A Rare Complication of Temporomandibular Joint Viscosupplementation Associated With the Intra-Articular Agent: A Case Report.

Viscosupplementation, which has been referred to as intra-articular injections of hyaluronic acid, is preferable in the treatment of patients with degenerative disease of the temporomandibular joint who have not responded to conservative therapy. The complications of intra-articular injections are reported as pain, swelling, heat, rash, itching, bruising, or redness. This article describes a patient who underwent arthrocentesis followed by viscosupplementation and subsequently experienced pain and malocclusion related to the applied agent.

Evaluation of Stresses on Temporomandibular Joint in the Use of Class II and III Orthodontic Elastics: A Three-Dimensional Finite Element Study.

PURPOSE: The purpose of the present study was to evaluate the effects of the orthodontic elastic forces used in fixed orthodontic treatment on the temporomandibular joint (TMJ) with normal and anteriorly displaced discs. MATERIALS AND METHODS: Four different computer models for Class II and III malocclusion with the TMJ disc in the normal and anterior position were created. All the models were subjected to a constant force of 200g (125 N) on both sides to simulate the elastic pull force placed between the upper and lower jaw with 2 different configurations. Stresses on the TMJ were evaluated using finite element analysis. RESULTS: The stresses in both the condyle and the disc were greater in the Class II models than in the Class III models. Similar results were found between the groups according to the direction of the orthodontic elastics. In the Class II models, the peak value of the maximum principal stresses was located in the posterior region of the condyle in the models with disc in the normal position. CONCLUSIONS: The elastic forces used during fixed orthodontic treatment increases the stress on the TMJ, especially for Class II patients. If the disc is in an anterior position, the stresses could be more harmful to the retrodiscal tissue. Thus, during orthodontic treatment, the TMJ should be carefully assessed to avoid irreversible damage.

Is Repeated Arthrocentesis Beneficial in the Treatment of Temporomandibular Disorders: A Retrospective Study.

PURPOSE: Arthrocentesis is an effective, simple, and minimally invasive treatment in patients with temporomandibular joint (TMJ) closed lock (CL). The aim of this study was to compare the effectiveness of 1- versus 2-session arthrocentesis procedures in the management of TMJ CL. MATERIALS AND METHODS: A retrospective cohort study was conducted using the files of patients with TMJ CL according to diagnostic criteria for temporomandibular disorders. Patients who underwent 1- or 2-session arthrocentesis were included in the study. The decision of whether to undergo 1- or 2-session arthrocentesis was made by the patients: Those who accepted a second arthrocentesis procedure were assigned to group 1 (repeated arthrocentesis group), and those who did not accept, to group 2 (arthrocentesis group). The primary predictor variable was treatment method. TMJ pain (scored on a visual analog scale) and maximum mouth opening (MMO) were selected as the outcome variables. To evaluate the clinical outcomes of 1- or 2-session arthrocentesis, MMO and pain score (on a visual analog scale) before treatment and at 1, 3, and 6 months' follow-up were analyzed. Descriptive, comparative, correlation, and multivariate analyses were conducted. RESULTS: A total of 30 patients (25 female and 5 male patients) with TMJ disc displacement without reduction were enrolled in the study. Each group consisted of 15 patients. Statistically significant decreases in pain scores and increases in MMO values were observed in both treatment groups at 3 and 6 months (P < .05). At 6 months, MMO values were significantly higher and pain levels were significantly lower in patients who received 2 arthrocentesis procedures. CONCLUSIONS: Repeated arthrocentesis is more successful at reducing pain and improving MMO than a single intervention in the treatment of TMJ CL.

Clinical and intra-operative factors affecting the outcome of arthrocentesis in disc displacement without reduction: A retrospective study.

