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OBJECTIVES: The aim of the study was to analyse differences in pharyngeal airway dimensions and head posture between obstructive sleep apnea patients with and without morphological deviations in the upper cervical spine and to analyse associations between pharyngeal airway dimensions and head posture in the total sample. MATERIAL AND METHODS: The sample comprised 53 obstructive sleep apnea (OSA) patients of which 32.1% had upper spine morphological deviations. Accordingly two groups were defined: 17 OSA patients with morphological deviations in the upper spine and 36 without upper spine deviations. Pharyngeal airway dimensions in terms of distances, cross-sectional areas and volume and upper spine morphological deviations were evaluated on cone-beam computed tomography. Head posture was evaluated on two-dimensional generated lateral cephalograms. Differences were analysed and adjusted for age and gender by multiple linear regression analysis. RESULTS: OSA patients with upper spine morphological deviations had a significantly more backward and curved neck posture (OPT/HOR, P < 0.01; OPT/CVT, P < 0.05) compared to OSA patients without spine deviations. No significant differences were found in airway dimensions between patients with and without upper spine deviations. In the total group significant associations were found between head posture and pharyngeal airway distances and cross-sectional area at the nasal floor, epiglottis and hyoid bone level (P < 0.05, P < 0.01, P < 0.001). No significant association was found between head posture and airway volume. CONCLUSIONS: The results may contribute to differentiate obstructive sleep apnea patients and thereby may prove valuable in diagnosis and treatment planning of obstructive sleep apnea patients.

RESUMEN

OBJECTIVES: To compare 1) temporomandibular joint (TMJ) mobility between patients with and without reduced upper cervical spine (UCS) mobility and with and without TMJ osseous osteoarthritic-like changes, and 2) UCS osseous changes between patients with and without TMJ osseous osteoarthritic-like changes and with and without reduced UCS mobility. STUDY DESIGN: The study comprised 39 patients without pain from TMJ or UCS and with obstructive sleep apnea, 15 women (age range 26-72 years, mean 56.0) and 24 men (age range 27-71 years, mean 49.8). The range of motion (ROM) of the mandible and UCS was assessed clinically. Osseous changes of the TMJ and UCS were assessed by cone beam computed tomography. Differences were tested and adjusted for age and gender by multiple linear and logistic regression analyses. RESULTS: The mandibular ROM was within normal range (45-64 mm) but the UCS ROM was reduced in 15 patients. Osseous TMJ and UCS changes were both found in 38.5% of the patients. Osseous UCS changes were found more frequently in patients with than without TMJ changes (P = .0003; odds ratio 21.9). No other significant results were found. CONCLUSIONS: The present findings of comorbid osseous changes in patients with obstructive sleep apnea support a possible biomechanical relationship between the TMJ and the UCS.

Asunto(s)

Vértebras Cervicales/fisiopatología , Osteoartritis/fisiopatología , Articulación Temporomandibular/fisiopatología , Adulto , Anciano , Vértebras Cervicales/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Rango del Movimiento Articular , Articulación Temporomandibular/diagnóstico por imagen

RESUMEN

OBJECTIVES: The purpose of this study was to examine magnetic resonance imaging findings in patients with painful disc displacement without reduction of the temporomandibular joint to determine whether the findings were able to predict treatment outcome of lavage and a control group treated with local anaesthesia without lavage in a short-term: 3-month perspective. MATERIAL AND METHODS: Bilateral magnetic resonance images were taken of 37 patients with the clinical diagnosis of painful disc displacement without reduction. Twenty-three patients received unilateral extra-articular local anaesthetics and 14 unilateral lavage and extra-articular local anaesthetics. The primary treatment outcome defining success was reduction in pain intensity of at least 30% during jaw movement at the 3-month follow-up. RESULTS: Bilateral disc displacement was found in 30 patients. In 31 patients the disc on the treated side was deformed, and bilaterally in 19 patients. Osteoarthritis was observed in 28 patients, and 13 patients had bilateral changes. Thirty patients responded to treatment and 7 did not, with no difference between the two treated groups. In neither the treated nor the contralateral temporomandibular joint did treatment outcome depend on disc diagnosis, disc shape, joint effusion, or osseous diagnoses. Magnetic resonance imaging findings of disc position, disc shape, joint effusion or osseous diagnosis on the treated or contralateral side did not give information of treatment outcome. CONCLUSIONS: Magnetic resonance imaging findings could not predict treatment outcome in patients treated with either local anaesthetics or local anaesthetics and lavage.

