Edvitar Leibur

Reliability and Validity of Eight Dental Age Estimation Methods for Adults

This paper evaluates the reliability and validity of eight published dental age estimation methods for adults that may aid in victim identification. Age was calculated on 20 Caucasian teeth of known age according to the methods of Kvaal (for in situ and extracted teeth), Solheim (for in situ and sectioned teeth), Lamendin (for extracted teeth), Johanson (for sectioned teeth) and Bang (for extracted and sectioned teeth) by one independent observer. For each method, mean age error and standard error were assessed as the measures of accuracy and precision. In addition, method simplicity, requirements for tooth preparation and the equipment necessary were assessed and recommendations given for forensic use in various situations. Methods for sectioned teeth gave more reliable results when compared to methods for intact teeth.

Inflammatory mediators and radiographic changes in temporomandibular joints of patients with rheumatoid arthritis

The aim of this study was to investigate the relation between the inflammatory mediators tumor necrosis factor alpha (TNF ! ) and serotonin (5-HT), the inflammatory markers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as rheumatoid factor (RF) and thrombocyte particle concentration (TPC) in blood versus temporomandibular joint (TMJ) radiographic changes in patients with clinical TMJ involvement by rheumatoid arthritis (RA). Twenty patients were included. Venous blood was collected for quantification of the mediators, markers, and TPC. The radiographic signs of erosion, flattening, sclerosis, subchondral pseudocyst, and osteophyte as well as radiographic grade were investigated with computed tomography. The median (IQR) plasma levels of TNF ! and 5-HT were 0 (13) r pg/mL and 13 (22) r nmol/L, respectively, while serum level of 5-HT was 1360 (874) nmol/L. ESR, CRP, and TPC were abnormally high in 53%, 25%, and 15% of the patients, respectively. The most frequent radiographic signs were sclerosis (75%), erosion (50%), and flattening (30%). Erosion was found to be associated with high TPC and flattening with high plasma level of TNF ! . In conclusion, patients with clinical TMJ involvement by RA show an association between high level of TPC and TNF ! in plasma versus radiographic signs of joint bone destruction.

Impact of temporomandibular joint pain on activities of daily living in patients with rheumatoid arthritis.

The aim of this study was to investigate the impact of temporomandibular joint (TMJ) pain on daily living in patients with rheumatoid arthritis (RA) involving the TMJ. Nineteen patients (17 F, 2 M) with a median (IQR) age of 44 (23) years were included. A scale for the influence of TMJ pain/discomfort on the activities of daily living was used. TMJ resting pain and pain upon maximum mouth opening according to a visual analog scale as well as pressure pain threshold and tenderness to digital palpation of the TMJ were assessed. Blood samples were collected to measure the level of acute phase proteins. Activities of daily living were influenced in all patients at different levels. The impact on daily living by TMJ pain/discomfort was greatest on the performance of physical exercises and jaw movements, while it was smallest on the performance of hobbies and eating. Pain during maximum mouth opening and tenderness to digital palpation were correlated to difficulties with several activities such as to yawn and open the mouth wide, while pressure pain threshold was correlated with difficulties during eating, which confirms that the pain was located in the TMJ. In conclusion, this study indicates that pain/discomfort from the TMJ in patients with RA has a significant negative impact on activities of daily living

Immediate effects of the serotonin antagonist granisetron on temporomandibular joint pain in patients with systemic inflammatory disorders.

The aim of this study was to investigate if the 5-HT3 antagonist granisetron reduces temporomandibular joint (TMJ) pain in patients with systemic inflammatory joint disorders. Sixteen patients with systemic inflammatory joint disease with pain localized over the TMJ region and tenderness to digital palpation of the TMJ were included. The current resting pain (VASRest) and the pain during maximum mouth opening (VAS(MVM)) of the TMJs were assessed with a 100 mm visual analogue scale. An electronic pressure algometer was used to estimate the pressure pain threshold (PPT) over the lateral aspect of the TMJ. Venous blood was collected for measurement of the plasma and serum levels of 5-HT, erythrocyte sedimentation rate, rheumatoid factor and C-reactive protein. The selective 5-HT3 receptor antagonist granisetron or saline were injected into the posterior part of the upper TMJ compartment in a randomized double-blind manner. The patients in the granisetron group had lower VASRest than the patients in the saline group after 10 min. In the granisetron group, VASRest was decreased after 10 min, while VAS(MVM) was decreased and PPT increased after 20 min. In the saline group, VAS(MVM) was decreased after 20 min. In conclusion, granisetron has an immediate, short-lasting and specific pain reducing effect in TMJ inflammatory arthritis. The 5-HT3 receptor may therefore be involved in the mediation of TMJ pain in systemic inflammatory joint disorders.

