Cyclooxygenase-2 in synovial tissue and fluid of dysfunctional temporomandibular joints with internal derangement.

PURPOSE: This study investigated cyclooxygenase-2 (COX-2) gene expression in temporomandibular joint (TMJ) synovial tissue and fluid from patients with internal derangement. PATIENTS AND METHODS: Seventeen synovial tissue biopsy specimens and 16 synovial fluid samples were obtained from patients (1 male and 11 female) during arthroscopic TMJ surgery. The samples were frozen at -70 degrees C and, by using Northern and reverse transcription polymerase chain reaction (RT-PCR) analysis, the levels of COX-2 RNA in relation to beta-actin RNA message levels were determined. RESULTS: COX-2 RNA message was detected in 16 of 17 synovial tissue samples (94%) and 12 of 16 synovial fluid samples (75%) by using beta-actin RNA levels in the same sample (either tissue or fluid) as an internal control. Samples were not quantified because of the same sample mass. CONCLUSION: COX-2, an important inflammatory mediator, is present in the TMJ synovial tissue and fluid from patients with internal derangement. Therefore, COX-2 antagonists may be indicated in the treatment of TMJ arthralgia.

Arthroscopic management of temporomandibular joint disc perforations and associated advanced chondromalacia by discoplasty and abrasion arthroplasty: a supplemental report.

PURPOSE: This article describes the results of treating temporomandibular joint (TMJ) articular disc perforation and advanced chondromalacia arthroscopically by the use of discoplasty and abrasion arthroplasty. PATIENTS AND METHODS: Forty-four joints were treated in 25 patients (23 females and 2 males). Twenty-nine disc perforations were present, 24 joints had grade III chondromalacia (fibrillated cartilage), and 14 joints had grade IV chondromalacia (exposed bone). Surgical procedures included 14 abrasion arthroplasties and 24 motorized shavings or holmium laser vaporizations. Holmium laser discoplasty with mobilization was used in 29 joints. Patients were followed-up for an average of 40.8 months (11 to 74 months). RESULTS: Preoperative pain on the visual analog scale (VAS) (1 to 10 cm) ranged from 5 to 10 cm, with an average of 7.4 cm. Postoperatively, nine patients had no pain and 16 patients had an average VAS of 2.7 cm (range, 1 to 5 cm). Preoperatively, 30 joints had clicking, and 14 joints had crepitation. Postoperatively, 25 joints had no noise, 12 joints had slight intermittent clicking, and seven joints had crepitation. The preoperative range of motion averaged 29.7 mm. Postoperatively, the range of motion averaged 37.7 mm (range, 33 to 42 mm). All patients could masticate a regular diet except hard food after an average of 40.8 months (11 to 74 months). CONCLUSIONS: These findings seem to justify the arthroscopic surgical procedures of discoplasty for disc perforations, motorized shaving, or holmium laser vaporization of grade III chondromalacia, and abrasion arthroplasty for bone exposure. The results also question the need for discectomy in the treatment of disc perforation.

Mandibular exercises to control bruxism and deviation problems.

A discussion of bruxism, mandibular deviation and hypermobility problems producing temporomandibular joint (TMJ) and masticatory muscle pathology is presented. The pathophysiology of painful masticatory muscle hyperactivity, TMJ dysfunction and chondromalacia are presented. The role that pain mediators play in the degradation of TMJ fibrocartilage, acute synovitis and joint and muscle pain is analyzed. Isokinetic and stretching exercises are described to assist in correcting or preventing pathology and dysfunction of these structures.

Arthroscopic management of temporomandibular joint disc perforations and associated advanced chondromalacia by discoplasty and abrasion arthroplasty: preliminary results.

This article describes the arthroscopic surgical treatment of disc perforations by discoplasty to mobilize the disc and reduce joint friction. Grade IV chondromalacia with exposed bone was treated by abrasion arthroplasty with the goal of resurfacing the bone with fibrocartilage. Preliminary data on the results of these procedures are presented.

Temporomandibular joint arthroscopy: a 6-year multicenter retrospective study of 4,831 joints.

Four health outcomes (range of motion, pain, diet, and disability) were measured in six diagnostic categories (internal derangement with closed lock, internal derangement with painful click, osteoarthritis, hypermobility, fibrous ankylosis, and arthralgia) in a 6-year retrospective multicenter study of 4,831 temporomandibular joints having undergone arthroscopic surgery. After arthroscopic surgery, 91.6% of all patients had good or excellent motion; 91.3% had good or excellent pain reduction; 90.6% had good or excellent ability to maintain a normal diet; and 92% had a good or excellent reduction in disability. These health outcomes compare favorably with all other known treatments for these conditions. Also, the surgical technique was relatively free of complications (4.4%).

The clinical effects of electrostimulation on salivary function of Sjögren's syndrome patients. A placebo controlled study.

