Maximum Interincisal Distance Research Articles

The Outcome of Temporomandibular Joint Disc Repositioning with Retrodiscal Contracture

Statement of the Problem: One of the common surgical procedure for management of mechanical interferences in TMJ is disc repositioning procedure. Disc repositioning for TMJ internal derangement is established procedure with variable success and means of fixation. The purpose of this study is to assess the outcome of using temporomandibular joint (TMJ) arthroscopy disc repositioning with retrodiscal contracture as a minimally invasive surgical treatment for TMJ internal derangement (ID). Materials and Methods: 25 patients, were treated in the period from 2015-‌ 2017. All patients were evaluated for changes in preoperative versus postoperative clinical assessment through visual analog scale score (VAS), maximum interincisal opening distance, Joint loading Sign, joint noise and pain, muscle pain, diet and medication intake. Methods of Data Analysis: All patients were followed up for 1 year after treatment. Statistical analyses included the Student t test and Chi square test to determine if there were significant differences in preoperative and postoperative assessments. Results: 25 patients (32 TMJ), the mean age was 39 years; 21 were female and 4 male. 13 classified as Wilkes II, 19 as Wilkes III. The success rate was 72% based on improvement of joint pain. The study showed statistically significant improvement in all outcome variables except muscle pain. Conclusion: Clinical outcome data presented show that TMJ arthroscopy disc repositioning with retrodiscal contracture is an effective, predictable surgical treatment. The present study further specifies Wilkes II, early III TMD patients as the most successful category of patients for such procedure.

Comparative Evaluation of Novel Gel-Containing Curcumin, Aloe vera, and Honey with Triamcinolone Acetonide as an Adjunct to Oral Physiotherapy in Oral Submucous Fibrosis Patients: A Pilot Study

Background and Objective: Oral submucous fibrosis (OSMF) is a juxtraepithelial inflammatory reaction followed by fibro elastic change of lamina propria. Hence, the inflammation is a definite component of OSMF. Combinations of turmeric, Aloe vera, and honey have antioxidant and anti-inflammatory effects which may act synergistically to serve as beneficiary for treating OSMF disease. Hence, the present study aims to compare the efficacy of topical application of novel gel containing curcumin, Aloe vera, honey, and physiotherapy with 0.1% triamcinolone acetonide and physiotherapy in the reduction of clinical signs and symptoms of OSMF patients. Materials and Methods: A total of 20 clinically diagnosed OSMF patients were divided into two groups containing 10 patients each. Participants including in Group A were treated with topical application of novel gel-containing curcumin, Aloe vera, and honey along with physiotherapy. Group B patients were treated with the topical application of 0.1% triamcinolone acetonide along with physiotherapy. Participants were evaluated at baseline and at the 7th day, 14th day, and 21st day. They were evaluated for mouth opening (maximum interincisal distance) and burning sensation (Visual Analogue Scale). Results: The reduction in burning sensation and increase in mouth opening is observed in both the groups. Both groups showed no statistically significant difference. Thus, both are statistically equally effective. Reduction burning sensation at the 21st day was more in Group A than in Group B, but difference is not statistically significant. Conclusion: Novel gel is as effective as topical steroid triamcinolone acetonide in reducing the signs and symptoms of OSMF.

Comparison between TMJ arthrocentesis techniques with different needle positions: A randomized single-blind controlled clinical trial

Abstract Objective To compare different temporomandibular joint (TMJ) arthrocentesis techniques with needles arranged in two different patterns. Materials and methods Two groups of TMJ arthrocentesis techniques were studied: group 1, with the classic positioning of the needles; and group 2, with a parallel positioning of the needles. Clinical data (patient’s pain perception and mandibular movements) were evaluated before and 18 months after arthrocentesis. The duration of the procedure was also recorded. Results Forty patients were equally and randomly divided into the two groups. The paired Student’s t-test showed that both arthrocentesis procedures reduced the intensity of patient pain perception and improved mandibular movements (maximal interincisal distance, protrusion, and laterality) with statistically significant differences between the evaluations before and after the TMJ arthrocentesis (p Conclusion Both arthrocentesis procedures reduced the intensity of patient pain perception and improved mandibular movements. The two-needle TMJ arthrocentesis with parallel positioning of the second needle was performed more quickly, and should be chosen whenever possible.

Clinical variables associated with the presence of articular pain in patients with temporomandibular joint clicking.

