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International Journal of Oral and... Jan 2023The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle fracture. Three databases were searched (PubMed, Embase, Cochrane Library) and 2670 unique papers were identified. A total of 337 studies were included (121 case reports, 89 case series, and 127 cohort/clinical studies). In total 14,396 patients and 21,560 prostheses were described. Of the 127 cohort or clinical studies, 100 (79%) reported inclusion criteria, 54 (43%) reported exclusion criteria, and 96 (76%) reported the inclusion period. The base population from which patients were recruited was reported in 57 studies (45%). The reason for TMJ prosthesis implantation was reported for 4177 patients (29.0%). A history of condylar fracture was present in 83 patients (2.0%); a history of mandibular trauma was present in 580 patients (13.9%). The meta-analysis showed a pooled prevalence of condylar fracture of 1.6% (95% confidence interval 0.9-2.4%) and a pooled prevalence of trauma or condylar fracture of 11.3% (95% confidence interval 7.1-16.0%). Heterogeneity was highly significant (P < 0.001). The TMJ prosthesis appears to be reserved for patients with persistent pain, bony or fibrous ankylosis, or osteomyelitis after primary closed or open treatment of fractures of the mandibular condyle.
Topics: Humans; Mandibular Condyle; Temporomandibular Joint Disorders; Tooth Ankylosis; Mandibular Fractures; Temporomandibular Joint; Ankylosis
PubMed: 35752530
DOI: 10.1016/j.ijom.2022.05.014 -
Clinical Oral Investigations Aug 2021To identify the preferred surgical approach (intra- or extra-oral) to remove an ectopic third mandibular molar (ETMM) according on its location and presence of an... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To identify the preferred surgical approach (intra- or extra-oral) to remove an ectopic third mandibular molar (ETMM) according on its location and presence of an associated cyst or cutaneous fistula, and to determine the indications for a graft or osteosynthesis.
MATERIALS AND METHODS
A surgical practice questionnaire was distributed to oral and maxillo-facial surgeons attending a National Congress of the French Society of Stomatology, Maxillo-facial and Oral Surgery. A systematic review of the literature and meta-analysis was carried on Pubmed, Cochrane, Embase and ScienceDirect databases using the MeSH terms: "Ectopic teeth", "Third molar", "Mandibular". One hundred and forty-three surgeons answered the questionnaire and the meta-analysis included 66 articles.
RESULTS
From the questionnaire, the preferred surgical approach was intra-oral except when the ETMM was in the condyle, when it was extra-oral (69.5%; p < 0.001). In the meta-analysis, an extra-oral approach was only indicated when a cutaneous fistula was present (90% vs. 35.9%; p = 0.002), irrespective of ETMM location. In the questionnaire and meta-analysis, the presence of a cyst did not change the approach (p < 0.05). The indications for a graft or osteosynthesis were a condylar location (p < 0.001), while a cutaneous fistula decreased the indication (p = 0.04) and a cyst (p = 0.009) was only associated with a graft.
CONCLUSIONS
The preferential approach was intra-oral, except when the ETMM was condylar or a cutaneous fistula was present when an extra-oral approach was preferred. Osteosynthesis or a graft were more likely when the ETMM was in the condyle.
CLINICAL RELEVANCE
This study will help to orientate surgeons vis-à-vis ETMM treatment.
Topics: Humans; Mandible; Mandibular Condyle; Molar; Molar, Third; Tooth Extraction; Tooth, Supernumerary
PubMed: 34137925
DOI: 10.1007/s00784-021-04018-z -
Journal of Oral Rehabilitation Aug 2021Mandibular collum fractures among growing patients can lead to abnormal growth, function, esthetics and ultimately quality of life. Among the proposed treatment... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Mandibular collum fractures among growing patients can lead to abnormal growth, function, esthetics and ultimately quality of life. Among the proposed treatment alternatives, orthopaedic treatment with functional appliances has been suggested, with encouraging results. Aim of the present systematic review was to critically appraise existing evidence on the outcome of functional appliance treatment among growing patients with mandibular collum fractures.
MATERIALS AND METHODS
Eight databases were searched up to October 2020 for randomised and non-randomised clinical studies assessing functional appliance treatment outcome for children with mandibular fractures. After duplicate study selection, data extraction and risk of bias assessment, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE.