RESUMEN

OBJECTIVE: To investigate if TNF, IL-1 or their endogenous controls, in relation to ACPA, are associated with radiological signs of ongoing temporomandibular joint (TMJ) bone tissue resorption and disc displacement in RA patients. METHODS: Twenty-two consecutive outpatients with TMJ of RA were included. Systemic inflammatory activity was assessed by DAS28. The number of painful regions in the body and ESR, CRP, RF and ACPA were analyzed. TMJ synovial fluid and blood samples were obtained and analyzed for TNF, TNFsRII, IL-1ra, IL-1sRII and ACPA. The ratios between the mediators and their endogenous control receptors were used in the statistical analysis. Magnetic resonance imaging was performed in closed- and open-mouth positions and evaluated regarding disc position and presence of condylar and temporal erosions of the TMJ. RESULTS: A high TNF level in relation to TNFsRII in TMJ synovial fluid correlated to the degree of TMJ condylar erosion. A high IL-1ra level in relation to TNF in TMJ synovial fluid was also correlated to the degree of TMJ condylar erosion. The total degree of TMJ condylar erosion was correlated with the number of painful regions. CONCLUSION: This study indicates that TNF in TMJ synovial fluid mediates TMJ cartilage and bone tissue resorption in RA. The study also suggests that the degree of endogenous cytokine control is of importance for development of bone tissue destruction.

Asunto(s)

Artritis Reumatoide/inmunología , Trastornos de la Articulación Temporomandibular/inmunología , Articulación Temporomandibular/inmunología , Factor de Necrosis Tumoral alfa/inmunología , Adulto , Artritis Reumatoide/patología , Autoanticuerpos/análisis , Sedimentación Sanguínea , Resorción Ósea/inmunología , Proteína C-Reactiva/análisis , Cartílago Articular/inmunología , Femenino , Humanos , Proteína Antagonista del Receptor de Interleucina 1/análisis , Interleucina-1beta/análisis , Luxaciones Articulares/inmunología , Imagen por Resonancia Magnética/métodos , Masculino , Cóndilo Mandibular/inmunología , Persona de Mediana Edad , Dolor/inmunología , Receptores Tipo II de Interleucina-1/análisis , Receptores Tipo II del Factor de Necrosis Tumoral/análisis , Líquido Sinovial/inmunología , Articulación Temporomandibular/patología , Disco de la Articulación Temporomandibular/inmunología , Trastornos de la Articulación Temporomandibular/patología

RESUMEN

AIMS: To assess the prevalence of temporomandibular joint (TMJ) bony changes in cone beam computed tomography (CBCT) images of adult subjects without ongoing orofacial pain or complaints from the TMJ. METHODS: The study included 84 TMJs from 28 men and 14 women (mean age [± SD]: 51 ± 11 years) without orofacial pain or TMJ complaints who were participants in a study of patients with obstructive sleep apnea. They were examined before any treatment with the Research Diagnostic Criteria for Temporomandibular Disorders and with CBCT (NewTom VGi; 15 × 15 cm, exposure time 18 seconds, axial thickness 0.3 mm). Osseous TMJ deviations were assessed blindly and classified. RESULTS: Degenerative changes were noted in the CBCT images of 33 (39.3%) of the TMJs, of which 21 were classified as osteoarthritic alterations and 12 as indeterminate changes of osteoarthritis. Two TMJs were clinically classified as osteoarthrosis and 6 as disc displacement with reduction. The CBCT images of the 2 TMJs with a clinical diagnosis of osteoarthrosis showed also bony changes, but the CBCT images also revealed osteoarthritic bony changes in the 18 TMJs without any clinical diagnosis. CONCLUSION: CBCT images of asymptomatic adult TMJs commonly show degenerative bony alterations. Accordingly, such radiographic findings should be used with care and only as a supplement to clinical assessment.

