Burcu Baş

Diagnostic Value of Ultrasonography in Temporomandibular Disorders

PURPOSE The purpose of this study was to determine the diagnostic value of ultrasonographic imaging (USI) in temporomandibular disorders. PATIENTS AND METHODS USI and magnetic resonance imaging (MRI) were performed in 182 temporomandibular joints (TMJs) of 91 patients who were referred for treatment. After a detailed clinical examination, patients who were clinically diagnosed with TMJ disc derangement were referred to the radiology department for MRI and USI examinations. USI and MRI diagnoses of disc displacement were compared, using clinical diagnosis as the golden standard. The overall agreement between USI and MRI results was evaluated. RESULTS Compared with the clinical diagnosis, MRI showed a sensitivity of 85%, specificity of 62%, and an accuracy of 80% in the detection of internal derangements. The positive predictable value, negative predictive value, and likelihood ratio were 88%, 54%, and 2.29, respectively. Compared with the clinical diagnosis, USI showed a sensitivity of 69%, specificity of 80%, and accuracy of 71% in the detection of internal derangements. The positive predictable value, negative predictive value, and likelihood ratio were 92%, 42%, and 3.45, respectively. Comparing the agreements between the MRI and USI diagnoses of internal derangement, the κ value was found to be 0.36, indicating poor reliability (P < .001). CONCLUSION USI, a noninvasive and dynamic imaging method, is a reliable method in evaluating the position of the disc in TMJ disc derangements. Better visualization of joint structures and more reliable results with higher sensitivity and accuracy can be achieved with high-resolution devices (≥12 MHz).

Effect of platelet-rich plasma on fibrocartilage, cartilage, and bone repair in temporomandibular joint.

PURPOSE The purpose of the present study was to explore the potential use of platelet-rich-plasma (PRP) in the treatment of temporomandibular joint osteoarthritis (TMJ-OA). MATERIALS AND METHODS Surgical defects were created bilaterally on the condylar fibrocartilage, hyaline cartilage, and bone to induce an osteoarthritic TMJ in rabbits. PRP was applied to the right joints of the rabbits (PRP group), and the left joints received physiologic saline (control group). After 4 weeks, the rabbits were sacrificed for histologic and scanning electron microscopy (SEM) examinations. The data were analyzed statistically. RESULTS The new bone regeneration was significantly greater in the PRP group (P < .011). Although the regeneration of the fibrocartilage and hyaline cartilage was greater in the PRP group, no statistically significant difference was found between the 2 groups. SEM showed better ultrastructural architecture of the collagen fibrils in the PRP group. CONCLUSIONS PRP might enhance the regeneration of bone in TMJ-OA.

Ultrasound assessment of increased capsular width in temporomandibular joint internal derangements: relationship with joint pain and magnetic resonance grading of joint effusion

OBJECTIVE The relationship between radiologic evidence of effusion in the temporomandibular joint (TMJ) and the occurrence of clinical symptoms (e.g., pain) is still unclear. Increased capsular width (CW) measured in ultrasonographic imaging (USI) of the TMJ was considered to be an indirect marker of TMJ effusion. The purpose of this study was to evaluate the relationship between the grades of magnetic resonance imaging (MRI)-depicted joint effusion (JE), increased CW measured in USI, and joint pain in TMJ internal derangement (ID) patients. STUDY DESIGN During a 4-year period, 91 patients clinically diagnosed with TMJ ID according to the Research Diagnostic Criteria for Temporomandibular Disorders classification were included in the study. Those with mainly myogenic complaints were excluded. In clinical examination, the severity of pain was assessed by visual analog scale (VAS, 0 to 10). All TMJs (n = 182) were evaluated to detect the presence of joint effusion by means of USI and MRI. MRI-depicted effusion was classified as no effusion, moderate effusion, and severe effusion. Receiver operating characteristic curve analysis was performed to depict the critical cutoff value for TMJ CW. USI sensitivity was evaluated by means of MRI effusion, and a cutoff value was depicted that was considered to be the threshold to discriminate the TMJs with and without effusion. The relationship between the joint pain and USI and MRI findings of effusion were evaluated with Friedman and Wilcoxon tests. RESULTS The average VAS scores of the TMJs without effusion was found to be 2.55, with moderate effusion 2.92, and with severe effusion 4.80. A significant positive correlation was found between the VAS scores and the intensity of MRI JE (P = .003). The most accurate cutoff value of CW is found to be 1.65 mm. The average VAS score with CW <1.65 was found to be 2.10 and the average VAS score with CW >1.65 was found to be 3.75. A significant positive correlation was found between the clinical pain scores and CW measured in USI (P = .001). CONCLUSIONS Both MRI-depicted effusion and USI assessment of CW were found to be related to the pain in TMJ ID patients.

