Oral P r e s e n t a t i o n s / O36, TMJ III

69

patients. There was no difference between PCR-positive and -negative

rate regarding sex and disease categories, e.g., internal derangement
(ID) and osteoarthritis (OA). However, the prevalence of M. fermentans
DNA in ID patients was higher in elderly patients (73.3%) than in
younger patients (31.8%). Anti-M. fermentans immunoreactivities specific
for lipoproteins of M. fermentans with various molecular sizes, 56 kiloDalton (kDa), 48 kDa, 38 kDa, and 29 kDa, were identified in the
SE The immunoreactivity was also detected in the patient's sera. The
reactivity patterns of the anti-M, fermentans antibodies to the lipoproteins
were, however, different between the SF and the sera; reactivities to
48 kDa and 29 kDa lipoproteins were prominent in the former, while
the reactivities to those of 56 kDa, 48 kDa, and 29 kDa were evidently
increased in the latter. The presence of specific DNA and antibody for
M. fermentans in the TMJ implies that M. fermentans could possibly
induce joint specific immunoreaction, thus perpetuating the inflammatory
reaction in the diseased TMJ.

specimens with severe arthrotic alterations were excluded from further

evaluation. In the central area of the mandibular condyle the trabecular
bone density appeared higher than in the peripheral zones medially
and laterally. Comparing left and right condyles significant differences
between specimens from edentate (r=0.54) and endentulous (r=0.92)
individuals existed. The in vivo scanning data of patients revealed similar
results and were reproducable. Using a special adapted software conventional CT scans can be used to analyse the trabecular bone density
in the mandibular condyle. The different load on the bone in the head of
the mandible is reflected in the distribution of the trabecular bone density.
Local differences in the bone density, which point out a higher loading in
the central areas compared with the peripheral areas exist. Thus it can
be assumed that the main flow of force predominantly occurs through
the central area of the condyle. The interindividual differences in the left
and the right side of edentate individuals depended on the preferred side
of chewing.

References

References

[1] Henry C. H., Hughes C. V., Gerard H. C., Hudson A. P., and Wolford
L. M.: Reactive arthritis: preliminary microbiologic analysis of the human
temporomandibular joint. J Oral Maxillofac Surg 58:1137-1142, 2000.
[2] Suga M., Hamada N., and Kubota E.: Evidence of cytokine and matrix
degrading enzyme induction by Mycoplasma fermentans-derived lipoprotein in blood cells and synoviocytes. Bull Kanagawa Dent Col 31:151-159,
2003.

[1] M. Yamada et al., Bone 21:441.

[2] E.B.W Giesen et al., J. Dent. Res. 83:255.
[3] T. Hothan et al., Radiologie 41:497.

[-0-'3--~ DIAGNOSTIC QUALITY OF DYNAMIC HIGH-RESOLUTION

ULTRASONOGRAPHY OF THE TMJ - A PILOT STUDY
S. Jank, R. Emshoff, B. Norer, M. Missmann, A. Nicasi, H. Strobl,
R. Gassner, A. Rudisch, G. Bodner. University oflnnsbruck Department

of Oral and Maxillofacial Surgery, Innsbruck, Austria

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 HRUS 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.
[-0-'3--~ CT MEASUREMENTS OF THE BONE DENSITIY IN THE
MANDIBULAR CONDYLE

G. Muehlberger, M. Svejda, C. Lottersberger, R. Putz, M. Rasse,

V. Kuhn. Klinische Abteilung ffJr Mund-, Kiefer- und Gesichtschirurgie,

Universit#tsklinik ffJr Zahn- Mund- und Kieferheilkunde, Medizinische

Universit#t Innsbruck, Innsbruck, Austria
We hypothesize that loss of teeth in older patients changes forces and
loading conditions in the temoporomandibular joint. The aim of this
study was to investigate the adaption of bone density and its distribution
within the mandibular condyle. The right and left mandibular heads of 11
edentated and 10 endentulous mandibles from an anatomical dissection
course were investigated. The mean age was 79.6 years. The specimens
were scanned in a clinical multislice-CT with maximal resolution and
reconstructed in the three main planes. Trabecular bone density and
its distribution was determined using special software (Geanie 2.1,
Bonalyse, Finnland). Results were compared with the trabecular bone
density of the mandibular heads from CT scans of patients without
fractures in the temporomandibular joint area. The measurements were
performed in the axial plane with a minimal slice thickness of 1.5 mm. Six