Asunto(s)

Tomografía Computarizada de Haz Cónico/métodos , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/diagnóstico por imagen , Adulto , Anciano , Enfermedades Asintomáticas , Cartílago Articular/diagnóstico por imagen , Femenino , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Osteofito/diagnóstico por imagen , Apnea Obstructiva del Sueño/diagnóstico por imagen , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico

RESUMEN

AIMS: To examine (1) the occurrence of magnetic resonance imaging (MRI) signal changes in the painful regions of patients with atypical odontalgia (AO) and (2) the correlation of such findings to periapical bone defects detected with a comprehensive radiographic examination including cone beam computed tomography (CBCT). METHODS: A total of 20 patients (mean age 52 years, range 34 to 65) diagnosed with AO participated. Mean pain intensity (± standard deviation) was 5.6 ± 1.8 on a 0-10 numerical rating scale, and mean pain duration was 4.3 ± 5.2 years. The inclusion criterion was chronic pain (> 6 months) located in a region with no clear pathologic cause identified clinically or in periapical radiographs. In addition to a clinical examination and a self-report questionnaire, the assessments included radiographic examinations (panoramic, periapical, and CBCT images), and an MRI examination. Changes in MRI signal in the painful region were recorded. Spearman's rank correlation between radiographic and MRI findings was calculated. RESULTS: Eight of the patients (40%) had MRI signal changes in the pain region. The correlation to radiographic periapical radiolucencies was 0.526 (P = .003). Of the eight teeth displaying changes in MRI signal, six showed periapical radiolucency in the radiographs. CONCLUSION: MRI examination revealed no changes in the painful region in a majority of patients with AO, suggesting that inflammation was not present. MRI findings were significantly correlated to radiographic findings.

Asunto(s)

Tomografía Computarizada de Haz Cónico , Dolor Facial/diagnóstico , Imagen por Resonancia Magnética , Odontalgia/diagnóstico , Adulto , Anciano , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/patología , Apicectomía , Dolor Crónico/diagnóstico , Dolor Crónico/diagnóstico por imagen , Diagnóstico Diferencial , Dolor Facial/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Periodontitis Periapical/diagnóstico , Periodontitis Periapical/diagnóstico por imagen , Radiografía de Mordida Lateral , Radiografía Panorámica , Autoinforme , Sensibilidad y Especificidad , Ápice del Diente/diagnóstico por imagen , Ápice del Diente/patología , Diente no Vital/diagnóstico , Diente no Vital/diagnóstico por imagen , Odontalgia/diagnóstico por imagen

RESUMEN

AIMS: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. METHODS: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. RESULTS: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions. CONCLUSION: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.

Asunto(s)

Trastornos de la Articulación Temporomandibular/diagnóstico , Artralgia/diagnóstico , Consenso , Diagnóstico Diferencial , Odontología Basada en la Evidencia , Dolor Facial/diagnóstico , Cefalea/diagnóstico , Humanos , Luxaciones Articulares/diagnóstico , Tamizaje Masivo/métodos , Músculos Masticadores/patología , Mialgia/diagnóstico , Osteoartritis/diagnóstico , Dolor Referido/diagnóstico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Disco de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/psicología , Síndrome de la Disfunción de Articulación Temporomandibular/diagnóstico , Terminología como Asunto

RESUMEN

BACKGROUND: This systematic review assesses the effect of methods commonly used to manage the pulp in cases of deep caries lesions, and the extent the pulp chamber remains uninfected and does not cause pulpal or periapical inflammatory lesions and associated tooth-ache over time. STUDY DESIGN: An electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to March 2013. In addition, hand searches were carried out. Two reviewers independently evaluated abstracts and full-text articles. An article was read in full if at least one of the two reviewers considered the abstract potentially relevant. Altogether, 161 articles were read in full text. Of these, 24 studies fulfilled established inclusion criteria. Based on studies of at least moderate quality, the quality of evidence of each procedure was rated in four levels according to GRADE. RESULTS: No study reached the high quality level. Twelve were of moderate quality. The overall evidence was insufficient to assess which of indirect pulp capping, stepwise excavation, direct excavation and pulp capping/partial pulpotomy, pulpotomy or pulpectomy is the most effective treatment approach for teeth with deep caries. CONCLUSIONS: Because of the lack of good studies it is not possible to determine whether an injured pulp by deep caries can be maintained or whether it should be removed and replaced with a root canal filling. Both randomized studies and prospective observational studies are needed to investigate whether a pulp exposed to deep caries is best treated by measures intended to preserve it or by pulpectomy and root filling.

