AbstractObjectivesPeriodontal Ehlers–Danlos syndrome (pEDS) has recently been delineated as a molecularly defined cause of early severe periodontitis. Here we report that implant treatment failed in three affected individuals from one family.Materials and MethodsLongitudinal data before and after implant treatment were examined for three individuals with genetically confirmed pEDS in the course of a large‐scale pedigree analysis.ResultsMost detailed information was available for individual 1 in whom first periodontal bone loss was diagnosed at age 16 years. Rapid progression resulted in multiple tooth extractions at age 23 years and interforaminal placement of four implants. After primary implant success, peri‐implant bone loss accompanied by highly inflamed tissues and receding gums led to explantation five years later. In individual 2, severe periodontitis was diagnosed at age 15 years and resulted in extraction of all mandibular teeth at age 28 years. Four interforaminal implants were placed. Peri‐implant bone loss was diagnosed four years later, when up to three implant threads were exposed. Individual 3 showed complete tooth loss at age 29 years. He was restored with ten implants and removable prosthesis. Peri‐implant bone loss was diagnosed radiologically eight years later, when seven implant threads were exposed.ConclusionThis is the first report on severe peri‐implant bone loss in pEDS. Retention of teeth as long as possible is the primary objective in pEDS as satisfying prosthetic solutions are missing. Further evaluation of dental management in individuals with pEDS is needed to develop concise treatment guidelines.

Rehabilitation of the single anterior tooth in the esthetic region after a dental implant fracture requires management of contributing biomechanical and/or biological etiologic factors. The multidisciplinary treatment of a fractured maxillary anterior single dental implant with a staged, combined surgical and prosthetic approach is discussed. Alleviation of several, but not all, risk factors eliminated the need for replacement of gingiva with pink porcelain and maintained a stable post implant host complex.

Fragestellung. Ziel der Arbeit war es, die posttraumatische Bulbusmotilität in Bezug auf die Fraktursituation am Orbitaboden und eventuelle Begleitverletzungen zu untersuchen.

The purpose of this prospective, cohort study of patients with dental injuries was to develop prediction rules to predict treatment response related to the management of dental injuries. The study comprised of 130 patients with a single permanent incisor affected by a dental displacement (n = 100) or fracture injury (n = 30). Laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF) were taken 6 and 18 weeks after dental injury Treatment response (success or failure) was categorized based on findings of clinical and radiographical evaluation after 9 months. Forty-four (34%) subjects were categorized as treatment success (absence of loss of sensitivity, periapical radiolucency and grey discolouration of crown), 43 (33%) as treatment failures (loss of sensitivity, and periapical radiolucency and/or grey discolouration of crown) and 43 (33%) as acceptable outcome (loss of sensitivity). After using univariate analysis to determine the association between potential clinical and LDF predictor variables and treatment response status, preliminary prediction rules were developed for prediction of success [positive likelihood ratio (LR), 29.0; 95% confidence interval (CI), 1.7-496.4] and failure (negative LR, 0.55; CI, 0.4-0.7). The most important variables were subluxation, root fracture, baseline PBF level and change in PBF level at 3-month follow-up. Outcome following the management of dental injuries may be predicted from variables collected from LDF and physical examination. Predictive modelling may provide clinicians with the opportunity to identify 'at-risk' patients early and initiate specific treatment approaches.

