Neurosensory function and implant survival rate following implant placement with nerve transpositioning: a case study.

In patients with extensive bone resorption, implant placement posterior to the mental foramen is a problematic surgical procedure. This paper reports the results in 6 patients (aged 20-61) with edentulous areas in the posterior part of the mandible, in whom 26 Nobelpharma implants were placed, including 17 with transposition of the inferior alveolar nerve allowing the use of implant fixtures of at least 10 mm in length. Subsequent neurosensory function, based on British Medical Research Council definitions, and implant survival rate were examined. In all cases, postoperative numbness occurred in the lower lip and mental area. Three years after surgery, while one patient had completely recovered neurosensory function, five patients still experienced partial numbness, although this was not perceived as a problem by those patients. The implant survival rate was 100% approximately three years after surgery. The results suggest that a higher implant survival rate is likely when longer fixtures are used, but this is also more likely to lead to slight long-term neurosensory dysfunction.

Histopathological and immunohistological analyses in IgA deficient lymphoplasia (aly/aly) mouse.

The aly/aly mouse has a severe immunodeficiency, because it lacks peripheral lymph nodes as well as IgA and IgG immunoglobulin synthesis. In the present study, we performed histopathological and immunohistological examinations to clarify histological disorders of various immune organs in these mice. Carbon CH40 injections into the apex of the tongue confirmed the absence of submandibular lymph nodes in aly/aly mice. The thymus had a poorly constructed cortex and medulla, and the number of lymphoid follicles was clearly decreased in the spleen. No IgG- or IgA- producing cells were found in any immune organs, including the mucosal immune sites, though several IgM -producing cells were identified. Other characteristic findings included perivascular lymphocytes accumulation in the salivary glands, lungs, liver and pancreas, which caused tissues damage. These results demonstrated that the various lymphoid tissues disorders and organ-specific lymphocyte infiltration cause immuno-deficiency in the aly/aly mouse.

Predicting tumor metastasis in patients with oral cancer by means of the proliferation marker Ki67.

Recent developments of a Ki67 antibody to recombinant parts of the Ki67 nuclear antigen have provided a marker for tumor proliferation. In the present study, biopsy specimens were obtained from 20 patents with squamous cell carcinoma of the oral cavity at various sites, who also received a regional neck dissection. The patients' mean age was 61 years. Normal mucosa obtained from the surgical materials of 10 patients with a non-tumor condition was also examined as a control. The expression of Ki67 was examined immunohistochemically and the labeling index (LI) assessed in the biopsy specimens. The patients were divided into two groups; patient who already had a regional lymph node metastasis at the time of tumor resection and patient without any metastasis. All of the oral carcinoma and normal mucosa specimens were positive for Ki67, while the magnitude of staining showed a wide variation. The median LI of the patients with metastasis and without metastasis was 37.63 +/- 8.30 and 20.40 +/- 4.22 respectively, while the normal mucosa control was 7.62 +/- 1.70. The results of this study suggest that an immunohistochemical examination of the biopsy materials for the Ki67 antigen and assessed LI index should prove useful for the prediction of lymph node metastasis.

Releasing severe adhesions around the eminence and the synovial portion of the TMJ: a clinical study of combined treatment using hydraulic lavage, arthroscopic surgery and rehabilitative therapy.

This paper evaluates the effects of treatment with a pumping technique and arthroscopic lysis and lavage, followed by rehabilitative training, on condylar head mobility of the temporomandibular joint (TMJ). We studied 32 TMJs in 19 patients suffering from chronic closed lock with severe adhesion. The results were compared between cases with adhesions concentrated in two areas: mostly in the posterior and/or the anterior synovial portion of the upper TMJ compartment (11 joints) and mostly around the eminence (21 joints). The results showed a statistically significant improvement in condylar head movement for both groups between the initial and final stages of treatment. However, the results also suggested that patients with adhesion concentrated around the eminence are less likely to recover condylar head mobility to the same extent as those in the other group.

Worsening of pre-existing TMJ dysfunction following sagittal split osteotomy: a study of three cases.

When patients seeking treatment for malocclusion also suffer from temporomandibular joint (TMJ) disorders, it is hard to predict the result of simultaneous treatment of both conditions, or to plan for its different goals, because of unpredictable changes in the relationship between the disk, the fossa and the condylar head. Prediction is harder in cases of presurgical TMJ hypomobility, especially those with adhesion in the upper TMJ compartment. Authors differ widely on the likely effect of orthognathic surgery on TMJ disorders. This paper reports three cases in which TMJ disorders worsened after treatment of malocclusion by sagittal split osteotomy. It examines how presurgical diagnosis of TMJ disorders could assist treatment planning in such cases. The results suggest that microbleeding in the upper TMJ compartment during orthognathic surgery, as well as long-term postoperative intermaxillary fixation, carries a risk of creating worse adhesion that adversely affects the outcome for patients. Therefore, preoperative diagnosis of disk position and pathological conditions in the upper TMJ compartment, as well as careful choice of method and term of postoperative fixation, are essential in planning the treatment of malocclusion with sagittal split osteotomy.

Prosthetic restorations with osseointegrated implants after bone grafts to correct large jaw defects caused by extraction of multi-impacted teeth: a case report.