Asunto(s)

Caries Dental , Pulpa Dental , Tratamiento Restaurativo Atraumático Dental , Caries Dental/terapia , Recubrimiento de la Pulpa Dental , Humanos , Estudios Prospectivos , Materiales de Recubrimiento Pulpar y Pulpectomía , Pulpotomía , Caries Radicular

RESUMEN

This study comprises a survey of Swedish dentists'treatment preferences in cases of carious exposure of the dental pulp in adults.The survey was conducted as part of a comprehensive report on methods of diagnosis and treatment in endodontics, published in 2010 by the Swedish Council on Health Technology Assessment. A questionnaire was mailed to a random subsample of 2012 dental offices where one dentist at each office was requested to answer all questions. Each questionnaire contained one of three sets of questions about endodontic practice routines.Thus around one-third of the subsample received case-specific questions about treating carious exposure. Only general practitioners aged below 70 years were included.The final study sample comprised 412 participants.The dentists were presented with two case scenarios. In Case 1 a 22-year old patient had a deep carious lesion in tooth 36 and in Case 2 a 50-year old patient had a deep carious lesion in tooth 14.The participants were asked to nominate their treatment of choice: pulp capping, partial pulpotomy or pulpectomy. For Case 1, 17 per cent of the respondents selected pulpectomy; the corresponding rate for Case 2 was 47 per cent. Female gender and age group 25-49 years were predictive of selection of less invasive treatment options. However, according to recent guidelines (2011) from the National Board of Health and Wellfare, Swedish dentists are recommended to elect pulpectomy prior to pulp capping/partial pulpotomy when confronted with a tooth having a cariously exposed pulp in adults.

Asunto(s)

Recubrimiento de la Pulpa Dental/estadística & datos numéricos , Exposición de la Pulpa Dental/terapia , Pautas de la Práctica en Odontología , Pulpectomía/estadística & datos numéricos , Pulpotomía/estadística & datos numéricos , Adulto , Distribución de Chi-Cuadrado , Femenino , Adhesión a Directriz , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Odontología/estadística & datos numéricos , Obturación del Conducto Radicular/estadística & datos numéricos , Consejos de Especialidades , Encuestas y Cuestionarios , Suecia , Adulto Joven

RESUMEN

AIM: To assess whether changes in diagnoses and management of temporomandibular joint disorder (TMJD) patients are influenced by radiographic findings and if there is an association between specific radiologic alterations and management strategy changes. METHODS: A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Diagnoses and management were first decided without the aid of radiographs. Management categories were: pharmacology, physiotherapy, counseling and behavioral treatment, occlusal stabilization, surgery, additional examinations, and referrals, each with subcategories. Sagittal TMJ tomograms were assessed for the presence of flattening, erosion, osteophyte, and sclerosis in the TMJ components. Diagnoses and management were reevaluated after gaining access to the radiographs and radiographic classifications. Logistic regression analyses were performed with changes in management as the dependent variable and age and radiographic findings as the independent variables. RESULTS: Diagnosis was changed for 56 patients, mainly from arthralgia to osteoarthritis. Management was changed for 55 patients. Most changes occurred in pharmacology and physiotherapy followed by counseling and behavioral treatment, occlusal stabilization, referrals, additional examinations, and surgery. Changes were mostly within the categories, and the highest number of changes was seen in pharmacology, physiotherapy, and counseling and behavioral treatment. Radiographic degenerative findings increased the chance of change (any change) (odds ratio [OR] ⋝ 2.03) and the chance of change in pharmacology (OR ⋝ 2.56) and physiotherapy (OR = 2.48) separately. No other significant associations were found. CONCLUSION: Radiographic degenerative findings increased the chance of changes in management strategy. However, 73% of the TMJD patients had no changes in management after radiographic examination. In cases with changes, these were mainly adjustments within management categories.