BACKGROUND: Temporomandibular disorder (TMD) is a group of disease which affects the temporomandibular joint (TMJ) and supporting tissues of the musculoskeletal structures. Arthrocentesis is an effective treatment modality for TMD, especially in patients who suffer from pain and limited mouth opening. OBJECTIVE: The aim of this study was to investigate the effects of pre-operative and intra-operative variables on the clinical outcome of arthrocentesis therapy. METHODS: The records of 83 patients diagnosed as disc displacement (DD) without reduction according to DC/TMD, and treated with arthrocentesis were selected. Sex, age, bruxism history, pain intensity and maximum mouth opening (MMO) were recorded as pre-operative variables. Extravasation and the amount of irrigation were recorded as intra-operative variables. The success of the arthrocentesis procedure was determined as MMO <35 mm and pain intensity lower than 3, at third-month follow-up. RESULTS: At 3-month follow-up, clinical evaluation showed a significant reduction in TMJ pain and an increase in MMO (P < 0.05). It was found that patients with an unsuccessful outcome are those who had a more restricted MMO and severe pain before the procedure. Extravasation was found to be a significant factor that affects the success of the procedure. CONCLUSION: The success of arthrocentesis in TMJ DD without reduction is adversely affected by the severity of the pre-operative clinical symptoms. Extravasation is also a factor that has a negative effect on the success of the procedure.

The Effect of Exercise on Range of Movement and Pain After Temporomandibular Joint Arthrocentesis.

PURPOSE: Arthrocentesis is an effective treatment modality for temporomandibular disorders, especially in patients who have pain and limited mouth opening. Surgeons generally suggest physical exercises after arthrocentesis and arthroscopy procedures; however, there has been no study in the literature evaluating the effects of exercise on clinical outcomes. This study investigated whether physical exercises after arthrocentesis would result in early improvements in clinical symptoms in patients with temporomandibular joint disc displacement without reduction (TMJ DDw/oR). MATERIALS AND METHODS: The study group was composed of 27 patients with TMJ DDw/oR. Patients who needed arthrocentesis after failed conservative nonsurgical treatment were enrolled in the study. Group 1 was composed of 14 patients who were not started on a physiotherapy program after the arthrocentesis procedure. Group 2 was composed of 13 patients who were started on a self-administered physiotherapy program immediately after the arthrocentesis procedure. Physiotherapy included a 6-week exercise program. Patients were followed for 3 months. Range of maximal mouth opening (MMO) and joint pain as measured by the visual analog scale (VAS) were examined to determine clinical efficacy before and after treatment. RESULTS: In groups 1 and 2, mouth opening increased and pain scores decreased at 1-week and 1- and 3-month follow-ups (P < .05). No relevant relation was found between the 2 groups according to MMO for all time points and VAS scores at 1 week. A relevant relation was found between the 2 groups according to VAS scores at 1 and 3 months. CONCLUSION: Physical exercise after arthrocentesis has no effect on range of mouth opening but does decrease pain.

The Effects of Unilateral Alloplastic Temporomandibular Joint Replacement on the Opposite-Side Natural Joint: A Finite-Element Analysis.

PURPOSE: The purpose of this study was to evaluate the stress distribution on the temporomandibular joint (TMJ) prosthesis and contralateral natural TMJ with finite-element analysis. MATERIALS AND METHODS: A TMJ implant was used to create a 3-dimensional model with a computer. This model was integrated with a mandible model created with a computer by use of computed tomography images, similar to a real TMJ replacement procedure. Masticatory loads were applied to the model. The loads transmitted to the TMJ prosthesis and contralateral healthy joint were evaluated by means of finite-element analysis. RESULTS: In the model without the TMJ prosthesis, maximum von Mises stress was 252.697 N/mm2 at the condyle and 5.418 N/mm2 at the disc. In the model with the unilateral TMJ prosthesis, maximum stress at the joint prosthesis was 792.681 N/mm2. In the contralateral natural joint, maximum stress was 268.908 N/mm2 at the condyle and 8.357 N/mm2 at the disc. CONCLUSIONS: In the TMJ model with the unilateral total TMJ prosthesis, increased stress values were observed at the disc and condyle of the contralateral natural TMJ.

