Publications by authors named "Rüdiger Emshoff"

44 Publications

A logistic analysis prediction model of TMJ condylar erosion in patients with TMJ arthralgia.

BMC Oral Health 2021 07 24;21(1):374. Epub 2021 Jul 24.

University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria.

Background: In terms of diagnostic and therapeutic management, clinicians should adequately address the frequent aspects of temporomandibular joint (TMJ) osteoarthritis (OA) associated with disk displacement. Condylar erosion (CE) is considered an inflammatory subset of OA and is regarded as a sign of progressive OA changes potentially contributing to changes in dentofacial morphology or limited mandibular growth. The purpose of this study was to establish a risk prediction model of CE by a multivariate logistic regression analysis to predict the individual risk of CE in TMJ arthralgia. It was hypothesized that there was a closer association between CE and magnetic resonance imaging (MRI) indicators.

Methods: This retrospective paired-design study enrolled 124 consecutive TMJ pain patients and analyzed the clinical and TMJ-related MRI data in predicting CE. TMJ pain patients were categorized according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD) Axis I protocol. Each patient underwent MRI examination of both TMJs, 1-7 days following clinical examination.

Results: In the univariate analysis analyses, 9 influencing factors were related to CE, of which the following 4 as predictors determined the binary multivariate logistic regression model: missing posterior teeth (odds ratio [OR] = 1.42; P = 0.018), RDC/TMD of arthralgia coexistant with disk displacement without reduction with limited opening (DDwoR/wLO) (OR = 3.30, P = 0.007), MRI finding of disk displacement without reduction (OR = 10.96, P < 0.001), and MRI finding of bone marrow edema (OR = 11.97, P < 0.001). The model had statistical significance (chi-square = 148.239, Nagelkerke R square = 0.612, P < 0.001). Out of the TMJs, 83.9% were correctly predicted to be CE cases or Non-CE cases with a sensitivity of 81.4% and a specificity of 85.2%. The area under the receiver operating characteristic curve was 0.916.

Conclusion: The established prediction model using the risk factors of TMJ arthralgia may be useful for predicting the risk of CE. The data suggest MRI indicators as dominant factors in the definition of CE. Further research is needed to improve the model, and confirm the validity and reliability of the model.
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http://dx.doi.org/10.1186/s12903-021-01687-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305951PMC
July 2021

Implant-to-nasal floor dimensions projected by panoramic radiographs in the maxillary incisor-canine region: implications for dental implant treatment.

Odontology 2021 Jun 30. Epub 2021 Jun 30.

University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.

To make a comparison of panoramic radiography (PAN) and cone-beam computed tomography (CBCT) determinations of implant-to-nasal floor dimensions (INFD) in the anterior maxillary region, and to assist in determining in which tooth regions additional radiation exposure involved in CBCT scans is justifiable. Data related to INFD by PAN (PAN-D) at implant-to-nasal floor sites (central incisor, lateral incisor, canine) were gathered using 141 implant sites from 119 adult patients. INFD was estimated employing the CBCT technique as a reference method. PAN analysis equations were created for estimation of INFD by CBCT (CBCT-D) specific to implant sites. For assessment of the agreement between the PAN and CBCT methodologies, the Bland-Altman approach was employed. There were robust and significant odds ratios that implants in the canine region would fall into the underestimation groups of > 0 mm (4.5:1) (p = 0.003), > 0.5 mm (6.2:1) (p < 0.001), and > 1 mm (5.4:1) (p = 0.002). The root mean squared error (RMSE) and pure error (PE) were highest for the canine region (RMSE = 1.973 mm, PE = 2.20 mm). This research offers evidence of site-specific underestimations of available horizontal bone dimensions for implants when PAN is employed to assess the availability of vertical bone dimensions. The data suggest that it may be necessary to exclude canine regions when making assessment of INFD through PAN. Use of CBCT may, therefore, be recommended for all implant size and angulation estimations in this region.
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http://dx.doi.org/10.1007/s10266-021-00632-1DOI Listing
June 2021

Panoramic prediction equations to estimate implant- to-mandibular canal dimensions in the mandibular posterior region: implications for dental implant treatment.

Head Face Med 2021 Jun 9;17(1):19. Epub 2021 Jun 9.

University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.

Background: To develop and cross-validate site-specific panoramic radiography (PAN) analysis prediction equations of implant-to-mandibular canal dimensions (IMCD) in mandibular regions posterior to the mental foramen, and to help determine in which instances CBCT technology will be a justified adjunct in clinical practice.

Methods: IMCD by PAN (Pan-D) from implant site-specific regions (first premolar, second premolar, first molar, and second molar sites) were collected from 40- to 70-year-old adolescents. They were randomly assigned to validation (n = 144) and cross-validation (n = 148) groups. The cone-beam computed tomography (CBCT) technique was used as the criterion method for the estimation of IMCD (CBCT-D). The PAN analysis equations were developed using stepwise multiple regression analysis and cross-validated using the Bland-Altman approach.

Results: There was a significant relationship between PAN-D and CBCT-D for both validation (R = 57.8 %; p < .001) and cross-validation groups (R = 52.5 %; p < .001). Root means-squared error (RMSE) and pure error (PE) were highest for the first molar (RMSE = 1.116 mm, PE = 1.01 mm) and the second molar region (RMSE = 1.162 mm, PE = 1.11 mm).

Conclusions: PAN-D has the potential to be developed as an indirect measure of IMCD. However, the findings suggest to exclude scoring of the first and second molars when assessing IMCD via PAN. Use of CBCT may be justified for all IMCD estimations in the first and second molars regions.

Trial Registration: This study has been registered and approved by the Ethics Committee of the Martin-Luther University, Halle, Germany (2020-034).
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http://dx.doi.org/10.1186/s13005-021-00270-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188713PMC
June 2021

Implant-to-root dimensions projected by panoramic radiographs inthe maxillary canine-premolar region: implications for dental implant treatment.

BMC Med Imaging 2021 03 10;21(1):46. Epub 2021 Mar 10.

University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.

Backgound: This study aimed to compare panoramic radiography (PAN) and cone beam computed tomography (CBCT) determinations of implant-to-root dimensions (IRD) in anterior and posterior maxillary regions, and to help determine in which instances increased radiation exposure from CBCT scans may be justified.