Use of artificial neural network in differentiation of subgroups of temporomandibular internal derangements: a preliminary study.

PURPOSE Artificial neural networks (ANNs) have been developed in the past few decades for many different applications in medical science and in biomedical research. The use of neural networks in oral and maxillofacial surgery is limited. The aim of this study was to determine the use of ANNs for the prediction of 2 subgroups of temporomandibular joint (TMJ) internal derangements (IDs) and normal joints using characteristic clinical signs and symptoms of the diseases. MATERIALS AND METHODS Clinical symptoms and diagnoses of 161 patients with TMJ ID were considered the gold standard and were employed to train a neural network. After the training process, the symptoms and diagnoses of 58 new patients were used to verify the networks ability to diagnose. The diagnoses obtained from ANNs were compared with diagnoses of a surgeon experienced in temporomandibular disorders. The sensitivity and specificity of ANNs in predicting subtypes of TMJ ID were evaluated using clinical diagnosis as the gold standard. RESULTS Eight cases evaluated as bilaterally normal in clinical examination were evaluated as normal by ANN. In detecting unilateral anterior disc displacement with reduction (ADDwR; clicking), the sensitivity and specificity of ANN were 80% and 95%, respectively. In detecting unilateral anterior disc displacement without reduction (ADDwoR; locking), the sensitivity and specificity of ANN were 69% and 91%, respectively. In detecting bilateral ADDwoR, the sensitivity and specificity of ANN were 37% and 100%, respectively. In detecting bilateral ADDwR, the sensitivity and specificity of ANN were 100% and 89%, respectively. In detecting cases of ADDwR at 1 side and ADDwoR at the other side, the sensitivity and specificity of ANN were 44% and 93%, respectively. CONCLUSION The application of ANNs for diagnosis of subtypes of TMJ IDs may be a useful supportive diagnostic method, especially for dental practitioners. Further research, including advanced network models that use clinical data and radiographic images, is recommended.

Screw fixation is superior to N-butyl-2-cyanoacrylate in onlay grafting procedure: a histomorphologic study

The aim of this study is the histopathological evaluation of the efficiency of N-2-butyl cyanoacrylate in the fixation of bone block grafts on mandible. Autogenous monocortical block grafts taken from tibial bone were fixed to the outer surface of the angle of the mandible with N-2-butyl cyanoacrylate on the right side and mini screws on the left side. Postoperatively in the first and third months, six rabbits were killed and tissue samples were obtained from the grafted area. No significant difference was found between the cyanoacrylate and screw group with respect to inflammation or foreign body reaction. The level of graft necrosis was found to be significantly higher in the cyanoacrylate group than in the screw group in both the first and third month samples. Bone formation between the graft and recipient bone was evaluated and bone formation was found to be significantly higher in the screw group than in the cyanoacrylate group. No trabecular bone formation was observed between the graft and recipient bone in the cyanoacrylate group. Screw fixation was found to be superior to N-2-butyl cyanoacrylate in all parameters.

Fixation of vertically distracted segment with dental implants after breakage of distraction device: case report.

Distraction osteogenesis is an efficient method to augment the mandibular alveolar process for dental implants. Complications of this procedure include fracture of the basal bone, breakage of distractor, wound dehiscenses, undesirable soft tissue changes, and defective movement of the transported segment. We report a case of breakage of the distractor after mandibular alveolar vertical distraction osteogenesis. Mandibular alveolar vertical distraction osteogenesis was applied to 53-year-old woman for prosthetic rehabilitation. Fracture of the distraction device occurred on the 13th day of the activation phase. Radiographic examination revealed the fracture of the distractor rod and lingually displaced alveolar segment. Lingually displaced segment was successfully advanced to the desired position, and fixed to the basal bone using dental implants before the maturation of the distracted bone. We consider that this technique is eligible for the management of these kind of complications.

