Does the Cannula Diameter Affect Outcomes of Temporomandibular Joint (TMJ) Arthrocentesis?

PURPOSE: Since its implementation, temporomandibular joint (TMJ) arthrocentesis can be performed with cannulas of different diameters. The aim of this study was to determine the differences in cannula diameter for TMJ arthrocentesis on intraoperative and postoperative parameters. METHODS: A prospective randomized clinical study was conducted using the documentation of Wilkes stage 3 patients with TMJ disorders. Patients were assigned to 2 groups using a system of computer-assisted randomization. Double puncture arthrocentesis (DPA) was performed with 21-gauge cannulas (group 1) and 18-gauge cannulas (group 2). The primary predictor variable was cannula diameter. Pain values assessed using a Likert-type (0 to10) visual analog scale (VAS) were selected as primary outcome variable. Mandibular movements including maximum mouth opening (MMO), lateral excursions (LE) and protrusion (P), were selected as secondary outcomes. Mandibular movements and pain values were recorded before treatment and at 1st day and 3rd months intervals. Descriptive, comparative, and bivariate analyses were conducted. Intraoperative complications were also recorded. RESULTS: DPA was applied to 33 patients (29 females, 4 males). Although group 1 was found to be significantly more advantageous than group 2 in terms of pain levels (P < .05), no statistically significant difference was discovered in terms of total complication numbers and mandibular movements at the follow-up periods (P >.05). CONCLUSIONS: Despite the limited sample size cannula thickness affects postoperative pain level significantly in conventional TMJ arthrocentesis.

Effect of platelet rich fibrin on edema and pain following third molar surgery: a split mouth control study.

BACKGROUND: To evaluate the efficacy of platelet-rich fibrine (PRF) on postoperative edema and pain after impacted mandibular third molar surgery. METHODS: The prospective study was comprised 30 patients who presented for the removal of bilateral impacted mandibular third molar teeth. After extraction, the sockets were filled with PRF or without PRF in the study and control groups, respectively. Postoperative edema was measured with a flexible tape measure by calculating the distance between several facial landmarks on postoperative days two and seven. Postoperative pain was evaluated with a line-type visual analogue scale (VAS) and a verbal scale (VRS). SPSS version 20.0 was used for data analysis. RESULTS: Both groups recorded significant improvement compared to the baseline levels in almost all of the outcome variables. There was no statistically significant difference between the study and control groups (p > 0.05). CONCLUSIONS: Using or not using PRF to reduce postoperative pain and edema in third molar surgery was equally successful. TRIAL REGISTRATION: This study was retrospectively registered at the ISRCTN registry ( ISRCTN16849867 ) on 6 March 2017.

Extraoral approach of the surgical treatment of sublingual epidermoid cyst: A case report.

Epidermoid and dermoid cysts account for <0.01% of all oral cavity lesions with dermoid cyst which is twice as common to epidermoid. Epidermoid cysts are benign lesions that occur rarely in children. They usually present early in life as an asymptomatic mass. The treatment option is surgical and intraoral or extraoral approaches can be performed according to the localization and size of the mass. This report presents an 11 year old child with a sublingual epidermoid cyst treated extraorally.

Oncologists awareness about bisphosphonate related osteonecrosis of the jaws.

OBJECTIVE: To evaluate the oncologists thoughts about the positive and adverse effects of bisphosphonates, drug holiday and the awareness about BRONJ. METHODS: A written questionnaire was sent to 7 hospitals, which have oncology facilities in Ankara, Turkey. Results were evaluated as percentages. Chi Square and Kruskal Wallis H test was used to analyze the data. RESULTS: A total of 53 oncologists replied to the questionnaire. BRONJ is the most seen complication (66%) due to bisphosphonates usage. Temporary suspension of the drug (52.8%) is the best treatment choice for this complication. Oncologists usually prefered dentist consultatation (39.6%). CONCLUSIONS: A good cooperation of oncologists and dentists is very important to prevent BRONJ.

Distribution and pattern of implant therapy in a part of the Turkish population.