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Toma de Decisiones , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia , Articulación Temporomandibular/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Anatomía Transversal , Artralgia/diagnóstico por imagen , Distribución de Chi-Cuadrado , Diagnóstico Diferencial , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/patología , Adulto Joven

RESUMEN

The aim of this research was to study if changes in condyle position in temporomandibular disorders (TMD) patients could be a factor that is affected by resilient appliance therapy and if it influences the treatment outcome. The study investigated 48 patients randomly assigned to a treatment group (T group = 21 patients, using resilient appliance) or a control group (C group = 27 patients, using nonoccluding appliance). Changes in the condyle-fossa relationship (with and without the appliance) were determined in an MRI examination. Ten weeks after treatment, the treatment outcome was measured. The results showed that with the appliance, change in condyle position occurred in 76% of the T group and 22% of the C group (p < 0.001). Sixty-seven percent (67%) of the T group and 44% of the C group experienced a successful treatment outcome. Treatment outcome was not related to changes in condyle position in patients with TMD pain.

Asunto(s)

Dolor Facial/terapia , Cóndilo Mandibular/patología , Ferulas Oclusales , Disco de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/terapia , Adolescente , Adulto , Relación Céntrica , Dolor Facial/complicaciones , Dolor Facial/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Persona de Mediana Edad , Diseño de Aparato Ortodóncico , Radiografía , Rango del Movimiento Articular , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/patología , Resultado del Tratamiento , Adulto Joven

RESUMEN

AIM: To describe evidence for a relationship between diagnoses and findings of clinical examination and diagnoses and findings of magnetic resonance imaging (MRI) examination for degenerative and inflammatory temporomandibular joint diseases. METHODS: PubMed and the Cochrane Library were searched using specific indexing terms and reference lists were hand-searched. Included publications satisfied pre-established criteria. Primary studies were interpreted using a modification of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. RESULTS: The literature search yielded 219 titles and abstracts. Eighty-two studies were selected and read in full-text. After data extraction and interpretation with the QUADAS tool, 23 studies remained. There was a vast heterogeneity in study design, clinical examination methods, and diagnostic criteria. No clear evidence was found for a relationship between clinical and MRI diagnoses and findings. Several studies reported a relationship between clinical pain and internal derangements diagnosed with MRI, but the calculated odds ratio (OR) for this relationship was generally low (1.54-2.04). ORs for the relationship between pain and disc displacement without reduction (4.82) or between crepitation and disc displacement without reduction (3.71) were higher. CONCLUSION: This review reveals a need for studies with improved quality in reporting of samples, examination techniques, findings, and definitions and rationales for cutoffs, categories, and diagnoses. We recommend that standardized protocols such as the Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD) and the Standards for Reporting of Diagnostic Accuracy (STARD) statement be implemented in future studies.

Asunto(s)

Artritis/diagnóstico , Trastornos de la Articulación Temporomandibular/diagnóstico , Artritis/complicaciones , Ensayos Clínicos como Asunto/normas , Dolor Facial/etiología , Humanos , Luxaciones Articulares , Imagen por Resonancia Magnética , Oportunidad Relativa , Osteoartritis/complicaciones , Osteoartritis/diagnóstico , Examen Físico , Garantía de la Calidad de Atención de Salud/normas , Estándares de Referencia , Sonido , Trastornos de la Articulación Temporomandibular/complicaciones

RESUMEN

OBJECTIVES: The aim of this study was to evaluate if different ways of adjusting brightness and contrast of monitors with different technical standards influence the diagnosis of carious lesions in digital radiographs. STUDY DESIGN: One hundred extracted teeth (premolars and molars) were radiographed. Seven observers evaluated images for approximal carious lesions on 3 monitors: a standard color monitor with brightness and contrast manually adjusted for viewing radiographs, a Digital Imaging and Communication in Medicine (DICOM) part 14 precalibrated color monitor, and a DICOM part 14 precalibrated monochromatic monitor. All evaluations were made in ambient light <50 lux. Receiver operating characteristic curves were plotted to evaluate results. The standard criterion was a histologic examination of sliced teeth. Kappa statistic evaluated intraobserver agreement. RESULTS: No significant difference in accuracy of approximal carious lesion diagnosis was found between the monitors. Intraobserver agreement varied between fair and good. CONCLUSION: No differences that could affect clinicians' abilities to detect carious lesions in digital radiographs existed between the standard monitor and the color and monochrome DICOM part 14 precalibrated monitors.

