Is there a link between tinnitus and temporomandibular disorders?

STATEMENT OF PROBLEM: The frequent concurrence of tinnitus and temporomandibular joint and masticatory muscle disorders (TMD) has led to the assumption that a possible relationship exists between these 2 conditions. PURPOSE: The present prospective clinical study was conducted to assess the possible association between tinnitus and TMD and to investigate the effect of stomatognathic therapy on tinnitus distress. MATERIAL AND METHODS: The prevalence of TMD and tinnitus was investigated in a consecutive series of 951 patients at the Department of Prosthetic Dentistry at the University Medical Center Regensburg, Germany. Patients with TMD and simultaneous tinnitus were included in the prospective clinical trial (n=25). Baseline examination comprised a detailed functional analysis, diagnosis of temporomandibular joint and masticatory muscle disorder, and a tinnitus questionnaire. All the participants received individual dental functional therapy (oral splints, physiotherapy). The effects of functional therapy on TMD and tinnitus symptoms were examined 3 to 5 months after the initiation of dental functional therapy. Means (standard deviations) were calculated, and 1-way ANOVA was used to investigate statistical differences (α=.05). The differences of the 2 binary outcomes were compared with the Pearson χ(2) test, and the relative risk was calculated. RESULTS: Prevalence of tinnitus was found to be 8 times higher in participants with TMD (30 of 82 [36.6%]) than in participants without TMD (38 of 869 [4.4%]). All the participants with unilateral TMD and unilateral tinnitus showed these conditions on the same side. Stomatognathic therapy improved tinnitus symptoms in 11 of 25 participants (44%). CONCLUSIONS: The results of this study and the prospective clinical trial showed a significant correlation between tinnitus and TMD. The observed treatment outcome suggests that dental functional therapy may have a positive effect on TMD-related tinnitus.

Streptococcal adhesion to various luting systems and the role of mixing errors.

OBJECTIVE: This study aims at ranking various luting systems according to their susceptibility to adhering Streptococcus mutans and at evaluating the influence of incongruent mixing ratios on adhesion quantities. MATERIAL AND METHODS: Circular specimens measuring 8 mm in diameter were made of nine widely used dental cements -- three of them mixed in different ratios -- and then incubated with S. mutans. Adhering streptococci were quantified using a biofluorometric assay in combination with an automated plate reader for cell quantification. Surface roughness (R(a)) was determined by perthometer measurements. RESULTS: Meron plus revealed the highest R(a) (0.90 microm) and glass the lowest R(a) (<0.01 microm). In regular cement mixtures, the highest mean fluorescence intensities indicated the presence of many viable bacteria [Meron Plus (35,533 relative fluorescence units (rfu)), Maxcem (13,374 rfu), and Panavia F 2.0 (11,701 rfu)]. Moderate fluorescence intensities were found in Harvard (4,171 rfu), Ketac cem (3,766 rfu), Durelon (3,276 rfu), Calibra (3,259), Rely X Unicem (4,358 rfu), and Bifix SE (3,102 rfu). A medium correlation between R(a) and S. mutans adhesion was found. Changes in regular cement proportions (powder/liquid and base/catalyst, respectively) had a significant influence on relative fluorescence intensities, which linearly increased with a higher proportion of liquid in Harvard and with a higher proportion of catalyst in Calibra and Maxcem. CONCLUSIONS: Various luting systems revealed considerable differences in their potential to adhere S. mutans. Variations from recommended cement proportions led to significant changes in the amount of adhering streptococci.

Multi-slice real-time MRI of temporomandibular joint dynamics.

