Depression and anxiety levels in patients with temporomandibular disorders: comparison with the general population.

OBJECTIVES: The objective of this study was to compare levels of depression and anxiety of a group of patients with orofacial pain attributed to a temporomandibular disorder (TMD) to the general population. MATERIALS AND METHODS: Diagnosis of orofacial pain attributed to a TMD was given according the DC/TMD classification system. PHQ-9 and GAD-7 questionnaires were used to respectively screen for depression and anxiety. Scores of these two questionnaires in the study group were compared to the scores of two large population samples representing normative data in the general population. RESULTS: Two hundred forty-three patients (191 females and 52 males) were included in the study. Both Kolmogorov-Smirnov and chi-square testing showed statistically significant higher scores (p ≤ 0.05) for both PHQ-9 and GAD-7 in the study group in comparison with the general population and PHQ-9 and GAD-7 scores were strongly correlated. CONCLUSIONS: The results of this study indicate that screening for depression and anxiety should be considered in the diagnosis of patients with orofacial pain attributed to a TMD. CLINICAL RELEVANCE: PHQ-9 and GAD-7 could be used to assist clinicians, without specific training in mental health, to screen for potential signs of existing comorbidity of depression or anxiety disorders in patients with orofacial pain attributed to TMD.

Do patients with chronic unilateral orofacial pain due to a temporomandibular disorder show increased attending to somatosensory input at the painful side of the jaw?

BACKGROUND: Patients with chronic orofacial pain due to temporomandibular disorders (TMD) display alterations in somatosensory processing at the jaw, such as amplified perception of tactile stimuli, but the underlying mechanisms remain unclear. This study investigated one possible explanation, namely hypervigilance, and tested if TMD patients with unilateral pain showed increased attending to somatosensory input at the painful side of the jaw. METHODS: TMD patients with chronic unilateral orofacial pain (n = 20) and matched healthy volunteers (n = 20) performed a temporal order judgment (TOJ) task indicated which one of two tactile stimuli, presented on each side of the jaw, they had perceived first. TOJ methodology allows examining spatial bias in somatosensory processing speed. Furthermore, after each block of trials, the participants rated the perceived intensity of tactile stimuli separately for both sides of the jaw. Finally, questionnaires assessing pain catastrophizing, fear-avoidance beliefs, and pain vigilance, were completed. RESULTS: TMD patients tended to perceive tactile stimuli at the painful jaw side as occurring earlier in time than stimuli at the non-painful side but this effect did not reach conventional levels of significance (p = .07). In the control group, tactile stimuli were perceived as occurring simultaneously. Secondary analyses indicated that the magnitude of spatial bias in the TMD group is positively associated with the extent of fear-avoidance beliefs. Overall, intensity ratings of tactile stimuli were significantly higher in the TMD group than in the control group, but there was no significant difference between the painful and non-painful jaw side in the TMD patients. DISCUSSION: The hypothesis that TMD patients with chronic unilateral orofacial pain preferentially attend to somatosensory information at the painful side of the jaw was not statistically supported, although lack of power could not be ruled out as a reason for this. The findings are discussed within recent theories of pain-related attention.

Treatment needs and therapy experiences in patients with temporomandibular disorders: a retrospective survey.

OBJECTIVES: This study investigated a patient population suffering from temporomandibular disorders (TMD) with respect to their need for treatment, satisfaction with the information received, and the treatment provided. METHODS: A survey was sent by post to 1011 patients. RESULTS: Almost one-third of the patients had used analgesics prior to the start of any treatment. Having pain and functional jaw complaints was a risk factor for patients experiencing social restrictions. Subjects with severe complaints needed a range of conservative treatment modalities in combination with more follow-up appointments in agreement with the practitioners. Persons with remaining functional limitations were often unsatisfied with information and care they had received. The rate of compliance with prescribed treatment modalities and advice corresponded significantly higher with patient contentment with final outcome. DISCUSSION: Patient satisfaction is often determined by a qualitative doctor-patient relationship. The influence of complaints and pain on daily functioning was illustrated. Pain medication use at baseline seems to be predictive for persistent orofacial pain (OFP).