Methods: IRD measured by PAN (PAN-D) from implant-to-root sites (central incisor, lateral incisor, canine, first premolar, and second premolar) was collected from 418 implant sites in 110 adults. The CBCT technique was used as the reference method for the estimation of IRD. The PAN analysis equations were developed using stepwise multiple regression analysis and the Bland-Altman approach was applied to assess the agreement between PAN and CBCT methods.

Results: The odds ratio that an implant at the canine-to-first premolar (9.7:1) (P = 0.000) or at the first premolar-to-second premolar region (4.5:1) (P = 0.000) belongs to the underestimation group was strong and highly significant. The root mean square error (RMSE) and pure error (PE) were highest for the canine-to-first premolar (RMSE = 0.886 mm, PE = 0.45 mm) and the first premolar-to-second premolar region (4.5:1) (RMSE = 0.944 mm, PE = 0.38 mm).

Conclusions: This study provides evidence of site-specific underestimations of available horizontal bone dimensions for implants when assessed by PAN. These data suggest that the canines and first and second premolars may have to be excluded when assessing root angulations via PAN.
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http://dx.doi.org/10.1186/s12880-021-00567-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7945351PMC
March 2021

Early responses to 3 mm resilient stabilization appliance therapy for sub-acute and chronic temporomandibular disorder pain predict 12-months follow-up outcomes.

Cranio 2019 Oct 10:1-7. Epub 2019 Oct 10.

Department of Restorative and Prosthetic Dentistry, Medical University of Innsbruck , Innsbruck , Austria.

: To estimate whether outcomes at 12-month follow-up may be predicted by an intermediate and early response to a 3 mm resilient splint therapy for unilateral arthralgia and myofascial pain assessed at 3- and 6-month follow-ups. : Data obtained from one retrospective cohort study consisting of 78 patients suffering from chronic and sub-acute unilateral arthralgia and myofascial pain who were managed with 3 mm resilient splint therapy were subjected to analysis. : Baseline visual analog scale (VAS) intensity, gender as well as changes in the intensity of VAS pain at 3- and 6-month follow-ups predicted unilateral arthralgia and myofascial pain group membership ( < .001). The function classified 83.3% of the cross-validated and 87.2% of original grouped cases correctly. : The proposed model may be used to timely identify patients who are at risk of developing prolonged non-responsive unilateral arthralgia and myofascial pain chronicity.
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http://dx.doi.org/10.1080/08869634.2019.1677301DOI Listing
October 2019

Assessment of Location of the Mandibular Canal: Correlation Between Panoramic and Cone Beam Computed Tomography Measurements.

Int J Prosthodont 2018 Mar/Apr;31(2):129–134. Epub 2018 Feb 15.

Purpose: To compare panoramic and cone beam computed tomography (CBCT) determinations of implant-to-mandibular canal (MC) dimensions in mandibular regions posterior to the mental foramen and to investigate whether factors such as gender, age, region, and vertical dimension influence correlation between the two techniques.

Materials And Methods: A retrospective analysis was carried out in 64 consecutive adult patients (42 females, 22 males; average age 57.1 ± 13.3 years) in whom 126 implants were positioned in the posterior segment of the mandible. Implant sites (first premolar, second premolar, first molar, and second molar) were assessed on each panoramic and CBCT radiograph by measuring the distance from the inferior border of the implant to the superior border of the MC. Binary logistic regression analysis was used to compute the odds ratios (ORs) of each implant site for underestimation vs nonunderestimation. Linear regression analysis was performed with CBCT dimension as the dependent variable and panoramic dimension, gender, and age as the independent variables.

Results: The mean implant-to-MC dimension was 2.50 ± 1.31 mm in panoramic radiography and 2.91 ± 1.62 mm in CBCT. The OR that an implant at the second molar region belonged to the underestimation group was strong (15.1:1) and highly significant (P = .011). If a predictive value of .95 was demanded, the implant-to-MC dimensions had to be overestimated by 2 mm compared to the predicted CBCT dimension.

Conclusion: This study provides evidence of an underestimation of available vertical bone dimensions for implants in the posterior regions of the mandible when assessed by panoramic radiography. Use of CBCT is therefore recommended for all implant size estimations in this region.
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http://dx.doi.org/10.11607/ijp.5430DOI Listing
February 2018

Association Between Missing Posterior Teeth and Occurrence of Temporomandibular Joint Condylar Erosion: A Cone Beam Computed Tomography Study.

Int J Prosthodont 2018 January/February;31(1):9–14. Epub 2017 Nov 16.

Purpose: To determine a possible association between asymptomatic temporomandibular joint (TMJ) condylar erosion and the number of missing posterior teeth and their location, as well as the number of dental quadrants with missing posterior teeth.

Materials And Methods: This case-control study involved 210 patients (male to female ratio = 98:112) aged 16-74 years, with 105 asymptomatic patients with TMJ condylar erosion and a control group of 105 patients without TMJ condylar erosion. Cone beam computed tomography images were evaluated to classify the severity of TMJ condylar erosion as grade 0 (absence of erosion), grade I (slight erosion), grade II (moderate erosion), or grade III (extensive erosion).

Results: The number of missing posterior teeth (mean ± standard deviation [SD]; 2.7 ± 2.4 vs 0.7 ± 1.2) (P < .001), number of dental quadrants with missing posterior teeth (1.5 ± 1.3 vs 0.6 ± 0.9) (P < .001), and bilateral location of missing posterior teeth (41 ± 39.0 vs 10 ± 9.5) (P < .001) were all significantly higher in patients with erosion than in those without erosion. The condylar erosion grade was significantly associated with the number of missing posterior teeth (odds ratio [OR] = 1.24; P = .006), the number of dental quadrants with missing posterior teeth (OR = 1.36; P = .006), and the bilateral occurrence of missing posterior teeth (OR = 3.03; P = .002).

Conclusion: The findings from this study suggest a possible association between TMJ condylar erosion grades and the number of missing posterior teeth, the number of quadrants with missing posterior teeth, and the bilateral occurrence of missing posterior teeth.
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http://dx.doi.org/10.11607/ijp.5111DOI Listing
April 2018

Association Between Chronic Tension-Type Headache Coexistent with Chronic Temporomandibular Disorder Pain and Limitations in Physical and Emotional Functioning: A Case-Control Study.

J Oral Facial Pain Headache 2017 Winter;31(1):55-60

Aims: To assess the association between chronic tension-type headache coexistent with chronic temporomandibular disorder (TMD) pain and severe limitations in physical and emotional functioning.