OBJECTIVE: To report the distribution and pattern of implant replacement of missing tooth/teeth. METHODS: This retrospective study was conducted at the Suleyman Demirel University, Isparta, Turkey, and used data of patients who had undergone implant replacement of missing teeth/tooth from May 2008 to May 2013. Data analysis included age, gender, number of implants placed, implant location distribution, additional surgery protocol, type of dentures and failure rate. SPSS 12 was used for data analysis. RESULTS: A total of 843 dental implants were performed on 280 patients, 143(51.1%) of whom were men and 137(48.9%) women. Besides, 89(31.8%) of all the participants were aged between 40-49 years. Moreover, 218(77.9%) patients received fixed dentures and 62(22.1%) received overdentures. The posterior region of mandible was the location in 281(33.3%) implants. Bone augmentation was performed in 152(54.3%) patients. Hard tissue grafting with sentetic bone grafts was used in 125(63.8%) patients. Failure was observed in 23(2.7%) implants. CONCLUSIONS: The relationships between denture type and age, and denture type and additional surgery were statistically significant.

The Short-Term Results of the Modified Concentric-Needle Technique for Single-Puncture Arthrocentesis: A Preliminary Study.

OBJECTIVE: To determine the clinical applicability of the modified concentric cannula technique (CCT), focusing on the duration of the arthrocentesis, the number of reposition of cannula, and the occurrence of complications. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ankara Yildirim Beyazit University, Ankara, Turkiye, between September 2021 and May 2022. METHODOLOGY: Forty patients with Wilkes III temporomandibular joints (TMJ) internal derangement were identified and 13 patients who met the inclusion criteria were reviewed. The main outcomes regarding the clinical applicability of modified CCT included the duration of arthrocentesis, the number of reposition of cannula, and the occurrence of complications. RESULTS: The values of maximum mouth opening (MMO) without pain and MMO without assistance measured in the immediate postoperative period and at the 4th and 8th postoperative weeks were found to be significantly higher than the pre-arthrocentesis values. The values of MMO with assistance measured in the immediate postoperative period and at the 8th postoperative week were also significantly higher than the baseline values. Compared with preoperative values, notable decreases in pain scores were observed at the 4th (p = 0.003) and 8th (p = 0.002) postoperative weeks. The assessment of the jaw dysfunction also revealed significantly lower scores at the 4th (p = 0.024) and 8th (p <0.001) postoperative weeks. CONCLUSION: Modified CCT of arthrocentesis substantially decreased pain and improved mandibular functions in patients with internal derangement of TMJ. Additionally, this technique could be performed with a reduced number of cannula relocations and required a shorter operative time even with the use of a higher irrigation volume during the lavage procedure. KEY WORDS: Arthrocentesis, Temporomandibular joint disorder, Temporomandibular joint.

Recommendations on the Use of Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders: Current Evidence and Clinical Practice.

Background: 'Temporomandibular joint disorders (TMDs)' denote an umbrella term that includes arthritic, musculoskeletal and neuromuscular conditions involving the temporomandibular joint, the masticatory muscles, and the associated tissues. Occlusal devices are one of the common treatment modalities utilized in the conservative management of TMDs. The indications for the available 'oral splints' or 'oral orthotic occlusal devices' remain ambiguous. Methods: A joint international consortium was formulated involving the subject experts at TMJ Foundation, to resolve the current ambiguity regarding the use of oral orthotic occlusal appliance therapy for the temporomandibular joint disorders based on the current scientific and clinical evidence. Results: The recommendations and the conclusion of the clinical experts of the joint international consort has been summarized for understanding the indications of the various available oral orthotic occlusal appliances and to aid in the future research on oral occlusal orthotics. Conclusion: The use of the oral orthotic occlusal appliances should be based on the current available scientific evidence, rather than the archaic protocols.

Evaluation of the effectiveness of different puncture points for second cannula in double puncture arthrocentesis of temporomandibular joint.