Asunto(s)

Terminales de Computador , Caries Dental/diagnóstico por imagen , Radiografía Dental Digital , Humanos , Iluminación , Curva ROC , Sistemas de Información Radiológica

RESUMEN

AIM: To identify associations between clinical symptoms of temporomandibular joint disorders and radiographic findings. METHODS: Two hundred four adult patients (156 women, 48 men, mean age 40 years) with temporomandibular joint (TMJ) pain/sounds or changes in mandibular motion were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Bilateral sagittal corrected TMJ tomograms in closed and open positions were assessed for the presence of flattening, erosion, osteophytes, and sclerosis in the joint components and the range of mandibular motion. Logistic regression analyses were performed with the radiographic findings as the dependent variables and the following clinical variables as independent variables: opening pattern, maximal jaw opening, TMJ sounds, number of painful muscle/TMJ sites, duration of pain, presence of arthritic disease, depression and somatization scores, graded chronic pain, and age and gender. RESULTS: Coarse crepitus on opening/closing (odds ratio [OR] > or = 3.12), on lateral excursions (odds ratio > or = 4.06), and on protrusion (OR > or = 5.30) was associated with increased risk of degenerative findings in tomograms. A clinical diagnosis of osteoarthritis increased the risk of radiographic findings (OR > or = 2.95) and so did increasing age (OR > or = 1.03 per year) and the female gender (OR > or = 2.36). Maximal assisted opening and maximal opening without pain (< 40 mm) was associated with a posterior condyle-to-articular tubercle position (OR > or = 2.60). No other significant associations were observed. CONCLUSION: Age, gender, and coarse crepitus, but no pain-related variables, were associated with increased risk of degenerative findings in TMJ tomograms. Maximal opening < 40 mm was associated with a posterior condyle-to-articular tubercle relation on opening.

Asunto(s)

Trastornos de la Articulación Temporomandibular/diagnóstico , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Artritis/diagnóstico , Depresión/diagnóstico , Dolor Facial/diagnóstico , Dolor Facial/diagnóstico por imagen , Femenino , Humanos , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/diagnóstico por imagen , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Músculos Masticadores/diagnóstico por imagen , Músculos Masticadores/patología , Persona de Mediana Edad , Osteoartritis/diagnóstico , Osteoartritis/diagnóstico por imagen , Osteofito/diagnóstico , Osteofito/diagnóstico por imagen , Osteosclerosis/diagnóstico , Osteosclerosis/diagnóstico por imagen , Rango del Movimiento Articular/fisiología , Factores Sexuales , Trastornos Somatomorfos/diagnóstico , Articulación Temporomandibular/diagnóstico por imagen , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Disco de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Síndrome de la Disfunción de Articulación Temporomandibular/diagnóstico , Síndrome de la Disfunción de Articulación Temporomandibular/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos

RESUMEN

OBJECTIVE: The objective of this study was to evaluate the impact of clinical TMJ diagnosis, gender, and age on the agreement between expected and actual radiographic findings. STUDY DESIGN: A total of 204 patients with TMJ symptoms were examined using the Research Diagnostic Criteria (RDC/TMD). Expected radiographic findings were recorded. TMJ tomograms in closed and open mouth position were assessed for osseous changes and condyle position. Expected and actual findings were compared. Logistic regression analyses were performed with agreement on radiographic findings as the dependent variable and with clinical RDC/TMD diagnoses, gender and age as the independent variables. RESULTS: The number of radiographic findings was mostly underestimated. A clinical diagnosis of osteoarthritis and age increased the chance of overestimating osseous changes. Disc displacement and age decreased the chance of agreement on certain condyle positions. CONCLUSION: Tomography often revealed unexpected findings. It was not possible to select particular patient groups who would benefit more or less from a radiographic examination.