Methods: Sample size estimation was used to determine that this case-control study should include 126 subjects. Subjects suffering from chronic TMD who were aged between 18 and 68 were recruited in routine clinical practice. Of the 126 included subjects, 63 had TMD pain associated with chronic tension-type headache (cases) and 63 had TMD pain without a history of tension-type headache (controls). Clinical diagnosis of TMD was made according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I criteria, and clinical diagnosis of headache was made according to the International Classification of Headache (ICHD-II). RDC/TMD Axis II criteria were applied to record the scores from the Graded Chronic Pain Scale (GCPS) and the Symptoms Checklist-90-Revised Depression (SCL-DEP) and Somatization (SCL-SOM) scales. A logistic regression analysis was used to assess the relationship between TMD pain with chronic tension-type headache and high levels of depression and somatization severity as scored on the SCLDEP and SCL-SOM scales, respectively, and high pain-related disability (GCPS grade III or IV). Data were adjusted to take into account age, gender, time since TMD pain onset, chronic TMD pain intensity, and characteristic pain intensity.

Results: The presence of chronic tension-type headache was significantly associated with severe SCL-DEP (odds ratio [OR] = 7.2; P < .001), severe SCLSOM (OR = 13.8; P < .001), and high pain-related disability (OR = 9.7; P < .001).

Conclusion: This study provides evidence of associations between the clinical diagnosis of chronic tension-type headache coexistent with chronic TMD pain and key aspects of physical and emotional functioning reflected in severe depression, severe somatization, and high pain-related disability.
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http://dx.doi.org/10.11607/ofph.1654DOI Listing
May 2017

Condylar Erosion in Patients With Chronic Temporomandibular Joint Arthralgia: A Cone-Beam Computed Tomography Study.

J Oral Maxillofac Surg 2016 Jul 25;74(7):1343.e1-8. Epub 2016 Jan 25.

Associate Professor, University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria.

Purpose: The objective of this study was to assess the association between temporomandibular joint (TMJ) condylar erosion and chronic TMJ arthralgia.

Materials And Methods: Based on a sample size estimation, this case-and-control study involved 198 patients 16 to 73 years old recruited from a routine clinical practice (99 cases, patients with chronic TMJ arthralgia and mean pain duration of 16.4 months; 99 controls, asymptomatic patients without a history of orofacial pain). The clinical diagnosis of arthralgia was made according to the Research Diagnostic Criteria for Temporomandibular Disorders. Cone-beam computed tomographic (CBCT) images were evaluated for the presence or absence of erosive osseous changes of the TMJ condyle. Severity of TMJ condylar erosion was classified as grade 0 (absence of erosion), grade I (slight erosion), grade II (moderate erosion), or grade III (extensive erosion). Logistic regression analysis was used to assess the association between chronic TMJ arthralgia and condylar erosion, adjusting for age, gender, number of missing posterior teeth, and number of dental quadrants with missing posterior teeth.

Results: TMJ condylar erosion was found in 59.6% of cases and 21.2% of controls. There was a significant association between TMJ arthralgia and degree of condylar erosion (P < .001). The odds ratio that a TMJ with condylar erosion grade II might belong to the TMJ arthralgia group was strong (3.1:1; 95% confidence interval [CI], 1.17 to 8.09) and significant (P = .023). Significant increases in risk of TMJ arthralgia occurred with condylar erosion grade III (7.7:1; 95% CI, 3.09 to 19.18; P < .001).

Conclusions: The study provides evidence of an association between TMJ condylar erosion and chronic TMJ arthralgia.
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http://dx.doi.org/10.1016/j.joms.2016.01.029DOI Listing
July 2016

Clinically important difference thresholds of the visual analog scale: a conceptual model for identifying meaningful intraindividual changes for pain intensity.

Pain 2011 Oct 2;152(10):2277-2282. Epub 2011 Jul 2.

Orofacial Pain Unit, Department of Oral and Maxillofacial Surgery, Center of Dentistry and Oral Surgery, Innsbruck Medical University, Anichstraβe 35, 6020 Innsbruck, Austria Private Practice in Oral and Maxillofacial Surgery, 5071 Wals-Siezenheim, Austria Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, 6020 Innsbruck, Austria.

The aim of this study was to estimate a range of clinically important difference (CID) values of the visual analog scale for pain intensity (VAS-PI), and to assess the effect of patient baseline characteristics on VAS change scores. Data from a prospective cohort study with 678 patients with subacute and chronic temporomandibular disorder pain were analyzed. Patients were divided into 9 cohorts on the basis of the baseline VAS score and the duration of pain. The CID was estimated over a 12-week period, and 2 different methods were used: (1) mean change scores, and (2) optimal cutoff point in receiver operator characteristic curves. The patient's global impression of change was used as an external criterion. The general linear model univariate analysis was applied to assess the effect of baseline pain level and duration of pain on the raw VAS change scores, while adjusting for age and sex. The CID mean change ranged from 20.9 to 57.5 mm (64.1-76.3%), and the CID optimal cutoff point from 11.5 to 28.5 mm (29.9-47.7%). For the VAS change scores, the main effect of the variable baseline pain level was significant (F=107.09, P<.001). However, there was no significant baseline pain level by duration of pain interaction effect (F=1.13, P=.340). On the basis of the results, we advocate the choice of a single CID value according to the context of the patient's baseline level of pain.
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http://dx.doi.org/10.1016/j.pain.2011.06.003DOI Listing
October 2011

Cephalometric variables discriminate among magnetic resonance imaging-based structural characteristic groups of the temporomandibular joint.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011 Jul 5;112(1):118-25. Epub 2011 May 5.

Orofacial Pain Unit, Department of Oral and Maxillofacial Surgery, Center of Dentistry and Oral Surgery, Innsbruck, Austria.

Objective: The aim of this study was to assess retrospectively whether, in patients with temporomandibular joint (TMJ) arthralgia, commonly used cephalometric variables of dentofacial morphology can discriminate among magnetic resonanace imaging (MRI)-based TMJ structural characteristic groups of "uni- or bilateral disc displacement without reduction (DDwoR) associated with bilateral osteoarthrosis (OA)" and "uni- or bilateral disc displacement with reduction (DDwR) without OA."

Study Design: Bilateral MRI of the TMJ was performed in 56 consecutive TMJ arthralgia patients to identify individuals with specific structural characteristic of uni- or bilateral TMJ DDwoR, DDwR, and OA. Application of the criteria resulted in a study group of 31 patients with "uni- or bilateral DDwoR with bilateral OA" and 25 with "uni- or bilateral DDwR without OA." Linear and angular cephalometric measurements were taken from lateral cephalograms to apply selected criteria of dentofacial morphology. One-way analysis of variance was used to assess differences in cephalometric variables by MRI-based TMJ group. Then, discriminant function analysis predicted TMJ group membership.

