Madeleine Rohlin

A study of indications used for removal of the mandibular third molar

To study the indications used for removal of the mandibular third molar, questionnaires were sent to 35 Oral Surgery Clinics in Sweden, out of which 29 clinics participated. In each clinic, the questionnaires were to be recorded for 30 patients. The indications for removal were classified into 15 groups. There were also questions about symptoms as well as eruption status for the molar being removed. The results were based on data from 870 individuals with a mean age of 27 years. More than half of the removed third molars (54%) presented no subjective symptoms. Such symptoms were more frequent in association with fully or partially erupted molars than molars completely covered by soft or bone tissue. The indication for removal was classified as prophylactic in 27% and as orthodontic in 14%. Earlier episodes of pericoronitis consisted of 1/4 of the indications and caries or pulpitis of the third molar made up 13%. Pathologic entities like cysts, tumours and root resorption were registered in less than 3% each, and were more frequent among patients 40 years of age or older.

Pathoses associated with mandibular third molars subjected to removal

OBJECTIVES To measure the prevalence of disease of mandibular third molars referred for removal and to estimate the risk for development of pathoses for two cues. STUDY DESIGN A prospective cohort study on molars subjected to removal was performed. The prevalence of different diseases and the patients age, angular position, and degree of impaction of the molars were registered. Odds ratio for molars with different positions and impaction states were estimated. RESULTS Pericoronitis was found in 64% of cases, caries in the third molar in 31%, periodontitis in association with 8%, caries in the second molar in 5%, and root resorption of the second molar with 1% of the molars with pathoses. Odds ratio was highest for distoangular molars (5.8) and for molars partially covered by soft tissue (6.7). CONCLUSIONS The odds ratio is about 22 and 34 times higher for molars partially covered by soft tissue than for molars completely covered by soft or bone tissue. For distoangular molars the odds ratio is 5 to 12 times higher than for molars in other positions.

Dental panoramic radiograph as a tool to detect postmenopausal women with low bone mineral density: untrained general dental practitioners’ diagnostic performance.

The detection of postmenopausal women with low bone mineral density (BMD) is an important strategy to reduce the incidence of osteoporotic fracture. Recent studies suggested that incidental findings on dental panoramic radiographs may be used as a tool to detect women with low BMD. However, little is known whether this finding is sufficiently assessed by untrained general dental practitioners (GDPs). The purpose of this study was to investigate: (1) the observer agreement and (2) the diagnostic efficacy in detecting women with low BMD, when untrained GDPs assess the appearance (normal or eroded) of the mandibular inferior cortex on dental panoramic radiographs of postmenopausal women. Twenty-seven GDPs were asked to classify the appearance of the mandibular inferior cortex on dental panoramic radiographs of 100 postmenopausal women who had completed BMD assessments of the lumbar spine and of the femoral neck. Intra-and inter-observer agreements were analyzed with kappa statistics. The diagnostic efficacy (sensitivity, specificity and predictive values) was analyzed by comparing two groups classified by the mandibular inferior cortex (women with normal and women with eroded mandibular inferior cortex) with those classified by BMD (women with normal BMD and women with osteopenia or osteoporosis). The mean sensitivity and specificity were 77% and 40%, respectively, when BMD of the lumbar spine was used as standard and 75% and 39%, respectively, when BMD of the femoral neck comprised the standard. Nineteen untrained GDPs (70%) presented a moderate to almost perfect intra-observer agreement. We conclude that dental panoramic radiograph may be used in clinical dental practice to identify postmenopausal women who have undetected low BMD and should undergo further testing with bone densitometry.

The correlation of temporomandibular joint sounds with joint morphology in fifty-five autopsy specimens

Joint sounds from 55 fresh temporomandibular joint autopsy specimens were correlated with the macroscopic examination of joint morphology. Fifty-eight per cent of the joints were silent. Two thirds of these showed normal superior disc positions and remodeled articular surfaces, whereas one third exhibited anterior disc displacement. Twenty per cent of the joints elicited clicking and showed anterior disc displacement. Twenty-two per cent of the joints elicited crepitation and exhibited mostly arthrosis of the articular surfaces and perforation of the discs. Our results confirm previous statements that clicking and crepitation may be looked upon as signs of abnormal joint morphology, clicking indicating anterior disc displacement and crepitation usually indicating arthrosis. Absence of sound alone, however, should not be accepted as an indication of a normal joint.

