Effect of Low-level Light Therapy on Post-operative Healing of Secondary Chronic Osteomyelitis of the Jaws - A Prospective Study.

Introduction: Osteomyelitis of the jaws is a common disease of the maxillofacial region. The goal of treatment is to alleviate pain, reduce infection, inhibit the progression of the disease and induce bone and mucosal healing. In addition to surgical management and antibiotic and oxygen hyperbaric therapy, new therapeutic strategies for the treatment of osteomyelitis are developed. One of the novel approaches is photobiomodulation therapy or low-level light therapy (LLLT). Materials and Methods: After surgical treatment, experimental group patients (n = 4) were treated with LLLT for five sessions with an extraoral pulsed 635-nm LED lamp (Repuls7, Repuls Lichtmedizintechnik GmbH, Austria), maximum output power: 140 mW/cm2, frequency: 2.5 Hz, duty cycle: 50%. Clinical achievement and patient pain perception (through Visual Analogue Scale score) were evaluated at 1-, 3- and 6-month follow-up appointments and compared with control group (n = 4) patients, treated with standard therapy. Results: At three and six months, clinical achievement was better in patients treated with LLLT. Pain and discomfort resolution was significantly greater in the experimental group. Discussion: Taking into consideration the results of this study, it can be concluded that LLLT shows potential for improving clinical outcome of surgical and medical treatment of secondary chronic osteomyelitis of the jaws. Furthermore, pain and discomfort were significantly reduced in patients treated with LLLT. Further research with a larger sample size is needed to obtain a more accurate insight into this promising field.

The effect of disinfectants on dimensional stability of addition and condensation silicone impressions.

BACKGROUND/AIM: Dimensional stability and accuracy of an impression after chemical disinfection by immersion in disinfectants are crucial for the accuracy of final prosthetic restorations. The aim of this study was to assess the deformation of addition and condensation silicone impressions after disinfection in antimicrobial solutions. METHODS: A total of 120 impressions were made on the model of the upper arch representing three full metal-ceramic crown preparations. Four impression materials were used: two condensation silicones (Oranwash L - Zhermack and Xantopren L Blue - Heraeus Kulzer) and two addition silicones (Elite H-D + regular body - Zhermack and Flexitime correct flow - Heraeus Kulzer). After removal from the model the impressions were immediatel immersed in appropriate disinfectant (glutaraldehyde, benzalkonium chloride - Sterigum and 5.25% NaOC1) for a period of 10 min. The control group consisted of samples that were not treated with disinfectant solution. Consecutive measurements of identical impressions were realized with a Canon G9 (12 megapixels, 2 fps, 6x/24x), and automated with a computer Asus Lamborghini VX-2R Intel C2D 2.4 GHz, by using Remote Capture software package, so that time-depending series of images of the same impression were obtained. RESULTS: The dimensional changes of all the samples were significant both as a function of time and the applied disinfectant. The results show significant differences of the obtained dimensional changes between the group of condensation silicones and the group of addition silicones for the same time, and the same applied disinfectant (p = 0.026, F = 3.95). CONCLUSION: The greatest dimensional changes of addition and condensation silicone impressions appear in the first hour after their separation from the model.

[The effects of orthognathic surgery on mandibular movements in patients with mandibular prognathism].

INTRODUCTION: Mandibular prognathism, one of the most severe dentofacial deformities, affects the person's appearance, psychological health and the quality of life in the most sensitive age period. OBJECTIVE: The aim of this study was to evaluate the effects of sagittal split ramus osteotomy on the range of mandibular border movements in the early postoperative period. METHODS: The study was conducted on 20 patients, of mean age 20.8 years, with mandibular prognathism. All patients included in this study were operated on by bilateral sagittal spliting ramus osteotomy according to Obwegeser and Dal Pont followed by mandibular immobilization during eight weeks. In all patients mandibular border movements were recorded before and six months after surgery using the computerized pantograph Arcus-Digma (KaVo EWL GmbH, Leutkirch, Germany). RESULTS: The analysis of the chosen kinematic parameters revealed that sagittal split ramus osteotomy followed by eight weeks of mandibular immobilization had severe effects on the mouth opening. Six months after surgery the range of maximal mouth opening decreased for approximately 13.9 mm in relation to the preoperative stage. On the contrary, the ranges of maximal protrusion and the border of laterotrusive excursions increased significantly after surgery. CONCLUSION: In patients with mandibular prognathism where enormous mandibular growth was the main causal factor of the deformity, the sagittal split ramus osteotomy yielded good results. The rigid fixation of bone fragments and reduced period of mandibular immobilization followed by appropriate physical therapy could considerably contribute to a more rapid recovery of mandibular kinematics in the postoperative period.

[Analysis of sagittal condyle inclination in subjects with temporomandibular disorders].

