- Email: [email protected]
Chronic closed lock of the temporomandibular joint. Comparison of two therapeutical methods: arthrocentesis and arthroscopical lavage
1098 ICOMS 2011—Abstracts: Oral Papers osteoblasts and mineralized tissue for bone regeneration. The main advantage of using DPSC is non-morbidity access and can be obtained noninvasively from deciduous teeth that are routinely extracted and generally discarded as medical waste without any ethical concerns. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.241
241 Factors influencing bone formation capacity of human embryonic stem cell-derived osteoblast-like cells P. Arpornmaeklong 1,∗ , M.J. Pressler 2 , P.H. Krebsbach 2 1 Oral and Maxillofacial Surgery, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Thailand 2 Biologic and Materials Sciences, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
To apply human embryonic stem cells (hESCs) as a source of osteoblast-like cells (hESC-OS), factors influencing bone formation potential of hESC-OS need to be evaluated. Aims: The study aimed to investigate effects of implantation sites and biomaterials on bone formation capacity of hESC-OS. Materials and methods: Human ESCOS were seeded on various biomaterials including porous collagen type I and polycarpolactone/ß-tricalcium phosphate scaffolds, gelatin sponges and ß-TCP particles. Samples were subcutaneously transplanted in immunodeficient mice for 6 weeks. Human ESC-OS on ß-TCP particles were transplanted in calvarial defects of immunodeficient rats for 6 weeks as a positive control. Bone formation and mineralization were investigated using soft radiograph, micro-computer tomography, polarized light microscope, histological analysis, von Kossa and immunohistochemical staining and qRT-PCR. Oligonucleotide microarry was applied to compare expression of genes related to osteogenesis of hESC-OS with osteoblast-like cells derived from human bone marrow stromal cells (hBMSC-OS). Results: Human ESC-OS deposited bone on ß-TCP particles in rat calvarial defects. Only mineralization of bone matrixes on the scaffolds and expression of human osteoblast-related genes were detected in subcutaneous transplantation. In comparison to hBMSC-OS, microarray analysis demonstrated lower expression
levels of genes related to osteogenesis and mineralization, such as MSX1, TGFBR1, BGLAP, IBSP, BMP4, BMP6 and wnt1 and higher levels of osteogenesis inhibitor, DKK3 of hESC-OS. Conclusion: Bone formation capacity of hESC-OS is influenced by implantation sites. Human ESC-OS required osteogenic stimuli from local host cells to enhance their bone formation capacity. Local stimuli are essential to survival, growth and differentiation of transplanted hESC-OS. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.242
Topic: TMJ and pain 242 9 Years follow up of TMJ prosthetic reconstruction R.J. Daruge Ceddar, Campinas, Brazil
Patients that have undergone to total TMJ prosthetic reconstruction for different reasons, such as trauma, degenerative diseases and cysts. TMJ total prosthetic reconstruction turned up to be a wonderful manner to rehabilitate major TMJ lost, but demands special attention on muscular prepare and rehabilitation in order to reach its very special goal – stomatological function and stability. We will present several reconstructions cases that have been follow up with electromyography and jaw tracking technology for 9 years, with the demonstration of the surgery technique and pre/post operative needs. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.243
243 Synovitis in internal derangement of the temporomandibular joint: correlation between primary and secondary arthroscopic findings and final outcome J.P. McCain 1,2 , R. Hossameldin 3,∗ 1 Oral and Maxillofacial Surgery, Nova Southeastern University, USA 2 Oral and Maxillofacial Surgery, Baptist Hospital, Miami, FL, USA 3 Oral and Maxillofacial Surgery, Cairo University, Cairo, Egypt
Background and aim of study: To evaluate the effect of primary diagnostic arthroscopic procedures on TMJ Synovitis when compared to secondary surgical
