Temporomandibular joint arthrocentesis. Review of the literature

The treatment of the temporomandibular joint (TMJ) is still controversial. TMJ arthrocentesis represents a form of minimally invasive surgical treatment in patients suffering from internal derangement of the TMJ, especially closed lock. It consists of washing the joint with the possibility of depositing a drug or other therapeutic substance. Resolution of symptoms is due to the removal of chemical inflammatory mediators and changes in intra-articular pressure. Numerous clinical studies regarding this technique have been published. The goal of this paper is to review all clinical articles that have been published with regard to the critique of this technique. 19 articles with different designs fulfilling selection guidelines were chosen. A series of clinical and procedure variables were analyzed. Although the mean of improvement was higher that 80%, further research is needed to determine more homogeneous indications for TMJ athrocentesis

Microstructural and densiometric analysis of extra oral bone block grafts for maxillary horizontal bone augmentation: a comparison between calvarial bone and iliac crest

Purpose The main purpose of the present clinical study was to compare architectural metric parameters using micro‐computed tomography (μ‐ CT ) between sites grafted with blocks harvested from the intramembranous origin calvarium and endochondral origin iliac crest for horizontal bone augmentation in the maxilla. The second aim was to compare primary stability of implants placed in both types of block grafts. Material and Methods Nine consecutive healthy partially edentulous patients requiring extensive horizontal bone reconstruction in the maxilla were included in this study from J uly 2011 to M arch 2012. A total of 14 block grafts (seven each from the calvarium and iliac crest) were studied. After 6–7 months of the bone regeneration surgery, 43 implants were placed. Twenty‐four implants (55.2%) were placed on calvaria (group 1) and 19 (44.8%) on iliac crest (group 2). All implants were clinically stable. A resonance frequency analysis ( RFA ) and μ‐ CT analysis were performed. Furthermore, two randomly biopsies were selected for histomorphometric analysis. Results Micro‐ CT analyses evidenced completely different parametric values between intramembranous and endochondral extra oral bone block grafts, being the group 1 higher in density and in % of bone volume. However, these parametric values cannot be considered statistically different due to the sample size, excepting the trabecular thickness, which is statistically higher for group 1 ( P  = 0.06). Conclusion Calvarial bone blocks for horizontal maxillary augmentation provided a higher degree of bone volume and density than the iliac crest bone grafts. Nonetheless, both grafts provide implant with the same primary stability, as assessed by RFA .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106829/1/clr12159.pd

Predictability of the resonance frequency analysis in the survival of dental implants placed in the anterior non-atrophied edentulous mandible

Background: Dental primary implant stability is considered essential in the success of the osseointegration process. The recent advent of the resonance frequency analysis (RFA) seems to effectively measure primary implant stability, although its relationship with implant survival has to be further established. Patients and Methods: Seventy patients with complete mandibular edentulism underwent dental implant rehabilitation by means of the placement of 68 dental implants within the interforaminal region and subsequent placement of an overdenture. Primary implant stability was measured by means of RFA and it was expressed in terms of implant stability quotient (ISQ) on the day of the implant insertion and at the time of the healing abutment placement in a conventional implant two-stage surgical procedure. Results: Overall implant survival rate was 97.1% at the end of the follow-up period. The mean ISQ value for 3.75 and 4.25 mm diameter implants was 78.4 ± 5.46 and 80.83 ± 5.35 respectively, at the time of the implant placement; and 76.68 ± 4.34 and 78.22 ± 6.87 respectively, at the second surgical stage. No statistical differences were observed in relation to changes in mean ISQ value along the healing process Conclusions: No statistical differences in terms of primary and secondary implant stability measured by RFA exists between 3.75 mm and 4.25 mm diameter implants in the conventional implant two-stage surgical procedure in patients with non-atrophied edentulous mandible being restored with an overdenture. Furthermore, no statistical association between RFA and the implant insertion torque was observed for endosseous dental implant placement at the first surgical stage. © Medicina Oral

Comparison between microcomputed tomography and cone‐beam computed tomography radiologic bone to assess atrophic posterior maxilla density and microarchitecture

Purpose The aim of this study was to analyze the relationship between bone density obtained by cone‐beam computed tomography ( CBCT ) and morphometric parameters of bone analyzed by microcomputed tomography (μ‐ CT ). Material and methods An overall of 32 subjects ≤8 mm of bone height were included in the study. One site per patient was randomly selected to obtain bone core. Totally, 27 biopsies were available for μ‐ CT analysis. In addition, CBCT was taken after positioning a previously fabricated acrylic resin template with a 2‐mm‐diameter metal rod at the randomly selected implant site to study radiographic bone density ( RBD ). The relationship between μ‐ CT and CBCT quantitative variable and RBD was analyzed using Spearman correlation. Results Positive correlations between BV / TV ( r  = 0.769, P  < 0.001), BS / TV ( r  = 0.563, P  = 0.002), T b. T h ( r  = 0.491, P  = 0.009), T b. N ( r  = 0.518, P  = 0.005) and v BMD ( r  = 0.699, P  < 0.001) with RBD were identified. On the contrary, BS / BV ( r  = −0.509, P  = 0.006), T b. S p ( r  = −0.539, P  = 0.003) and T b. P f ( r  = −0.636, P  < 0.001) were negatively correlated with RBD . Moreover, SMI ( r  = −0.380, P  = 0.050) and DA (−0.245, P  = 0.217) were negatively correlated but not statistically significant. Conclusion This study demonstrated the correlation between radiographic bone density ( RBD ) and bone density assessed by μ‐ CT . Therefore, our data supported the use of CBCT as pre‐operative tool for implant treatment planning because it is shown to be reliable to assess atrophic posterior maxilla density and microarchitecture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106929/1/clr12133.pd

