Therapeutic effects of sialendoscopy for diagnosis and treatment of hyposalivation patients: a retrospective study.

BACKGROUND: Hyposalivation is disease with multiple symptoms. This disease is hard to be diagnosed and to be treated, and there are not enough clinical protocols to cure the disease. In this study, we propose our own treatment protocols which aim not only to cure the disease but also to care for the disease-related symptoms. METHODS: At the 1st visit, we collect patient-related information. This procedure includes an intraoral exam, patient history taking, VAS value and unstimulated whole saliva (UWS) measurement, and salivary buffer test. Following the interview and oral examination, objective results are obtained by radiological image, CT, and sialoscintigraphy. At the 2nd visit, we analyze radiographic images including neck CT and salivary scintigraphy. These images can allow accurate diagnosis and help the patients to better understand the current condition. Depending on the severity of symptoms and patient's discomfort, we try a surgical approach at the 3rd visit, sialendoscopy. RESULTS: With treatment, we can manage the discomfort of patients in daily life. The VAS value of hyposalivation patients dropped gradually with the trial of sialendoscopy. In the case of Sjogren's syndrome patients, the treatment efficacy has been decreased with low reactivity of treatment. The true meaning of this treatment is in not only curing the disease, but also caring for the disrupted patients. Overall, the amount of UWS increased with the progress after the procedure. Especially in the lower UWS at the 1st visit, there was a more significant increase after the procedure. CONCLUSION: Although many factors that cause hyposalivation have not been identified, the efficacy of sialendoscopy to relieve discomfort in hyposalivation patients has been observed. However, treatment was more difficult and complicated in the group of patients with systemic disease. This study will not only present a treatment protocol for hyposalivation patients, but also consider methods for diagnosing more precisely and improving treatment efficacy. Hyposalivation is a curable and manageable disease in some cases, so interpretation between the clinician and the patient is important.

The effect of loading time on marginal bone change of implants immediately placed after extraction: a retrospective study.

BACKGROUND: The purpose of this study is to compare and analyze the treatment outcomes between two groups which are both immediately placed implant cases, one is immediate loading, and the other is conventional loading group. METHODS: Medical records of the patients who underwent implant treatment which were immediately placed after tooth extraction were analyzed. Demographic data were collected and by using periapical or panoramic radiographic image, marginal bone level and distant crestal bone level were measured. Marginal bone change over time was analyzed and compared between immediate loading group and conventional loading group. RESULTS: A total of 71 patients, 112 immediately placed implants after tooth extraction were initially involved. Measuring was done with implants which had not failed (81). 10 implants were had failed and removed. The others were excluded because of follow-up loss, absence of radiographic image, etc. Demographic data were collected, and measured values were averaged at each follow-up and showed in linear graphs. CONCLUSIONS: In case of immediate implantation of dental implant after extraction, loading time could affect marginal bone level or biological width of the implant. Immediate loading group showed 0.92 mm (mean value) more bone loss compared to conventional loading group at bone-implant contact points 24 months after implantation. At distant crestal points, there was no noticeable difference in bone change pattern between two groups.

Biosilicated collagen/ß-tricalcium phosphate composites as a BMP-2-delivering bone-graft substitute for accelerated craniofacial bone regeneration.

BACKGROUND: Bioceramic ß-tricalcium phosphate (ß-TCP) is used as a bone-grafting material and a therapeutic drug carrier for treatment of bone defects in the oral and maxillofacial regions due to the osteoconductivity and biocompatibility. However, the low mechanical strength and limited osteoinductivity of ß-TCP agglomerate restrict bone regenerating performance in clinical settings. METHODS: Herein, a biomimetic composite is proposed as a bone morphogenetic protein-2 (BMP-2)-delivering bone graft substitute to achieve a robust bone grafting and augmented bone regeneration. RESULTS: The sequential processes of brown algae-inspired biosilicification and collagen coating on the surface of ß-TCP enable the effective incorporation of BMP-2 into the coating layer without losing its bioactivity. The sustained delivery of BMP-2 from the biosilicated collagen and ß-TCP composites promoted in vitro osteogenic behaviors of pre-osteoblasts and remarkedly accelerated in vivo bone regeneration within a rat calvarial bone defect. CONCLUSIONS: Our multicomposite bone substitutes can be practically applied to improve bone tissue growth in bone grafting applications with further expansion to general bone tissue engineering.

