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Purpose: The aim of this study was to investigate the ability of clinical and magnetic resonance imaging (MRI) diagnoses to predict pain in the temporomandibular joint (TMJ)., Materials and Methods: One hundred forty-nine patients were examined by 2 calibrated examiners in strict accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All patients who presented with a defined clinical RDC/TMD diagnosis were included and underwent bilateral coronal and sagittal MRI of the TMJ. Two raters blinded to the clinical diagnosis interpreted the MRI scans for TMJ pathology. The results were tested against the clinical diagnosis according to the RDC/TMD, including pain-related disability and psychosocial status, for associations to TMJ arthralgia using logistic regression analysis (GENMOD procedure, P < .05)., Results: MRI-depicted anatomic changes, such as joint effusions, disc displacement, and osteoarthrosis, were not significantly correlated with the presence of pain in the TMJ. However, a significant relationship between pain on palpation of the masseter muscle origin (P = .0050) and psychosocial factors (P = .0452) and pain in the TMJ was demonstrated., Conclusions: Pain in the TMJ caused by the anatomic proximity of the muscle masseter origin and the lateral TMJ pole and the possible existence of trigger points in the musculature may lead to a false-positive or a false-negative diagnosis of arthralgia. Additionally, clinicians must consider the psychosocial aspects of pain in ideal treatment planning.

The aim of this in vitro study was to evaluate the fracture resistance of upper and lower incisors restored with glass fiber reinforced posts (FRP). There were 32 upper and 32 lower incisors endodontically treated and FRPs were cemented, using pretreated (Rocatec) and non-pretreated posts. Crowns were fabricated and cemented with Ketac-cem or Panavia. Additionally, eight upper and lower incisors with intact natural crowns were used as control groups. Mandibular incisors restored with FRPs attain fracture strengths comparable to those of natural teeth. The fracture strength of all teeth was increased by using Rocatec. Cementation of the crowns using Panavia only increased the fracture strength in upper incisors. Rocatec used to pretreat the posts and crowns cemented using an adhesive cement appear to reduce the risk of clinical failure.

Objective: The aim of this study was to investigate the influence of the age of the subject on inter-examiner reliability of the clinical signs of temporomandibular disorder (TMD)., Methods: Forty-three elderly (ES) and 44 younger adults (YS) were selected. The female/male distribution was almost the same in the two groups. All participants underwent clinical examination according to the Research Diagnostic Criteria for TMD, performed successively by two clinicians., Results: For metric measurements - with the exception of unassisted opening - the ES gave a significantly lower range of motion with both examiners and significantly worse percentage agreement between the examiners. A remarkable inter-examiner disagreement in the elderly was found with laterotrusion and protrusion movements. The prevalence of joint sounds was rated inconsistently by the examiners. The reliability of detection was not different in the two groups. The prevalence of tender muscle sites was also inconsistent. The overall percentage agreement for subjects with at least one tender muscle point was not age dependent. Because of the very low prevalence in ES, further statistical assessment of reliability is not possible., Conclusions: The age-dependent lower range of motion and the inferior reliability of metric measurements in the elderly could lead to wrong diagnoses. The reliability of detecting joint sounds and tender muscles was not age dependent within the limitations of the study.

Objective: The aim of this study was to investigate factors associated with the oral health-related quality of life (OHRQoL) of institutionalized elderly in Germany., Material and Methods: One-hundred-and-fifty-eight subjects from old people's homes were selected (mean 82.8 years). OHRQoL was measured using the Oral Health Impact Profile (OHIP). Denture characteristics (kind and age of denture, retention of removable denture, number of teeth in static occlusion) and general issues (age, gender, education level, and general pain status) were assessed. All factors were subjected to bivariate testing for their effects on the OHIP summary score (OHIP-SC) and to multivariate testing in subjects with removable dentures (n = 128); a linear regression model with backward elimination was used, with OHIP-SC as the dependent variable., Results: In the context of other studies, a median OHIP-SC of 29 indicated highly impaired OHRQoL. According to the bivariate analysis, retention, age of denture, number of teeth in static occlusion, general pain status, and education all exhibited significant influence on OHIP-SC. In the final linear regression model, general pain status, education level, and retention of denture remained at a statistically significant level. The model explained 34% (R2 = 0.34) of the variance of the OHIP-SC. The kind of denture had no significant impact on OHIP-SC., Conclusions: In contrast to other groups, the kind of denture exhibited little impact on OHIP-SC for this highly specific collective. However, there were functional aspects of dentures which seemed to be important. Non-dental factors had a striking effect on OHRQoL.

