to five uncovered fixture threads on the palatal aspect, implants of optimal length could be installed. Eighty-six implants were placed (four to six implants in every patient). One implant was lost during the observation time (range, 36 to 54 months; mean, 45 months). All patients had stable fixed prostheses at the end of the observation time. CONCLUSION: This cost-effective surgical technique may be considered as an alternative to more resource-demanding techniques such as bone grafting in patients with severely resorbed edentulous maxillae. However, further prospective comparative studies are necessary for full evaluation.

Synovial inflammation in arthroscopically obtained biopsy specimens from the temporomandibular joint: a review of the literature and a proposed histologic grading system.

Data indicate that the synovial lining of the temporomandibular joint (TMJ) in some respects differs from other joints. The normal variation in morphology of the synovial lining of the TMJ is quite great, whereas the variation in pattern of pathologic changes appears to be relatively small (ie, synovial inflammation is not of the severity as that in other joints). In the current review, a system for histologic grading of synovial inflammation is proposed. The system is based on semiquantitative evaluation of the following set of parameters: 1) synovial lining cell layers; 2) vascularity (number or size of vascular profiles); and 3) Inflammatory cell infiltrate (commonly lymphocytes).

Comparison of arthroscopy and radiography in patients with temporomandibular joint symptoms and generalized arthritis.

OBJECTIVE: To compare arthroscopy with radiography in patients with temporomandibular joint (TMJ) symptoms and generalized joint disease. METHODS: Twenty patients with generalized osteoarthritis (GOA) and TMJ symptoms and 21 patients with rheumatoid arthritis (RA) and TMJ symptoms were examined with arthroscopy and radiography (individualized oblique lateral transcranial projections and sagittal and frontal tomography). RESULTS: In the GOA group there was a significant correlation between pronounced degenerative changes at arthroscopy and flattening of the eminence and reduced joint space superiorly and posteriorly on radiographs and between moderate to pronounced bone or disk remodelling and reduced joint space superiorly and posteriorly. In the RA group there was a significant correlation between moderate to pronounced degenerative changes at arthroscopy and radiographically extensive erosions in the condyle and between moderate to pronounced fibrosis and reduced translation. CONCLUSION: Compared with conventional tomography, arthroscopy revealed TMJ pathology earlier and more frequently. It may therefore in individual cases be the first choice examination, particularly as treatment can be given simultaneously.

Dental implant installation without antibiotic prophylaxis.

The objective of this study was to retrospectively compare the outcomes of dental implant treatment with and without antibiotic prophylaxis. Two groups of patients with edentulous or partially edentulous maxillas or mandibles (or both) were treated with dental implants. One group, consisting of 147 patients (790 implants), was given prophylaxis with oral phenoxymethylpenicillin; 1 g of antibiotic was administered 1 hour preoperatively, and 1 g was administered every 8 hours for 10 days postoperatively. The other group, consisting of 132 patients (664 implants) was not given any antibiotics preoperatively or postoperatively. There were no significant differences with respect to early and late postoperative infections or with respect to implant survival between the two groups. It appears that antibiotic prophylaxis for routine dental implant surgery offers no advantage for the patient.

Efficacy of arthroscopic lysis and lavage in patients with temporomandibular joint symptoms associated with generalized osteoarthritis or rheumatoid arthritis.

PURPOSE: This study evaluated the efficacy of arthroscopic lysis and lavage in patients with temporomandibular joint (TMJ) symptoms and generalized osteoarthritis (GOA) or rheumatoid arthritis (RA). PATIENTS AND METHODS: Twenty-three GOA patients and 23 RA patients were evaluated after 1 year. RESULTS: Seventeen of 23 patients (74%) in the RA group improved after arthroscopic lysis and lavages compared with 10 of 23 (43%) of the GOA patients. Lateral joint tenderness, crepitation, maximal opening, and maximal protrusion showed most improvement in the RA group. CONCLUSIONS: On the basis of this short-term follow-up study, arthroscopic lysis and lavage seem to provide an effective treatment for TMJ pain and dysfunction in RA patients but not in GOA patients.

Temporomandibular joint involvement in generalized osteoarthritis and rheumatoid arthritis: a clinical, arthroscopic, histologic, and immunohistochemical study.

