Radiographic changes in TMJ in relation to serology and disease activity in RA patients.

OBJECTIVES: This study was undertaken as an attempt to assess radiographic temporomandibular joint (TMJ) changes in relation to rheumatoid factor (RF), anticitrullinated protein (ACCP) antibodies and disease activity score 28 (DAS28) in rheumatoid arthritis (RA) patients to find the best predictor of rheumatoid affection of the TMJ with the ultimate goal of maintaining TMJ function and preventing joint damage. METHODS: 20 Rheumatoid Arthritis patients as well as 20 volunteers were included in this study. RA group were assessed for RF, ACCP, DAS28. Both groups were assessed by CBCT for TMJ dimensions and radiographic osteoarthritic changes. All data were statistically analyzed. RESULTS: Rheumatoid Arthritis group showed significantly less condylar height and more radiographic osteoarthritic changes than the control group. RF showed no significant correlation with either TMJ measurements or TMJ radiographic osteoarthritic changes. ACCP showed significant inverse correlation with condylar height and anteroposterior (AP) dimensions, but non-significant relation with mediolateral dimension and radiographic osteoarthritic changes. DAS28 showed significant inverse correlation with condylar AP and mediolateral dimensions. It also showed significant correlation with flattening of the TMJ condylar head and flattening of the articular fossa. Patients with high and moderate disease activity showed significantly smaller AP TMJ dimension than patients with low disease activity. Disease activity showed statistically significant direct correlation with all osteoarthritic changes except for erosions of the glenoid fossa and condyle. CONCLUSION: Disease Activity Score28 score and disease activity are strong indicators of TMJ affection in RA patients when compared to RF and ACCP. ACCP is a better indicator of changes in condylar measurements than TMJ osteoarthritic changes. While RF is the least efficient indicator of TMJ involvement in RA patients.

Positional and dimensional temporomandibular joint changes after correction of posterior crossbite in growing patients: A systematic review.

OBJECTIVE: To elucidate the positional and dimensional temporomandibular joint (TMJ) changes after correction of posterior crossbite in growing patients. MATERIALS AND METHODS: A systematic unrestricted search was done in six databases until June 27, 2017. A manual search in the reference lists of the included studies and gray literature was also performed. The eligibility criteria included randomized controlled trials and prospective nonrandomized controlled clinical trials and a sample of growing subjects with posterior crossbite that required maxillary expansion. Risk of bias assessment was performed using Cochrane's Risk of Bias Tool. The literature search, study inclusion, risk of bias assessment, evaluation of quality of evidence (GRADE), and data extraction were performed by two reviewers independently. RESULTS: Only two articles were finally eligible to be included in the qualitative analysis. Both studies were RCTs and were assessed as having unclear risk of bias. Meta-analysis was not possible since one study used cone-beam computed tomography as an assessment tool while the other used ultrasonography. One study reported significant reduction in the condylar positional difference between centric and habitual occlusion in the treatment group, while no spontaneous correction of condylar asymmetric position occurred in the control group. The other study reported minor changes of condylar position in both treatment and control groups. CONCLUSIONS: The current available data provide insufficient and weak evidence to form a solid and firm conclusion. There is poor, very low-quality evidence regarding the positional and dimensional effects of posterior crossbite correction on the TMJs.

Effect of adjunctive low level laser therapy (LLLT) on nonsurgical treatment of chronic periodontitis.

OBJECTIVE: The aim of this split-mouth, double blinded, short-term, controlled clinical trial was to study the effect of low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP) for treatment of chronic periodontitis. BACKGROUND DATA: LLLT is reported to improve the outcome of traditional SRP, but the evidence is still weak. MATERIALS AND METHODS: Sixteen patients with a probing pocket depth (PPD) of 4-6 mm involving at least three teeth in each quadrant were recruited for the study. Afterwards, SRP quadrants were randomly assigned for 10 sessions of LLLT. RESULTS: Results showed that when compared to sites treated with SRP alone, those treated with SRP+LLLT (10 sessions, 830 nm, 100 mW, 3 J per point, 3 J/cm(2)) exhibited greater reductions in PPD at 5 weeks and 3 months but not at 6 months. Further, SRP+LLLT-treated sites had a statistically significant increase in mean radiographic bone density when comparing 6- and 12-month data and overall from baseline to 12 months. There was a trend to reduce interleukin (IL)-1ß but the difference between control and laser sites was not statistically significant. CONCLUSIONS: SRP combined with LLLT improved radiographic bone density and short-term PPD reduction in patients with chronic periodontitis, but did not significantly affect either the gingival crevicular fluid of IL-1ß or the gingival or plaque index.