Splinting of traumatically displaced permanent teeth has been described as an effective modality in the treatment of patients with dental injuries. The purpose of this study was to (i) investigate whether dental injury diagnosis may predict adverse outcomes occurring 96 weeks after splint removal, and (ii) evaluate whether the severity of adverse outcome is related to laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF). In 206 trauma patients, 273 permanent maxillary incisors treated by repositioning and splinting, and the respective contralateral homologous control teeth were investigated clinically and radiographically, and by LDF to assess local PBF values. Dental displacement injuries were classified as grade I (subluxation), grade II (lateral or extrusive luxation) and grade III (avulsion or intrusive luxation). Outcomes were classified as 'absence of loss of sensitivity, periapical radiolucency, and/or grey discolouration of crown', type I (loss of sensitivity), type II (loss of sensitivity and periapical radiolucency or grey discoloration of crown) and type III (loss of sensitivity, periapical radiolucency and grey discoloration of crown). An adverse outcome was defined as the presence of 'periapical radiolucency and/or grey discoloration'. A multiple logistic regression analysis was used to compute the odds ratio (OR) for dental displacement injury for adverse outcome (n = 69) vs non-adverse outcome (n = 168). An ordinal stepwise regresssion was completed to assess the degree of association between PBF measurements and outcome groups. Significant increase in risk of an adverse outcome occurred with a grade II dental displacement injury (OR 14.3) (P = 0.000) and a grade III dental displacement injury (OR 19.9) (P = 0.000). PBF measurements that were significantly associated with more severe outcome were PBF levels of < or =3 perfusion units (PU) (OR 399.4) (P = 0.000), those of >3 PU and < or =6 PU (OR 100.5) (P = 0.000), and those of >6 PU and < or =9PU (OR 6.2) (P = 0.000). Diagnoses of displaced teeth predicted dental injury patients who went on to show adverse treatment outcomes of splinting. PBF measurements were related to the severity of adverse outcome.

The purpose of this study was to investigate whether dental injury diagnoses may predict adverse outcomes occurring 102 weeks after trauma, and to evaluate whether the severity of adverse outcome is related to laser Doppler flowmetry (LDF) measurements of blood flow from teeth. In 309 trauma patients, 404 permanent maxillary incisors and the respective contralateral homologous control teeth were investigated clinically and radiographically, and by LDF to assess local blood flow values. Dental displacement injuries were classified as grade I (subluxation), grade II (lateral or extrusive luxation), and grade III (avulsion or intrusive luxation). Dental fracture injuries were classified as uncomplicated crown fractures, complicated crown fractures, and root fracture. An adverse outcome was defined as the presence of 'periapical radiolucency and/or grey discolouration'. Significant increase in risk of an adverse outcome occurred with a grade II dental displacement injury (15.07 odds ratio; P = 0.000), a grade III dental displacement injury (28.33 odds ratio; P = 0.000), and a root fracture (106.25 odds ratio; P = 0.000). Blood flow measurements that were significantly associated with more severe outcome were blood flow levels of <= 3 perfusion units (PU; 170.72 odds ratio; P = 0.000), and those of > 3 PU and <= 6 PU (76.71 odds ratio; P = 0.000). Diagnoses of displaced and root fractured teeth predicted dental injury patients who went on to show adverse treatment outcomes of splinting. Blood flow measurements from teeth were related to the severity of adverse outcome.

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.

Objective. To evaluate whether there are any correlations between the clinical parameters of temporomandibular joint (TMJ) arthritis and pathologic ultrasound (US) findings of the TMJ in patients with juvenile idiopathic arthritis (JIA).Methods. We conducted prospective clinical and US investigations of the TMJs of 48 patients with JIA. The US investigation was performed by a 12-MHz high-resolution transducer, which was positioned parallel to the ramus of the mandible overlying the zygomatic arch in a closed-mouth position and maximum open-mouth position.Results. Patients with >= 5 peripheral affected joints showed significantly more sonographically diagnosed destructive changes in the TMJ than did patients with < 5 affected joints. There was no significance between the number of affected peripheral joints and disc dislocation in the closed-mouth position. In the maximum open-mouth position, there was a significant correlation between the number of affected peripheral joints and disc dislocation. Patients with a JIA duration > 23 months had a significantly higher rate of disc dislocation and destructive changes. Patients with a JIA duration > 60 months had a significantly higher rate of destructive changes of the TMJ than patients with a disease duration < 60 months, but no statistical significance was found concerning disc dislocation.Conclusion. The significant correlation between pathologic sonographic findings, duration of JIA, and the number of affected peripheral joints make the technique interesting for use as a diagnostic screening method.

A 52-year-old patient presented with an orbital swelling and exophthalmos that enlarged over a period of about 40 years. The clinical examination showed massive exophthalmos and ptosis of the right eye without diplopia. The radiological investigation (MRI, CT and ultrasound) showed an unclear intraorbital mass with erosion of the orbital floor, infraorbital rim and orbital roof. The lesion was diagnosed histologically as a plexiform neurofibroma. The patient did not present any features of neurofibromatosis type 1 (NF-1) and molecular genetic analysis was unable to uncover a pathogenic sequence alteration in the NF-1 gene. Owing to the absence of clinical and ophthalmologic symptoms and the improbability of complete removal, the patient refused surgical intervention.

