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.

Efficacy of Lornoxicam as a Pre-emptive Analgesic in Mandibular Third Molar Surgery - A Comparative Study.

Introduction: The most common complication following third molar surgery is pain. The purpose of the study is to determine the efficacy of lornoxicam as a preventive analgesic in patients undergoing surgical removal of impacted mandibular third molars. Materials and Methods: This study included 26 participants aged 18-28 years with bilateral symmetrical third molars. Group A, the control group, received lornoxicam 8 mg 1 h after surgery, whereas Group B, the study group, received lornoxicam 8 mg 1 h before surgery. All patients were evaluated for pain at the 1st, 2nd, 4th, 6th, 8th and 12th post-operative hours. The number of rescue analgesics taken within 24 h of the procedure, as well as the first occurrence of pain postoperatively, was recorded and analysed. Results: Using the Mann-Whitney U-test and Friedman's analysis, the resulting data were statistically analysed. When Group B was compared to Group A, there was a significant difference in pain reduction levels in the immediate post-operative hours. When compared to Group A, Group B had a lower need for rescue analgesics within the first 24 h postoperatively. Discussion: Following mandibular third molar surgery, pre-emptive use of lornoxicam is effective in reducing post-operative pain and reducing the need for rescue analgesic consumption.

Comparing the Efficacy of Twin Mix and Lidocaine for Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis.

This randomized, active-controlled, double-blind, prospective clinical trial evaluated the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine versus an admixture of 2% lidocaine with 1:200,000 epinephrine and 1 mL of 4 mg dexamethasone (Twin mix) for inferior alveolar nerve blocks (IANBs) in patients with symptomatic irreversible pulpitis (SIP) of the mandibular molars. Seventy-eight patients with SIP of mandibular molars were randomly allocated to the 2 groups of 39 subjects. All patients were required to have profound lip numbness within 10 minutes of local anesthetic deposition. The efficacy of pulpal anesthesia was confirmed by absence of pain or mild pain (Heft-Parker visual analogue scale ≤54 mm) during access cavity preparation and placement of glide path files. The collected data were subjected to independent t test, chi-square test, and Fisher exact test using SPSS software version 20.0 at a significance level of 0.05. IANB success rates for the lidocaine group and the Twin mix group was 66% and 68% respectively, which was not a statistically significant difference (p > .05). This study demonstrated that the anesthetic efficacy of Twin mix was equivalent to 2% lidocaine for IANBs in teeth with SIP.

Management of Non-syndromic Multiple Impacted Teeth with Dentigerous Cysts: A Case Report.

Impacted teeth may not only interfere with function, but also can act as a source of many pathological lesions such as odontogenic cysts and tumors. One of the most prevalent types of odontogenic cysts associated with erupted, developing or impacted tooth is dentigerous cyst. Multiple impacted teeth with dentigerous cysts in both the maxillary and mandibular arches without the association of any syndromes is a very rare occurrence. In the present article, we report such a non-syndrome case of bilateral multiple impacted teeth in both maxilla and mandible with dentigerous cysts treated with enucleation and ridge augmentation with autogenous bone graft harvested from posterior iliac region. Further, dental rehabilitation was carried out with dentures.

The Role of Ultrasound in Diagnosis of Temporomandibular Joint Disc Displacement: A Case-Control Study.

PURPOSE: Ultrasound is extensively being used for imaging of temporomandibular joint as it is non-invasive and relatively inexpensive. The purpose of this study was to evaluate the use of ultrasound in identifying TMJ with internal derangement and to access its usefulness as a diagnostic tool in patients with TMJ clicking. METHODS: A case-control study was done: 25 patients with a complaint of clicking sound while opening the jaw were randomly selected as the study group and 25 patients who were asymptomatic on TMJ examination were selected as the control group. Both the groups were subjected to bilateral ultrasound scanning of the TMJ. The lateral part of capsule to condyle distance (LCCD) and the anterior part of capsule to condyle distance (ACCD) were measured. RESULTS: The mean LCCD of all the 50 joints in the control group was 1.3630 mm, and the mean ACCD of the 50 joints was 1.4850 mm. These values were compared with each of the 50 symptomatic joints scanned in the study group. It was noted that 56% of the subjects showed deviation towards right side and 44% showed deviation towards right side. Clicking was heard in all the subjects while opening the mouth on auscultation. The frequency and percentage distribution of negative and non-negative deviations of LCCD from that of control group were noted. In total, 40% showed negative deviation and 60% showed non-negative deviation. In total, 24% of the subjects showed negative deviation and 76% showed non-negative 190 deviation of ACCD when compared with the control group. T test shows that with respect to LCCD measurement there is no significant difference between symptomatic and asymptomatic subjects, whereas ACCD measurements are significantly different between the symptomatic and asymptomatic subjects. CONCLUSIONS: Hence, it can be concluded that auscultation is mandatory in the examination of temporomandibular joint for clicking sound. Ultrasonography, which has shown high specificity, can supplement clinical evaluation in patients with TMJ disorders and can be used as a potential diagnostic tool for identifying internal derangement of the temporomandibular joint with reduction.

A Novel, Minimally Invasive Technique in the Management of a Large Cyst Involving the Maxilla in a Child: A Case Report.

The conservative management of large, odontogenic, developmental cysts involving the jaws in young children using the technique of decompression has become increasingly popular to reduce the incidence of morbidity associated with aggressive treatment modalities. The lack of development of a stock device has made clinicians to explore various possible and readily available materials to customize the devices. This paper highlights the use of a novel material to be used as a decompression device that is readily available and can be used with good patient compliance and a predictable outcome.

Cervicofacial Actinomycosis and its Management.

Cervicofacial actinomycosis is an invasive destructive infectious syndrome, caused by Gram-positive, branching filamentous bacteria, Actinomyces. Most of the cases are traced to an odontogenic source with periapical abscess and posttraumatic or surgical complications with poor hygiene and immunosuppression as contributing factors. Diagnosis is often delayed because of nonspecific and prolonged symptoms usually mimicking a malignant or a granulomatous lesion. Solitary or multiple abscesses and fistula formation across normal tissue planes accompany chronic draining lesions and may lead to invasion of viscera. Hence, early diagnosis and appropriate treatment is mandatory to reduce morbidity. In this paper, we report two cases of cervicofacial actinomycosis, one presented with intraoral granulomatous lesion treated with surgical curettage and intramuscular penicillin and another case with extraoral swelling and multiple draining sinuses treated with oral antibiotics.

Subconjunctival ecchymosis after extraction of maxillary molar teeth: a case report.

Extraction of teeth is usually performed by either intra-alveolar or trans alveolar methods. Subconjunctival ecchymosis occurring after intra-alveolar extraction of maxillary first and second molar teeth is a rare entity and finds no mention in the latest clinical literature. The etiology of subconjunctival ecchymosis includes traumatic and non-traumatic causes. We report a case and discuss the possible etiology and management of this complication.