1/12. Nonsurgical and nonextraction treatment of skeletal Class III open bite: its long-term stability.Two female patients, aged 14 years 5 months and 17 years 3 months with skeletal Class III open bite and temporomandibular dysfunction are presented. They had previously been classified as orthognathic surgical cases, involving first premolar removal. The primary treatment objective was to eliminate those skeletal and neuromuscular factors that were dominant in establishing their malocclusions. These included abnormal behavior of the tongue with short labial and lingual frenula, bilateral imbalance of chewing muscles, a partially blocked nasopharyngeal airway causing extrusion of the molars, with rotation of the mandible and narrowing of the maxillary arch. Resultant occlusal interference caused the mandible to shift to one side, which in turn produced the abnormal occlusal plane and curve of Spee. As a result, the form and function of the joints were adversely affected by the structural and functional asymmetry. These cases were treated by expanding the maxillary arch, which brought the maxilla downward and forward. The mandible moved downward and backward, with a slight increase in anterior facial height. Intruding and uprighting the posterior teeth, combined with a maxillary protraction, reconstructed the occlusal plane. A favorable perioral environment was created with widened tongue space in order to produce an adequate airway. myofunctional therapy after lingual and labial frenectomy was assisted by vigorous gum chewing during and after treatment, together with a tooth positioner. Normal nasal breathing was achieved.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/12. Neuropathic orofacial pain. Part 2-Diagnostic procedures, treatment guidelines and case reports.Neuropathic orofacial pain can be difficult to diagnose because of the lack of clinical and radiographic abnormalities. Further difficulties arise if the patient exhibits significant distress and is a poor historian regarding previous diagnostic tests and treatments, such as somatosensory local anaesthetic blockade. Valuable information can be obtained by utilising the McGill Pain Questionnaire that allows the patient to choose words that describe the qualities of his/her pain in a number of important dimensions (sensory and effective). Basal pain intensity should be measured with the visual analogue scale, a simple instrument that can evaluate the efficacy of subsequent treatments. The dentist or endodontist can employ sequential analgesic blockade with topical anaesthetics and perineural administration of plain local anaesthetic to ascertain sites of neuropathology in the PNS. These can be performed in the dental chair and in a patient blinded manner. Other, more specific, tests necessitate referral to a specialist anaesthetist at a multidisciplinary pain clinic. These tests include placebo controlled lignocaine infusions for assessing neuropathic pain, and placebo controlled phentolamine infusions for sympathetically maintained pain. The treatment/management of neuropathic pain is multidisciplinary. Medication rationalisation utilises first-line antineuropathic drugs including tricyclic antidepressants such as amitriptyline and nortriptyline, and possibly an anticonvulsant such as carbamazepine, sodium valproate, or gabapentin if there are sharp, shooting qualities to the pain. mexiletine, an antiarrhythmic agent and lignocaine analogue, may be considered following a positive patient response to a lignocaine infusion. All drugs need to be titrated to achieve maximum therapeutic effect and minimum side effects. Topical applications of capsaicin to the gingivae and oral mucosa are a simple and effective treatment in two out of three patients suffering from neuropathic orofacial pain. Temporomandibular disorder is present in two thirds of patients and should be assessed and treated with physiotherapy and where appropriate, occlusal splint therapy. attention to the patient's psychological status is crucial and requires the skill of a clinical psychologist and/or psychiatrist with pain clinic experience. Psychological variables include distress, depression, expectations of treatment, motivation to improve, and background environmental factors. Unnecessary dental treatment to "remove the pain" with dental extractions is contraindicated and aggravates neuropathic orofacial pain.- - - - - - - - - - ranking = 0.25keywords = extraction (Clic here for more details about this article) |
3/12. Oro-dental manifestations of the Schwartz-Jampel syndrome.A boy with the Schwartz-Jampel syndrome (chondrodystrophic myotonia) had a number of oro-dental complications. These included difficulty in tooth extraction and orthodontic care due to a small oral aperture and rigidity of the temporo-mandibular joints. General anaesthesia was hazardous because of a propensity to malignant hyperthermia, and endotracheal intubation was difficult because of shortness and rigidity of the neck and the small size of the laryngeal structures. awareness of these potential problems is crucial for anaesthesia and comprehensive dental management. The radiological demonstration of dentigerous cysts is a hitherto unreported observation in this disorder.- - - - - - - - - - ranking = 0.25keywords = extraction (Clic here for more details about this article) |