The study at checking if treatment outcomes in double puncture temporomandibular joint (TMJ) arthrocentesis (DPTMJA) changed when the puncture points of the second cannula punctate were changed. Using a retrospective cohort study design, the investigators enrolled a sample of temporomandibular joint disorder (TMD, internal derangement) patients receiving DPTMJA. The decision of whether to perform a modified or traditional arthrocentesis was made by the patients: Patients who accepted the close cannula relationship were evaluated as group 1 (modification group), and those who did not agree as group 2 (traditional group). The predictor variable was puncture points of the second cannula (close to vs. far from the first cannula; group 1 and 2, respectively). The main outcome variables included maximum mouth opening (MMO), and pain assessed using a Likert-type (0-10) visual analogue scale (VAS) before treatment and at 1st day and 3rd months intervals. Appropriate statistics were computed using P < .05 was considered significant. The study sample comprised 32 patients (93.8% females; 50% in each study arm) with an average age of 36.9 ± 15.3 years (range, 18-78). Although, patient age and gender, and baseline VAS in both groups were not significant different (P > .05), the baseline MMO in group 2 was significant higher than that in group 1 (P = .03). The within-group analyses demonstrated the significant improvement of both MMO and VAS at postoperative month 3 (P < .05). However, the between-group analyses rejected the significant differences between the 2 groups at day 1 and month 3 (P > .05). Within the limitations of the study the choice of one or the other technique should be left to the discretion of the surgeon.

Evaluation of ultrasonography guidance for single-puncture temporomandibular joint arthrocentesis: A randomized clinical study.

Objective To evaluate ultrasonography (US) guidance on the single-puncture temporomandibular joint (TMJ) arthrocentesis technique. Methods Twenty-four patients were randomly divided into two groups (n = 12 in each group), and single puncture arthrocentesis (SPA) was performed with and without US guidance in groups 1 and 2. During the one-year follow-up period, the groups were statistically evaluated by the visual analog scale for pain, maximum mouth opening, lateral excursion, and protrusion within each group and between the two groups. Results Both treatment groups showed significant improvement, compared to the baseline levels for almost all outcome variables. However, there were no statistically significant differences between groups 1 and 2 (p > 0.05). Conclusion US guidance can be used for cannula placement in SPA. However, the outcome results are the same with or without its use.

Radiographic Evaluation of Low-Level Laser Therapy-Enhanced Maxillary Sinus Augmentation with Simultaneous Dental Implant Placement.

BACKGROUND: To evaluate the effect of low-level laser therapy (LLLT) on bone healing in patients undergoing bilateral sinus lifting and simultaneous dental implant application. METHODS: Twelve patients with total/partial posterior maxillary edentulism who needed bilateral sinus bone augmentation were included in the study. Dental implants were inserted in the same session. LLLT (λ = 630-660 nm, 25 mW/cm2, 6 min) was used for one operation side on the 1st, 3rd, 5th, and 7th days, whereas contralateral side served as control side. Preoperative and postoperative 1st, 3rd, and 6th month orthopantomograms were obtained using the aluminum step-wedge technique. Optic density analyses were performed using a Cardinal Health Digital Densitometer (Fluke Biomedical 07-443) with 1 mm diameter. Digital densitometry results were obtained as the equivalent aluminum thickness for each radiograph. These data were used to evaluate the changes in optical bone density and to compare the treatment side with the control side for each patient. RESULTS: The LLLT side showed better results than the control side according to the densitometry results. Increase in the bone density at all the postoperative intervals was statistically significant (P < 0.05). CONCLUSIONS: LLLT enhances bone regeneration in sinus augmentation with simultaneous dental implant placement.

Techniques and modifications for TMJ arthrocentesis: A literature review.

OBJECTIVES: To discuss advantages and disadvantages of TMJ arthrocentesis techniques, identifying modifications as reported in the literature. METHODS: A PubMed web-based search was carried out, using the terms TMJ and arthrocentesis, to determine the scope of coverage in well-documented articles in English. RESULTS: Among 237 articles, 12 distinct techniques were described for TMJ arthrocentesis in 12 articles. Among 12 techniques, 5 were classified as double puncture arthrocentesis (DPA) and 7 as single puncture arthrocentesis (SPA). In total, 17 well documented articles about SPA were found in literature. DISCUSSION: Arthrocentesis of the temporomandibular joint (TMJ) was first described in 1991. To make the traditional procedure even less invasive, many arthrocentesis methods have been described. However, in 2015, TMJ arthrocentesis techniques were divided into two groups to limit the complexities surrounding the concepts related to TMJ arthrocentesis techniques.