RESULTS
A total of 8 unique studies (one prospective and nine retrospective non-randomised) with 223 children could be identified. Functional appliance treatment was associated with greater anteroposterior condyle dimensions of the injured condyle compared with the contralateral healthy condyle (3 studies; MD = 0.87 mm; 95% CI = 0.30 to 1.45 mm; p = .003). No difference was found in the mesiodistal condyle size between the injured and the contralateral healthy joint (3 studies; MD = -0.05 mm; 95% CI = -1.05 to 0.95 mm; p = .92), but collum length was smaller at the injured side compared with the contralateral one (1 study; MD = -2.89 mm; 95% CI = -5.29 to -0.49 mm; p = .02). Treatment outcome might be influenced by patient age, patient sex and severity/localisation of the fracture, but the quality of evidence for all analyses was very low due to methodological limitations leading to bias.
CONCLUSIONS
While some evidence exists that functional appliances might lead to good clinical rehabilitation of fractured mandibular condyles, including considerable bone remodelling, available studies are small and have methodological weaknesses.
Topics: Child; Esthetics, Dental; Humans; Mandibular Fractures; Prospective Studies; Quality of Life; Retrospective Studies
PubMed: 33963591
DOI: 10.1111/joor.13178 -
Journal of Biomechanics Oct 2020Motion of the mandible and temporomandibular joint (TMJ) plays a pivotal role in the function of the dentition and associated hard and soft tissue structures, and...
Motion of the mandible and temporomandibular joint (TMJ) plays a pivotal role in the function of the dentition and associated hard and soft tissue structures, and facilitates mastication, oral communication and access to respiratory and digestive systems. Quantification of TMJ kinematics is clinically relevant in cases of prosthetic rehabilitations, TMJ disorders, osteoarthritis, trauma, tumour resection and congenital abnormalities, which are known to directly influence mandibular motion and loading. The objective of this systematic review was to critically investigate published literature on historic and contemporary measurement modalities used to quantify in vivo mandibular and TMJ kinematics in six degrees of freedom. The electronic databases of Scopus, Web of Science, Medline, Embase and Central were searched and 109 relevant articles identified. Publication quality was documented using a modified Downs and Black checklist. Axiography and ultrasonic tracking are commonly employed in the clinical setting due to their simplicity and capacity to rapidly acquire low-fidelity mandibular motion data. Magnetic and optoelectronic tracking have been used in combination with dental splints to produce higher accuracy measurements while minimising skin motion artefact, but at the expense of setup time and cost. Four-dimensional computed tomography provides direct 3D measurement of mandibular and TMJ motion while circumventing skin motion artefact entirely, but employs ionising radiation, is restricted to low sampling frequencies, and requires time-consuming image processing. Recent advances in magnetic tracking using miniature sensors adhered to the teeth in combination with intraoral scanning may facilitate rapid and high precision mandibular kinematics measurement in the clinical setting. The findings of this review will guide selection and application of mandibular and TMJ kinematic measurement for both clinical and research applications.
Topics: Biomechanical Phenomena; Mandible; Mandibular Condyle; Range of Motion, Articular; Temporomandibular Joint
PubMed: 32971491
DOI: 10.1016/j.jbiomech.2020.109994 -
Diagnostics (Basel, Switzerland) Oct 2023The aim of this study was to describe the prevalence of anatomical variants in the bifid mandibular condyle (BMC) and report its association with temporomandibular joint... (Review)
Review
OBJECTIVE
The aim of this study was to describe the prevalence of anatomical variants in the bifid mandibular condyle (BMC) and report its association with temporomandibular joint (TMJ) pathology.
METHODS
We searched the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to September 2023. Two authors independently performed the search, study selection, and data extraction, and they also assessed the methodological quality with an assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model.
RESULTS
A total of 50 studies met the eligibility criteria. Twenty studies, with a total of 88,625 subjects, were included in the meta-analysis. The overall prevalence of the bifid mandibular condyle (BMC) variant was 1% (95% CI = 1% to 2%).
CONCLUSIONS
The correlation between the BMC and TMJ pathologies has a relatively low prevalence in studies that present a considerable number of subjects. From a clinical point of view, a direct association cannot be made between the presence of the BMC and TMJ pathologies or symptoms.
PubMed: 37892103
DOI: 10.3390/diagnostics13203282 -
International Journal of Oral and... Oct 2017Since the introduction of rigid internal fixation devices, more and more surgeons favour an open approach to treating condylar fractures of the mandible in adult... (Review)
Review
Since the introduction of rigid internal fixation devices, more and more surgeons favour an open approach to treating condylar fractures of the mandible in adult patients. Different indications for open treatment have been published. Open treatment is associated with surgical complications because of the technique employed. The aim of this systematic review was to provide an overview of the studies published exclusively on open treatment, and to summarize the existing open treatment modalities and their clinical outcomes. A total of seventy studies were selected for detailed analysis. Most studies reported good results with regard to the outcome measures of open treatment. Surgical complications including hematoma, wound infection, weakness of the facial nerve, sialocele, salivary fistula, sensory disturbance of the great auricular nerve, unsatisfactory scarring, and fixation failure were reported in the studies. This review suggests that because of the high level of methodological variance in the relevant studies published to date, among other factors, there are currently no evidence-based conclusions or guidelines that can be formulated with regard to the most appropriate open treatment. Establishment of such standards could potentially improve treatment outcomes.