BACKGROUND/AIM: Disturbances of mandibular border movements is considered to be one of the major signs of temporomandibular disorders (TMD). The purpose of this study was to evaluate the possible association between disturbances of mandibular border movements and the presence of symptoms of TMD in the young. METHODS: This study included two groups of volunteers between 18 and 26 years of age. The study group included 30 examineers with signs (symptoms) of TMD, and the control group also included 30 persons without any signs (symptoms) of TMD. The presence of TMD was confirmed according to the craniomandibular index (Helkimo). The functional analysis of mandibular movements was performed in each subject using the computer pantograph. RESULTS: The results of this study did not confirm any significant differences between the values of the condylar variables/sagittal condylar inclination, length of the sagital condylar guidance, in the control and in the study group. CONCLUSION: The study did not confirm significant differences in the length and inclination of the protrusive condylar guidance, as well as in the values of the sagittal condylar inclination between the subjects with the signs and symptoms of TMD and the normal asymptomatic subjects.

The role of occlusal factor in the etiology of temporomandibular dysfunction.

INTRODUCTION: The influence of occlusal condition at the onset of temporomandibular disorders (TMD) has been strongly debated for many years and still is the source of controversy. Up to the eighties in the last century, the occlusal factors such as the presence of uncured malocclusions, discrepancies between intercuspal position and retruded contact position greater than two millimeters, retrusive and nonworking side interferences and loss of posterior teeth were considered to be the primary causes of TMD. OBJECTIVE: The aim of this study was to estimate the role of occlusal factor in the etiology of craniomandibular dysfunction and therapeutic effects of irreversible occlusal therapy (occlusal equilibration) in patients with TMD. METHODS: In the investigation we studied a group of 200 men and women. The average age of the selected patients was between 18 and 25 years. The purpose of TMD signs and symptoms was confirmed in every patient using a special functional analysis and evaluating the craniomandibular index (CMI) according to Fricton and Schiffman. The value of craniomandibular index was determined in the group of 15 patients with signs and symptoms of temporomandibular dysfunction. In the study groups occlusal equilibration (selective grinding) was performed according to Okeson using the central position of the mandible as the referent position in the occlusal therapy. The value of CMI was determined before and 30 days after occlusal equilibration. RESULTS: The results of this study confirmed the significant reduction in the signs and symptoms of TMD after occlusal equilibration. The statistical elaboration of the differences between the values of CMI I (before treatment) and CMI II (30 days after treatment) revealed highly significant differences. The CMI I values in the group ranged between 0.076 and 0.346 with the mean value of 0.188 +/- 0.082.The values of CMI II ranged between 0.038 and 0.19 with the mean value of 0.038 +/- 0.053. CONCLUSION: The study conformed the validity of irreversible occlusal therapy (selective grinding) in patients with TMD.

[Roentgencraniometric analysis of the angular craniofacial dimensions in subjects with temporomandibular disorders].

INTRODUCTION: Anomalies in growth and development of the craniofacial skeleton, particularly of vertical dysplasia, may be accompanied by distinct signs and symptoms of temporomandibular disorders. Vertical dysplasia followed by numerous occlusal disturbances alters muscular activity resulting in non-physiological strain on articular structures and their remodelling. OBJECTIVE: The purpose of this study was to evaluate a possible assocciation between certain morphologic features of the craniofacial skeleton and the presence of signs and symptoms of temporomandibular disorders in young adults with preserved natural dentition. METHOD: The investigation was carried out on 30 lateral cephalometric radiographs made of 30 subjects with signs and symptoms of temporomandibular disorders. According to the values of the ANB angle (Steiner cephalometric analysis), all subjects were classified in the skeletal class 1. The control group consisted of 50 lateral cephalometric radiographs made of subjects with the skeletal class 1 without signs and symptoms of temporomandibular disorders. The roentgencraniometric analysis of lateral cephalometric radiographs included the evaluation of 20 angular dimensions. RESULTS: The result of this study points at significant differences between the Bolton standards and the following angular dimensions in subjects with temoromandibular disorders: (S-Na)-Pg, (B-Na)-Pg, (Pns-Ans)-(Go-Gn), Occl-i, (S-Na)-i, (S-Na)-(Go-Me), (Go-Me)-i, SNB. The comparative analysis between the subjects of the experimental and the control group revealed significant differences in the values of the following angular dimensions: OccP-(Go-Po) i (S-N)-(Go-Me) at the level of p < 0.001. CONCLUSION: The values of the analysed angular dimensions in both subjects of the experimental and the control group show significant differences when related to the same angular dimensions in the Bolton standards. This can be explained by specific morphologic features of the craniofacial skeleton in subjects of our population. Small number of significant differences in the values of the examined angular variables between the subjects with signs and symptoms of temporomandibular disorders and subjects without such signs/symptoms can be explained by the fact that the study included young persons with the skeletal class 1 jaw relationships and relatively harmonious relations within the orofacial complex.