A 1-year prospective study on Co-Axis implants immediately loaded with a full ceramic crown.

INTRODUCTION: The Co-Axis implant (Southern Implants, Irene, South Africa) has a 12-degree angle in the implant neck to overcome angulation problems. AIM: To examine bone loss, peri-implant health, and aesthetical outcome after 1-year follow-up. MATERIALS AND METHODS: Fifteen single implants were placed in 14 patients in the premaxilla and immediately loaded with a screw-retained full ceramic crown. Periapical radiographs and standardized photographs were taken to determine bone loss and soft tissue changes. Plaque and bleeding levels were assessed. Patients' satisfaction was measured using the Oral Health Impact Profile-14 questionnaire. RESULTS: After 1 year, all implants survived and mean bone loss was 1.20 mm, with no significant changes after 6 months. Plaque levels were low and no significant changes were observed. Bleeding levels decreased during the initial 3 months, but were constant thereafter. Before final torqueing was performed after 6 months, four cases of screw loosening occurred. Also, one crown had a piece of porcelain chipped off. Patients reported an overall increase in well-being. A mean midfacial recession of 0.37 mm was observed. The mesial papilla showed a slight increase of 0.14 mm, while the distal papilla decreased 0.35 mm. CONCLUSION: With 100% survival and stable bone levels after 6 months, the Co-Axis implant showed a good clinical outcome when immediately loaded. The use of a full ceramic crown as a first and final restoration resulted in a good aesthetic outcome with few changes in papilla fill, although midfacial soft tissue was stable only after 1 year.

An up to 20-year retrospective study of 4-unit fixed dental prostheses for the replacement of 2 missing adjacent teeth.

PURPOSE: This study evaluated treatment outcomes of 4-unit porcelain-fused-to-gold fixed dental prostheses (FDPs) replacing 2 adjacent missing teeth. MATERIALS AND METHODS: A total of 102 FDPs made in an undergraduate university clinic for 73 patients were evaluated for up to 20 years, with a mean survival follow-up time of 11.4 years. All patients were offered an oral health maintenance program. Treatment failures were divided into irreversible (loss of FDPs/finish line involved) or reversible (FDPs and finish line intact after conservative treatment) complications and into biologic and technical/patient-related failures. RESULTS: The Kaplan-Meier overall estimated survival rate was 68.3% at year 20. There was a statistically significant difference (P = .007) between the survival rates in the maxilla for the vital group (73.8%) and those for the root canal-treated group (25.1%). Comparing the survival rate in the root canal-treated group for the restorations in the maxilla (25.1%) versus the mandible (66.8%), a statistically significant difference (P = .011) was found. The main reason for irreversible failure was caries (32.0%). CONCLUSION: The estimated successful outcome of 4-unit FDPs over an up to 20-year period is considered favorable and should be compared with the survival rates of other treatment options for the replacement of 2 adjacent teeth. Occurrence of a previously reversible complication appears to be a predictive factor for an irreversible complication later on. A reversible complication within the first 2 years will lead to an early irreversible complication.

Long-term results of short-span versus long-span fixed dental prostheses: an up to 20-year retrospective study.

