Scientific evidence on the usefulness of intraarticular hyaluronic acid injection in the management of temporomandibular dysfunction

Hyaluronic acid (HA) is found in high concentrations in cartilage and synovial fluid, and is an important component of the extracellular matrixes- exerting joint lubrication and buffering actions thanks to its viscoelastic properties. The present study examines the scientific evidence found in the current literature on the usefulness of the intraarticular injection of HA in patients with temporomandibular dysfunction. A literature search was made up until May 2008 in the following databases: PubMed / MEDLINE. Of the articles found in the literature, the present review included 18 relevant studies on the application of HA in the temporomandibular joint (TMJ). The quality, level of evidence and strength of recommendation of the articles was evaluated based on the"Strength of Recommendation Taxonomy" criteria. It is concluded that type A level of recommendation exists in favor of the intraarticular injection of HA in dysfunction of the TMJ. However, further studies are needed to establish the true therapeutic effects and to identify the best dosing regimen

Implant Complications

Implant treatment is regarded as a safe technique with high rates of success ( Adell et al., 1981; Adell et al., 1990; Buser et al., 1997; Buser et al., 2000; Wennström et al., 2005). Nevertheless, it has, as every surgical procedure, several complications that can occur and that must be known in order to prevent or solve them. Implantology is an ever growing field that is reaching the practice of general dentists due to the simplification of technical procedures. Specialists in oral surgery now perform more demanding procedures, along with general dentists, they must pay special attention during the learning curve in order to avoid risks. The osseointegration process is considered to be safe and durable by both patients and dentists, for this reason, implants are considered as the first option to treat almost all cases of complete or partial edentulism. Regarded as a problem free procedure, it´s demand is increasing. Despite the severe complications index is low, risk evaluation must be conducted systematically during the preoperatory stage based on clinical history, thorough exploration and if necessary consulting other specialists, dentists or physicians. Only by using a good work protocol, we can detect the local and systemic risk factors that could determine the success of the treatment and allow us to implement preventive measures if needed..

Oral implant rehabilitation in a patient with Moebius syndrome

Introduction: Moebius syndrome is a rare congenital disorder characterized by unilateral or bilateral involvement of the sixth and seventh cranial nerves, resulting in a lack of facial expression and eye movements. These patients suffer a series of oral manifestations that may complicate their dental treatment, such as facial and tongue muscle weakness, uncontrolled salivation secondary to defi cient lip sealing, micrognathia, microstomia, bifi d uvula, gothic and fi ssured palate, fi ssured tongue, and glossoptosis. The underlying etiology remains unclear, though vascular problems during embryogenesis appear to be involved.Clinical case: We report the case of a woman with Moebius syndrome and total edentulism. Eight years ago she underwent complete oral rehabilitation with the placement of two implants in each dental arch.Discussion: Moebius syndrome has still an unknown etiology, although it is related to disorders during pregnancy.This kind of patient can be rehabilitated using oral implants

Nasopalatine duct cyst : report of 22 cases and review of the literature

Objectives: Nasopalatine duct cysts (NPDCs) are the most common developmental, epithelial and non-odontogenic cysts of the maxillae. The present study describes the clinicopathological characteristics of 22 NPDCs and discusses their etiology, incidence, treatment and prognosis, with a review of the literature on the subject. Study design: A retrospective observational study was made comprising a period of 36 years (1970-2006), and yielding a series of 22 patients with histopathological confirmation of NPDC. Surgical treatment was carried out under local anesthesia and comprised the dissection and removal of the cyst adopting a usually palatine approach, with the preparation of an enveloping flap from 1.4 to 2.4. Results: No statistically significant correlation was observed between the size of the lesion and patient age, although the size of the cyst differed according to patient gender, with a mean NPDC diameter of 16 mm in males and 12 mm in females. In no case did we observe root reabsorption or loss of vitality of the upper incisors following surgery. The X-ray image was rounded in 15 cases and heart-shaped in the remaining 7 cases. In the majority of cases panoramic X-rays and periapical and occlusal X-rays sufficed to identify the lesion, though computed tomography was used in cases of doubt. Conclusions: The etiology of NPDC is unclear. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case