Effect of arthrocentesis on the clinical outcome of various treatment methods for temporomandibular joint disorders.

BACKGROUND: We evaluated the improvement of pain and the increase in mouth opening after temporomandibular joint arthrocentesis and the possible association with various factors such as previous splint treatment, medication, and diagnosis. RESULTS: We studied 57 temporomandibular joint disorder patients who underwent arthrocentesis at Korea University Anam Hospital. These patients (24 males and 33 females, aged between 15 and 76 years) underwent arthrocentesis that was performed by one surgeon. The degree of mouth opening (assessed using the maximum mouth opening: MMO) and pain (assessed using the visual analog scale: VAS) were assessed pre- and post-arthrocentesis. The study also investigated whether treatment modalities other than arthrocentesis (medication and appliance therapy) were performed. Statistical analysis revealed that there was a significant difference in mouth opening and pain after temporomandibular joint arthrocentesis. Preoperative appliance therapy affected the results of arthrocentesis, but it was not statistically significant. With regard to pain relief, preoperative diagnosis did not show a significant difference. However, with regard to maximum mouth opening, patients with disc displacement without reduction with limited mouth opening (closed lock) showed the highest recovery (11.13 mm). CONCLUSION: The average of MMO increase after arthrocentesis was 9.10 mm, and patients with disc displacement without reduction with locking (closed lock) showed most recovery in maximum mouth opening and it was statistically significant. The average pain relief of patients after arthrocentesis was 3.03 in the VAS scale, and patients using anterior repositioning splint (ARS) preoperatively showed the most pain relief.

Preliminary study on the efficacy of xerostomia treatment with sialocentesis targeting thyroid disease patients given radioiodine therapy.

BACKGROUND: Radioiodine therapy has been widely used for thyroid disease patients, but hyposalivation and xerostomia may occur in 10~30% of patients. Sialocentesis is a procedure that removes inflammatory substances in the salivary duct and expands the duct for the secretion and delivery of saliva. In this study, thyroid disease patients treated with radioactive iodine were selected among the patients with xerostomia who visited the hospital, and the effect of sialocentesis was compared and analyzed. And then, comparison between the radioiodine therapy-experienced group and the non-radioiodine therapy-experienced group was conducted. RESULTS: In this study, we studied xerostomia patients who underwent radioiodine therapy due to thyroid diseases and who underwent sialocentesis at the Korea University Anam Hospital. Sialocentesis is conducted by one surgeon. The study also compares the clinical symptoms before and after the surgery. After the procedure, the discomfort due to xerostomia was reduced, and the symptom was improved effectively. CONCLUSIONS: The results of this study showed that sialocentesis has a clinical effect in the treatment of xerostomia, which is a side effect of radioiodine therapy. In addition, the possibility of further clinical application of sialocentesis in the future is found.

Sialolithotomy of the submandibular duct using sialendoscopy.

BACKGROUND: Conventionally, indirect radiography has been used to diagnose salivary gland diseases. However, with the development of sialendoscopy, diagnosis and treatment of salivary gland diseases have become more effective. Herein, we report a case of sialolithotomy treated with sialendoscopy and compare it with the existing methods through a literature review. CASE PRESENTATION: Two patients with a foreign body sensation under the tongue and dry mouth visited the Anam Hospital, Korea University. Radiographic examination revealed salivary stones inside the right Wharton duct, and the patients underwent sialolithotomy under local or general anaesthesia. The stones were totally removed, and there were no postoperative complications such as bleeding or pain. CONCLUSION: The development of sialendoscopy has enabled better definitive diagnosis of salivary gland diseases compared with the conventional methods; better treatment outcomes can be obtained when sialendoscopy is used in appropriate cases.