Quo Vadis?

Despite the shift in third-party dollars for dental care to dental managed care payment systems because of payers' perceptions that they are more cost effective, significant segments of the population still have no access to oral health care. Costs to consumers continue to rise faster than the economy, generally placing pressure on the profession. The accelerating cost of dental education places pressure on young practitioners. It is unclear whether organized dentistry or market forces will have the strongest influence in addressing these problems.

Mandibular fracture fixation and reconstruction using the lower-border threaded rod: an eleven-year follow-up study.

Twenty-five cases in which a lower border threaded rod was used for fracture fixation and mandibular reconstruction were reviewed. These cases were performed during the last 11 years and have been followed for periods of up to five years and ten months. The fixation technique, originally reported in 1978, is well tolerated and provides excellent mechanical stability when enhanced security of fixation is indicated. Three unusual cases are reported in detail.

A retrospective analysis of 327 mandibular fractures.

The cases of 372 mandibular fractures are reviewed with respect to treatment, including the indications for extraction of teeth in the line of fracture, complications, and duration of maxillomandibular fixation. It was found that, in general, teeth can be maintained in the line of fracture, although there appeared to be an increased rate of complications associated with fractures when teeth are in the line of injury. In addition, a four-week period of maxillomandibular fixation appears to be an appropriate guideline for treatment.

Internal derangements of the temporomandibular joint: an assessment of condylar position in centric occlusion.

Subjects experiencing painful dysfunction of the TMJ and diagnosed by arthrography to have displacements of the meniscus were compared to normal or asymptomatic subjects to assess condyle-fossa relationships. The groups did not differ by linear or area determinations of the P/A ratio. The use of plain film alone is not adequate for diagnosis or assessment of treatment if abnormalities of meniscus function are the primary etiology.

Internal derangements and arthritis of the temporomandibular joint.

Internal derangements of the temporomandibular joint (TMJ) may be a significant factor in the etiology of painful dysfunction of the jaw and associated clinical symptoms. In a two-year prospective investigation, 170 TMJs in 85 patients were studied with plain tomography prior to arthrotomography. Arthritis was detected in 19 patients (22%), predominantly in the second to fourth decade of life, which correlated with internal derangements depicted by arthrotomography, operative findings, and histopathological examination of the condylar surface. The authors suggest that internal derangements related to meniscal dysfunction may be an important factor in the etiology of TMJ arthritis.

Correlation of condylar mobility and arthrotomography in patients with internal derangements of the temporomandibular joint.

The objective of this clinical study was to determine the relationship between condylar translation on plain tomographic radiographs and internal derangements assessed by a clinical and arthrographic evaluation. One hundred two joints in sixty-two patients were evaluated by linear tomography in closed versus opened positions and classified according to the type of internal derangement depicted by arthrotomography in sixty-two cases. A decrease in condylar translation was noted in patients diagnosed as having meniscus displacement without reduction. Patients who had meniscus displacement with reduction (painful clicking) were found to have hypermobility of the condyle on the symptomatic side. Meniscus displacement without reduction, which appears to be an advanced stage of internal derangement, is a serious sequela leading to marked restriction of condylar motion.

New observations with routine and CT-assisted arthrography in suspected internal derangements of the temporomandibular joint.

A simplified arthrotomographic technique has been performed successfully in more than 200 patients with symptoms referable to the temporomandibular joint. Soft-tissue abnormalities not detected by plain film radiography were demonstrated. Anterior meniscus displacement was the most significant finding in patients with unilateral pain and limitation of opening. New arthrographic observations and research imaging methods, including CT-assisted arthrography, are described. Leakage of contrast material along the lateral condylar neck in patients with anterior meniscus displacement suggests associated tearing of the lateral capsular attachment. Our results confirm that arthrography is a useful diagnostic procedure for suspected internal derangements of the temporomandibular joint.

The prostaglandins of articular cartilage. I. Correlates of prostaglandin activity in a chondrocyte culture system.

Suspensions of aggregated chondrocytes display active prostaglandin (PG) production. Radioimmunoassay of culture media and thin layer chromatographic analysis suggests that PGE2 is the primary PG synthesized. In order of decreasing concentration, the following PG were tentatively identified; PGE greater than PGI greater than PGA + PGB greater than or equal to PGF1+2 greater than TxB. An inverse logarithmic relationship was identified between PG synthesis and cells cultured at densities of 1.5 to 7.5 x 10(6) cells/ml. Little or no change in the PG distribution profile was seen at these high cell densities. Maximum PG synthesis was attained after 36 hours of incubation with persistence of high synthetic levels up to 48 hours. PGE2 production measured at various post-isolation intervals indicated an initial high rate of synthesis during the first 4 hours which decreased with time up to 24 hours. Cartilage explant organ cultures demonstrated a similar level of PG synthesis suggesting minimal effect of matrix on cellular PG production. Indomethacin (5 microgram/ml) inhibited PG synthesis by 70% within 4 hours and 85% after 24 hours of exposure. Arachidonic acid supplementation (10 microM) stimulated PG synthesis by 300%.

Surgical treatment of mandibular hypomobility.

Mandibular hypomobility may be the result of a number of intra- and extra-articular conditions. Its treatment, predicated on an accurate diagnosis, varies from minor manipulative maneuvers to several surgical procedures. The applicability of coronoidectomy, in certain conditions, has become increasingly important.

The application of xeroradiography in diagnosis of maxillofacial problems.

The evaluation of maxillofacial pathology was undertaken using xeroradiography. The edge enhancement and wide image latitude were shown to give additional information, especially in areas of bony overlap, such as the temporomandibular joint, without resorting to tomography. Other areas of possible utilization are also discussed, including sialography.

Portsmouth syndrome: review of the literature and clinicopathological correlation.

Hereditary and acquired abnormalities of platelet function are recognized more frequently. Recent advances in platelet physiology have led to new tests of platelet function. Assessment of platelet adhesiveness and aggregation have allowed more definitive classification of platelet dysfunction. Platelet abnormalities will not be diagnosed before surgery. It would be impractical to perform these tests for platelet function as screening procedures on all patients; however, they should be considered as an important part of the laboratory screening for abnormal postoperative bleeding.