arthroscopic findings and its impact on the final outcome of TMJ arthroscopy. Materials and methods: 51 patients were selected from a total of 286 patients suffering from internal derangement (ID) of TMJ with different etiological factors; who required 2ry arthroscopic procedure starting from July 2007 to March 2011. A total of 75 joints were subjected to first diagnostic arthroscopic TMJ lysis and lavage, followed by second therapeutic arthroscopic TMJ discopexy. Those procedures were done in Baptist hospital, Miami, Florida, USA. This study was assessed through showing changes in the different grades of Retrodiscal Synovitis revealed in arthroscopic interventions and was correlate to the general outcome of those procedures in terms of improvement in the painless range of mandibular motion, pain on loading and functional jaw pain via visual analog scale. Results of investigation: This study revealed that improvement of the Retrodiscal Synovitis was achieved in 52% of arthroscopic treated patients primarily. This improvement has lead to significant improvement of the general outcome of treatment as assessed clinically (R = 0.623, P = 0.001). On the other hand, different etiological factors neither affected the changes in Synovitis nor the final outcome of treated patients. Conclusion: This study concluded that the primary arthroscopic intervention has a positive effect on reducing the degree of Retrodiscal Synovitis, which indeed improve the final outcome of the second therapeutic arthroscopic discopexy procedure. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.244
244 Chronic closed lock of the temporomandibular joint. Comparison of two therapeutical methods: arthrocentesis and arthroscopical lavage V. Machon 1,∗ , R. Foltán 1 , D. Hirjak 2 Oral Maxillofacial Surgery, Faculty Hospital and Charles University Prague, Prague, Czech Republic 2 Oral Maxillofacial Surgery, Faculty Hospital and Charles University Prague, Bratislava, Slovak Republic 1
Authors performed a prospective study in 100 patients with chronic anterior disc displacement without reduction. Patients with subjective problems lasting less than one year were assigned as group A (N = 50) and
ICOMS 2011—Abstracts: Oral Papers patients with problems lasting more than one year were group B (N = 50). 25 patients from group A and 25 patients from group B underwent arthrocentesis, 25 patients from group A and 25 patients from group B underwent arthroscopical lavage. Good result for both methods were pain in value 0–1 (pain score 0–5) and mouth opening minimally 30 mm (interincisivaly). Group A – effect of arthrocentesis was 75%, effect of arthroscopical lavage was 82%, group B – effect of arthrocentesis was 64%, effect of arthroscopical lavage was 80%. In conclusion, almost all patients with chronic anterior disc displacement without reduction benefited from lysis and lavage of the temporomandibular joint. Patients with shorter history of subjective problems benefited from the treatment more than patients with longer history. Conflict of interest: None declared.
sis supported by an MRI were studied with a lateral teleradiography and a Delaire skeletal analysis to determine the skeletal biotype. Inclusion criteria: Adults, OA diagnosis, no systemic diseases, active symptoms, restricted dynamics, and no history of surgical procedures on both TMJs. The patients also were registered under gender, age and distribute in Class I, II or III. Results: Class I: 4, Class II: 13, Class III: 3 these results were statistically analyzed (Systat v12.0). Conclusions: There’s a significant relationship between skeletal biotype and OA. Conflict of interest: Main author is in the ICOMS scientific commission. doi:10.1016/j.ijom.2011.07.246
doi:10.1016/j.ijom.2011.07.245
245 Skeletal biotype in TMJ Osteoarthritis C. Droguett Tidy 1,∗ , D. Lazo Pérez 2 , F. Cardenas Ojeda 2 1 Oral and Maxillofacial Surgery Department, San Jose Hospital, Chile 2 Oral Surgery Department, Universidad Mayor, Santiago, Chile
TMJ Osteoarthritis (OA) is defined as a chronic and degenerative disease with an important yet secondary inflammatory component and is the result of an unbalance anabolic and catabolic metabolism inside the TMJ. Although the exact molecular mechanisms are still in dark, literature agrees that this imbalance is caused by the action of functional overload as main factor and the combination of risk factors that exceed the adaptive capacity of the joint. OA is characterized mainly by three factors: destruction of the articular surface, bone remodeling and a secondary sinovitis. Clinical findings are pain, restricted mandibular dynamics, and crepitus. It has been found several risk factors such as age, genetics, gender, systemic diseases, parafunctional habits, loss of posterior molar support, inflammatory joint disease and trauma. Within these, craniofacial development plays a fundamental role in the etiology to determine patterns predisposing skeletal joint overload. Objective: Determine the relationship between skeletal biotype and OA. Patients and methods: A Universe of twenty patients with clinical OA diagno-