Finite Element Evaluation of Different Osteosynthesis Variations That Used After Segmental Mandibular Resection.

PURPOSE: The purpose of this study was to evaluate the effect of different reconstruction plates and screw combinations on stress distribution of segmental resected mandibles using finite element analysis. METHODS: Lateral (L) and lateral-central (LC) defects were simulated by a computer aided design modeling. The straight (s) and angular (a) titanium locking reconstruction plates of 2.5 mm (12 holes for L defects and 16 holes for LC defects) were modeled. Each screw was 2.5 mm in diameter and 10 mm in length. A total of 20 different screw placement combinations were created. The bite force used in the present model was a unilateral molar clench. The data obtained from finite element analysis were recorded as von Mises, maximum principle and minimum principle stress values. RESULTS: It was observed that stress values on neck of screw were higher for screws close to the resection area. When the first screw was loosened, the stress on the plate body and the remaining screws increased. Principle stress values were within the tolerance limits of the bone. CONCLUSION: The highest stress is observed in the screws nearest to the resection edge. Therefore, it is very important to place a screw adjacent to the resection edge.

Could Calcified Triglyceride Bone Cement Be an Alternative Graft Material in Maxillary Sinus Augmentation?

The ideal graft material for maxillary sinus augmentation is still a matter of controversy and the search for a more appropriate bone substitute for use continues. The aim of this study was to evaluate bone formation as a sign of the regeneration following maxillary sinus augmentation in rabbits using 3 different biomaterials, one of which is a newly developed graft material; calcified triglyceride bone cement (CTBC).Twenty-one New Zealand rabbits were used and randomly divided into 3 groups. Bilateral maxillary sinus augmentation was carried out and autogenous bone (AB), bovine hydroxyapatite (BHA), and CTBC were administered. Maxillary sinuses were dissected after fourth and eighth weeks of the operation. The bone formation was evaluated by stereological and histopathological analysis and the data were analyzed statistically.When the volume of primary bone is compared, statistically significant differences were found among all groups at both of the fourth and eighth weeks. The highest value was obtained from AB applied group. In BHA and CTBC applied groups, active bone formation, osseointegration of graft materials were observed at both fourth and eighth weeks. In CTBC applied group, primary bone formation was only seen as linked to the continuation of parent sinus bony wall.The efficiency of primary bone formation of CTBC was found less than AB and BHA. Of the 3 graft materials tested, BHA is the strongest alternative to AB graft for maxillary sinus augmentation.

Treatment of Maxillary Glandular Odontogenic Cyst Involving the Same Place of Previously Treated Traumatic Bone Cyst.

Glandular odontogenic cyst is a rare developmental odontogenic cysts of the jaws having an aggressive behavior. The most common site of occurrence is the anterior mandible, and it is widely seen in middle-aged people. It is suggested that trauma could be a precipitating factor for its occurrence. This article presents the diagnosis and treatment of a case of glandular odontogenic cyst at anterior maxilla that occurred at the same localization of a traumatic bone cyst, 5 years after its management.

The Diagnosis and Management of Multiple Supernumerary Teeth Involving Both Jaws.

Supernumerary teeth are frequently seen anomalies however its occurrence in both jaws is rare without being associated with complex syndromes. This case report describes the orthodontic and surgical treatment of a 13-year-old boy with nonsyndromal multiple and abnormal supernumerary teeth. The patient had several erupted and unerupted supernumerary teeth involving both jaws. Two abnormal tuberculate type erupted supernumerary teeth were present at the site of upper central incisors which leads to the impaction of the permanent incisors. In this report, clinical and radiographic evaluation as well as the treatment alternatives of this rare case was presented.

Effect of platelet-rich plasma on fibrocartilage, cartilage, and bone repair in temporomandibular joint.