Assessment of the trabecular pattern before endosseous implant treatment: Diagnostic outcome of periapical radiography in the mandible

OBJECTIVES To study the diagnostic outcome of periapical radiography in the assessment of the bone trabecular pattern of the mandible. STUDY DESIGN Mandibular autopsy specimens were radiographed. Seven observers assessed the radiographs with the aid of a proposed classification with and without reference images and the classification presented by Lekholm and Zarb. Accuracy was estimated on the basis of morphometric measurements of trabecular bone volume. Observer agreement was calculated as the estimated probability of agreement between and within observers and as kappa index. RESULTS With the classification proposed by us, the overall accuracy was 58% with and 50% without reference images. The accuracy for assessing dense trabeculation was higher (78%) than that for sparse trabeculation (28%). The accuracy of the proposed classification by Lekholm and Zarb was not possible to evaluate. The interobserver agreement varied between 49% and 64% and the intraobserver agreement between 75% and 86%. CONCLUSION A new classification with reference images is recommended to assess the trabecular pattern in periapical radiographs before implant treatment.

Diagnostic accuracy of direct digital dental radiography for the detection of periapical bone lesions: overall comparison between conventional and direct digital radiography.

OBJECTIVES The diagnostic accuracy of direct digital radiography for the detection of small, experimentally made, periapical lesions was compared with that of E speed film. The high- and low-contrast resolutions of the imaging systems were also compared. STUDY DESIGN The high-contrast resolution was evaluated with a line pair plate. The low-contrast resolution was determined with a contrast-detail plexiglass phantom. To evaluate the diagnostic accuracy, the periapical region of dry human mandibles was examined. Receiver operating characteristic based on the readings of seven observers were generated. RESULTS The high-contrast resolution of the digital system was inferior, but the low-contrast resolution was comparable to that of E-speed film. For diagnostic accuracy no significant difference was seen between the areas under the receiver operating characteristic curves. CONCLUSIONS The quality of the direct digital images is comparable to that of E-speed film for the detection of periapical bone lesions.

Temporomandibular joint sounds in patients with disc displacement

Temporomandibular joint sounds have been viewed as signs of different pathological changes. However, the correlation between joint sounds on the one hand and function and morphology of the joint on the other, are not well documented. We have therefore presurgically recorded sound from 35 operated joints with disc displacement and have studied arthrographically and during surgery the position, function and configuration of the disc as well as arthrotic changes. 12 joints were silent, 12 elicited reciprocal clicking, 3 single clicking, and 8 crepitation. Joints with reciprocal clicking consistently showed disc displacement with reduction and silent and crepitating joints showed disc displacement without reduction. All joints with reciprocal clicking as well as most silent joints demonstrated non-arthrotic articular surfaces, whereas crepitation was recorded in both arthrotic and non-arthrotic joints. Our results implied that crepitation is a rather unreliable sign of arthrosis. Reciprocal clicking can be considered as an accurate sign of reduction of anteriorly displaced discs. However, neither the degree of displacement nor the degree of deformation of the disc could be disclosed by analysis of the sound. This information can only be obtained by further examination, such as arthrotomography.

Osteogenetic activity in composite grafts of demineralized compact bone and marrow.

The effects of a composite graft of autologous marrow and demineralized autologous compact bone on the healing of a surgically created bone defect were observed in adult rabbits. A segment of the radius was bilaterally resected, demineralized, and replaced. On one side the bone graft was supplemented with autologous marrow. The new bone formation was measured 14 and 28 days after operation by roentgenography, including planimetry with scintigraphy and autoradiography using 99mTc-labelled MDP. The composite graft, i.e., demineralized compact bone and marrow, had a significantly higher (p less than 0.01) bone formation rate 14 days after operation compared with the graft with demineralized compact bone in the opposite radius. At 28 days, however, there were no differences between the sides. Viable autologous marrow cells and demineralized autologous compact bone graft accelerate the rate of osteogenesis, but only at the beginning of the healing process.

Relationship between clinical and radiologic findings of the temporomandibular joint in rheumatoid arthritis.

The relationship between clinical findings in the craniomandibular system and radiologic findings in the temporomandibular joint was investigated in 101 adults with rheumatoid arthritis. Radiologic changes were correlated with duration and severity of temporomandibular joint symptoms and general joint disease. The radiologic changes were also associated with loss of occlusal support, anterior open bite, and occlusal interferences. Most joints with crepitus exhibited radiologic erosion. Joints with mutilating changes were silent.

Rheumatoid arthritis of the temporomandibular joint: Radiologic evaluation based on standard reference films

A radiologic scoring system that uses tomography and panoramic radiography to evaluate severity of rheumatoid arthritis in the temporomandibular joint of adults is presented. The scoring system is based on six verbally described grades illustrated by standard reference films. The interobserver agreement was significantly higher for the grading with reference films than for that without reference films. Intraobserver performance was similar for grading with and without reference films. The grading system with reference films is recommended in epidemiologic studies of rheumatoid arthritis localized to the temporomandibular joint or other studies in which multiple observers are involved.