Internal derangements of the temporomandibular joint. III. Anterior repositioning splint therapy

A bstract — Over a four-year period, anterior repositioning (REPO) splint therapy was used to treat 241 temporomandibular joint pain patients for whom a clinical diagnosis of anterior disc displacement had been made. Following an initial six months of active REPO therapy, the response to treatment over the ensuing twelve months was generally encouraging, control of joint noise and discomfort being achieved in 70 per cent of the treated sample. This figure had decreased to 53 per cent at the two-year follow-up and, by the end of three years, only 36 per cent were considered successfully treated.
It is suggested that REPO splint therapy for anterior disc displacement should not be lightly undertaken by the general dental practitioner but that a more conservative approach should be adopted for the vast majority of TMJ pain patients.     

p63 expression in epithelial ovarian tumors

Ovarian cancer is a highly lethal disease and its underlying biology is poorly understood. The p63 is a homologue gene of the tumor suppressor p53. p63 appears to be important for the development and differentiation of reproductive epithelium and interacts with p53 in human tumorigenesis. This study presents the immunoexpression of the p63 in benign and malignant epithelial ovarian tumors. We evaluated the p63 immunoexpression in 91 ovarian benign cystadenomas (29 mucinous and 62 serous) and in 29 ovarian malignant tumors (3 mucinous borderline, 3 serous borderline, 17 serous carcinomas, 2 endometrioid, 2 undifferentiated, 1 mucinous, and 1 clear-cell carcinoma) using a monoclonal antibody clone 4A4 (1:200), which recognizes all p63 variants. The tumors were considered p63 positive if 5% or more cells presented nuclear immunostaining. We observed 85.7% of positivity in benign tumors, 50% in borderline tumors, and 8.7% in invasive ovarian cancer (P < .0001). The benign serous cystadenomas were positive in 91.9% of cases and benign mucinous cystadenomas in 72.4% (P= .02). These data suggests an important role of p63 in the control of ovarian epithelium behavior. The p63 may be involved in the development of benign and malignant epithelial ovarian tumors.     

The effect of splint therapy on TMJ position measured by the Gerber Resiliency Test

The Gerber Resiliency Test is a clinical approach to possible evaluation of compression or distraction in the temporomandibular joints. In this study the same principle was used to check the tendency of mechanical responses of joints to the use of bite-splints. Sequences of tests were performed on 18 adult patients of the UTHSCSA clinical pool who had been previously treated for splint therapy. From this population nine patients presented one or more symptoms of TMD and nine were free of symptoms. Separation of the molars with the use of one thickness of tin foil indicated tendency to compression in the joints and three or four thicknesses to distraction. The tests were performed during delivery of the appliance and 1 week later. One sample chi-square statistical test was performed and did not show any statistically significant difference between dysfunction and non-dysfunction groups (P < .05). At delivery, there was a higher frequency of distraction in both left and right joints (P < .05) when the splint was inserted. Compression was present at very low frequency. One week later, the joints did not stay distracted in the same frequency.     

Vectorial analysis of the equilibrium of forces transmitted to TMJ and Occlusal biteplane splints

SUMMARY A mechanical model (link quadrilateral bell crank) is used to demonstrate the equilibrium of normal force vectors transmitted to the masticatory system and maxillary occlusal biteplane splints with different designs. Occlusal contacts were imposed on the proposed models under the action of a masticatory force vector with an arbitrary value of 40 kgf. The consequence of this force action created different responses within the joint and at the level of the dentition. When compared to the intercuspal position in centric occlusion, intra-oral appliances with either smooth contacting surfaces or indentations, both with increased vertical dimension, forced the mandible to assume an anterior position with a con- current increase of joint forces. The bite-splint that produced the least amount of joint force was the stabilization type with minimal increase of vertical dimension.