Flexure deformation in temporomandibular joint disk displacement without reduction may predict treatment outcome.

To identify whether the direction of disk flexure deformation predicts the prognosis in cases of anterior disk displacement without reduction of painful temporomandibular joint (TMJ), the relationship between the direction of flexure, observed on pseudodynamic magnetic resonance (MR) images, and the outcome of conservative treatment using a flat occlusal splint was analysed in 40 female patients who perceived occasional or constant pain at unilateral TMJ with disk displacement without reduction. From the MR findings, 20 patients were classified as having upward flexure deformation of the disk and 20 as having downward flexure deformation. Patients' TMJ pain, masticatory muscle pain, amount of maximal mouth opening, and MR findings were evaluated before treatment. All patients were treated with a flat occlusal splint for 6 months. The patients' signs and symptoms were analysed statistically within each group before treatment and 3 and 6 months afterwards, and were also compared between the upward and downward flexure groups. There was no statistical difference between the groups before treatment, except in the amount of maximal mouth opening and the extent of disk displacement. The upward flexure group had persistent TMJ pain and tendency of delayed alleviation of masticatory muscle pain compared with the downward flexure group, although maximal opening gradually increased in both groups. Thus, the direction of the flexure in deformation of the disk, which can be observed only with pseudodynamic MR imaging, may predict the prognosis of painful disk displacement without reduction following treatment with a flat occlusal splint.

Flexure deformation of the temporomandibular joint disk in pseudodynamic magnetic resonance images.

OBJECTIVE: The purpose of this study was to determine correlation of flexure disk deformation during jaw movement with other findings on magnetic resonance images and with clinical signs and symptoms in patients with anterior displacement of the temporomandibular joint disk. STUDY DESIGN: T(1)-weighted magnetic resonance images and gradient recalled acquisition in steady state magnetic resonance images were obtained in 62 subjects with flexure deformed disk in the jaw opening phase. Each disk deformation observed on a pseudodynamic image during jaw opening was classified as an upward or downward flexure deformation. The relationships between type of disk deformation, clinical signs and symptoms, and other findings on the magnetic resonance images were statistically analyzed by chi(2) test.Results. Of 80 delineated joints, 30 showed upward deformation and 50 showed downward deformation. There were significant differences between the upward and downward deformations in TMJ sound, TMJ pain, restricted jaw opening, extent of anterior displacement, and presence of disk reduction. CONCLUSIONS: The type of disk deformation appeared to correlate with the clinical signs and symptoms and with the progress of internal derangement.

Magnetization transfer contrast on gradient echo MR imaging of the temporomandibular joint.

Thirty-nine temporomandibular joints (TMJ) from 20 patients with suspected internal derangements were imaged by a 1.5 T MR imager. The on-resonance binomial magnetization transfer contrast (MTC) pulse was applied to gradient echo images with a dual receiver coil (9 s/section). With the use of an opening device, a series of sequential images were obtained at increments of mouth opening and closing. The tissue signal intensities with (Ms) and without (Mo) MTC were measured and subjective image analysis was performed. Compared with the standard images, MTC technique provided selective signal suppression of disks. The average of Ms/Mo ratio of the disks (0.56) was lower than that of the retrodiskal pad (0.79) and of the effusion (0.89). With MTC technique, fluid conspicuity was superior to standard image. However, no significant superiority was found in disk definition subjectivity.

[Histo-pathology of the regenerating process in the tissue around the periodontally diseased teeth of beagle dogs. Clinical and histological analysis following flap surgery].

The regenerating process in tissue around periodontally diseased teeth (PDTs) and non-diseased teeth (NDTs) was studied with clinical and histological analysis following flap surgery. PDTs were prepared in the premolars of 7 beagle dogs by which surgically denuding the root surfaces by removing the alveolar bone. The denuded sites were covered with gutta-percha plates and gingival epithelial tissues and exposed to the oral environment for 4 weeks. Then flap surgery was performed on the PDTs. As control sites, the root surfaces of the NDTs were denuded by removing the alveolar bone at the time of flap surgery. The root surfaces of the PDTs and NDTs were planed with curette scalers at one root site but not at the other site. Clinical and histopathological findings were evaluated at fixed intervals for 32 weeks after surgery. Results of observation were as follows. 1. In the clinical evaluations, the gingival inflammation index, probing depth and attachment level were improved in the root planing (PR) group of both the PDTs and the NDTs, but in the non RP group of PDTs there was no improvement. 2. In the histologic observation, the position of the gingival margin, length of regenerated junctional epithelium, depth of gingival sulcus and the level of connective tissue attachment in the RP groups recovered in both the PDTs and the NDTs but not in the non RP groups.

[Histological study on gingival tissue reattachment after periodontal surgery. Effects of hydroxyapatite ceramic implantation to denuded dentin surfaces in rats].

The purpose of this study was to evaluate histological regeneration of epithelial and connective tissue attachment to the denuded dentin surface after hydroxyapatite ceramic granule (HAP) implantation. HAP (particle size 100-300 microns, burn temperature 900 degrees C) were implanted into dehiscent defects of alveolar bone which eliminated about a 1 x 1 mm area at mesial and palatal sites of the upper 1st molar in 20 male Wistar rats. Subsequently the root cementum was removed totally and dentin was denuded. Same osseous defects were formed but HAP was not implanted at any contralateral site for the purpose of control. Results of 8-week examination using light and electron microscopy were as follows: 1. In the HAP group junctional epithelium was regenerated on the denuded dentin surface 2 weeks after implantation and epithelial down growth was less than at the control site. 2. In the HAP group connective tissue reattachment with new cementum formation was observed at 2 to 4 weeks after implantation, the healing period tended to be shorter than at the control site and the connective tissue reattachment level was located more coronally. 3. In ultrastructural findings collagen fiber bundles attached to the denuded dentin surface had fibers continuing around HAP granules.