OBJECTIVES: The purpose of this work was to improve the clinical versatility of high-speed real-time MRI studies of temporomandibular joint (TMJ) dynamics by simultaneous recordings of multiple MRI movies in different sections. METHODS: Real-time MRI at 3 T was realized using highly undersampled radial FLASH acquisitions and image reconstruction by regularized nonlinear inversion (NLINV). Multi-slice real-time MRI of two, three or four slices at 0.75 mm resolution and 6 to 8 mm thickness was accomplished at 50.0 ms, 33.3 ms or 25.5 ms temporal resolution, respectively, yielding simultaneous movies at 2 × 10, 3 × 10 or 4 × 10 frames per second in a frame-interleaved acquisition mode. Real-time MRI movies were evaluated by three blinded raters for visibility of the anterior and posterior border of disc, shape of the disk body and condyle head as well as movement of the disc and condyle (1 = excellent, 5 = no visibility). RESULTS: Effective delineation of the disk atop the mandibular condyle was achieved by T1-weighted images with opposed-phase water-fat contrast. Compared to 8 mm sections, multi-slice recordings with 6 mm thickness provided sharper delineation of relevant structures as confirmed by inter-rater evaluation. Respective dual-slice and triple-slice recordings of a single TMJ as well as dual-slice recordings of both joints (one slice per TMJ) received the highest visibility ratings of ≤ 2 corresponding to high confidence in diagnostic content. CONCLUSIONS: The improved access to TMJ dynamics by multi-slice real-time MRI will contribute to more effective treatment of temporomandibular disorders.

Efficacy of denture disinfection methods in controlling Candida albicans colonization in vitro.

OBJECTIVE: The aim of this study was to rank 10 denture disinfection methods according to their efficacy in reducing Candida albicans (C. albicans) colonization on soft denture relining material. MATERIAL AND METHODS: Circular specimens (diameter 8 mm) were made of soft denture relining material (Mucopren E, Kettenbach) and thermally aged. Specimens were incubated with C. albicans (strain 1386, DSMZ) followed by 1 of 10 disinfection procedures (6 soaks, 2 microwave irradiation regimes, 1 effervescent commercial cleansing product, and denture left dry overnight). Incubation with phosphate buffered saline (PBS) served as a control. Adhering fungi were quantified using a bioluminometric assay in combination with an automated plate reader for cell quantification. Scanning electron micrographs (SEMs) were made for validation. RESULTS: Low median luminescence intensities indicated the presence of a few viable fungi after the soaking of specimens in sodium hypochlorite (10 relative luminescence units (rlu)), microwave irradiation immersed in water (8 rlu), and application of effervescent cleansing tabs (22 rlu). No statistically significant difference (p>0.05) to control PBS (200 rlu) was found after immersion in hydrogen peroxide (172 rlu), glutaraldehyde (103 rlu), household vinegar (196 rlu), Listerine coolmint (194 rlu), Plax (222 rlu), dry microwave irradiation (221 rlu) and specimens left dry overnight (165 rlu). SEM displayed C. albicans monolayers with different morphologic forms on each surface investigated. CONCLUSIONS: Only soaking in sodium hypochlorite (1%; 10 min), microwave irradiation immersed in water (800 W; 6 min), and application of effervescent cleansing tabs (Blend-a-dent tabs; 10 min) proved to be effective against C. albicans colonization on soft denture relining material.

Elongated styloid process in patients with temporomandibular disorders - Is there a link?

BACKGROUND: Elongated styloid processes may display clinical signs that can easily be confused with symptoms associated with temporomandibular disorders (TMD). Thus, the present study aimed to investigate alterations of the styloid process in patients with TMD. METHODS: Temporomandibular joint (TMJ) X-ray images of 192 patients with RDC/TMD diagnoses were examined retrospectively. On each side, the styloid process and mandibular ramus were evaluated regarding length as well as sagittal angulation. Data were statistically analyzed using two-way ANOVA, Pearson's r and Kruskal-Wallis test. In order to confirm the accuracy of the obtained X-ray measurements, the available cone-beam-computed tomographies (CBCT) of the subjects were also examined as reference standard and compared with the X-ray TMJ data by using Bland-Altman analysis. RESULTS: In a group of TMD patients we assessed a mean styloid length of 40.8mm over both genders. In female subjects the means of length and angulation of the styloid process were 40.4mm and 54.9°, male subjects showed means of 42.1mm and 63.4°. The mean height of the mandibular ramus in males was significantly higher than the same measurement in females (66.8mm vs 59.7mm). Styloid length in relation to ramus height (relative styloid length) was significantly larger in females. No significant correlations between RDC/TMD diagnoses and process length as well as process angle were found. A Bland-Altman analysis revealed conformity of CBCT and digital X-ray results. CONCLUSION: The mean styloid length measured in a group of TMD patients is referred to as elongated, whereas females showed longer styloid in relation to body height. However, it appears that alterations of the styloid are not related to TMD diagnoses.