Asunto(s)

Cóndilo Mandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico , Articulación Temporomandibular/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Artralgia/diagnóstico , Artralgia/diagnóstico por imagen , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/diagnóstico por imagen , Diagnóstico Diferencial , Dolor Facial/fisiopatología , Femenino , Humanos , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/diagnóstico por imagen , Masculino , Cóndilo Mandibular/patología , Persona de Mediana Edad , Osteoartritis/diagnóstico , Osteoartritis/diagnóstico por imagen , Rango del Movimiento Articular/fisiología , Factores Sexuales , Sonido , Articulación Temporomandibular/patología , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Síndrome de la Disfunción de Articulación Temporomandibular/diagnóstico , Síndrome de la Disfunción de Articulación Temporomandibular/diagnóstico por imagen

RESUMEN

Modified condylotomy may be relevant in severe painful reciprocal clicking of the temporomandibular joint (TMJ) where conservative treatment is insufficient. The effect of the modified condylotomy was analyzed and compared with conventional nonsurgical treatment in a randomized pilot study of eight patients, 19-44 years of age, with severe painful reciprocal clicking. Before and after treatment, assessments were performed by subjective reports, clinical recordings, and blinded evaluations of radiography and magnetic resonance imaging (MRI). Based on the clinical evaluations before treatment, all conditions were disc displacements with reduction and arthralgia (Research diagnostic criteria for temporomandibular disorders), but based on MRI, one patient had disc displacement without reduction and another had normal disc position. The treatment effect was significantly better and the disorders were significantly more reduced with condylotomy than with conventional nonsurgical treatment (P < 0.05, Mann-Whitney U test). In the surgical group, the clicking and locking had disappeared, the pain during function was significantly reduced (P < 0.05, Friedman ANOVA), and in two patients the disc position was normalized. The clicking still persisted in the nonsurgical patients and the disc position was unchanged. Our conclusion is that modified condylotomy is a promising option to reduce symptoms and signs in severe painful reciprocal clicking.

Asunto(s)

Cóndilo Mandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Adolescente , Adulto , Artralgia/etiología , Artralgia/cirugía , Artralgia/terapia , Auscultación , Dolor Facial/etiología , Dolor Facial/cirugía , Dolor Facial/terapia , Femenino , Humanos , Luxaciones Articulares/complicaciones , Luxaciones Articulares/cirugía , Luxaciones Articulares/terapia , Masculino , Ejercicios de Estiramiento Muscular , Ferulas Oclusales , Procedimientos Quirúrgicos Orales , Dimensión del Dolor , Proyectos Piloto , Estudios Prospectivos , Sonido , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/terapia , Adulto Joven

RESUMEN

OBJECTIVE: To evaluate the evidence for the efficacy of magnetic resonance imaging (MRI) in the diagnosis of disk position and configuration, disk perforation, joint effusion, and osseous and bone marrow changes in the temporomandibular joint. STUDY DESIGN: A PubMed literature search with specific indexing terms and a hand search were made. Two reviewers assessed the level of evidence of relevant publications as high, moderate, or low. Based on this, the evidence grade for diagnostic efficacy was rated as strong, moderately strong, limited, or insufficient. RESULTS: The literature search yielded 494 titles, of which 22 were relevant. No publication had a high level of evidence, and 12 had moderate and 10 low levels of evidence. The evidence grade for diagnostic efficacy expressed as sensitivity, specificity, and predictive values was insufficient. CONCLUSION: That evidence is insufficient emphasizes the need for high-quality studies on the diagnostic efficacy of MRI, incorporating accepted methodologic criteria.

Asunto(s)

Imagen por Resonancia Magnética , Osteoartritis/diagnóstico , Trastornos de la Articulación Temporomandibular/diagnóstico , Médula Ósea/patología , Toma de Decisiones , Humanos , Funciones de Verosimilitud , Variaciones Dependientes del Observador , Planificación de Atención al Paciente , Pronóstico , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Líquido Sinovial , Articulación Temporomandibular/patología , Disco de la Articulación Temporomandibular/patología

RESUMEN

OBJECTIVE: The aim was to study periapical status and the technical quality of root-filled teeth in Swedish adolescents and young adults in Malmö, Sweden. MATERIAL AND METHODS: The sample, collected from dental records in the Public Dental Service, consisted of notes and radiographs of all root-filled permanent teeth in all 19-year-olds born in 1979 (mean age at root filling=16.2 years). The sample for assessing periapical status and technical quality consisted of 124-153 teeth. The criterion for inclusion for assessing periapical status was a follow-up time of at least one year. Periapical status was assessed with the Periapical Index (PAI). Technical quality was analyzed from radiographs in two respects: sealing quality of the root canal and distance from the root filling to the radiographic apex. The radiographs were analyzed independently by two observers with inter-examiner kappa values of 0.82-0.85. RESULTS: Apical periodontitis was found in 52% of the teeth and occurred significantly more often among molars than among anterior teeth. As judged radiographically, 51% of the teeth were inadequately sealed. In 38%, the distance to the apex was >2 mm and overfilling was registered in 14% of the teeth. Compared with anterior teeth, significantly more root fillings of molars had a distance to the apex of >2 mm. Technical quality was statistically significantly correlated with periapical status at follow-up. CONCLUSIONS: The technical quality and periapical status of root-filled teeth in adolescents and young adults were unsatisfactory in about half of the teeth.