PURPOSE: The purpose of the present study was to explore the potential use of platelet-rich-plasma (PRP) in the treatment of temporomandibular joint osteoarthritis (TMJ-OA). MATERIALS AND METHODS: Surgical defects were created bilaterally on the condylar fibrocartilage, hyaline cartilage, and bone to induce an osteoarthritic TMJ in rabbits. PRP was applied to the right joints of the rabbits (PRP group), and the left joints received physiologic saline (control group). After 4 weeks, the rabbits were sacrificed for histologic and scanning electron microscopy (SEM) examinations. The data were analyzed statistically. RESULTS: The new bone regeneration was significantly greater in the PRP group (P < .011). Although the regeneration of the fibrocartilage and hyaline cartilage was greater in the PRP group, no statistically significant difference was found between the 2 groups. SEM showed better ultrastructural architecture of the collagen fibrils in the PRP group. CONCLUSIONS: PRP might enhance the regeneration of bone in TMJ-OA.

Graft necrosis occurred after iliac crest reconstruction after mandibular segmental resection of ameloblastoma.

Ameloblastoma is an uncommon benign odontogenic neoplasm of the maxillofacial region constituting less than 1% of tumors of the oral cavity. Ameloblastomas have been categorized broadly into 3 biologic variants: cystic (unicystic), solid, and peripheral. Unicystic ameloblastoma is a rare and less aggressive variant of ameloblastoma. The aim of this report is to describe a case of cystic ameloblastoma treated with segmental resection and iliac graft reconstruction. The possible reasons of graft failure seen in our patient at the early stage of the healing were also discussed.

Use of artificial neural network in differentiation of subgroups of temporomandibular internal derangements: a preliminary study.

PURPOSE: Artificial neural networks (ANNs) have been developed in the past few decades for many different applications in medical science and in biomedical research. The use of neural networks in oral and maxillofacial surgery is limited. The aim of this study was to determine the use of ANNs for the prediction of 2 subgroups of temporomandibular joint (TMJ) internal derangements (IDs) and normal joints using characteristic clinical signs and symptoms of the diseases. MATERIALS AND METHODS: Clinical symptoms and diagnoses of 161 patients with TMJ ID were considered the gold standard and were employed to train a neural network. After the training process, the symptoms and diagnoses of 58 new patients were used to verify the network's ability to diagnose. The diagnoses obtained from ANNs were compared with diagnoses of a surgeon experienced in temporomandibular disorders. The sensitivity and specificity of ANNs in predicting subtypes of TMJ ID were evaluated using clinical diagnosis as the gold standard. RESULTS: Eight cases evaluated as bilaterally normal in clinical examination were evaluated as normal by ANN. In detecting unilateral anterior disc displacement with reduction (ADDwR; clicking), the sensitivity and specificity of ANN were 80% and 95%, respectively. In detecting unilateral anterior disc displacement without reduction (ADDwoR; locking), the sensitivity and specificity of ANN were 69% and 91%, respectively. In detecting bilateral ADDwoR, the sensitivity and specificity of ANN were 37% and 100%, respectively. In detecting bilateral ADDwR, the sensitivity and specificity of ANN were 100% and 89%, respectively. In detecting cases of ADDwR at 1 side and ADDwoR at the other side, the sensitivity and specificity of ANN were 44% and 93%, respectively. CONCLUSION: The application of ANNs for diagnosis of subtypes of TMJ IDs may be a useful supportive diagnostic method, especially for dental practitioners. Further research, including advanced network models that use clinical data and radiographic images, is recommended.

Excessive fluoride intake alters the MMP-2, TIMP-1 and TGF-ß levels of periodontal soft tissues: an experimental study in rabbits.