To study and estimate the impact of clinical, somatosensory, and psychosocial variables associated with the concomitant presence of temporomandibular joint (TMJ) pain in patients with TMJ clicking. Ninety-three individuals composed the sample: patients with painful TMJ clicking (n = 47) and patients with painless TMJ clicking (n = 46). Four categories of data were evaluated: clinical features (gender, maximal interincisal distance (MID), side of complaint, age); bruxism (sleep bruxism (SB), awake bruxism (AB)); somatosensory (mechanical pain threshold (MPT), wind-up ratio (WUR), pressure pain threshold (PPT), conditioned pain modulation (CPM)); and psychosocial (Pittsburgh Sleep Quality Index (PSQI), pain vigilance and awareness questionnaire (PVAQ), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK/TMD), Oral Behaviors (OBs)). Female gender, AB, WUR, CPM, PSQI, PCS, and OBs significantly (p < 0.05) increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. On the other hand, MID, MPT, and PPT significantly (p < 0.05) decreased this chance. The other variables had no association. It can be concluded that being a woman, having AB, hyperalgesia in WUR, less efficient CPM, poor sleep quality, pain catastrophizing, and harmful OBs significantly increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. In the opposite, high figures of MID, MPT, and PPT decreased the chance. Most patients with TMJ clicking usually postpone seeking treatment until the clicking truly disturbs or there is a concomitant presence of TMJ pain. Understanding the variables associated with this concomitance can be important in clinical practice.

Correlation between joint effusion and clinical symptoms, magnetic resonance imaging and arthroscopic findings in patients with temporomandibular joint disease

ObjectivesThe aim of this study was to evaluate the relationship between temporomandibular joint (TMJ) effusions and clinical, magnetic resonance imaging and arthroscopic variables. MethodsWe designed a retrospective cohort study of patients attending our Department who presented temporomandibular joint disease according to the Research Diagnostic Criteria for Temporomandibular Disorders. According to the presence of effusion in magnetic resonance imaging, the sample was divided into 2 groups: patients with or without joint effusion. ResultsA total of 203 patients fulfilled the inclusion criteria, of which 99 (48.8%) showed no joint effusion and 104 (51.2%) presented effusion. We found no significant differences between clinical variables and joint effusion. However, patients without effusion showed significantly longer duration of symptoms that patients with effusion (mean = 34.8 months, standard deviation = 43.41 vs 20.25, 23.76; p = 0.005). We found no significant differences in magnetic resonance imaging and arthroscopic variables associated with the presence of effusions. For both groups, there were statistically significant differences in values of mean pain scores and mean maximum interincisal distance between the different times of examination (before surgery and 3, 6 and 12 months after surgery). ConclusionJoint effusion is not associated with clinical, imaging or arthroscopic variables, but may be a clinical characteristic of early stages of temporomandibular joint disease.

Arthroplasty Followed by Distraction Osteogenesis Versus Distraction Osteogenesis Followed by Arthroplasty in the Management of TMJ Ankylosis: A Comparative Study.

To compare treatment outcome of arthroplasty followed by distraction osteogenesis (AFD) and distraction osteogenesis followed by arthroplasty (DFA) in the management of mandibular deficiencies in temporomandibular joint (TMJ) ankylosis. A total of 20 patients with TMJ Ankylosis were included in the study. Patients were randomly divided into two groups. Group 1 consisted of patients for whom arthroplasty was done prior to distraction osteogenesis (AFD) for the correction of deficient mandible. Group 2 included patients where distraction osteogenesis was performed prior to arthroplasty (DFA). The treatment outcome was assessed based on maximum interincisal distance, overjet, corpus length, ramus height, upper airway, lower airway, duration of the procedure and the complications for the treatment at the end of 3, 6 and 12months. After the treatment was ended, the patients of both groups had increase in mouth opening and appearance was improved remarkably. There was general increase in all the parameters in both the groups. But at the end of 12months, airway and the ramus height were more stable and the control of the proximal segment was superior in DFA group. Open bite was noticed in 2 cases of AFD group which was treated by elastics. There required additional surgery for the removal of distractors in the AFD Group. Establishing the airway during the surgery was easier in AFD group. The study concludes that distraction followed by arthroplasty was a better procedure for the management of TMJ ankylosis owing to its stable results and less number of surgeries.