Nasopalatine duct cyst: report of 22 cases and review of the literature

Objectives: Nasopalatine duct cysts (NPDCs) are the most common developmental, epithelial and non-odontogenic cysts of the maxillae. The present study describes the clinicopathological characteristics of 22 NPDCs and discusses their etiology, incidence, treatment and prognosis, with a review of the literature on the subject. Study design: A retrospective observational study was made comprising a period of 36 years (1970-2006), and yielding a series of 22 patients with histopathological confirmation of NPDC. Surgical treatment was carried out under local anesthesia and comprised the dissection and removal of the cyst adopting a usually palatine approach, with the preparation of an enveloping flap from 1.4 to 2.4. Results: No statistically significant correlation was observed between the size of the lesion and patient age, although the size of the cyst differed according to patient gender, with a mean NPDC diameter of 16 mm in males and 12 mm in females. In no case did we observe root reabsorption or loss of vitality of the upper incisors following surgery. The X-ray image was rounded in 15 cases and heart-shaped in the remaining 7 cases. In the majority of cases panoramic X-rays and periapical and occlusal X-rays sufficed to identify the lesion, though computed tomography was used in cases of doubt. Conclusions: The etiology of NPDC is unclear. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case

Short time guided bone regeneration using beta-tricalcium phosphate with and without fibronectin. An experimental study in rats

 The aim of this histomorphometric study was to assess the bone regeneration potential of beta-tricalcium phosphate with fibronectin (β-TCP-Fn) in critical-sized defects (CSDs) in rats calvarial, to know whether Fn improves the new bone formation in a short time scope.  CSDs were created in 30 Sprague Dawley rats, and divided into four groups (2 or 6 weeks of healing) and type of filling β-TCP-Fn, β-TCP, empty control). Variables studied were augmented area (AA), gained tissue (GT), mineralized/non mineralized bone matrix (MBM/NMT) and bone substitute (BS). 60 samples at 2 and six weeks were evaluated. AA was higher for treatment groups comparing to controls (p < 0.001) and significant decrease in BS area in the β-TCP-Fn group from 2 to 6 weeks (p = 0.031). GT was higher in the β-TCP-Fn group than in the controls expressed in % (p = 0.028) and in mm2 (p = 0.011), specially at two weeks (p=0.056).  Both β-TCP biomaterials are effective as compared with bone defects left empty in maintaining the volume. GT in defects regeneration filed with β-TCP-Fn are significantly better in short healing time when comparing with controls but not for β-TCP used alone in rats calvarial CSDs

Efecto de la matriz de beta-fosfato tricálcico con fibronectina en la reparación de defectos óseos críticos: estudio experimental del potencial de regeneración ósea y su aplicabilidad clínica

