Intraoral Vertical Ramus Osteotomy - Objective and Subjective Treatment Outcomes

Combined orthodontic and orthognathic surgical treatment is conducted when a jaw discrepancy exceeds what can be treated with orthodontic treatment alone with an acceptable esthetical and functional result. The intraoral vertical ramus osteotomy (IVRO) is one of mainly three different surgical techniques used to move the mandible posteriorly in patients with a skeletal Class III jaw relationship due to excess growth of the mandible. The purpose of this thesis is to evaluate the IVRO procedure with special focus on stability, satisfaction with treatment, oral health-related quality of life (OHRQoL), and impact on respiratory function during sleep. Thirty-six previous skeletal Class III patients operated with an isolated IVRO procedure and subsequent six weeks of intermaxillary fixation were examined 10-15 years after surgery and completed a 37- item structured questionnaire. Pre- and post-surgical orthodontic treatment had been performed in all patients. Skeletal and dental changes were evaluated with lateral cephalograms and dental casts obtained before treatment started, eight weeks, one year and 10-15 years after surgery. OHRQoL was measured with the OIDP index. A prospective cohort study was performed to evaluate the effect of mandibular setback surgery on the respiratory function during sleep. Eight otherwise healthy skeletal Class III patients between 18 and 33 years of age conducted in-home respiratory sleep recordings within two weeks before and at least three months after surgery. Primary outcome variable was apnoea hypopnea index (AHI). In the long-term follow-up study mean mandibular surgical setback was 8.3 mm (range 4.5 - 13.5 mm). The mean skeletal change between eight weeks and 10-15 years after surgery was 1.6 mm in anterior direction. Ninety-two percent had positive horizontal overjet 10-15 years after surgery. Sixty-one percent were very satisfied and the remainder were reasonably satisfied with the treatment. The mean OIDP frequency score was 8.49, indicating that OHRQoL was good. In the group of patients conducting pre- and post-operative sleep recordings, the AHI was below three events per hour before surgery and below four events per hour after surgery in all patients. The mean surgical setback was 4.3 mm (range: 2.5-7.4 mm) in this patient group. In conclusion, 10-15 years after mandibular setback surgery with the IVRO procedure the clinical result was good in most of the patients. All were either reasonably or very satisfied with the treatment, and OHRQoL was reported to be good. In the group of eight young, adult skeletal Class III patients in the prospective study, surgery did not increase AHI above five events per hour, i.e. all were below the threshold for mild obstructive sleep apnoea

Temporomandibular joint pain and associated magnetic resonance findings: a retrospective study with a control group

Background To better understand and evaluate clinical usefulness of magnetic resonance imaging (MRI) in diagnosis and treatment of temporomandibular disorders (TMD), parameters for the evaluation are useful. Purpose To assess a clinically suitable staging system for evaluation of MRI of the temporomandibular joint (TMJ) and correlate the findings with age and some clinical symptoms of the TMJ. Material and Methods Retrospective analysis of 79 consecutive patients with clinical temporomandibular disorder or diagnosed inflammatory arthritis. Twenty-six healthy volunteers were included as controls. Existing data included TMJ pain, limited mouth opening (<30 mm) and corresponding MRI evaluations of the TMJs. Results The patients with clinical TMD complaints had statistically significantly more anterior disc displacement (ADD), disc deformation, caput flattening, surface destructions, osteophytes, and caput edema diagnosed by MRI compared to the controls. Among the arthritis patients, ADD, effusion, caput flattening, surface destructions, osteophytes, and caput edema were significantly more prevalent compared to the healthy volunteers. In the control group, disc deformation and presence of osteophytes significantly increased with age, and a borderline significance was found for ADD and surface destructions on the condylar head. No statistically significant associations were found between investigated clinical and MRI parameters. Conclusion This study presents a clinically suitable staging system for comparable MRI findings in the TMJs. Our results indicate that some findings are due to age-related degenerative changes rather than pathological changes. Results also show that clinical findings such as pain and limited mouth opening may not be related to changes diagnosed by MRI.publishedVersio

Laserbehandling av infiserte tannkjøttslommer

De fleste pasienter med kronisk marginal periodontitt responderer godt på tradisjonell periodontal behandling, men ca. 10 % ser ut til å ha en bakterieflora som er særlig behandlingsresistent. For disse pasientene er laserbehandling lansert som et effektivt hjelpemiddel til desinfisering av periodontale lommer. Det finnes ulike typer lasere, men vurdert ut fra tekniske egenskaper ser Er:YAG-laser ut til å være mest lovende til odontologisk bruk. Ved gjennomgang av nyere litteratur og klinisk utprøving av Er: YAG-laser, ønsket vi å få kunnskaper om laserbehandling. Det ble vurdert 8 studier som sammenliknet bruk av tradisjonell behandling og laserbehandling på pasienter med kronisk periodontitt. I tillegg ble 3 pasienter behandlet for kronisk periodontitt. Resultatene ble sammenholdt med resultatene fra de utvalgte litteraturstudiene. Hovedkonklusjonen er at laserbehandling ikke ser ut til å ha noen tilleggseffekt utover den effekten som en oppnår med tradisjonell mekanisk rensing, verken på pasienter under primærbehandling eller under vedlikehold. For å kunne komme til en sikrere konklusjon, er det behov for flere gode kliniske studier som evaluerer langtidseffekten av laserbehandling. Laserteknikken er under stadig utvikling og forbedring. Det er viktig å følge denne spennende utviklingen som sannsynligvis vil kunne ende opp med nye lasermodeller med forbedret behandlingspotensiale