[-0-~-~

EFFICACY OF CONDILECTOMY AS AN EXCLUSIVE

TREATMENT OF CONDYLAR HYPERPLASIA

R. FariSa, L. Castellon, A. Basili, E Pintor. Hospital Exequiel Gonzalez

Cortes, Facultad de Odontologia Universidad Mayor, Santiago, Chile
Demonstrate that the condilectomy is the best treatment to the condylar
hiperplasia We did a retrospective study to 5 patients with a horizontal
condylar hyperplasia (hemimandibular elongation). We did complete facial, oclusal and cefalometric studies, and bone scintigraphy with SPECT.
We measured facial points (chin deviation, commissural level), oclusal
relations (in 3 planes of space) and skeletal measurements (symphysis
deviations, levels of mandibular angles, level of oclusal plane, dimensions
of the condylar process and mandibular ramus. The 5 patients showed in
the SPECT a high hyperactivity of the affected side. All patients were only
surgically treated with a condilectomy in the hyperplasic side. To analyze
the results we repeated the same preoperative exam after 8 months of
the surgery, doing statistical study, "t student", comparing preoperative
with postoperative results in the 5 patients for each parameter, obtaining
a statistical difference in all points (p < 0.05) except in oclusal level. We
can say that the condilectomy as a unique surgical treatment of the
condylar hyperplasia allows to re-establish in an etiologic form the facial,
skeletal and oclusal disturbances, with a minimal invasive treatment.
[-0-'3--~ META-ANALYSIS OF TMJ DISCECTOMY WITH
OR WITHOUT AUTOGENOUS/ALLOPLASTIC
INTERPOSITIONAL MATERIALS: COMPARATIVE
ANALYSIS OF FUNCTIONAL OUTCOME
A. Kramer, L. Lee, O. Beirne. University of Washington, USA
The aim of this meta-analysis was to analyze the functional outcomes of
different autogenous and alloplastic TMJ interpositional materials, and
compare them with discectomy. A Medline search from 1965-2001 was
performed to identify studies meeting the following inclusion criteria:
(1) 10 patients; (2) Documentation of follow-ups; (3) Use of objective
tests for pre- and post-operative assessment of jaw function, and pain;
(4) Established criterion for success. A comprehensive statistical analysis
was performed. Success was defined as the absence of joint pain and
MIO greater than 35 mm, and mean success rate (MSR) was calculated
for each implant type. Confidence interval (CI) was used to formulate
a risk ratio (RR) on changes in joint pain and MIO. A 95 percent CI
above 1 was considered to be statistically significant (p less than 0.05).
Seventeen studies met the criteria. Discectomy (4 studies; n = 432; mean
f/u 5.7 years): MSR 86.5 percent. CI for pain and MIO improvement
following surgery was statistically significant (RR greater than 3.39 &
2.78, respectively). Silastic implants (3 studies; n= 159; mean f/u 5.2
years): MSR 81.1 percent (75.4 percent for temporary / 83 percent for
permanent implants). CI for pain improvement was statistically significant
(RR greater than 1.5), but the improvement in MIO was not (RR less
than 0.38). Proplast-Teflon (6 studies; n =934; mean f/u 5.1 years): MSR
58.9 percent. CI for pain and MIO improvement was not statistically
significant (RR less than 0.8). Temporalis flap (2 studies; n =35; mean
f/u 2.2 years): MSR 91.4 percent. CI for pain improvement was not