Assessment of Maximum Mouth Opening of Public Primary and Secondary School Children in Ibadan, Nigeria

Background: Excessive opening of the mouth has been reported to cause clinical problems such as luxations and traumatic injury to the temporomandibular joint (TMJ). The knowledge of the normal range of mouth opening will help to avoid excessive opening of the mouth which can cause injury to the TMJ of patients during procedures that involve mandibular manipulations. Maximum mouth opening (MMO) has age, race, gender and ethnic variations. Previous studies have looked at normal range of mouth opening among adults, but to the best of our knowledge, no study has looked at this among the paediatric/children population in Nigeria. Thus, this study aimed to determine the normal maximum mouth opening (MMO) among the paediatric population in Ibadan (South Western part of Nigeria) and the effect of gender, age, height and weight of these children on their MMO.&#x0D; Materials and methods: Six hundred and nine primary and secondary school pupils aged 6 – 15 years were included in this study. Patients with any condition affecting the temporomandibular joint (TMJ) function were not included. Measurements of height, weight and two readings of maximum interincisal distance were performed for each participant. Student's t-test, one-way analysis of variance (ANOVA) and Pearson bivariate correlation were used to assess the sample.&#x0D; Results: The mean MMO was 44.0 ± 5.3 mm and 42.6 ± 5.6 mm for males and females respectively. There was no significant difference in the MMO of males and females (t= 0.335, p = 0.563). MMO increases gradually with age irrespective of the gender and this was statistically significant (F= 17.1, p =0.001).&#x0D; Conclusion: The maximum mouth opening established for the paediatric population in this study will help practitioners whose care involves the stomathognathic system to have information about the normal range of mouth opening in this group of patients. The result will also be useful asbaseline for future research.&#x0D;

Maximum mandibular mobility in patients with temporomandibular disorders.

Assessment of mandibular mobility is an integral part of many dental examinations. Yet, information on the maximum range of mandibular motion in large groups of patients with temporomandibular disorders (TMDs) is limited. Therefore, we analyzed the corresponding data of 500 TMD patients who had presented at the University Center for Dental Medicine Basel. All measurements had been carried out by one examiner. The average maximal values for unassisted jaw opening, protrusion, and movement to the right and left were 49.3 mm (SD: 9.1), 8.8 mm (SD: 2.3), 9.4 mm (SD: 2.5), and 11.8 mm (SD: 3.1), respectively. Since activities such as chewing, talking, oral hygiene or even yawning require neither very wide openings nor extensive lateral or protrusive excursions, we would like to propose the following general threshold values for impaired mandibular function: maximum interincisal distance < 30 mm; maximum laterotrusion as well as maximum protrusion < 5 mm. These cut-off values, which are lower than those traditionally suggested in the dental literature, appear to be sufficient to carry out functionally undisturbed mandibular movements. By lowering the traditionally higher thresholds, the spectrum of anatomical and functional variability is increased. In this way, patients and non-patients may be protected against medicalization, overdiagnosis, and overtreatment.

Maximum mandibular mobility in patients with temporomandibular disorders.

Assessment of mandibular mobility is an integral part of many dental examinations. Yet, information on the maximum range of mandibular motion in large groups of patients with temporomandibular disorders (TMDs) is limited. Therefore, we analyzed the corresponding data of 500 TMD patients who had presented at the University Center for Dental Medicine Basel. All measurements had been carried out by one examiner. The average maximal values for unassisted jaw opening, protrusion, and movement to the right and left were 49.3 mm (SD: 9.1), 8.8 mm (SD: 2.3), 9.4 mm (SD: 2.5), and 11.8 mm (SD: 3.1), respectively. Since activities such as chewing, talking, oral hygiene or even yawning require neither very wide openings nor extensive lateral or protrusive excursions, we would like to propose the following general threshold values for impaired mandibular function: maximum interincisal distance < 30 mm; maximum laterotrusion as well as maximum protrusion < 5 mm. These cut-off values, which are lower than those traditionally suggested in the dental literature, appear to be sufficient to carry out functionally undisturbed mandibular movements. By lowering the traditionally higher thresholds, the spectrum of anatomical and functional variability is increased. In this way, patients and non-patients may be protected against medicalization, overdiagnosis, and overtreatment.