4/12. Oral and maxillofacial surgery in patients with chronic orofacial pain.PURPOSE: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required surgical treatment as recommended by an interdisciplinary orofacial pain team. The major goal of this investigation was to determine the role of oral and maxillofacial surgery in patients with chronic orofacial pain. patients and methods: The study population included patients seen at the Center for Oral, Facial and Head Pain at new york Presbyterian Hospital from January 1999 through April 2001. (120 patients; female-to-male ratio, 3:1; mean age, 49 years; average pain duration, 81 months; average number of previous specialists, 6). The patient population was evaluated by an interdisciplinary orofacial pain team and the following characteristics of this population were profiled: 1) the frequency and types of previous surgical procedures, 2) diagnoses, 3) the frequency of previous misdiagnoses, and 4) treatment recommendations made by the center team. RESULTS: There was a history of previous oral and maxillofacial surgical procedures in 38 of 120 patients (32%). Procedures performed before our evaluation included endodontics (30%), extractions (27%), apicoectomies (12%), temporomandibular joint (TMJ) surgery (6%), neurolysis (5%), orthognathic surgery (3%), and debridement of bone cavities (2%). Surgical intervention clearly exacerbated pain in 21 of 38 patients (55%) who had undergone surgery. Diagnoses included myofascial pain (50%), atypical facial neuralgia (40%), depression (30%), TMJ synovitis (14%), TMJ osteoarthritis (12%), trigeminal neuralgia (10%), and TMJ fibrosis (2%). Treatment recommendations included medications (91%), physical therapy (36%), psychiatric management (30%), trigger injections (15%), oral appliances (13%), biofeedback (13%), acupuncture (8%), surgery (4%), and Botox injections (1%) (Allergan Inc, Irvine, CA). Gross misdiagnosis leading to serious sequelae, with delay of necessary treatment, occurred in 6 of 120 patients (5%). CONCLUSIONS: Misdiagnosis and multiple failed treatments were common in these patients with chronic orofacial pain. These patients often have multiple diagnoses, requiring management by multiple disciplines. Surgery, when indicated, must be based on a specific diagnosis that is amenable to surgical therapy. However, surgical treatment was rarely indicated as a treatment for pain relief in these patients with chronic orofacial pain, and it exacerbated and perpetuated pain symptoms in some of them.- - - - - - - - - - ranking = 0.25keywords = extraction (Clic here for more details about this article) |
5/12. A European Board of orthodontics case report. Case category: severe skeletal discrepancy.OBJECTIVES: this 18.1 year-old girl presented with a chief complaint of progressive worsening of facial and dental esthetics, crowding, headache and facial pain. MATERIALS AND methods: clinically, she was at the end of her growth and exhibited a severe facial asymmetry, but with normal sagittal and vertical cranial relationships. Clicking in the right TMJ was evident. This was accompanied by a deviation upon opening, and pain in the joint. The pain she experienced during jaw movement, and upon palpation, was significant. There was a shift to the right from centric relation to intercuspal position. Intraorally, the tissues were normal, with mild tetracycline staining, still present primary canines, impacted third molars and upper permanent canines. Her first molars had fillings. Orthodontically, her occlusion was a severe Class III subdivision left, with a severe right-side crossbite, lower midline deviation to the right 6 mm, and a 1 mm lateral shift in intercuspal position. She also exhibited severe crowding and asymmetry in both arches. The sequence of her treatment was as follows: (a) extraction of primary canines and impacted third molars, surgical exposure of impacted canines, (b) lower occlusal splint for TMJ dysfunction and an upper arch fixed appliance for ideal alignment and leveling, (c) upper occlusal splint for the maintenance of TMJ function and lower arch fixed appliance for ideal alignment and leveling, (d) surgical skeletal correction, (e) post-surgical orthodontic finishing, (f) post-treatment retention.- - - - - - - - - - ranking = 0.25keywords = extraction (Clic here for more details about this article) |
6/12. Cementable implant-supported prosthesis, serial extraction, and serial implant installation: case report.Cement-retained implant-supported prostheses are particularly indicated where access for screw placement is limited or impossible like in posterior locations or where there is limited jaw opening. The patient in this case report suffered from limited jaw opening as a result of a long history of temporomandibular joint ankylosis related to hemophilia. Cement-retained implant-supported prostheses coupled with serial extraction, serial implant installations, and chairside provisional restorations made uneventful treatment possible.- - - - - - - - - - ranking = 1.25keywords = extraction (Clic here for more details about this article) |
