Regional Nerve Block of the Temporomandibular Joint Capsule: A Technique for Clinical Research and Differential Diagnosis

In previous studies in which regional anesthesia of the temporomandibular joint capsule was used to examine the role of the joint in mandibular movement and distinguish it from muscle control, the anesthetic techniques used have not been satisfactorily described. The accuracy of the injeetion technique described in this paper was determined by dissection and radiographic examination of fixed and fresh specimens. Using this technique, trial patient studies were made using an anesthetic solution to which a radiopaque medium was added. Radiographic examination of the patients affirmed the location of the injected material, while clinical assessment determined its functional effectiveness. Using the described technique, anesthetic solution was accurately and reproducibly introduced posteriorly and laterally to the temporomandibular joint to achieve anesthesia of the joint.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67376/2/10.1177_00220345800590110101.pd

Occlusion and clinical practice: an evidence-based approach

xi+145hlm.;24c

Functional occlusion in restorative dentistry and prosthodontics / edited by Iven Klineberg, Steven E. Eckert ; foreword by Professor George Zarb.

dental bookfair2016Includes bibliographical references and index.xi, 270 pages

Loading of a single implant in simulated bone

This study investigated the effect of occlusal design on the strain developed in simulated bone of implant-supported single crown models. Triaxial strain gauges were attached at the cervical area of each model. Occlusal design, load location, and magnitude were examined to determine the maximum axial principal strains (με) of four occlusal designs: 30-degree cusp inclination with 4- and 6-mm occlusal table dimensions and a 10-degree cusp inclination with 4- and 6-mm occlusal table dimensions. Statistical differences were found for peak average maximum principal strains between each occlusal design when the applied load was directed along the central fossa and 2 mm buccal to the central fossa along the inclined plane, with strain gauges attached at the cervicobuccal (P < .001) and cervicolingual (P ≤ .001) aspects. In all loading conditions, the 30-degree cusp inclination and 6-mm occlusal table dimension consistently presented the largest strains compared with the other occlusal designs. A reduced cusp inclination and occlusal table dimension effectively reduced experimental bone strain on implant-supported single crowns. The occlusal table dimension appeared to have a relatively more important role than cusp inclination.4 page(s

Neuroplasticity in the adaptation to prosthodontic treatment

To investigate cerebral cortical changes by using functional magnetic resonance imaging (fMRI) after denture renewal and to test how these relate to prosthodontic treatment adaptability as measured by chewing efficiency and maximum bite force

Differential activation of the human trigeminal nuclear complex by noxious and non-noxious orofacial stimulation

There is good evidence from animal studies for segregation in the processing of non-nociceptive and nociceptive information within the trigeminal brainstem sensory nuclear complex. However, it remains unknown whether a similar segregation occurs in humans, and a recent tract tracing study suggests that this segregation may not exist. We used functional magnetic resonance imaging (fMRI) to define and compare activity patterns of the trigeminal brainstem nuclear complex during non-noxious and noxious cutaneous and non-noxious and noxious muscle orofacial stimulation in humans. We found that during cutaneous pain, signal intensity increased within the entire rostrocaudal extent of the spinal trigeminal nucleus (SpV), encompassing the ipsilateral oralis (SpVo), interpolaris (SpVi) and caudalis (SpVc) subdivisions. In contrast, muscle pain did not activate SpVi, but instead activated a discrete region of the ipsilateral SpVo and SpVc. Further, muscle noxious stimulation activated a region of the ipsilateral lateral pons in the region of the trigeminal principal sensory nucleus (Vp). Innocuous orofacial stimulation (lip brushing) also evoked a significant increase in signal intensity in the ipsilateral Vp; however, non-noxious muscle stimulation showed no increase in signal in this area. The data reveal that orofacial cutaneous and muscle nociceptive information and innocuous cutaneous stimulation are differentially represented within the trigeminal nuclear complex. It is well established that cutaneous and muscle noxious stimuli evoke different perceptual, behavioural and cardiovascular changes. We speculate that the differential activation evoked by cutaneous and muscle noxious stimuli within the trigeminal sensory complex may contribute to the neural basis for these differences

Changes in human primary motor cortex activity during acute cutaneous and muscle orofacial pain

To use functional magnetic resonance imaging (fMRI) to determine whether orofacial cutaneous or muscle pain is associated with changes in primary motor cortex (M1) activity that outlast the duration of perceived pain, and whether these M1 changes are different during cutaneous pain compared with muscle pain. fMRI was used in healthy subjects experiencing orofacial muscle (n = 17) or cutaneous (n = 15) pain induced by bolus injections of hypertonic saline (4.5%) into the belly of the masseter muscle (0.5 ml) or subcutaneously (0.2 ml) into the overlying skin, respectively. To determine the effects of the injection volume, isotonic saline (n = 4) was injected into the masseter muscle. Similar pain scores were observed following subcutaneous (mean [± SEM]; 4.73 ± 0.51) or intramuscular injections (4.35 ± 0.56). Orofacial muscle but not cutaneous pain was associated with a transient increase in signal intensity in the contralateral M1. Cutaneous and muscle orofacial pains were associated with similar signal intensity decreases within the contralateral M1 that continued to decrease for the entire scanning period. Isotonic saline did not evoke pain or changes in M1 signal intensity. The transient contralateral M1 signal intensity increase during orofacial muscle pain may underlie escape-like motor patterns. However, once the initial threat has subsided, longer-term reductions in M1 activity and/or excitability may occur to aid in minimizing movement of the affected part, an effect consistent with the general proposals of the Pain Adaptation Model