Results: A-B plane to facial plane angle, palatal plane to occlual plane, and interincisal angle produced a significantly discriminant function that predicted TMJ group membership (P < .001). This function correctly classified 85.7% of original grouped cases.

Conclusions: Cephalometric variables may discriminate among MRI-based TMJ structural characteristic groups. Additional diagnostic information related to MRI-based classification groups was generated.
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http://dx.doi.org/10.1016/j.tripleo.2011.02.021DOI Listing
July 2011

Structural characteristics of bilateral temporomandibular joint disc displacement without reduction and osteoarthrosis are important determinants of horizontal mandibular and vertical ramus deficiency: a magnetic resonance imaging study.

J Oral Maxillofac Surg 2011 Jul 21;69(7):1898-904. Epub 2011 Mar 21.

Private Practice, Oral and Maxillofacial Surgery, Wals-Siezenheim, Austria.

Purpose: To estimate in patients with temporomandibular joint (TMJ) arthralgia whether magnetic resonance (MR) imaging findings of bilateral TMJ disc displacement without reduction (DDwoR) and/or osteoarthrosis (OA) are determinants of horizontal mandibular and vertical ramus deficiencies.

Patients And Methods: Bilateral MR imaging of the TMJ was performed in 68 consecutive patients with TMJ arthralgia to identify those with bilateral TMJ DDwoR and/or OA. Linear and angular cephalometric measurements were performed to apply selected criteria of horizontal mandibular (gonion-menton [Go-Me] <73 mm and articulare-pogonion [Ar-Pog] <105 mm) and vertical ramus (articulare-gonion [Ar-Go] <45 mm) deficiencies. Logistic regression analysis was used to estimate the association between selected MR imaging and cephalometric parameters.

Results: In the age- and gender-adjusted analysis, significant increases in the risk of horizontal mandibular (odds ratio, 7.5:1; P = .031) and vertical ramus (odds ratio, 9.5:1; P = .003) deficiencies occurred with bilateral DDwoR and OA.

Conclusion: In patients with TMJ arthralgia, the MR imaging parameters of DDwoR and OA seem important determinants of horizontal mandibular and vertical ramus deficiencies.
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http://dx.doi.org/10.1016/j.joms.2010.12.026DOI Listing
July 2011

Are temporomandibular joint disk displacements without reduction and osteoarthrosis important determinants of mandibular backward positioning and clockwise rotation?

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011 Apr;111(4):435-41

Department of Oral and Maxillofacial Surgery, Center of Dentistry and Oral Surgery, Innsbruck Medical University, Innsbruck, Austria.

Objective: The aim of this study was to estimate whether, in patients with temporomandibular joint (TMJ) arthralgia, the magnetic resonanace imaging (MRI) findings of bilateral TMJ disk displacement without reduction (DDwoR) and/or osteoarthrosis (OA) are determinants of mandibular backward positioning and/or clockwise rotation.

Study Design: Bilateral MRI of the TMJ was performed in 50 consecutive TMJ arthralgia patients to identify individuals with bilateral TMJ DDwoR and/or OA. Linear and angular cephalometric measurements were taken to apply selected criteria of mandibular backward positioning (FH to Na-Pog <84°, Na-A-Pog >5°, and SNB <75°) and clockwise rotation (FH to OP >13°, MP to FH >35°, and S-Gn to FH >64°). Logistic regression analysis was used to estimate the association between selected MRI and cephalometric parameters.

Results: In the age- and gender-adjusted analyses, significant increases in risk of mandibular backward positioning and clockwise rotation occurred with bilateral DDwoR and OA (9.5:1; P = .040).

Conclusion: In patients with TMJ arthralgia the MRI parameters of DDwoR and OA seem to be important determinants of mandibular backward positioning and clockwise rotation.
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http://dx.doi.org/10.1016/j.tripleo.2010.05.064DOI Listing
April 2011

Estimation of clinically important change for visual analog scales measuring chronic temporomandibular disorder pain.

J Orofac Pain 2010 ;24(3):262-9

Orofacial Pain Unit, University Clinic of Oral and Maxillofacial Surgery, Innsbruck Medical University, Innsbruck, Austria.

Aims: To estimate the clinically important change (CIC) on a 100-mm visual analog scale for pain intensity (VAS-PI) by relating it to the patient's global impression of change (PGIC) in patients with chronic temporomandibular disorder (TMD) pain and to assess the dependency of the CIC on their baseline pain scores.

Methods: Data from a prospective cohort study with 588 patients with chronic TMD pain were analyzed. The CIC was estimated over a 3-month period, and receiver operating characteristic methods were used to assess the optimal cut-off point. The PGIC category of "much improved" served as an external criterion. Dependency of absolute and percent change on baseline VAS-PI scores was determined by linear regression analysis.

Results: A VAS-PI change score of -19.5 mm and a percent change score of -37.9% were best associated with the concept of CIC. Since patients with high baseline pain required greater absolute reductions in pain to reach a clinically important improvement, percent change scores performed better in classifying improved patients.

Conclusion: Providing a standard definition of the CIC adds to the interpretability of study results, ie, the estimates will aid in understanding individual patient outcomes.
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November 2010

Mineralization density and apparent density in mandibular condyle bone.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009 Apr 25;107(4):573-9. Epub 2009 Jan 25.

Department of Oral and Maxillofacial Surgery, Medical University Innsbruck, Innsbruck, Austria.

Objectives: This study evaluated a method for determining the density and distribution of bone of mandibular condyles using proprietary computerized tomography (CT) software.

Study Design: Thirty-eight condylar specimens were investigated with a high-resolution multislice CT. The density was determined by using bone density analysis algorithms available within the proprietary software. Apparent density was estimated over the total cross-sectional area, the total trabecular bone area apart from the cortical fraction, and on individually selected points. Color-coded pictures were created to demonstrate density differences.

Results: The cortical bone presented significantly higher densities than the trabecular bone. The anterior cortical bone had significantly higher densities than the posterior. The central anterior cortical and the central trabecular areas showed significantly higher densities than the medial and lateral areas.

