Hari Parkash

Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: A report of 50 cases

OBJECTIVE The purpose of this study was to determine the cause of temporomandibular ankylosis and the long-term results of gap arthroplasty with coronoidectomy followed by immediate postoperative jaw exercises as a treatment of the condition. STUDY DESIGN This retrospective study evaluated the cause of temporomandibular joint ankylosis and the 36-month postoperative results of gap arthroplasty in 50 patients (62 joints). The patients were divided into 2 groups; group I (aged 0-12 years) consisted of 29 cases (24 unilateral and 5 bilateral; 34 joints); group II (aged 13-30 years) consisted of 21 cases (14 unilateral and 7 bilateral; 28 joints). A postoperative jaw opening exercise regimen was followed. Descriptive statistics, the Wilcoxon signed rank test, and rank sum 2-sample (Mann-Whitney) tests were applied. RESULT Trauma to the temporomandibular joint was documented as a major etiologic factor in 86% of cases. The 36-month postoperative mean maximal incisal opening was 30.62 mm (+/- 6.25 mm) for group I and 30.14 mm (+/- 3.9 mm) for group II. The P value in each group was highly significant for the Wilcoxon signed rank test; the Mann-Whitney test showed no difference between the groups, indicating that both groups had done well. The recurrence rate was 2%. CONCLUSION Trauma is the major cause of temporomandibular joint ankylosis in India. The long-term functional results of gap arthroplasty are satisfactory and comparable to those obtained through use of other treatments. Postoperative exercises play a crucial role in lasting success.

Dental and skeletal changes after intraoral molar distalization with sectional jig assembly.

The present study was conducted on 10 subjects to evaluate dental and skeletal changes after intraoral molar distalization. The maxillary molars were distalized with a sectional jig assembly. Sentalloy open coil springs were used to exert 150 gm of force for a period of 12 weeks. A modified Nance appliance was the main source of anchorage. The pre- and postdistalization records included dental study casts, clinical photographs, and cephalograms. A total of 665 readings recorded from lateral cephalograms and dental casts were subjected to statistical analysis. The mean distal movement of the first molar was 2.78 mm, which was highly significant (o < 0.001). It moved distally at the rate of 0.86 mm/month. There was clinically some distal tipping (3.50 degrees) and distopalatal rotation (2.40 degrees). These changes were statistically significant (p < 0.001). The second molars accompanied the first molars and moved distally by nearly the same amount. There was 1.00 mm increase in the overjet and 2.60 degrees mesial tip of second premolar. The changes in the facial skeleton and dentition bases were minimal and statistically not significant. However, there was clockwise rotation of the mandible of 1.30 degrees that was statistically significant. This was the result of molar extrusion (1.60 mm).

Myositis ossificans of medial pterygoid muscle : a cause for temporomandibular joint ankylosis

An unusual case of myositis ossificans of the medial pterygoid muscle has been discussed. It is important to know the exact cause of the temporomandibular joint ankylosis, for successful treatment. Computed tomographic scan and panoramic radiographs are essential diagnostic aids for evaluating conditions such as myositis ossificans. Myositis ossificans can be one of the causes of extra-articular temporomandibular joint ankylosis.

Muscle response to the Twin-block appliance: An electromyographic study of the masseter and anterior temporal muscles

An electromyographic study was performed on 10 young growing girls in the age group of 9 to 12 years with Class II Division 1 malocclusion and retruded mandible, who were under treatment with Twin-block appliances. Bilateral EMG activity of elevator muscles of the mandible (ie, anterior temporalis and masseter) was monitored longitudinally with bipolar surface electrodes to determine changes in postural, swallowing, and maximal voluntary clenching activity during an observation period of 6 months. The changes were noted at the start of treatment (0 month), within 1 month of Twin-block insertion, at the end of 3 months, and at the end of 6 months. The results revealed a significant increase in postural and maximal clenching EMG activity in masseter (P <.01) and a numeric increase in anterior temporalis activity during the 6 month period of treatment. The increased electromyographic activity can be attributed to an enhanced stretch (myotatic) reflex of the elevator muscles, contributing to isometric contractions. The main force for Twin-block treatment appears to be provided through increased active tension in the stretched muscles (motor unit stimulation) and from initiation of myotatic reflex activity and not through passive tension (viscoelastic properties) of jaw muscles. The results of this study reaffirm the importance of full-time wear for functional appliances to exert their maximum therapeutic effect by way of neuromuscular adaptation.

