Journal of Craniomandibular Function, 02/2015

Arthrocentesis is a minimally invasive procedure that is thought to reduce inflammation by removing damaging molecules and inflammatory mediators from the temporomandibular joint (TMJ). In many clinics, it is common to flush the joint with anti-inflammatory medications, usually some form of corticosteroid, following the procedure. The aim of this article is to review the rationale, risks, and effectiveness of arthrocentesis of the TMJ. Keywords: TMJ, arthrocentesis

The field of temporomandibular joint (TMJ) endoprosthetics developed in two waves. After an initial period of poor long-term results, the material and structural improvements of alloplastic TMJ replacements achieved in recent years have reduced these failures significantly. The indications for total TMJ replacement include inflammatory and degenerative TMJ diseases and, in particular, TMJ deformities, trauma, and tumor complications. Total TMJ replacement must be embedded in the general decision cascade of available conservative and surgical options, and it should always be regarded as the treatment of last resort, to be performed only after all other options have been exhausted. Both stock and custom-made total TMJ prostheses are used in a largely standardized operating procedure. Pre- and postoperative physical therapy is a key component of successful restoration of function. The results reported in the literature show low complication rates, with significant improvement in the areas of pain reduction, and improvement of function and quality of life. Thus, modern total alloplastic TMJ replacement is a safe and reliable treatment modality that has significantly expanded the range of treatments, especially for end-stage TMJ disorders. Keywords: alloplastic temporomandibular joint replacement, biological reconstruction, CAD/CAM prosthetics, conservative treatment cascade, endoprosthetics, functional analysis, joint resection, nerve damage, physical therapy

The aim of this study was to assess the objectivity of a newly developed computer-based analysis method for the Bruxcore Bruxism Monitoring Device (BBMD), and to evaluate the ability of the BBMD to differentiate between patients with and without sleep bruxism (SB). A total of 48 SB patients and 21 non-bruxing controls participated in the study. After detailed functional diagnosis by a dentist according to the clinical criteria for the diagnosis of SB of the American Academy of Sleep Medicine (AASM), each participant was fitted with a BBMD and instructed to wear it for 5 consecutive nights. Subsequently, the appliances were digitized, and their abrasion was assessed by two independent raters using the new method, in which the abraded area was measured in pixels. Inter-rater reliability was very high, as is reflected by an intraclass correlation coefficient (ICC) of 0.99 between the two raters. Mean pixel scores for SB patients were about 8 times higher than those for the controls. Using 2,900 as the cutoff pixel score, the method achieved a sensitivity of 79.2%, a specificity of 95.2%, and positive and negative predictive values of 97.4% and 66.7%, respectively. The results of this study support the view that the newly developed analyzing method of Bruxcore analysis is objective, capable of differentiating between patients with and without SB, and suitable for clinical use. Keywords: sleep bruxism, quantification, abrasion, reliability, clinical diagnosis, monitoring, practicability