Temporomandibular joint function 10-15 years after mandibular setback surgery and six weeks of intermaxillary fixation

Intermaxillary fixation (IMF) is a classic method for immobilization of the mandible after mandibular fractures and corrective surgery. However, it has been suggested that IMF may be a risk for developing temporomandibular joint (TMJ)-related symptoms, especially when applied for longer periods. Objective: To evaluate the clinical function of TMJs and masticatory muscles 10-15 years after mandibular setback surgery and subsequent six weeks of IMF. The patients' self-reported TMJ and masticatory muscle symptoms were also addressed. Methodology: Thirty-six patients (24 women and 12 men) treated with intraoral vertical ramus osteotomies and subsequent six weeks of IMF, underwent a clinical examination of TMJs and masticatory muscles 10-15 years after surgery and completed a five-item structured questionnaire reporting subjective TMJ-related symptoms. Mean age by the time of clinical examination was 34.1 years (range 27.2–59.8 years). The clinical outcome was registered according to the Helkimo clinical dysfunction index. Descriptive and bivariate statistics were performed and level of significance was set to 5%. Results: Mean maximum unassisted mouth opening 10-15 years after surgery was 50.1 mm, (range 38-70 mm, SE 1.2), statistically significantly greater in men compared to women (p=0.004). Mean Helkimo dysfunction group was 1.5 (range 1-3, SE 0.10). Eighty-one percent experienced pain on palpation in either the masseter muscle, temporal muscle or both, and 31% experienced pain when moving the mandible in one or more directions. Thirty-one percent reported pain from palpating the TMJs. In the questionnaire, none reported to have pain during chewing or mouth opening on a weekly or daily basis, but 22% reported difficulties with maximum opening of the mouth. Conclusion: Ten to fifteen years after mandibular setback surgery the patient's mandibular range of movement is good. Despite clinically recognizable symptoms, few patients reported having TMJ- or masticatory muscle-related symptoms in their daily life

Temporomandibular joint function 10-15 years after mandibular setback surgery and six weeks of intermaxillary fixation

Intermaxillary fixation (IMF) is a classic method for immobilization of the mandible after mandibular fractures and corrective surgery. However, it has been suggested that IMF may be a risk for developing temporomandibular joint (TMJ)-related symptoms, especially when applied for longer periods. Objective: To evaluate the clinical function of TMJs and masticatory muscles 10-15 years after mandibular setback surgery and subsequent six weeks of IMF. The patients' self-reported TMJ and masticatory muscle symptoms were also addressed. Methodology: Thirty-six patients (24 women and 12 men) treated with intraoral vertical ramus osteotomies and subsequent six weeks of IMF, underwent a clinical examination of TMJs and masticatory muscles 10-15 years after surgery and completed a five-item structured questionnaire reporting subjective TMJ-related symptoms. Mean age by the time of clinical examination was 34.1 years (range 27.2–59.8 years). The clinical outcome was registered according to the Helkimo clinical dysfunction index. Descriptive and bivariate statistics were performed and level of significance was set to 5%. Results: Mean maximum unassisted mouth opening 10-15 years after surgery was 50.1 mm, (range 38-70 mm, SE 1.2), statistically significantly greater in men compared to women (p=0.004). Mean Helkimo dysfunction group was 1.5 (range 1-3, SE 0.10). Eighty-one percent experienced pain on palpation in either the masseter muscle, temporal muscle or both, and 31% experienced pain when moving the mandible in one or more directions. Thirty-one percent reported pain from palpating the TMJs. In the questionnaire, none reported to have pain during chewing or mouth opening on a weekly or daily basis, but 22% reported difficulties with maximum opening of the mouth. Conclusion: Ten to fifteen years after mandibular setback surgery the patient's mandibular range of movement is good. Despite clinically recognizable symptoms, few patients reported having TMJ- or masticatory muscle-related symptoms in their daily life

Temporomandibular joint pain and associated magnetic resonance findings: a retrospective study with a control group

Background To better understand and evaluate clinical usefulness of magnetic resonance imaging (MRI) in diagnosis and treatment of temporomandibular disorders (TMD), parameters for the evaluation are useful. Purpose To assess a clinically suitable staging system for evaluation of MRI of the temporomandibular joint (TMJ) and correlate the findings with age and some clinical symptoms of the TMJ. Material and Methods Retrospective analysis of 79 consecutive patients with clinical temporomandibular disorder or diagnosed inflammatory arthritis. Twenty-six healthy volunteers were included as controls. Existing data included TMJ pain, limited mouth opening (<30 mm) and corresponding MRI evaluations of the TMJs. Results The patients with clinical TMD complaints had statistically significantly more anterior disc displacement (ADD), disc deformation, caput flattening, surface destructions, osteophytes, and caput edema diagnosed by MRI compared to the controls. Among the arthritis patients, ADD, effusion, caput flattening, surface destructions, osteophytes, and caput edema were significantly more prevalent compared to the healthy volunteers. In the control group, disc deformation and presence of osteophytes significantly increased with age, and a borderline significance was found for ADD and surface destructions on the condylar head. No statistically significant associations were found between investigated clinical and MRI parameters. Conclusion This study presents a clinically suitable staging system for comparable MRI findings in the TMJs. Our results indicate that some findings are due to age-related degenerative changes rather than pathological changes. Results also show that clinical findings such as pain and limited mouth opening may not be related to changes diagnosed by MRI