Radiographic evaluation of cases referred for surgical endodontics.

AIM: The aim of this study is to test the hypothesis that more patients with failed root-canal treatment or other endodontic problems are referred for periradicular surgery rather than nonsurgical re-treatment. METHODOLOGY: Three sets of 100 periapical radiographs representing typical cases referred for surgical treatment were collected in three departments of oral and maxillo-facial surgery situated in different parts of the Netherlands. Of these, a total of 278 radiographs were evaluated to determine whether endodontic surgery was indicated or whether the primary endodontic treatment or endodontic re-treatment was a realistic option. An oral and maxillo-facial surgeon, an endodontist and a general dental practitioner viewed the radiograph independently under standard conditions. RESULTS: Overall, orthograde root-canal (re-)treatment was considered possible in 63% of the cases. The results differed between the three examiners with the oral surgeon reporting that 41% of cases were amenable to conventional treatment, for the general dental practitioner and the endodontists the figures were 67 and 80%, respectively. CONCLUSIONS: Based on these observations, it is concluded that most of the teeth referred for surgical treatment to an oral surgeon could be treated by orthograde nonsurgical root-canal treatment.

Long-term results of nonsurgical management of condylar fractures in children.

Twenty-five patients with 28 condylar or subcondylar fractures, sustained during their growth period and treated nonsurgically, have been followed for an average period of 15 years. The fractures were classified as intracapsular, high condylar neck and low condylar neck fractures. In 5 patients, two weeks of intermaxillary fixation, followed by elastic traction in order to achieve a proper occlusion, was applied. All the other patients were treated by instruction, exercises and observation. In 4 patients, subsequent orthodontic treatment was provided. It is not advocated to perform orthodontic aftercare as a routine action in all patients. Satisfaction with the treatment results, as measured on a visual analogue scale (VAS), was very high. The masticatory function of all patients at last follow-up was good to excellent. From this study, it appears that especially the commonly occurring high condylar fractures (64%) show good regeneration tendency as observed on radiographs. Low condylar and intracapsular fractures may give rise to some asymmetry. In 4 cases this asymmetry was clearly visible to the experienced observer, but did not concern the patient. One patient (low condylar neck fracture) showed obvious malocclusion and facial asymmetry, which needed to be corrected by orthognathic surgery. Unfortunately, it is impossible to predict which type of fracture is at risk of facial asymmetry. It is concluded that nonsurgical management of condylar fractures of the mandible in children is still the method of choice.

Reconsideration of the TMJ condylar position during internal derangement: comparison between condylar position on tomogram and degree of disk displacement on MRI.

The objective of this study was to investigate condylar position during different degrees of disk displacement. The degree of disk displacement was evaluated on 1.5 Tesla high-field sagittal MR images of 76 joints (48 patients; mean age 19.4 years) and was classified into three grades (1 to 3). To establish condylar position, the anterior, superior and posterior joint spaces were measured on corrected tomograms. The possible relationship between condylar position, indicated by the width of joint space and successive degree of disk displacement, was compared by a one-way factorial ANOVA (p < 0.05). The anterior joint space was significantly larger in grades 1, 2, and 3 disk displacements than in grade 0 pointing to a dorsal condylar position. The posterior joint space was significantly smaller in grades 1 and 2 compared with grade 0. When the degree of the disk displacement becomes severe (i.e., grade 3 disk displacement), the posterior joint space tends to increase to a similar distance as in a normal healthy joint pointing to a more normal condylar position.

Mandibular overdentures supported by two or four endosteal implants. A prospective, comparative study.

The aim of this prospective study was to evaluate the effect of the number of implants supporting a mandibular overdenture on the condition of the peri-implant tissues. Sixty edentulous patients (Cawood class V VI) participated in this study. After randomization, thirty patients were treated with an overdenture supported by two IMZ implants (group A) and thirty patients with an overdenture on four IMZ implants (group B). The implants were inserted in the anterior region of the mandible. After three months overdentures were constructed, supported by round bar and clip attachments. A standardized clinical and radiographic evaluation was performed 0, 6 and 12 months after insertion of the denture. One implant was lost (group A) during the healing period. There were no significant differences with regard to any of the studied clinical or radiographic parameters of the peri-implant tissues, neither were significant differences found between the lateral and central implants in group B. None of the patients reported a sensory change in lip or chin region. From this study it is concluded that there seems to be no need to insert more than two endosteal implants to support an overdenture, however, long-term prospective studies are needed to support this notion.