PURPOSE: This study of short-span fixed dental prostheses (Ss-FDPs) versus long-span FDPs (Ls-FDPs) evaluated the long-term efficacy and determined the frequencies and causes of failures. MATERIALS AND METHODS: A total of 236 Ss-FDPs and 86 Ls-FDPs made in an undergraduate university clinic for 149 and 70 patients, respectively, were evaluated over a 20-year period. Kaplan-Meier analysis with a 95% confidence interval was used to estimate the survival probability. Failures of the FDPs were divided into irreversible (loss of FDPs or finish line involvement) or reversible (FDPs and abutments intact after conservative treatment) complications and into biologic and technical/patient-related failures. RESULTS: The overall survival estimations for Ss-FDPs (70.8%; 95% Cl: 63%-79%) and Ls-FDPs (52.8%; 36%-70%) at year 20, were statistically significantly different (P = .030). There was no statistically significant difference (P = .126) for the survival estimations for Ss-FDPs (60.4%; 48%-73%) versus Ls-FDPs (59.0%; 44%-74%) at year 19 in the root-canal treated (RCT) group. For the Ss-FDPs group there was a statistically significant difference (P = .009) between the vital (82.4%; 73%-92%) and RCT (60.4%; 49%-73%) groups at year 20. The reason for failure in the Ss-FDP group was of biologic origin in 55.6% to 66.7% of cases, but for the Ls-FDP group the failures were of technical origin in 56.0% to 84.0% of cases. CONCLUSION: The survival of Ss-FDPs and Ls-FDPs over a 20-year period was favorable. The overall survival estimation for Ss-FDPs was statistically significantly better than for Ls-FDPs at year 20. The use of an RCT abutment becomes more significant in fixed prosthetic restorations with 4 or more units. Occurrence of a previously reversible complication is a predictive factor for an irreversible complication later on. A reversible complication within the first 2 years for an Ss-FDP will lead to an irreversible complication.

The influence of gender and age on fixed prosthetic restoration longevity: an up to 18- to 20-year follow-up in an undergraduate clinic.

PURPOSE: This study investigated the possible relationship between the survival of complete crowns (CCs), 3-unit fixed dental prostheses (3uFDPs), and fixed dental prostheses (FDPs) versus gender and age at initial treatment over a period of 18 to 20 years in an undergraduate clinic. MATERIALS AND METHODS: Complete treatment and follow-up records of 1,037 CCs (60.5% women/39.5% men; age range: 18 to 82 years), 134 3uFDPs (59.2% women/40.8% men; age range: 33.6 to 93.6 years), and 322 FDPs (62.1% women/37.9% men; age range: 33.6 to 94.2 years) were available for analysis. Failures of the fixed prosthetic restorations were defined as irreversible complications (finish line involved or loss of CCs, FDPs, or abutments). RESULTS: The association between gender versus irreversible complications for the CCs (P = .481), 3uFDPs (P= .814), and FDPs (P = .410) groups was not statistically significant. The relationship between age versus irreversible complications for the fixed prosthetic restorations was statistically significant for all test groups. The patients with the failing restorations (66.2 years; mean range: 64.8 to 67.5 years) were 4.5 to 5.5 years older at initial treatment than the patients with the surviving restorations (61.3 years; mean range: 59.5 to 63.0 years). CONCLUSIONS: There was no relationship between gender and irreversible complications. There was a clear statistically significant association between age and irreversible complications. Receiver operating characteristic analysis for all study groups revealed that for age, no clear cutoff point exists with acceptable specificity and sensitivity.

Long-term survival of complete crowns, fixed dental prostheses, and cantilever fixed dental prostheses with posts and cores on root canal-treated teeth.