Comparison of two needles arthrocentesis versus double needle cannula arthrocentesis in the treatment of temporomandibular disc displacement

ABSTRACT Objective To compare clinical and imaging results of two needles arthrocentesis (TNA) versus double-needle cannula arthrocentesis (DNCA) in the treatment of temporomandibular joint disc displacement (DD). Methods Twenty patients with DD were randomly divided into two groups: TNA and DNCA. Clinical data (pain scores; maximal interincisal distance [MID], and protrusion and laterality movements) were evaluated before and 24 months after the arthrocentesis. Disc and condyle position and joint effusion (JE) were evaluated by magnetic resonance exams. Results Both groups presented improvement in the MID, including pain reduction, modifications in disc and condyle positions, and reduction of the presence of JE, without difference between groups (p > 0.05). The DNCA was performed significantly faster (p = 0.0001). Conclusion Both TNA and DNCA are efficient in promoting improvement in the MID: reduction in pain, modifications in disc and condyle positions, and, in part, may account for less JE, without difference between techniques.

The Effect of Submucous Dexamethasone Injection on the Post-Operative Sequelae After Impacted Third Molar Surgery

Background: Different method were attempted by many researchers to reduce postoperative inflammatory response following surgical extraction of lower wisdom teeth because this is a very common procedure and is usually associated with pain, difficulty in mouth opening and swelling. Aims: To assess the effect of sub mucosal injection of 4mg/1ml dexamethasone on reduction of postoperative pain, facial swelling and trismus following the surgical extraction of impacted lower wisdom teeth. Materials and Method: forty patients were selected to be included in this randomized clinical study with a total number of 42 impacted mandibular third molars, they divided randomly into two groups, control and study group of twenty patients for each, patients in the study group received 4mg/1 ml submucos injection of dexamethas one, while patients in the control group received placebo (normal saline) five minutes after local anesthesia administration, and surgical removal of impacted teeth was done after further five minutes. evaluation of mouth opening and swelling was done as a baseline and on the second and seventh post-operative days after surgery, while pain was scored daily until the 7 th postoperative day by the patient according to numerical rating scale. Assessment of trismus was done by measuring the maximum interincisal distance swelling was evaluated by measuring the distance between five selected points. Every one of these factors in addition to the time of surgery were compared between the two groups. Results: Study group showed less limitation in mouth opening than control group but there was no statistically significant difference between them however study group showed a significant reduction in pain scores on the first and the second post-operative days and a significant improvement of swelling compared with the control group at the 48 hour follow up. Conclusion: Submucosal injection of dexamethasone was effective in minimizing facial swelling, Pain and trismus after surgical extraction of mandibular third molar.

Comparison of Different Kinesio Taping Techniques After Third Molar Surgery

Elastic therapeutic taping method has been shown to reduce pain and edema after surgery. The purpose of the present study was to compare the effects of 2 different Kinesio taping (KT) techniques on swelling, pain, and trismus after third molar surgery. The study was designed as a split-mouth, single-blinded, and controlled randomized clinical trial. Patients undergoing lower impacted third molar extraction at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, were included in the present study. Group I included 30 patients and was used to compare the classic KT technique (technique A) and the new KT technique (technique B). Group II included 15 patients and was used to compare the classic KT technique (technique A) and no KT (No-KT [control]). Group III included 15 patients and was used to compare the new KT technique (technique B) and No-KT (control). Swelling was assessed using the 3dMD Face System (3dMD, Atlanta, GA). The maximum interincisal distance was recorded using a digital caliper preoperatively (T0) and at postoperative days 2 (T1) and 7 (T2). The visual analog scale for pain scores were recorded postoperatively at 30minutes, 1, 2, 3, 4, 5, 6, 8, 10, 12, and 24hours, and 1, 2, 3, 4, 5, 6, and 7days. The effects of operative time, patient age, and patient gender were also evaluated. The data from 60 patients (27 men and 33 women) with a mean age of 22.28years (range, 18 to 31years) were analyzed in the present study. The amount of swelling and the interincisal distance were less with technique B than with technique A and no KT (control group). KT is a useful method for reducing postoperative morbidity after impacted third molar extraction. In particular, the application of KT using the new technique described in the present study could be more effective than the classic methods.

