A comparison of the effects of Methylprednisolone Acetate, Sodium Hyaluronate and Tenoxicam in the treatment of non-reducing disc displacement of the temporomandibular joint

This clinical study aimed to radiologically and clinically compare the effect of intra-articular injection of methylprednisolone, sodium hyaluronate or tenoxicam following arthrocentesis with that of arthrocentesis alone in patients with non-reducing disc displacement. A total of 44 patients radiographically diagnosed with non-reducing disc displacement of the temporomandibular joint (TMJ) were randomly divided into four treatment groups, as follows: Group 1, arthrocentesis alone; Group 2, arthrocentesis plus methylprednisolone acetate; Group 3, arthrocentesis plus sodium hyaluronate; Group 4, arthrocentesis plus tenoxicam. Maximum mouth opening (MMO), lateral movement, pain severity and tenderness of TMJ and muscles of mastication on palpation were measured before treatment and at 1 week and 1, 3 and 6 months after treatment. Disc position, presence or absence of disc reduction, level of effusion, joint movement and joint space were also evaluated using magnetic resonance imaging (MRI) before treatment and 6 months after treatment. No significant differences in treatment success were found among the four groups. MRI findings did not vary significantly among the groups, but pre- and post-operative MRI findings varied significantly within all four groups (p<0.001). According to the data from this study, it may be concluded that either arthrocentesis alone or arthrocentesis with methylprednisolone acetate or sodium hyaluronate or tenoxicam intra-articular injections are similarly effective and promising methods in the treatment of TMJ with non-reducing disc displacement

A decision analysis for periapical surgery : retrospective study

Periapical surgery is now a reliable therapeutic procedure for the treatment of teeth with periapical lesions, particularly when orthograde retreatment is problematic. However, little information is available regarding treatment planning of cases referred for periapical surgery. Therefore, this study was conducted to analyze and evaluate the factors that affect the decision-making process for periapical surgery. This study retrospectively assessed clinical and radiographic data from patients undergoing periapical surgery. The factors involved in deciding to perform periapical surgery were classified into technical, biological, and combined factors. Out of 821 patients, 544 (66.3%) underwent endodontic treatment/retreatment, 204 (24.8%) were treated with coronal restorations and 60 (7.3%) were treated with post. Periapical surgery was indicated for biological reasons in 35% of patients and for technical reasons in 17.9%. The common biological factor was persistent clinical symptoms (19.7%). The most common technical cause was failure of previous endodontic treatment (66.3%). Nearly half of all periapical lesions (45%) were <5 mm in size. Periapical surgery was justified in only 434 (52.9%) subjects. We suggest that it is very important for patients to be informed and encouraged about endodontic retreatment in order to reduce unnecessary surgical procedures

Non-syndromic supernumerary premolars

Objective: The objective of this study was to estimate the incidence of non-syndromic supernumerary premolars, to classify them and to identify the complications related to them. Study Design: This retrospective cohort study was composed of 8400 panoramic radiographs of patients who presented at our Oral and Maxillofacial Surgery Services from January 1998 to May 2008. The number of supernumerary premolars, their localization, the ages and the sex of the patients, any associated complications and treatment methods were estimated. Results and Conclusion: A total of 20 supernumerary premolar teeth were found in 10 of the 8400 patients (0.24%) with 7 of those being females and three males. Three patients had pain localized to the mental foramen and one patient had resorption in the root of the adjacent tooth. In these series, 18 supernumerary premolar teeth were extracted. In contrast with previous studies, this study suggested that this phenomenon is more frequently encountered in females than in males. The presence of complications associated with the supernumerary premolars in 4 patients necessitated consideration of surgical intervention as a treatment choice for these teeth. Otherwise, they should be kept under observation. © Medicina Oral S. L

Prevalence of impacted premolars in a Turkish population and considerations for surgical treatment

Objective: The aim of this study was to identify the prevalence, associated pathology and symptoms, and treatment of impacted premolars in a Turkish population. Study Design: This retrospective study examined panoramic radiographs and clinical records of 9,000 patients who presented consecutively at our oral and maxillofacial surgery clinics between January 1998 and January 2009. In addition to demographic data (patient sex and age), data was compiled on the number and location of impacted missing maxillary and mandibular premolars, retained deciduous molars, associated pathologies and symptoms, and treatment methods. Results: A total of 105 impacted maxillary or mandibular premolars were observed in 93 patients (1.03%). Of these, 48 (51.6%) were female (age range: 13-57 years) and 45 (43.4%) were male (age range: 13-58 years). Impacted mandibular second premolars accounted for 55.2% (n=58) of all impacted premolars. Migration was observed in only 11.83% of patients (n=11). Pathological changes and symptoms were noted in 15.05% of patients. Conclusion: Our results suggest that the prophylactic extraction of non-migrated impacted premolars may not be necessary. If the patient is cooperative, a "wait and see" approach may be preferable. Orthodontic or prosthetic treatment options should also be considered when planning treatment of non-migrated impacted premolars. Migrated impacted premolars should be kept under observation and should only be removed if they are associated with pathology or if extraction is required for prosthetic or orthodontic treatment. © Medicina Oral S. L

Soft tissue pathosis associated with asymptomatic impacted lower third molars

Objective: The aim of this study was to identify the prevalence of pathological changes in the pericoronal tissue of asymptomatic impacted lower third molars and to assess the correlation between pathological changes and patient demographic, radiographic and morphological characteristics. Study Design: Follicles associated with fully impacted lower third molars were submitted for histological examination after surgical extraction from 50 patients. The correlation between pathological changes in the dental follicle and age, gender, depth of impaction, angular position, and coverage and tooth development was analyzed. Results: Cystic changes were observed in 10% of specimens and inflammatory changes in 62%. Incidence of pathological changes was significantly higher in Class B impacted teeth when compared to Class C impacted teeth. A significant correlation was found between epithelial cell activity and the completion of tooth development. Conclusion: We recommend monitoring all third molars whether or not they are symptomatic and conducting histopathological analyses on all surgically extracted follicle tissue. © Medicina Oral S. L