PURPOSE: This study investigated the long-term survival of posts and cores on root canal-treated (RCT) teeth restored with complete crowns, fixed dental prostheses (FDPs), 3-unit FDPs, and cantilever FDPs (C-FDPs) made over a period of 16 to 20 years in an undergraduate clinic. MATERIALS AND METHODS: Complete treatment and follow-up records of 1,037 complete crowns, 134 three-unit FDPs, 322 FDPs, and 168 C-FDPs were available for analysis. All RCT teeth studied had a post-and-core buildup. Kaplan-Meier survival curves were used to evaluate the different types of fixed restorations. RESULTS: For complete crowns, the estimated survival rates at year 18 were 74.9% for the vital group and 79.4% for the RCT group (P = .602). For 3-unit FDPs, the survival rate at year 20 was 83.2% for the vital group and 60.5% for the RCT group (P = .108). For the FDPs, the survival rate at year 20 was 77.4% for the vital group, while for the RCT group with at least 1 RCT abutment, the survival rate was 56.7% (P = .002). For C-FDPs with vital abutments, the survival rate was 73.5% at year 16, while for the RCT group with at least 1 RCT abutment, the survival rate was 52.3% at year 18 (P < .01). CONCLUSIONS: There was no statistically significant difference in the long-term survival of complete crowns on vital abutments versus post-and-core complete crowns or in the survival of 3-unit FDPs on vital abutments versus those with at least 1 RCT abutment. For FDPs with more than 3 units and C-FDPs, the use of a post-and-core abutment led to significantly more failures.

Survival of complete crowns and periodontal health: 18-year retrospective study.

PURPOSE: This study investigated the survival of complete crowns in relation to periodontal variables on a long-term basis. MATERIALS AND METHODS: A total of 1,037 complete crowns made in an undergraduate clinic for 456 patients were evaluated over an 18-year period. The study population was a mixture of periodontally affected and non-periodontally affected patients, which is comparable to the population group in a private practice. Patients were offered a supportive maintenance program. Periodontal variables were measured, including Plaque Index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and attachment level. The Community Periodontal Index for Treatment Needs (CPITN) was calculated per sextant in a full-mouth assessment. RESULTS: The estimated survival rate was 78% at year 18. For the surviving restorations, the improved PI over time was statistically significant (P = .001). Odds ratios were 1.00 for both PI and BOP. For the CPITN, odds ratios were 3.00 to 3.83. Caries was the most frequent reason for failure, followed by periodontal disease. CONCLUSION: PI and BOP were not directly related to the frequency of failures. Patients with a high CPITN at baseline had a 3.8 times greater likelihood of losing a complete crown (and abutment tooth) than patients with a low CPITN. The higher failure rate was related not only to periodontal disease, but also to a wide range of biologic and technical problems. In relation to complete crown survival, caution is needed in patients with a high CPITN at baseline. Prosthetic work should be preceded by periodontal examination and prophylactic and periodontal treatment if needed.

Single-tooth replacement: is a 3-unit fixed partial denture still an option? A 20-year retrospective study.

PURPOSE: This study of 3-unit fixed partial dentures (FPDs) evaluated the long-term efficacy and determined the frequencies and causes of failures. MATERIALS AND METHODS: A total of 134 FPDs made in an undergraduate university clinic for 98 patients were evaluated over a 20-year period. All patients were offered a supportive maintenance program. Failures of the FPDs were divided into irreversible (loss of FPDs) or reversible (FPDs intact after conservative treatment) complications and into biologic and technical/patient-related failures. RESULTS: The overall survival rate was 73.1% after 20 years. There was a statistically significant difference (P = .036) between the survival rates in the mandible for the vital group (96.3%) versus the root canal-treated group (69.3%). Comparing the survival rate in the vital group for the restorations in the maxilla (70.2%) versus the mandible (96.3%), a statistically significant difference (P = .045) was found. The survival rate after 20 years for the 3-unit FPDs (73.1%) was significantly different from that of the FPDs with more than 3 units (61.5%) (P = .026). The main reason for failure was caries (38.1%). CONCLUSION: The survival of 3-unit FPDs over a 20-year period is favorable and should be compared with other single-tooth replacement treatment options. There is an indication that the occurrence of a reversible complication has a predictive value for an irreversible complication later on.

An 18-year retrospective survival study of full crowns with or without posts.