246 Complete TMJ replacement using custom titanium-HTR prosthetics following a partial mandibulectomy, a case presentation with 5-year follow-up M.A. Fonseca Díaz ∗ , J.R. Velazquez, ˜ Alsina P.L. Acuna Pontificia Universidad Catolica Argentina, Buenos Aires, Argentina
This case presentation refers to a 56 year old male patient, which is diagnosed with a recurrent keratocystic odontogenic tumor that completely compromises the left ascending ramous, condylar complex and retro molar portion of the mandible, requiring excision of the lesion. After the excision intervention, under a secondary surgical procedure, a complete TMJ replacement surgery utilizing custom made titanium-HTR prosthesis is executed under general anesthesia. This presentation refers to the experience utilizing this procedure and a 5 year follow-up to determine the long term viability and functionality of such prosthesis. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.247
1099
247 Glucosamine and Chondroitin Sulfate versus Arthrocentesis in internal derangement of TM joint: A 5 years experience P. Sharma Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India
An internal derangement occurs when there is disturbance in the normal anatomic relationship between the disc and condyle of the Temporomandibular Joint (TMJ) that interferes with smooth movement of the joint and causes momentary catching, clicking, popping or locking. The objective of the study is to compare the efficacy of systemically administered Chondroitin Sulfate and Glucosamine Sulfate, Arthrocentesis alone and a combination therapy of Arthrocentesis followed by systemically administered Chondroitin Sulfate and Glucosamine Sulfate. In this study 75 patients diagnosed with Internal derangement were selected. They were divided into three groups (A–C). Group A underwent Arthrocentesis only. Second group were administered Chondroitin Sulfate and Glucosamine Sulfate. Third group underwent a combination therapy; Arthrocentesis was performed followed by systemically administering Chondroitin Sulfate and Glucosamine Sulfate for six months. The patients were followed up at intervals of 1, 3 and 6 weeks, then after 3 and 6 months, till 5 years. Assessment was based upon relief of symptoms and four criteria viz. Pain, Mouth opening, TMJ Sounds and Deviation/Deflection were chosen. This study shows that Arthrocentesis along with Chondroitin Sulfate and Glucosamine Sulfate is effective for internal derangement, however patients who are apprehensive about invasive procedures, Chondroitin Sulfate and Glucosamine Sulfate is an effective treatment modality. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.248
241 Factors influencing bone formation capacity of human embryonic stem cell-derived osteoblast-like cells P. Arpornmaeklong 1,∗ , M.J. Pressler 2 , P.H. Krebsbach 2 1 Oral and Maxillofacial Surgery, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Thailand 2 Biologic and Materials Sciences, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
To apply human embryonic stem cells (hESCs) as a source of osteoblast-like cells (hESC-OS), factors influencing bone formation potential of hESC-OS need to be evaluated. Aims: The study aimed to investigate effects of implantation sites and biomaterials on bone formation capacity of hESC-OS. Materials and methods: Human ESCOS were seeded on various biomaterials including porous collagen type I and polycarpolactone/ß-tricalcium phosphate scaffolds, gelatin sponges and ß-TCP particles. Samples were subcutaneously transplanted in immunodeficient mice for 6 weeks. Human ESC-OS on ß-TCP particles were transplanted in calvarial defects of immunodeficient rats for 6 weeks as a positive control. Bone formation and mineralization were investigated using soft radiograph, micro-computer tomography, polarized light microscope, histological analysis, von Kossa and immunohistochemical staining and qRT-PCR. Oligonucleotide microarry was applied to compare expression of genes related to osteogenesis of hESC-OS with osteoblast-like cells derived from human bone marrow stromal cells (hBMSC-OS). Results: Human ESC-OS deposited bone on ß-TCP particles in rat calvarial defects. Only mineralization of bone matrixes on the scaffolds and expression of human osteoblast-related genes were detected in subcutaneous transplantation. In comparison to hBMSC-OS, microarray analysis demonstrated lower expression
levels of genes related to osteogenesis and mineralization, such as MSX1, TGFBR1, BGLAP, IBSP, BMP4, BMP6 and wnt1 and higher levels of osteogenesis inhibitor, DKK3 of hESC-OS. Conclusion: Bone formation capacity of hESC-OS is influenced by implantation sites. Human ESC-OS required osteogenic stimuli from local host cells to enhance their bone formation capacity. Local stimuli are essential to survival, growth and differentiation of transplanted hESC-OS. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.242