[spa] Estudio experimental, prospectivo y controlado en el que se incluyeron 30 ratas Sprague-Dawley, machos adultos, ex-reproductivos, de 14 semanas de edad y peso entre 250 y 300 g. Los animales se distribuyeron de forma aleatoria a los grupos de estudio mediante una tabla de aleatorización y se recogieron datos en situación basal y a las 6 y 8 semanas de la colocación de los injertos. Se utilizó un defecto de tamaño crítico en la calota craneal de la rata, ya que se trata de un modelo estándar, ventajoso desde el punto de vista económico y adecuado para evaluar la formación ósea en defectos óseos craneales. Las trepanaciones craneales de 5 mms de diámetro se efectuaron en cada lado del cráneo y se les injertaba según la tabla de aleatorización β-FTC con o sin Fn en un lado y nada en el lado contralateral (control); siempre junto a una membrana de colágeno de bovino nativo para evitar el colapso del espacio por el rápido crecimiento del tejido blando. Todos los animales recibieron fluorocromos de oxitetraciclina una semana más tarde, además de 1 dosis de 10 mg/kg de calceina 1 día antes de la eutanasia ambas por via subcutánea, con el fin de estudiar las muestras mediante microscopia de fluorescencia. Los animales fueron sacrificados por exposición a CO2 a las 6 y 8 semanas tras la intervención quirúrgica en función del grupo al que fueron asignados aleatoriamente. Se evaluó histomorfométricamente a las 6 y 8 semanas con microscopio óptico, cámara digital, lápiz óptico y análisis de la imagen por medición digitalizada con dos programas informáticos de su potencial regenerativo óseo en el área aumentada. Los análisis se efectuaron con el paquete estadístico R v3.12 (Development Core Team 2008). Se estableció un nivel de significación estadística de P < 0,05. En los resultados destacamos que el tejido ganado (TG) en el área diana era significativamente mayor en los dos grupos de tratamiento que en los controles. No se observaron diferencias estadísticamente significativas entre ambos grupos de tratamiento activo, excepto en el tejido ganado global a las 8 semanas. En la comparación en mm2 entre los grupos β-FTC-Fn y β-FTC a las 8 semanas se observa una diferencia estadísticamente significativa a favor del grupo β-FTC-Fn. En el grupo de β-FTC-Fn, el porcentaje de TG, definido como la suma de matriz de hueso mineralitzada (MHM) y sustituto óseo (SO), mostraba un aumento significativo en el área diana a lo largo del estudio, en tanto que en el grupo de β-TCP sin Fn parecía estabilizarse a las 6 semanas, sin que se detectara ningún aumento significativo posterior. Los cambios en la regeneración ósea según los biomateriales utilizados para el relleno de los defectos y el tiempo de exposición, también indican un efecto más favorable para la matriz con Fn, ya que el porcentaje de MHM en el área diana continuaba aumentando de la semana 6 a la semana 8 hasta doblar su cifra mientras que la matriz sin fibronectina mantenía prácticamente el mismo valor. El uso de β-FTC recubierto con Fn mostró un efecto no significativo y levemente más efectivo que el ß-FTC sin Fn respecto al incremento del volumen de hueso regenerado en los defectos de tamaño crítico de calota de rata como modelo experimental, posiblemente permitiendo un proceso más eficiente de remodelado (mayor ganancia de tejido y mayor mineralización del tejido ganado a igualdad de tiempo). No se encontraron diferencias claras entre β-FTC y β-FTC-Fn. Se necesitan estudios adicionales en que se extienda el período de seguimiento a más de 8 semanas o en períodos más cortos de 6 semanas para evaluar la capacidad osteogénica de β-FTC-Fn en la reconstrucción de defectos de calota de rata de tamaño crítico, así como estudiar la razón de crecimiento óseo de los defectos tratados mediante microscopio de fluorescencia.[eng] OBJECTIVE: This histomorphometric study compared bone regeneration potential of beta-tricalcium phosphate with fibronectin (β-TCP-Fn) in critical-sized calvarial defects (CSDs) in rats to assess whether fibronectin (Fn) improved new bone formation. MATERIAL AND METHODS: CSDs were created in 30 adult male Sprague Dawley rats, which were divided into four groups according to the time of euthanasia (6 or 8 weeks [wks] of healing) and type of filling (β-TCP-Fn/6 wks, β-TCP/6 wks, β-TCP-Fn/8 wks, β-TCP/8 wks). The primary variables related to new bone formation were augmented area (AA) and gained tissue (GT) (sum of mineralized bone matrix [MBM] and bone substitute [BS]). Secondary variables were the diameter of the defect, MBM, non-mineralized tissue (NMT), and BS. RESULTS: A total of 29 rats and 58 histological samples were evaluated, 28 (48.3%) samples obtained at 6 wks and 30 (51.7%) at 8 wks, homogeneously distributed between right and left sides. Thirteen (22.4%) were treated with β-TCP-Fn, 16 (27.6%) with β-TCP and 29 (50%) were controls. At 8 wks, histomorphometric analysis showed significant differences in AA using β-TCP and β-TCP-Fn vs controls (P = 0.001 and P = 0.005, respectively). Bone turnover expressed as % within the target area was slightly higher but not statistically significant in the β-TCP-Fn than in β-TCP (MBM) at 6 wks vs 8 wks (P = 0.067 and P = 0.335, respectively). Finally, total GT area in mm2 was higher using β-TCP-Fn as compared to β-TCP (P = 0.044). CONCLUSIONS: β-TCP-Fn was slightly but non-significantly more effective than β-TCP without Fn for improving the volume of regenerated bone in CSDs of rats, possibly allowing a more efficient bone remodeling process. This effect however should continue being investigated