Comparison of Triamcinolone Versus Platelet Rich Plasma Injection for Improving Trismus in Oral Submucous Fibrosis

Objective: To compare the effect of Triamcinolone versus Platelet Rich Plasma (PRP) injection intraorally for improving trismus in Oral Submucous Fibrosis (OSMF). Study Design and setting: Randomized double-blind comparative study, conducted at ENT department of PNS Shifa Hospital, Karachi from 1st June 2015 to 30th June 2016. Methodology: Eighty patients with trismus due to oral submucous fibrosis were divided randomly into two groups, ‘A’ and ‘B’ of 40 patients each. In Group A, Inj. Triamcinolone 40mg (1 ml) was injected into the sub-mucosal plane in the retro-molar trigone area and into the fibrous bands along the soft palate on multiple sites, weekly for 6 weeks. In group B Inj. PRP 1ml weekly was administered for 6 weeks along the same site. Vernier calipers were used to precisely measure the Maximum Interincisal Distance (MIID) in cms before and after the treatment. Result: There was a male preponderance in the study group with a male to female ratio of 5.1:1. In group ‘A’ mean pretreatment MIID was 2.3±0.7 cms, while in group ‘B’, it was 2.2± 0.5 cms. After completion of 6 weeks treatment the mean MIID improved in group ‘A’ to 3.08 ± 0.8cms, and in group ‘B’ to 3.22± 0.5cms. The mean improvement in MIID in group ‘A’ was 0.783± 0.25cms compared to 1.01± 0.05 cms in group ‘B’ (p &lt; 0.05). Conclusion: Intraoral injection of PRP is more effective than Triamcinolone in improving trismus due to OSMF

Retrospective analysis of a TMJ ankylosis protocol with a 9 year follow up

ObjectiveTemporomandibular joint ankylosis (TMJa) is a debilitating condition that causes difficulty in mastication, speech and mouth opening. Its treatment poses surgical and rehabilitative challenges along with a high incidence of reankylosis. This study was designed to assess the long-term outcomes with a new two phase physiotherapy protocol following conservative resection of the ankylotic mass. Materials and methods143 patients who were treated for TMJa were initially recruited, among whom 98 were inducted into the study and retrospectively evaluated using clinical records and 3-dimensional computed tomography. All the patients underwent a minimal pre auricular incision and conservative interpositional gap arthroplasty with collagen membrane. This was followed by the new two phase physiotherapy protocol with the use of a bite block. The primary outcome measures were the maximum interincisal distance, vertical ramus height and complications. The patients were followed up at monthly intervals during the first year, quarterly intervals during the second year, and at intervals of 6 months during subsequent follow-up years. The mean follow up period was 6.38 ± 2.36 years after ankylotic release. Paired student t test was used for statistical analysis. ResultsThe mean scores for mouth opening at T1, T2 and T3 were statistically significantly different at all intervals (p < 0.0005). The mean scores for ramal length were statistically significantly different at T1 and T2 interval (p < 0.0005) and insignificant at T2 and T3 interval. No reankylosis was observed in patients who followed the physiotherapy protocol. ConclusionsIn the management of TMJa, the success of the conservative surgical technique with interpositional arthroplasty is less dependent on the longevity and rigidity of the interpositional material but more indebted to the patient compliance in following the proposed physiotherapy protocol.

Comparative Evaluation of IV Paracetamol Versus IV Dexmedetomidine in Inpatient Oral and Maxillofacial Surgery: A Double-Blinded Randomized Controlled Study

