Host modulation as a therapeutic strategy in the treatment of periodontal disease.
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Specific microorganisms initiate the immunoinflammatory processes that destroy tissue in periodontitis. Recent work has demonstrated, in addition to bacterial control, that modulation of the host immunoinflammatory response is also capable of controlling periodontitis. Matrix metalloproteinases (MMPs) destroy collagen and other matrix components, and the osteoclastic bone remodeling determines the periodontal bone response to a bacterial challenge. Other components of the biology, including cytokines and prostanoids, regulate MMPs and bone remodeling and are also involved in regulating the production of defensive elements, such as antibody. Agents directed at blocking MMPs or osteoclastic activity are effective in reducing periodontitis. Agents that inhibit prostaglandin E2 and selective blockage of specific cytokines have also been effective. Improved knowledge of bacterium-host interactions and of the processes leading to tissue destruction will help to identify targets for host modulation to reduce periodontitis in selected situations. (+info)
Imaging of a Stafne bone cavity: what MR adds and why a new name is needed.
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Stafne bone cavities are asymptomatic radiolucencies seen at the angle of the mandible. Although plain films are often sufficient for diagnosis, confirmatory imaging is needed in atypical cases. We describe the MR imaging findings of a Stafne bone cavity, describe the contents, explain why a new name is needed, and discuss the relative merits of different radiologic techniques for establishing this diagnosis. (+info)
SAPHO syndrome of the temporomandibular joint associated with sudden deafness.
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We report a case of arthritis of the temporomandibular joint (TMJ) associated with sclerosing osteomyelitis of the mandible and temporal bone, causing deafness. The presence of a palmoplantar pustulosis established the diagnosis of SAPHO syndrome. SAPHO (an acronym referring to synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis) syndrome is defined by the association of characteristic osteoarticular and dermatologic manifestations, with diffuse sclerosing osteomyelitis of the mandible being a part of this entity. We review the literature of SAPHO syndrome with mandibular manifestations and discuss the mechanisms of inflammatory spread from the TMJ to the cochlea. To our knowledge, this is the first description of skull base involvement in a patient with SAPHO syndrome leading to sudden deafness. (+info)
A large maxillofacial prosthesis for total mandibular defect: a case report.
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We successfully fabricated a large maxillofacial prosthesis for replacement of a total mandibular defect resulting from surgical failure to reconstruct the mandible. Although a number of reports have described procedures for fabricating midfacial prostheses, there is little information on prostheses to compensate for total loss of the mandible. A 54-year-old woman was referred to the Dentistry and Oral Surgery Division of the National Cancer Center Hospital with total loss of the mandible and the surrounding facial soft tissue. The facial prosthesis we used to treat this patient is unique in that it is adequately retained without the use of extraoral implants and conventional adhesives. This prosthesis is retained by the bilateral auricles and the remaining upper front teeth. We present details of the design of this large silicone maxillofacial prosthesis, with which we successfully rehabilitated the patient. (+info)
Masticator space abnormalities associated with mandibular osteoradionecrosis: MR and CT findings in five patients.
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BACKGROUND AND PURPOSE: Imaging of patients with a clinical diagnosis of mandibular osteoradionecrosis (ORN) is often performed to support that clinical suspicion, evaluate the extent of the disease, or exclude coexistent tumor recurrence. The purpose of our study was to describe the clinical, MR imaging, and CT features of five patients with mandibular ORN associated with prominent soft-tissue abnormality in the adjacent masticator muscles. METHODS: The MR and CT examinations of five patients with mandibular ORN associated with soft-tissue abnormalities in the adjacent masticator muscles were reviewed. All patients had received external beam radiotherapy for primary head and neck malignancies, with a total radiation dose range of 60 Gy to 69 Gy in 30 to 38 fractions. RESULTS: CT revealed the typical osseous findings of cortical disruption, trabecular disorganization, and fragmentation in all five patients. Abnormal diffuse enhancement of the adjacent masseter and pterygoid muscles was noted in all patients. Four patients had prominent mass-like thickening of these muscles adjacent to the osseous abnormality. Of the three patients who underwent MR imaging, all showed homogeneous abnormal T1 hypointensity, T2 hyperintensity, and intense enhancement of the bone marrow in the involved mandible. The masticator muscles adjacent to the osseous abnormality also showed abnormal T2 hyperintensity and intense diffuse enhancement on MR images. CONCLUSION: Mandibular ORN can be associated with prominent soft-tissue thickening and enhancement in the adjacent musculature. These changes can appear mass-like and are not related to tumor recurrence or metastatic disease. (+info)
Post-extraction remodeling of the adult mandible.
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Following tooth loss, the mandible shows an extensive loss of bone in some individuals. This may pose a significant problem in the prosthodontic restoration of function and esthetics. The many factors which have been proposed as being responsible for the inter-individual variation in post-extraction remodeling mean that a perfunctory analysis of the literature, in which well-controlled, relevant studies are scarce, may not provide the whole story. This article reviews the local and systemic factors which may play a role in the post-extraction remodeling of the mandible. Since severe residual ridge resorption may occur even when the bone status in the rest of the skeleton is good and vice versa, it is concluded that local functional factors are of paramount significance. It is now essential to determine how they can be modified and applied to help maintain ridge height and quality in our aging, edentulous population. (+info)
Halicephalobus gingivalis encephalomyelitis in a horse.
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An 8-year-old, Arabian mare presented with acute progressive ataxia and a firm swelling over the right mandible. Radiographs revealed multiple radiolucent areas on the mandibles. The mare's neurological signs progressed, she was consequently euthanized. Postmortem examination revealed mandibular granulomatous reactions and meningoencephalitis due to the nematode Halicephalobus gingivalis. (+info)
The use of gutta-percha point to locate the origin of facial sinus.
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Infection from the wisdom teeth usually causes severe swelling at the region of the angle and body of the mandible. Occasionally, it tracts outward to form a cervicofacial sinus. This paper demonstrates the use of gutta-percha point to locate the origin of a cervicofacial sinus due to an asymptomatic impacted wisdom tooth. The advantage of using gutta-percha point is discussed. (+info)