Progression of radiographic changes in the temporomandibular joints of patients with rheumatoid arthritis in relation to inflammatory markers and mediators in the blood

The aim of this study was to investigate longitudinal radiographic changes in the temporomandibular joint (TMJ) with clinical involvement of rheumatoid arthritis (RA) and its relation to the blood level of inflammatory mediators and markers. Sixteen patients were investigated by computed tomography on two occasions 25–46 months apart. The radiographs were assessed independently for changes in presence of erosions, sclerosis, flattening, osteophytes, and subchondral pseudocysts. The serum (S) or plasma (P) concentrations of C‐reactive protein (CRP), thrombocyte particle concentration, serotonin (S‐5‐HT and P‐5‐HT), tumor necrosis factor alpha, interleukin‐1 receptor antagonist, tumor necrosis factor soluble receptor type II, interleukin‐1 soluble receptor type II (P‐IL‐1sRII) and interleukin 6 as well as the erythrocyte sedimentation rate (ESR) were measured. The radiographic status showed no consistent or significant change during the observation period, but the individual variation was considerable. The radiographic signs of erosion and sclerosis varied most. Regression of erosions was associated with high S‐5‐HT and P‐IL‐1sRII, while progression of erosions was associated with high P‐5‐HT. Regression of sclerosis was associated with an increase in P‐5‐HT and high ESR. Progression of flattening was associated with high CRP. In conclusion, this study indicates that the progression of radiographic changes that occurs in the TMJ of patients with well‐controlled RA during a period of 25–46 months seems to be related to the blood levels of CRP, 5‐HT, and IL‐1sRII. However, only minor progression can be expected to occur, and with considerable individual variation.

Influence of serotonin on the analgesic effect of granisetron on temporomandibular joint arthritis

The influence of circulating serotonin (5-HT) on the effects of intra-articular administration of granisetron on temporomandibular joint (TMJ) pain was investigated in 11 patients with chronic polyarthritides. An analgesic effect superior to placebo has been shown previously. The change in TMJ movement pain intensity was negatively correlated to circulating 5-HT; that is, the higher the 5-HT before injection, the greater the reduction of pain intensity. The resting pain intensity reduction was not related to 5-HT. In conclusion, this study indicates a stronger short-term analgesic effect on TMJ movement pain by intra-articular administration of the 5-HT3 receptor antagonist granisetron in patients with high levels of circulating 5-HT.

Long-term evaluation of arthroscopic surgery with lysis and lavage of temporomandibular joint disorders

AIM To estimate and analyse the long-term outcome of arthroscopy for the treatment of the temporomandibular joint (TMJ) internal derangements. PATIENTS AND METHODS Twenty-nine patients (35 joints) who underwent TMJ arthroscopy under general anaesthesia due to osteoarthritis between years 2000 and 2007 (Wilkes stages IV and V) were included in this study. The age range at the time of surgery was from 18 to 69 years. The scores for preoperative maximal interincisal opening (MIO), and visual analogue scale (VAS) score for pain before arthroscopy, 6 months and 5 years after arthroscopy were compared. RESULTS Fibrous adherences were found in all cases, fibrillations in 76% of cases. The most frequent radiographic sign was erosion (69%). There was a significant increase in the MIO postoperatively after 6 months (r(s)=0.56; n=29, p>0.01) that held during the longer-term follow-up (5 years) period (r(s)=0.58; p<0.001). VAS after 6 months was positively correlated to VAS after 5 years (r(s)=0.38; p=0.040). There were no significant differences between the results of follow-up when comparing the shorter (6 months) and longer (5 years) results. CONCLUSION Arthroscopic lysis and lavage for the treatment of TMJ disorders offers favourable long-term stable results with regard to increasing MIO and reduced pain and dysfunction.