Reconstructive surgeries following fractures in the maxillofacial region often involve considerable bone manipulation, and paracetamol is a commonly used analgesic medication in both intraoperative and postoperative periods. Dexmedetomidine, an alpha-2 adrenoceptor agonist, has both sedative and analgesic properties with minimal cardiorespiratory effects and has been used primarily for its sedative properties in oral and maxillofacial surgery. To compare the intraoperative analgesic requirements among patients undergoing oral and maxillofacial surgery who receive IV paracetamol versus IV dexmedetomidine. The time to requirement for the first postoperative analgesic dose and safety and adverse events of both medications were also assessed. In total, 64 patients needing primary reconstructive surgery for facial fractures were recruited and divided into two groups for this double-blinded study. Patients were randomized to receive a preinduction dose of either IV paracetamol 1g (Group P) or IV dexmedetomidine 1µg/kg (Group D). Sedation scores (Ramsay sedation scale), maximal interincisal distance and pain scores at maximal mouth opening (visual analogue scale) were assessed in both groups just prior to and after the administration of the study drugs. After induction, Group P and Group D received a maintenance dose of normal saline and dexmedetomidine (0.5µg/kg/h) during the intraoperative period, respectively. Standard noninvasive cardiorespiratory monitoring was done for the entire duration of surgery. Following extubation, postoperative pain scores and the time to request for first analgesic dose in either group were recorded. The time taken to perform the surgery was comparable in both groups. There was a significant difference between the groups in visual analogue scores and interincisal distance after the bolus dose (p < 0.05). Systolic and diastolic blood pressure was significantly lower in Group D at around 150 and 175min of surgery. While the intraoperative fentanyl consumption was comparable in both groups, the time to request for the first analgesic dose in the postoperative period was significantly delayed in Group P (p < 0.05). No adverse cardiopulmonary events were observed in either group. The intraoperative anesthetic and analgesic requirements and hemodynamic stability were comparable in IV paracetamol and dexmedetomidine groups. Dexmedetomidine did not confer any enhanced analgesia effect in the postoperative period. More research examining the role of dexmedetomidine for longer duration inpatient oral and maxillofacial surgery is needed. http://ClinicalTrials.gov (No. CTRI/2017/08/009468).

A comparative clinical study on physiotherapy outcomes with wooden tongue depressors versus Heister jaw opener in oral submucous fibrosis patients

ObjectiveThe aim of this study was to compare mouth opening exercise outcomes with wooden tongue depressors (WTDs) versus Heister jaw opener (HJO) in improving mouth opening after reconstruction of the surgical defect with buccal fat pad (BFP) in oral submucous fibrosis (OSF) patients. Materials and methodsFifty consecutive patients were divided randomly into two groups (25 patients in each group) corresponding to postoperative physiotherapy with WTDs (group 1) and HJO (group 2) respectively. Groups 1 and 2 were evaluated for maximum interincisal distance at 3, 6 and 12 months of follow up. In groups 1 and 2, mouth opening differed substantially at all periods of follow up from preoperative values. ResultsThe increase in mouth opening was greater in group 2 at 3 (P = 0.003) and 6 (P = 0.010) month follow up visit respectively. No relevant difference was observed in mouth opening between groups 1 and 2 at 12 months (P = 0.066). The mean increase in mouth opening at 12 months compared with the preoperative value was 22.2 mm in group 1 and 25 mm in group 2. ConclusionWe conclude both WTDs and HJO are effective in improving postoperative mouth opening in OSF surgical patients.

The use of arthrocentesis in patients with temporomandibular joint disc displacement without reduction.

The aim of this study was to evaluate the efficacy of the use of the arthrocentesis in patients with disc displacement without reduction (DDWOR). Two hundred and thirty-four (234) patients with DDWOR were evaluated and the following data collected: gender; affected side; age (years); duration of the pain (months); patient's perception of pain (measured by Visual Analogue Scale [VAS 0–10]); maximal interincisal distance (MID) (mm); and joint disc position, determined by magnetic resonance imaging. Data were obtained in two different moments: before the arthrocentesis (M1) and three or four months later (M2). Paired t-Student Test, Scores Test and Wilcoxon Test showed a statistical significant difference (p<0.0001) between the M1 and M2 for the variables VAS and MID. There was an alteration in the joint disc position in 93.88% of the cases after arthrocentesis. There was no association between the general characteristics of the patients on the M1 and the results of the arthrocentesis (p>0.05). It can be concluded that the arthrocentesis is efficient in reducing the pain, in increasing interincisal distance, and altering the joint disc position in patients with DDWOR regardless gender, age side and pain duration.

A pilot study of the maximum interincisal distance among adult Northern and Southern Nigerians

