Tore Bjørnland

The effect of soft-laser application on postoperative pain and swelling. A double-blind, crossover study.

The effect of soft-laser application on postoperative pain and swelling was evaluated in a double-blind, crossover study. Twenty-five healthy adults with bilateral identically impacted lower third molars were selected for this study. The teeth were removed in two separate operations. Laser treatment was tested in comparison with placebo laser, with a 40-mW, 830-nm Biophoton laser (Roenvig Dental, Denmark). All surgical procedures and measurements were done by the same surgeon. The following features were statistically analyzed: swelling, trismus, and subjective registration of pain on a visual analog scale. No statistically significant differences were observed in comparison of the experimental side with the placebo side. It may be concluded that soft-laser treatment has no beneficial effect on swelling, trismus, and pain after third molar surgery.

Injection of sodium hyaluronate compared to a corticosteroid in the treatment of patients with temporomandibular joint osteoarthritis: a CT evaluation

OBJECTIVE Osseous changes in the temporomandibular joint (TMJ) were evaluated using computed tomography (CT) examinations before and after TMJ injections of sodium hyaluronate or a corticosteroid in patients with osteoarthritis (OA). STUDY DESIGN Forty patients were randomly allocated into 2 groups for 2 intra-articular injections with either sodium hyaluronate or a corticosteroid. Bilateral TMJ examinations with high resolution CT were obtained in 36 patients before and 6 months after treatment. Treated and contralateral TMJs were evaluated for the presence of osteoarthritic osseous abnormalities by 2 reviewers independently. RESULTS Progression, regression, and no changes of osseous abnormalities were demonstrated in 13, 9, and 14 TMJs, respectively, 6 months after treatment. There was no significant difference between the groups. CONCLUSIONS Progression/regression and no changes of osteoarthritic abnormalities were observed on CT examinations in both the treated and the contralateral TMJs after treatment with intra-articular injection with sodium hyaluronate or corticosteroid.

Dental characteristics in Williams syndrome: a clinical and radiographic evaluation

Williams syndrome is a rare congenital syndrome with distinctive craniofacial features, cardiovascular abnormalities, and behavior characteristics including mental retardation. The dental abnormalities have received scant attention in previous literature. The aim of this study was to describe dental characteristics in individuals with Williams syndrome. In a group of 41 individuals more than 10 years of age, 40.5% had agenesis of one or more permanent teeth and 11.9% had agenesis of 6 permanent teeth or more. The mesio-distal and labio-lingual dimensions of permanent tooth crowns were measured on 31 dental study casts from individuals older than 12 years. The mesio-distal and labio-lingual dimensions were significantly smaller compared with a reference sample. An analysis of tooth morphology was performed on the same dental study casts revealing altered tooth morphology. A high proportion of maxillary and mandibular incisors was tapered or screwdriver shaped. An evaluation of taurodontism on mandibular permanent molars was performed using a metric crown-body/root ratio. However, most of the molars rated as being taurodontic had short or extremely short total tooth lengths and could thus be rated taurodontic without meeting the classical definition. The results of this study indicate that although there is variation in dental development in individuals with Williams syndrome, agenesis of permanent teeth in combination with aberrations in tooth size and morphology may affect dental esthetics and complicate orthodontic and prosthodontic treatment.

Efficacy of Temporomandibular Joint Ankylosis Surgical Treatment

PURPOSE The purpose of the present study was to answer the following clinical question: of the patients with temporomandibular joint ankylosis, do those treated with ankylosis resection and ramus-condyle unit reconstruction with a prosthetic total joint (total joint replacement [TJR]) have improved jaw function and decreased pain compared with those treated with ankylosis resection and interpositional arthroplasty (IA)? MATERIALS AND METHODS Using a retrospective study design, the investigators enrolled a sample derived from the population of patients presenting to the Massachusetts General Hospital (Boston, MA) and the University of Oslo Faculty of Dentistry from 1998 to 2008 for the evaluation and management of temporomandibular joint ankylosis. The primary predictor variable was treatment (ie, TJR or IA). The outcome variables were the maximal interincisal opening and pain. Data analyses were performed using bivariate and multiple regression methods. RESULTS The final study sample included 36 subjects with a mean age of 40 +/- 13.1 years, and 25 were women (69%). Of the 36 patients, 14 (39%) and 22 (61%) were in the TJR and IA groups, respectively. The changes in the maximal interincisal opening in the TJR and IA groups were 9.4 +/- 6.7 and 18 +/- 9.7 mm (P = .02). After adjusting for institutional location, number of previous operations, laterality (unilateral versus bilateral operation), age, and etiology, the difference in the maximal interincisal opening between the 2 treatment groups was not significant (P = .06). The changes between preoperative and postoperative pain scores were insignificant between the groups (P = .16). CONCLUSION Ankylosis resection and ramus-condyle unit reconstruction with a prosthetic total joint and IA produced comparable outcomes in terms of mandibular range of motion and pain.

The effect of locally applied gauze drain impregnated with chlortetracycline ointment in mandibular third-molar surgery

A prospective randomized crossover, within-patient, controlled study was performed in 26 healthy patients to test the effect of the prophylactic local use of gauze drain impregnated with chlortetracycline (Aureomycin 3%, Lederle) ointment on postoperative alveolitis formation after surgical removal of 52 bilaterally impacted mandibular third molars. The teeth were removed on two separate occasions; on one side drain was inserted in the socket, and on the other side no drain treatment was used for control. The influence on postoperative pain, swelling, and mouth opening ability was investigated. The results indicated a statistically significant reduction (P = 0.02) in the incidence of postoperative inflammatory complications, defined as postoperative alveolitis, from 35% in the no-drain group to 4% in the drain group. No statistically significant difference was found between the two treatment methods with regard to pain and mouth opening reduction. There was a significant difference between the drain and no-drain treatment with regard to swelling on the 1st postoperative day in favor of the no-drain method. It is concluded that insertion of a chlortetracycline-impregnated drain may be an effective method for reducing postoperative alveolitis formation but has no beneficial effect on pain, swelling, and mouth opening reduction after impacted mandibular third-molar surgery.

