Temporomandibular joint involvement in rheumatoid arthritis; clinical, tomographic and magnetic resonance imaging study, a new MRI scoring system

The primary objective of this study was to create a new MRI scoring system for assessment of tembromandibular joints [TMJs] arthritic changes in rheumatoid arthritis [RA] based on the precise TMJ tomographic scoring system adopted in 2004[1]. The second aim was to assess the correlation and compare the sensitivity between the new MRI scoring system and the previously established tomographic one. Finally was to correlate the TMJ image findings with the RA clinical disease activity score and disease duration. Twenty RA patients represented forty TMJs were included in the study and recruited from the Rheumatology and Rehabilitation department, Cairo University Hospitals. Full history taking and thorough rheumatologic and intra oral clinical examination were carried out. The patients' disease activity score with three variables [DAS-3]; the Ritchie articular index [RAI], swollen joint count [0-44] and ESR, was recorded. Bilateral TMJ conventional tomography and MRI were done to all patients. Anew MRI scoring system for the severity of TMJ arthritic changes was created based on the TMJ tomographic scoring system[1]. This newly scoring system termed as RA-TMJ-MRI-S states for Rheumatoid Arthritis in TMJ by Magnetic Resonance Imaging Score. The new RA-TMJ-MRI-S not only showed a very high statistical correlation to tomographic scoring system [p = 0.0000] but also demonstrated a respectable sensitivity in early detection of the arthritic changes in TMJ. There was no correlation between the MRI or tomography findings and the DAS-3 or the disease duration. It is recommended to use the new RA-TMJ-MRI-S system; the first MRI scoring system of TMJ that was proved to be superior to the tomographic scoring system, when proper assessment and follow up of the TMJ in RA patients are needed

Clinical and radiographic assessment of the effect of adjunctive alendronate in management of patients with chronic periodontitis

The ultimate goal of periodontal therapy is arresting the disease process, preventing disease recurrence and regenerating the lost periodontium. The prevention of bone loss associated with chronic periodontitis could be enhanced by modulating the host response as an adjunct to mechanical debridement. Alendronate, a member of the bisphosphonate family, had been shown to be a potent inhibitor of osteoclast-mediated bone resorption without adverse effects on matrix mineralization. The present study was designed to assess whether the systemic administration of alendronate is effective in improving periodontal disease in patients with chronic periodontitis. Twenty four patients with a mean age of 52.6+/- 2.3 years, with established chronic periodontitis have undergone initial periodontal therapy and divided into two equal age-matched groups. The participants in the experimental group received one tablet of alendronate 10 mg every morning for 6 months while those in the control group received one tablet of alendronate 10 mg every morning for 6 months while those in the control group received no drugs during the study period. At the base line and after 6 months, clinical periodontal parameters as plaque index [PI], papillary bleeding index [PBI], probing pocket depth [PPD], gingival recession and clinical attachment level [CAL] were recorded. Moreover, the bone mineral density [BMD] and the distance from the cement-enamel junction [CEJ] to the depth of osseous defect on standardized intraoral direct radiographs were evaluated. Although the clinical periodontal parameters were improved in both groups, the improvement in the experimental group was greater. However, the BMD and alveolar bone height were significantly increased in the experimental group [P <0.001 and p< 0.05 respectively], while they were non-significantly reduced in the control group. It could be concluded from the results of the present study that alendronate could be a valuable addition to initial periodontal therapy in the treatment of chronic periodontitis