The influence of surface texture and wettability on initial bacterial adhesion on titanium and zirconium oxide dental implants.

BACKGROUND: This study aims to investigate bacterial adhesion on different titanium and ceramic implant surfaces, to correlate these findings with surface roughness and surface hydrophobicity, and to define the predominant factor for bacterial adhesion for each material. METHODS: Zirconia and titanium specimens with different surface textures and wettability (5.0 mm in diameter, 1.0 mm in height) were prepared. Surface roughness was measured by perthometer (R a ) and atomic force microscopy, and hydrophobicity according to contact angles by computerized image analysis. Bacterial suspensions of Streptococcus sanguinis and Staphylococcus epidermidis were incubated for 2 h at 37 °C with ten test specimens for each material group and quantified with fluorescence dye CytoX-Violet and an automated multi-detection reader. RESULTS: Variations in surface roughness (R a ) did not lead to any differences in adhering S. epidermidis, but higher R a resulted in increased S. sanguinis adhesion. In contrast, higher bacterial adhesion was observed on hydrophobic surfaces than on hydrophilic surfaces for S. epidermidis but not for S. sanguinis. The potential to adhere S. sanguinis was significantly higher on ceramic surfaces than on titanium surfaces; no such preference could be found for S. epidermidis. CONCLUSIONS: Both surface roughness and wettability may influence the adhesion properties of bacteria on biomaterials; in this context, the predominant factor is dependent on the bacterial species. Wettability was the predominant factor for S. epidermidis and surface texture for S. sanguinis. Zirconia did not show any lower bacterial colonization potential than titanium. Arithmetical mean roughness values R a (measured by stylus profilometer) are inadequate for describing surface roughness with regard to its potential influence on microbial adhesion.

Antimicrobial effect and biocompatibility of novel metallic nanocrystalline implant coatings.

AIM: The present in vitro study was designed to evaluate the surface characteristics, biocompatibilities and antimicrobial effects of experimental titanium implant surfaces, coated by nanocrystalline silver, copper, and bismuth. Biocompatible and antimicrobial implant modifications could result in reduced biofilm formation on implant surfaces and therefore in less periimplant inflammation. FINDINGS: Titanium discs (thickness 1 mm and 12 mm in diameter) were coated by pulsed magnetron-sputtering of nanocrystalline metals (bismuth, copper, and silver). Bismuth coatings revealed higher surface roughness values in comparison to silver and copper coatings via atomic force microscopy. Ion release after 168 h in culture medium was analyzed by inductively coupled plasma-mass spectrometry and showed significant different amounts of released copper (>120 000 µg/L), silver (550 µg/L) or bismuth (80 µg/L). No cytotoxic effect on HaCaT cell proliferation was detected on the uncoated Ti/TiO2 reference surfaces, the bismuth coatings and silver coatings. In contrast, copper-coated discs showed a strong cytotoxic effect. All three coatings exhibited antimicrobial effects by trend in the fluorometric Resazurin testing and significant localized antibacterial effects in live/dead microscopy after incubation of the specimens for 150 min in bacterial solution of S. epidermidis. CONCLUSIONS: The tested metallic implant coatings (silver and bismuth) allowed surface modifications that may improve therapeutic approaches to biofilm prevention on dental implants. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2015. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1571-1579, 2016.

