Clinical evaluation of patients with temporomandibular joint implants

PURPOSE: An undetermined number of patients with temporomandibular joint (TMJ) symptoms have been treated with intra-articular disc implants composed of Teflon ethylene/propylene or Teflon polytetrafluoroethylene and aluminum oxide (Proplast-Teflon; Vitek, Houston, TX). These implants have shown the potential to fragment in situ resulting in nonbiodegradable particles that stimulate a giant cell reaction and lead to degeneration of local structures, pain, and limitation of mandibular opening. We examined the possible relationship between TMJ implants and persistent pain, responses to sensory stimuli, quality of life, and systemic immune dysfunction. PATIENTS AND METHODS: This case series (32 patients) were referred from university-based orofacial pain centers and private practices from across the United States. Laboratory and clinical assessments evaluated orofacial pain symptoms, neurologic function, clinical signs and symptoms of rheumatologic disease, physical function, systemic measures of immune function, and behavioral measures. RESULTS: We found that TMJ implant patients appeared to have altered sensitivity to sensory stimuli, a higher number of tender points with a diagnosis of fibromyalgia, increased self-report of chemical sensitivity, higher psychologic distress and significantly lower functional ability. Systemic illness or autoimmune disease was not evident in this series of TMJ implant patients. CONCLUSIONS: Significant problems were noted on clinical assessment of TMJ implant patients. This is a US government work. There are no restrictions on its use.     

Performance of Five Commercially Available Tooth Color-Measuring Devices

PURPOSE: Visual tooth color assessment is neither accurate nor precise due to various subjective and objective factors. As newly developed tooth color-measuring devices for dental application provide the possibility of a more objective means of color determination, their performances in vitro and in vivo must be evaluated. The objective of this study was to evaluate the accuracy and precision of five commercially available tooth color-measuring devices in standardized and in clinical environments. MATERIALS AND METHODS: In an in vitro study, standards (A1, A2, A3, A3.5, and A4 shade tabs of Vita Lumin) were measured five times with five electronic devices (ShadeScan, Easyshade, Ikam, IdentaColor II, and ShadeEye) by two operators. In an in vivo study, the right upper central incisors of 25 dental students were measured with the same electronic devices by a single operator. Vita shade tab codes were expressed as CIE (International Commission on Illumination) L*a*b* values and in terms of the precision and accuracy of DeltaE color differences. The Mann-Whitney statistical test was used to analyze the differences between the two operators in the in vitro study, and the Kruskal-Wallis one-way analysis of variance on ranks with the post-hoc Tukey test was used to analyze the accuracy and precision of electronic devices. RESULTS: No statistically significant difference was found between the different operators in the in vitro study. The obtained precision was Easyshade > ShadeScan approximately equal Ikam > IdentaColor II > ShadeEye. The obtained accuracy was Easyshade > ShadeScan approximately equal Ikam > ShadeEye > IdentaColor II. In the in vivo study, the Easyshade and the Ikam were the most precise, and the ShadeEye and the IdentaColor II were more precise than the ShadeScan. With respect to accuracy, there was no statistical difference between the ShadeScan, Ikam, and the Easyshade. The IdentaColor II was considered inaccurate (DeltaE(a)= 3.4). CONCLUSIONS: In the clinical setting, the Easyshade and Ikam systems were the most reliable. The other devices tested were more reliable in vitro than in vivo.     

Primary central adenoid cystic carcinoma of the mandible

An intraosseous adenoid eystic carcinoma occurring within the body of the mandible of a 47-year-old man is described. A radical en bloc Commando's operation was performed. A five-year follow-up showed no local recurrence or distant metastasis.     

Bruxism-induced parotitis: A retrospective case series analysis

ABSTRACT

Objective: A group of patients with recurrent parotitis had clinical symptoms suggesting an obstruction of the glandular duct system, though without any signs of sialoliths or other ductal pathologies.

Methods: Clinical and radiological data of five patients with recurrent obstructive parotitis and long-standing definite bruxism were reviewed retrospectively. Ultrasonography, MRI, and sialendoscopy were performed for evaluation of ductal pathologies as the cause of glandular obstruction. Electromyography was used to evaluate the activity of masticatory muscles in all patients. The parotitis was treated with injection of botulinum toxin into the buccinator muscle.

Results: Dilatation of the Stensen’s duct proximal to the area of the buccinator muscle was shown in radiological examination with no evidence of ductal strictures. Electromyography revealed an abnormal activity of the ipsilateral buccinator muscle. All patients were free of disease after treatment of the buccinator muscle.

Discussion: Bruxism should be considered as a possible cause of recurrent parotitis.