Study objective: To determine the agreement between rectal temperature and infrared tympanic membrane temperatures in marathon runners presenting to a field hospital at the finish line. Methods: The subjects of this prospective, blinded, controlled study were runners 18 years or older who were triaged to the acute care medical area at the finish line for suspected hypothermia, hyperthermia, dehydration, or altered mental status. Rectal and tympanic temperatures were measured simultaneously in all subjects for whom rectal temperature measurement had been deemed necessary and recorded on separate data cards. Results: Of the 239 runners treated in the acute care medical area, 37 required rectal temperature measurement and were enrolled in the study. The mean rectal temperature was 38.45º±1.20º C (range, 35.9º to 41.5º C). The mean tympanic membrane temperature was 37.81º±.95º C (range, 36.3º to 40.4º C). Pearson's correlation coefficient revealed a moderate correlation (r=.6902, P=.00023). The mean temperature difference between the two thermometers, mean rectal minus mean tympanic membrane, was .64º C (95% confidence interval, .35º to .93º C). Sixty-two percent of the tympanic membrane readings were within 1º C of their rectal counterparts. Agreement ranged from 1.16º (+2 SD) to -2.95º (-2 SD). The 95% confidence interval was 1.67º to -2.95º C. Conclusion: We were able to demonstrate only a moderate correlation between the two thermometer readings, with a wide spread between the limits of agreement. This spread could be clinically significant and therefore limits the usefulness of tympanic temperature in the marathon race setting. Because of the potentially large and clinically significant differences in rectal and tympanic temperatures and the limitations inherent in our study, we cannot endorse the use of tympanic temperature in the setting of a marathon event. [Roth RN, Verdile VP, Grollman LJ, Stone DA: Agreement between rectal and tympanic membrane temperatures in marathon runners. Ann Emerg Med October 1996;28:414-417.]

Objective: The purpose of this study is to determine whether there are statistically significant variations among different observers when examining fractures of the orbital walls. Material and methods: From December 2003 to April 2004, 28 patients with clinically suspected orbital fractures were examined by ultrasound prospectively. The US images of the infra-orbital margins, the orbital floors, the medial and lateral orbital walls of each patient were reexamined by two independent investigators. Results: Computed tomography revealed fractures of the orbital floor in 28 out of 31 patients (90.3%). The infra-orbital margins showed fractures of 14 of 31 patients (45.2%). The ultrasound examinations of the orbits by the three examiners presented satisfactory correlation regarding sensitivity and specificity. There were no significant differences between investigators. There was good agreement among the ultrasound examiners regarding the infra-orbital margins. This was not the case for the orbital floors. Conclusions: If there are clear cut clinical findings ultrasound examination could represent an alternative to computed tomography. If the clinical findings were indeterminate, computed tomography was essential as implicated by this study. Accordingly, further evaluation of ultrasound examinations of fractures of the orbital margins and floors are necessary.

The thermal signature of an equilibrium liquid–liquid transition (LLT) in triphenyl phosphite was detected by differential scanning calorimetry measurements at a fast heating rate reaching 500 K min−1. The estimated temperature, enthalpy, and entropy of the LLT were 241.7 K, 12.0 kJ mol−1, and 49.5 J K−1 mol−1, respectively. The estimated residual entropy for a glacial sample prepared at 224.7 K was 6 J K−1 mol−1; this value is much smaller than that for the normal glassy liquid. This glacial state was found to be a highly ordered liquid compared with the normal glassy liquid in terms of entropy.

