Hadar Better

Long-term outcome of arthrocentesis for sudden-onset, persistent, severe closed lock of the temporomandibular joint

PURPOSEnThis study analyzed the long-term effect of arthrocentesis for severe closed lock of the temporomandibular joint (TMJ) and reevaluated the pathogenesis of this condition based on the data obtained.nnnPATIENTS AND METHODSnThirty-nine patients (40 joints) who had experienced sudden-onset, persistent limited mouth opening were the subjects of this study. After unsuccessful noninvasive treatment, arthrocentesis of the upper compartment of the affected TMJ was performed using saline. The follow-up, which consisted of patient self-assessment and clinical examination, ranged from 6 to 37 months (mean, 16.6 +/- 12.0 months). Visual analog scales were used for preoperative and postoperative self-evaluation of pain and dysfunction on forced mouth opening and for assessment of overall change in these parameters postarthrocentesis. Maximal mouth opening (MMO), contralateral movement (CLM) and protrusive movement of the jaw, and presence of joint noises were noted preoperatively and at clinical follow-up examinations.nnnRESULTSnAt 6 to 37 months postarthrocentesis, MMO and CLM had increased significantly (from a mean of 23.10 +/- 5.15 mm to 44.25 +/- 4.96 mm, and from a mean of 4.81 +/- 2.36 mm to 8.20 +/- 1.90 mm, respectively; P < .001). Functional improvement was associated with a significant reduction in pain and dysfunction levels (from a mean of 9.24 +/- 2.90 to 1.45 +/- 1.74, and from a mean of 9.26 +/- 2.82 to 2.68 +/- 2.80, respectively, on a scale of 0 to 15; P < .001). The overall improvement, as expressed in pain and dysfunction levels, was about 95%, with no recurrence of severe closed lock.nnnCONCLUSIONSnArthrocentesis for sudden-onset closed lock provided sustained normal joint function and marked pain relief. Because the available literature shows that arthrocentesis changes neither disc position nor disc shape, it places in doubt the concept of a displaced and deformed disc limiting joint function. Rather, the efficacy of lavage in resolving closed lock suggests that the condition is the result of sudden adherence of the normally shaped disc to the fossa, rendering it incapable of sliding. The characteristic features of sudden-onset, limited mouth opening warrants classification of this disorder as an independent entity within the realm of TMJ disturbances.

Case selection for apical surgery: a retrospective evaluation of associated factors and rational.

Endodontic failures associated with poor quality of endodontics respond favorably to retreatment. Nevertheless, under certain clinical conditions, apicoectomy should be the preferred procedure. A retrospective survey of 200 roots that were referred for apical surgery revealed that 83% of the roots were inadequately obturated, including 8.5% with no root canal filling at all. In 49 of the roots in this group (24.5% of the referred cases) nonsurgical retreatment was judged by an endodontist as either impossible or improbable because it might jeopardize the root integrity. Retreatment should have been the preferred treatment modality for the rest of the group, provided that coronal restorations could be safely bypassed or removed. Posts were found in 63 of these teeth, however 35 of them were either short or loosely fitting and could safely be removed. The rest of the posts were longer than 5 mm, which might have presented a problem if their removal was attempted. In 45% of the 200 cases in the present study, surgical intervention was justified. The rest of the cases (55%) should have either been subjected to a follow-up (10.5%) or retreated nonsurgically by a skilled endodontist (44.5%). These results indicate that referring dentists may not appreciate the retreatment possibilities offered by modern endodontics, and they emphasize the need for a shift of concept: endodontists should be involved in the decision making before referring a patient to surgery.

Healing Kinetics of Periapical Lesions Enhanced by the Apexum Procedure: A Clinical Trial

The new Apexum procedure (Apexum Ltd, Or-Yehuda, Israel) is based on a minimally invasive removal of periapical chronically inflamed tissues through a root canal access. Its goal is to enhance healing kinetics of periapical lesions. This clinical study was conducted to explore the safety and efficacy of this procedure. The Apexum procedure was applied, as a supplementary step, during conventional root canal treatment in 48 teeth with periapical lesions. Safety and efficacy were clinically and radiographically assessed and teeth of the Apexum-treated group were compared with 39 similar teeth treated by the same endodontic procedure with no additional intervention. No adverse events occurred in either the Apexum-treated or conventional treatment groups. Furthermore, healing kinetics was significantly enhanced in the Apexum-treated group (p < 0.005). At 3 and 6 months, 87% and 95% of the lesions in the Apexum-treated group, respectively, presented advanced or complete healing, whereas only 22% and 39% of the lesions in the conventional treatment group presented this degree of healing at 3 and 6 months, respectively.