Topics: Adult; Fracture Fixation, Internal; Humans; Jaw Fixation Techniques; Mandibular Condyle; Mandibular Fractures; Mandibular Reconstruction
PubMed: 28732561
DOI: 10.1016/j.ijom.2017.06.018 -
Medicina Oral, Patologia Oral Y Cirugia... Nov 2018Bifid mandibular condyle (BMC) constitutes an extremely rare disorder characterized by a duplication of the head of the mandibular condyle. Its prevalence ranges from...
BACKGROUND
Bifid mandibular condyle (BMC) constitutes an extremely rare disorder characterized by a duplication of the head of the mandibular condyle. Its prevalence ranges from 0.31% to 1.82% in the published literature.
OBJECTIVES
The primary objective was to describe the main etiological, clinical and radiological characteristics of patients with BMCs and the existent treatment options. The secondary objective was to simultaneously include the characteristics of two new cases of BMC.
MATERIAL AND METHODS
An electronic search in Pubmed (MEDLINE), Scopus and The Cochrane Library was carried out by two independent reviewers until April 2018. Prospective or retrospective cohort studies, case series and case reports describing clinical and/or radiological characteristics of patients with BMC were included. Registered variables were demographic, etiological factors, diagnostic exam, clinical characteristics and treatment options. The results from the articles selected were organized in a Table along with the characteristics of two new cases of BMC provided by the authors.
RESULTS
From a total of 431 articles found in the initial search, 68 articles were finally included. This systematic review included 216 patients and 270 BMC with an average age of 30.6 (SD=14.7) years and a women:men ratio of 1.4:1. Mediolateral condylar orientation was the most prevalent position (80.1%). Among cases with known etiology, 40.8% of cases had a history of traumatism, while 55.9% did not present any relevant medical background. Half of the symptomatic cases had history of trauma. The most common symptoms were hypomobility (22.7%), arthralgia (18.1%), articular noise (17.2%) and ankylosis (17.6%). Active monitoring and manufacturing an occlusal splint were the most frequent treatment options.
CONCLUSIONS
BMC may have congenital or traumatic etiology. Hypomobility and arthralgia are the most frequent symptoms and treatment options are often conservative.
Topics: Congenital Abnormalities; Female; Humans; Male; Mandibular Condyle; Middle Aged
PubMed: 30341271
DOI: 10.4317/medoral.22681 -
The Journal of Prosthetic Dentistry Apr 2016Immediate mandibular lateral translation (IMLT) has been widely described in theory, but its clinical significance in prosthodontics and restorative dentistry is not... (Review)
Review
STATEMENT OF PROBLEM
Immediate mandibular lateral translation (IMLT) has been widely described in theory, but its clinical significance in prosthodontics and restorative dentistry is not clear.
PURPOSE
The purpose of this study was to systematically review the existing literature to identify the clinical significance of IMLT (immediate side shift).
MATERIAL AND METHODS
An electronic search for articles in the English language literature was performed independently by multiple investigators using a systematic search process with the PubMed search engine. After applying predetermined inclusion and exclusion criteria, the final list of studies was analyzed to identify the clinical significance of IMLT.
RESULTS
The initial electronic search yielded 858 titles. The systematic application of the inclusion and exclusion criteria eventually produced 23 studies addressing IMLT in 914 human participants. Eleven studies reported use of voluntary movements, 5 articles reported use of only induced movements, 2 studies reported use of both voluntary and induced movements, and 5 articles did not report the recording method. The amount of IMLT reported ranged from 0 to 3 mm with minimal clarity among authors on the exact description of IMLT. No studies reported on any clinical implication (harm or benefit to patients or clinicians) of incorporating IMLT in diagnosis and treatment planning.
CONCLUSIONS
This systematic review did not identify any scientific evidence on the clinical implications of IMLT. Furthermore, there is a lack of clear terminology related to IMLT and the timing of the side shift, occurrence of IMLT on the working versus nonworking condyle, and induced versus noninduced methods of recording and measuring. Current scientific evidence does not support the need to include IMLT as a factor when prosthodontic or restorative treatment is planned and executed.