[Roentgencraniometric evaluation of the craniofacial dimensions in subjects with symptoms of temporomandibular disorders].

BACKGROUND/AIM: The aim of this study was to evaluate the possible association between certain morphologic features of the craniofacial skeleton and the presence of symptoms of temporomandibular disorders in young subjects with natural dentitions. METHODS: The investigation was carried out on 80 lateral cephalometric radiographs of two groups of male and female subjects between 18 and 25 years of age with natural dentitions. The analysed group consisted of 30 subjects with symptoms of temporomandibular disorders, and the control group of 50 subjects without such symptoms. According to the values of the ANB angle (position of the maxilla with the mandible-Steiner cephalometric analysis) all subjects were classified in the skeletal class 1. The roentgencraniometric analysis of cephalometric radiographs included the evaluation of 25 linear dimensions which values were compared between the examined groups and with the values of the same dimensions in the Bolton standards for 18 years of age. RESULTS: The results of this study confirmed the presence of significant differences between the examined linear dimensions in the Bolton standards and the same dimensions measured in the subjects of the analysed and the control group. The comparative analysis of these values between the groups confirmed the presence of significant differences in following linear dimensions at the level of p < 0.00: S - Cs(Go), Mol - PP, Mol - MP and Ar - Go. CONCLUSION: Significant differences between the examined linear dimensions measured in the subjects included in this study and the same dimensions in the Bolton standards can be explained by specific morphologic features of the craniofacial skeleton in people of our population. Within the limitation of this study, the minor differences in the values of the examined linear variables between the subjects of the experimental and the control group can not be accepted as indicators of disturbed function of the orofacial system.

[The prevalence of craniomandibular disorders in the military population of the Republic of Serbia].

INTRODUCTION: The aim of this study was to determine the prevalence of craniomandibular dysfunction (CMD) in the military personnel of the Republic of Serbia, as well as the distribution of sings and symptoms of CMD in this population group. MATERIAL AND METHODS: The epidemiological investigation included 284 male persons between 18 - 25 years of age. The sample consisted of Military Academy students, and soldiers from different regions of the Republic of Serbia. A questionnaire was designed using Helkimo's clinical dysfunction index and sings and symptoms of CMD were evaluated, namely the anamnestic index (Ai) and the dysfunction index (Di). RESULTS: According to the anamnestic dysfunction index (Ai), 85% of persons among the examined group presented without any symptoms of CMD (Ai = 0), 14% had mild symptoms (Ai =1) and 1% had severe symptoms of CMD (Ai = 5). Functional analysis of the orofacial system in the examined group (evaluation of dysfunction index - Di) revealed, however, that 70% of solders had at least one sign of CMD, precisely a dysfunction index Di > 0. The analysis of signs and symptoms of CMD revealed that disturbances in mandibular kinematics were the most prevalent sign of CMD in this population group, which was confirmed in 56% of examined persons. Disturbed functions of temporomandibular (TM) joints (click, and reciprocal click, deviation and deflection during mandibular opening) were established in 31% of examined persons, and sensitivity of TM joints and masticatory muscles during palpation in 4% of examined persons. Pain during mandibular movements was established only in 1% of examined persons. CONCLUSION: The results of this investigation point to significant prevalence of craniomandibular disorders in the examined population group. The incidence of TMJ and masticatory muscle pain in 4% of examined persons and of pain during mandibular movements only in 1% of examined persons, points to presence of mild or initial types of CMD in this population group.

[Positional changes of the lower and upper anterior teeth after surgical correction of mandibular prognathism].

BACKGROUND/AIM: To establish the influence of surgical corrections of mandibular prognathism upon the position of the lower and upper anterior teeth (incisors). METHODS: The changes in position of the lower and upper anterior teeth (incisors) after the surgical correction of mandibular prognathism were analyzed by means of x-ray craniometry in 183 patients (female: n = 110, male: n = 73) in which the correction had been made in accordance with the principles of sagital osteotomy of the mandibular ramus. There were 4 angular and 2 linear parameters determined in the pre- and postoperative tele-x-ray-pictures. The changes of these parameters were tested by means of the parametric statistic tests. RESULTS: The performed surgical procedures did not cause statistically significant changes in the angular parameters. The changes of both linear parameters were thought highly statistically significant. CONCLUSION: Under the influence of the performed surgical procedures no changes were found in the position of anterior teeth (incisors) in relation to SN and the mandibular plane. They were actually moved along with the medium fragment of the lower jaw and that fragment was moved linearly backwards along the occlusal plane with a practically insignificant rotation in the cranial direction.