Conclusion: This technique proved to be a valuable method for determination of the differences in density in the mandibular condyle. It shows potential in providing clinicians with an imaging modality for specific clinical use.
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http://dx.doi.org/10.1016/j.tripleo.2008.11.006DOI Listing
April 2009

Outcomes of dental fracture injury as related to laser Doppler flow measurements of pulpal blood-flow level.

Dent Traumatol 2008 Aug;24(4):416-21

Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Austria.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood flow (PBF). Dental fracture injuries have been associated with significant PBF reduction The purpose of this study was: (i) to evaluate whether the severity of outcomes of dental fracture injuries may be related to LDF measurements of PBF, and (ii) to investigate whether outcomes of dental fracture injuries may predict PBF levels. The relationship between outcomes and PBF measurements was analyzed in 72 permanent maxillary incisors of 52 consecutive dental trauma patients. The diagnostic outcome group comprised 72 incisors with a type I (absence of sensitivity, periapical radiolucency, and grey discoloration of crown) (n = 42), type II (loss of sensitivity) (n = 16), or type III (loss of sensitivity, periapical radiolucency, and/or grey discoloration of crown) diagnosis. At each session, when an injured permanent maxillary incisor was recorded, a contralateral homologous tooth was used as a control. An ordinal stepwise regression was completed to assess the degree of association between PBF measurements and diagnostic outcomes. A logistic regression analysis was used to compute the odds ratios for the outcome features for incisor non-injury controls vs two outcome groups: type II (n = 16) and type III (n = 14). PBF measurements that were significantly associated with more severe outcome were PBF levels of
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http://dx.doi.org/10.1111/j.1600-9657.2008.00585.xDOI Listing
August 2008

Likelihood ratio methodology to identify predictors of treatment outcome in temporomandibular joint arthralgia patients.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008 Oct 26;106(4):525-33. Epub 2008 Jul 26.

Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Innsbruck, Austria.

Objectives: The purpose of this prospective, cohort study of patients with temporomandibular joint (TMJ) pain was to develop rules to predict treatment outcome related to occlusal stabilization splints.

Study Design: The study comprised 119 patients with a unilateral Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I diagnosis of arthralgia. Visual analog scale (VAS) pain level of function was assessed before stabilization splint therapy and compared with the respective 2-month and 6-month follow-up findings. Magnetic resonance (MR) images were obtained immediately before treatment to establish the presence or absence of disk displacement, osteoarthrosis, effusion, and bone marrow edema. Treatment outcome (success or failure) was categorized based on changes in the VAS pain level after 6 months.

Results: Sixty-five (55%) subjects were categorized as treatment success, 17 (14%) as treatment failures, and 37 (31%) as somewhat improved. After using univariate analyis to determine the association between potential clinical and MR imaging predictor variables and treatment outcome status, preliminary prediction rules were developed for prediction of success (positive LR, 10.8; 95% confidence interval [CI], 0.6-188.1) and failure (negative LR, 0.05; CI, 0.0-0.8). The most important variables were time since pain onset, basic VAS pain level, change in VAS level at 2-month follow-up, and clinical diagnoses of disk displacement with and without reduction.

Conclusion: Outcome following use of occlusal stabilization splints may be predicted from variables collected from self-report and physical examination. Predictive modeling may provide clinicians with the opportunity to identify "at-risk" patients early and initiate alternative treatment approaches.
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http://dx.doi.org/10.1016/j.tripleo.2008.05.014DOI Listing
October 2008

Low-level laser therapy for treatment of temporomandibular joint pain: a double-blind and placebo-controlled trial.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008 Apr;105(4):452-6

Department of Oral and Maxillofacial Surgery, Innsbruck Medical University, Innsbruck, Austria.

Objective: The objective of this study was to assess the effectiveness of low-level laser therapy (LLLT) in the management of temporomandibular joint (TMJ) pain in a random and double-blind research design.

Study Design: TMJ pain patients, randomly assigned, received 2 to 3 treatments per week for 8 weeks of active LLLT (Helium Neon, 632.8 nm, 30 mW) (n = 26) or sham LLLT (n = 26). Measures of TMJ pain during function were evaluated at baseline and weeks 2, 4, and 8 after the first laser therapy.

Results: At the 8-week point, within-group improvements were present for TMJ pain during function, for both the active and sham LLLT groups (P = .000). Between-group differences were not highly evident (P > .05).

Conclusion: The study suggests that LLLT is not better than placebo at reducing TMJ pain during function.
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http://dx.doi.org/10.1016/j.tripleo.2007.09.012DOI Listing
April 2008

Characteristics of pulpal blood flow levels associated with non-segmented and segmented Le Fort I osteotomy.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008 Mar;105(3):379-84

Department of Oral and Maxillofacial Surgery, University Clinic of Innsbruck, Innsbruck, Austria.

Objectives: Laser Doppler flowmetry (LDF) is a noninvasive method to assess pulpal blood-flow (PBF). The purpose of this study was (1) to test whether Le Fort I (LF-I) osteotomy may show tooth type-related effects on LDF measurements, and (2) to investigate whether LF-I and tooth type may predict adverse PBF outcomes.

Material And Methods: PBF was recorded bilaterally in maxillary incisors, canines, and first premolars in a surgical group of patients who underwent a segmented (n = 14) or nonsegmented LF-I osteotomy (n = 12), and in a nonsurgical group of control subjects (n = 12) who did not undergo orthodontic treatment. PBF measurements were made before surgery (session I), and at intervals between 3 and 5 days (session II), and 55 and 59 days after surgery (session III). The nonsurgical control subjects were tested at similar intervals. An adverse outcome was defined as the presence of "PBF reduction of > 40%." Statistical analysis consisted of univariate analysis of variance for repeated measurements. A multiple logistic regression analysis was used to compute the odds ratio for LF-I and tooth type for adverse outcome versus nonadverse outcome.

Results: For the LF-I osteotomy study group there was a significant change in PBF values (P = .000). Analysis of session-related measurements revealed a significant difference between session I- and II-related measurements for the canine (P = .004) of the segmented LF-I osteotomy. Significant increase in risk of a session II-related adverse outcome occurred with a nonsegmented (16.6 odds ratio) (P = .009) and segmented LF-I osteotomy (59.2 odds ratio) (P = .000). The odds ratio that a patient with a segmented LF-I osteotomy might belong to the session III-related adverse outcome group was strong (20.6) and significant (P = .007).