Use of botulinum neurotoxin A in uncontrolled salivation in children with cerebral palsy: a pilot study

This study investigated the safety and efficacy of botulinum neurotoxin type-A (BNT-A) injections into the salivary glands for treatment of sialorrhea in children with cerebral palsy (CP) and assessed the clinical factors that affect treatment outcome. The parotid and submandibular glands of nine CP patients were injected with BNT-A 1.4 U/kg in each parotid gland, and 0.6 U/kg in each submandibular gland. All children had neurological disorders. Gross motor function classification system levels ranged from I to V. All children had moderate to severe intellectual disability. A telephone interview with one parent determined response to treatment. Drooling intensity and frequency were measured with the drooling severity and frequency scale. After BNT-A treatment, the patients were followed up for 6 months using self-assessed rating scales for drooling intensity, discomfort and treatment effect (drooling impact scale). All parents reported an improvement in sialorrhea in the first week. Drooling was very intensive at baseline, and moderate 2 weeks after treatment. Maximum response occurred at 2-8 weeks. The use of BNT-A in uncontrolled salivation in children with CP can be considered acceptable and effective. Malocclusion and anterior salivation are closely related clinical characteristics and should be taken into account when planning treatment.

Temporomandibular Joint Arthroscopy versus Arthrotomy

Although some patients with temporomandibular joint (TMJ) disorders are successfully treated by nonsurgical means or by arthrocentesis or arthroscopic surgery, there is still a group of patients who do not respond to these procedures and for whom an arthrotomy and disc surgery (discoplasty) are necessary. Arthroscopy is an important diagnostic and therapeutic modality in the treatment of TMJ disorders being an alternative to arthrotomy ( „open“ TMJ surgery) and can be very effective in eliminating symptoms as pain, mandibular dysfunction, hypomobility, acute and chronic „closed lock“ due to osteoarthritis and arthrosis with adhesive capsulitis, where nonsurgical treatment has been unsuccessful. Bony ankylosis and fibrosis are best managed by open arthrotomy procedures. It has been found that a total of 22 of the 137 arthroscopies were diagnostic only, which resulted in immediate arthrotomy, including arthroplasty, meniscectomy [1]. Arthroscopy is a technique for direct visual inspection of internal joint structures, including biopsy and other surgical procedures per‐ formed under visual control. In 1918 Takagi first described arthroscopy of the knee joint examinations using cystoscope [2]. Onishi in 1970 was the first to report arthroscopy of the human temporomandibular joint and the first results were published by him [3,4]. The progress in research and applications of TMJ arthroscopy in joint disease have led to the acceptance of small operative procedures as a safe, minimally invasive means of effectively treating a number of intra-articular and degenerative TMJ problems [5-7]. Arthroscopic surgery has been an effective treatment for TMJ disorders refractory to nonsurgical treatments [8-10]. TMJ arthroscopy has been variously reported as successful in up to 80% of cases where outcome of arthroscopic surgery to the TMJ correlates with the stage of internal derangement [11-13]. Studies have been variable in their scientific methods and some long-term outcomes studies have been completed where both quality of life and functional outcome have been assessed [14-16]. For enabling direct comparison of the clinical results following arthroscopic

Temporomandibular Joint Arthroscopy

Arthroscopy is a technique for direct visual inspection of internal joint structures, including biopsy and other surgical procedures performed under visual control. In 1918 Takagi first described arthroscopy of the knee joint examinations using cystoscope (Tag, 1939). Onishi in 1970 was the first to report arthroscopy of the human temporomandibular joint (TMJ) and the first results were published by him (Onishi, 1975, 1980). The progress in research and applications of TMJ arthroscopy in joint disease have led to the acceptance of small operative procedures as a safe, minimally invasive means of effectively treating a number of intra-articular and degenerative TMJ problems (McCain, 1992; Holmlund A Holmlund et al., 2001). Arthroscopic surgery has been an effective treatment for TMJ disorders refractory to nonsurgical treatments ( Ohnuki et al., 2003; Gonzalez-Garcia et al., 2008, Leibur et al., 2010). TMJ arthroscopy has been variously reported as successful in up to 80% of cases where outcome of arthroscopic surgery to the TMJ correlates with the stage of internal derangement (K. Murakami et al., 2000; Sanroman, 2004). Studies have been variable in their scientific method and some long-term outcomes studies have been completed where both quality of life and functional outcome have been assessed (Voog et al., 2003a; Undt et al., 2006; Jagur et al., 2011). For enabling direct comparison of the clinical results following arthroscopic surgery and open surgery a retrospective study comparing two centers results using the Jaw Pain and Function Questionnaire ( Clark et al., 1989) has been performed and these treatment results of open surgery were comparable with arthroscopic treatment results (Undt et al., 2006).