Nonsurgical healing of large periradicular lesions using a triple antibiotic paste: A case series

The infection of the root canal system is considered to be a polymicrobial infection, consisting of both aerobic and anaerobic bacteria. Because of the complexity of the root canal infection, it is unlikely that any single antibiotic could result in effective sterilization of the canal. A combination of antibiotic drugs (metronidazole, ciprofloxacin, and minocycline) is used to eliminate target bacteria, which are possible sources of endodontic lesions. Three case reports describe the nonsurgical endodontic treatment of teeth with large periradicular lesions. A triple antibiotic paste was used for 3 months. After 3 months, teeth were asymptomatic and were obturated. The follow-up radiograph of all the three cases showed progressive healing of periradicular lesions. The results of these cases show that when most commonly used medicaments fail in eliminating the symptoms then a triple antibiotic paste can be used clinically in the treatment of teeth with large periradicular lesions.

The global network on dental education: a new vision for IFDEA

The advent of globalization has changed our perspectives radically. It presents increased understanding of world affairs, new challenges and exciting opportunities. The inequitable distribution and use of finite energy resources and global warming are just two examples of challenges that can only be addressed by concerted international collaboration. Globalization has become an increasingly important influence on dentistry and dental education. The International Federation for Dental Educators and Associations (IFDEA) welcomes the challenges it now faces as a player in a complex multifaceted global community. This report addresses the new circumstances in which IFDEA must operate, taking account of the recommendations made by other working groups. The report reviews the background and evolution of IFDEA and describes the extensive developments that have taken place in IFDEA over the past year with the introductions of a new Constitution and Bylaws overseen by a newly established Board of Directors. These were the consequence of a new mission, goals and objectives for IFDEA. An expanded organization is planned using http://www.IFDEA.org as the primary instrument to facilitate the exchange of knowledge, programmes and expertise between colleagues and federated associations throughout the world, thereby promoting higher standards in oral health through education in low-, middle- and high-income countries of the world. Such aspirations are modified by the reality and enormity of poverty-related global ill health.

Primary malignant fibrous histiocytoma of the maxilla

Abstract A case of a primary malignant fibrous histiocytoma of the maxilla in a 14-year-old girl is presented. A search of the literature has revealed only one previous case. Primary malignant fibrous histiocytoma is a rare tumour of the jaws which is locally aggressive with little tendency to metastasize, although there have been reports of distant spread. There is no effective treatment but surgery might increase the survival time. The tumour does not respond to radiotherapy or chemotherapy. Recurrence is common, being about 73 per cent. In the present case in spite of early diagnosis and prompt treatment the patient survived for only 10 months.

Benign osteoblastoma of the mandible

Abstract A rare case of benign osteoblastoma involving the mandible is presented. This neoplasm can easily be confused with other bening or malignant lesions of the jaws. The differential diagnosis can be made only by histopathologic examination. The lesion usually does not recur after complete excision.

Burkitt's lymphoma.

The case of a 33-year-old woman with Burkitts lymphoma is presented. This is the third case that has been reported from India. The primary involvement was in the mandible. Endoxan was administered without response. Radiotherapy was resorted to as the second choice of treatment, but metastases developed rapidly in other organs. The patient survived for only 3 months after a diagnostic biopsy.

Adenomatoid odontogenic tumour of the jaws.

Abstract The adenomatoid odontogenic tumour of the jaws is rare. It is important to differentiate it from other odontogenic tumours because of its benign behaviour and this can be reliably done by the histological features.