Aims: The aim of this in vitro study was to evaluate the fracture load of zircon frames veneered with a polymer glass holding box inlay-retained fixed partial dentures (FPDs). The influence of the position of the frame and the span length was tested. Additionally, the fracture load values of zircon frames veneered with a press ceramic were evaluated., Material and Methods: Box inlay cavities were prepared on mandibular molars and premolars. Forty-eight FPDs were manufactured using industrially prefabricated zircon frames veneered with the polymer glass Artglass. Sixteen FPDs received individually manufactured CAD/CAM zircon frames veneered with a press ceramic. All FPDs underwent thermal cycling and mechanical loading (ML). The load to fracture was measured and fracture sites were evaluated., Results: Four polymer veneered FPDs showed fractures in the veneering material after ML. The mean fracture resistance ranged from 531 N to 727 N. No significant influence of frame localization could be observed. Significantly greater fracture resistance values were found in the ceramic veneered FPDs (1276 N to 1413 N). There was no significant effect of span length in the polymer veneered group or in the all-ceramic group, with the exception of a significant peak in fracture load value for intermediate span lengths in the polymer group with a localized occlusal zircon frame., Conclusions: Polymer veneered FPDs with Y-TZP frames showed acceptable fracture resistance values, but they cannot yet be unreservedly recommended for clinical use. Fracture values for CAD/CAM manufactured Y-TZP frames combined with a press ceramic deserve further clinical investigation.

Purpose: The objective of this study was to investigate whether a systematically arranged shade guide system (Vita 3D-Master) allows clinicians to achieve a better shade match of a restoration, as compared to a conventional shade guide with a design based on empirical values (Vita Classical)., Materials and Methods: Fifty-nine restorations in 42 patients being treated by student clinicians were assessed. Using 1 of the 2 shade systems assigned randomly, each student independently determined the tooth shade. With the aid of a visual rating scale, the accuracy of the shade match of the finished restoration was assessed., Results: All restorations whose shades had been determined with the 3D-Master could be placed without any further shade corrections. In contrast, almost 17% of restorations determined with the conventional system required subsequent shade modifications. The match of the shades selected with the 3D-Master was judged significantly better by the clinicians., Conclusion: Within the limitations of the study, clinicians with less clinical experience who use a system that guides them through the shade-taking procedure in a relatively systematic manner will be more successful in selecting the correct tooth shade and in avoiding shade corrections. Clinical assessment of the restoration shades showed significant differences between the shade guide with a systematic design and that based on empirical values.

Purpose: We performed a comparative evaluation of different types of splint therapy for anterior disc displacement without reduction (ADDWR) of the temporomandibular joint., Patients and Methods: Seventy-four patients agreed to participate (65 females and 9 males). All patients were examined using a clinical temporomandibular joint disorder examination protocol, including muscle palpation, mandibular range-of-motion measurement, and joint sound detection. Additionally, the patients marked their pain (during chewing, mandibular movements, and rest position) and limitation levels on a visual analog scale. Bilateral magnetic resonance images were acquired, confirming ADDWR in at least one joint. After clinical examination and imaging, randomized splint therapy was provided: 38 patients received a centric splint, while 36 received a distraction splint. After 1, 3, and 6 months of therapy, outcome was evaluated using the Wilcoxon signed rank test for matched pairs. Success after 6 months was defined as improvement in active mouth opening of greater than 20% and pain reduction (on chewing) of at least 50%. Success was statistically verified using logistic regression test., Results: The improvements in mouth opening were significant in both groups. The improvements in pain on chewing, pain during other functions, pain at rest, functional limitation on chewing, and other functions were also comparable in both groups. However, the logistic regression test suggested that patients using centric splints were treated more successfully than the others (confidence interval, 1.014 to 8.741, odds ratio = 2.785)., Conclusions: Centric splints seem to be more effective than distraction splints. Therefore, before the surgical treatment of ADDWR, centric splints should be used instead of distraction splints.