Conclusions: LF-I osteotomy type proved to be linked to changes in tooth type-related LDF measurements; it was an important prognostic determinant of adverse PBF outcomes.
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http://dx.doi.org/10.1016/j.tripleo.2007.08.027DOI Listing
March 2008

Magnetic resonance imaging findings of temporomandibular joint soft tissue changes in type V and VI condylar injuries.

J Oral Maxillofac Surg 2007 Aug;65(8):1550-4

Department of Oral and Maxillofacial Surgery, University Clinic Innsbruck, Innsbruck, Austria.

Purpose: The objective of this study was to describe the incidence of acute temporomandibular joint (TMJ) soft tissue lesions associated with the occurrence of type V (high condylar fractures with dislocation) and type VI condylar fractures (condylar head fractures).

Patients And Methods: The study comprised 11 consecutive patients, who were assigned a diagnosis of a uni- or bilateral type V or type VI condylar fracture. Bilateral sagittal and coronal magnetic resonance (MR) images were obtained immediately after injury to establish the presence or absence of disc disruption, capsular tear, retrodiskal tissue tear, and hemarthrosis.

Results: There was 1 condylar fracture site showing signs of disc disruption (16.7%). Tears in the capsule and retrodiscal tissue were found with an incidence of 77% and 71%, respectively, while the incidence of hemarthrosis accounted for 100%. MR imaging failed to show any signs of soft tissue lesions for condylar nonfracture sites.

Conclusions: Type V and type VI condylar fracture sites are associated with a high incidence of injuries to the joint capsule and retrodiscal tissue. Investigation of longitudinal evidence, including risk factors, natural history, and response to treatment appears warranted and necessary.
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http://dx.doi.org/10.1016/j.joms.2006.10.068DOI Listing
August 2007

Sonography of periimplant buccal bone defects in periodontitis patients: A pilot study.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008 Jan 7;105(1):99-103. Epub 2007 May 7.

Oral and Maxillofacial Surgery, Freilassing, Germany.

Objectives: The degree of marginal bone loss at buccal periimplant sites may now be measured noninvasively using sonography. The purpose of the present study was to assess the reproducibility and validity of linear measurements of periimplant buccal bone loss on sonographic images.

Study Design: In 25 patients with 29 buccal bone defects in the mandibular anterior region, the vertical distance between the upper thread of the implant and the most apical level of the marginal bone was evaluated sonographically by using a linear (B-scan) 12.5-MHz small-part transducer, and surgically by using a calibrated periodontal probe. For each subject, measurements were taken in 2 test settings, on the day of periodontal reevaluation ("test re-test"), and 2 weeks after periodontal re-evaluation on the day of periodontal surgery ("sonography versus surgery"). Statistical analysis consisted of univariate analysis of variance for repeated measurements. Data were analyzed for reliability by using the intraclass correlation coefficient (ICC) and the method error (ME).

Results: For the sonographic measurements, there was a significant "session"/"test setting"/"bone loss level" interaction (P = .024). Analysis of simple session-within-level effects revealed a significant difference between the measurements for advanced bone loss levels at the "sonography versus surgery" setting (P = .037). Measurements made at moderate bone loss levels were the most reliable (ICC = 0.76 to 0.81; ME = 4.2% to 6.6%).

Conclusions: The results of this study indicate that sonography may be a reliable and valid method for assessment of marginal bone loss at buccal periimplant sites. The difference in defect assessment ability depends on defect depth.
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http://dx.doi.org/10.1016/j.tripleo.2007.01.014DOI Listing
January 2008

Temporomandibular joint internal derangement and osteoarthrosis: are effusion and bone marrow edema prognostic indicators for arthrocentesis and hydraulic distention?

J Oral Maxillofac Surg 2007 Jan;65(1):66-73

Department of Oral and Maxillofacial Surgery, University Clinic Innsbruck, Innsbruck, Austria.

Purpose: Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has proven to be an effective modality in treating patients exhibiting clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the magnetic resonance imaging (MRI) variables of effusion and/or bone marrow edema may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ.

Patients And Methods: The study group comprised 37 consecutive patients with TMJ pain, who were assigned a unilateral clinical TMJ disorder of TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction) and a TMJ pain side-related MRI diagnosis of disc displacement without reduction associated with osteoarthrosis (OA). Bilateral sagittal and coronal MRI images were obtained immediately before the operation to establish the presence or absence of ID, OA, TMJ effusion, and bone marrow edema. Pain level and mandibular range of motion (ROM) were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria for success were a ROM >or=35 mm and pain reduction >50%. A logistic regression analysis was used to compute the odds ratio for TMJ effusion and bone marrow edema for successful outcomes (n = 21) versus unsuccessful (n = 16) outcomes.

Results: At the 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P = .000), a significant reduction in clinical diagnoses of TMJ disorders (P = .016), and a significant increase in ROM (P = .000). A significant increase in the risk of an unsuccessful outcome of ROM <35 mm and/or pain reduction >or=50% occurred with MRI findings of effusion (odds ratio 1:10.8 = 0.09; P = .007).

Conclusions: TMJ effusion may prove to be an important prognostic determinant of successful arthrocentesis. However, the data re-emphasize the concept that the prediction of a specific outcome is not a matter of simple linearity, in which the presence of 1 factor may equate with predictive ability, but rather is a function of a complex interaction among different biological variables.
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http://dx.doi.org/10.1016/j.joms.2005.11.113DOI Listing
January 2007

Magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema before and after performance of arthrocentesis and hydraulic distension of the temporomandibular joint.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006 Jun 17;101(6):784-90. Epub 2006 Apr 17.

Department of Oral and Maxillo-Facial Surgery, University Clinic of Innsbruck, Innsbruck, Austria.

Objectives: To investigate whether temporomandibular joint (TMJ) internal derangement type III and capsulitis/synovitis are related to magnetic resonance imaging (MRI) diagnoses of internal derangement, osteoarthrosis (OA), effusion, and/or bone marrow edema (BME), and whether arthrocentesis is associated with changes in diagnoses of internal derangement, OA, effusion, and/or BME.

Study Design: The study comprised 28 patients with a clinical unilateral TMJ disorder of internal derangement type III and capsulitis/synovitis. Bilateral MRI was immediately performed preoperatively and at a 2-month follow-up.

Results: There was a significant relationship between TMJ internal derangement type III and capsulitis/synovitis and TMJ internal derangement (P = .000), effusion (P = .036), and BME (P = .002). MRI showed a significant decrease in diagnoses of TMJ BME ((P = .018).