Objective: To study the average maximum interincisal distance (MID) and its association with individual physical parameters and dietary pattern in a representative convenient sample of healthy adult Nigerians from two ethnic groups. Materials and Methods: This was a pilot cross-sectional study of healthy adults, free of temporomandibular joint (TMJ) disorders, aged 18–58 years in Ile-Ife (Southwest Nigeria) and Kano (Northwest Nigeria). MID, body weight, and height were determined using a clean wooden spatula on a transparent plastic linear gauge, calibrated body weight electronic scale, and wall-mounted height scale, respectively. Dietary habits and history were assessed using a validated structured questionnaire. MID was compared in each group and related to subjects' age, sex, height, and weight. Results: Of 853 subjects screened, 794 (93.1%), aged 18–58 years, met the inclusion criteria. About 393 (49.5%) and 401 (50.5%) subjects were from the Northwest (Kano City) and Southwest (Ile-Ife), respectively. The mean age of the subjects from the Northwest and Southwest Nigeria was 35.4 years and 26.7 years, respectively, and M:F ratio was 1:1.02. Female subjects recorded higher body mass index (BMI) and were slightly older than the males. Mean MID (SD) values in millimeters were 45.68 (6.7), 47.60 (7.73), and 46.69 (7.29) in the Southwest, Northwest, and combined groups, respectively. MID was significantly higher in males than females, peaked at age 33 years in both the sexes and, thereafter, decreased with increasing age. Conclusion: The MID vary with ethnic origin, weight, height, age, and BMI. A peak MID in adult appears to exist at about 33 years.

Temporomandibular joint arthrocentesis: a technique proposal. Case report

ABSTRACT BACKGROUND AND OBJECTIVES: Arthrocentesis is an effective treatment to reduce or eliminate pain, increase maximal interincisal distance, and to eliminate joint effusion in patients with disc displacement without reduction. This study aims to expose and to discuss a new technique proposal of temporomandibular joint arthrocentesis applied in the treatment of a single case of disc displacement without reduction. CASE REPORT: Female patient, 18-year-old patient sought treatment due to joint pain and mouth opening limitation. The maximal interincisal distance was 30.28mm. Magnetic resonance imaging confirmed the diagnosis of disc displacement without reduction with signs of joint effusion in the right temporomandibular joint. Temporomandibular joint arthrocentesis was performed under selective sensory nerve block of the auriculotemporal, the masseteric and posterior deep temporal nerves. Two needles were inserted in the upper compartment of the temporomandibular joint. In the second needle, a transparent catheter was connected into a vacuum pump. Clinically, after the arthrocentesis, the maximal interincisal distance increased to 46.25mm, and the patient referred no more pain. After six months, a magnetic resonance imaging was performed to observe the results, and there were no more signs of joint effusion. CONCLUSION: Temporomandibular joint arthrocentesis was an effective treatment for this patient with disc displacement without reduction. The aspect of this technique that is particularly relevant for clinical practice was the connection of a transparent catheter to a vacuum pump. In fact, it allowed the visualization of the solution fluidity, as well as guides the flow of the solution used for joint washing, optimizing the irrigation. However, new studies are necessary to compare different protocols of irrigation with and without the associated use of a vacuum pump.

Efficacy of Autologous Leucocyte-Platelet-rich Fibrin (L-PRF) versus Hydroxyapatite as a Graft Material for Socket Healing after Surgical Extraction of Impacted Mandibular Third Molars: A Comparative Clinical and Radiographic study

OBJECTIVE: The purpose of this study was to compare the efficacy of Leucocyte -platelet‑rich fibrin (L-PRF), and hydroxyapatite (HA) for reduction of pain and swelling, the incidence of dry socket, soft tissue healing, and bone regeneration after surgical removal of impacted mandibular third molar in human patients.Patients and Methods: Thirty-six patients (20 males and 16 females) requiring extraction of mandibular third molars were randomly grouped as L-PRF, HA, and Control‑treated. All the procedures were done on an outpatient basis without any complication such as lip numbness. The patients were assessed for postoperative pain, swelling and maximal inter-incisal distance on the 1st, 3rd and 7th postoperative days. Exposed bony socket wall (dry socket), as well as soft tissue healing (healthy granulation tissue Formation), were also assessed at 1st, 3rd, 7th and 14th day of postoperative periods depending on the standard methods. Assessment of daily and total analgesics consumption was done and Radiological assessment of the extraction site was done at 2 and 6 months interval. Results: Pain, swelling, interincisal distance, and soft tissue healing had statistically significant more improvement for L-PRF group compared to HA and control groups. Radiographic assessment showed comparatively lesser bone density values in PRF and control sites at 2 and 6 months than HA site. Conclusion: Our study showed that L-PRF is better graft materials than HA regarding pain, swelling, dry socket, and soft tissue healing post‑L-PRF placement in the extraction socket. Bone regeneration is induced quickly by HA as compared to PRF. However, study with a wide scale of clinical cases is very much essential to be more decisive regarding the efficacy of the graft materials.