MRI of the temporomandibular joint (TMJ) requires 1.5 T. The radiologist must be familiar with the anatomy and pathology of the TMJ. This review gives a description of MRI protocols for the TMJ, and MRI anatomy and pathology of the TMJ (open and closed mouth) by means of MR images and drawings. Diagnosing of the TMJ related diseases depends on standardized clinical and MR examinations. Therefore close interdisciplinary cooperation between dentist and radiologist is necessary.

Purpose: To assess the normal position of the temporomandibular joint (TMJ) disk relative to the condyle by using coronal magnetic resonance (MR) imaging in asymptomatic volunteers., Materials and Methods: This study was approved by the review committee for human research, and all subjects signed an informed consent form. Thirty symptom-free volunteers without histories of TMJ disorders underwent standardized clinical examinations. Afterward, bilateral sagittal oblique and coronal oblique MR images were acquired with the patient's mouth opened and closed. The coronal oblique opened- and closed-mouth images were analyzed by using computer software. The medial and lateral edges of both the TMJ disk and the condyle were marked for these imaging examinations by using the section through the posterior 3 mm of the disk. To eliminate the effect of different magnifications and/or distortions, the distance between these points was measured automatically and divided by the largest mediolateral dimensions of the condyle. To assess the reliability of the measurements, four observers evaluated the position of the disk in the coronal plane. To assess the changes in position of the posterior 3 mm of the disk in the coronal plane in the closed- and opened-mouth positions, the Wilcoxon signed rank test for matched pairs was used. Interobserver measurement reliability was evaluated by using interclass correlation coefficients (ICCs)., Results: Analysis of the coronal closed-mouth disk position revealed a medial position of the TMJ disk relative to the condyle in 11 (21%) of 52 analyzed joints. In the opened-mouth position, the medial location of the disk was more frequent: 29 (85%) of 34 analyzed joints exhibited a medial position of the disk relative to the condyle in this plane. This increasingly medial position of the disk was statistically significant (P < or = .001). Measurement reliability assessment revealed sufficient results (ICC > or = 0.7)., Conclusion: At both closed- and opened-mouth MR imaging, a medially located TMJ disk seems to be within the normal range of variation. The disk seems to shift even more medially when the mouth is opened.

Objective: To investigate the influence of location and preparation design on the survival and complication rate of metal-free polymer crowns within a prospective clinical study., Methods: After randomization, a total of 114 (68 posterior and 46 anterior) single crowns were prepared, either with a chamfer finishing line or with a shoulder combined with occlusal reduction of at least 1 mm. Build-ups were made with a composite material, using the corresponding dentin adhesive. After making impressions with polyether material, polymer crowns were manufactured on stone dies and adhesively luted with resin cement. Follow-ups were scheduled after 1 month, 1 year, 2 years and 3 years. Documentation included failures and other complications, as well as ratings of esthetic and functional performance. After 3 years, data from 100 single crowns were statistically evaluated., Results: Within a minimal observation period of 3 years, 10 complications occurred, including 3 total fractures, 3 partial fractures and 3 decementations. Only 4 crowns (3 total fractures +1 partial fracture) had to be replaced, whereas 2 partial fractures could be repaired and all loosened crowns could be recemented. Kaplan-Meier survival analysis did not show any influence of location or preparation design on the complication rate. Esthetic and functional evaluation by the patients revealed a high acceptance of single polymer crowns, indicated by medians of 9-10 on a 10-point-scale., Conclusion: Within the 3 year observation period, it can be concluded that 0.5 mm chamfer and shoulder preparation ensure that the stability of metal-free polymer crowns for anterior and posterior teeth is acceptable. Long-term stability and wear behavior has still to be evaluated.