OBJECTIVES: This study evaluated the influence of fluoride on periodontal soft tissues by investigating any alterations in their MMP-2, TIMP-1 and TGF-ß profiles secondary to excessive fluoride intake. MATERIAL AND METHODS: Fluorosis was induced in 18 rabbits (test group) through consumption of fluoride added to drinking water, whereas 10 rabbits consumed regular tap water as daily supply (control group). Following fluorosis verification, animals were sacrificed and their 1st mandibular molar teeth were utilized in the assessments. MMP-2, TIMP-1 and TGF-ß were separately investigated for gingival epithelium (GE), gingival connective tissue (GC) and periodontal ligament (PL) to evaluate periodontal soft tissues. Histological sections were prepared from the groups, the parameters were determined by immunohistochemistry, and their levels were calculated by quantification of the immunostainings. RESULTS: Staining intensity of MMP-2 in GC and PL (p < 0.01); TIMP-1 and TGF-ß of GE, GC and PL (p < 0.01) were higher in the test group compared to those of the control group. Intra-group staining of TIMP-1 was higher than MMP-2 in all test group compartments (p < 0.01) and in the control group GE (p < 0.01). TIMP-1 was also higher than TGF-ß in the GE and PL of the test group (p < 0.05) and in the GE of the control group (p < 0.01). CONCLUSION: These results suggest that excessive fluoride intake may affect periodontal soft tissues by increasing MMP-2, TIMP-1 and TGF-ß, and thereby altering the MMP-2/TIMP-1 and TIMP-1/TGF-ß ratios. CLINICAL RELEVANCE: Excessive fluoride consumption may alter the periodontal tissue homeostasis which may be detrimental in the maintenance of periodontal health.

Diagnostic value of ultrasonography in temporomandibular disorders.

PURPOSE: The purpose of this study was to determine the diagnostic value of ultrasonographic imaging (USI) in temporomandibular disorders. PATIENTS AND METHODS: USI and magnetic resonance imaging (MRI) were performed in 182 temporomandibular joints (TMJs) of 91 patients who were referred for treatment. After a detailed clinical examination, patients who were clinically diagnosed with TMJ disc derangement were referred to the radiology department for MRI and USI examinations. USI and MRI diagnoses of disc displacement were compared, using clinical diagnosis as the golden standard. The overall agreement between USI and MRI results was evaluated. RESULTS: Compared with the clinical diagnosis, MRI showed a sensitivity of 85%, specificity of 62%, and an accuracy of 80% in the detection of internal derangements. The positive predictable value, negative predictive value, and likelihood ratio were 88%, 54%, and 2.29, respectively. Compared with the clinical diagnosis, USI showed a sensitivity of 69%, specificity of 80%, and accuracy of 71% in the detection of internal derangements. The positive predictable value, negative predictive value, and likelihood ratio were 92%, 42%, and 3.45, respectively. Comparing the agreements between the MRI and USI diagnoses of internal derangement, the κ value was found to be 0.36, indicating poor reliability (P < .001). CONCLUSION: USI, a noninvasive and dynamic imaging method, is a reliable method in evaluating the position of the disc in TMJ disc derangements. Better visualization of joint structures and more reliable results with higher sensitivity and accuracy can be achieved with high-resolution devices (≥12 MHz).

Eosinophilic granuloma: resolution of lesion after biopsy.

Langerhans cell histiocytosis is a collective term used to describe a group of enigmatic proliferative disorders. Three disease variants include eosinophilic granuloma, Letterer-Siwe disease, and Hand-Schuller-Christian syndrome. Eosinophilic granuloma is reported to be the most benign type of the triad. In this report, a 7-year-old child with an eosinophilic granuloma of the left side of her mandible is presented. There was a painless, hard, tender mass arising from the left side of the molar region. Panoramic radiographs showed a radiolucent area at the molar region. The lesion was resolved 2 weeks after the biopsy. The 1.5 years of radiographic and clinical follow-up was satisfactory.

Treatment of masseteric hypertrophy with botulinum toxin: a report of two cases.