Minimally Invasive Sinus Lift Implant Device: A Multicenter Safety and Efficacy Trial Preliminary Results

PURPOSEnIn cases of advanced maxillary sinus atrophy of the bone (pneumatization), the sinus floor has to be augmented in order to obtain acceptable bone volume for implantation. The objective of the present study is to evaluate a new procedure and device, designed as a closed sinus lift using a dedicated dental implant that allows for Schneiderian membrane elevation and the placement of a flowable bone replacement graft.nnnMATERIALS AND METHODSnEighteen patients (8 males, 10 females) underwent 23 procedures. All procedures were completed successfully, with elevation of the sinus membrane and insertion of bone graft and the dental implant at the planned site. No membrane tears were noted. No intraoperative or postoperative adverse events were observed in any of the cases. There were no postprocedural emergency or distress calls.nnnRESULTSnThe patients average age was 52 (range 38-72). The mean residual alveolar ridge height was 5.5u2009mm (range 4.0-7.0). The average bone gain was 11.2u2009mm (range 9-13) after an average healing period of 8.7 months (range 6.7-13.1). All implants achieved clinical stability and prosthetic rehabilitation was uneventful.nnnCONCLUSIONSnA closed sinus floor elevation procedure can be accomplished using a dedicated dental implant that allows for hydraulic elevation of the Schneiderian membrane and placement of a flowable bone replacement graft and dental implant placement all at the same time with minimal patient discomfort.

Enhancement of Healing Kinetics of Periapical Lesions in Dogs by the Apexum Procedure

In nonsurgical endodontic procedures, the healing of apical periodontitis is achieved by treatment provided within the root canal system. The new Apexum procedure is based on advancing the debridement one step further by minimally invasive removal of the inflamed periapical tissues through root canal access, thereby enhancing the healing kinetics of periapical lesions. The Apexum procedure uses 2 sequential rotary devices designed to extend beyond the apex and to mince periapical tissues on rotation in a low-speed handpiece, followed by washing out the minced tissue. This initial animal study was conducted to evaluate the efficacy and potential adverse effects of this procedure. Periapical lesions were induced in the lower premolars in dogs by placement of autologous dental plaque and subsequent radiographic verification. Fifty roots with periapical lesions were then subjected to cleaning, shaping and disinfection of their root canals, using a conventional root canal treatment protocol. Teeth in group 1 were subjected to the new Apexum procedure just before obturation, whereas roots in group 2 were subjected to no additional intervention before obturation. Clinical and radiographic follow-ups were carried out for 6 months. Radiographic healing of the periapical lesions in dogs at 3 and 6 months showed significantly enhanced kinetics in the Apexum-treated group compared with the conventional treatment group, at both time points (p <0.01). No noticeable adverse events occurred in either of the groups. This new procedure might significantly enhance healing kinetics of apical periodontitis compared with conventional nonsurgical endodontic treatment.

The Feasibility of Flapless Approach to Sinus Augmentation Using an Implant Device Designed According to Residual Alveolar Ridge Height

Hydraulic sinus lift and augmentation may be successfully performed using a dedicated implant device designed according to residual bone height (RBH). The aim of this study was to evaluate whether a flapless surgical approach might negatively influence the outcome. A total of 40 consecutive patients (16 men and 24 women) were included in the study, 20 in each group (minimal flap/control versus flapless/study). Inclusion criteria were ≥ 3 mm RBH, ≥ 6 mm width of the residual alveolar ridge according to preoperative cone beam computerized tomography, and ≥ 8 mm buccopalatal keratinized gingiva for the flapless group. Primary outcome parameters included intraoperative membrane perforation. Secondary outcome parameters included postoperative infection, soft tissue healing, bone gain, and short-term dental implant survival. Mean RBH was 4.6 mm. No intraoperative membrane perforations and no postoperative infections were observed. Mean bone gain height was similar for both groups, at 11 mm. Soft tissue healing was observed within 2 months. In all cases, second-stage surgery allowed generation of at least 2 mm of keratinized gingiva buccally. All implants were osseointegrated at second-stage surgery. The use of a flapless approach to maxillary sinus augmentation using an implant device based on RBH yields predictable results.