Previous studies on the prevalence of signs of temporomandibular disorders (TMD) in elderly people have used non-standardized and invalidated examination protocols. The prevalence of the different signs of TMD in this group is therefore still unclear. The aim of this study was to evaluate the prevalence of signs of TMD in subjects of advanced aged, using a standardized and validated examination protocol. Additionally, young subjects were examined as a control group. Fifty-eight old peoples' home inhabitants and 44 young subjects were examined using a standardized and validated examination protocol. Differences between the groups were assessed using Mann-Whitney U-test or t-test. Geriatric subjects more often exhibited objective symptoms of TMD (38% exhibited joint sounds on opening), but rarely suffered from pain (pain at rest: 0%, joint pain: 0%, muscle pain: 12%). In contrast, young subjects rarely exhibited objective symptoms (joint sounds: 7%), but suffered more frequently from pain (facial: 7%, joint pain: 16%, muscle pain: 25%). The mandibular range of motion was higher in young subjects. Differences between the groups with respect to joint sounds, muscular palpation pain and mandibular range of motion were significant. Although older subjects more frequently exhibited objective signs (joint sounds) of TMD, they rarely suffered from pain. In contrast, younger subjects rarely exhibited objective TMD signs but more frequently suffered from subjective signs (muscular pain on palpation) and facial pain.

The aim of this study was to investigate the reliability between different examiners when using the axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The hypothesis was that the standardized RDC/TMD examination protocol enables calibrated examiners to evaluate all examination items reliably. After calibration training by the RDC/TMD calibration team including the calibration of palpation pressure and the performance of the standardized examination protocol, four examiners, blinded to the patients' medical histories examined 24 subjects in a randomized sequence. One experienced examiner was the standard (hierarchical calibration). The recorded measurements strictly followed the RDC/TMD. Intraclass correlation coefficients (ICC), bias and precision were calculated to estimate interrater reliability. Acceptable (0.75 > or = CC > 0.4) to excellent (ICC > 0.75) reliability was found for 20 of the 23 (87%) examinations. Only sub-retromandibular muscle palpation and joint sound vibration recordings on lateral excursion showed poor-results (ICC < or = 0.4). The RDC/TMD examination protocol enables calibrated examiners to perform most (87%) examination items with satisfactory reliability. Therefore multi-site studies based on the RDC/TMD examination protocol may become feasible, keeping in mind the unsatisfactory reliability of 13% of the items (clicking during laterotrusion to the ipsilateral side, palpation of the posterior and submandibular region).

Unlabelled: The aim of this study was to evaluate psychosocial behaviour and differences in health care utilization between subgroups of patients suffering from temporomandibular disorders, using both clinical examination and magnetic resonance imaging (MRI)., Materials and Methods: 70 patients were examined according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD), and were divided into groups according to their clinical diagnoses. MRIs were acquired and joint-related RDC/TMD diagnoses were modified on the basis of MRI findings. Group I suffered from joint pathology, group II from myofascial pain and group III from a combination. Non-parametric statistics were used to reveal group-related differences in psychosocial and behavioural aspects. Differences in group assignment based on clinical and MRI examination were assessed (kappa statistics)., Results: MRI findings led to group assignments that were different from clinical assignments (k = 0.3). For both types of assignment, patients with myofascial pain displayed higher somatization scores, used more splints and consulted more physicians. For clinical assignment only, depression scores were higher in the myofascial pain group. For MRI based assignment, sex differences were significant between groups I and III., Conclusion: Somatization-specific behaviour is more widespread in patients suffering from exclusively myofascial pain than in patients presenting joint pathology. Inconsistencies in differences of other psychosocial variables between groups of TMD patients seem to be related to differences in group assignment either with or without objective information on joint pathology.

Objectives: Effects of calibration on interrater agreement in evaluating magnetic resonance (MR) images of the temporomandibular joint (TMJ) have already been examined. The objectives of the present study were to assess to what extent the quality of MR images of the TMJ influences interrater agreement and to evaluate interrater agreement with respect to image quality assessment., Methods: Two non-calibrated medical radiologists and two general dentists evaluated sagittal images of 100 TMJs for both a rating of the image quality and the performance of five diagnostic tasks. The agreement between these raters with respect to the diagnoses was evaluated. Additionally, two additional raters, calibrated during a 5 h training including the evaluation of 70 MR images, also evaluated the diagnostic aspects and the image quality, on the basis of objective criteria. The agreement between the subjective diagnoses of the non-calibrated raters and the objective diagnoses of the calibrated raters was evaluated. Afterwards, the subjective and the objective quality assessments were compared using kappa statistics., Results: When good quality images were evaluated, higher kappa values were obtained for all diagnostic categories by the non-calibrated raters (mean Deltak for making diagnoses >0.1). This finding was confirmed by the value obtained for the agreement between the non-calibrated and the calibrated raters. The non-calibrated raters were in good agreement (k=0.67, standard error +/-0.09) with the calibrated raters for assessment of image quality., Conclusion: The present study shows that it is possible even without calibration to obtain a better interrater agreement when higher quality MR images of the TMJ are evaluated.