[Comparison of dental implant systems for mandibular overdentures]. / Implantaatsystemen voor overkappings-protheses in de onderkaak vergeleken.

OBJECTIVE: To compare three implant systems in patients with severely resorbed mandibles 1 year after insertion of the mandibular denture. DESIGN: A prospective multicenter randomized clinical trial. SETTING: Centers at University of Nijmegen and Groningen. METHODS: Three different implant systems were used: the transmandibular implant, the IMZ and the Brånemark system. Treatment was assigned to 88 patients according to a balanced allocation method. Evaluation included clinical and radiographic parameters. A Clinical Implant Performance scale (CIP) was constructed based on all conceivable complications of the different implant systems. RESULTS: During the healing period 1 IMZ- and 1 BRA-implant were lost. One TMI was removed after functional loading. The results of the clinical and radiographic parameters and the CIP-scale showed no significant differences between the three implant systems. CONCLUSION: Taking the one year evaluation into account the three systems used did not differ in clinical and radiographic performance.

[Relapse after endodontic treatment: endodontic retreatment or apex resection?]. / Recidief na endodontische behandeling: herbehandeling of apexresectie?

In many cases, unsuccessful endodontic treatment is followed by apicoectomy. Endodontic retreatment, however, could be an appropriate alternative for apicoectomy more frequently. In this paper indications, specific problems and treatment methods are presented for endodontic retreatment, apicoectomy and intentional replantation.

[Overdenture prostheses on implants versus complete dentures]. / Overkappingsprothese op implantaten versus volledige prothese.

OBJECTIVE: To establish the treatment outcome of implant retained overdentures (IRD) versus complete dentures (CD) in which the outcome assessment focuses on the patient's subjective evaluation ('denture-satisfaction and chewing ability'). DESIGN: A multicenter randomized clinical trial (prospective). SETTING: The department of Oral Function and Prosthetic Dentistry of the University of Nijmegen, the department of Oral and Maxillofacial Surgery of the University Hospital Nijmegen and the department of Oral and Maxillofacial Surgery and Maxillofacial Prosthodontics of the University Hospital Groningen. METHODS: In this study 151 patients with severely resorbed mandibles participated, treatment had been assigned according to a balanced allocation method. Denture satisfaction and chewing ability were assessed using questionnaires before and 1 year after treatment. RESULTS: Before treatment all patients were dissatisfied with their mandibular denture and they could hardly chew tough or had food. One year after treatment the IRD-group was satisfied with their mandibular denture, whereas only one third of the CD-group was satisfied. With respect to the chewing ability the IRO-group scored significantly better than the CD-group (p < or = 0.0001). CONCLUSION: For patients with a severely resorbed mandible, overdentures retained by dental implants appear to provide a more satisfactory solution to their denture-related problems.

Mandibular overdentures supported by two Brånemark, IMZ or ITI implants. A prospective comparative preliminary study: one-year results.

The aim of this prospective comparative study was to evaluate the condition of the peri-implant tissues of three different implant systems supporting a mandibular overdenture. Ninety edentulous patients (Cawood class V-VI) participated in this study. After randomization, 30 patients were treated with 2 Brånemark implants, 30 patients with 2 IMZ implants and 30 patients with 2 ITI implants. The implants were inserted in the canine region of the mandible. After 3 months overdentures were fabricated supported by a round bar and clip attachment. A standardized clinical and radiographic evaluation was performed 0,6 and 12 months after insertion of the denture. The intraoral radiographs were made, using the long-cone technique with an aiming device. Two implants were lost (1 Brånemark, 1 IMZ) during the healing period. None of the patients showed any sensory change in lip or chin region. The pocket depth in the Brånemark group decreased significantly whereas the mucosa recession increased significantly in both the Brånemark as well as in the IMZ group. After 12 months, there was significantly less bone loss in the ITI group. From our study it was concluded that 2 (Brånemark, IMZ or ITI) implants placed in the interforaminal region connected with a bar supply a proper base for the support of a mandibular overdenture in the (Cawood V-VI) edentulous patient. The ITI implant appears to be the implant of choice for mandibular overdenture therapy, because only one operation is required for a comparable result.

Maxillary sinus function after sinus lifts for the insertion of dental implants.

