Arthrocentesis Followed by Autologous Blood Injection in the Treatment of Chronic Symptomatic Subluxation of Temporomandibular Joint.

Introduction: Temporomandibular joint subluxation is defined as self-reducing partial dislocation of the TMJ during which the condyle passes anterior to the articular eminence. Material and Method: The study consisted of 30 patients, 19 females and 11 males with 14 unilateral and 16 bilateral cases of chronic symptomatic subluxation. Treatment consisted of arthrocentesis followed by 2 ml of autologous blood injection into upper joint space and 1 ml into pericapsular tissues using an autoclaved soldered double needle with single puncture technique. Parameters evaluated were pain, maximum mouth opening, excursive jaw movements, deviation on mouth opening and quality of life, hard and soft tissue changes on X-ray TMJ view and MRI. Results: At 12 month follow-up, average reduction in maximum interincisal opening, deviation on mouth opening, range of excursive movements on right and left sides and VAS scores were 20.54%, 32.84%, 29.59%, 27.37% and 74.53%, respectively. Out of 93.3% who responded to therapy, 66.7%, 20% and 6.7% responded after 1st, 2nd and 3rd AC + ABI, respectively. Remaining 6.7% patients had persistent painful subluxation and underwent open joint surgery. 93.3% patients responded to therapy, 80% were relieved of painful subluxation, 13.3% had painless subluxation and kept on follow-up. X-ray TMJ and MRI did not show any hard and soft tissue changes. Conclusion: A soldered double needle, single puncture, AC + ABI are a simple, safe, cost-effective, repeatable and minimally invasive nonsurgical therapy for treatment of CSS without any permanent radiographically evident soft or hard tissue changes.

Sinus elevation with an alloplastic material and simultaneous implant placement: a 1-stage procedure in severely atrophic maxillae.

AIMS AND OBJECTIVE: The aim of the study is to evaluate clinically and radiographically the long term success of one-stage direct (lateral) sinus lift procedure using alloplastic bone graft material and bio-absorbable membrane in conjunction with two stage implant placement in atrophic partially edentulous posterior maxilla. MATERIALS AND METHODS: One stage direct maxillary sinus lift in conjunction with two stage implant placement was carried out in 12 patients at 13 sites. All the patients were partially edentulous with posterior maxillary alveolar ridge height of >5 mm and were in the age group of 20-50 years. Bioactive glass putty, bio-absorbable collagen membrane and 3.75 × 11.5 mm implants were used. Loading of implants was done 6 months after placement of implants. Patients were evaluated clinically and radio-graphically 6, 18, 30 months after placement of implants to assess increase in residual ridge height, peri-implant condition (marginal bone loss, plaque and gingival index) and implant stability. RESULTS: Maxillary first molar was the most common site (69.23 %) for sinus lift and implant placement. Caries was the most common cause (76.92 %) for loss of tooth. Increase in residual ridge height ranged from (71.43 to 133.33 %) as measured by Denta-Scan. Implant survival rate was 100 %. Marginal bone loss ranged from 0.68 to 1.22 mm. Implant stability was measured by periotest (-2.7 to -3.6). Only one patient had perforation of sinus membrane, but it was sealed satisfactorily by bio-absorbable membrane. CONCLUSION: One stage lateral sinus lift procedure with alloplastic bone graft material in combination with 2 stage implant placement has a predictable outcome in patients with severe resorption of posterior maxilla.

Conventional 2.0 mm miniplates versus 3-D plates in mandibular fractures.

AIM: To compare and evaluate the treatment outcome and postoperative complications in mandibular fractures using 2- and 3-dimensional miniplates. MATERIALS AND METHODS: This study consisted of a sample of 28 patients (40 fracture sites) divided randomly but equally (single-blind control trial study) into two groups. Each group contains 14 patients (20 similar fracture sites in each group). Group 1 was treated with open reduction and internal fixation using 3-dimensional (3-D) miniplates. Group II was treated using 2-dimensional (2-D) 2-mm miniplates. RESULTS: Out of 14 patients treated by conventional 2-mm miniplates, 2 patients developed occlusal discrepancy, another 2 had postoperative mobility at fracture site, and 1 developed plate failure and subsequent infection, which was treated by removal of the plate under antibiotic coverage. One patient treated by 3-dimensional plates had tooth damage. STATISTICAL ANALYSIS: Chi-square test. CONCLUSION: The results of this study suggested that the treatment of mandibular fractures (symphysis, parasymphysis, and angle) with 3-dimensional plates provided 3-dimensional stability and carried low morbidity and infection rates. The only probable limitations of 3-dimensional plates were excessive implant material due to the extra vertical bars incorporated for countering the torque forces.