Masseter muscle hypertrophy is a rare condition of unknown cause which is important in the differential diagnosis of head and neck masses, located in the cheek. Several treatment options reported for masseter hypertrophy, which range from simple pharmacotherapy to more invasive surgical reduction. Botulinum toxin type A is a powerful neurotoxin which is produced by the anaerobic organism Clostridium botulinum and when injected into a muscle causes interference with the neurotransmitter mechanism producing selective paralysis and subsequent atrophy of the muscle. Injection of botulinum toxin type A into the masseter muscle is generally considered a less invasive modality and has been advocated for cosmetic sculpting of the lower face. Botulinum toxin type A injection is considered to be a beneficial treatment modality in masseter muscle hypertrophy patients. The aim of this article is to report two cases of masseteric muscle hypertrophy which were treated with botulinum toxin type A injection. Marked changes in facial feature were achieved 3 months after the procedure.

Effects of polyglecaprone 25, silk and catgut suture materials on oral mucosa wound healing in diabetic rats: an evaluation of nitric oxide dynamics.

OBJECTIVES: The purpose of this study is to investigate the effects of monocryl (Polyglecaprone 25), silk and catgut suture materials on wound healing in diabetic rats and to evaluate NO (nitric oxide) dynamics. STUDY DESIGN: Fourty-eight male Wistar-Albino rats weighing 220-270 g were used in this study. The rats were categorized into 2 groups, as control group (n=24) and streptozotocin (STZ) induced diabetic group (n=24). For each group, incision wounds were created on the inner cheek mucosa of the animals and wounds were closed primarily with three different types of sutures. These materials were sized 3-0 monocryl (polyglecaprone 25), silk and catgut sutures swaged on. Excisional biopsies were performed at 2nd, 7th, 14th and 21st day (2 rats per day) from the initial surgical procedure. Effects of these suture materials on wound healing and NOS (nitric oxide synthase) activities were compared immunohistochemically in the study. eNOS and iNOS (Endothelial and induced nitric oxide synthase) activities were classified as mild (+), moderate (++) and severe (+++). RESULTS: Mild eNOS activities were seen in both diabetic and control groups at 2nd day specimens. Activities of silk and catgut were similar both in diabetic and control groups at 14th day, this activity in monocryl was mild. 21st day specimens revealed that monocryl has mild eNOS activity than silk and catgut sutures. iNOS activities in diabetic group were greater than control groups and the degrees of the activity in monocryl, silk and catgut sutures were mild, severe and moderate at the 7th day. At the 14th day there was no iNOS activity in diabetic monocryl group. CONCLUSION: All of the materials have the potential capacity to be well tolerated however monocryl seemed to have more beneficial effects on wound healing in diabetic subjects.

Are age and radiographic features effective on orthodontic alignment of palatally impacted maxillary canines? a retrospective study.

PURPOSE: The purpose of the study was to evaluate the effects of age and radiographic parameters on success of orthodontic alignment of impacted maxillary canines. MATERIALS AND METHODS: The retrospective records of 50 patients (mean age 20.44 years) who had impacted maxillary canines in palatal position were included. The patients was requiring surgical exposure and mechanical orthodontic treatment were divided into two groups as adolescent (age≤18; n=24) and adult (age>18; n=26). In both groups, the treatment time and success were evaluated clinically and radiographically. RESULTS: Fifty patients between the ages of 13 to 42 (12 males and 38 females) with palatally impacted canines were treated with combined surgical-orthodontic approach. Forty-seven teeth (94%) had reacted to surgical exposure and orthodontic alignment within 16 to 36 months with a mean of 24.81 months. Three of the impacted canines (6%) were surgically removed because no movement was observed following 10 months of traction forces. CONCLUSION: The distance of the canine tip to the occlusal plane on the lateral cephalometric radiographs have found to be related with the total orthodontic treatment time. Neither the age of the patient nor other clinic and radiographic parameters had influence on the treatment results of alignment of maxillary canines following surgical exposure.

Inferior alveolar nerve paresthesia caused by a dentigerous cyst associated with three teeth.

The dentigerous cyst is a common pathologic entity associated with an impacted tooth, usually third molars. They generally are asymptomatic, being found on routine dental radiographic examination. This report describes the case of a 43 year old male with a large dentigerous cyst associated with mandibular canine, first and second premolar teeth that caused paresthesia of the inferior alveolar nerve.