Real-time MRI of the temporomandibular joint at 15 frames per second-A feasibility study.

The purpose of this study was to develop and evaluate a novel method for real-time MRI of TMJ function at high temporal resolution and with two different contrasts. Real-time MRI was based on undersampled radial fast low angle shot (FLASH) acquisitions with iterative image reconstruction by regularized nonlinear inversion. Real-time MRI movies with T1 contrast were obtained with use of a radiofrequency-spoiled FLASH sequence, while movies with T2/T1 contrast employed a gradient-refocused FLASH version. TMJ function was characterized in 40 randomly selected volunteers by sequential 20s acquisitions of both the right and left joint during voluntary opening and closing of the mouth (in a medial, central and lateral oblique sagittal section perpendicular to the long axis of the condylar head). All studies were performed on a commercial MRI system at 3T using the standard head coil, while online reconstruction was achieved with a bypass computer fully integrated into the MRI system. As a first result, real-time MRI studies of the right and left TMJ were successfully performed in all 40 subjects (80 joints) within a total examination time per subject of only 15min. Secondly, at an in-plane resolution of 0.75mm and 5mm section thickness, the achieved temporal resolution was 66.7ms per image or 15 frames per second. Thirdly, both T1-weighted and T2/T1-weighted real-time MRI movies provided information about TMJ function such as disc position, condyle mobility and disc-condyle relationship. While T1 contrast offers a better delineation of structures during rapid jaw movements, T2/T1 contrast was rated superior for characterizing the articular disc. In conclusion, the proposed real-time MRI method may become a robust and efficient tool for the clinical assessment of TMJ function.

Clinical outcome of double crown-retained implant overdentures with zirconia primary crowns.

PURPOSE: This retrospective study aims at the evaluation of implant-supported overdentures (IODs) supported by ceramo-galvanic double crowns (CGDCs: zirconia primary crowns + galvano-formed secondary crown). MATERIALS AND METHODS: In a private practice, 14 patients were restored with 18 IODs (mandible: 11, maxilla: 7) retained by CGDCs on 4 - 8 implants and annually evaluated for technical and/or biological failures/complications. RESULTS: One of the 86 inserted implants failed during the healing period (cumulative survival rate (CSR) implants: 98.8%). During the prosthetic functional period (mean: 5.9 ± 2.2 years), 1 implant demonstrated an abutment fracture (CSR-abutments: 98.2%), and one case of peri-implantitis was detected. All IODs remained in function (CSR-denture: 100%). A total of 15 technical complications required interventions to maintain function (technical complication rate: 0.178 treatments/patients/year). CONCLUSION: Considering the small sample size, the use of CGDCs for the attachment of IODs is possible without an increased risk of technical complications. However, for a final evaluation, results from a larger cohort are required.

Peri-implant Biofilm Formation on Luting Agents Used for Cementing Implant-Supported Fixed Restorations: A Preliminary In Vivo Study.

This study investigated subgingival peri-implant biofilm formation on four luting agents (Kerr TempBond, Harvard Dental Harvard Cement, 3M ESPE RelyX Unicem, and Kuraray Panavia F 2.0) under realistic in situ conditions. Samples of the luting agents were positioned in the subgingival area of healing abutments, and the biofilm accumulation on the samples at the interface between luting agent and titanium and on the smooth titanium surface was investigated using scanning electron microscopy. In comparison to plane titanium surfaces, interfaces between implant abutment, cement, and suprastructure showed an increased bacterial accumulation and should therefore be regarded as predisposing substrates for peri-implant biofilm formation.

Implant-supported overdentures with different bar designs: A retrospective evaluation after 5-19 years of clinical function.