Imaging temporomandibular joint abnormalities in patients with rheumatic disease. Comparison with surgical observations.

The preoperative examination findings in the soft tissue and bone of 22 temporomandibular joints of 15 patients with rheumatic disease were compared with the diagnosis after TMJ surgery. Agreement was found in 15 joints with rheumatic involvement and in 4 with internal derangement. In 5 (with unsuccessful arthrotomography) of the 15 rheumatic joints, magnetic resonance imaging showed destruction of disks with soft-tissue replacement, corresponding to fibrous tissue/ankylosis observed at surgery. Bony fusions in 2 of these joints were depicted with computed tomography. In the remaining 10 joints, arthrotomography showed irregularly outlined small compartments corresponding to synovial proliferations observed during surgery. Similar arthrotomographic interpretation, however, was made in 2 of 3 temporomandibular joints with imaging-surgery disagreement; surgery showed fibrous adhesions. In the third joint with unsuccessful arthrotomography, magnetic resonance imaging showed internal derangement but no synovial proliferations that were surgically observed. As experienced with other joints, synovial proliferations (or fibrous adhesions) could not be depicted with magnetic resonance imaging. Thus, differentiation between internal derangement with and without rheumatic involvement could be impossible with both arthrotomography and unenhanced magnetic resonance imaging.

Arthrographic findings in the temporomandibular joint in patients with rheumatic disease.

Hypocycloidal multisection tomography and lower-space arthrotomography with videofluoroscopy were performed on 20 symptomatic temporomandibular joints (TMJs) of 17 patients. All patients (16 women, one man, aged 17 to 38 years) had definite or suspected rheumatoid arthritis (adult or juvenile type), ankylosing spondylitis, or psoriatic arthropathy. Bone abnormalities were found in 14 TMJs, primarily cortical erosion (11 joints), but also condylar flattening (three joints). Irregularity in outline of the contrast material, bone contour-contrast material gaps, evidence of adherent discs and/or small joint compartments indicated synovial hyperplasia/pannus formation in 15 joints. Six of these (four with normal disc position) showed perforation between the joint compartments. In those with normal disc position the perforation seemed to occur in the central portion. Ten of the 15 joints had normal disc position; the remaining five had anterior disc displacement without reduction. One joint showed only disc displacement. Most joints with bone abnormalities (12 of 14) showed arthrographic signs of rheumatic involvement. Such signs were also observed in two of the six joints with no bone abnormalities, indicating the value of arthrography in the early diagnosis of patients with rheumatic disease and TMJ problems.

Histopathologic changes of the temporomandibular joint disk in patients with chronic arthritic disease

Histopathologic examination was performed of the disk and the posterior attachment extirpated from 17 temporomandibular joints from 15 patients with chronic arthritic disease. Seven patients had rheumatoid arthritis (including two with juvenile type), five had ankylosing spondylitis, and three had psoriatic arthropathy, which affected more joints than the temporomandibular joint. Specimens removed from 16 temporomandibular joints from 15 patients with internal derangement were used for histopathologic comparison. In both groups of patients, inflammatory changes were observed, but no specific histopathologic signs could distinguish the groups. Patients with chronic arthritic disease seemed to have more pronounced changes of vascular proliferation, perivascular cellular infiltrate, inflammatory cells, and fibrosis throughout the soft tissues. Destruction of the disk was another finding evident in patients with chronic arthritic temporomandibular joint disease; there was no visible disk structure in 8 of these 17 joints, compared with 1 of the 16 joints in the internal derangement group.

Side-effects and patient acceptance of 0.2% versus 0.1% chlorhexidine used as postoperative prophylactic mouthwash

In a double-blind parallel group study including 30 patients, the side-effects and patient acceptance of chlorhexidine mouthwash 0.2% and 0.1% were studied. Side-effects such as loss of taste, burning sensation of the oral mucosa, subjective dryness of the oral cavity and discoloration of teeth and tongue were encountered. There was no statistically significant difference between the chlorhexidine groups with respect to the frequency of the reported side-effects. However, the taste of chlorhexidine 0.1% was significantly better accepted than chlorhexidine 0.2%. 4 patients discontinued the use of chlorhexidine 0.2% before the end of the trial. The quality of the experienced side-effects was stated by the patients as the reason for the discontinuation of chlorhexidine 0.2%. The present work concludes with the recommendation of chlorhexidine 0.1% compared to chlorhexidine 0.2% as a prophylactic mouthwash after oral surgical interventions.

Discectomy of the temporomandibular joint: an experimental study in monkeys.

Postoperative changes have been observed in the temporomandibular joint (TMJ) after discectomies. Animal models have often shown that interventions in the TMJ may heal uneventfully. Discectomies were performed on 14 Macaca fascicularis and macroscopic and microscopic examination performed after sacrifice of the animals. Two of the animals did not show any apparent macroscopic or microscopic changes. The remaining 12 joints showed minor to major changes. The most serious changes were seen in three joints with fibrous ankylosis and five joints showed marked destruction of the articular cartilage.