Maxillary Sinus Lateral Wall Thickness and Morphologic Patterns in the Atrophic Posterior Maxilla

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141013/1/jper0676.pd

Influence of Atrophic Posterior Maxilla Ridge Height on Bone Density and Microarchitecture

PurposeThere is limited evidence available on the influence of residual ridge height (RH) on bone density. Therefore, this study aimed to investigate the correlation between the atrophic posterior RH in the maxilla and its bone density as determined by microcomputed tomography (μ‐CT).Material and MethodsThirty‐two subjects with atrophic posterior maxilla of residual RH <8 mm were included in this study. A preoperative cone beam CT scan with a radiographic stent was taken for each patient. A bone core biopsy was thus obtained from the predetermined surgical site. Out of 32 biopsies, 27 were intact and sent for μ‐CT analysis.ResultsA statistically significant positive correlation between bone volumetric fraction (BV/TV) and RH was identified (r = 0.417, p = .03). A statistically significant negative correlation between trabecular pattern factor and RH was also found (r = −0.415, p = .03). The rest of the morphometric parameters analyzed did not have any significant correlation to RH.ConclusionBV/TV is potentially influenced by the residual bone height at the posterior maxilla. The lesser the RH, the lower the bone quantity and quality present.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110564/1/cid12075.pd

Vertical and Horizontal Ridge Augmentation of a Severely Resorbed Ridge in the Anterior Maxilla

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142214/1/cap0230.pd

Comparison of implant primary stability between maxillary edentulous ridges receiving intramembranous origin block grafts

Purpose: The purposes of the present study were: to compare the resonance frequency analysis (RFA) values of implant placed in either ramus or calvaria block grafts; and to determine if implant diameter influences RFA implant stability quotient (ISQ) value. Material and Methods: This was a retrospective study that included 16 consecutives healthy patients treated with autogenous onlay block grafts for horizontal bone reconstruction in maxilla. Ten ramus and ten calvaria block graft treated patients were selected and compared. Results: Totally, 59 implants were placed, 35 (59.3%) were placed on the calvaria bone grafts and the remaining 24 (40.7%) were on the ramus bone graft. Of all the implants studied, 13 (22%), 35 (59.3%), and 11 (18.6%) were 10 mm, 11.5 mm and 13 mm in length respectively. Regarding the diameter, 4 (7%) were 3.3 mm, 3 (5%) were 3.5 mm, 20 (34%) were 3.7 mm and 32 (54%) were 4 mm. Mean ISQ value obtained by RFA was 73.06 ± 6.08, being 72.19 ± 6 and 74.47 ± 6.06 for the calvaria and ramus treated group respectively. No significant differences were noted between the two groups (p= 0.154). Implants were pooled and divided by their diameter. Mean ISQ value obtained for 3.3 mm was 80 ± 5.09, while for 4.0 mm was 72.5 ± 7.19. Again, no significant differences were found among the groups (p= 0.138). Conclusion: For RFA ISQ value, the bone graft origins (calvaria or ramus) or implant diameters did not influence the outcome

Defining a Standard Set of Health Outcomes for Patients With Squamous Cell Carcinoma of the Head and Neck in Spain

Head and neck cancer; Outcome measurement; Patient-centered careCáncer de cabeza y cuello; Medición de resultados; Atención centrada en el pacienteCàncer de cap i coll; Mesura del resultat; Atenció centrada en el pacientPurpose: A systematic, standardized collection of health outcomes during patient treatment and follow-up, relevant from the perspective of all stakeholders, is a crucial step toward effective and efficient disease management. This project aimed to define a standard set of health outcomes for patients with squamous cell carcinoma of the head and neck (SCCHN). Methods: The project was led and coordinated by a scientific committee (SC). It comprised: (1) a literature review (to identify variables used during SCCHN management); (2) 1st-SC meeting (to select the variables for presentation during nominal groups-NG); (3) five NG (n=42 experts) and four interviews with patients (to reach consensus on the variables for inclusion); and (4) final-SC meeting (to review the results of NG ensuring consensus on the variables where consensus was not reached). Results: Experts agreed to include the following variables in the standard set: treatment-related (treatment intent and type, response to treatment, treatment toxicity/complication, treatment completion), degree of health (performance status, patient-reported health status, pain, dysphonia, feeding and speech limitations, body image alteration, tracheotomy), survival (overall and progression-free survival, cause of death), nutritional (weight, nutritional intervention), other variables (smoking status, alcohol consumption, patient satisfaction with aftermath care, employment status), and case-mix variables (demographic, tumor-related, clinical and nutritional factors). Conclusions: This project may pave the way to standardizing the collection of health outcomes in SCCHN and promote the incorporation of patients’ perspective in its management. The information provided through the systematic compilation of this standard set may define strategies to achieve high-quality, patient-centered care.The project was sponsored by Bristol Myers Squibb