The aim of the present 5-year follow-up was to clarify the nature of occlusal support status and radiographic changes in condyles of the elderly, and the association between these two variables.
The present study is part of a comprehensive medical survey of a random sample born in 1904, 1909, and 1914. A total of 364 subjects living in Helsinki participated in the dental part of the examination during 1990 to 1991, and after 5 years a total of 103 were reexamined. Comprehensive data on occlusal support status were available for 94 subjects, and radiographic data were available for 88 subjects. Occlusal support status was assessed on the basis of the Eichner index, radiographic changes were assessed from panoramic radiographs, and symptoms of temporomandibular disorders were assessed using Helkimo's anamnestic index.
The most frequent radiographic finding in the mandibular joint was flattening of the articular surface of the condyle associated with osteoarthrosis, found at baseline in 17% and during follow-up in 13% of the subjects. During the 5-year follow-up, Eichner index for natural dentition remained unaltered in 94% of the subjects and in 85% of the subjects when removable dentures were included. There were no radiographic changes in 92% of the cases. No differences based on age or gender were found. A logistic regression model revealed associations between the selected baseline factors. The odds ratio for baseline Helkimo's anamnestic index was 4.1, 5.7 for Eichner index with the support of removable dentures, and 356 for radiographic findings.
Radiographic changes in condyles of elderly people were small during the 5-year follow-up, but baseline radiographic findings, Helkimo's anamnestic index, and Eichner index with removable dentures were risk factors for radiographic findings at the end of the follow-up.
PURPOSE: The aim of this study was to evaluate by computed tomography (CT) and clinically the structure and function of costochondral grafts (CCG) used to replace the mandibular condyles. MATERIAL AND METHODS: CT and clinical examination were performed in 11 patients with CCGs (9 female, 2 male; mean age at surgery, 25 years; range, 9 to 44 years) approximately 4.5 years after surgery (range, 5 months to 10.5 years). One mandibular condyle was replaced in six patients and two in five patients. RESULTS: Facial asymmetry was observed in two cases and palpation tenderness of the TMJs or clicking and crepitation were found in 10 of 16 operated TMJs. In three cases coronal CT scans showed the graft to be situated laterally in the mandibular fossa, and lateral overgrowth of the graft was seen in three cases. In two cases, coronal CT slices showed that a new fossa had developed. In most cases translatory movement of the graft was minimal. The graft was either partially or almost completely mineralized, especially in cases with longer follow-up. CONCLUSIONS: Most of the patients in this study seemed to have benefitted from replacement of the deformed mandibular condyle with a CCG as estimated by improved range of mandibular movements and decreased symptoms. There were some problems related to unpredictable growth and location of the graft, as well as restricted movement of the replaced condyle. In the future, care should be taken to ensure proper postoperative functional therapy and to examine the role of cartilage thickness on future growth in young patients.
Displacement of the mandible in a child with congenital unilateral temporomandibular joint ankylosis treated with two-stage condylar replacement: a long-term study with the aid of roentgen stereometric analysis.
OBJECTIVE: To monitor mandibular displacement in three dimensions with a high degree of accuracy before, during, and after treatment. DESIGN: Prospective roentgen stereometric analysis from age 3 years 7 months to age 13 years 8 months. SETTING: Center for Craniofacial Anomalies and Department of Maxillofacial Surgery, Malmö University Hospital, Malmö, Sweden. PATIENT: Girl with unilateral congenital temporomandibular joint (TMJ) ankylosis and marked facial asymmetry. INTERVENTIONS: Epipharyngeal inspection at age 2 years 6 months and insertion of implants under general anesthesia. Resection of the affected right condyle at age 5 years 4 months, replacement of the ramus-condyle complex with a custom made titanium prosthesis at age 5 years 5 months, and replacement of the artificial condyle by a costochondral graft at age 9 years 7 months. Roentgen examinations were performed at intervals from age 3 years 7 months to age 13 years 8 months. Body length was measured annually. MAIN OUTCOME MEASURES: Stereo roentgenograms were digitized by the Department of Orthopedic Surgery, Malmö University Hospital. RESULTS: Unexpected lowering of the mandible occurred before treatment. Each procedure had a distinct effect on the direction of mandibular displacement. There was little or no pathological involvement of the functional matrix. Growth of the costochondral graft exceeded growth of the unaffected TMJ. Anterior displacement as well as rotation and tilting of the mandible to the unaffected side accelerated after the age of body peak height velocity. CONCLUSIONS: Accurate monitoring of mandibular displacement may contribute to a rationale for clinicians' decision on treatment protocol and reveal compensatory differential growth.
