It has been suggested that stabilization appliances and mandibular anterior repositioning appliances work by decompressing the temporomandibular joint. To indirectly test this assumption, tomograms ...of right temporomandibular joints of seven subjects were taken during comfortable closure and maximum clenching in maximum intercuspation and on the two types of occlusal appliances. Outlines of the condyle and the temporal fossa were automatically determined by an edge detection protocol. Upon comfortable closure, the anterior joint space dimension was reduced with stabilization appliances and mandibular anterior repositioning appliances. Upon maximum clenching, the minimum joint space dimension on stabilization appliances was equivalent to that seen in maximum intercuspation, while that on mandibular anterior repositioning appliances was substantially less (P < .05). Findings do not indicate that these appliances induce an increase in joint space during clenching.
The IMZ implant system incorporates stress-absorbing elements, such as the intramobile element (IME). There are varying reports regarding the characteristics of the IME however, its effectiveness is ...still controversial. In order to evaluate the effectiveness of the stress-absorbing elements under dynamic loading conditions, the stress-transfer characteristics around a single freestanding IMZ implant were investigated with three types of internal elements: an IME made of polyoxymethylene, an intramobile connector (IMC) consisting of a polyoxymethylene head and titanium screw, and a metal element (Metal-E) made of stainless steel. The vertical (10-kgf) and horizontal (2-kgf) dynamic forces applied to the surface of the superstructure and the strain values around the implant were measured with the strain gauges. The results were as follows: 1. Under axial dynamic force, the three types of elements had no significant difference in the stresses around a single freestanding implant. 2. Under vertical tilting dynamic forces, a more uniform stress around a single freestanding implant was observed with IME and IMC than Metal-E. 3. Under horizontal dynamic force, a more uniform stress around a single freestanding implant was observed with IME and IMC than Metal-E. The stress-absorbing elements were significantly effective under the dynamic conditions, while they were not effective under the static conditions.
The purpose of this study was to evaluate the effect of occlusal treatment on the symptoms of temporomandibular disorders (TMD) by questionnaire. Three hundred sixty-nine consecutive TMD patients who ...had finished treatment in our TMD clinic from April 1985 to March 1995 were included in this study. Questionnaires were sent to the patients, and 260 (80.5%) patients returned them. These patients were divided into two groups. One was the occlusal treatment (OT) group (mean age: 49.3±16.3, male/female=20/114) who received occlusal treatment. The other was a non-occlusal treatment (n-OT) group (mean age: 36.3±16.1, male/female=34/92) who did not receive occlusal treatment. The prevalence of pain in theorofacial region at the first visit was 66.9% in the OT group, and 73.3% in the n-OT group. The questionnaire included a visual analogue scale of pain (VAS), maximum range of opening (MRO), patient's estimation of treatment outcome (TO score), and daily activity limitation attributable to TMD symptoms (DAL score). As a result, no statistically significant difference could be found between the two groups for the three variables (Mann-Whiteney U-test). However, the TO score showed statistically significant difference for the three variables (Mann-Whiteney U-test).
Although patient attrition might be a serious threat to the validity of treatment-outcome studies on temporomandibular disorders (TMD), studies on TMD patient attrition are scarce. Of the 1405 ...consecutive TMD patients examined in a recent 10-year period, 367 (26.1%) drop-out patients or patients identified with a control group were sampled. A mailed questionnaire failed to reach 41 patients, and 203 (62.3%) were returned. The questionnaire elicited information on reasons for dropping out, changes in symptoms, treatment received in other clinics after dropping out, present treatment needs, and current signs and symptoms. Dropouts were divided into two groups: (1) those who failed to show up for their first scheduled appointment after the clinical examination; (2) those who failed to complete treatment. A group of patients who were judged by the examiner not to need treatment were included as a control group. The main reasons for dropping out were environmental obstacles, perceived improvement of the disease, and dissatisfaction with services. Only 21.7% considered themselves to be in need of treatment, and only 10.3% had visited other clinics after dropping out. Only 8.9% complained of the continued aggravation of symptoms, whereas 57.6% reported improvement. In addition, pain, dysfunction, and daily activity limitation tended to improve with time, although temporomandibular joint noise tended to persist. These results suggest that TMD signs and symptoms tend to decrease in patients after dropping out, and that the natural fluctuation of TMD signs and symptoms should be taken into consideration when treating TMD.
Trauma to the peripheral nervous system occurs during common dental treatment such as root canal treatment, periodontal surgery and tooth extraction. It has been reported that non-odontogenic ...continuous neuropathic pain occasionally appears after such invasive dental treatments (after pulpectomy, approx. 3-6% incidence). In this report, a case of neuropathic pain condition initiated by periodontal curettage is presented. The patient was a 56-year-old female who suffered from severe burning pain in the left maxillary molar alveolar area. No abnormal findings were observed by imaging examination of the central nervous system (magnetic resonance imaging and angiography). Results of clinical and radiographic examinations of the painful area were also negative. A tricyclic antidepressant, amitriptiline hydrochloride (5-20 mg/day) was prescribed and an intra-oral stent with a capsaicin (0.025 wt%) cream was applied to compress the painful area. These therapies substantially ameliorated her pain and insomnia.
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