Serum, salivary, and tissue levels of plasminogen in familial Mediterranean fever, amyloidosis, and chronic periodontitis.

BACKGROUND: There are no published studies regarding the role of the plasminogen (PLG) system in familial Mediterranean fever (FMF), FMF-associated secondary amyloidosis, or chronic periodontitis (CP), although recent limited data have focused on the association between FMF and chronic periodontitis. Therefore, the aim of this study was to evaluate the serum, salivary, and gingival tissue levels of PLG in patients with CP, FMF, and amyloidosis. METHODS: The study population included 122 patients with FMF (only FMF, and FMF and amyloidosis and 128 individuals who were systemically healthy controls. Blood and salivary samples were obtained from the cases and controls, and clinical periodontal parameters were recorded. Serum and salivary PLG levels were assessed. The gingival tissue samples of the case and control groups were analyzed histopathologically and immunohistochemically for amyloid deposition and PLG. RESULTS: The amyloidosis group had significantly more severe clinical periodontal parameters than those of the FMF and systemically healthy groups (P < 0.05). Salivary levels of PLG were significantly higher in the FMF and amyloidosis groups compared with those in the control group (P < 0.001). The FMF with periodontitis and amyloidosis with periodontitis groups had higher salivary PLG levels compared with those in the CP group. Serum and salivary PLG levels were significantly associated with the clinical periodontal parameters in the FMF group. The amyloidosis cases had hyperplasia, severe inflammation, and activation of the gingiva. CONCLUSION: The PLG system could play an important role in inflammatory diseases, such as chronic periodontitis, FMF, and FMF-associated secondary amyloidosis.

Prospective short term comparison of outcomes after single or double puncture arthrocentesis of the temporomandibular joint.

Our aim was to compare the single puncture technique for arthrocentesis of the temporomandibular joint (TMJ) with the double puncture technique and to evaluate the short-term effects of a single puncture. Forty patients were randomly divided into two groups: the first was treated by single puncture, and the second with double puncture, arthrocentesis. During the one-month follow-up period the visual analogue and verbal scales for pain, maximal mouth opening, and satisfaction were evaluated within each group and between the two groups. Both groups recorded significant improvements compared with the baseline values in almost all outcome variables. There were no significant differences between the groups. Arthrocentesis of the TMJ was successful with both techniques.

Horizontal maxillary sinus septa: An uncommon entity.

INTRODUCTION: Maxillary sinus septas are barriers of cortical bone that arise from the floor or from the walls of sinus and may even divide the sinus into two or more cavities. Morphologically maxillary sinus septa are generally oriented in buccopalatinal orientation horizontal or sagittal orientation of the sinus septa is a rare condition. PRESENTATION OF CASE: This report presents two sinus lift case, in which observed septa in a horizontal orientation was presented. Both cases were fixed by an implant supported prosthethic restoration. DISCUSSION: Surgeons must know detailed knowledge about maxillary sinus anatomy for successful sinus augmentation. Computed tomography (CT) is useful for examining the maxillary sinus. CONCLUSION: Horizontal-type sinus septa are rarely seen. Surgeons must be aware of septa types and orientations.

Florid cementoosseous dysplasia: a rare case report.

Florid cementoosseous dysplasia (FCOD) is a rare, benign, fibroosseous, and multifocal dysplastic lesion of the jaw that consists of cellular fibrous connective tissue with bone and cementum-like tissue. FCOD is most commonly found in middle-aged black women, is generally asymptomatic, and is usually detected during radiological examination. FCOD associated with multiple impacted teeth and bone expansion is a very rare phenomenon, and there are only a few familial cases reported in the literature. In this report, a 35-year-old male Turkish patient is presented who was diagnosed with nonfamilial FCOD from clinical, radiological, and histopathological findings. To our knowledge this is the first case of the nonfamilial FCOD with this many impacted teeth and severely expanded bones.