PURPOSE: This retrospective study evaluated the outcome of implant-retained overdentures (IODs) after 5-19 years of clinical function. MATERIALS AND METHODS: A retrospective analysis of patient files was performed referring to 27 patients who received 36 IODs with 3 different bar designs (group A=prefabricated round bars, n=7; group B=one-piece anterior milled bars, n=20; and group C=two bilaterally placed milled bars, n=9) in the mandible (n=24) and/or in the maxilla (n=12). The analysis focused on the survival and success rates (according to Kaplan-Meier) of the implants and prostheses. Technical complication rates for each type of restoration were analyzed and compared via one-way ANOVA and the Chi-squared test. The prevalence of peri-implantitis (radiographic bone loss ≥3.5 mm) was evaluated by digital analysis of panoramic radiographs taken post-operative (baseline) and after 5-19 years of clinical function (follow-up). RESULTS: The mean observational time was 7.3 years. The survival rates of the prostheses and implants were 100% and 97.7%, respectively. Technical complications occurred more frequently in group A (mean: 3.5 during observational time) than in the other two groups (B: 0.8; C: 1.0). However, this difference was not statistically significant (P=0.58). Peri-implantitis was diagnosed for 12.4% of the implants in 37% of the patients. CONCLUSION: Bar-retained IODs are an adequate treatment option for edentulous jaws. These restorations may exhibit high implant/prosthesis survival rates (>97%), and a limited incidence of technical complications after a mean observational period of >7 years. Nevertheless, peri-implantitis was identified as a frequent and serious biological complication for this type of reconstruction.

Clinical performance of cast clasp-retained removable partial dentures: a retrospective study.

PURPOSE: This retrospective study investigated the survival rate of 174 clasp-retained removable partial dentures (CR-RPDs) made at the Department of Prosthodontics of the Regensburg University Medical Center over a 25-year period (1984 to 2009). MATERIALS AND METHODS: The study analyzed the frequency of and time to the fracture of clasps, connectors, or denture bases; the occurrence of caries or periodontal lesions; the loss of abutment teeth; and the necessity of maintenance procedures such as relining or treatment of pressure areas. RESULTS: The median follow-up time of 3 years was calculated using the inverse Kaplan-Meier method. The 5-year survival rate (time to renewal) of all CR-RPDs was 96.4%; the 10-year survival rate was 89.8%. Fractures most frequently occurred in clasps (n = 28, 16.1%) followed by major connectors (n = 9, 5.1%) and minor connectors (n = 6, 3.4%). The 5-year event-free rate for clasp fracture was 80.4%; the 10-year event-free rate was 76.9%. Caries lesions on abutment teeth were seen in 31.6% of patients, and 35.6% showed inflammation of the periodontal tissue surrounding the abutment teeth. The 5-year event-free rate for caries was 58.4%; the 10-year rate was 39.6%. A frequent complication was loss of abutment teeth (n = 15), but this complication was not age-dependent. After insertion of their prostheses, one-third of patients (n = 53, 30.5%) showed pressure areas of the mucosa. Significantly more (P < .001) pressure areas were caused by prostheses of the mandible (39.6%) than by those of the maxilla (12.5%). CONCLUSIONS: CR-RPDs showed a survival rate of approximately 90% after 10 years of oral service. The predominant complications during oral service were caries lesions, loss of abutment teeth, and fracture of clasps.

The effects of erroneous mixing of zinc carboxylate cements.

The mechanical properties of luting agents are determined by the mixing ratio of powder and liquid. The purpose of this in vitro study was to evaluate the therapeutic range of zinc carboxylate cements by investigating the mechanical properties of such cements when formulated using erroneous powder/liquid ratios. Using the recommended powder/liquid ratio as a standard, four different mixing ratios (25% and 50% more or less powder) were used to prepare each carboxylate cement (Aqualox, Carboco, Durelon). A veneering composite (Sinfony) was used as control. Vickers hardness and three-body abrasion were evaluated. In each carboxylate cement, both a 25% and 50% increase in liquid content resulted in significantly lower Vickers hardness, whereas a higher powder content altered the saturation concentration but did not result in increased hardness; this effect was particularly obvious in Carboco. Durelon showed a linear relationship between wear and powder/liquid ratio, whereas Carboco and Aqualox displayed a more exponential increase in wear in mixings with an increased liquid content. The mechanical properties of carboxylate cements were altered in mixtures with an increased liquid content, but not in those with a high powder content. Mixing ratio errors greater than 25% may significantly affect the clinical performance of carboxylate cements.