7/12. Nonsurgical and nonextraction treatment of a skeletal class III adult patient with severe prognathic mandible.AIM: A patient with a skeletal Class III malocclusion, prognathic mandible, anterior open bite, large tongue, and temporomandibular disorders is presented. Treatment objectives included establishing a stable occlusion with normal respiration, eliminating temporomandibular disorder symptoms, and improving facial esthetics through nonextraction and nonsurgical treatment by creating a favorable perioral environment, restoring the harmony to the tongue and perioral environment, improving masticatory muscle function, and creating adequate tongue space for establishment of normal respiration. SUBJECT AND methods: The patient was a Japanese adult male, who had previously been advised to have orthognathic surgery, with tongue-size reduction. An expansion plate was used to expand the maxillary dentoalveolar arch. Distalization of the mandibular arch was achieved by reduced excessive posterior vertical dimension, through uprighting and intruding the mandibular posterior teeth and rotating the mandible slightly counter-clockwise. The height of the maxillary alveolar process and the vertical height of symphysis were increased slightly. The functional occlusal plane was reconstructed by uprighting and intruding the posterior teeth with a full-bracket appliance, combined with a maxillary expansion plate, with short Class III and vertical elastics in the anterior area. myofunctional therapy involved sugarless chewing gum exercises. RESULTS: The excessive posterior vertical occlusal dimension was reduced slightly, creating a small clearance between the posterior maxilla and mandible. At the same time, the interferences in the posterior area were eliminated by the expansion of the maxillary dentoalveolar arch. As a result, the laterally displaced mandible moved to a more favorable jaw relationship, with distalization of the mandibular arch. The functional occlusal plane was reconstructed and an almost-normal overjet and overbite were created. Adequate tongue space for normal respiration was established during the early stage of treatment, by 7 months. A stable occlusion, with adequate posterior support and anterior guidance, was established and maintained at more than 4 years posttreatment.- - - - - - - - - - ranking = 1.25keywords = extraction (Clic here for more details about this article) |
8/12. Septic arthritis of the temporomandibular joint successfully treated with arthroscopic lysis and lavage: case report and review of the literature.Septic arthritis of the temporomandibular joint (TMJ) is infrequently reported. We present a case of septic arthritis of the TMJ following the extraction of the left upper second molar that occurred 1 week before beginning of symptoms. No evident predisposing factors were detected. Arthroscopic diagnosis of septic arthritis, lysis and lavage, and capsular stretch were performed. Cultures taken from the TMJ space grew streptococcus sp. After 1 month of antimicrobial therapy the patient was asymptomatic and mandibular function was normal. literature related to septic arthritis of TMJ and its treatment was reviewed. Different surgical procedures are available to treat this condition. arthroscopy should be preferred as initial treatment on account of the possibility of drainage and accurate lavage under direct visualization of joint space, at the same time allowing confirmation of diagnostic hypotheses. Improving joint mobility with lysis of adhesions and capsular stretch in an early stage of disease may be helpful in stopping the fibrosis process.- - - - - - - - - - ranking = 0.25keywords = extraction (Clic here for more details about this article) |
9/12. A new look at the treatment of Class II Division 2 malocclusions.This case report illustrates a treatment option for managing a skeletal Class II relationship with a Class II Division 2 malocclusion and impinging overbite. The patient's maxillary first premolars were extracted during unsuccessful orthodontic treatment at age 15. These extractions and the retraction of the maxillary anterior teeth during space closure worsened the facial profile deficiency caused by the original facial skeletal Class II discrepancies. During the retreatment described here, the second premolars were moved into the place of the previously extracted first premolars. The opened spaces at the second premolars were then restored with implant-supported restorations. Lingual brackets were used to correct the severe overbite. This approach created sufficient overjet to correct the Class II skeletal relationship with bisagittal mandibular advancement osteotomy. Reconstruction of the skeletal and occlusal relationships resulted in a more desirable facial profile for this patient.- - - - - - - - - - ranking = 0.25keywords = extraction (Clic here for more details about this article) |
10/12. retreatment of a patient who presented with condylar resorption.This case report describes the retreatment of a patient whose initial nonextraction treatment several years earlier had been unsuccessful. When she sought new treatment, she had an open bite, proclined incisors, and severe temporomandibular joint derangement with almost complete resorption of the condyles. The new treatment, which included extractions and surgery, gave her balanced and harmonious facial proportions, a Class I occlusion with normal overjet and overbite, and a healthy dentition. There was no further loss of condylar tissue and the temporomandibular joints were asymptomatic.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
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