Influence of discoplasty and discectomy of the temporomandibular joint on elimination of pain and restricted mouth opening.

The retrospective study was based on 36 open joint surgeries done in 33 consecutive patients with anterior disc dislocation without reduction with severe signs and symptoms and unsuccessful nonsurgical treatment lasting at least 6 months. The patients underwent either discoplasty or discectomy followed by auricular cartilage graft implantation and were evaluated for amount of interincisal mouth opening, severity of pain on VAS scores preoperatively and as well as 12 months postsurgically. The minimum pain levels were preoperatively 50 on VAS for the discoplasty group and 60 on VAS for the discectomy group. After the surgery, the VAS values lower than 20 were reported on 69.4% of 25 sides (72.7% in the discoplasty group, 68.0% in the discectomy group). Using the cutoff point for maximal interincisal opening of more than 35 mm, only 6 patients (16.6%) fulfilled the criterion at the baseline. Interincisal distance measured vertically 12 months after the operation increased in all but five patients. In three of the five subjects, the opening was at the same level as before the surgery. Almost ninety-one percent of the patients (90.9%) in discoplasty group and 81.8% in discectomy group, respectively reached 35 mm or more of vertical opening after the operation. Applying the 1984 Criteria for classification of postoperative results (AAOMS), 12 months after surgery, 24 patients (72.7%) displayed good results, 6 patients (18.2%) were evaluated with acceptable results, and in 3 cases (9.1%) we observed bad results. Although only short-term evaluation is presented, our findings show that both discoplasty and discectomy are effective methods for surgical treatment of patients suffering from severe temporomandibular pain and limited mouth opening. Discoplasty should be reserved only for patients without severe changes of the disc.

Técnica de restricción combinada de la hipermovilidad de la articulación temporomandibular: reporte de tres casos / Combined restriction technique of hipermobility of temporomandibular joint: 3 cases report

La hipermovilidad de la articulación temporomandibular se debe a factores locales, sistémicos o de ambos, los cuales producen cambios irreversibles. Algunos pacientes sufren injurias en las estructuras articulares con episodios simples de dislocación aguda, produciendo laxación de los tejidos y dislocación recurrente. La unión fibroósea es un delicado eslabón susceptible a daños e injurias. El objetivo de los métodos conservadores es limitar la excesiva apertura bucal. Los procedimientos quirúrgicos están indicados cuando la terapia es insuficiente y los problemas empeoran. Introducimos la llamada Técnica de Restricción Combinada y presentamos tres casos con hipermovilidad del ATM. El objetivo de esa terapia combinada es engrosar los tejidos capsulares y pericapsulares promoviendo la formación de tejido de cicatrización y adherencias dentro y alrededor de la articulación, gracias a lo cual, se puede limitar el movimiento de manera independiente. Los autores mencionan las causas y los factores predisponentes de la hipermovilidad.

Can we predict maxillary sinus mucosa perforation?

This study was carried out to evaluate the prevalence of sinus mucosa perforation occurred during maxillary sinus mucosa elevation surgery, its relation to objective conditions and to the causative medical history, and its influence on postoperative sinusitis, as well. One hundred and forty-six sinus lift procedures have been evaluated in 118 patients. The prevalence of the sinus mucosa perforation was evaluated and subdivided into four groups according to its size and way of treatment. No relation was observed between the perforation and the presence of sinus septa, smoking, radiographic thickening and cyst-like lesions of the maxillary sinus, and previous sinus allergy (P < 0.05). Despite of high prevalence of the perforation of the mucosa (56.16%), no signs of bone graft infection or maxillary sinusitis were noted in any of our patient.

Two ways of immediate rehabilitation of edentulous mandible with dental implants and prostheses--critical view on Brånemark System Novum.