Oral implant rehabilitation in a patient with Moebius syndrome

Introduction: Moebius syndrome is a rare congenital disorder characterized by unilateral or bilateral involvement of the sixth and seventh cranial nerves, resulting in a lack of facial expression and eye movements. These patients suffer a series of oral manifestations that may complicate their dental treatment, such as facial and tongue muscle weakness, uncontrolled salivation secondary to defi cient lip sealing, micrognathia, microstomia, bifi d uvula, gothic and fi ssured palate, fi ssured tongue, and glossoptosis. The underlying etiology remains unclear, though vascular problems during embryogenesis appear to be involved. Clinical case: We report the case of a woman with Moebius syndrome and total edentulism. Eight years ago she underwent complete oral rehabilitation with the placement of two implants in each dental arch. Discussion: Moebius syndrome has still an unknown etiology, although it is related to disorders during pregnancy. This kind of patient can be rehabilitated using oral implants

Application of ultrasound in bone surgery: two case reports

The present study describes some of the applications of ultrasound in bone surgery, based on the presentation of two clinical cases. The Piezosurgery® ultrasound device was used (Tecnología Mectron Medical, Carasco, Italy). In one case the instrument was used to harvest a chin bone graft for placement in a bone defect at level 1.2, while in the other case a bony window osteotomy was made in the external wall of the maxillary sinus, in the context of a sinus membrane lift procedure. The Piezosurgery® device produces specific ultrasound frequency modulation (25-29 kHz), and has been designed to secure increased precision in application to bone surgery. This instrument produces selective sectioning of the mineralized bone structures, and causes less intra- and postoperative bleeding. One of the advantages of the Piezosurgery® device is that it can be used for maxillary sinus lift procedures in dental implant placement. In this context it considerably lessens the risk of sinus mucosa laceration by preparing the bony window in the external wall of the upper maxilla, and can be used to complete the lifting maneuver. The use of ultrasound in application to hard tissues can be regarded as a slow technique compared with the conventional rotary instruments, since it requires special surgical skill and involves a certain learning curve

Evidencia científica de la inyección intraarticular de ácido hialurónico en el tratamiento de la disfunción temporomanibular

El ácido hialurónico (AH) está presente en altas concentraciones en el cartílago y en el líquido sinovial siendo un importante componente de las matrices extracelulares corporales, a quienes confiere las funciones de amortiguación y lubricación articular por sus propiedades viscoelásticas. El objetivo de este trabajo es valorar la evidencia científica existente en la literatura actual sobre la inyección intraarticular de AH en pacientes con disfunción temporomandibular. Material y Métodos: se realizó una búsqueda de la bibliografía hasta mayo de 2008 en las bases de datos electrónicas: PubMed/ MEDLINE. Resultados: de los artículos encontrados en la literatura, han sido incluidos en esta revisión 18 estudios relevantes de la aplicación de AH en la articulación temporomandibular (ATM). La calidad, nivel de evidencia y fuerza de recomendación de los artículos ha sido valorada basada en los criterios 'Strength of Recommendation Taxonomy'. Conclusiones: existe un nivel de recomendación del tipo A, a favor de la inyección intraarticular de AH en la patología disfuncional de la ATM. Sin embargo, creemos necesarios más estudios para establecer los verdaderos efectos terapéuticos y encontrar la mejor posología para su aplicación