Longitudinal epidemiological analysis of three decades of TMD populations

OBJECTIVES This study aims to compare the epidemiological data of three cohorts of dysfunctional patients attending to the Clinical Gnathology Service of Policlinico Umberto I University Hospital - Sapienza University of Rome, in order to highlight the salient characteristics of Temporomandibular disorders (TMD) and patients who are affected, and understand their evolution over time. MATERIALS AND METHODS A homogeneous population of 387 dysfunctional patients, belonging to three different decades, consecutively extracted from the medical records in the archive, which contained all their personal, anamnestic and clinical data, was selected. All patients were divided into three homogeneous groups of 129 subjects: GI (1990-1993), GII (2000-2003) and GIII (2010-2013). A descriptive statistical analysis of all the clinical and anamnestic data was performed. RESULTS The female gender (F) is far more interested in the development of TMD, although the study groups of more recent times shows an increasing trend in the incidence on the male one (M): in GI, the patients of M and F sex are respectively 14.84% and 85.16%; in GII are 15.50% and 84.50%; in GIII are 20.16% and 79.84%. Regarding the age, in all three groups the most affected range is between 16 and 40 years: 80% in GI, the 68.26% in GII and the 62.02% in GIII. However, the highest age groups, from 41 to 70 years and over, shows a progressive increase in incidence, from the 90s (GI) to today (GIII): the 17.27% in GI; the 30,16% in GII; the 37.20% in GIII. The most frequent TMDs are the joint diseases (GI: 85%; GII: 54.3%; GIII: 51.2%). The disc displacement with reduction (DDWR) is present in the 44.89% of GI patients, the 40.31% of GII, and the 34.11% of GIII. The disc displacement without reduction (DDWoR) is present in the 40.15% of GI patients, the 13.96% of GII, and in the 17.06% of GIII. GIII shows an increased incidence of muscular pathologies (37.2%) compared to previous decades (GI: 10.2%; GII: 35.6%). The parafunctions are a datum of remarkable incidence in all the study groups, especially in GIII. Clenching is present in the 17.05% of GI, in the 30.23% of GII, and in the 62.8% of GIII. Bruxism is present in the 14.96% of GI, in the 11.63% of GII, and in the 35.66% of GIII. Joint pain is the symptom with higher incidence in all analyzed groups, being reported by the 74.42% of GI, the 79.07% of GII and the 69.77% of GIII. This symptom, whether present on the right, on the left or bilaterally, is mostly referred as moderate/severe by patients of GI, GII and GIII, and shows no remarkable discrepancies between the different decades. Headache is a symptom mostly referred as bilateral, and is the comorbidity most reported all three groups: 45.74% in GI, 57.36% in GII, and 66.67% in GIII. Neck pain occurs mostly bilaterally and is reported by a higher percentage of GIII patients (61.24%), compared to GII (41.87%). CONCLUSIONS The TMD patient, compared to the past, is on average less young and afflicted by painful and chronic diseases, almost constantly accompanied by painful symptoms associated with the purely articular or muscular one, such as headache and neck pain. These features make the dysfunctional patient more complex to be examined, so the specialist need to train properly in order to have a valid diagnostic and therapeutic expertise. CLINICAL SIGNIFICANCE The dysfunctional patient has changed over time several characteristics that must be considered in clinical practice

Implant stability in different techniques of surgical sites preparation: an in vitro study

In the last few decades the implantology has achieved excellent results in the prosthetic rehabilitation of the partially or totally edentulous patients. The clinicians, given the pressing demand by patients, must deal with the situations in which the lack of the availability and sometimes the low quality of the bone can lead to the treatment failure. Although the manufacturers recommend to follow codified surgical protocols, alternative techniques of preparation, apt to ensure a better primary implant stability, have been developed. The aim of this study was to determine in vitro, by using the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) is able to improve implant stability of type IV cancellous bone. 10 pig ribs were prepared, and a surgical pre-drilled and calibrated guide for proper implant placement was used. On each rib, 5 implant sites were prepared, one for each technique. One-way ANOVA did not show statistically significant differences among the “implant stability quotient” (ISQ) values of the 5 techniques utilized. Thus, in light of these results, in the clinical practice of the type IV bone one technique is replaceable with the others, as none of them improves implant stability. The choice should instead be directed to the technique that accelerates the healing process and the osseointegration