PURPOSE: This study of full crowns investigated long-term survival in relationship to biologic and technical variables. MATERIALS AND METHODS: A total of 1,037 full crowns in 456 patients, made in an undergraduate university clinic, were evaluated over an 18-year period. All patients were offered a supportive maintenance program. Failures of full crowns were classified as irreversible (loss of full crown and/or tooth) or reversible (full crown intact after conservative treatment) complications and as biologic or technical/patient-related failures. RESULTS: The Kaplan-Meier survival rate after 18 years was 78%. No statistically significant differences were found between restorations in the maxilla and mandible (P= .150); between restorations on molars, premolars, and anterior teeth (P = .671); and between restorations on posts and cores compared to restorations without posts and cores (P = .602). For the surviving restorations, the improved plaque score over time was statistically significant (P = .001). Biologic failures (66.4%) resulting in removal were more common than technical and patient-related failures (33.6%). Caries was the most frequent reason for failure (irreversible complication). CONCLUSION: The survival of full crowns made in an undergraduate university clinic during an 18-year period is comparable to the results published by university departments or private practitioners. Plaque scores and bleeding on probing were not directly related to failures. Occurrence of a previously reversible complication is a predicting factor for an irreversible complication. A reversible complication within the first 2 years will probably lead to an early irreversible complication.

A 20-year retrospective survival study of fixed partial dentures.

PURPOSE: This study of fixed partial dentures (FPDs) evaluated the long-term efficacy and determined frequencies and causes of failures. MATERIALS AND METHODS: A total of 322 FPDs in 193 patients, fabricated at an undergraduate university clinic, were evaluated over a 20-year period. All patients were invited to participate in a supportive maintenance program. Failures of the FPDs were divided into irreversible complications (loss of FPD/abutment) and reversible complications (FPD intact after conservative treatment) and into biologic and technical/patient-related failures. RESULTS: The Kaplan-Meier survival rate after 20 years was 66.2%. Statistically significant differences in survival rates were found between FPDs without post-and-core abutment teeth as compared to FPDs with at least one post-and-core abutment tooth (P = .002) and for vital abutments versus post-and-core abutments (P = .001), but significant differences were not found between restorations in the maxilla and mandible (P = .27). Caries and loss of retention were the main reasons for failure and accounted for 61% of the failures. CONCLUSION: The survival of FPDs by undergraduate students at a university clinic during a 20-year period was comparable to the results published by university departments or general practitioners. Occurrence of a previously reversible complication is a predictive factor for an irreversible complication later on. A reversible complication within the first 2 years will probably lead to an early irreversible complication.

Generalized joint hypermobility and temporomandibular disorders: inherited connective tissue disease as a model with maximum expression.

AIMS: To study the relationship between generalized joint hypermobility (GJH) and temporomandibular disorders (TMD) by assessing prevalence and patient characteristics of TMD in a population of patients with maximum expression of GJH as a symptom of inherited connective tissue disease. In addition, diagnostic reliability of a series of clinical signs indicative of temporomandibular joint (TMJ) hypermobility was tested. METHODS: The study sample consisted of 42 subjects with GJH, 24 with Marfan syndrome and 18 with Ehlers-Danlos syndrome. A subgroup of 27 individuals was selected by age (> or = 18 yrs) and was compared to 40 controls with TMD and normal peripheral joint mobility. TMD diagnoses were assigned to each subject according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: In the GJH sample (n = 42), 71.4% of the subjects were symptomatic for TMD. Of those, 13.3% had sought treatment. A myofascial pain diagnosis was made in 69%, disc dislocation with reduction was diagnosed in 85.7%, and TMJ arthralgia in 61.9%. Multiple TMD diagnoses were assigned in 69% of the subjects; of these, 57% had 3 or more subgroup diagnoses. Joint noises (P < .01) and recurrent TMJ dislocations (P < .01) were a frequent finding in adult GJH subjects (n = 27) compared to controls, with symptomatic GJH subjects presenting more and more prolonged dislocation events than asymptomatic subjects (P < .001). TMJ hypermobility signs were expressed significantly more often in GJH compared to controls with TMD and normal joint mobility. CONCLUSION: This study indicates a positive relationship between GJH and TMD.