Color Doppler sonography in assessment of mental artery blood flow

Blood supply of the mandible is an important determinant of the healing process after injury or operation. This fact makes it clear that mandibular hypoperfusion and ischemia are particular problems in the elderly patients and in those who have had radiotherapy. Doppler sonography is widely used to assess blood flow in most major arteries and several of the smaller arteries in the body. Though to our knowledge, its use in the mandible to assess central blood flow has not yet been described. This study was designed to assess the feasibility of using Color Doppler Sonography to evaluate the characteristics of blood flow in the mental artery which would indicate the blood flow in the inferior alveolar artery and to compare between results obtained from control group and that obtained from atherosclerotic patients. Thirty subjects with different ages [22-69 years] were included in this study and comprised two groups; atherosclerotic and control group on whom color Doppler Sonographic examination of the external carotid artery and the mental artery on both sides [Right and Left] was carried out. Results of this study revealed a significant difference between mental and external carotid arteries' indices within the two included groups. Also a significant correlation was proved between mental and external carotid arteries' indices and advancement in age within the two groups. A strong correlation was recorded between mental artery - resistive index and external carotid artery- resistive index within each of the two groups. No wonder that, as the mandibular blood supply is an important factor contributing for many clinical dental problems, its assessment is considered critical in the overall evaluation of healing of the mandible

Depiction and clarity of TMJ in corrected tomography: influence of variabilities of the pre-estimated condylar angle measurements

The primary objective of TMJ tomography is the accurate depiction of anatomic detail from which diagnostic information concerning osseous morphology, surface irregularities and condylar-fossa relationships can be determined. The current use of the term corrected lateral tomography implies that the parasagittal condyle position and image layer have been individually selected on the basis of condyle position in relation to reference plane as determined by submento-vertex radiographs. This study was designed to evaluate the effect of variation of horizontal condylar angulation on the diagnostic quality of the produced tomographic images. The horizontal condylar angle was measured on dry skull using cephalometric submento-vertex radiograph using a standardized technique. Corrected lateral tomograms were produced using the pre-determined horizontal condylar angle and by varying this angle +2, +4, +6 and +8 or -2, -4, -6, and -8 degrees. Qualitative analysis, include depiction and clarity, of condylar head and outline form and cortication of the joint temporal components and quantitative analysis, include geometric linear and angular measurements of the produced tomograms were carried out by the investigators. The results of this study showed that condylar slopes were well demarcated in all cut depths while the temporal components were presented well in the most medial cuts only. By increasing or decreasing the condylar angle, the most medial cuts showed the highest concordance with the predetermined angle followed by the central cuts, while the most lateral cut revealed the heighst variation and was markedly affected. With regards to joint space, Joint space measurements were not greatly affected by decreasing the angle except at the extreme (-8°) but it is affected prematurely on increasing the angle by [+4°].

value of pre-operative radiographic examination of edentulous patients prior to denture construction: the risk versus the benefit

Many investigators recommended a routine radiographic examination for the edentulous cases before denture treatment. Panoramic radiographs obtained from inactive files of 212 patients -of both sexes- who required treatment in the college of dentistry KSU. The radiographs were me-ticulously examined. The plan of this study was to examine panoramic radiographs of edentulous patients with emphasis on the incidence of five entities ; root fragments, impacted teeth, radio-lucencies, radiopacities, and foreign bodies. Of the 212 panoramic radiographs examined, 180 were free of positive findings, and 32 [15.1%] have shown positive findings ,eighteen patients [8.5%] had one or more remaining root fragments, and this entity was statistically significant from the other entities. Three patients [1.4%] demonstrated impacted teeth. Five patients [2.4%] demonstrated radiopacities, two patients [1.9%] demonstrated radiolucencies. The radiographs of four patients [1.9%] demonstrated foreign bodies. The results of this study have proved the necessity of performing routine radiographic examination of the jaws for all edentulous patients before constructing complete dentures. It also indicates the need for a better extraction technique together with the use of radiographs before and after extraction

Assessment of the influence of disc position on disc configuration in tmj internal derangement by using magnetic resonance imaging

Improvements in diagnostic imaging of the TMJ during the past two decades have shown that disk displacement, with reduction or without reduction

Safety and efficacy of proseal laryngeal mask airway versus classic laryngeal mask airway and endo tracheal tube during elective surgery