Diseases of the mandible affect the soft tissues aside from the osseous manifestation. This can be shown clearly and in great detail by magnetic resonance imaging (MRI). MRI is the gold standard in the diagnostic evaluation of any internal derangement of the temporomandibular joint. Dental MRI requires high resolution techniques and in some cases also intravenous administration of contrast material. These techniques allow delineation of the neurovascular bundle. In the past few years new indications were formulated, for example, the evaluation of the integrity of the inferior alveolar nerve in trauma and in radicular cysts. New quantitative methods now enable insights into the pathophysiology. The objective of this review is to communicate accepted indications for MRI of the mandible and to present innovative applications.

Objective: We sought to determine the prevalence of joint diseases in patients with either of 2 forms of myofascial pain (with and without limited mouth opening) and to verify the accuracy of temporomandibular joint-related clinical diagnoses through the use of magnetic resonance imaging (MRI)., Study Design: On the basis of the results of a clinical examination carried out according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 61 patients were divided into 2 subgroups. The first group consisted of 36 patients who had myofascial pain with limited mouth opening (MPLO), whereas the other 25 patients were diagnosed with myofascial pain without limited mouth opening. MRI was carried out on all patients. The clinical joint-related diagnoses from RDC/TMD were compared with MRI results., Results: Patients with MPLO often had joint diseases that were not detected by means of a clinical examination alone. The kappa statistic was used to compare MRI and clinical diagnoses, confirming poor agreement in patients with MPLO (kappa=0.13) and acceptable agreement in patients with myofascial pain without limited mouth opening (kappa=0.72)., Conclusion: Restricted mandibular mobility is frequently associated with temporomandibular joint diseases that were not identified during a clinical examination. Therefore, an adaptation of the classification scheme used for the RDC/TMDs may result in the improvement of the sensitivity of clinical joint-related diagnoses, especially in patients with MPLO.

Objective: To investigate the effect of differences in endometrial thickness and pattern as visualized with present-day high-resolution transvaginal ultrasound equipment on the outcome of assisted reproductive treatment., Design: Prospective cohort study., Setting: Two large infertility units in university hospitals., Patient(s): The endometrial characteristics of 981 patients during 1,600 assisted reproductive treatment cycles were compared with those of 205 untreated women. In addition, abnormal echogenic patterns of the endometrium were characterized histologically in 44 patients., Intervention(s): None., Main Outcome Measure(s): Pregnancy rates., Result(s): The endometrium was significantly thinner in untreated women and women treated with IUI than in women treated with IVF or intracytoplasmic sperm injection. The exponential proliferation of the endometrium was similar in conception and nonconception cycles. The odds for a successful pregnancy were significantly lower in the presence of a thin endometrium in women treated with IUI but not in women treated with the long stimulation protocol for IVF or intracytoplasmic sperm injection. Singleton pregnancies were more common than multiple pregnancies in patients with thin endometria., Conclusion(s): The pregnancy rates of assisted reproductive procedures are influenced only marginally by the degree of endometrial proliferation, and treatment should not be canceled because of inadequate endometrial thickness.

In the pineal organ of the female rat, proportional changes in the area of contact of pinealocyte processes and glial processes with the perivascular space were found after bilateral adrenalectomy. The contact area was evaluated by measuring the length of pinealocyte and glial cell membranes directly abutting on the basal lamina. In the normal female rat, 40% of the contact area is occupied by pinealocyte and 60% by glial cell processes. Fourteen days after bilateral adrenalectomy, this proportion is reversed. In addition, cell counts demonstrate that more pinealocytes gain access to the pericapillary space due to the experimental conditions. In order to prove whether or not these results indicate an increase of pineal endocrine activity, the melatonin-forming enzyme hydroxyindole-O-methyltransferase (HIOMT, E.C. 2.1.1.4) was assayed. After bilateral adrenalectomy the HIOMT activity was found to significantly increase.