A multi-center double-blind study of an electro-stimulator device was conducted to evaluate its ability to increase the production of saliva and reduce clinical symptomatology. A total of 77 Sjögren's syndrome patients at three centers were assigned to active devices (n = 40) or to placebo devices (n = 37). There were 2 male and 32 female patients assigned to active devices, and 1 male and 36 female patients assigned to placebo devices. The age range with the greatest number of patients was 60-69 years making up more than 31% of the study population. The selection criteria required the patients to have no greater than 0.2 g/min of whole salivary production (approximately 19% of normal salivary production). At the start of the study, the patients assigned the active device had a mean salivary production of 0.06 ml per min (6% of normal) and patients assigned placebo devices had a mean salivary production of 0.07 ml per min (7% of normal). There were three scheduled visits, 2 weeks apart, over a treatment period of 4 weeks. At all visits, the patients using active devices showed a statistically greater (P = 0.005 to 0.02) increase in the production of saliva than placebo patients. The study also evaluated the reduction of patients symptoms associated with xerostomia. Patients showed significant improvement in (1) difficulty in swallowing and (2) burning tongue (P = 0.008). Some patients on their initial visit had no response to the active device and did not show a significant response at subsequent visits.(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of prostaglandin E2 and leukotriene B4 in the synovial fluid of painful, dysfunctional temporomandibular joints.

It has been hypothesized that prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) should be present in the synovial fluid of inflamed, dysfunctional temporomandibular joints. An assay to identify PGE2 and LTB4 and platelet-activating factor (PAF) was used, and a strong correlation between the levels of these lipid mediators of pain and inflammation and an index of clinical joint pathology was found.

Hydroxylapatite alveolar ridge reconstruction: clinical experiences, complications, and technical modifications.

Results of the reconstruction of 228 deficient alveolar ridges (208 patients) using hydroxylapatite with or without autogenous cancellous bone over a six-year period are reported. Complications included erosion, mental nerve neuropathy, migration and displacement of particles, overfill, and loose material. Modified techniques are presented that minimize the occurrence of these complications in Class III and IV ridge-deficient patients.

Preservation of the alveolar ridge with hydroxylapatite tooth root substitutes.

A total of 49 patients, who were followed for 3 to 31 months, have had 92 hydroxylapatite root implants placed in fresh extraction sockets without soft tissue closure. Hydroxylapatite root implants maintain approximately twice as much alveolar bone as the contralateral control sites without implants. It is believed that this method is a more effective and efficient procedure to preserve alveolar bone for retention of dentures than previously described procedures.

Alveolar ridge maintenance with solid nonporous hydroxylapatite root implants.

Animal studies were carried out to determine a simple technique of implantation of nonresorbable polycrystalline hydroxylapatite solid root forms and the biocompatibility of the material placed in fresh extraction sockets. An appropriately shaped root form was evaluated, and alveolar bone preservation was investigated in dogs and primates. It was found that bone and soft tissue would migrate across the HA root implant when placed 2 to 3 mm below the alveolar bone crest without soft-tissue closure. It was not necessary to use roots that fit the socket from the apex to the alveolar crest. An average of 2 mm more alveolar bone was preserved in fresh extraction sites as compared to control sites. The results of the animal studies indicated the appropriateness of a clinical trial in human beings.

Alveolar ridge augmentation using nonresorbable hydroxylapatite with or without autogenous cancellous bone.

A four-year prospective evaluation of the use of nonresorbable, particulate hydroxylapatite (HA) to augment deficient alveolar ridges was performed. The material was used alone and in combination with finely crushed autogenous cancellous bone. Implants were delivered subperiosteally by syringe injection, usually using local anesthesia for Class I to Class III ridges and general anesthesia for Class III and Class IV ridges. The improved ridge height and width were stable. Postoperative resorption with significant loss of ridge height, frequently seen with rib and iliac crest onlayed grafts, was not observed with HA augmentation. Permanent denture construction began as early as three weeks postoperatively and by four to six weeks if HA was combined with autogenous cancellous bone. It was possible to place mandibular staple implants simultaneously or following HA augmentation. Visor osteotomy techniques were improved by use of HA to produce a wider, more convex stable ridge. Although skin, mucosa, or dermal vestibuloplasties were performed as early as three months postoperatively in a small number of patients, there appeared to be a lesser need for vestibuloplasty after HA augmentation than after onlay bone grafting. In addition, prosthodontists performed fewer denture relines after HA augmentation than after onlay bone grafts. The authors believe the most significant factor accounting for these observations is the firm, nonmobile mucosal base resulting from augmentation with HA. The resultant stable, soft tissue base and improved ridge height and contour have contributed to a comfortable, retentive, stable denture for these patients. The prosthetic and surgical procedures are easier to perform and have produced superior, more permanent results than onlay bone grafts and alloplasts. Preliminary studies also point to exciting possibilities for use of HA as a bone substitute/marrow extender in maxillary and mandibular defects, cysts, and clefts and in osteotomies for orthognathic surgery.