Streptococcal adhesion to novel low-shrink silorane-based restorative.

OBJECTIVES: The aim of the present study was to compare the susceptibility of one novel silorane-based and four widely used conventional methacrylate-based resin composites to adhere oral streptococci and to relate any differences to surface roughness, hydrophobicity and type of matrix. METHODS: Specimens of restoratives Filtek Silorane, Filtek Z250, Tetric EvoCeram, Quixfil and Spectrum TPH were prepared (10.0-mm diameter, 2.0-mm height). Surface roughness was assessed by perthometer measurements and hydrophobicity according to water contact angles was determined by computerized image analysis. Bacterial suspensions of Streptococcus oralis, Streptococcus sanguinis, Streptococcus gordonii and Streptococcus mutans were incubated for 2.5 h at 37 degrees C with 15 test specimens for each material and adhesion was quantified with fluorescence dye Alamar Blue/Resazurin and an automated multi-detection reader. Glass served as reference. Statistical analysis was performed using the Mann-Whitney U-test (alpha=0.05). RESULTS: Median roughness values of all composites ranged between 0.04 and 0.11 microm, median contact angles between 59.7 degrees and 92.1 degrees. Significantly lowest fluorescence intensities of all test materials were found on Filtek Silorane for three of four streptococcal strains. The fluorescence intensities of the four conventional methacrylate resin composites were significantly higher and comparable among each other. SIGNIFICANCE: When compared against four conventional methacrylate composite resins, a general significance to a lower quantity of adhering streptococci was found on the novel silorane-based composite resin, which might result from its increased hydrophobicity. The low adhesion potential of the silorane-based composite may potentially improve the longevity of direct fillings and reduce recurrent caries.

Bacterial adhesion of Streptococcus mutans to provisional fixed prosthodontic material.

STATEMENT OF PROBLEM: Bacterial adhesion and formation of dental plaque on provisional fixed prosthodontic materials results in gingival inflammation and secondary caries. PURPOSE: The purpose of this in vitro study was to compare 10 commonly used provisional fixed prosthodontic materials (2 acrylic polymethyl methacrylates, 2 improved methacrylates, and 6 bisacrylate composite resins), based on their susceptibility to adhere to Streptococcus mutans, and examine the influence of surface roughness and hydrophobicity. MATERIAL AND METHODS: Surface roughness was assessed by perthometer and hydrophobicity by contact angle measurements. Streptococcus mutans suspension was incubated with 15 disk-shaped specimens for each material (10 x 2 mm) and examined with the fluorescence dye, Alamar Blue/resazurin, and an automated multidetection reader. Glass and the veneering composite resin, Sinfony, served as controls. Statistical analysis was performed using the Mann-Whitney U-test in combination with the Bonferroni adjustment. Additionally, scanning electron micrographs were made. RESULTS: Median surface roughness values ranged between 0.04 microm and 0.08 microm, and median contact angles between 46.5 and 71 degrees. High relative fluorescence intensities (>10,000) were found for Snap, UniFast LC, and CronMix K plus, moderate values (5000-10,000) for Trim, Temphase, Structur Premium, and PreVISION CB, and lowest fluorescence intensities (<5000) were found for Cronsin, Protemp 3 Garant, and Luxatemp. Scanning electron micrographs displayed streptococcal monolayers on all investigated surfaces, indicating initial bacterial adhesion. CONCLUSIONS: The quantity of bacterial adhesion differed significantly among the assessed provisional materials. A correlation between bacterial adhesion and surface roughness or hydrophobicity was not confirmed. Bisacrylate composite resins and acrylic polymethyl methacrylates had significantly lower adhesion potentials than improved methacrylates.