Predictability and Feasibility of Total Alloplastic Temporomandibular Joint Reconstruction using DARSN TM Joint Prosthesis for patients in Indian subcontinent-A prospective clinical study.

PURPOSE: The aim of this study was to investigate the feasibility of a custom made alloplastic Temporomandibular Joint (TMJ) device design in patients undergoing temporomandibular (TM) Total Joint Reconstruction (TJR). OBJECTIVE: TMJ disease with functional and anatomic distortion dictates the need for TJR. There are various materials to reconstruct a TMJ. However, various factors, such as cost, availability of prosthetic joint, limit its use to tertiary health care center. Hence, we have investigated the feasibility and efficacy of the custom made alloplastic TMJ prosthesis (DARSN TM Joint Prosthesis) with the advantage of being acceptable financially and the overall Quality of life (QoL) diagnosed with TMJ ankylosis and End Stage Joint Disease (ESJD) selected from the study population. MATERIALS AND METHODS: The study group comprised of 20 patients with TMJ ankylosis or End Stage Joint Disease (ESJD) who needed TM TJR of which few subjects in the study population had history of failed previous surgery to the TMJ region. The patients underwent resection of the joint followed by TJR using the custom made alloplastic TMJ prosthesis. Various subjective and objective variables were evaluated such as the Jaw Function (JF), Inter-incisal opening (IO), Diet intake (DI), Quality of Life (QoL) using a Psychometric Modified Likert Scale and nutritional status of the patient using the Mid-Upper Arm Circumference (MUAC) as reference. RESULTS: All the subjective and objective variables showed significant improvement in the postoperative period as compared to the preoperative period. The JF score increased with a mean score of 6.25 (P<0.00001). Postoperative mean DI score was 3.15 (P<0.00001) and IO increased up to 29-38mm in 95% of the study population. The study population exhibited an improved overall QoL and nutritional status post-operatively. Follow up period of 1 year showed significant functional improvement among the study population. CONCLUSION: The results shows that the custom made alloplastic joint replacement is safe and effective and reliable alternative to treat patients with TMJ disease which restricts the normal function to a greater degree requiring TM TJR.

Comparison of latency and efficacy of twin mix and modified twin mix in impacted mandibular third molar surgery - A Preliminary Randomized Triple Blind Split Mouth Clinical Study.

INTRODUCTION: Intra-space drug administration have recently gained popularity in the clinical practice posing several advantages over the conventional routes of drug administration. A preliminary prospective randomized triple blind clinical study was conducted to compare the latency and duration of anesthesia with twin mix (1.8ml 2% lignocaine with 1:200,000 epinephrine and 1ml/4mg dexamethasone) and modified twin mix (1.7ml of 4% articaine with 1:100,000 epinephrine and 1ml/4mg dexamethasone) to two conventional local anesthesia solutions along with co-relation of clinical effects in the postoperative phase in patients undergoing extraction of impacted mandibular third molars in terms of patients comfort post-surgery. MATERIALS AND METHODS: The study was conducted among 20 patients with bilateral impacted mandibular third molars who were randomly allotted to two groups, Group A and B. Each patients in both the groups was allotted with study and control site. Among Group A, patients were further divided into Sub-group L (Control) and Sub-group TM (Twin Mix). Group B patients were divided as Sub-group A (Control) and sub-group MTM (Modified Twin Mix). Sub-group L patients received 1.8ml of 2% lignocaine with 1:200,000 adrenaline and sub-group TM received twin mix. Sub-group A received 1.7ml of 4% articaine with 1:100,000 adrenaline and sub-group MTM received modified twin mix solution. All the procedure was performed by a single operator with a gap of 1 month between the two interventions among both the groups. Various subjective and objective parameters were measured pre-operatively and postoperatively to assess the latency and efficacy of various anesthesia solutions used in this study for third molar removal. RESULTS: Mean (±SD) VAS scores for sting on injection and pain were found to be less in TM and MTM sub-group with a score of 2.3 (±0.768) and 2.7 (±0.065) respectively. The anesthetic latency was significantly less in sub-group TM, with a mean (±SD) of 52.4 (±28.3) seconds. Sub-groups A and MTM had longer latency of anesthesia when compared with L and TM sub-groups. The duration of soft tissue anesthesia was maximum in sub-group MTM as compared to the other sub-groups. Patients from control sub-groups among both the groups had increased swelling, post-surgical pain and trismus postoperatively. DISCUSSION: Intra-space administration of twin mix and modified twin mix is clinically efficacious in impacted mandibular third molars surgery with better clinical outcomes postoperatively. We observed one significant difference between TM and MTM that the latter solution provided a prolonged duration of anesthesia increasing the patient's comfort postoperatively after surgical removal of mandibular third molars.

Partial thickness temporalis rotation for alloplastic temporomandibular joint - how I do it.

With increasing clinical evidence, the replacement of the temporomandibular joint with alloplastic joints is being increasingly accepted in severe degenerative diseases. There remains a risk of infection and a possibility of a failure of not just these prostheses but any alloplastic joint prosthesis post-operatively. Therefore, an extra precaution and additional coverage to the joint using partial thickness myo-temporalis rotation flap could be a useful option to minimize post-operative joint failure.