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1/17. Long-term stability of mandibular orthopedic repositioning.

    Mandibular anterior repositioning appliances attempt to diminish temporomandibular joint pain, soft tissue noise, and myofascial discomfort by altering condyle-disc relationships. Secondary stabilization of the occlusion to this arbitrary anterior position through orthodontic tooth movement may significantly alter functional and muscular relationships. A case report is illustrated to show that as the functional environment attempted to reestablish equilibrium through adaptation, relapse occurred as the condyles "seated" posteriorly and superiorly toward their original relationship within the fossa. For all practical purposes, complete relapse of the orthodontic treatment result took place over time.
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2/17. Metastatic cancer presenting as TMD. A case report.

    The dentist's responsibility in managing patients should include the awareness that not every pain in the face is due to a toothache or a temporomandibular disorder (TMD). This paper reviews the case of a 66-year-old patient who presented to the dental office with a chief complaint of unilateral jaw pain. The symptoms seemed consistent with TMD. Two years prior, the patient had undergone successful removal of a cancerous prostate and had remained under urologist care with a favorable prognosis. Subsequent imaging studies confirmed that the facial pain was due to multiple metastatic lesions to areas including the zygoma, infratemporal fossa, maxilla and brain. However, these metastatic lesions were not of prostate origin, but rather were from a squamous cell carcinoma originating in a primary site other than the prostate.
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3/17. Nonsurgical and nonextraction treatment of skeletal Class III open bite: its long-term stability.

    Two female patients, aged 14 years 5 months and 17 years 3 months with skeletal Class III open bite and temporomandibular dysfunction are presented. They had previously been classified as orthognathic surgical cases, involving first premolar removal. The primary treatment objective was to eliminate those skeletal and neuromuscular factors that were dominant in establishing their malocclusions. These included abnormal behavior of the tongue with short labial and lingual frenula, bilateral imbalance of chewing muscles, a partially blocked nasopharyngeal airway causing extrusion of the molars, with rotation of the mandible and narrowing of the maxillary arch. Resultant occlusal interference caused the mandible to shift to one side, which in turn produced the abnormal occlusal plane and curve of Spee. As a result, the form and function of the joints were adversely affected by the structural and functional asymmetry. These cases were treated by expanding the maxillary arch, which brought the maxilla downward and forward. The mandible moved downward and backward, with a slight increase in anterior facial height. Intruding and uprighting the posterior teeth, combined with a maxillary protraction, reconstructed the occlusal plane. A favorable perioral environment was created with widened tongue space in order to produce an adequate airway. myofunctional therapy after lingual and labial frenectomy was assisted by vigorous gum chewing during and after treatment, together with a tooth positioner. Normal nasal breathing was achieved.
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4/17. Metallic residues as a source of artifacts in magnetic resonance imaging of the temporomandibular joint.

    OBJECTIVES: To establish the source of metallic artifacts on postoperative MRI of the temporomandibular joint after arthroplasty. methods: An experiment was carried out to evaluate MR artifacts which were thought to have been caused by minute metallic particles deposited at surgery. Four types of cutting instruments were used to cut an extracted tooth: a diamond bur attached to a dental air turbine handpiece, a steel bur and bone bur attached to a dental micromotor handpiece and a bone file. The tooth fragments were collected in plastic centrifuge tubes in water. These samples were evaluated with six MR sequences. RESULTS: MR artifacts were clearly demonstrated in samples using the bone bur and the bone file but not the diamond and steel burs. CONCLUSIONS: The artifacts seen on postoperative MRI were derived from minute metal particles from the bone bur or file used for condylar arthroplasty. Metal artifacts should be considered when interpreting postoperative MR images.
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5/17. The diagnosis of referred orofacial dental pain.