Asunto(s)

Fracaso de la Restauración Dental , Periodontitis Periapical/etiología , Obturación del Conducto Radicular/efectos adversos , Adolescente , Adulto , Niño , Índice CPO , Filtración Dental/etiología , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Estudios de Seguimiento , Humanos , Modelos Logísticos , Periodontitis Periapical/diagnóstico por imagen , Calidad de la Atención de Salud , Radiografía , Estudios Retrospectivos , Obturación del Conducto Radicular/estadística & datos numéricos , Suecia

RESUMEN

The aim was to evaluate the experiences of Swedish general dental practitioners (GDPs) with digital radiography and their opinion on the same, particularly regarding quality issues. A letter was sent to all GDPs in private care in Region Skåne, Sweden, asking whether they used digital radiography (n=513). The response rate was 79%. The number of private GDPs who replied that they used digital radiography was 106. The Public Dental Service in Region Skåne listed 33 GDPs who worked with digital radiography. Based on these answers, a questionnaire was sent to the GDPs working with digital radiography (n=139). The questionnaire comprised 27 questions about the dentists, the system of intra-oral digital radiography, and the GDPs' experiences of and opinions on issues regarding image quality and quality control. The response rate to the questionnaire was 94%. Almost all, 92%, worked with charge-coupled device (CCD) and complementary metal oxide semiconductor (CMOS) sensors. Most GDPs were satisfied with their digital radiographic system. The majority (65%) experienced problems. Detector failure and trouble with the software were common. The GDPs wrote that they used lower exposure times in digital radiography than traditional film radiography. The estimated reduction in exposure time was said to be between 51% and 75%. Thirty-five per cent continued to use film parallel with digital radiography. The answers indicated that less than half of the equipment (40%) underwent quality control. Quality controls, when conducted, were undertaken once or twice a year, mainly by technicians from the companies that had sold the digital equipment. Based on the results of the questionnaire, there seems to be a need to improve the maintenance and the quality of digital radiography. It is also important that the GDPs become more aware of the problems that can occur when a new technique is introduced and that they develop the skills to handle these problems.

Asunto(s)

Radiografía Dental Digital/normas , Actitud del Personal de Salud , Odontólogos , Odontólogas , Femenino , Humanos , Masculino , Pautas de la Práctica en Odontología , Sector Privado , Sector Público , Control de Calidad , Encuestas y Cuestionarios , Suecia

RESUMEN

OBJECTIVE: We sought to measure the bone mineral density (BMD) of various regions in the maxilla before implant treatment and to investigate correlations between these values and the BMDs of the spine and hip. STUDY DESIGN: Eighteen patients were examined by means of quantitative computed tomography, and the BMD of the maxillary alveolar ridge was calculated. The same patients also underwent dual-energy x-ray absorptiometry of the lumbar spine and the total hip. Analysis of variance was used to compare BMD values between and within individuals. The Pearson correlation coefficient was used to correct for sex and body mass and to calculate the correlation between the BMD of the maxillary alveolar ridge and the BMD of the spine and hip. RESULTS: The maxillary BMD varied significantly between individuals (P <.001) and within individuals (P <.001). The BMD of the anterior region of the maxilla was correlated significantly with the BMD of the lumbar spine (r=0.6; P <.05). CONCLUSION: A site-specific evaluation of maxillary bone tissue could be of value before implant treatment.

Asunto(s)

Densidad Ósea , Cadera/anatomía & histología , Vértebras Lumbares/anatomía & histología , Maxilar/anatomía & histología , Absorciometría de Fotón , Anciano , Análisis de Varianza , Femenino , Cadera/diagnóstico por imagen , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Valores de Referencia , Estadísticas no Paramétricas , Tomografía Computarizada Espiral