A comparison of the outcomes of four minimally invasive treatment methods for anterior disc displacement of the temporomandibular joint

The purpose of this study was to compare the effectiveness of four non-surgical conservative treatment methods for temporomandibular disorders (TMD). The study group comprised 40 patients with unilateral TMD who fell into group II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients were divided into four groups according to the treatment method: splint therapy, arthrocentesis, medical therapy, and low-level laser therapy. Magnetic resonance imaging (MRI) was performed before treatment and at the 1-month follow-up. The type of TMD and joint effusion were examined in the MRI scans. Patients were followed up after treatment for 6 months. Mouth opening increased and pain scores decreased at 1, 3, and 6 months after treatment in all groups (P<0.05). No statistically significant difference in the improvements in clinical symptoms was observed between the groups. A positive correlation was found between pain and effusion (P<0.05). A significant positive relationship was also found between internal derangement and effusion (P<0.05). All treatment methods were successful at improving the clinical symptoms. It was determined that the effusion demonstrated on MRI was associated with pain. Although the symptoms improved after treatment, joint effusion did not show any decrease in the 1-month follow-up MRI.

Descending necrotizing mediastinitis associated with an infected dentigerous cyst

Descending necrotizing mediastinitis (DNM) is a rare condition in which an infection from the head and neck propagates into the mediastinum. The most common cause of DNM is odontogenic infection. DNM is spread by the fascial planes from the neck into the mediastinum and requires an aggressive surgical drainage through cervical and thoracic approaches. We report on a 67-year-old male patient, who had acute mediastinitis related to an infected dentigerous cyst in the left parasymphyseal region. A multidisciplinary team approach was used to treat the patient. The team consisted of thoracic surgeons, maxillofacial surgeons, and a radiologist. After the drainage of the mediastinum and pleural cavity, the cyst was enucleated. The patient was discharged at the 42nd day of hospitalization. The aim of this article is to present diagnosis, management, and follow-up of an infected dentigerous cyst that caused DNM.

Excessıve fluorıde ıntake alters the MMP-2, TIMP-1 and TGF-β levels of perıodontal soft tıssues: an experımental study ın rabbıts

ObjectivesThis study evaluated the influence of fluoride on periodontal soft tissues by investigating any alterations in their MMP-2, TIMP-1 and TGF-β profiles secondary to excessive fluoride intake.Material and methodsFluorosis was induced in 18 rabbits (test group) through consumption of fluoride added to drinking water, whereas 10 rabbits consumed regular tap water as daily supply (control group). Following fluorosis verification, animals were sacrificed and their 1st mandibular molar teeth were utilized in the assessments. MMP-2, TIMP-1 and TGF-β were separately investigated for gingival epithelium (GE), gingival connective tissue (GC) and periodontal ligament (PL) to evaluate periodontal soft tissues. Histological sections were prepared from the groups, the parameters were determined by immunohistochemistry, and their levels were calculated by quantification of the immunostainings.ResultsStaining intensity of MMP-2 in GC and PL (p < 0.01); TIMP-1 and TGF-β of GE, GC and PL (p < 0.01) were higher in the test group compared to those of the control group. Intra-group staining of TIMP-1 was higher than MMP-2 in all test group compartments (p < 0.01) and in the control group GE (p < 0.01). TIMP-1 was also higher than TGF-β in the GE and PL of the test group (p < 0.05) and in the GE of the control group (p < 0.01).ConclusionThese results suggest that excessive fluoride intake may affect periodontal soft tissues by increasing MMP-2, TIMP-1 and TGF-β, and thereby altering the MMP-2/TIMP-1 and TIMP-1/TGF-β ratios.Clinical relevanceExcessive fluoride consumption may alter the periodontal tissue homeostasis which may be detrimental in the maintenance of periodontal health.

Closure of a Large Palatal Fistula With Maxillary Segmental Distraction Osteogenesis in a Cleft Palate Patient

Various techniques have been proposed for the repair of palatal clefts. The first surgical closure technique that should be kept in mind is the use of adjacent mucosal flaps. When the palatal cleft is too large to close with adjacent mucosal flaps, distant flaps such as from the tongue or nasolabial region may be considered. This report presents a cleft patient who had previously undergone an unsuccessful palatal cleft repair with a tongue flap. The size of the large palatal fistula was reduced by approximating the segments to each other with maxillary anterior segmental distraction osteogenesis to make it more manageable using conventional mucosal flaps.