    Every patient's description of the location of pain must be treated with caution. In order to arrive at a diagnosis of pain a logical method should be employed. This consists of the history and clinical examination including pulp tests and radiographs. Where the patient complains of pain on hot or cold, an attempt should be made to reproduce the patient's pain to check on the accuracy of its description and to aid in localisation. patients frequently refer pain to previously endodontically-treated teeth. These may not be the cause of the problem. In order to facilitate the process of diagnosis the following hypothesis has been advanced. A tooth can only be the source of pain if there are objective signs associated with that tooth. Lack of response to pulp tests constitutes such a sign, provided the tooth has not previously been endodontically treated. If, however, such treatment has taken place, (regardless of whether this was well or poorly executed), a further objective sign other than lack of vitality is required before such a tooth can be implicated as the source of pain. The guidelines suggested are illustrated by means of clinical examples.
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6/17. Oro-dental manifestations of the Schwartz-Jampel syndrome.

    A boy with the Schwartz-Jampel syndrome (chondrodystrophic myotonia) had a number of oro-dental complications. These included difficulty in tooth extraction and orthodontic care due to a small oral aperture and rigidity of the temporo-mandibular joints. General anaesthesia was hazardous because of a propensity to malignant hyperthermia, and endotracheal intubation was difficult because of shortness and rigidity of the neck and the small size of the laryngeal structures. awareness of these potential problems is crucial for anaesthesia and comprehensive dental management. The radiological demonstration of dentigerous cysts is a hitherto unreported observation in this disorder.
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7/17. Implant replacement of congenitally missing lateral incisor: a case report.

    The therapeutic goal of reconstruction dentistry is to provide our patients with a dentition that is in harmony with the patient's musculature and temporomandibular joints. malocclusion can contribute to both muscular and joint dysfunction. This case report demonstrates the reconstruction of a malocclusion caused by a congenitally missing lateral incisor utilizing a combination of orthodontic treatment and a dental implant to replace the congenitally missing tooth.
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8/17. Unusual oral findings in dermatosparaxis (ehlers-danlos syndrome type VIIC).

    A 13-year-old patient with dermatosparaxis (ehlers-danlos syndrome type VIIC), an autosomal recessive disorder of procollagen-I-N-proteinase, is presented. The oral findings comprise micrognathia, hypodontia, localized microdontia, opalescent tooth discoloration, root dysplasia, pulp obliteration, severe gingival hyperplasia, frontal open bite, and severe restriction of TMJ mobility. The reported anomalies suggest the need for expanding the present phenotypic spectrum. This is the first report on oral findings in the syndrome.
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9/17. Supernumerary fourth and fifth molars: a report of two cases.

    Panoramic radiographs of two female patients ages 22 and 21 revealed the presence of two impacted bilateral upper fourth molars and unilateral (right) upper fourth and fifth molars. All of the teeth were distomolars. The supernumerary teeth had normal tooth morphology with regard to their crowns and roots but were slightly smaller than the existing third molars. Their crowns were either two or three tuberculated and they all had single roots.
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10/17. Two- and three-dimensional orthodontic imaging using limited cone beam-computed tomography.

    Considerable progress has been made in diagnostic, medical imaging devices such as computed tomography (CT). However, these devices are not used routinely in dentistry and orthodontics because of high cost, large space requirements and the high amount of radiation involved. A device using computed tomography technology has been developed for dental use called a limited cone beam dental compact-CT (3DX). The aim of this article is to demonstrate the usefulness of 3DX imaging for orthodontic diagnosis and treatment planning. We present three cases: (1) one case shows delayed eruption of the upper left second premolar, (2) the second case shows severe impaction of a maxillary second bicuspid; and (3) the third case shows temporomandibular joint disorder (TMD). In the tooth impaction cases, the CT images provided more precise information than conventional radiographic images such as improved observation of the long axis of the tooth, root condition, and overlap with bone. In the TMD case, clear and detailed temporomandibular joint images were observed and pre- and posttreatment condylar positions were easily compared. We conclude that 3DX images provide useful information for orthodontic diagnosis and treatment planning.
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