PURPOSE: The influence of bone augmentation of the floor of the maxillary sinus for the insertion of dental implants on sinus function has not been well investigated. In this study, the influence of the sinus lift on the development of maxillary sinus pathology was evaluated using generally accepted diagnostic criteria. MATERIAL AND METHODS: A group of 45 patients in whom a sinus lift procedure had been performed were evaluated for sinus pathology 12 to 60 months after bone transplantation and implant insertion, using a questionnaire, conventional radiographic examination, and nasoendoscopy. RESULTS: Postoperative maxillary sinusitis was detected in two of five patients with a predisposition for sinusitis, but in none of the other 40 patients. The occurrence of iatrogenic sinus membrane perforations during surgery was not related to the development of postoperative sinusitis in patients with healthy sinuses. CONCLUSION: The occurrence of postoperative chronic sinusitis appears to be limited to patients with a predisposition for this condition. These predisposing factors need to be considered when evaluating patients for sinus lift procedures.

Psychosocial effects of implant-retained overdentures.

The aim of this study was to compare implant-retained mandibular overdentures and two conventional treatments for their effects on functional ability (chewing, speaking, etc), patient satisfaction, and quality of life (psychosocial functioning). Assignment of 90 patients was executed by means of a balancing allocation computer program to ensure the pretreatment comparability of the three groups. Twelve months after treatment, the average scores for almost all specific quality-of-life measures had improved significantly in all three groups. On average, all patients experienced fewer restrictions in their social activities and had fewer psychological problems because of their full dentures. No impact on the general quality of life was established. One year after treatment, all three dental treatment modalities had a comparably positive effect on dental health-related quality of life.

A controlled clinical trial of implant-retained mandibular overdentures: clinical aspects.

In a controlled clinical trial, treatment effects of mandibular overdentures on two different implant-systems in edentulous patients were compared one year after insertion of the new dentures. The implant-systems used were the Brånemark system (Brå) and the IMZ-system. Treatment was randomly assigned to 60 patients according to a balanced allocation method. Evaluation included peri-implant and radiographical parameters. According to the Delphi method a clinical implant performance scale (CIP) was constructed based on all conceivable complications of the different implant systems. During the osseointegration period, five Brå- and one IMZ-implants were lost. The results of one of the peri-implant parameters and the radiographical score showed significant differences considering the (pseudo) pocket probing depth (Brå better than IMZ, P < 0.001) and the radiographic-score (IMZ better than Brå, P < 0.003). The results for the CIP-scale were less favourable for the Brå-group than for the IMZ-group; however, these differences were not significant.

Morbidity from iliac crest bone harvesting.

PURPOSE: The iliac crest is the most common donor site for autogenous bone grafting in maxillofacial surgery. The aim of this study was to evaluate retrospectively the morbidity of bone harvesting from the inner table of the anterior iliac crest. PATIENTS AND METHODS: Sixty-five patients were recalled 1 to 4 years after iliac crest bone harvesting. The morbidity as well as the patient's satisfaction were evaluated by a survey of the medical record, a mail-in questionnaire, and a standardized physical examination. RESULTS: There was good acceptance of this bone harvesting procedure, and the morbidity was low. CONCLUSION: Bone harvesting from the inner table of the anterior iliac crest is a good option for reconstructing bone defects.

Hard and soft tissue imaging of the temporomandibular joint 30 years after diagnosis of osteoarthrosis and internal derangement.

PURPOSE: This article describes the clinical and imaging findings in the temporomandibular joints (TMJs) of patients 30 years after the initial diagnosis of osteoarthrosis and internal derangement. PATIENTS AND METHODS: Fifty-five TMJs with a history of osteoarthrosis and internal derangement and 37 contralateral TMJs that were asymptomatic 30 years ago were examined in 46 former patients. To visualize degenerative changes of the bony parts of the TMJ, transpharyngeal and transcranial radiographs were made; to visualize disc position, sagittal T1-weighted magnetic resonance (MR) images were made. For comparison, 22 TMJs of an age-matched control group without complaints related to the masticatory system were similarly examined. RESULTS: Thirty years after the initial diagnosis of osteoarthrosis and internal derangement, clinical signs in former patients hardly differed from those of control subjects. radiographic signs were significantly more common and more severe in former patients. A high percentage of osteoarthrosis and internal derangement was seen on MRI in both TMJs with a history of osteoarthrosis and internal derangement and in the contralateral TMJs. It appeared that osteoarthrosis and internal derangement in the contralateral TMJs had developed asymptomatically in most cases. None of the patients had required treatment for the contralateral TMJ; only one fourth of the patients had noticed symptoms. In the control subjects, osteoarthrosis and internal derangement were infrequently seen. A significant correlation was found between disc position and the severity of radiographically detectable degenerative changes of the TMJ. CONCLUSIONS: It was concluded that 30 years after initial diagnosis there were few clinical signs of osteoarthrosis and internal derangement, although radiographic signs were extensive. Bilateral osteoarthrosis and internal derangement, with one symptomatic and one asymptomatic TMJ, is a common phenomenon. Moderate to severe radiographically detectable degenerative changes may be the only sign of an underlying internal derangement.