The present study was performed to compare safety , efficacy of Proseal Laryngeal Mask Airway [PLMA], classic Laryngeal mask airway [LMA] and cuffed Endo Tracheal Tube [ETT] as a ventilatory device during controlled positive pressure ventilation and airway management , Haemodynamic response to insertion and removal, gastric tube insertion through either device, air leak detection and assessment of position by fiberoptic bronchoscope . Forty five ASA I or II patients aged between 18-55 years old , were divided equally into three groups of fifteen patients each , and airway management either through PLMA[groupI],classic LMA [groupII]and ETT [group III] . All patients were premedicated by zantac hydrochloride 150 mg orally at mid night and two hours before the operation – Anaesthesia was induced with fentanyl 2 ug/kg and propofol 2.5 mg /kg and maintenance was with a mixture of 50% N2O , 50% O2 and isoflurane 1 - 1.5 % and rocuronium 0.5 mg /kg followed by continous infusion of rocuronium 0.3-0.6 mg/kg/hr A proper size PLMA , classic LMA or ETT was selected oxygenation and ventilation were optimal in 100% in group I and III while in group II 80% optimal and suboptimal in 13.3% and failed in 6.7 % . Haemodynamic parameters showed that significantly increase in HR and MAP in the three studied groups especially at insertion and removal of the airway device with statisticaly significant difference between group I,II in comparison to group III, comparison of gastric tube insertion showed that positive insertion was 86.7% in group I and in 46.7% in group II, while in group III positive insertion was 100% air leak was detected by epigastric auscultation which signified lower leakage in PLMA group than LMA group . Position assessment by fiberoptic bronchoscope in PLMA group was grade 4 in 5 patients , grade 3 in 5 patients , grade2 in 4 patients and grade 1 in 1 patient while in LMA group it was grade 4 in 7 patients , grade 3 in 6 patients , grade 2 in 2 patients and grade 1 in no patient In conclusion :- PLMA and classic LMA could be better choices as ventilatory device in hypertensive and coronary artery disease patients

Pre-surgical implant planning at first maxillary molar region using conventional tomography, reformatted cross-sectional, true coronal, and modified coronal spiral computed tomography

Accurate estimation of bone height and width of the intended implant site is highly important to obtain reference measurements that can he used during surgery. It determines the depth and width necessary for surgical drilling, and also the bone height that has to be surgically reduced until a level is reached where the hone width is sufficient for implant placement. Fifteen patients undergoing pre- implant radiographic assessment of maxillary first molar ridge area in relation to the floor of the maxillary antrum. They were being the subject of this study, Conventional cross-sectional tomography; reformatted cross-sectional spiral CT scanning: modified coronal CT images and true coronal CT images were being peformed to all patients. No statistical significant difference was observed between the 4 studied modalities in both bone height and width except there was statistical significant difference between true coronal CT bone width measurements and the other three imaging modalities

Intra- and inter-observers agreement in tracing of submentovertex as a prerequisite for corrected lateral tomography of TMJ

TMJ is a complex articulation that shows great variability from one individual to another and also within each individual, indicating that the normal range of the condyle morphology. angulation, and position are fairly large. Tomography is a better tool for condyle/fossa relationship assessment, the technique overcome the problem of superimposition of anatomic structures hindered, allow accurate and repeatable visualization of TMJ pathology. Before started corrected lateral tomographic examination of the TMJ, submento-vertex cephalometric projection had been taken for determination of the horizontal condylar axis using hypocycloidal multi slice tomography with Comm CAT multidirectional tomograpltic machine. Twenty patients of both sexes with different ages were selected, Measurements of the horizontal condylar angle and the condylar head length were taken from each scanned SMV image, 3 times with one month interval by the same observer, during each tracing; data from the previous scan were obscured. Then tracings of the SMV images were done by 4 observers independently. There was a significant difference in the linear measurements of the condyle head in some of intra-observer and inter-observers measurements in both right and left condyles. Also there was a significant difference in the horizontal condylar angle in intra-observer measurements 7° on the right condylar angle and 8° on the left condylar angle as well as in the inter-observer measurements 8° on the right side and 10° on left side. In addition, there was no significant difference and strong confidence correlation in-between intra-observer and inter-observer measurements except only one of the inter-observer showed a significant difference, also a great reliability and small angle variation in intra-observers measurements compared to inter-observers measurements. Moreover there were some similarities between the intra-observer and inter- observers data, including poor reliability of the condylar poles and poor reliability of the horizontal condylar angles