Conclusions: MRI variables of internal derangement, effusion, and BME were related to TMJ internal derangement type III and capsulitis/synovitis; however, arthrocentesis was only associated with a significant change in diagnoses of TMJ BME.
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http://dx.doi.org/10.1016/j.tripleo.2005.09.005DOI Listing
June 2006

Clinical factors affecting the outcome of arthrocentesis and hydraulic distension of the temporomandibular joint.

Authors:
Rüdiger Emshoff

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005 Oct;100(4):409-14

Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.

Objective: Significant psychosocial distress and substantial cost are associated with the diagnosis and management of chronic temporomandibular joint (TMJ) pain conditions. Successful intervention based on identified risk factors has potential functional and financial benefits. Arthrocentesis and hydraulic distension of the TMJ has been described as an effective modality in the treatment of patients demonstrating clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether clinical variables such as age, gender, time since pain onset (TSO), visual analog scale (VAS) pain level, and mandibular range of motion (ROM) may predict treatment outcomes of arthrocentesis and hydraulic distension of the TMJ.

Study Design: The study comprised 64 consecutive patients presenting with TMJ pain, who were diagnosed with a unilateral clinical TMJ disorder of "TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction)." TMJ pain level of function and mandibular range of motion were assessed initially and then compared with the respective 2-month follow-up findings after arthrocentesis and hydraulic distension. Outcome criteria of success included an absence of signs and symptoms characteristic of a diagnosis of ID type III. A multiple logistic regression analysis of pretreatment data was used to compute the odds ratio for variables of age, gender, TSO, VAS pain level, and ROM for successful outcomes (n = 34) vs nonsuccessful (n = 30) outcomes.

Results: At 2-months follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P < .001), a significant reduction in clinical diagnoses of TMJ disorders (P < .001), and a significant increase in mandibular range of motion (P < .001). For the outcome criteria of "absence of ID type III," there was a significant difference between the clinical outcome groups for the variables of age (P = .029) and VAS pain level (P < .001). Significant increase in benefit of a successful outcome occurred with an age of < or = 25 years (11.8 odds ratio; P = .044), a VAS pain level of > 75 mm (6.5 odds ratio; P = .026), and an ROM of < 25 mm (6.9 odds ratio; P = .029).

Conclusion: Clinical variables predicted TMJ "ID type III and pain" patients who went on to show successful treatment outcomes of arthrocentesis and hydraulic distension. Predictive modeling may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatments.
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http://dx.doi.org/10.1016/j.tripleo.2004.12.024DOI Listing
October 2005

Use of laser Doppler flowmetry to predict vitality of luxated or avulsed permanent teeth.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004 Dec;98(6):750-5

Department of Oral and Maxillofacial Surgery, University Of Innsbruck, Innsbruck, Austria.

Objective: Splinting of traumatically displaced or avulsed permanent teeth has been described as an effective modality in the treatment of patients with dental injuries. The purpose of this study was to investigate whether laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF) and/or dental injury type may predict treatment outcome of splinting of permanent maxillary incisors.

Study Design: The study comprised 64 patients undergoing dental trauma splinting, who were characterized by the presence of a single permanent maxillary incisor affected by a subluxation, luxation, or avulsion type injury. Perfusion units (PU) were taken in 2 sessions, on the day of splint removal (6 weeks after trauma; session I) and 12 weeks after splint removal (session II). At each session, when an injured permanent maxillary central incisor was recorded, the respective contralateral homologous tooth was used as a control. An adverse outcome occurring 36 weeks after splint removal was defined as the presence of "periapical radiolucency and/or grey discoloration." A multiple logistic regression analysis was used to compute the odds ratio for session-related PBF characteristics and dental injury type for adverse outcome (n=22) versus nonadverse outcome (n=42).

Results: There was a significant increase in PBF values from session I to session II (P=.047) for teeth without an adverse outcome, whereas teeth affected by an adverse outcome showed a significant decrease in PBF values (P=.001). PBF measurements did not change over time for the control group of contralateral incisors (P=.185). For the outcome criterion of "presence of periapical radiolucency and/or grey discoloration," there was a significant association between the treatment outcome groups and the variables of dental injury type (P=.049), session-related PBF difference (P=.000), and session II-related PBF level (P=.000). Significant increase in risk of an adverse outcome occurred with a session-related PBF difference (PBF(Session I) - PBF(Session II)) of >/=0 PU (8.6 odds ratio) (P=.014), and a session II-related PBF level of
Conclusion: The data suggest the LDF test to be a valuable diagnostic adjunct for luxated teeth showing signs of adverse outcomes. Predictive modeling may provide clinicians with the opportunity to identify "at-risk" teeth early and initiate specific treatments.
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http://dx.doi.org/10.1016/j.tripleo.2004.05.003DOI Listing
December 2004

Determining predictor variables for treatment outcomes of arthrocentesis and hydraulic distention of the temporomandibular joint.

J Oral Maxillofac Surg 2004 Jul;62(7):816-23

University of Innsbruck, Innsbruck, Austria.

Purpose: Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has been described as an effective modality in the treatment of patients demonstrating clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the clinical variable of TMJ pain chronicity and the magnetic resonance (MR) imaging variable of osteoarthrosis (OA) may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ.

Patients And Methods: The study consisted of 29 TMJ pain patients, who were assigned a unilateral clinical temporomandibular disorder (TMD) of "TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction)," and a TMJ pain side-related MR imaging diagnosis of disc displacement without reduction. Bilateral sagittal and coronal MR images were obtained immediately preoperatively to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria of success were 1). an absence of signs and symptoms characteristic of a diagnosis of ID type III and/or 2). a reduction in pain level of 85% or greater. A multiple logistic regression analysis was used to compute the odds ratio for TMJ pain chronicity (duration >6 months and <2 years) and OA for successful outcomes versus nonsuccessful outcomes.

Results: The pretreatment data revealed no significant relationship between the clinical disorder "TMJ pain associated with ID type III" and the MR imaging finding of OA (P =.103). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P =.000), a significant reduction in clinical diagnoses of TMDs (P =.000), and a significant increase in mandibular range of motion (P =.000). Significant increase in risk of a nonsuccessful outcome (pain reduction <85%) occurred with TMJ pain chronicity (odds ratio of 41.0) (P =.018). Significant increase in benefit of a successful outcome (absence of ID type III) occurred with TMJ OA (odds ratio 1:16.7, P =.06) (P =.044).