Topic: TMJ and pain 242 9 Years follow up of TMJ prosthetic reconstruction R.J. Daruge Ceddar, Campinas, Brazil
Patients that have undergone to total TMJ prosthetic reconstruction for different reasons, such as trauma, degenerative diseases and cysts. TMJ total prosthetic reconstruction turned up to be a wonderful manner to rehabilitate major TMJ lost, but demands special attention on muscular prepare and rehabilitation in order to reach its very special goal – stomatological function and stability. We will present several reconstructions cases that have been follow up with electromyography and jaw tracking technology for 9 years, with the demonstration of the surgery technique and pre/post operative needs. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.243
243 Synovitis in internal derangement of the temporomandibular joint: correlation between primary and secondary arthroscopic findings and final outcome J.P. McCain 1,2 , R. Hossameldin 3,∗ 1 Oral and Maxillofacial Surgery, Nova Southeastern University, USA 2 Oral and Maxillofacial Surgery, Baptist Hospital, Miami, FL, USA 3 Oral and Maxillofacial Surgery, Cairo University, Cairo, Egypt
Background and aim of study: To evaluate the effect of primary diagnostic arthroscopic procedures on TMJ Synovitis when compared to secondary surgical
arthroscopic findings and its impact on the final outcome of TMJ arthroscopy. Materials and methods: 51 patients were selected from a total of 286 patients suffering from internal derangement (ID) of TMJ with different etiological factors; who required 2ry arthroscopic procedure starting from July 2007 to March 2011. A total of 75 joints were subjected to first diagnostic arthroscopic TMJ lysis and lavage, followed by second therapeutic arthroscopic TMJ discopexy. Those procedures were done in Baptist hospital, Miami, Florida, USA. This study was assessed through showing changes in the different grades of Retrodiscal Synovitis revealed in arthroscopic interventions and was correlate to the general outcome of those procedures in terms of improvement in the painless range of mandibular motion, pain on loading and functional jaw pain via visual analog scale. Results of investigation: This study revealed that improvement of the Retrodiscal Synovitis was achieved in 52% of arthroscopic treated patients primarily. This improvement has lead to significant improvement of the general outcome of treatment as assessed clinically (R = 0.623, P = 0.001). On the other hand, different etiological factors neither affected the changes in Synovitis nor the final outcome of treated patients. Conclusion: This study concluded that the primary arthroscopic intervention has a positive effect on reducing the degree of Retrodiscal Synovitis, which indeed improve the final outcome of the second therapeutic arthroscopic discopexy procedure. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.244
244 Chronic closed lock of the temporomandibular joint. Comparison of two therapeutical methods: arthrocentesis and arthroscopical lavage V. Machon 1,∗ , R. Foltán 1 , D. Hirjak 2 Oral Maxillofacial Surgery, Faculty Hospital and Charles University Prague, Prague, Czech Republic 2 Oral Maxillofacial Surgery, Faculty Hospital and Charles University Prague, Bratislava, Slovak Republic 1
Authors performed a prospective study in 100 patients with chronic anterior disc displacement without reduction. Patients with subjective problems lasting less than one year were assigned as group A (N = 50) and
ICOMS 2011—Abstracts: Oral Papers patients with problems lasting more than one year were group B (N = 50). 25 patients from group A and 25 patients from group B underwent arthrocentesis, 25 patients from group A and 25 patients from group B underwent arthroscopical lavage. Good result for both methods were pain in value 0–1 (pain score 0–5) and mouth opening minimally 30 mm (interincisivaly). Group A – effect of arthrocentesis was 75%, effect of arthroscopical lavage was 82%, group B – effect of arthrocentesis was 64%, effect of arthroscopical lavage was 80%. In conclusion, almost all patients with chronic anterior disc displacement without reduction benefited from lysis and lavage of the temporomandibular joint. Patients with shorter history of subjective problems benefited from the treatment more than patients with longer history. Conflict of interest: None declared.