A random sample of panoramic radiographs was taken of 1027 (386 male and 641 female) university students. All the students were born between 1965 and 1971. The following were examined: caries, apical radiolucencies, endodontically treated teeth, marginal and vertical bone loss, third molars, supernumerary, missing, and persisting teeth, bone structure, condyles, maxillary sinuses and soft tissue calcifications. In the inter- (of two examiners) and intra-examiner variation Kappa indices varied between 0.15 and 1.00, and agreement percentages from 52, to 100. Kappa index was poor (0.15) in evaluation of the bone structure. The mean DMFT index for the students was 8.4. A sound dentition was found in 6.6%, and 48.4% of the students were free of caries. The mean number of carious lesions was 1.1. There were 50 retained roots (49 from primary teeth). 76.6% of the students had one or more unerupted wisdom teeth and 22.7% had radiologic changes typical of pericoronitis in the region of the mandibular third molars. 16.2% of the students had at least one missing wisdom tooth. Bone structure was normal in 92.4% of the students, idiopathic osteosclerosis being the most common divergence (3.5%). Arthrotic changes in the condyles were found in 9% of the students. In eight cases there was erosion of the condyles, which was diagnosed as arthritis. Styloid ligament calcifications were found in 21.5% of the students. In the maxillary sinuses, male students exhibited changes 1.7 times more often than female students (26.3% in males and 15.1% in females).
In the present survey the radiographic findings in the jaws of 124 clinically edentulous old people living at home in Helsinki, Finland, were studied, using panoramic radiography supplemented by intraoral radiographs. Only 9% of the subjects had root remains. Impacted teeth were found in 4%, radiolucent lesions in 3%, and radiopaque findings in 13%. Deviations from normal condylar structure were found in 17% and mucosal thickenings in the maxillary sinuses in 7%. The mental foramen was situated at the top of the residual ridge in 42% of the subjects. Topically situated mental foramen and condylar changes were commoner in women. The radiographic oral health status of the population studied was good.
The Radiation and Nuclear Safety Authority in Finland has paid attention to the large numbers of dental panoramic tomographs (DPTs), particularly in 7-12-year-old children. The majority of these radiographs are taken for orthodontic reasons. Because of the high radiosensitivity of children, the size of the irradiated field should be carefully chosen to yield the necessary diagnostic information at the lowest possible dose. The purpose of the present study was, therefore, to assess the outcome of DPTs within this age group in terms of type and location of pathological findings. It was also hypothesized that DPTs of orthodontic patients rarely display unrestored caries.
Four hundred and forty-one DPTs, taken of 7-12-year-old children in 2010-2014, were randomly sampled. The 413 of them (94%) that had been taken for orthodontic reasons were analysed.
All pathologic findings were restricted to the tooth-bearing area and there was no pathology in the bone structure or any incidental findings in the region of temporomandibular joint. Unlike hypothesized, 27% of the orthodontic DPTs showed caries in deciduous teeth and 16% in permanent teeth. A sub-sample of 229 DPTs, analysed for developmental dental and occlusal problems, most commonly displayed crowding (50%), positional anomalies and local problems with tooth eruption (32%), as well as hyperodontia (15%).
Inclusion of only the actual area of interest in the image field should be considered case-specifically as a means to reduce the radiation dose.