With appropriate stabilization and occlusal loading, mandibular implants can be immediately loaded in a complete-arch configuration with no apparent detrimental effect on the rates of osseointegration. Ten patients were treated with the immediate loading protocols in completely edentulous mandible either with conventional one-stage implants and a provisional denture or with the Brånemark System Novum and a definite restoration. A total of 42 implants were placed. One Novum implant was lost 1 month after placement. The clinical success rate of the immediately loaded implants at the time of the 6-month check-up was 97.6%. Radiographic surveys completed by panoramic radiographs 6 months after the surgery revealed good healing of bone at implant interface. After the period, mean marginal bone loss was 0.4 mm (ranged from 0 mm to 1.5 mm). The results of this short-term clinical and radiographic study indicate that the precise surgical and prosthetic protocol allows successful prosthetic rehabilitation of mandibular edentulism and that the provisional or permanent fixed reconstruction can be provided to a patient on a day of fixture surgery. Finally, authors consider critical comments on Brånemark System Novum.

Maxillary sinus augmentation with deproteinized bovine bone (Bio-Oss) and Impladent dental implant system. Part II. Evaluation of deprotienized bovine bone (Bio-Oss) and implant surface.

The objective of this clinical study was to determine the predictability of endosseous implant placed in a maxillary sinus augmented with deproteinized bovine bone (Bio-Oss). A total of 185 implants (109 titanium and 76 hydroxyapatite-coated) were placed in 77 patients representing 92 sinuses either a one- or two-stage surgical technique. A mixture of venous patient's blood and Bio-Oss was used alone within 20 sinuses (Group 1), or in combination with autogenous bone within 72 sinuses (Group 2). Thirty-nine implants were placed in Group 1 and 147 implants were inserted in Group 2. The grafted sinuses were evaluated clinically and radiographically at second stage surgery. According to certain criteria, of the implants placed, only two titanium implants (1.08%) failed with 98.91% implant survival. There was no statistically variable difference for the use of hydroxyapatite-coated or titanium implants. The two failed implants were from Group 2. No clinical benefit has been achieved from the combination with autogenous bone (P<0.05). All the grafted sinuses were sufficient to place dental implants of at least 12 mm length (100% graft success). The results of this short-term study support the hypothesis that Bio-Oss can be a suitable material for sinus augmentation.

Evaluation of the accuracy of panoramic radiograph in the definition of maxillary sinus septa.

The purpose of this study was to determine the accuracy of panoramic radiography in identification of maxillary sinus septa. Out of 68 sinuses were radiographically examined using both panoramic and computerized tomographic radiographs (CT scan). Using CT scan, 24 (35.9%) out of 68 cases maxillae showed at least one septum, 22 sinuses (32.3%) showed one septum, whereas two sinuses (2.9%) exhibited two septa. Panoramic radiograph led to a false diagnosis regarding the presence or absence of sinus septa in 18 of 68 sinuses (26.5%). On the other hand, they gave negative diagnosis of sinus septa in 12 of 24 septa (50%). There was fully agreement between the two methods (positive septa) only in 12 of 24 septa (50%). We cannot depend on panoramic radiograph for the detection of sinus septa because it can lead to false or negative results.

Maxillary sinus augmentation using deproteinized bovine bone (Bio-Oss) and Impladent Dental Implant System. Part I. Comparison between one-stage and two-stage procedure.

This study was undertaken to compare implant survival after one- or two-stage sinus augmentation. Ninety-two maxillary sinuses in 77 patients were augmented with deproteinized bovine bone (Bio-Oss). These sinuses were sub-divided into two groups: Group 1 (n = 49) was operated on with a one-stage procedure, and Group 2 (n = 43) with a two-stage operation. A hundred and eighty-five implants were inserted in these augmented sinuses. Clinical and radiographical evaluations were performed and recorded according to certain criteria. The follow-up period was ranging from 16 to 44 months. Out of the implants inserted using the one-stage procedure, all survived. Two implants failed in the two-stage procedure group (98.91% implant survival). This study showed that no statistically significance was observed between the two surgical techniques (P < 0.05). Therefore, the authors concluded the type of surgical procedure (one- or two-stage) has no effect on implant survival.