Topics: Humans; Mandible; Patient Care Planning
PubMed: 26723093
DOI: 10.1016/j.prosdent.2015.09.021 -
Oral Surgery, Oral Medicine, Oral... Nov 2023Surgical innovation led to an endoscopic-assisted intraoral approach for managing condyle fractures. The purpose of this systematic review is to purview the role of the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Surgical innovation led to an endoscopic-assisted intraoral approach for managing condyle fractures. The purpose of this systematic review is to purview the role of the endoscope and determine the range of information, summarizing the evidence for the benefit of surgeons on an endoscopic-assisted intraoral approach.
STUDY DESIGN
A literature search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library databases for studies mentioning the endoscopic intraoral approach for managing mandibular condylar fractures. Outcomes include the role of the endoscope, challenges, adjunct armamentarium, duration, and complications associated with the transoral and transbuccal approach for screw fixation. The meta-analysis was conducted with prevalence estimates and standardized means using STATA.
RESULTS
Thirty-nine studies were included. A 30° angulated, 4-mm-thick endoscope was the most commonly used endoscope. Two mini plates were most commonly used for fixation. Facial nerve weakness was higher in the transbuccal approach (1.24%) than in the transoral approach (0.8%). Pooled analysis (6 studies) showed that the duration of the surgical procedure was less in the transoral approach compared with the transbuccal approach for screw fixation. The bailout was 1.49%.
CONCLUSIONS
The endoscopic-assisted intraoral approach is reliable for condylar fracture management. The transoral and transbuccal approaches can be used for screw fixation with comparable outcomes.
Topics: Humans; Mandibular Condyle; Fracture Fixation, Internal; Endoscopy; Mandibular Fractures; Bone Screws; Treatment Outcome; Bone Plates
PubMed: 37635009
DOI: 10.1016/j.oooo.2023.04.013 -
Journal of Clinical Medicine Aug 2021Fixing fractures of the base and neck of mandibular condyles is demanding due to the difficulties in surgical access and the various shapes of bone fragments. Classic... (Review)
Review
INTRODUCTION
Fixing fractures of the base and neck of mandibular condyles is demanding due to the difficulties in surgical access and the various shapes of bone fragments. Classic fixation techniques assume the use of straight mini-plates, utilized for other craniofacial bone fractures. Three dimensional mini-plates may provide a reasonable alternative due to their ease of use and steadily improved mechanical properties. The multitude of different shapes of 3D mini-plates proves the need for their evaluation.
AIM
This paper aims to summarize the clinical trials regarding the use of various types of 3D condylar mini-plates in terms of need for reoperation and the incidence of loosening and damage to the osteosynthetic material.
MATERIALS AND METHODS
A systematic review was conducted in accordance with PICOS criteria and PRISMA protocol. The risk of bias was assessed using ROBINS-I and RoB 2 Cochrane protocols. The obtained data series was analyzed for correlations (Pearson's ) respecting statistical significance (Student's -test > 0.05) and visualized using OriginLab.
RESULTS
13 clinical trials with low overall risk of bias regarding 6 shapes of 3D mini-plates were included in the synthesis. The number of reoperations correlates with the number of fixations ( = 0.53; = 0.015) and the total number of screw holes in the mini-plate ( = -0.45; = 0.006). There is a strong correlation between the number of loosened osteosynthetic screws and the total number of fractures treated with 3D mini-plates ( = 0.79; = 0.001 for each study and = 0.99; = 0.015 for each mini-plate shape). A correlation between the percentage of lost screws and the number of distal screw holes is weak regarding individual studies ( = -0.27; = 0.000) and strong regarding individual mini-plate shape ( = -0.82; = 0.001). Three cases of 3D mini-plate fractures are noted, which account for 0.7% of all analyzed fixation cases.
DISCUSSION
The reasons for reoperations indicated by the authors of the analyzed articles were: mispositioning of the bone fragments, lack of bone fragment union, secondary dislocation, and hematoma. The known screw loosening factors were poor bone quality, bilateral condylar fractures, difficulties in the correct positioning of the osteosynthetic material due to the limitations of the surgical approach, fracture line pattern, including the presence of intermediate fragments, and mechanical overload. Fractures of the straight mini-plates fixing the mandibular condyles amounts for up to 16% of cases in the reference articles.
CONCLUSIONS
There is no convincing data that the number of reoperations depends on the type of 3D mini-plate used. The frequency of osteosynthetic screw loosening does not seem to depend on the 3D mini-plate's shape. Clinical fractures of 3D mini-plates are extremely rare.
PubMed: 34441900
DOI: 10.3390/jcm10163604