Structure of the normal synovial membrane of the temporomandibular joint: a review of the literature.

PURPOSE: The structure of the normal synovial membrane of the temporomandibular joint (TMJ) is discussed, based on knowledge of synovial membrane in synovial joints in general.

Two-center clinical trial of implant-retained mandibular overdentures versus complete dentures-chewing ability.

This study is a two-center clinical trial with the aim to assess the treatment effects of implant-retained mandibular overdentures versus conventional complete dentures. Treatment had been assigned according to a balanced allocation method. The following criteria were used to enhance the comparability of the treatment groups: age, gender, the edentulous period of the mandible, the number of previously made mandibular dentures, the number of years having worn the present mandibular denture and the symphyseal bone height. 151 patients with severely resorbed mandibles participated in the study, they were treated at two centers. Ninety-one patients received an implant-retained mandibular overdenture (IRO) and 60 patients a conventional complete denture (CD). Since some patients refused the allocated treatment the "Intention To Treat" principle was applied. This implies that patients are evaluated in the originally allocated treatment group regardless of the actual treatment they received. Patient's experiences were evaluated before treatment and 1 yr after insertion of the new dentures. Results before treatment showed that both treatment groups were comparable: they were dissatisfied with their mandibular denture and they could hardly chew tough or hard foods. One year after insertion of the new dentures the IRO-group was satisfied with their mandibular denture, whereas only one third of the CD-group was satisfied. With respect to the chewing ability the IRO-group scored significantly better than the CD-group(P<0.0001).

Complications after mandibular third molar extraction.

The records of 1,797 patients were retrospectively examined to analyze the possible relationships between postoperative complications following mandibular third molar extraction and parameters such as age, sex, indication for surgery, position of the molar, surgical experience, surgical technique, and postoperative care. Older patients tended to suffer more often from complications. Surgery performed while there were signs of pericoronal inflammation also resulted in more complications. There was no statistically significant difference in the mean complication rate arising from surgery performed by staff members and the rate when surgery was performed by residents. There seems to be no reason for patients to return routinely for removal of resorbable sutures or other postoperative care because this practice does not result in a decrease in postoperative symptoms.

Patient satisfaction and chewing ability with implant-retained mandibular overdentures: a comparison with new complete dentures with or without preprosthetic surgery.

PURPOSE: The objective of this study was to compare denture satisfaction and chewing ability of edentulous patients treated with dental implant-retained overdentures or with full dentures with or without previous preprosthetic surgery. PATIENTS AND METHODS: This study was a controlled clinical trial. Thirty-eight men and 52 women participated in the study. The mean height of the anterior mandible was 21 mm (range, 16 to 25 mm), measured on a lateral cephalometric radiograph. The subjects were randomly assigned to the three treatment modalities. The main outcome measures were denture satisfaction and chewing ability, which were assessed using questionnaires focusing on denture-related complaints and the ability to chew different types of food, and an overall denture satisfaction score. RESULTS: Based on the baseline data from the "denture complaints" and "chewing ability" questionnaires, nine interpretable factors could be extracted. Two factors did not vary following treatment and were excluded from the outcome analysis. At the 1-year evaluation five of seven factors showed significantly better scores for the two surgical groups than for the control group. The same was found for the overall denture satisfaction rate. CONCLUSION: Overdentures retained by dental implants or complete dentures made after a vestibuloplasty and deepening of the floor of the mouth provide a more satisfactory solution for denture-related problems than complete dentures alone. For the scale "functional complaints lower denture," the overdenture group showed even a significantly better score than the preprosthetic surgery group.