sis supported by an MRI were studied with a lateral teleradiography and a Delaire skeletal analysis to determine the skeletal biotype. Inclusion criteria: Adults, OA diagnosis, no systemic diseases, active symptoms, restricted dynamics, and no history of surgical procedures on both TMJs. The patients also were registered under gender, age and distribute in Class I, II or III. Results: Class I: 4, Class II: 13, Class III: 3 these results were statistically analyzed (Systat v12.0). Conclusions: There’s a significant relationship between skeletal biotype and OA. Conflict of interest: Main author is in the ICOMS scientific commission. doi:10.1016/j.ijom.2011.07.246
doi:10.1016/j.ijom.2011.07.245
245 Skeletal biotype in TMJ Osteoarthritis C. Droguett Tidy 1,∗ , D. Lazo Pérez 2 , F. Cardenas Ojeda 2 1 Oral and Maxillofacial Surgery Department, San Jose Hospital, Chile 2 Oral Surgery Department, Universidad Mayor, Santiago, Chile
TMJ Osteoarthritis (OA) is defined as a chronic and degenerative disease with an important yet secondary inflammatory component and is the result of an unbalance anabolic and catabolic metabolism inside the TMJ. Although the exact molecular mechanisms are still in dark, literature agrees that this imbalance is caused by the action of functional overload as main factor and the combination of risk factors that exceed the adaptive capacity of the joint. OA is characterized mainly by three factors: destruction of the articular surface, bone remodeling and a secondary sinovitis. Clinical findings are pain, restricted mandibular dynamics, and crepitus. It has been found several risk factors such as age, genetics, gender, systemic diseases, parafunctional habits, loss of posterior molar support, inflammatory joint disease and trauma. Within these, craniofacial development plays a fundamental role in the etiology to determine patterns predisposing skeletal joint overload. Objective: Determine the relationship between skeletal biotype and OA. Patients and methods: A Universe of twenty patients with clinical OA diagno-
246 Complete TMJ replacement using custom titanium-HTR prosthetics following a partial mandibulectomy, a case presentation with 5-year follow-up M.A. Fonseca Díaz ∗ , J.R. Velazquez, ˜ Alsina P.L. Acuna Pontificia Universidad Catolica Argentina, Buenos Aires, Argentina
This case presentation refers to a 56 year old male patient, which is diagnosed with a recurrent keratocystic odontogenic tumor that completely compromises the left ascending ramous, condylar complex and retro molar portion of the mandible, requiring excision of the lesion. After the excision intervention, under a secondary surgical procedure, a complete TMJ replacement surgery utilizing custom made titanium-HTR prosthesis is executed under general anesthesia. This presentation refers to the experience utilizing this procedure and a 5 year follow-up to determine the long term viability and functionality of such prosthesis. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.247
1099
247 Glucosamine and Chondroitin Sulfate versus Arthrocentesis in internal derangement of TM joint: A 5 years experience P. Sharma Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India
An internal derangement occurs when there is disturbance in the normal anatomic relationship between the disc and condyle of the Temporomandibular Joint (TMJ) that interferes with smooth movement of the joint and causes momentary catching, clicking, popping or locking. The objective of the study is to compare the efficacy of systemically administered Chondroitin Sulfate and Glucosamine Sulfate, Arthrocentesis alone and a combination therapy of Arthrocentesis followed by systemically administered Chondroitin Sulfate and Glucosamine Sulfate. In this study 75 patients diagnosed with Internal derangement were selected. They were divided into three groups (A–C). Group A underwent Arthrocentesis only. Second group were administered Chondroitin Sulfate and Glucosamine Sulfate. Third group underwent a combination therapy; Arthrocentesis was performed followed by systemically administering Chondroitin Sulfate and Glucosamine Sulfate for six months. The patients were followed up at intervals of 1, 3 and 6 weeks, then after 3 and 6 months, till 5 years. Assessment was based upon relief of symptoms and four criteria viz. Pain, Mouth opening, TMJ Sounds and Deviation/Deflection were chosen. This study shows that Arthrocentesis along with Chondroitin Sulfate and Glucosamine Sulfate is effective for internal derangement, however patients who are apprehensive about invasive procedures, Chondroitin Sulfate and Glucosamine Sulfate is an effective treatment modality. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.248