Conclusions: Arthrocentesis in chronic TMJ pain patients was less successful than in nonchronic patients with regard to treatment outcome of pain reduction. Arthrocentesis in patients with TMJ OA was more beneficial with regard to the disappearance of ID type III than in non-OA patients. Predictive modeling may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatments.
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http://dx.doi.org/10.1016/j.joms.2003.12.020DOI Listing
July 2004

Effectiveness of ultrasonography in determining medial and lateral orbital wall fractures with a curved-array scanner.

J Oral Maxillofac Surg 2004 Apr;62(4):451-5

Department of Oral and Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria.

Purpose: The purpose of the study was to evaluate the diagnostic value of ultrasonography to determine medial and lateral orbital wall fractures.

Materials And Methods: Sixty-two patients with the clinical diagnosis of an orbital trauma underwent coronal computed tomography (CCT) and ultrasonographic investigation (US). Inclusion criteria were clinically suspected orbital injuries defined by reduced bulbus motility, diplopia, or additional traumatic injuries of the orbit or the globe. US and CCT were used as imaging diagnostic methods.

Results: Ultrasonography showed a sensitivity of 56%, a specificity of 95%, and an accuracy of 88% at the medial orbital rim. Regarding the lateral orbital rim, ultrasonography showed a sensitivity of 92%, a specificity of 88%, and an accuracy of 90% using CCT as a reference method.

Conclusion: Ultrasonography with a curved-array scanner seems to be a valuable method in the detection of lateral orbital wall fractures. Further studies have to be done to improve sensitivity in the interpretation of medial orbital wall fractures.
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http://dx.doi.org/10.1016/j.joms.2003.05.016DOI Listing
April 2004

Evaluation of pulpal blood flow after tooth splinting of luxated permanent maxillary incisors.

Dent Traumatol 2004 Feb;20(1):36-41

Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, A-6020 Innsbruck, Austria.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood flow (PBF). Dental injury has been associated with losses of pulpal sensibility. The purpose of this study was to assess whether LDF could be used to detect short- and long-term changes of PBF values of luxated permanent maxillary central incisors after repositioning and splinting. In 18 trauma patients, a single maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous tooth were investigated by LDF to assess local PBF values. Perfusion units (PU) were taken in four sessions: on the day of splint removal, and 12, 24, and 36 weeks after splint removal. Analysis of the luxation type-related PBF measurements revealed intrusion type-related PBF values to be associated with a significant decrease in PBF values (P < 0.05), while lateral luxation and extrusion type-related PBF values showed no significant difference between the session-related values (P > 0.05). PBF measurements did not change over time for the contralateral incisors (P > 0.05). Teeth affected by an intrusion-type luxation injury remained unresponsive to sensitivity testing at follow up, while 3 (60%) developed grey discoloration of the crown. LDF may become useful in the detection of ischemic episodes of luxated maxillary central incisors after repositioning and splinting. Further studies are warranted to assess the validity of post-traumatic 'ischemic episodes' by comparing it to histological tooth pulp changes.
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http://dx.doi.org/10.1046/j.1600-4469.2003.00223.xDOI Listing
February 2004

Ultrasound versus computed tomography in the imaging of orbital floor fractures.

J Oral Maxillofac Surg 2004 Feb;62(2):150-4

Department of Oral and Maxillofacial Surgery, University of Insbruck, Inssdbruck, Austria.

Purpose: The aim of the study was to investigate whether orbital ultrasonography (US) with a curved-array transducer could be an alternative imaging method to computed tomography (CT) to detect orbital wall fractures and fractures of the infraorbital rim.

Materials And Methods: Fifty-eight patients with the clinical ophthalmologic or radiologic diagnosis of an orbital trauma were investigated prospectively by US and CT. The reference method was the intraoperative findings.

Results: CT evaluation of the infraorbital rim yielded a sensitivity of 79%, a specificity of 90%, and an accuracy of 94%. The positive predictive value (PPV) and the negative predictive value (NPV) of the infraorbital rim reached 69% and 83%, respectively. CT evaluation of the orbital floor showed a sensitivity of 96%, a specificity of 71%, and an accuracy of 96%. PPV and NPV resulted in 71% and 93%, respectively. US investigation of the infraorbital rim yielded a sensitivity of 77%, a specificity of 89%, and an accuracy of 97%, whereas PPV and NPV reached 65% and 83%, respectively. US investigation of the orbital floor reached a sensitivity of 94%, a specificity of 57%, and an accuracy of 96%, whereas PPV and NPV yielded 57% and 91%, respectively. No significant difference was found between US and CT in the investigation of the infraorbital rim (P =.809) and the orbital floor (P =.729).

Conclusions: US with a curved-array transducer appears to be a useful alternative method in the investigation of orbital floor fractures. Further studies have to be conducted to reduce the presence of false-negative results.
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http://dx.doi.org/10.1016/j.joms.2003.01.004DOI Listing
February 2004

Assessing revascularization of avulsed permanent maxillary incisors by laser Doppler flowmetry.

J Am Dent Assoc 2003 Dec;134(12):1597-603

Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.

Background: Laser Doppler flowmetry, or LDF, is a noninvasive method used to assess pulpal blood flow, or PBF. Dental avulsion is associated with loss of pulpal sensitivity. The authors conducted this study to assess whether LDF could be used to detect revascularization of replanted teeth.

Methods: The authors used LDF to assess the PBF values of avulsed permanent maxillary incisors treated using replantation and splinting in 17 subjects. They took measurements at four sessions: on the day of splint removal and at 12 weeks, 24 weeks and 36 weeks after splint removal. Five vital control teeth and five nonvital control teeth were used to assess the background signal. At 36 weeks, the authors determined clinically and radiographically whether revascularization had occurred.

Results: LDF readings correctly predicted the pulp status in 88.2 percent of the readings. Of the readings for vital teeth, 100 percent were correct, and of the readings for nonvital teeth, 80 percent were correct. Univariate analysis of variance demonstrated that in revascularized teeth, the PBF value increased significantly from splint removal to week 12 after splint removal and from week 24 to week 36 after splint removal. In the teeth that failed to revascularize, the PBF value dropped significantly from week 24 to week 36 after splint removal.

Conclusions: The results of this study suggest that LDF accurately diagnoses revascularization of avulsed maxillary incisors after replantation and splinting.

Clinical Implications: LDF may become useful in detecting revascularization much earlier than standard sensitivity tests.
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http://dx.doi.org/10.14219/jada.archive.2003.0105DOI Listing
December 2003
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