The aim of this study was to compare sensitivity, specificity, accuracy and positive and negative predictive value for high-resolution ultrasonography (HR-US) in diagnosing degenerative changes, effusion and disk displacement using magnetic resonance imaging (MRI) as a reference. Over a period of 6 months, 100 patients with TMJ disorders (200 TMJs) were investigated by an experienced radiologist with HR-US and magnetic resonance imaging (MRI). The MRI investigation showed degenerative changes in 190 joints (95%), while an effusion was found in 59 (29.5%) joints. At closed-mouth position a disc dislocation was found in 138 joints (69%) and in maximum-mouth-opening position disc dislocation was diagnosed in 76 joints (38%). In the determination of degenerative changes HR-US showed a sensitivity of 94%, a specificity of 100% and an accuracy of 94%. In the detection of effusion HR-US yielded a sensitivity of 81%, a specificity of 100% and an accuracy of 95%. In the determination of disk displacement at closed-mouth position HR-US showed a sensitivity, specificity and an accuracy of 92% each. At maximum-mouth-opening position HR-US reached a sensitivity of 86%, a specificity of 91% and an accuracy of 90%. The results of the current study imply that HR-US is a valuable diagnostic imaging method of the TMJ which can be used as an alternative method to a MRI-investigation, but is yet not able to replace it. Further studies have to be done to reduce false-negative results.

Purpose: The aims of the study were to document the effectiveness of ultrasound (US) in diagnosing orbital wall fractures when compared with computed tomography (CT) and to measure the intraobserver reliability of US using a curved array transducer.Materials and Methods: From December 2003 to March 2004, 13 patients with the clinical diagnosis of an orbital trauma were investigated prospectively by CT (reference) and 2 US investigators. Both orbits were investigated. Sensitivity, specificity, accuracy, and positive and negative predictive value were calculated. The statistical difference between the 2 US investigators was calculated by a chi-square test. The interrater reliability was calculated using the lambda coefficient. Values below 0.4 represent poor reliability, between 0.4 and 0.75 represent fair to good reliability, and a score > 0.75 is graded as excellent reliability.Results: The comparison of the results of the 2 US investigators by the chi-square test showed P values of .385 for the medial orbital wall and .638 for the lateral orbital wall, which shows no significant difference. The A-value for the investigation of the medial orbital wall reached 0.429, 0.714, and 0.750. The lambda-value for the investigation of the lateral orbital wall yielded 0.647, 0.750, and 0.882. These values show a good and excellent inter-rater reliability.Conclusion: The US investigation does not yet reach the diagnostic quality of CT. US could be a helpful diagnostic imaging tool in cases with clear clinical symptoms. The results of the current study and the previously published results imply that US has the potential to reach the same diagnostic quality as CT in the future, but further studies must be performed to improve the diagnostic quality of the method. (c) 2006 American Association of Oral and Maxillofacial Surgeons.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood-flow (PBF). Dental injury has been associated with significant PBF reduction. The purpose of this study was to assess whether (i) the type of luxation trauma may affect PBF measurements and (ii) whether luxation type-related measurements may show short- and long-term changes of PBF values. In 41 trauma patients, 69 maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous tooth were investigated by LDF to assess local PBF values. Perfusion units were recorded in four sessions, on the day of splint removal, and 12, 24 and 36 weeks after splint removal. Statistical analysis consisted of univariate analysis of variance for repeated measurements. For the LDF measurements, the main effect of the variable 'session' was not significant (P = 0.119). However, there was a significant 'session'/'luxation type' interaction (P = 0.000). Analysis of simple session-within-luxation type effects revealed intrusive luxations to be associated with a significant decrease in PBF values (P = 0.000), while subluxations (P = 0.568), lateral luxations (P = 0.980), extrusive luxations (P = 0.910), and avulsions (P = 0.996) showed no significant difference between session-related values. The PBF measurements did not change over time for the contralateral incisors (P = 0.996). The LDF may become useful in the detection of pulpal ischaemic episodes in luxated maxillary incisors after repositioning and splinting. Further studies are warranted to assess the validity of the diagnosis of post-traumatic 'ischaemic episodes' by comparing it with histological tooth pulp changes, and by determining how well it may predict course and response to treatments in clinical trials.

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 <or=6 perfusion units (PU) (106.70 odds ratio) (P = 0.000). Significant increase in the risk of a PBF level of <or=6 PU occurred with a type III outcome (32.49 odds ratio) (P = 0.004). PBF measurements were related to the severity of adverse outcomes. Diagnoses of treatment outcomes predicted the presence of specific PBF levels.

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.

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.