A case is reported of a 21-year-old Japanese man examined for unerupted molar teeth on the left side of both jaws. Intraoral examination revealed edentulous regions from the second premolar to the molar, with moderate atrophy of the upper alveolar ridge. A panoramic X-ray revealed eight impacted teeth. The impacted mandibular teeth were extracted through decortication and bone replacement. The impacted maxillary teeth were extracted following reflection of a mucoperiosteal flap. The large defects caused by the extractions in both jaws were filled with autogenous cancellous marrow and bone chips. Eleven months later, in the first stage of the Branemark implant procedure, fixtures were placed in the edentulous regions of both jaws, with simultaneous additional corticocancellous block onlay bone grafting in the maxilla to correct slight resorption. After another seven months, second-stage abutment surgery was performed. Occlusion was then restored through a prosthetic procedure. Next, orthodontic treatment was commenced, using the implant supported teeth as an anchor. Despite the slight resorption in the maxilla, implantation was successful and occlusion was restored in the previously edentulous regions. This suggests that application of a simultaneous corticocancellous block onlay bone graft is a valuable basis for implant procedures in the maxilla.

Rapid diagnosis of oral tuberculosis by amplification of Mycobacterium DNA from paraffin embedded specimens.

The polymerase chain reaction (PCR) assay is a powerful tool for quick diagnosis of various infectious diseases. We applied this technique as well as conventional histopathological examination to diagnose oral tuberculosis. Ziehl-Neelsen staining of oral mucosal specimens often fails to detect Mycobacterium (M.) tuberculosis due to the low number of bacteria in the tissue. Specific primers and probes were synthesized based upon the nucleotide sequence of the 65 kDa membrane protein of M. tuberculosis. DNA extracted from the paraffin-embedded tissue was amplified using taq polymerase. PCR assay detected M. tuberculosis in 5 of 6 samples. Although the gene segments from these species were quite similar, the gamma 32P labeled noligonucleotide probes distinguished between M. tuberculosis and M. fotuitum by southern blot hybridization. In all specimens that were Ziehl-Neelsen negative, M. tuberculosis DNA was detected by PCR. These results suggest that PCR is a useful means of diagnosing mycobacterium infection.

Clinical evaluation of orthodontic treatment after surgical repositioning or transplantation of teeth.

Fourteen impacted teeth in thirteen patients aged 9 to 17 years were either repositioned or transplanted, followed by postoperative orthodontic treatment. Successful results were achieved in twelve of the teeth. In one tooth, ankylosis of the root prevented a successful outcome, and deficient bone healing of the alveolar process led to an unsuccessful result in a second tooth.

Clinical assessment of the pumping technique in treating TMJ arthrosis with closed lock.

The treatment of closed jaw locking due to temporomandibular joint (TMJ) arthrosis is described. Conventional mandibular manipulation of the lower and/or upper joint compartments was performed using hydraulic pressure from an imaging X-ray medium. The procedure was used in 40 patients with closed locking (5 acute and 35 chronic). The results of the treatment are evaluated and factors affecting the results are examined. In four of the five patients with acute closed locking, the lock was successfully released after use of the pumping technique on the lower joint compartment. In patients with chronic locking, an average improvement of 6.6 mm in the degree of interincisal opening was observed within 3-4 days of treatment with the pumping technique. In 13 of these patients, satisfactory opening (at least 40 mm) was achieved immediately. All the patients underwent further forward and contralateral manipulation to assist mouth opening, and after a period of 2-3 months 16 patients showed a further average improvement of 5.4 mm in interincisal opening.

Two cases of symptomatic elongated styloid process.

Two cases of elongated styloid process are reported. The first occurred in a 27-year-old man whose only complaint was pain when moving the jaw, and its differential diagnosis was comparatively simple. The second case occurred in a 33-year-old woman, for whose condition differential diagnosis was more difficult, as she presented many symptoms, including neuralgic pain in the face and neck, pain in the pharynx when swallowing, and pain in the region of the temporomandibular joint, radiating to the subauricular and submandibular regions. Following surgical shortening of the elongated styloid process through an intraoral approach, both patients' symptoms disappeared or were improved.

Comparison of the functional occlusal plane in adults with class III malocclusion showing open bite and non-open bite.

A retrospective study of lateral cephalograms of 24 Japanese adults with Class III malocclusion was made in order to compare the angles of the horizontal plane between open bite and non-open bite cases. The following results were obtained: i) There was no significant difference in the angle of the NF-upper occlusal plane between the open bite and non-open bite groups. ii) There were significant differences between the two groups in the angle of the SN-upper and lower occlusal planes, the FH-upper and lower occlusal planes and MP-lower occlusal plane. There was also a significant difference between the groups in the distance from the Xi point to the upper occlusal plane. iii) In both the open bite and non-open bite groups there was a wide variation in occlusal plane angles, compared with normal cases.

Preprosthetic surgery for severely atrophic maxilla with poor palatal vault form; report of two cases treated by hard palate compression through palatal vault osteotomy.

Two cases of severely atrophic maxilla with poor palatal vault form treated by Kitayama's modified palatal vault osteotomy technique are described. The advantages of this osteotomy technique are outlined in comparison with other surgical methods.