Twenty patients having generalized osteoarthritis (GOA) and symptomatic temporomandibular joints (TMJs) were compared with 22 patients having rheumatoid arthritis (RA) and TMJ symptoms, and also with an age-matched reference tissue material obtained at autopsy from 17 TMJs. Muscle tenderness was commoner in GOA. Arthroscopically, high frequencies of synovitis, degenerative changes, and fibrosis were observed in both groups, with more pronounced inflammatory and degenerative changes in RA patients, despite a shorter duration of TMJ symptoms. A correlation was noted between lateral joint tenderness and pronounced synovitis in RA patients. Histologic and immunohistochemical examinations added useful information to arthroscopy and showed similarly high frequencies of synovial inflammation in GOA and RA patients, differing clearly from those in the reference material. Connective-tissue degeneration was commoner in GOA patients. GOA and RA probably have different causes, but, interestingly, the tissue reaction was similar in the TMJs, although pronounced inflammatory and degenerative changes seemed to develop faster in RA.

Radiographic changes in the temporomandibular joint in patients with generalized osteoarthritis and rheumatoid arthritis.

This is the first study concerned with radiographic characteristics in patients with generalized osteoarthritis and signs and symptoms of temporomandibular joint involvement. For comparison, patients with rheumatoid arthritis and temporomandibular joint involvement were used. The patient material comprised 20 patients with generalized osteoarthritis (20 joints) and 21 patients with rheumatoid arthritis (21 joints). The radiographic methods were corrected sagittal tomography (hard tissue changes, joint space, and condylar position), frontal tomography (hard tissue changes), and individualized oblique lateral transcranial projections (condylar translation). Sixteen (80%) joints in the group of patients with generalized osteoarthritis and 15 (71%) joints in the group with rheumatoid arthritis revealed structural changes. The condyle was the predominant location. No radiographic criterion was pathognomonic for generalized osteoarthritis or rheumatoid arthritis. However, osteophytes, flattening of the condyle, or a reduced joint space was observed more often in joints with generalized osteoarthritis, whereas erosions in the condyle were more common in joints with rheumatoid arthritis. The radiographic findings in patients with generalized osteoarthritis are more similar to those seen in patients who have the common form of temporomandibular joint osteoarthritis than to those in patients with rheumatoid arthritis.

Synovitis in internal derangement of the temporomandibular joint: correlation between arthroscopic and histologic findings.

PURPOSE: To define arthroscopic criteria for synovitis (SYN) reflecting specific histologic changes. Arthroscopic observations in the temporomandibular joint of patients with internal derangement were compared with histologic patterns in synovial biopsies obtained during arthroscopy. PATIENTS AND METHODS: Arthroscopic biopsies were obtained in 31 joints of 31 patients using an oriented semiblind technique. The histologic changes in the biopsies were compared with those in age-matched reference material obtained at autopsy. RESULTS: Microscopic examination of the reference material showed inflammation in three specimens (18%), whereas it showed inflammation in 22 patient specimens (71%). Biopsies from the patients also exhibited more pronounced inflammation. According to conventional criteria, arthroscopy showed mild SYN (increased vascularity) in 51%, moderate changes in 39%, and more pronounced changes in 10% of the joints. The presence of moderate or pronounced arthroscopic signs of SYN (capillary hyperemia and synovial hyperplasia), correlated well with the histologic diagnosis of SYN. This was in contrast to patients with mild arthroscopic SYN (increased vascularity). CONCLUSION: Increased vascularity seen during arthroscopy must be questioned as a sign of SYN. More reliable criteria seem to be capillary hyperemia and synovial hyperplasia.

Disk derangement and inflammatory changes in the posterior disk attachment of the temporomandibular joint. A histologic study.

Temporomandibular joint disk derangements were investigated in 42 patients (47 joints) with respect to occurrence and degree of histologic inflammation in the posterior disk attachment and compared with reference material obtained at autopsy. Sensitivity and specificity for arthroscopy versus macroscopic observation at arthrotomy in regard to inflammation were also investigated. On histologic examination, inflammation was found in 1 joint (5.5%) in the reference material and 30 joints (64%) in the patients where pronounced inflammation was found in 6 joints (20%). Arthroscopy revealed inflammation more accurately (sensitivity 0.94%, specificity 0.86%) than macroscopic observation at arthrotomy (sensitivity 0.58%; specificity 0.90%).