Innovations in oral and maxillofacial surgery: biomimetics meets physiology

Background Biomimetics is the study of the formation, structure, or function of biologically produced substances and materials (such as enzymes or silk) and biological mechanisms and processes (such as protein synthesis or photosynthesis) especially for the purpose of synthesizing similar products by artificial mechanisms which mimic natural ones. Discussion Humans has been in a process of continuously deriving ideas and innovations from nature for the day to day problems of a living. As teeth do not have natural method of repair, Biomimetic principles should be used to artificially repair the tooth to its natural functions and aesthetics. A material fabricated by biomimetic technique based on natural processes found in biological systems is called a biomimetic material. There are two main concepts concerning the biomimetic approach in dentistry: the restorative approach, that is the act of restoring the tooth to its former condition, and the regenerative approach, that is the process of producing new tissues following damage. Conclusions When the biomimetics meets physiology, the results will be long-lasting, the function will be preserved, and the aesthetics will meet the patient’s satisfaction

Myeloid cell diversification and complexity: an old concept with new turns in oncology.

Tumour development is accompanied by an enhanced haematopoiesis. This is not a widespread activation since only cells belonging to the myelo-monocytic compartment are expanded and mobilized from primary sites of haematopoiesis to other organs, reaching also the tumour stroma. This process occurs early during tumour formation but becomes more evident in advanced disease. Far from being a simple, unwanted consequence of cancer development, accumulation of myelo-monocytitc cells plays a role in tumour vascularization, local spreading, establishment of metastasis at distant sites, and contribute to create an environment unfavourable for the adoptive immunity against tumour-associated antigens. Myeloid populations involved in these process are likely different but many cells, expanded in primary and secondary lymphoid organs of tumour-bearing mice, share various levels of the CD11b and Gr-1 (Ly6C/G) markers. CD11b(+)Gr-1(+) cells are currently named myeloid-derived suppressor cells for their ability to inhibit T lymphocyte responses in tumour-bearing hosts. In this manuscript, we review the recent literature on tumour-conditioned myeloid subsets that assist tumour growth, both in mice and humans

Implant stability in different techniques of surgical sites preparation: an in vitro study

In the last few decades the implantology has achieved excellent results in the prosthetic rehabilitation of the partially or totally edentulous patients. The clinicians, given the pressing demand by patients, must deal with the situations in which the lack of the availability and sometimes the low quality of the bone can lead to the treatment failure. Although the manufacturers recommend to follow codified surgical protocols, alternative techniques of preparation, apt to ensure a better primary implant stability, have been developed. The aim of this study was to determine in vitro, by using the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) is able to improve implant stability of type IV cancellous bone

Unilateral deep brain stimulation of the pedunculopontine tegmental nucleus improves oromotor movements in Parkinson's disease

BACKGROUND: Jaw movements are severely affected in Parkinson's disease. Deep brain stimulation (DBS) of basal ganglia targets is known to ameliorate oromotor control. In this study, we examined the effects of DBS of the pedunculopontine tegmental nucleus (PPTg) on jaw movements in selected parkinsonian patients. METHODS: The effects of low-frequency (25 Hz) stimulation of the PPTg on jaw movements were investigated through electrognathographic analysis in parkinsonian patients who were selected for PPTg stimulation. Changes in jaw velocity and amplitude during voluntary opening and closing movements of the mouth, as well as the maximum frequency of self-paced sequences of opening and closing cycles, were analyzed. RESULTS: Low-frequency stimulation of the PPTg in the OFF-drugs condition significantly improved the opening and closing velocities, vertical amplitude and rhythm of voluntary movements. In some instances, movement parameters during stimulation were within the range of those recorded in healthy controls. DISCUSSION: This is the first study investigating the impact of PPTg DBS on oromotor control in parkinsonian patients. The results show that jaw movements may be restored under stimulation and suggest that the pedunculopontine nucleus may play a key role in controlling oromotor activity